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Park JH, Cho ES, Yoon J, Rhee HJ, Park J, Choi JY, Chung YE. MRI radiomics model differentiates small hepatic metastases and abscesses in periampullary cancer patients. Sci Rep 2024; 14:23541. [PMID: 39384874 PMCID: PMC11464643 DOI: 10.1038/s41598-024-74311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 09/25/2024] [Indexed: 10/11/2024] Open
Abstract
This multi-center, retrospective study focused on periampullary cancer patients undergoing MRI for hepatic metastasis and abscess differentiation. T1-weighted, T2-weighted, and arterial phase images were utilized to create radiomics models. In the training-set, 112 lesions in 54 patients (median age [IQR, interquartile range], 73 [63-80]; 38 men) were analyzed, and 123 lesions in 55 patients (72 [66-78]; 34 men) comprised the validation set. The T1-weighted + T2-weighted radiomics model showed the highest AUC (0.82, 95% CI 0.75-0.89) in the validation set. Notably, < 30% T1-T2 size discrepancy in MRI findings predicted metastasis (Ps ≤ 0.037), albeit with AUCs of 0.64-0.68 for hepatic metastasis. The radiomics model enhanced radiologists' performance (AUCs, 0.85-0.87 vs. 0.80-0.84) and significantly increased diagnostic confidence (P < 0.001). Although the performance increase lacked statistical significance (P = 0.104-0.281), the radiomics model proved valuable in differentiating small hepatic lesions and enhancing diagnostic confidence. This study highlights the potential of MRI-based radiomics in improving accuracy and confidence in the diagnosis of periampullary cancer-related hepatic lesions.
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Affiliation(s)
- Jae Hyon Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Armed Forces Daejeon Hospital, Daejeon, Republic of Korea
| | - Eun-Suk Cho
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jongjin Yoon
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Jin Rhee
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - June Park
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Eun Chung
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea.
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul, 03722, Republic of Korea.
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2
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Morana G, Beleù A, Geraci L, Tomaiuolo L, Venturini S. Imaging of the Liver and Pancreas: The Added Value of MRI. Diagnostics (Basel) 2024; 14:693. [PMID: 38611607 PMCID: PMC11011374 DOI: 10.3390/diagnostics14070693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/14/2024] Open
Abstract
MR is a powerful diagnostic tool in the diagnosis and management of most hepatic and pancreatic diseases. Thanks to its multiple sequences, the use of dedicated contrast media and special techniques, it allows a multiparametric approach able to provide both morphological and functional information for many pathological conditions. The knowledge of correct technique is fundamental in order to obtain a correct diagnosis. In this paper, different MR sequences will be illustrated in the evaluation of liver and pancreatic diseases, especially those sequences which provide information not otherwise obtainable with other imaging techniques. Practical MR protocols with the most common indications of MR in the study of the liver and pancreas are provided.
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Affiliation(s)
- Giovanni Morana
- Radiological Department, General Hospital Treviso, 31100 Treviso, Italy; (A.B.); (L.G.); (L.T.)
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Yumoto K, Hattori T, Hasegawa H, Matsushita A, Saitou F, Mihara W. A Case of Postthoracic Endovascular Aortic Repair Stent-Graft Infection Caused by Campylobacter insulaenigrae. Ann Vasc Dis 2023; 16:230-233. [PMID: 37779654 PMCID: PMC10539121 DOI: 10.3400/avd.cr.23-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/25/2023] [Indexed: 10/03/2023] Open
Abstract
An 81-year-old Japanese man who had distal aortic arch dilatation at age 77 had thoracic endovascular aortic surgery. The patient developed a fever and was taken to the hospital. Reduced diffusion in the descending aortic wall along the stent graft was discovered using whole-body diffusion-weighted imaging with background body signal suppression, and stent-graft infection was identified. The 16S ribosomal RNA gene analysis and blood culture results identified Campylobacter insulaenigrae as the etiological bacterial species. The patient was released from the hospital after 6 weeks of antibiotic treatment since the swelling and inflammatory response had decreased.
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Affiliation(s)
- Keita Yumoto
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Takashi Hattori
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Hideomi Hasegawa
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Akihito Matsushita
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Fumie Saitou
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
| | - Wahei Mihara
- Department of Cardiovascular Surgery, Seikeikai Chiba Medical Center, Chiba, Chiba, Japan
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Anichini M, Galluzzo A, Danti G, Grazzini G, Pradella S, Treballi F, Bicci E. Focal Lesions of the Liver and Radiomics: What Do We Know? Diagnostics (Basel) 2023; 13:2591. [PMID: 37568954 PMCID: PMC10417608 DOI: 10.3390/diagnostics13152591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Despite differences in pathological analysis, focal liver lesions are not always distinguishable in contrast-enhanced magnetic resonance imaging (MRI), contrast-enhanced computed tomography (CT), and positron emission tomography (PET). This issue can cause problems of differential diagnosis, treatment, and follow-up, especially in patients affected by HBV/HCV chronic liver disease or fatty liver disease. Radiomics is an innovative imaging approach that extracts and analyzes non-visible quantitative imaging features, supporting the radiologist in the most challenging differential diagnosis when the best-known methods are not conclusive. The purpose of this review is to evaluate the most significant CT and MRI texture features, which can discriminate between the main benign and malignant focal liver lesions and can be helpful to predict the response to pharmacological or surgical therapy and the patient's prognosis.
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Affiliation(s)
| | | | - Ginevra Danti
- Department of Radiology, Careggi University Hospital, Largo Brambilla 3, 50134 Florence, Italy; (M.A.); (A.G.); (G.G.); (S.P.); (F.T.); (E.B.)
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Furtado FS, Mercaldo ND, Vahle T, Benkert T, Bradley WR, Ratanaprasatporn L, Seethamraju RT, Harisinghani MG, Lee S, Suarez-Weiss K, Umutlu L, Catana C, Pomykala KL, Domachevsky L, Bernstine H, Groshar D, Rosen BR, Catalano OA. Simultaneous multislice diffusion-weighted imaging versus standard diffusion-weighted imaging in whole-body PET/MRI. Eur Radiol 2023; 33:2536-2547. [PMID: 36460925 DOI: 10.1007/s00330-022-09275-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To compare standard (STD-DWI) single-shot echo-planar imaging DWI and simultaneous multislice (SMS) DWI during whole-body positron emission tomography (PET)/MRI regarding acquisition time, image quality, and lesion detection. METHODS Eighty-three adults (47 females, 57%), median age of 64 years (IQR 52-71), were prospectively enrolled from August 2018 to March 2020. Inclusion criteria were (a) abdominal or pelvic tumors and (b) PET/MRI referral from a clinician. Patients were excluded if whole-body acquisition of STD-DWI and SMS-DWI sequences was not completed. The evaluated sequences were axial STD-DWI at b-values 50-400-800 s/mm2 and the apparent diffusion coefficient (ADC), and axial SMS-DWI at b-values 50-300-800 s/mm2 and ADC, acquired with a 3-T PET/MRI scanner. Three radiologists rated each sequence's quality on a five-point scale. Lesion detection was quantified using the anatomic MRI sequences and PET as the reference standard. Regression models were constructed to quantify the association between all imaging outcomes/scores and sequence type. RESULTS The median whole-body STD-DWI acquisition time was 14.8 min (IQR 14.1-16.0) versus 7.0 min (IQR 6.7-7.2) for whole-body SMS-DWI, p < 0.001. SMS-DWI image quality scores were higher than STD-DWI in the abdomen (OR 5.31, 95% CI 2.76-10.22, p < 0.001), but lower in the cervicothoracic junction (OR 0.21, 95% CI 0.10-0.43, p < 0.001). There was no significant difference in the chest, mediastinum, pelvis, and rectum. STD-DWI detected 276/352 (78%) lesions while SMS-DWI located 296/352 (84%, OR 1.46, 95% CI 1.02-2.07, p = 0.038). CONCLUSIONS In cancer staging and restaging, SMS-DWI abbreviates acquisition while maintaining or improving the diagnostic yield in most anatomic regions. KEY POINTS • Simultaneous multislice diffusion-weighted imaging enables faster whole-body image acquisition. • Simultaneous multislice diffusion-weighted imaging maintains or improves image quality when compared to single-shot echo-planar diffusion-weighted imaging in most anatomical regions. • Simultaneous multislice diffusion-weighted imaging leads to superior lesion detection.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Nathaniel D Mercaldo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Thomas Vahle
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Thomas Benkert
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - William R Bradley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lisa Ratanaprasatporn
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Ravi Teja Seethamraju
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- MR Collaborations, Siemens Medical Solutions USA, Inc., 30 Jonathan Ln, Malden, MA, 02148, USA
| | - Mukesh G Harisinghani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Susanna Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Krista Suarez-Weiss
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Lale Umutlu
- Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - Ciprian Catana
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | | | - Liran Domachevsky
- Sheba Medical Center, Derech Sheba 2, Ramat Gan, Israel
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
| | - Hanna Bernstine
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - David Groshar
- Tel Aviv University, 6997801, Tel Aviv-Yafo, Israel
- Assuta Medical Center, HaBarzel 20 St, Ramat Hahayal, Tel Aviv, Israel
| | - Bruse R Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - Onofrio Antonio Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA.
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Ji D, Lu JD, Zhang ZG, Mao XP. Misdiagnosis of food-borne foreign bodies outside of the digestive tract on magnetic resonance imaging: Two case reports. World J Clin Cases 2023; 11:1650-1655. [PMID: 36926397 PMCID: PMC10011975 DOI: 10.12998/wjcc.v11.i7.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/27/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Patients with foreign bodies in the digestive tract are often encountered, but complete penetration of a foreign body through the gastrointestinal tract is rare, and the choice of imaging method is very important. Improper selection may lead to missed diagnosis or misdiagnosis.
CASE SUMMARY An 81-year-old man was diagnosed as having a liver malignancy after he took magnetic resonance imaging and positron emission tomography/computed tomography (CT) examinations. The pain improved after the patient accepted gamma knife treatment. However, he was admitted to our hospital 2 mo later due to fever and abdominal pain. This time, he received a contrast-enhanced CT scan, which showed fish-boon-like foreign bodies in the liver with peripheral abscess formation, then he went to the superior hospital for surgery. It lasted for more than 2 mo from the onset of the disease to the surgical treatment. A 43-year-old woman with a 1 mo history of a perianal mass with no obvious pain or discomfort was diagnosed as having an anal fistula with the formation of a local small abscess cavity. Clinical perianal abscess surgery was performed, and fish bone foreign body was found in perianal soft tissue during the operation.
CONCLUSION For patients with pain symptoms, the possibility of foreign body perforation should be considered. Magnetic resonance imaging is not comprehensive and that a plain computed tomography scan of the pain area is necessary.
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Affiliation(s)
- Dan Ji
- Department of Radiology, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
| | - Jian-Dong Lu
- Department of Radiology, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
| | - Zhi-Guo Zhang
- Department of Radiology, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
| | - Xu-Ping Mao
- Department of Radiology, Zhangjiagang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang 215600, Jiangsu Province, China
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7
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Geng R, Zhang Y, Rice J, Muehler MR, Starekova J, Rutkowski DR, Uboha NV, Pirasteh A, Roldán-Alzate A, Guidon A, Hernando D. Motion-robust, blood-suppressed, reduced-distortion diffusion MRI of the liver. Magn Reson Med 2023; 89:908-921. [PMID: 36404637 PMCID: PMC9792444 DOI: 10.1002/mrm.29531] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate feasibility and reproducibility of liver diffusion-weighted (DW) MRI using cardiac-motion-robust, blood-suppressed, reduced-distortion techniques. METHODS DW-MRI data were acquired at 3T in an anatomically accurate liver phantom including controlled pulsatile motion, in eight healthy volunteers and four patients with known or suspected liver metastases. Standard monopolar and motion-robust (M1-nulled, and M1-optimized) DW gradient waveforms were each acquired with single-shot echo-planar imaging (ssEPI) and multishot EPI (msEPI). In the motion phantom, apparent diffusion coefficient (ADC) was measured in the motion-affected volume. In healthy volunteers, ADC was measured in the left and right liver lobes separately to evaluate ADC reproducibility between the two lobes. Image distortions were quantified using the normalized cross-correlation coefficient, with an undistorted T2-weighted reference. RESULTS In the motion phantom, ADC mean and SD in motion-affected volumes substantially increased with increasing motion for monopolar waveforms. ADC remained stable in the presence of increasing motion when using motion-robust waveforms. M1-optimized waveforms suppressed slow flow signal present with M1-nulled waveforms. In healthy volunteers, monopolar waveforms generated significantly different ADC measurements between left and right liver lobes ( p = 0 . 0078 $$ p=0.0078 $$ , reproducibility coefficients (RPC) = 470 × 1 0 - 6 $$ 470\times 1{0}^{-6} $$ mm 2 $$ {}^2 $$ /s for monopolar-msEPI), while M1-optimized waveforms showed more reproducible ADC values ( p = 0 . 29 $$ p=0.29 $$ , RPC = 220 × 1 0 - 6 $$ \mathrm{RPC}=220\times 1{0}^{-6} $$ mm 2 $$ {}^2 $$ /s for M1-optimized-msEPI). In phantom and healthy volunteer studies, motion-robust acquisitions with msEPI showed significantly reduced image distortion ( p < 0 . 001 $$ p<0.001 $$ ) compared to ssEPI. Patient scans showed reduction of wormhole artifacts when combining M1-optimized waveforms with msEPI. CONCLUSION Synergistic effects of combined M1-optimized diffusion waveforms and msEPI acquisitions enable reproducible liver DWI with motion robustness, blood signal suppression, and reduced distortion.
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Affiliation(s)
- Ruiqi Geng
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA
| | - Yuxin Zhang
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA
| | - James Rice
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, WI, USA
| | | | - Jitka Starekova
- Department of Radiology, University of Wisconsin-Madison, WI, USA
| | - David R. Rutkowski
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, WI, USA
| | - Nataliya V. Uboha
- Division of Hematology and Oncology, Department of Medicine, University of Wisconsin-Madison, WI, USA,UW Carbone Cancer Center, WI, USA
| | - Ali Pirasteh
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Mechanical Engineering, University of Wisconsin-Madison, WI, USA
| | | | - Diego Hernando
- Department of Radiology, University of Wisconsin-Madison, WI, USA,Department of Medical Physics, University of Wisconsin-Madison, WI, USA,Department of Electrical and Computer Engineering, University of Wisconsin-Madison, WI, USA,Department of Biomedical Engineering, University of Wisconsin-Madison, WI, USA
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Kagatani J, Asakura T, Sekine K, Watanabe H, Kawada M, Ohkusu K, Koyama T. Clinical utility of whole body diffusion-weighted imaging in an immunocompetent adult with atypical cat scratch disease. J Infect Chemother 2022; 28:1558-1561. [PMID: 35921966 DOI: 10.1016/j.jiac.2022.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/25/2022] [Accepted: 07/18/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cat scratch disease (CSD) is an infectious disease caused by Bartonella henselae. CSD follows a typical course, characterized by regional lymphadenopathy. In atypical CSD, the lesions spread to systemic organs and can cause fever of unknown origin (FUO). A previous study showed the usefulness of whole-body magnetic resonance imaging (WB-MRI) with diffusion-weighted imaging (DWI) for limited areas in the diagnosis of FUO, but there are no studies on the clinical utility of whole-body DWI (WB-DWI). We herein report the case of an immunocompetent young man in whom contrast-enhanced CT-unidentifiable multiple liver abscess and osteomyelitis were successfully detected by WB-DWI. Follow-up with a liver biopsy helped confirm an atypical CSD diagnosis. CASE PRESENTATION A 23-year-old previously healthy man was admitted for a 19-day history of high fever despite 3-day treatment by azithromycin. His physical examination was unremarkable and contrast-enhanced CT showed only a low attenuated area in the right lobe of the liver, indicating a cyst. WB-DWI revealed multiple nodular lesions of hypo-diffusion in the liver, spine, and pelvic region. The biopsy specimens of the liver abscess showed no evidence of tuberculosis/malignancy and the polymerase chain reaction (PCR) test of liver abscess aspirate showed positive findings for Bartonellahenselae, confirming the diagnosis of CSD. He completed minocycline monotherapy for a total of 60 days without any deterioration. CONCLUSIONS WB-DWI can be useful for the diagnosis of atypical CSD with hepatic and bone involvement, which can cause FUO in young immunocompetent adults.
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Affiliation(s)
- Jin Kagatani
- Department of Internal Medicine, Saitama City Hospital, Saitama, Japan.
| | - Takanori Asakura
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan; Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Katsutoshi Sekine
- Department of Internal Medicine, Saitama City Hospital, Saitama, Japan
| | - Hiromi Watanabe
- Department of Diagnostic Radiology, Saitama City Hospital, Saitama, Japan
| | - Miki Kawada
- Department of Infectious Diseases, Saitama City Hospital, Saitama, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Takashi Koyama
- Department of Internal Medicine, Saitama City Hospital, Saitama, Japan
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9
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Yoshino Y, Ishida T. Infected hepatic cyst detected by abdominal ultrasonography. J Gen Fam Med 2022; 23:407-408. [PMID: 36349203 PMCID: PMC9634129 DOI: 10.1002/jgf2.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/10/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yuta Yoshino
- Department of General Internal MedicineSaitama Citizens Medical CenterSaitamaJapan
| | - Takeshi Ishida
- Department of General Internal MedicineSaitama Citizens Medical CenterSaitamaJapan
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10
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Assouline V, Dabi Y, Jalaguier-Coudray A, Stojanovic S, Millet I, Reinhold C, Bazot M, Thomassin-Naggara I. How to improve O-RADS MRI score for rating adnexal masses with cystic component? Eur Radiol 2022; 32:5943-5953. [PMID: 35332409 DOI: 10.1007/s00330-022-08644-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/02/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To test the performance of the Ovarian-Adnexal Reporting Data System (O-RADS) MRI in characterizing adnexal masses with cystic components and to test new specific MRI features related to cystic components to improve the ability of the O-RADS MRI score to stratify lesions according to their risk of malignancy. METHODS The EURopean ADnexal study (EURAD) database was retrospectively queried to identify adnexal masses with a cystic component. One junior and 13 radiologists independently reviewed cases blinded to the pathological diagnosis. For each lesion, the size of the whole lesion, morphological appearance, number of loculi, presence of a thickened wall, thickened septae, signal intensity of the cystic components on T1-weighted/T2-weighted/diffusion weighted, mean value of the apparent diffusion coefficient, and O-RADS MRI score were reported. Univariate and multivariate logistic regression analysis was performed to determine significant features to predict malignancy. RESULTS The final cohort consisted of 585 patients with 779 pelvic masses who underwent pelvic MRI to characterize an adnexal mass(es). Histology served as the standard of reference. The diagnostic performance of the O-RADS MRI score was 0.944, 95%CI [0.922-0.961]. Significant criteria associated with malignancy included an O-RADS MRI score ≥ 4, ADCmean of cystic component > 1.69, number of loculi > 3, lesion size > 75 mm, the presence of a thick wall, and a low T1-weighted, a high T2-weighted, and a low diffusion-weighted signal intensity of the cystic component. Multivariate analysis demonstrated that an O-RADS MRI score ≥ combined with an ADC mean of the cystic component > 1.69, size > 75 mm, and low diffusion-weighted signal of the cystic component significantly improved the diagnostic performance up to 0.958, 95%CI [0.938-0.973]. CONCLUSION Cystic component analysis may improve the diagnosis performance of the O-RADS MRI score in adnexal cystic masses. KEY POINTS • O-RADS MRI score combined with specific cystic features (area under the receiving operating curve, AUROC = 0.958) improves the diagnostic performance of the O-RADS MRI score (AUROC = 0.944) for predicting malignancy in this cohort. • Cystic features that improve the prediction of malignancy are ADC mean > 1.69 (OR = 7); number of loculi ≥ 3 (OR = 5.16); lesion size > 75 mm (OR = 4.40); the presence of a thick wall (OR = 3.59); a high T2-weighted signal intensity score 4 or 5 (OR = 3.30); a low T1-weighted signal intensity score 1, 2, or 3 (OR = 3.45); and a low diffusion-weighted signal intensity (OR = 2.12). • An adnexal lesion with a cystic component rated O-RADS MRI score 4 and an ADC value of the cystic component < 1.69 associated with a low diffusion-weighted signal, has virtually a 0% risk of malignancy.
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Affiliation(s)
- Victoria Assouline
- Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France.
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France.
| | - Yohann Dabi
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France
- Service de gynécologie et obstétrique, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France
| | | | - Sanja Stojanovic
- Centre for Radiology, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia
| | - Ingrid Millet
- Department of Radiology, Lapeyronie Hospital, Montpellier, France
- Institut Desbrest d'Epidémiologie et de Santé Publique, IDESP UMR UA11 INSERM - Univ. Montpellier, Montpellier, France
| | - Caroline Reinhold
- Department of Medical Imaging, McGill University Health Centre, Montreal, Canada
| | - Marc Bazot
- Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France
| | - Isabelle Thomassin-Naggara
- Service de radiologie, Hôpital Tenon, Sorbonne Université, APHP, 75020, Paris, France
- Service de radiologie, Hôpital Tenon, Sorbonne Université, Institut Universitaire de Cancérologie, 75020, Paris, France
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11
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Sureka B, Rai B, Varshney VK, Nag VL, Garg MK, Garg P, Yadav T, Khera PS. Diffusion-Weighted Magnetic Resonance Imaging Is an Ideal Imaging Method to Detect Infection in Pancreatic Collections: A Brief Primer for the Gastroenterologists. Cureus 2022; 14:e21530. [PMID: 35223305 PMCID: PMC8863503 DOI: 10.7759/cureus.21530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The development of infection in pancreatitis significantly increases the mortality rate up to 100% in the absence of any intervention. Therefore, it is extremely important to diagnose these cases at an early stage. The objectives of this study were to assess the diagnostic performance of computed tomography (CT) and diffusion-weighted MR imaging (DW-MRI) in the diagnosis of infection in pancreatic collections. Materials and methods: Prospective observational study of abdominal collections due to pancreatitis that underwent both CT and DW-MRI from August 2018 to July 2020 were enrolled in the study. The collections were analysed for infections - air foci in CT and diffusion restriction on DW-MRI. Results: Of the 39 patients recruited in the study, infected collections were present in 17, and 22 cases had sterile collections. On CT, air foci within the collection were present only in seven of the cases in our study (sensitivity 35%, specificity 95.4%, PPV 85.7%, NPV 65.6%). DW-MRI detected infection in all 17 cases (sensitivity 100%, specificity 72.7%, PPV 74%, NPV 100%). Discussion: Thirteen out of 17 collections suspicious for infection on DW-MR showed microbiological growth on culture examination. We believe that this is likely due to the patient's prior antibiotic use, which might have altered the micro-environment or inflammatory cell and bacterial content of the collection. Conclusion: DW-MRI is complementary and superior to CT in detecting infection in pancreatic collections. CT may be used to detect disease burden, extent and vascular complication.
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12
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The role of "penumbra sign" and diffusion-weighted imaging in adnexal masses: do they provide a clue in differentiating tubo-ovarian abscess from ovarian malignancy? Pol J Radiol 2022; 86:e661-e671. [PMID: 35059059 PMCID: PMC8757038 DOI: 10.5114/pjr.2021.111986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the role of “penumbra sign”, diffusion-weighted imaging (DWI), and the apparent diffusion coefficient (ADC) value in differentiating tubo-ovarian abscess (TOA) from ovarian malignancy. Material and methods Thirty-six patients with 50 adnexal masses (tubo-ovarian abscess, n = 24; ovarian malignancy, n = 26), who underwent magnetic resonance imaging (MRI) with DWI, were retrospectively evaluated. “Penumbra sign” (hyperintense rim on T1W images), diffusion restriction, and mean apparent diffusion coefficient (ADC) values from cystic (c-ADC) and solid (s-ADC) components were evaluated for all the masses. Results “Penumbra sign” on T1W images was significantly more common in the TOA group (n = 21, 87.5%) than in the ovarian malignancy group (n = 2, 7.7%) (p < 0.001). Similarly, diffusion restriction in the cystic component was more frequent in the TOA group (n = 24, 100% vs. n = 2, 10.5%; p < 0.001). In contrast, diffusion restriction in the solid component was more common in the ovarian malignancy group (n = 5, 20.8% vs. n = 26, 100%; p < 0.001). The mean c-ADC value was significantly lower in TOAs (p < 0.001). A c-ADC value of 1.31 × 10-3 mm2/s may be an optimal cut-off in distinguishing TOAs from ovarian malignancies. Conversely, the mean s-ADC value was significantly lower in the ovarian malignancy group (p < 0.001). An s-ADC value of 0.869 × 10-3 mm2/s may be an optimal cut-off in differentiating ovarian malignancies from TOAs (p < 0.001). ROC curve analysis showed that c-ADC values had a higher diagnostic accuracy than s-ADC values. Conclusions “Penumbra sign” on T1W images, diffusion characteristics, and ADC values provide important clues in addition to conventional MR imaging features in differentiating TOA from ovarian malignancy.
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Chan KS, Shelat V. Pyogenic Liver Abscess. THE IASGO TEXTBOOK OF MULTI-DISCIPLINARY MANAGEMENT OF HEPATO-PANCREATO-BILIARY DISEASES 2022:509-519. [DOI: 10.1007/978-981-19-0063-1_66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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Hernando D, Zhang Y, Pirasteh A. Quantitative diffusion MRI of the abdomen and pelvis. Med Phys 2021; 49:2774-2793. [PMID: 34554579 DOI: 10.1002/mp.15246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion-weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal-to-noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.
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Affiliation(s)
- Diego Hernando
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yuxin Zhang
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Soni S, Pareek P, Narayan S, Varshney V. Mucinous cystic neoplasm of the liver (MCN-L): a rare presentation and review of the literature. Med Pharm Rep 2021; 94:366-371. [PMID: 34430860 DOI: 10.15386/mpr-1543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/19/2020] [Accepted: 02/06/2020] [Indexed: 11/23/2022] Open
Abstract
Mucinous cystic neoplasms of the liver (MCN-L, (previously referred to as cystadenomas or cystadenocarcinoma) are rare cystic tumors that occur within the liver parenchyma, or less frequently, in the extrahepatic bile ducts. They are reported to account for <5% of all liver cysts. The differential diagnosis of MCN-L includes intraductal papillary neoplasm of the bile duct (IPNB), intrahepatic cholangiocarcinoma with cystic change, echinococcal cyst, and a simple cyst. Invasive MCNs can only be differentiated from non-invasive MCNs by microscopic evaluation for the presence of ovarian-type stroma. Intraoperative biopsy and frozen section(s) are essential to differentiate MCNs from other cystic liver lesions. The treatment of choice is complete excision and can result in excellent survival with initial correct diagnosis. But its rare presentation and insufficient recognition frequently lead to an incorrect initial or delayed diagnosis or misdiagnosis.
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Affiliation(s)
- Sweta Soni
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rajasthan, India
| | - Puneet Pareek
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rajasthan, India
| | - Satya Narayan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rajasthan, India
| | - Vaibhav Varshney
- Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Zhuo LY, Xing LH, Ma X, Zhang Y, Ma ZP, Yin XP, Wang JN. Differentiating Between an Atypical Hepatic Abscess and Tumor Metastasis Using Magnetic Resonance Imaging and Hepatobiliary Phase Imaging. Infect Drug Resist 2021; 14:3263-3274. [PMID: 34429624 PMCID: PMC8380289 DOI: 10.2147/idr.s318291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To identify diffusion-weighted imaging (DWI) patterns and conspicuity discrepancies on hepatobiliary phase imaging (HBPI) to distinguish atypical hepatic abscesses from hepatic metastases. Materials and Methods This retrospective study recruited 31 patients with 43 atypical hepatic abscesses and 32 patients with 35 hepatic metastases who underwent gadobenate dimeglumine-enhanced magnetic resonance imaging. All lesions were confirmed by pathological or clinical diagnosis. For the qualitative and quantitative analyses, the signal intensity, DWI pattern, apparent diffusion coefficient, degree of perilesional edema, perilesional hyperemia, perilesional signal on HBPI, conspicuity, size discrepancy between sequences, contrast-to-noise ratio, signal-to-noise ratio, and relative enhancement ratio on dynamic phases were independently assessed by two radiologists. Significant findings for differentiating the two groups were identified via univariate and multivariate analyses with a nomogram for predicting atypical hepatic abscesses. The interobserver agreement was also analyzed for each variable. Results The multivariate analysis revealed that the conspicuity discrepancy (odds ratio [OR] 34.78, 95% confidence interval [CI] 2.09–579.47, p = 0.013) and non-peripheral high signal intensity (SI) rim on DWI (OR 67.46, 95% CI 2.64, 1723.20, p = 0.011) were significant independent factors for predicting atypical hepatic abscesses. They were also shown to be high predictor points on the nomogram. When any of the set criteria were satisfied, 97.7% of atypical hepatic abscesses were correctly identified, with a specificity of 65.7%. When both criteria were combined, the specificity was up to 100%, with a sensitivity of 44.9%. Conclusion Conspicuity discrepancy and a non-peripheral high SI rim on DWI are reliable and meaningful features that can distinguish atypical hepatic abscesses from hepatic metastases.
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Affiliation(s)
- Li-Yong Zhuo
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Li-Hong Xing
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Xi Ma
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Yu Zhang
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Ze-Peng Ma
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Xiao-Ping Yin
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Jia-Ning Wang
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
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Li J, Ma C, Chen Y, Fu C, Wang X, Kuehn B, Yang Q, Lu J. The Feasibility of a Fast Liver MRI Protocol for Lesion Detection of Adults at 3.0-T. Front Oncol 2021; 11:586343. [PMID: 34422623 PMCID: PMC8371706 DOI: 10.3389/fonc.2021.586343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To investigate the feasibility of a fast liver magnetic resonance imaging (MRI) protocol for lesion detection in adults using 3.0-T MRI. METHODS A fast liver MRI exam protocol was proposed. The protocol included motion-resistant coronal T2-w sequence, axial T2-w fast spin echo sequence with fat suppression, axial in-op phase gradient recalled echo (GRE) T1, axial diffusion weighted imaging (DWI), and axial contrast-enhanced T1 sequences. To evaluate the diagnostic capacity of the proposed protocol, 31 consecutive patients (20 males and 11 females; mean age, 53.2 years) underwent a liver MRI exam with conventional sequences, including the proposed protocol as a subset. Images from the conventional protocol and extracted abbreviated protocol were independently read, and the diagnostic concordance rate was assessed for each patient. The concordance analysis is presented as the proportion of concordant cases between the two protocols. RESULTS The net measurement time of the fast liver MRI protocol without adjustment and waiting time were 4 min and 28 s. In the 31 patients included in this study, 139 suspicious findings were found from both the conventional liver MR protocol and the fast liver MRI protocol. The diagnostic concordance rate was 96.4%. CONCLUSIONS The fast liver MRI protocol is feasible at 3.0-T, with a shorter exam time and high diagnostic concordance compared to the conventional liver MRI workflow.
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Affiliation(s)
- Jing Li
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Chao Ma
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Yukun Chen
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Caixia Fu
- Application Developments, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | - Xinrui Wang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Bernd Kuehn
- Oncology Applications Predevelopment, Siemens Healthcare, Erlangen, Germany
| | - Qingsong Yang
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
| | - Jianping Lu
- Department of Radiology, Changhai Hospital of Shanghai, Naval Medical University, Shanghai, China
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Role of MRI in the Evaluation of Thoracoabdominal Emergencies. Top Magn Reson Imaging 2021; 29:355-370. [PMID: 33264275 DOI: 10.1097/rmr.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thoracic and abdominal pathology are common in the emergency setting. Although computed tomography is preferred in many clinical situations, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) have emerged as powerful techniques that often play a complementary role to computed tomography or may have a primary role in selected patient populations in which radiation is of specific concern or intravenous iodinated contrast is contraindicated. This review will highlight the role of MRI and MRA in the emergent imaging of thoracoabdominal pathology, specifically covering acute aortic pathology (acute aortic syndrome, aortic aneurysm, and aortitis), pulmonary embolism, gastrointestinal conditions such as appendicitis and Crohn disease, pancreatic and hepatobiliary disease (pancreatitis, choledocholithiasis, cholecystitis, and liver abscess), and genitourinary pathology (urolithiasis and pyelonephritis). In each section, we will highlight the specific role for MRI, discuss basic imaging protocols, and illustrate the MRI features of commonly encountered thoracoabdominal pathology.
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Motta R, Lupi A, Pirazzini A, Giraudo C, Marchesi P. Caroli’s Disease. DISEASES OF THE LIVER AND BILIARY TREE 2021:85-92. [DOI: 10.1007/978-3-030-65908-0_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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20
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Mohsen LA, Osman NM. Diffusion-weighted imaging in the evaluation of perianal fistula and abscess. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00193-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
Background
Perianal fistulas are a common inflammatory condition of the anal canal and perianal tissue. The introduction of MRI in the evaluation of suspected perianal inflammation has greatly improved the surgical outcome of these patients as it allowed the direct visualization of anal sphincters, levator ani muscle, and the extent of the disease in relation to these vital structures. Diffusion-weighted imaging (DWI) has been under extensive research to evaluate whether it adds any value in the setting of perianal inflammation.
The aim of our study was to evaluate the visibility of perianal inflammation on DWI and evaluate the diffusion characteristics of perianal fistulas and abscesses and how accurately can DWI classify perianal disease.
Results
Mean age of patients was 37 ± 8.9 years old. The study included 30 fistulas and 15 abscesses. Seven patients had more than 1 fistula or fistula and abscess. Perianal abscesses were well visualized equally on DWI and T2W images and correctly classified by DWI, when compared to post-contrast images. Perianal fistulas without abscesses, on the other hand, had variable visibility scores. Although the visibility of these fistulas on DWI was generally less than T2W and combined DWI and T2W, yet this did not reach a significant level and it was not significantly different between positive and negative inflammatory groups. Combined DWI and T2W evaluation had the highest performance and accurately classified 97.8 % of perianal fistulas and abscesses, and only 1 case was misclassified (2.3%).
Conclusion
DWI had a good performance in the evaluation of perianal inflammatory disease. However, combined DWI and T2W evaluation had better performance which was not significantly different from combined T2W and post-contrast images.
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CT-based radiomics model to distinguish necrotic hepatocellular carcinoma from pyogenic liver abscess. Clin Radiol 2020; 76:161.e11-161.e17. [PMID: 33267948 DOI: 10.1016/j.crad.2020.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022]
Abstract
AIM To investigate the feasibility of a computed tomography (CT)-based radiomics model in distinguishing necrotic hepatocellular carcinoma (nHCC) from pyogenic liver abscess (PLA). MATERIAL AND METHODS One hundred-four enrolled patients with nHCC (n=56) and PLA (n=48) were divided randomly into a training cohort (n=62) and validation cohort (n=42). ROI (region of interest) of the wall (ROI-wall) and ROI of the necrotic cavity (ROI-necrotic cavity) of the lesion were delineated from each arterial phase (AP) and portal venous phase (PP) image. The least absolute shrinkage and the selection operator logistic regression method was used to select radiomics features, and radiomics scores (R-scores) were calculated. Four radiomics models, including R-score (ROI-wall) in the AP, R-score (ROI-necrotic cavity) in the AP, R-score (ROI-wall) in the PP and R-score (ROI-necrotic cavity) in the PP, were constructed and evaluated by area under the curve (AUC) of receiver operating characteristic curve. RESULTS The AUCs of R-score (ROI-wall) in the AP, R-score (ROI-necrotic cavity) in the AP, R-score (ROI-wall) in the PP, and R-score (ROI-necrotic cavity) in the PP were 0.935 and 0.917, 0.906 and 0.824, 0.985 and 0.928, 0.899 and 0.850, in the training and validation cohorts, respectively. In the training cohort, the AUC of R-score (ROI-wall) in the PP was higher than that of R-score (ROI-wall) in the AP (p=0.024) or R-score (ROI-necrotic cavity) in the AP (p=0.046) or R-score (ROI-necrotic cavity) in the PP (p=0.044). CONCLUSION CT-based radiomics models can be used to distinguish nHCC from PLA.
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Integrating baseline MR imaging biomarkers into BCLC and CLIP improves overall survival prediction of patients with hepatocellular carcinoma (HCC). Eur Radiol 2020; 31:1630-1641. [PMID: 32910233 DOI: 10.1007/s00330-020-07251-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/21/2020] [Accepted: 08/31/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES We aimed to evaluate the independent predictive role of baseline imaging biomarkers for overall survival (OS) and transplant-free survival (TFS) in patients with HCC and assess the incremental value of these biomarkers to current staging systems. METHODS In this retrospective IRB approved study, the clinical, laboratory, and imaging parameters of 304 HCC patients were collected. Cox regression model was utilized to identify the potential predictors of survival. Recursive partitioning test was utilized to identify the optimal ADC cutoff for stratifying patients' OS. Patients were stratified based on Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program (CLIP). Binary ADC value (above vs. below the cutoff) and tumor margin (well- vs. ill-defined) were integrated into BCLC and CLIP. OS and TFS was compared for patients based on standard criteria with and without imaging biomarkers. RESULTS At baseline, patients with low tumor ADC and well-defined tumor margin (favorable imaging biomarkers) had longer survival, as compared to those with high ADC and ill-defined tumor margin (unfavorable imaging biomarkers) (median OS of 43 months vs. 7 months, respectively) (p < 0.001). Tumor ADC and tumor margin remained strong independent predictors of survival after adjustment for demographics, BCLC and CLIP staging, and tumor burden. Incorporating ADC and tumor margin improved performance of OS prediction by 9% in BCLC group and 6% in CLIP group. CONCLUSION Incorporating ADC and tumor margin to current staging systems for HCC significantly improve prediction of OS and TFS of these criteria. KEY POINTS • ADC and tumor margin are predictors of overall survival in HCC patients, independent of clinical, laboratory, and other imaging variables. • Adding ADC and tumor margin improved the prognostic value of BCLC and CLIP criteria by 9% and 6%, respectively. • High ADC and ill-defined tumor margin at baseline predicted poor survival, regardless of patient's liver function and general health status.
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Ameli S, Shaghaghi M, Aliyari Ghasabeh M, Pandey P, Hazhirkarzar B, Ghadimi M, Rezvani Habibabadi R, Khoshpouri P, Pandey A, Anders RA, Kamel IR. Role of baseline volumetric functional MRI in predicting histopathologic grade and patients’ survival in hepatocellular carcinoma. Eur Radiol 2020; 30:3748-3758. [DOI: 10.1007/s00330-020-06742-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 12/22/2022]
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Khoshpouri P, Habibabadi RR, Hazhirkarzar B, Ameli S, Ghadimi M, Ghasabeh MA, Menias CO, Kim A, Li Z, Kamel IR. Imaging Features of Primary Sclerosing Cholangitis: From Diagnosis to Liver Transplant Follow-up. Radiographics 2019; 39:1938-1964. [DOI: 10.1148/rg.2019180213] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Pegah Khoshpouri
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Roya Rezvani Habibabadi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Bita Hazhirkarzar
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Sanaz Ameli
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Maryam Ghadimi
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Mounes Aliyari Ghasabeh
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Christine O. Menias
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Amy Kim
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Zhiping Li
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
| | - Ihab R. Kamel
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St, MRI Room 143, Baltimore, MD 21287 (P.K., R.R.H., B.H., S.A., M.G., M.A.G., A.K., Z.L., I.R.K.); and Department of Radiology, Mayo Clinic Phoenix, Scottsdale, Ariz (C.O.M.)
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Wang N, Ju Y, Wu J, Liu A, Chen A, Liu J, Liu Y, Li J. Differentiation of liver abscess from liver metastasis using dual-energy spectral CT quantitative parameters. Eur J Radiol 2019; 113:204-208. [DOI: 10.1016/j.ejrad.2019.02.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/30/2019] [Accepted: 02/17/2019] [Indexed: 01/14/2023]
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Preoperative evaluation of small bowel complications in Crohn’s disease: comparison of diffusion-weighted and contrast-enhanced MR imaging. Eur Radiol 2018; 29:2034-2044. [DOI: 10.1007/s00330-018-5734-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 02/08/2023]
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Diagnostic Value of Diffusion-Weighted Imaging and Apparent Diffusion Coefficient in Assessment of the Activity of Crohn Disease: 1.5 or 3 T. J Comput Assist Tomogr 2018; 42:688-696. [PMID: 29958199 PMCID: PMC6296832 DOI: 10.1097/rct.0000000000000754] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective The objective of this study is to evaluate the role of diffusion-weighted imaging (DWI) in assessment of the activity of Crohn disease (CD) and to explore differences between DWI in 3 T and 1.5 T. Methods Postcontrast magnetic resonance enterography with DWI of 72 patients with pathological proof of CD was retrospectively evaluated for restricted diffusion qualitatively and quantitavely in 3 T (n = 40) and 1.5 T (n = 32). Magnetic resonance activity score of 7 or higher was used as reference of activity. Results Fifty-five patients had active lesions. Diffusion-weighted imaging hyperintensity showed sensitivity (100%, 100%) and specificity (88.89%, 100%) in 1.5/3 T for activity assessment. Mean ± SD apparent diffusion coefficient for active lesions was 1.21 ± 0.42 and 1.28 ± 0.59 × 10−3 mm2/s in 1.5 and 3 T, respectively. The proposed cutoff values of 1.35 and 1.38 × 10−3 mm2/s in 1.5 and 3 T, respectively, had sensitivity (80%, 93%), specificity (100%, 90%), accuracy (88%, 93%), and no significant difference in accuracy between 1.5/3 T (P = 0.48). Conclusions Diffusion-weighted imaging hypersensitivity and apparent diffusion coefficient values accurately assessed the activity of CD. No significant statistical difference in diagnostic accuracy was detected between 1.5 and 3 T.
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Wang Y, Gu C, Huo Y, Han W, Yu J, Ding C, Zhao X, Meng Y, Li C. Diffusion tensor imaging for evaluating perianal fistula: Feasibility study. Medicine (Baltimore) 2018; 97:e11570. [PMID: 30024560 PMCID: PMC6086465 DOI: 10.1097/md.0000000000011570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
To explore the feasibility of using diffusion tensor imaging (DTI) in the diagnosis of anal fistula and evaluating its activity.Thirty-four patients with perianal fistulas were examined with DTI on a 3.0 T magnetic resonance imaging (MRI) before undergoing surgery. Based on the surgery requirement and preoperative examinations, the lesions fell into 2 groups: the positive inflammation activity (PIA) group and the negative inflammation activity (NIA) group. Each lesion was divided into 3 regions of interest (ROIs) (i.e., the fistula area, edema area, and distant normal-appearing area). Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated and analyzed.There were statistically significant differences in FA and ADC values of the fistula area, edema area, and distant normal-appearing area. The FA values of the fistula area, edema area, and distant normal-appearing area in PIA were 0.134 ± 0.046, 0.225 ± 0.060, 0.343 ± 0.070, respectively. The ADC values (×10 mm/s) of the fistula area, edema area, and distant normal-appearing area in PIA were 0.979 ± 0.441, 1.542 ± 0.274, 1.864 ± 0.336, respectively. The FA values of the fistula area, edema area, and distant normal-appearing area in NIA were 0.183 ± 0.057, 0.286 ± 0.059, 0.382 ± 0.084, respectively. The ADC values (×10 mm/s) of the fistula area, edema area, and distant normal-appearing area in NIA were 1.393 ± 0.256, 1.518 ± 0.274, 1.703 ± 0.432, respectively. Regarding the activity, the FA and ADC values of the PIA group were lower than those of the NIA group in the fistula area, and the differences were statistically significant (P = .009, .004). The FA values of the edema area in the PIA group were lower than those in the NIA group, and the difference was statistically significant. The ADC values of the edema area, and both the FA and ADC values of the distant normal-appearing area all exhibited no statistically significant differences between the 2 groups.DTI parameters may reflect microstructures of perianal fiatulas via quantitative information. FA and ADC values were instrumental in evaluating the activity of perianal fistulas.
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Affiliation(s)
- Yu Wang
- Shandong Medical Imaging Research Institute, Shandong University
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Chao Gu
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Yongjun Huo
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Weiwei Han
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Jinfen Yu
- Traditional Chinese Medical Hospital, Zhangqiu
| | - Chengzong Ding
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine
| | - Xiuyu Zhao
- Shandong Medical Imaging Research Institute, Shandong University
| | - Yunfang Meng
- Shandong Provincial Hospital, Jinan, Shandong, China
| | - Chuanting Li
- Shandong Medical Imaging Research Institute, Shandong University
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Chen C, Lin Z, Xiao Y, Bai P, Yue Q, Chen Y, Chen L. Role of diffusion-weighted imaging in the discrimination of benign and metastatic parotid area lymph nodes in patients with nasopharyngeal carcinoma. Sci Rep 2018; 8:281. [PMID: 29321485 PMCID: PMC5762796 DOI: 10.1038/s41598-017-18617-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/14/2017] [Indexed: 12/27/2022] Open
Abstract
To assess the utility of apparent diffusion coefficient (ADC) determined on diffusion-weighted MR imaging (DWI) to differentiate between benign and malignant parotid area lymph nodes (PLN) in nasopharyngeal carcinoma (NPC) patients. Thirty-nine consecutive NPC patients with a total of 40 enlarged, biopsied PLNs underwent DWI examination. ADC values for benign and malignant PLNs were measured and compared. Receiver operating characteristic (ROC) curve analysis was to evaluate the optimal threshold level of ADC values for metastatic PLNs. The kappa was to assess the degree of agreement between histopathological diagnoses and ADC values, or imaging features of PLNs on MRI. We found the mean ADC value for benign PLNs was markedly higher than malignant PLNs. A threshold ADC of 1.01 × 10−3 mm2/s was associated with a sensitivity of 85.7% and a specificity of 72.7% (area under the curve: 0.84). A moderate agreement was observed between the histopathological diagnosis and the threshold of ADC value (k value: 0.483). However, short axis diameter, necrosis, extranodal extension, and regional grouping of PLNs on MRI showed only a fair agreement with the histopathological diagnosis (k value: 0.257, 0.305, 0.276, and 0.205, respectively). Therefore, DWI may be a promising technique to differentiate metastatic from benign PLNs.
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Affiliation(s)
- Chuanben Chen
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical Universtiy Cancer Hospital, Fuzhou, Fujian, China. .,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China. .,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China.
| | - Zhizhong Lin
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical Universtiy Cancer Hospital, Fuzhou, Fujian, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Youping Xiao
- Department of Radiology, Fujian Cancer Hospital, Fujian Medical Universtiy Cancer Hospital, Fuzhou, Fujian, China
| | - Penggang Bai
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical Universtiy Cancer Hospital, Fuzhou, Fujian, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Qiuyuan Yue
- Department of Radiology, Fujian Cancer Hospital, Fujian Medical Universtiy Cancer Hospital, Fuzhou, Fujian, China
| | - Yunbin Chen
- Department of Radiology, Fujian Cancer Hospital, Fujian Medical Universtiy Cancer Hospital, Fuzhou, Fujian, China
| | - Lisha Chen
- Department of Radiation Oncology, Fujian Cancer Hospital, Fujian Medical Universtiy Cancer Hospital, Fuzhou, Fujian, China.,Shengli Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
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Shanshan W, Hui L, Yan L, Li W, Yongfang R, Yan W, Kader M, Wenxiao J. The study of biochemical profile of cyst fluid and diffusion-weighted magnetic resonance imaging in differentiating hepatic hydatid cysts from liver simple cysts. J Clin Lab Anal 2018; 32:e22192. [PMID: 28303600 PMCID: PMC6084328 DOI: 10.1002/jcla.22192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/31/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the value of biochemical profile of cyst fluid and diffusion-weighted imaging (DWI) in differentiating hepatic hydatid cysts (HCs) from liver simple cysts. MATERIALS AND METHODS Forty-six patients underwent MR imaging. Twenty-nine patients had 29 hydatid cysts and 17 patients had liver simple cysts. Thirteen patients with hydatid cysts and seven patients with liver simple cysts were evaluated with cyst fluid biochemical analysis. The concentration of glucose, protein, calcium ion (Ca2+ ) electrolyte, macroscopic appearance, and parasitological sediment were evaluated in this study. RESULTS In the respect of biochemical analysis cyst fluid, the concentration of glucose and calcium ion of HCs was significantly higher than that of the liver simple cysts. In the respect of DWI, in the b 1000 s/mm2 value in respect of mean application data center (ADC) values, there was a statistically significant difference between HCs group (the mean value was (2.50±0.79)×10-3 mm/s2 ) and liver simple cysts group (the mean value was (2.92±0.66)×10-3 mm/s2 ). However, no statistically significant results were obtained in the ADC measurements of b 500 s/mm2 between two groups. CONCLUSION The analysis of cyst fluid combined with the measurement of ADC values in the b 1000 s/mm2 value could be considered a promising parameter as an alternative to the differential diagnosis of hepatic hydatid cysts from liver simple cysts.
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Affiliation(s)
- Wang Shanshan
- Department of RadiologySecond Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiangChina
- Department of RadiologyPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiangChina
| | - Li Hui
- Department of RadiologyPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiangChina
| | - Liu Yan
- Department of RadiologyPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiangChina
| | - Wang Li
- Department of OrthopaedicsPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiangChina
| | - Ren Yongfang
- Department of RadiologyPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiangChina
| | - Wang Yan
- Department of RadiologyPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiangChina
| | - Muhetarjiang Kader
- Department of RadiologyPeople's Hospital of Xinjiang Uygur Autonomous RegionUrumqiXinjiangChina
| | - Jia Wenxiao
- Department of RadiologySecond Affiliated Hospital of Xinjiang Medical UniversityUrumqiXinjiangChina
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The value of gadoxetic acid-enhanced MRI for differentiation between hepatic microabscesses and metastases in patients with periampullary cancer. Eur Radiol 2017; 27:4383-4393. [PMID: 28342102 DOI: 10.1007/s00330-017-4782-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to identify features that differentiate hepatic microabscess from hepatic metastasis on gadoxetic acid-enhanced MRI in patients with periampullary cancer. METHODS We included 72 patients (31 patients with 83 hepatic microabscesses and 41 patients with 71 hepatic metastases) who had a history of periampullary cancer and underwent gadoxetic acid-enhanced MRI. Image analysis was performed for margin, signal intensity, rim enhancement, perilesional hyperaemia, pattern on DWI and dynamic phases, and size discrepancy between sequences by consensus of two observers. RESULTS Multivariate analysis revealed that the following significant parameters favour microabscess: a history of bile duct cancer, perilesional hyperaemia, persistent arterial rim enhancement through the transitional phase (TP), and size discrepancy between T1WI and T2WI and between T1WI and hepatobiliary phase image (HBPI). The diagnostic accuracy for microabscess was highest (90.9%) when showing a size discrepancy ≥30% between T1WI and HBPI or persistent arterial rim enhancement through the TP. When the lesion was positive for both these variables, specificity reached 100%. CONCLUSION The combination of a size discrepancy between T1WI and HBPI and persistent arterial rim enhancement through the TP represents a reliable MRI feature for distinguishing between hepatic microabscess and metastasis in patients with periampullary cancer. KEY POINTS • Gadoxetic acid-enhanced MRI is useful for distinguishing hepatic microabscess from metastasis. • Hepatic microabscess showed significant size discrepancy ≥30% between T1WI and HBPI. • Arterial rim enhancement persistent through the TP indicates hepatic microabscess.
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Debees NL, Sherif MF, Yones SG, Ahmad AH. Assessment of hepatic focal lesions on top of cirrhotic liver using dynamic and diffusion weighted magnetic resonance imaging. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2016.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Fusco R, Sansone M, Petrillo A. A comparison of fitting algorithms for diffusion-weighted MRI data analysis using an intravoxel incoherent motion model. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2016; 30:113-120. [PMID: 27670762 DOI: 10.1007/s10334-016-0591-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022]
Abstract
OBJECT The objective of this study is to propose a modified VARiable PROjection (VARPRO) algorithm specifically tailored for fitting the intravoxel incoherent motion (IVIM) model to diffusion-weighted magnetic resonance imaging (DW-MRI) data from locally advanced rectal cancer (LARC). MATERIALS AND METHODS The proposed algorithm is compared with classical non-linear least squares (NLLS) analysis using the Levenberg-Marquardt (LM) algorithm and with two recently proposed algorithms for 'segmented' analysis. These latter two comprise two consecutive steps: first, a subset of parameters is estimated using a portion of data; second, the remaining parameters are estimated using the whole data and the previous estimates. The comparison between the algorithms was based on the [Formula: see text] goodness-of-fit measure: performance analysis was carried out on real data obtained by DW-MRI on 40 LARC patients. RESULTS The performance of the proposed algorithm was higher than that of LM in 64 % of cases; 'segmented' methods were poorer than our algorithm in 100 % of cases. CONCLUSION The proposed modified VARPRO algorithm can lead to better fit of the IVIM model to LARC DW-MRI data compared to other techniques.
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Affiliation(s)
- Roberta Fusco
- Radiology Unit, Department of Diagnostic Imaging Radiant and Metabolic Therapy, Istituto Nazionale Tumori Fondazione Giovanni Pascale RCCS, Via Mariano Semmola, 80131, Naples, Italy
| | - Mario Sansone
- Department of Electrical Engineering and Information Technologies, University 'Federico II' of Naples, Via Claudio, 21, Naples, Italy.
| | - Antonella Petrillo
- Radiology Unit, Department of Diagnostic Imaging Radiant and Metabolic Therapy, Istituto Nazionale Tumori Fondazione Giovanni Pascale RCCS, Via Mariano Semmola, 80131, Naples, Italy
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Suo ST, Zhuang ZG, Cao MQ, Qian LJ, Wang X, Gao RL, Fan Y, Xu JR. Differentiation of pyogenic hepatic abscesses from malignant mimickers using multislice-based texture acquired from contrast-enhanced computed tomography. Hepatobiliary Pancreat Dis Int 2016; 15:391-8. [PMID: 27498579 DOI: 10.1016/s1499-3872(15)60031-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography (CECT). The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers. METHODS This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter (5 filter levels with sigma weighting ranging from 1.0 to 2.5). We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with one-way ANOVA followed by Tukey honestly significant difference (HSD) test. Diagnostic performance was evaluated using the receiver operating characteristic (ROC) curve analysis. RESULTS There were significant differences in entropy and uniformity at all sigma weightings (P<0.001) among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings (P=0.002-0.006). Tukey HSD test showed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers (P=0.000-0.004). Entropy (at a sigma 2.0 weighting) had the largest area under the ROC curve (0.888) in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64. CONCLUSION Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.
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Affiliation(s)
- Shi-Teng Suo
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China.
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Borens B, Arvanitakis M, Absil J, El Bouchaibi S, Matos C, Eisendrath P, Toussaint E, Deviere J, Bali MA. Added value of diffusion-weighted magnetic resonance imaging for the detection of pancreatic fluid collection infection. Eur Radiol 2016; 27:1064-1073. [PMID: 27300193 DOI: 10.1007/s00330-016-4462-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To investigate the added value of diffusion-weighted (DW) magnetic resonance (MR) imaging in the detection of infection in pancreatic fluid collections (PFC). METHODS Forty-patients with PFC requiring endoscopic-transmural drainage underwent conventional-MR and DW-MR imaging (b = 1000 s/mm2) before endoscopy. MR images were divided into two sets (set1, conventional-MR; set2, conventional-MR, DW-MR and ADC maps) and randomized. Two independent readers performed qualitative and quantitative (apparent diffusion coefficient, ADC) image analysis. Bacteriological analysis of PFC content was the gold standard. Non-parametric tests were used for comparisons. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and accuracy were calculated for the two sets for both readers. Receiver operating characteristic curves (ROC) were drawn to assess quantitative DW-MR imaging diagnostic performance. RESULTS For both readers, sensitivity, specificity, NPV, PPV and accuracy for infected PFCs were higher for set2 (P > .05). ADC were lower in infected versus non-infected PFCs (P ≤ .031). Minimum ADC cut-off: 1,090×10-3 mm2/s for reader 1 and 1,012×10-3 mm2/s for reader 2 (sensitivity and specificity 67 % and 96 % for both readers). CONCLUSION Qualitative information provided by DW-MR may help to assess PFCs infection. Infected PFCs show significantly lower ADCs compared to non-infected ones. KEY POINTS • DW improves MR diagnostic accuracy to detect infection of PFC • Infected PFCs show lower ADC compared to non-infected ones (P < .031) • DW-MR images are easy to interpret especially for non-experienced radiologist.
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Affiliation(s)
- Bruno Borens
- Polyclinique Santa Maria, 57, Avenue de la Californie, 06200, Nice, France.
| | - Marianna Arvanitakis
- Department of Gastroenterology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Julie Absil
- Department of Radiology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
| | | | - Celso Matos
- Department of Radiology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Pierre Eisendrath
- Department of Gastroenterology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Emmanuel Toussaint
- Department of Gastroenterology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Jacques Deviere
- Department of Gastroenterology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Maria Antonietta Bali
- Department of Radiology, Erasme Hospital, 808 Route de Lennik, 1070, Brussels, Belgium
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Bächler P, Baladron MJ, Menias C, Beddings I, Loch R, Zalaquett E, Vargas M, Connolly S, Bhalla S, Huete Á. Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls. Radiographics 2016; 36:1001-23. [PMID: 27232504 DOI: 10.1148/rg.2016150196] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Imaging plays an important role in the diagnosis, characterization, and management of infectious liver disease. In clinical practice, the main contributions of imaging are in detecting early disease, excluding other entities with a similar presentation, establishing a definitive diagnosis when classic findings are present, and guiding appropriate antimicrobial, interventional, or surgical treatment. The most common imaging features of bacterial, viral, parasitic, and fungal hepatic infections are described, and key imaging and clinical manifestations are reviewed that may be useful to narrow the differential diagnosis and avoid pitfalls in image interpretation. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging allow accurate detection of most hepatic infections and, in some circumstances, may provide specific signs to identify the underlying pathogen and exclude other entities with similar imaging features. In bacterial and parasitic infections, specific imaging features may be enough to exclude a neoplasm and, occasionally, to identify the underlying infectious agent. US and CT are important means to guide percutaneous aspiration or drainage when needed. In viral infections, imaging is critical to exclude entities that may manifest with similar clinical and laboratory findings. Disseminated fungal infections require early detection at imaging because they can be fatal if not promptly treated. Familiarity with the epidemiology, pathogenesis, clinical manifestations, imaging features, and treatment of hepatic infections can aid in radiologic diagnosis and guide appropriate patient care. (©)RSNA, 2016.
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Affiliation(s)
- Pablo Bächler
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - María José Baladron
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Christine Menias
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Ignacio Beddings
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Ron Loch
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Eugenio Zalaquett
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Matías Vargas
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Sarah Connolly
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Sanjeev Bhalla
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Álvaro Huete
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
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Foti PV, Ognibene N, Spadola S, Caltabiano R, Farina R, Palmucci S, Milone P, Ettorre GC. Non-neoplastic diseases of the fallopian tube: MR imaging with emphasis on diffusion-weighted imaging. Insights Imaging 2016; 7:311-27. [PMID: 26992404 PMCID: PMC4877350 DOI: 10.1007/s13244-016-0484-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/26/2016] [Accepted: 03/03/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE We illustrate the magnetic resonance imaging (MRI) features of non-neoplastic tubaric conditions. BACKGROUND A variety of pathologic non-neoplastic conditions may affect the fallopian tubes. Knowledge of their imaging appearance is important for correct diagnosis. With recent advances in MRI, along with conventional MR sequences, diffusion-weighted imaging (DWI) sequences are available and may improve lesion characterization by discriminating the nature of the content of the dilated tube. Tubal fluid with low signal intensity on T1-weighted images, high signal intensity on T2-weighted images and no restricted diffusion on DWI is indicative of hydrosalpinx. Content with high signal intensity on T1-weighted images and restricted diffusion on DWI is suggestive of hematosalpinx associated with endometriosis or tubal pregnancy. A dilated tube with variable or heterogeneous signal intensity content on conventional MR sequences and restricted diffusion on DWI may suggest a pyosalpinx or tubo-ovarian abscess. We describe morphological characteristics, MR signal intensity features, enhancement behaviour and possible differential diagnosis of each lesion. CONCLUSION MRI is the method of choice to study adnexal pelvic masses. Qualitative and quantitative functional imaging with DWI can be of help in characterization of tubaric diseases, provided that findings are interpreted in conjunction with those obtained with conventional MRI sequences. TEACHING POINTS • Nondilated fallopian tubes are not usually seen on MR images. • MRI is the method of choice to characterize and localize utero-adnexal masses. • MRI allows characterization of lesions through evaluation of the fluid content's signal intensity. • DWI in conjunction with conventional MRI sequences may improve tissue characterization. • Pelvic inflammatory disease is the most common tubal pathology.
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Affiliation(s)
- Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Noemi Ognibene
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Saveria Spadola
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Renato Farina
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Milone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Lee NK, Kim S, Kim DU, Seo HI, Kim HS, Jo HJ, Kim TU. Diffusion-weighted magnetic resonance imaging for non-neoplastic conditions in the hepatobiliary and pancreatic regions: pearls and potential pitfalls in imaging interpretation. ACTA ACUST UNITED AC 2015; 40:643-62. [PMID: 25216848 DOI: 10.1007/s00261-014-0235-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Potentially, diffusion-weighted magnetic resonance imaging (DWI) can assess the functional information on concerning the status of tissue cellularity, because increased cellularity is associated with impeded diffusion. DWI in the hepatobiliary and pancreatic regions has demonstrated the usefulness to detect malignant lesions and differentiate them from benign lesions. However, it has been shown more recently that there is some overlap in ADC values for benign and malignant neoplasms. Moreover, some non-neoplastic lesions in the hepatobiliary and pancreatic regions exhibit restricted diffusion on DWI, because of pus, inflammation, or high cellularity. Focal eosinophilic liver disease, hepatic inflammatory myofibroblastic tumor, granulomatous liver disease, acute cholecystitis, xanthogranulomatous cholecystitis, focal pancreatitis, or autoimmune pancreatitis frequently exhibit restricted diffusion on DWI, which may be confused with malignancy in the hepatobiliary and pancreatic regions. Thus, DWI should not be interpreted in isolation, but in conjunction with other conventional images, to avoid the diagnostic pitfalls of DWI. Nevertheless, the presence of diffusion restriction in the non-neoplastic lesions sometimes provides additional information regarding the diagnosis, in problematic patients where conventional images have yielded equivocal findings. DWI may help differentiate hepatic abscess from malignant necrotic tumors, gallbladder empyema from dense bile or sludge in the gallbladder, and pylephlebitis from bland thrombosis in the portal vein. Therefore, knowledge of DWI findings to conventional imaging findings of diffusion-restricted non-neoplastic conditions in the hepatobiliary and pancreatic regions helps establishing a correct diagnosis.
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Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Pusan National University, #179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Republic of Korea
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Feasibility of diffusion weighted magnetic resonance imaging in evaluation of different small bowel pathology. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Koken D, Cagli B, Tuncel SA, Sengul E, Yilmaz E, Unlu ME. Efficacy of diffusion-weighted MRI in the differentiation of all liver hydatid cyst types. J Med Imaging Radiat Oncol 2015; 60:59-65. [DOI: 10.1111/1754-9485.12417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/18/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Deniz Koken
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
| | - Bekir Cagli
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
| | | | - Ersin Sengul
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
| | - Erdem Yilmaz
- Department of Radiology; Trakya University School of Medicine; Edirne Turkey
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Affiliation(s)
- Rafel Tappouni
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Michelle D Sakala
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
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Bakan S, Olgun DC, Kandemirli SG, Tutar O, Samanci C, Dikici S, Simsek O, Rafiee B, Adaletli I, Mihmanli I. Perianal Fistula With and Without Abscess: Assessment of Fistula Activity Using Diffusion-Weighted Magnetic Resonance Imaging. IRANIAN JOURNAL OF RADIOLOGY 2015; 12:e29084. [PMID: 26715982 PMCID: PMC4691529 DOI: 10.5812/iranjradiol.29084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 06/09/2015] [Accepted: 07/12/2015] [Indexed: 12/13/2022]
Abstract
Background: Magnetic resonance imaging (MRI) is highly accurate for the depiction of both the primary tract of fistula and abscesses, in patients with perianal disease. In addition, MRI can be used to evaluate the activity of fistulas, which is a significant factor for determining the therapeutic strategy. Objectives: This study aimed to determine the usefulness of diffusion-weighted (DW) MRI for assessing activity and visibility of perianal fistula. Patients and Methods: Fifty-three patients with 56 perianal fistulas were included in the current retrospective study. The T2-weighted imaging (T2WI) and DWMRI were performed and apparent diffusion coefficient (ADC) values of fistulas were measured. Fistulas were classified into two groups: only perianal fistulas and fistulas accompanied by abscess. Fistulas were also classified into two groups, based on clinical findings: positive inflammatory activity (PIA) and negative inflammatory activity (NIA). Results: Mean ADC value (mm2/s) of PIA group was significantly lower than that of NIA group, regarding lesions in patients with abscess-associated fistulas (1.371 × 10-3 ± 0.168 × 10-3 vs. 1.586 × 10-3 ± 0.136 × 10-3; P = 0.036). No statistically significant difference was found in mean ADC values between PIA and NIA groups, in patients with only perianal fistulas (P = 0.507). Perianal fistula visibility was greater with combined evaluation of T2WI and DWMRI than with T2WI, for two reviewers (P = 0.046 and P = 0.014). Conclusion: The DWMRI is a useful technique for evaluating activity of fistulas with abscess. Perianal fistula visibility is greater with combined T2WI and DWMRI than T2WI alone.
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Affiliation(s)
- Selim Bakan
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
- Corresponding author: Selim Bakan, Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey. Tel: +90-2124143167, Fax: +90-2124143167, E-mail:
| | - Deniz Cebi Olgun
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Sedat Giray Kandemirli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Onur Tutar
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cesur Samanci
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Suleyman Dikici
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Osman Simsek
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Babak Rafiee
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ibrahim Adaletli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ismail Mihmanli
- Department of Radiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Parker RA, Menias CO, Quazi R, Hara AK, Verma S, Shaaban A, Siegel CL, Radmanesh A, Sandrasegaran K. MR Imaging of the Penis and Scrotum. Radiographics 2015; 35:1033-50. [PMID: 26090569 DOI: 10.1148/rg.2015140161] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Traditionally, due to its low cost, ready availability, and proved diagnostic accuracy, ultrasonography (US) has been the primary imaging modality for the evaluation of scrotal and, to a lesser extent, penile disease. However, US is limited by its relatively small useful field of view, operator dependence, and inability to provide much information on tissue characterization. Magnetic resonance (MR) imaging, with its excellent soft-tissue contrast and good spatial resolution, is increasingly being used as both a problem-solving tool in patients who have already undergone US and as a primary modality for the evaluation of suspected disease. Specifically, MR imaging can aid in differentiating between benign and malignant lesions seen at US, help define the extent of inflammatory processes or traumatic injuries, and play a vital role in locoregional staging of tumors. Consequently, it is becoming more important for radiologists to be familiar with the wide range of penile and scrotal disease entities and their MR imaging appearances. The authors review the basic anatomy of the penis and scrotum as seen at MR imaging and provide a basic protocol for penile and scrotal imaging, with emphasis on the advantages of MR imaging. Pathologic processes are organized into traumatic (including penile fracture and contusion), infectious or inflammatory (including Fournier gangrene and scrotal abscess), and neoplastic (including both benign and malignant scrotal and penile tumors) processes.
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Affiliation(s)
- Rex A Parker
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Christine O Menias
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Robin Quazi
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Amy K Hara
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Sadhna Verma
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Akram Shaaban
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Cary L Siegel
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Alireza Radmanesh
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
| | - Kumar Sandrasegaran
- From the Department of Radiology, Kaiser Los Angeles Medical Center, 1526 N Edgemont St, 5th Floor, Los Angeles, CA 90027 (R.A.P.); Department of Radiology, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M., A.K.H.); Department of Radiology, University of California-Los Angeles, Los Angeles, Calif (R.Q.); Department of Radiology, University of Cincinnati, Cincinnati, Ohio (S.V.); Department of Radiology, University of Utah, Salt Lake City, Utah (A.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.L.S., A.R.); and Department of Radiology, Indiana University Medical Center, Indianapolis, Ind (K.S.)
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Nononcologic applications of diffusion-weighted imaging in the gastrointestinal system. AJR Am J Roentgenol 2015; 204:758-67. [PMID: 25794064 DOI: 10.2214/ajr.14.12729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The purpose of this article is to review infectious, inflammatory, and auto-immune-mediated processes in the gastrointestinal system where diffusion-weighted imaging can be helpful as well as pitfalls associated with its use. CONCLUSION Diffusion-weighted imaging has become an important and widely used tool in abdominal and pelvic MRI, but it has been used primarily for oncologic applications. As more body MRI protocols are routinely including diffusion-weighted imaging, this sequence can be useful in evaluating an increasing number of nononcologic processes.
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Islim F, Salik AE, Bayramoglu S, Guven K, Alis H, Turhan AN. Non-invasive detection of infection in acute pancreatic and acute necrotic collections with diffusion-weighted magnetic resonance imaging: preliminary findings. ACTA ACUST UNITED AC 2015; 39:472-81. [PMID: 24441591 DOI: 10.1007/s00261-014-0076-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the contribution of diffusion-weighted magnetic resonance imaging (DW-MRI) to the detection of infection in acute pancreatitis-related collections. METHODS A total of 21 DW-MRI, and computed tomography (CT) were performed on 20 patients diagnosed as acute pancreatitis with acute peri-pancreatic fluid or necrotic collections. Collections were classified as infected or sterile according to the culture and follow-up results. Collections with gas bubbles on CT images were considered to be infected. Collections with peripheral bright signals on DW-MRI images were considered to be positive, whereas those without signals were considered to be negative. Apparent diffusion coefficient (ADC) values of the peripheral and central parts of the collections were measured. Student's t test was used to compare the means of ADC values of independent groups. RESULTS Apart from one false positive result, the presence of infection was detected by DW-MRI with 95.2% accuracy. The sensitivity and accuracy of DW-MRI were higher than CT for the detection of infection. The ADC values in the central parts of the collections were significantly different between the infected and sterile groups. CONCLUSION DW-MRI can be used as a non-invasive technique for the detection of infection in acute pancreatitis-associated collections.
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Affiliation(s)
- Filiz Islim
- Department of Radiology, Istanbul Bakirkoy, Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey,
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Kantarci M, Yuce I, Yalcin A, Yildirgan MI, Cayir K, Eren S, Atamanalp SS. Diffusion-weighted magnetic resonance imaging in evaluation of gastric cancer. Eurasian J Med 2015; 42:57-60. [PMID: 25610124 DOI: 10.5152/eajm.2010.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 05/24/2010] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To investigate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the diagnosis of gastric tumors and discuss the diagnostic importance and potential use of apparent diffusion coefficient (ADC) measurements. MATERIALS AND METHODS Beginning in March 2009, DW-MRI was added to the routine abdominal and pelvic MR examination for all patients imaged at our institution. A total of 21 patients (12 men and 9 women; mean age 55±6.3SD, range: 39-74 years) with known gastric malignancy were referred to our MR unit. All MRI examinations were performed using a 1.5-T MRI scanner (Magnetom Avanto, Siemens Healthcare). The evaluation of the DW-MRI examinations was made by radiologists' consensus. Changes in the signal intensity of the lesions were determined by their appearance in images at b=50, 400, and 800 s/mm(2) and in ADC maps. Results were compared with histopathological findings. RESULTS All of the gastric tumors in this study showed high signal intensity in DW-MRI and low signal intensity in ADC maps. Mean ADC values for gastric tumor and normal gastric wall were 0.892±0.23 SD mm(2)/s and 1.453±0.35 SD mm(2)/s respectively. The mean ADC values of gastric tumors were significantly lower than that of the normal gastric wall. CONCLUSION DW-MRI and ADC values together can successfully differentiate gastric tumors from normal gastric wall.
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Affiliation(s)
- Mecit Kantarci
- Ataturk University, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - Ihsan Yuce
- Ataturk University, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - Ahmet Yalcin
- Ataturk University, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - M Ilhan Yildirgan
- Ataturk University, School of Medicine, Department of General Surgery, Erzurum, Turkey
| | - Kerim Cayir
- Ataturk University, School of Medicine, Department of Medical Oncology, Erzurum, Turkey
| | - Suat Eren
- Ataturk University, School of Medicine, Department of Radiology, Erzurum, Turkey
| | - S Selcuk Atamanalp
- Ataturk University, School of Medicine, Department of General Surgery, Erzurum, Turkey
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Yu Y, Guo L, Hu C, Chen K. Spectral CT imaging in the differential diagnosis of necrotic hepatocellular carcinoma and hepatic abscess. Clin Radiol 2014; 69:e517-24. [PMID: 25248290 DOI: 10.1016/j.crad.2014.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 08/06/2014] [Accepted: 08/22/2014] [Indexed: 01/13/2023]
Abstract
AIM To explore the value of CT spectral imaging in the differential diagnosis of necrotic hepatocellular carcinoma (nHCC) and hepatic abscess (HA) during the arterial phase (AP) and portal venous phase (PP). MATERIALS AND METHODS Sixty patients with 36 nHCCs and 24 HAs underwent spectral CT during AP and PP. Iodine or water concentration were measured and the normalized iodine concentration (NIC) and lesion-normal parenchyma iodine concentration ratio (LNR) were calculated. The two-sample t-test was used to compare quantitative parameters. Two readers qualitatively assessed lesion types according to imaging features. Sensitivity and specificity were compared between the qualitative and quantitative studies. RESULTS NIC and LNR in the AP for the wall of nHCC (0.14 ± 0.04 mg/ml; 2.77 ± 0.74) were higher than those of HA (0.13 ± 0.02 mg/ml; 1.4 ± 0.9). NIC and LNR in the PP for the wall of HA (0.66 ± 0.05 mg/ml; 1.2 ± 0.2) were higher than those of nHCC (0.5 ± 0.11 mg/ml; 0.94 ± 0.12). The differences in NIC in the AP were not significant but the differences in LNR in AP, and NIC and LNR in the PP were significant. The best quantitative parameter was LNR in AP, and a threshold of 1.52 would yield a sensitivity and specificity of 100% and 91.7%, respectively, for differentiating nHCC from HA. CONCLUSION CT spectral imaging with quantitative iodine concentration analysis may help to increase the accuracy of differentiating nHCC from HA.
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Affiliation(s)
- Y Yu
- Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188, Shi Zi Street, Suzhou 215006, Jiangsu, China
| | - L Guo
- Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188, Shi Zi Street, Suzhou 215006, Jiangsu, China
| | - C Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, No. 188, Shi Zi Street, Suzhou 215006, Jiangsu, China
| | - K Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, No. 197, Rui Jin Er Road, Shanghai 200025, China.
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