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1.
M E Miquel A D Scott N D Macdougall R Boubertakh N Bharwani A G Rockall 《The British journal of radiology》2012,85(1019):1507-1512
Objective
To study the in vitro and in vivo (abdomen) variability of apparent diffusion coefficient (ADC) measurements at 1.5 T using a free-breathing multislice diffusion-weighted (DW) MRI sequence.Methods
DW MRI images were obtained using a multislice spin-echo echo-planar imaging sequence with b-values=0, 100, 200, 500, 750 and 1000 s mm−2. A flood-field phantom was imaged at regular intervals over 100 days, and 10 times on the same day on 2 occasions. 10 healthy volunteers were imaged on two separate occasions. Mono-exponential ADC maps were fitted excluding b=0. Paired analysis was carried out on the liver, spleen, kidney and gallbladder using multiple regions of interest (ROIs) and volumes of interest (VOIs).Results
The in vitro coefficient of variation was 1.3% over 100 days, and 0.5% and 1.0% for both the daily experiments. In vivo, there was no statistical difference in the group mean ADC value between visits for any organ. Using ROIs, the coefficient of reproducibility was 20.0% for the kidney, 21.0% for the gallbladder, 24.7% for the liver and 28.0% for the spleen. For VOIs, values fall to 7.7%, 6.4%, 8.6% and 9.6%, respectively.Conclusion
Good in vitro repeatability of ADC measurements provided a sound basis for in vivo measurement. In vivo variability is higher and when considering single measurements in the abdomen as a whole, only changes in ADC value greater than 23.1% would be statistically significant using a two-dimensional ROI. This value is substantially lower (7.9%) if large three-dimensional VOIs are considered.Diffusion-weighted (DW) MRI is based on the Brownian motion of water in biological tissues [1,2]. The technique has played a preponderant role in neuro-imaging over the last two decades and it is known to detect small changes before they are apparent on anatomical imaging [3,4].In recent years DW MRI has been increasingly used in other parts of the body, demonstrating great diagnostic potential in cancer imaging. To date, DW MRI has been successfully used for tissue characterisation and tumour staging. However, the apparent diffusion coefficient (ADC) is a potential biomarker that could be used to monitor treatment response or evaluate post-therapeutic changes. Details of the clinical use of DW MRI can be found in the 2009 consensus paper [5] or in general and organ-specific review articles [6-8].While DW MRI is a potentially powerful tool in diagnostic oncology, the lack of uniform protocols for imaging and data analysis hinder its clinical implementation. Large differences in ADC values are reported in the literature depending on the acquisition parameters, in particular the choice of b-values (e.g. see [9] for ADC values in the kidney or 5] highlighted the importance of quality analysis, validation and reproducibility studies. Although there are some emerging reproducibility and repeatability data in the abdomen [15,19-22], a recent review by Taouli and Koh [7] highlights the need for further work in this area. Recently, coefficients of variability of around 14% were published for both solid tumours [22] and bone marrow [23]. Other studies seem to indicate that only ADC changes of over 27% [20] or 30% [21] are significant. Substantial variations in ADC values have also been found between different scanners and vendors [24-26], further highlighting the difficulty of setting up multicentre trials.Table 1
Apparent diffusion coefficient values measured in normal liver at 1.5 TReference | Mean ADC (10−3 mm2 s−1) | Standard deviation | Range | Number of subjects | b-values (s mm−2) | Comments |
Taouli et al [10] | 1.60 | 0.13 | 1.44–1.88 | 10 v | 0, 500 | Conventional |
1.52 | 0.15 | 1.28–180 | With parallel imaging | |||
1.51 | 0.21 | 1.27–1.99 | Diffusion tensor/parallel imaging | |||
Mürtz et al [11] | 0.92–0.96a | 0.09–0.14 | 0.62–1.20 | 12 v | 50, 300, 700, 1000, 1300 | Pulse triggered |
1.03–1.14 | 0.22–0.40 | 0.67–2.57 | Non-triggered | |||
Kim et al [12] | 1.05/1.02b | 0.30/0.25 | 6 v/126 p | 3, 57, 192, 408, 517, 850 | ||
1.55/1.16 | 0.37/0.42 | 3, 57, 192, 408, 192, 408 | ||||
4.8/3.55 | 2.37/1.75 | 3, 57 | ||||
Ichikawa et al [13] | 2.28 | 1.23 | 46 p | 1.6, 55 | ||
Taouli et al [14] | 1.83 | 0.36 | 1.4–2.55 | 66 p | 0, 500 | |
1.51 | 0.49 | 1.12–2.71 | 0, 134, 267, 400 | |||
Kwee et al [15] | 1.60/1.62/1.57c | 0.14/0.18/0.15 | 11 v | 0, 500 | Breath-hold | |
2.13/2.27/2.07 | 0.33/0.47/0.43 | Respiratory triggered | ||||
1.65/1.62/1.65 | 0.09/0.16/0.17 | Free breathing (7 mm slice) | ||||
1.64/1.66/1.57 | 0.13/0.11/0.19 | Free breathing (5 mm slice) | ||||
Yamada et al [16] | 0.87 | 0.26 | 78 p | 30, 300, 900,1100 | ADC | |
0.76 | 0.27 | Diffusion coefficient (DC) | ||||
Müller et al [17] | 1.39 | 0.16 | 10 v+9 p | 8 b-values; bmax 328–454 | ||
Namimato et al [18] | 0.69 | 0.31 | 51 p | 30, 1200 | ||
This study | 1.04 | 0.05 | 0.95–1.11 | 10 v | 100, 200, 500, 750, 1000 | Free breathing |
2.
3.
The longitudiual relaxation time T1 of native cartilage is frequently assumed to be constant. To redress this, the spatial variation of T1 in unenhanced healthy human knee cartilage in different compartments and cartilage layers was investigated. Knees of 25 volunteers were examined on a 1.5 T MRI system. A three-dimensional gradient-echo sequence with a variable flip angle, in combination with parallel imaging, was used for rapid T1 mapping of the whole knee. Regions of interest (ROIs) were defined in five different cartilage segments (medial and lateral femoral cartilage, medial and lateral tibial cartilage and patellar cartilage). Pooled histograms and averaged profiles across the cartilage thickness were generated. The mean values were compared for global variance using the Kruskal–Wallis test and pairwise using the Mann–Whitney U-test. Mean T1 decreased from 900–1100 ms in superficial cartilage to 400–500 ms in deep cartilage. The averaged T1 value of the medial femoral cartilage was 702±68 ms, of the lateral femoral cartilage 630±75 ms, of the medial tibial cartilage 700±87 ms, of the lateral tibial cartilage 594±74 ms and of the patellar cartilage 666±78 ms. There were significant differences between the medial and lateral compartment (p<0.01). In each cartilage segment, T1 decreased considerably from superficial to deep cartilage. Only small variations of T1 between different cartilage segments were found but with a significant difference between the medial and lateral compartments.MRI relaxation parameters are used to evaluate cartilage degradation. T2 has been investigated extensively and has been demonstrated to vary with water and collagen content and with collagen orientation in the different cartilage layers [1–8].The quantification of the longitudiual relaxation time T1 of native cartilage has received less attention. In experimental studies, native T1 has been demonstrated to correlate with mechanical properties [9] and to depend upon the macromolecular structure of cartilage [10]. However, it is frequently assumed to be constant across cartilage [11–13]. A few studies have investigated the mean values of a single compartment (10, 14–19] but have not investigated the depth-dependent variation. To our knowledge, no study has systematically compared T1 of unenhanced human knee cartilage in different cartilage layers and in different cartilage compartments in healthy volunteers.
Open in a separate windowData are presented as the mean ± standard deviation. VFA, variable flip angle; GE, gradient echo; IR, inversion-recovery; IR-TSE, inversion-recovery turbo spin-echo; 3D, three-dimensional.*Mean value averaged over the femorotibial compartment.Usually, inversion-recovery (IR) sequences have been used to measure several points in the T1 relaxation curve. Although this technique provides ideal measurements of T1, it is not viable in most studies that require T1 values of a large volume within a reasonable time. Three-dimensional (3D) T1 mapping techniques were applied for this purpose [17, 20–22].The purpose of this study was to investigate the spatial variation of native cartilage T1 in different compartments and different cartilage layers in healthy human knee joints using a rapid 3D gradient-echo (GE) sequence with variable flip angle. 相似文献
Table 1
T1 of healthy human articular cartilage in the knee jointSequence | T1 (ms) | |||||
Field strength | Lateral femoral | Medial femoral | Lateral tibial | Medial tibial | Patellar | |
Van Breuseghem et al [16] | Combined T1–T2 | 449±34* | – | |||
IR-TSE | ||||||
1.5 T | ||||||
Tiderius et al [18] | Turbo-IR | 952±86 | 952±86 | – | – | – |
1.5 T | ||||||
Williams et al [14] | Turbo-IR | – | – | – | ||
1.5 T | 916±102 | 819±86 | ||||
3.0 T | 1146±133 | 1167±79 | ||||
Gold et al [19] | Look-Locker | – | – | – | – | |
1.5 T | 1066±155 | |||||
3.0 T | 1240±107 | |||||
Wang et al [15] | 3D GE with VFA | 1004±72* | 1193±108 | |||
3.0 T | ||||||
Trattnig et al [17] | 3D GE with VFA | 1013±89 | – | – | – | – |
3.0 T |
4.
R Girometti G Brondani L Cereser G Como M Del Pin M Bazzocchi C Zuiani 《The British journal of radiology》2010,83(988):351-361
Post-cholecystectomy syndrome (PCS) is defined as a complex of heterogeneous symptoms, consisting of upper abdominal pain and dyspepsia, which recur and/or persist after cholecystectomy. Nevertheless, this term is inaccurate, as it encompasses biliary and non-biliary disorders, possibly unrelated to cholecystectomy. Biliary manifestations of PCS may occur early in the post-operative period, usually because of incomplete surgery (retained calculi in the cystic duct remnant or in the common bile duct) or operative complications, such as bile duct injury and/or bile leakage. A later onset is commonly caused by inflammatory scarring strictures involving the sphincter of Oddi or the common bile duct, recurrent calculi or biliary dyskinesia. The traditional imaging approach for PCS has involved ultrasound and/or CT followed by direct cholangiography, whereas manometry of the sphincter of Oddi and biliary scintigraphy have been reserved for cases of biliary dyskinesia. Because of its capability to provide non-invasive high-quality visualisation of the biliary tract, magnetic resonance cholangiopancreatography (MRCP) has been advocated as a reliable imaging tool for assessing patients with suspected PCS and for guiding management decisions. This paper illustrates the rationale for using MRCP, together with the main MRCP biliary findings and diagnostic pitfalls.Post-cholecystectomy syndrome (PCS) consists of a group of abdominal symptoms that recur and/or persist after cholecystectomy [1, 2]. It is defined as early if occurring in the post-operative period and late if it manifests after months or years.Although this term is used widely, it is not completely accurate, as it includes a large number of disorders, both biliary (1, 2]. It has been reported that ∼50% of these patients suffer from organic pancreaticobiliary and/or gastrointestinal disorders, whereas the remaining patients are affected by psychosomatic or extra-intestinal diseases. Moreover, in 5% of patients who undergo laparoscopic cholecystectomy, the reason for chronic abdominal pain remains unknown [1]. Probably because of the uncertainty in nosographic definition, the reported prevalence of PCS ranges from very low [2] to 47% [1]. Symptoms include biliary or non-biliary-like abdominal pain, dyspepsia, vomiting, gastrointestinal disorders and jaundice, with or without fever and cholangitis [1, 2]. Severe symptoms are more likely to represent a complication of cholecystectomy if they occur early or to express a definite treatable cause when compared with non-specific, dyspeptic or mild symptoms. A non-biliary aetiology of PCS should be suspected if no calculi or gallbladder abnormalities are found at cholecystectomy and symptoms are similar to those suffered pre-operatively [1]. Treatment for PCS is tailored to the specific cause and includes medication, sphincterotomy, biliary stenting, percutaneous drainage of bilomas and surgical revision for severe strictures [1–4].
Open in a separate window
Open in a separate windowThe traditional imaging approach to PCS includes ultrasonography and/or CT, followed by direct cholangiography, as the gold standard [2]. Biliary scintigraphy has been advocated as a reliable non-invasive tool to evaluate sphincter of Oddi activity. Nevertheless, it has limited diagnostic accuracy compared with sphincter of Oddi manometry (SOM), which represents the gold standard for assessing functional forms of PCS [5]. Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive and reliable alternative to direct cholangiography for the evaluation of the biliary tract. This has led to an increasing demand for MRCP to be used in patients with suspected PCS, despite the fact that its role in patient management has been assessed only briefly [1, 2]. The main advantages of using MRCP are its non-invasiveness and its capability to provide a road-map for interventional treatments [1–4]. Heavily T2 weighted images with a high bile duct-to-background contrast may be obtained either with a set of single breath-hold, single-shot turbo spin-echo projective thick slabs or by using a respiratory-triggered three-dimensional (3D) turbo spin-echo sequence for a detailed representation of the biliary tree, together with multiplanar reformations and volumetric reconstructions [2–4]. Alternatives to the standard MRCP techniques include the use of fat-saturated 3D spoiled gradient-echo sequences in conjunction with intravenous contrast agents excreted (to a varying degree) via the biliary system, such as mangafodipir trisodium, gadobenate dimeglumine or gadoxetic acid. Advantages over fluid-based techniques include biliary function assessment, background suppression of ascites and bowel fluid, and identification of biliary leaks following cholecystectomy, with a reported sensitivity and specificity of 86% and 83%, respectively (Figure 1) [6].Open in a separate windowFigure 1A 31-year-old female patient presenting with right upper abdominal pain 1 week after laparoscopic cholecystectomy. (a) T2 weighted projective magnetic resonance cholangiopancreatography image shows an elongated hyperintense fluid collection proximal to the cystic duct stump, along with a small amount of subhepatic free fluid, which is well delineated in the axial T2 weighted single-shot fast spin-echo image. (b) An aberrant right intrahepatic bile duct is visible (arrow in (a)). (c) Coronal and (d) axially reformatted T1 weighted fat saturated three-dimensional gradient echo images obtained 20 min after intravenous injection of gadoxetic acid document the passage of contrast agent from the cystic duct stump into the fluid collection and the subhepatic space, demonstrating the presence of a bile leak. (Courtesy of Celso Matos, MD, Brussels, Belgium.) 相似文献
Table 1
Main biliary causes of post-cholecystectomy syndrome (PCS) related to cholecystectomy. (Biliary malignancies are the most frequent causes of PCS unrelated to cholecystectomy [1])Early PCS |
Retained stones in the cystic duct stump and/or common bile duct |
Bile duct injury/ligature during surgery |
Bile leakage |
Late PCS |
Recurrent stones in the common bile duct |
Bile duct strictures |
Cystic duct remnant harbouring stones and/or inflammation |
Gallbladder remnant harbouring stones and/or inflammation |
Papillary stenosis |
Biliary dyskinesia |
Table 2
Main extrabiliary causes of post-cholecystectomy syndrome (modified from [1])Gastrointestinal causes | Extra-intestinal causes |
Acute/chronic pancreatitis (and complications) | Psychiatric and/or neurological disorders |
Pancreatic tumours | Coronary artery disease |
Pancreas divisum | Intercostal neuritis |
Hepatitis | Wound neuroma |
Oesophageal diseases | Unexplained pain syndromes |
Peptic ulcer disease | |
Mesenteric ischaemia | |
Diverticulitis | |
Organic or motor intestinal disorders |
5.
M Oliver D McConnell M Romani A McAllister A Pearce A Andronowski X Wang K Leszczynski 《The British journal of radiology》2012,85(1020):1539-1545
6.
M H Seegenschmiedt O Micke R Muecke the German Cooperative Group on Radiotherapy for Non-malignant Diseases 《The British journal of radiology》2015,88(1051)
Every year in Germany about 50,000 patients are referred and treated by radiotherapy (RT) for “non-malignant disorders”. This highly successful treatment is applied only for specific indications such as preservation or recovery of the quality of life by means of pain reduction or resolution and/or an improvement of formerly impaired physical body function owing to specific disease-related symptoms. Since 1995, German radiation oncologists have treated non-malignant disorders according to national consensus guidelines; these guidelines were updated and further developed over 3 years by implementation of a systematic consensus process to achieve national upgraded and accepted S2e clinical practice guidelines. Throughout this process, international standards of evaluation were implemented. This review summarizes most of the generally accepted indications for the application of RT for non-malignant diseases and presents the special treatment concepts. The following disease groups are addressed: painful degenerative skeletal disorders, hyperproliferative disorders and symptomatic functional disorders. These state of the art guidelines may serve as a platform for daily clinical work; they provide a new starting point for quality assessment, future clinical research, including the design of prospective clinical trials, and outcome research in the underrepresented and less appreciated field of RT for non-malignant disorders.Every year about 50,000 patients in Germany are treated for “non-malignant disorders” respectively “benign disease conditions” by using ionizing radiation applied in >300 radiotherapy (RT) facilities.1–4 The aim of these treatments are and will be the preservation or recovery of various quality of life aspects, for example, by prevention of or reduction of pain and/or improvement of formerly disabled physical body functions.Non-malignant indications for RT comprise about 10–30% of all treated patients in most academic, public and private RT facilities in Germany. Over the past decade, various so called patterns of care studies (PCSs) have focused on the general and various specific aspects of these diseases and their RT treatment conditions and concepts in Germany.1–5 Overall, there is not a single RT institution among all 300 active RT facilities in Germany that does not offer RT for these benign or “non-malignant diseases”.1–4Since 1995 and together with the foundation of the German Society of Radiation Therapy and Oncology (DEGRO), a scientific task force group was formed, the German Cooperative Group on Radiotherapy for Benign Diseases (GCG-BD), which undertook the task to review the large amount of clinical experience gained in several decades from 1930 to 1990 in Germany about the use of RT for non-malignant disorders; the relevant articles and clinical data were systematically discussed and evaluated by a scientific panel and a “Delphi” consensus process involving all active RT providers. The first National guideline was defined and published in the year 2000.1 From then on, specific PCSs and prospective randomized clinical trials were developed to improve the available levels of evidence (LOEs) for various non-malignant disorders.5–8 Meanwhile, a considerable number of clinical trials have been carried out and published.9–14The updated National practice guideline v. 2.0 of the most common RT indications for non-malignant diseases were developed between 2010 and 2013 by a nominated group of specialists in conjunction with all members of the German Radiation Oncology Society (DEGRO) and GCG-BD; the Delphi consensus process comprised several national-held symposia, working group meetings and the circulation of all preliminary text versions within the responsible writing committee group members and the final presentation in the national scientific DEGRO meeting in the year 2013.These updated practice guidelines focus on those clearly defined RT indications that have become clinically relevant in terms of the high clinical demand (i.e. number of referrals from other medical disciplines), and the currently achieved quantity and quality of treatments, which had been determined by an evaluation of the continuously increasing number of treated patients between the first two evaluation periods within Germany (Non-malignant diseases (treatment groups) 1999 2004 Increase (%) Inflammatory 456 503 10.9 Degenerative 12,600 23,754 88.5 Hyperproliferative 972 1252 28.8 Functional/other 6099 10,637 74.4 Overall 20,082 37,410 86.3