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1.
K. Müller-Peltzer G. Negrão de Figueiredo V. Schwarze J. Rübenthaler D. A. Clevert 《Der Radiologe》2018,58(10):887-893
Clinical/methodical issue
Cystic renal lesions are commonly seen during routine ultrasound examinations of the abdomen.Standard radiological methods
Some cystic renal lesions cannot be sufficiently characterized using native ultrasound. In these cases additional imaging might be necessary.Methodical innovations
Contrast-enhanced ultrasound (CEUS) is a reliable imaging modality to characterize cystic renal lesions. Contrast enhancement of septations and the cystic wall are visualized in high resolution. This information helps to categorize the cystic renal lesions applying the CEUS Bosniak classification. This classification helps to estimate the probability of a malignant etiology of cystic renal lesions.Performance
Using CEUS, cystic renal lesions can be characterized with a high sensitivity and specificity.Achievements
The advantages of CEUS include that there is no effect on the function of the kidneys or the thyroid gland and no radiation exposure. In some cases, additional cross-sectional imaging is necessary to optimize diagnostic accuracy.Practical recommendations
CEUS is a helpful imaging modality to characterize cystic renal lesions, to avoid unnecessary follow-ups and to detect malignant cystic renal lesions.2.
Xiao?Chen Qingqiang?Zhu Baoxin?Li Wenjing?Cui Hao?Zhou Na?Duan Yongkang?Liu Vikas?Kundra Zhongqiu?Wang
Objectives
To characterize imaging features of renal cell carcinoma (RCC) associated with Xp11.2 translocation/TFE gene fusion.Methods
Twenty-one patients with Xp11.2/TFE RCC were retrospectively evaluated. Tumour location, size, density, cystic or solid appearance, calcification, capsule sign, enhancement pattern and metastases were assessed.Results
Fourteen women and seven men were identified with 12 being 25 years old or younger. Tumours were solitary and cystic-solid (76.2 %) masses with a capsule (76.2 %); 90.5 % were located in the medulla. Calcifications and lymph node metastases were each observed in 24 %. On unenhanced CT, tumour attenuation was greater than in normal renal parenchyma (85.7 %). Tumour enhancement was less than in normal renal cortex on all enhanced phases, greater than in normal renal medulla on cortical and medullary phases, but less than in normal renal medulla on delayed phase. On MR, the tumours were isointense on T1WI, heterogeneously hypointense on T2WI and slightly hyperintense on diffusion-weighted imaging.Conclusion
Xp11.2/TFE RCC usually occurs in young women. It is a cystic-solid, hyperdense mass with a capsule. It arises from the renal medulla with enhancement less than in the cortex but greater than in the medulla in all phases except the delayed phase, when it is lower than in the medulla.Key Points
? Xp11.2/TFE RCC was more prevalent in young women.? On unenhanced CT, Xp11.2/TFE RCC attenuation was greater than in renal parenchyma.? Xp111/2TFE RCC arises primarily from the renal medulla.? Xp11.2/TFE RCC enhancement was less than in the cortex on all phases.? Enhancement was greater than in the medulla in arterial and corticomedullary phase.3.
Purpose
Acute invasive fungal rhinosinusitis (AIFRS) is a life-threatening disease that is difficult to diagnose. Its overall imaging features have not been evaluated and the prognostic impact is unclear. The purpose of our study was to present MR imaging features and their impact on prognosis of AIFRS.Methods
MR images and clinical records of 23 patients with AIFRS were retrospectively evaluated to identify the imaging features and to determine the factors affecting patients’ survival. A multivariable Cox proportional hazard model was used to estimate the hazard ratio of the prognostic factors, and Kaplan-Meier survival curves were compared by using a log-rank test.Results
All cases showed extra-sinonasal involvement and the orbit was the most common (65.2%, 15/23) location. The lesion enhancement pattern was classified into lack of contrast enhancement (LoCE) (47.8%, 11/23) and homogeneous (34.8%, 8/23) and heterogeneous (17.4%, 4/23) enhancement. Although LoCE showed variable signal intensity (SI), homogeneously or heterogeneously enhancing lesions showed exclusively low SI (100%, 12/12) on T2WI. Among various clinical and imaging factors, LoCE was correlated with coagulation necrosis, probably provoked by numerous fungal hyphae, and was found to be a sole independent prognostic factor for disease-specific mortality (hazard ratio?=?16.819; 95% CI, 1.646–171.841, p?=?0.017). In addition, patients with LoCE showed worse survival than patients without LoCE (p?=?0.008).Conclusion
AIFRS showed frequent extra-sinonasal involvement and variable MR enhancement patterns. An enhancement pattern of LoCE was seen in about half of the cases and was a unique prognostic factor among the various clinico-radiologic factors.4.
Objectives
To obtain specific imaging findings of solitary necrotic nodule of the liver (SNNL) using longer delayed contrast-enhanced MRI and compare them with those of three mimic hepatic diseases.Methods
Sixteen patients with SNNL underwent plain and contrast-enhanced triphasic CT and multiphasic MRI with delayed time prolonged to 2 h after contrast bolus injection. Twenty-three patients with mimic lesions including seven with eight HCCs, five with five iCCs and 11 with metastatic lesions served as the control group. Those patients also received plain and multiphasic contrast-enhanced MRI. Imaging features of lesions such as peripheral wash-out time were evaluated.Results
Among the 16 SNNLs, with a prolonged delayed MRI time, the enhancement degree of tumour periphery increased gradually. When it was up to 1 h, all lesions represented moderate/marked peripheral enhancement with internal hypointensity. However, the peripheral wash-out in seven HCCs (87.5%) and all metastatic lesions except three appeared at 10 or 15 min, one iCC (20%) at 30 min and the other lesions at 1 h.Conclusions
Longer MRI with a delayed time of 1–2 h may be useful in diagnosis SNNL, revealing the specific imaging characteristic of SNNL as pronounced peripheral enhancement with internal hypointensity.Key Points
? Longer delayed MRI plays an important role in the diagnosis of SNNL. ? Characteristic imaging feature of SNNL is pronounced peripheral enhancement with internal hypointensity. ? Periphery wash-out time can differentiate SNNL from mimic diseases. ? Imaging findings of SNNL on routine CT and MRI are unspecific.5.
Purpose
The role of T2*-based MR imaging in intracranial germ cell tumors (GCTs) has not been fully elucidated. The aim of this study was to evaluate the susceptibility-weighted imaging (SWI) or T2* gradient echo (GRE) features of germinomas and non-germinomatous germ cell tumors (NGGCTs) in midline and off-midline locations.Methods
We retrospectively evaluated all consecutive pediatric patients referred to our institution between 2005 and 2016, for newly diagnosed, treatment-naïve intracranial GCT, who underwent MRI, including T2*-based MR imaging (T2* GRE sequences or SWI). Standard pre- and post-contrast T1- and T2-weighted imaging characteristics along with T2*-based MR imaging features of all lesions were evaluated. Diagnosis was performed in accordance with the SIOP CNS GCT protocol criteria.Results
Twenty-four subjects met the inclusion criteria (17 males and 7 females). There were 17 patients with germinomas, including 5 basal ganglia primaries, and 7 patients with secreting NGGCT.All off-midline germinomas presented with SWI or GRE hypointensity; among midline GCT, all NGGCTs showed SWI or GRE hypointensity whereas all but one pure germinoma were isointense or hyperintense to normal parenchyma. A significant difference emerged on T2*-based MR imaging among midline germinomas, NGGCTs, and off-midline germinomas (p?<?0.001).Conclusion
Assessment of the SWI or GRE characteristics of intracranial GCT may potentially assist in differentiating pure germinomas from NGGCT and in the characterization of basal ganglia involvement. T2*-based MR imaging is recommended in case of suspected intracranial GCT.6.
Shahin Zandieh Reinhard Bernt Siroos Mirzaei Joerg Haller Klaus Hergan 《Journal of nuclear cardiology》2018,25(4):1128-1134
Background
Sarcoidosis is a systemic disorder of unknown etiology. It is distinguished by the presence of noncaseating epithelioid granulomas. This study demonstrates the use of image fusion between (18)F-fluoro-2-deoxy-d-glucose positron emission tomography (18F-FDG PET) and magnetic resonance imaging (MRI) to diagnose patients with cardiac sarcoidosis (CS).Methods
Seven patients diagnosed with sarcoidosis were retrospectively included. All patients underwent 18F-FDG PET/CT and cardiac MRI.Results
On the MRI scan, late gadolinium enhancement (LGE) was observed in five patients. T2-weighted images revealed areas with an increased signal consistent with myocardial edema in two patients and with hypointensity suggesting fibrosis in one patient. Increased 18F-FDG uptake was seen in the myocardial wall in three patients, indicating active inflammation.Conclusion
18F-FDG PET and MRI image fusion allows clinicians to obtain complete morphofunctional cartography in patients with sarcoidosis. Our data show that 18F-FDG PET/MRI image fusion imaging can be useful in the diagnosis of CS.7.
Pistolese CA Perretta T Cossu E Della Gatta F Giura S Simonetti G 《La Radiologia medica》2011,116(4):584-594
Purpose
This study evaluated the role of the correct diagnostic pathway through conventional imaging in evaluating breast disease.Materials and methods
Six hundred patients aged between 35 and 75 years were enrolled in the study. All patients underwent detailed history and clinical examination, ultrasound (US) and mammography. US scans were repeated after mammography. All suspicious lesions were studied by cytological and histological characterisation and magnetic resonance (MR) imaging.Results
The first US scan showed 147 solid lesions, 67 lesions characterised by posterior acoustic shadowing and 193 areas of heterogeneous echostructure. The second US scan, performed after mammography, confirmed 123/147 solid nodular lesions, 53/67 lesions characterised by posterior acoustic shadowing and 183/193 areas of heterogeneous echostructure; it also showed 13 nodular lesions not seen on the first scan and two cases of nodular lesions with irregular calcifications.Conclusions
Our experience suggests that US not performed in conjunction with mammography gives rise to incorrect diagnostic interpretations (either false positive or false negative results). The detection rate of the US scan performed after mammography increases from 4.16% to5.5%.8.
Ji Yoon Moon Seong Hyun Kim Seo-Youn Choi Jeong Ah Hwang Ji Eun Lee Jisun Lee 《Japanese journal of radiology》2018,36(8):489-499
Purpose
To evaluate value of gadoxetic acid-enhanced and diffusion-weighted (DW) MRI for distinguishing malignant from benign hyperintense nodules on unenhanced T1-weighted images (T1WIs) in patients with chronic liver disease.Materials and methods
Forty-two patients with 37 malignant and 41 benign hyperintense nodules on unenhanced T1WIs who underwent gadoxetic acid-enhanced and DW MRI, followed by histopathological examination, were included. Qualitative and quantitative analyses were conducted. Significant findings on univariate and multivariate analyses were identified and their diagnostic performances were analyzed for predicting hyperintense hepatocellular carcinomas (HCCs).Results
In univariate analysis, hyperintensity on T2WI, arterial enhancement, washout, hypointensity on hepatobiliary phase, and diffusion restriction were more frequently observed (P?<?0.05) in hyperintense HCCs. Tumor-to-liver SI ratio on hepatobiliary phase and minimum apparent diffusion coefficient (ADCmin) were significantly lower in hyperintense HCCs (P?<?0.05). In multivariate analysis, hyperintensity on T2WI (OR, 13.58; P?=?0.02), arterial enhancement (OR, 8.21; P?=?0.002), and ADCmin?≤?0.83?×?10?3 mm2/s (OR, 6.88; P?=?0.008) were independently significant factors for predicting hyperintense HCCs. When two of three criteria were combined, 75.7% (28/37) of hyperintense HCCs were identified with a specificity of 92.7%, and when all three criteria were satisfied, the specificity was 97.6%.Conclusion
Gadoxetic acid-enhanced and DW MRI may be helpful for differentiating malignant from benign hyperintense nodules on unenhanced T1WI.9.
Objectives
Characteristics of hepatocellular carcinoma (HCC) on magnetic resonance (MR) images were compared in patients who did or did not undergo liver transplantation (LT), and we evaluated the relationship of these findings with overall survival (OS) and time-to-tumour recurrence (TTR) after transplantation.Methods
The enhancement pattern of gadoxetic acid-enhanced MR images of 25 patients with recurrent HCCs (LT group) and 25 surgically confirmed HCC patients in the non-transplanted (control) group were compared. Typical enhancement was defined as 1) arterial enhancement and delayed wash-out and 2) absence of typical features of cholangiocarcinoma consisting of arterial rim enhancement and target appearance on hepatobiliary phase images. OS and TTR were analyzed in the LT group according to these patterns using the log-rank test.Results
HCCs in the LT group significantly more often had an atypical enhancement pattern (16/25, 64.0%) than those in the control group (5/25, 20.0%; p = 0.004). However, OS and TTR did not differ significantly according to these enhancement patterns of recurrent HCC (p > 0.05).Conclusion
Although enhancement patterns of recurrent HCC in transplanted liver did not affect OS and TTR, these HCCs that arise after LT frequently revealed atypical enhancement on gadoxetic acid-enhanced MR imaging.Key Points
? Recurrent HCCs after LT showed atypical enhancement on gadoxetic acid-enhanced MRI.?They showed absence of delayed wash-out or cholangiocarinoma-like features.? Enhancement patterns of recurrent HCCs did not affect OS and TTR.10.
Objective
To investigate the value of ‘swallow-tail’ sign and putaminal hypointensity on 3 T susceptibility-weighted imaging (SWI) for distinguishing multiple system atrophy (MSA) from idiopathic Parkinson’s disease (IPD).Methods
Three groups – 39 MSA patients, 18 IPD patients,and 31 healthy controls (HCs) – were administered a 3 T SWI sequence to evaluate ‘swallow-tail’ sign and putaminal hypointensity using visual scales from 0 to 2 and 0 to 3 scores, respectively. The diagnostic accuracy of the two signs separately and combined was calculated using a receiver operating characteristic curve, with clinical diagnosis as the gold standard.Results
The scores of ‘swallow-tail’ sign were lower in IPD than in MSA or in HCs, as well as for putaminal hypointensity in IPD or HCs than in MSA (p?<?0.05). The sensitivity and specificity of ‘swallow-tail’ sign and putaminal hypointensity were 87.9% and 83.3%, and 35.9% and 100%, respectively, in the respective patient groups. The area under the curve of combined signs was increased from 0.85 (‘swallow tail’) or 0.68 (putaminal hypointensity) to 0.93.Conclusion
The combination of ‘swallow-tail’ sign and putaminal hypointensity can increase the accuracy of discriminating between MSA and IPD.Key Points
? Differential diagnosis of MSA and IPD is still challenging in clinical practice.? Absence of ‘swallow-tail’ sign is a valuable biomarker for IPD on SWI.? Putaminal hypointensity is a valuable biomarker for MSA on SWI.? Combined ‘swallow- tail’ sign and putaminal hypointensity increase diagnostic accuracy.11.
Objectives
To review the gadoxetic acid disodium (EOB)-enhanced magnetic resonance (MR) imaging features of cholangiolocellular carcinoma (CoCC) of the liver and compare them with those of hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC).Methods
EOB-enhanced MR images of 19 patients with CoCC, 23 with ICC, and 51 with HCC were retrospectively evaluated qualitatively and quantitatively. Univariate and multivariate analyses were performed to determine the characteristic MR features of CoCC with histopathological–imaging correlation.Results
Multivariate logistic regression analysis showed that dot-/band-shaped internal enhancement during the arterial and portal phases (P?<?0.001), and larger arterial ring enhancement ratio (CoCC, 0.13?±?0.04; ICC, 0.074?±?0.04; P?=?0.013) were significantly independently associated with CoCC in contrast to ICC, whereas several MR features including progressive enhancement during the portal and late phases (P?<?0.001), target appearance in the hepatocyte phase (P?=?0.004), and vessel penetration (P?=?0.013) were significantly more frequently associated with CoCC than HCC. The dot-/band-like internal enhancement (78.9% of CoCCs) histopathologically corresponded to the tumour cell nest with vascular proliferations and retained Glisson's sheath structure.Conclusions
EOB-enhanced MR features of CoCC largely differ from those of HCC but are similar to those of ICC. However, the finding of thicker arterial ring enhancement with dot-/band-like internal enhancement could help differentiate CoCC from ICC.Key Points
? Gadoxetic acid-enhanced MR features of cholangiolocellular carcinoma (CoCC) resembled those of intrahepatic cholangiocarcinoma (ICC).? Gadoxetic acid-enhanced MR features of CoCC largely differed from those of hepatocellular carcinoma.? Dot-/band-like internal enhancement of CoCC may be helpful for differentiating from ICC.? Arterial ring enhancement of CoCC was larger than that of ICC.12.
Objectives
To determine the diagnostic value of the cotton ball sign and other CT features in patients with gallbladder (GB) wall thickenings (WTs).Methods
Three blinded readers reviewed the preoperative CT and MR images of 101 patients with pathologically confirmed GB adenomyomatosis (GA) (n = 34) and other benign (n = 29), malignant (n = 41), and premalignant (n = 2) GBWTs. Three readers analysed the morphological features of GBWT and presence of the “cotton ball sign”, defined as fuzzy grey dots in GBWT or a dotted outer border of the inner enhancing layer on contrast-enhanced (CE) CT. In addition, the “pearl necklace sign” on MR was analysed.Results
In the GA group (n = 34), prevalence of the cotton ball sign and pearl necklace sign was 74% (25/34) and 44% (15/34), respectively. Presence of the cotton ball sign, smooth contour of the mucosa, double-layering enhancement, and enhancement degree weaker than the renal cortex on CT images were significant predictors of benign GBWT (p < 0.01). When differentiating GA from GB malignancy or premalignancy, accuracy of the cotton ball sign and pearl necklace sign was 81% (62/77) and 74% (57/77), respectively.Conclusion
The cotton ball sign on CE-CT showed higher sensitivity and comparable specificity to those of the pearl necklace sign in differentiating GA from malignancy.Key Points
? Prevalence of the cotton ball sign on CT was 74% in gallbladder adenomyomatosis. ? The cotton ball sign was useful in differentiating gallbladder adenomyomatosis from gallbladder cancer. ? The cotton ball sign was more sensitive than the pearl necklace sign for adenomyomatosis diagnosis.13.
Axel Schmid Raphael Schmieder Michael Lell Rolf Janka Roland Veelken Roland E. Schmieder Michael Uder Christian Ott 《Cardiovascular and interventional radiology》2016,39(3):426-432
Background/Aims
Renal denervation (RDN) emerged as a treatment option for reducing blood pressure (BP) in patients with treatment-resistant hypertension (TRH). However, concerns have been raised regarding the incidence of late renal artery stenosis or thromboembolism after RDN. The goal of the current study was, therefore, to conduct a prospective clinical trial on the mid-term vascular integrity of the renal arteries and the perfusion of the renal parenchyma assessed by magnetic resonance imaging (MRI) in the follow-up after catheter-based RDN.Methods
In our single-centre investigator initiated study, 51 patients with true TRH underwent catheter-based RDN using the Symplicity FlexTM catheter (Medtronic Inc., Palo Alto, CA). Follow-up MRI was performed at a median of 11 months (interquartile range 6–18 months) after RDN on a 1.5T MR unit. High-resolution MR angiography (MRA) and MRI results were compared to the baseline digital angiography of renal arteries obtained at time of RDN. In case of uncertainties (N = 2) catheter angiography was repeated.Results
Both office and 24-h ambulatory BP were significantly reduced 6 and 12 months after RDN. Renal function remained unchanged 6 and 12 months after RDN. In all patients, MRA excluded new or progression of pre-existing low grade renal artery stenosis as well as focal aneurysms at the sites of radiofrequency ablation. In none of the patients new segmental perfusion deficits in either kidney were detected on MRI.Conclusions
No vascular or parenchymal complications after radiofrequency-based RDN were detected in 51 patients followed up by MRI.14.
Purpose
We aimed to evaluate the MR findings of the orbit in patients with Vogt–Koyanagi–Harada disease (VKHD).Methods
We included 14 patients with clinically diagnosed VKHD, who underwent orbital MR imaging before treatment between May 2011 and August 2017. The mean duration from initial symptom onset to MR imaging was 16 days (range, 2–36 days). Fat-suppressed gadolinium-enhanced T1-weighted images were obtained in six patients. We retrospectively assessed the choroids and Tenon’s capsules for the presence of thickening on unenhanced images and abnormal enhancement on contrast-enhanced images.Results
Bilateral choroidal thickening was observed in 14 patients (100%) on T1-weighted images and in 12 patients (85.7%) on T2-weighted images. Choroidal thickening showed posterior pole predominance in 11 patients (78.6%) and diffusely distributed in the remaining three patients (21.4%). Bilateral Tenon’s capsule thickening was observed in five patients (35.7%) on T1-weighted images and in 14 patients (100%) on T2-weighted images. On contrast-enhanced images, the choroids and Tenon’s capsules were abnormally enhanced in six patients (100%).Conclusion
MR imaging sensitively detected abnormalities of the choroids and Tenon’s capsules in patients with VKHD. Bilaterality and predominant posterior pole distribution were characteristic of choroidal VKHD.15.
Purpose
Immunoglobulin G4 (IgG4)-related disease represents a spectrum of fibro-inflammatory disorders that affects various organ systems, including the central nervous system.Methods
Here we present the case of lgG4-related hypertrophic meningitis with exclusively leptomeningeal involvement and spread via perivascular spaces.Results
A 58-year-old male patient presented with complex partial seizures. Initial computed tomography examination showed left frontal sulcal hyperdensity. Subsequent magnetic resonance examination revealed FLAIR hyperintensity in the central sulcus, with post-contrast enhancement in the form of “dotted line.” Physical examination, routine laboratory, and cerebrospinal fluid analyses were unremarkable. Meningeal biopsy confirmed IgG4-related meningitis. After corticosteroid treatment, a complete resolution of imaging findings was observed. Two months later, the patient presented with relapsing neurological symptoms and radiological findings in postcentral, precentral, and temporal sulci, resembling the form of “dotted line” contrast enhancement. In addition, linear intraparenchymal enhancement that followed perivascular spaces was seen in the left parietal lobe. After repeated steroid therapy, all lesions resolved completely.Conclusion
We reported the first case of isolated IgG4-related leptomeningeal involvement with a “dotted line” enhancement and perivascular intraparenchymal spread. Although IgG4-related meningitis represents a rare disease, both clinicians and radiologists should include this condition in the differential diagnosis of unclear leptomeningeal disease.16.
Objectives
To compare the performance of diffusion-weighted imaging (DWI) with that of contrast-enhanced MRI in differentiating renal oncocytomas from chromophobe renal cell carcinomas (RCCs).Methods
We recruited 48 patients with histopathologically confirmed renal oncocytomas (n=16) and chromophobe RCCs (n=32). All patients underwent preoperative DWI and contrast-enhanced MRI. Apparent diffusion coefficient (ADC) and signal intensity were measured in each patient. ADC ratio and percentage of signal intensity change were calculated.Results
Mean ADC values for renal oncoctytomas were significantly higher than those for chromophobe RCCs (1.59±0.21 vs. 1.09±0.29× 10?3 mm2/s, p < 0.001). Area under the ROC curve, sensitivity and specificity were 0.931, 87.5% and 84.4%, respectively, for ADC measurement of DW imaging; 0.825, 87.5% and 75%, respectively, for enhancement ratio (p > 0.05). Adding ADC values to the enhancement ratios in the ROC, analysis to differentiate renal oncocytoma from chromophobe RCCs increased specificity from 75 to 87.5% at 87.5% sensitivity without significantly increasing the AUC (0.930).Conclusions
Both DWI and contrast-enhanced MRI may assist in differentiating renal oncocytomas from chromophobe RCCs, with DWI showing higher diagnostic value. The combination of the two parameters could potentially provide better performance in distinguishing these two tumours.Key Points
? ADC values can assist in differentiating renal oncocytomas from chromophobe RCCs. ? DW imaging possesses better specificity than does contrast-enhanced MR imaging. ? Combining the two parameters provides higher specificity regarding the differential diagnosis.17.
Koichi Koyama Shoji Kubo Ai Ueki Taro Shimono Shigekazu Takemura Shogo Tanaka Masahiko Kinoshita Genya Hamano Yukio Miki 《Japanese journal of radiology》2017,35(5):233-241
Purpose
To retrospectively investigate magnetic resonance (MR) imaging findings of occupational cholangiocarcinoma (oCC) occurring among workers in printing companies in Japan, compared to those of non-occupational cholangiocarcinoma (nCC), primary sclerosing cholangitis (PSC), and age-matched normal controls (NORs).Materials and methods
Participants comprised 27 consecutive patients (oCC, n = 5; nCC, n = 8; PSC, n = 6; NOR, n = 8) who underwent MR imaging between May 2009 and October 2012. MR imaging was evaluated with respect to tumor characteristics, abnormal MR cholangiographic findings (PSC-like findings), bile duct stricture, and signal changes of the hepatic parenchyma.Results
Tumors were detected in all nCCs and four oCCs. Tumors displayed a mass-forming type in all nCCs and two oCCs, and an intraductal growth type in two oCCs. Abnormal cholangiographic findings were detected in all oCCs and PSCs, but not in any nCCs or NORs. All oCCs and seven nCCs showed biliary strictures longer than 1 cm; five PSCs showed biliary strictures shorter than 1 cm. Both intra- and extrahepatic biliary strictures were detected in three PSCs and two oCCs. Peripheral hepatic hyperintensity on T2-weighted imaging was detected in two nCCs, two PSCs, and two oCCs.Conclusion
These results indicated that MR imaging of oCC showed findings of both PSC and nCC.18.
Jung Wook Seo Seong Hyun Kim Ah Yeong Kim Woo Kyoung Jeong Ji Young Woo Won Jeong Park 《Japanese journal of radiology》2017,35(11):655-663
Objectives
To assess the value of gadoxetic acid-enhanced and diffusion-weighted (DW) magnetic resonance (MR) imaging for differentiating primary hepatic angiosarcomas from hemangiomatosis and epithelioid hemangioendotheliomas (EHEs).Methods
We reviewed MR images of seven patients with pathologically determined hepatic angiosarcomas, 11 patients with hemangiomatosis, and five patients with EHEs. Two radiologists assessed morphologic features, signal intensity (SI), enhancement patterns, and the presence of diffusion restriction by consensus and compared between angiosarcoma vs hemangiomatosis and angiosarcoma vs EHEs.Results
Angiosarcomas more frequently showed mixed well- and ill-defined margins (6, 85.7%), mixed strong and intermediate-high SI (5, 71.4%) on T2-weighted images, mixed peripheral and/or central nodular and rim and/or target enhancement (5, 71.4%), and mixed presence and absence of diffusion restriction (7, 100%) compared with hemangiomatosis and EHEs (P < 0.05). The overall survival rate in patients with angiosarcomas was 42.9% at 3 months and 14.3% at 14 months, whereas all patients with EHEs were alive during the follow-up period from 4 to 43 months (P = 0.002).Conclusion
Gadoxetic acid-enhanced and DW MR imaging may help differentiate primary hepatic angiosarcomas with hemangioma-like appearance, EHE-like appearance, or both; and poor prognosis from hemangiomatosis and EHEs.19.
Sang Min Lee Jin Mo Goo Chang Min Park Soon Ho Yoon Jin Chul Paeng Gi Jeong Cheon Young Tae Kim Young Sik Park 《European radiology》2016,26(11):3850-3857
Objectives
To prospectively compare the accuracies of PET/MR and PET/CT in the preoperative staging of non-small cell lung cancer (NSCLC).Methods
Institutional review board approval and patients’ informed consents were obtained. 45 patients with proven or radiologically suspected lung cancer which appeared to be resectable on CT were enrolled. PET/MR was performed for the preoperative staging of NSCLC followed by PET/CT without contrast enhancement on the same day. Dedicated MR images including diffusion weighted images were obtained. Readers assessed PET/MR and PET/CT with contrast-enhanced CT. Accuracies of PET/MR and PET/CT for NSCLC staging were compared.Results
Primary tumour stages (n?=?40) were correctly diagnosed in 32 patients (80.0 %) on PET/MR and in 32 patients (80.0 %) on PET/CT (P?=?1.0). Node stages (n?=?42) were correctly determined in 24 patients (57.1 %) on PET/MR and in 22 patients (52.4 %) on PET/CT (P?=?0.683). Metastatic lesions in the brain, bone, liver, and pleura were detected in 6 patients (13.3 %). PET/MR missed one patient with pleural metastasis while PET/CT missed one patient with solitary brain metastasis and two patients with pleural metastases (P?=?0.480).Conclusions
This study demonstrated that PET/MR in combination with contrast-enhanced CT was comparable to PET/CT in the preoperative staging of NSCLC while reducing radiation exposure.Key points
? PET/MR can be comparable to PET/CT for preoperative NSCLC staging.? PET/MR and PET/CT show excellent correlation in measuring SUVmax of primary lesions.? Using PET/MR, estimated radiation dose can decrease by 31.1?% compared with PET/CT.20.
Mari?E.?Boesen Prasanna?Venkatesan?Eswaradass Dilip?Singh Alim?P.?Mitha Mayank?Goyal Richard?Frayne Bijoy?K.?Menon