Sonographic findings in patients with adenomyosis: can sonography assist in predicting extent of disease?

OBJECTIVE: We assessed whether specific sonographic characteristics are indicative of the extent of adenomyosis and whether fibroids alter this assessment. MATERIALS AND METHODS: Patients' records were evaluated for the diagnosis of adenomyosis determined by hysterectomy and for sonography performed within 2 months of surgery. Seventy-three sonograms were evaluated by sonologists without knowledge of the extent of adenomyosis. Sonographic categories included visualization of the endometrium, presence of a diffuse uterine process, presence of fibroids, and normal findings. Pathologic results included mild, focal, and severe adenomyosis. Histologic and sonographic categories were correlated using the chi-square and Fisher's exact tests. RESULTS: Forty-six specimens contained mild adenomyosis, 18 contained severe disease, and nine contained focal disease. Forty-one specimens contained fibroids. The endometrium was visualized in 10 cases of severe adenomyosis, seven cases of adenomyoma, and 35 cases of mild disease. Visualization of the endometrium did not relate to the severity of disease (p = 0.6). Of 18 cases of severe disease, 13 sonograms showed a diffuse process. Of nine cases of adenomyomas, no sonograms showed a diffuse process; and of 46 cases of mild disease, nine sonograms showed a diffuse process. A diffuse process was related to the severity of adenomyosis (p < 0.001). When fibroids were present, a diffuse process did not relate to the extent of adenomyosis (p = 0.01). CONCLUSION: In the absence of focal fibroids, a diffuse uterine process seen on sonography relates to the severity of adenomyosis. Fibroids limit the ability to diagnose the severity of adenomyosis. The visualization of the endometrium does not relate to the severity of adenomyosis.     

Pheochromocytomas and CT: can size predict malignancy?

OBJECTIVES: The purpose of this study was to determine clinical and imaging findings associated with malignancy in pheochromocytomas. MATERIAL: and methods. A multicentric retrospective CT study including 50 lesions (23 benign and 27 malignant histologically proven pheochromocytomas) was conducted. The diagnosis of malignancy was based on histological criteria (capsular rupture, local invasion), on synchronous metastases or on the occurrence of locoregional recurrences or metastases during the outcome. The analysis was based on clinical data (age, sex, secretion of the lesion and hypertension) and on radiological criteria (largest diameter of the tumor, side, homogeneity, regularity and sharpness of contours). RESULTS: A statistical difference was found between the median largest diameter, the regularity and sharpness of contours benign and malignant lesions (p<0.0001); other clinical and radiological criteria being non significantly different. A largest diameter greater than 45 mm enabled to suggest malignancy with a sensitivity of 100% and a specificity of 69%. CONCLUSION: A diameter larger than 50mm, presence of a locoregional invasion and of metastases are strong arguments favouring.     

Meningiomas with conventional MRI findings resembling intraaxial tumors: can perfusion-weighted MRI be helpful in differentiation?

Introduction To investigate the contribution of perfusion-weighted MRI to the differentiation of meningiomas with atypical conventional MRI findings from intraaxial tumors.Methods We retrospectively analyzed 54 meningiomas, 12 glioblastomas and 13 solitary metastases. We detected 6 meningiomas with atypical features on conventional MRI resembling intraaxial tumors. The regional cerebral blood flow (rCBV) ratios of all tumors were calculated via perfusion-weighted MRI. The signal intensity-time curves were plotted and three different curve patterns were observed. The type 1 curve resembled normal brain parenchyma or the postenhancement part was minimally below the baseline, the type 2 curve was similar to the type 1 curve but with the postenhancement part above the baseline, and the type 3 curve had the postenhancement part below the baseline accompanied by widening of the curve. Student’s t-test was used for statistical analysis.Results On CBV images meningiomas were hypervascular and the mean rCBV ratio was 10.58±2.00. For glioblastomas and metastatic lesions, the rCBV ratios were 5.02±1.40 and 4.68±1.54, respectively. There was a statistically significant difference in rCBV ratios between meningiomas and glioblastomas and metastases (P<0.001). Only one of the meningiomas displayed a type 2 curve while five showed a type 3 curve. Glioblastomas and metastases displayed either a type 1 or a type 2 curve. None of the meningiomas showed a type 1 curve and none of the glioblastomas or metastases showed a type 3 curve.Conclusion Differentiating meningiomas with atypical conventional MRI findings from malignant intraaxial tumors can be difficult. Calculation of rCBV ratios and construction of signal intensity-time curves may contribute to the differentiation of meningiomas from intraaxial tumors.     

Can CT predict the source of arterial hemorrhage in patients with pelvic fractures?

The objective of the study was to evaluate the ability of hemorrhage site and location as demonstrated on pelvic CT to predict the source of arterial hemorrhage in patients with traumatic pelvic fractures. CT scans of 104 consecutive patients who had sustained traumatic pelvic fracture and undergone emergent pelvic angiography were digitized, and fracture-related hemorrhage area and volume were measured at multiple locations within the pelvis. Clots that measured greater than 10 cm² were compared to angiographic results. The χ² test was used to find locations on CT that were significantly associated with specific arterial injuries found on angiography. Sixty-one (58%) of the patients had arterial bleeding at angiography. The most commonly injured arteries were the internal pudendal and the superior gluteal. Specific locations on CT were statistically significant indicators of injury to the superior gluteal artery (relative risk=2.9, 95% CI 1.2–7.3, P=0.013), the anterior division of the internal iliac artery (relative risk=3.2, 95% CI 1.4–4.1, P=0.006), and the internal pudendal arteries (relative risk=2.0, 95% CI 1.1–4.0, P=0.037). More blood was visible on CT when an artery was injured (mean volume with negative angiogram=318 ml, mean volume with positive angiogram=554 ml, (P=0.007)). The rectus sheath region at the top of the iliac crest (P=0.004), pelvic sidewalls at the L5–S1 disk space level (P=0.001), and gluteal regions also at the L5–S1 disk space level (P=0.012) were significant indicators of a positive arteriogram. CT can help predict the specific bleeding artery to potentially guide angiographic intervention. Electronic Publication     

PET and PET–CT imaging findings of peritoneal and omental involvement in patients with lymphoma

A retrospective institutional-review-board-approved study was performed evaluating positron emission tomography (PET)–computed tomography (CT) imaging findings of peritoneal and omental involvement of lymphoma. Twelve patients were identified with a wide spectrum of imaging findings on PET–CT including but not limited to peritoneal thickening, ascites, and serosal involvement. Lymphoma is among the rare causes of malignant peritoneal or omental involvement. The most common manifestations of peritoneal lymphomatosis are peritoneal 2-[fluorine 18] fluoro-2-deoxy-d-glucose uptake with corresponding peritoneal thickening and nonobstructive serosal masses on CT.     

Acute left colonic diverticulitis: can CT findings be used to predict recurrence?

OBJECTIVE: We explored CT and demographic predictors for unfavorable outcome of nonoperative treatment in patients with a first event of left colonic diverticulitis. MATERIALS AND METHODS: We retrospectively analyzed the medical files and CT scans of 312 consecutive patients who were diagnosed as having diverticulitis on an admission CT report or who had a final diagnosis of left colonic diverticulitis. Patients who did not undergo nonoperative treatment or were lost to follow-up (n = 144) were excluded from the study. Admission CT scans of 168 consecutive patients with a diagnosis of left colonic diverticulitis who underwent nonoperative treatment and had an 18-month follow-up were reassessed by three radiologists unaware of the clinical findings. Nonoperative treatment was defined as an attempt to treat the patient with only antibiotics without scheduling them for elective (delayed) surgery. Unfavorable outcome was defined as a failure of nonoperative treatment 18 months after admission that required either surgery or rehospitalization for antibiotic treatment. The risk of unfavorable outcome was modeled using logistic regression as a function of sex, age, and CT criteria including the maximum number of diverticula per 10 cm of colon; the presence of intraabdominal abscess or extraintestinal gas bubbles (< 5 mm diameter) or gas pockets (>or=5 mm); the length and location of the abnormal colonic segment; the maximum thickness of the colonic wall; the presence of associated free intraperitoneal fluid; and the extent of fatty infiltration. RESULTS: Among these 168 patients, 115 (68%) had an uneventful outcome, but nonoperative treatment failed in 53 (32%). The presence of an abscess (n = 19) or extraintestinal gas pocket (n = 14) were the only CT findings significantly associated with failure of nonoperative treatment. Adjusted odds ratios (95% confidence interval) for failure were 6.18 (1.76-21.68) when an abscess was diagnosed and 4.26 (1.04-17.57) when pockets of free air were observed. Sex and age were not significantly associated with unfavorable outcome of nonoperative treatment. CONCLUSION: Abscess and pockets of extraintestinal gas 5 mm in diameter or larger correlated with unfavorable outcome of nonoperative treatment. None of the other criteria evaluated were predictive of failure of nonoperative treatment, including bubbles of extraintestinal gas smaller than 5 mm in diameter.     

Comparison of non-sedated brain MRI and CT for the detection of acute traumatic injury in children 6 years of age or less

CT is considered the first-line study for acute intracranial injury in children because of its availability, detection of acute hemorrhage, and lack of sedation. An MRI study with rapidly acquired sequences can obviate the need for sedation and radiation. We compared the detection rate of rapid non-sedated brain MRI to CT for traumatic head injury in young children. We reviewed a series of children 6 years of age or less who presented to our ED during a 5-year period with head trauma and received a non-sedated brain MRI and CT within 24 h of injury. Most MRI studies were limited to triplane T2 and susceptibility sequences. Two neuroradiologists reviewed the MRIs and CTs and assessed the following findings: fracture, epidural hematoma (EDH)/subdural hematoma (SDH), subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), and parenchymal injury. Thirty of 33 patients had radiologically identified traumatic injuries. There was an overall agreement of 82 % between the two modalities. Skull fracture was the only injury subtype which had a statistically significant difference in detection between CT and MRI (p?=?0.0001), with MRI missing 14 of 21 fractures detected on CT. While not statistically significant, MRI had a higher detection rate of EDH/SDH (p?=?0.34), SAH (p?=?0.07), and parenchymal injuries (p?=?0.50). Non-sedated MRI has similar detection rates to CT for intracranial injury in young children presenting with acute head trauma and may be an alternative to CT in select patients.     

Stable or unstable tear of the anterior cruciate ligament of the knee: an MR diagnosis?

Purpose  

To determine the usefulness of magnetic resonance (MR) imaging to distinguish stable from unstable tears of the anterior cruciate ligament (ACL) of the knee.     

Pseudomembranous colitis: can CT predict which patients will need surgical intervention?

PURPOSE: Our purpose was to determine if patients with pseudomembranous colitis (PMC) requiring surgical intervention demonstrate radiographic features distinct from those of patients treated successfully with standard medical therapy. METHOD: The indications for a CT study and the imaging findings from 17 patients who required laparotomy with colon resection for PMC were retrospectively reviewed. The CT findings were compared with the findings from 17 control patients (matched by clinical presentation) with PMC who were treated medically and did not require surgical intervention. RESULTS: None of the CT findings evaluated in this study were significantly different between the surgical and nonsurgical groups. The CT findings evaluated for the surgical and nonsurgical groups, respectively, were as follows: wall thickness of the colon: 17.8+/-6.6 and 16.9+/-3.9 mm; largest caliber of the colon: 6.8+/-1.6 and 6.1+/-1.2 cm; presence of the accordion sign: 52.9 and 70.6%; heterogeneous contrast enhancement pattern (target sign): 57.1 and 57.1%; pericolonic stranding: 82.4 and 88.2%; ascites: 70.6 and 58.8%; pleural effusion(s): 64.7 and 64.7%; and subcutaneous edema: 64.7 and 64.7%. CONCLUSION: Although none of the CT findings evaluated in this study was significantly different between the surgical and nonsurgical groups, CT was often the initial diagnostic modality in both groups. It is important for radiologists to recognize the CT appearance of PMC and suggest the diagnosis. However, patient triage may not be based solely on the CT findings.     

Blunt bowel and mesenteric trauma: role of clinical signs along with CT findings in patients’ management

Background

Bowel and/or mesentery injuries represent the third most common injury among patients with blunt abdominal trauma. Delayed diagnosis increases morbidity and mortality. The aim of our study was to evaluate the role of clinical signs along with CT findings as predictors of early surgical repair.

Material and methods

Between March 2014 and February 2017, charts and CT scans of consecutive patients treated for blunt abdominal trauma in two different trauma centers were reread by two experienced radiologists. We included all adult patients who underwent contrast-enhanced CT of the abdomen and pelvis with CT findings of blunt bowel and/or mesenteric injury (BBMI). We divided CT findings into two groups: the first included three highly specific CT signs and the second included six less specific CT signs indicated as “minor CT findings.” The presence of abdominal guarding and/or abdominal pain was considered as “clinical signs.” Reference standards included surgically proven BBMI and clinical follow-up. Association was evaluated by the chi-square test. A logistic regression model was used to estimate odds ratio (OR) and confidence intervals (CI).

Results

Thirty-four (4.1%) out of 831 patients who sustained blunt abdominal trauma had BBMI at CT. Twenty-one out of thirty-four patients (61.8%) underwent surgical repair; the remaining 13 were treated conservatively. Free fluid had a significant statistical association with surgery (p?=?0.0044). The presence of three or more minor CT findings was statistically associated with surgery (OR?=?8.1; 95% CI, 1.2–53.7). Abdominal guarding along with bowel wall discontinuity and extraluminal air had the highest positive predictive value (100 and 83.3%, respectively).

Conclusion

In patients without solid organ injury (SOI), the presence of free fluid along with abdominal guarding and three or more “minor CT findings” is a significant predictor of early surgical repair. The association of bowel wall discontinuity with extraluminal air warrants exploratory laparotomy.

     

FDG PET or PET/CT in patients with pancreatic cancer: when does it add to diagnostic CT or MRI?

ObjectiveAssess the impact of FDG-PET or PET/CT (PI) on pancreatic cancer management when added to CT or MRI (CDI).Materials and MethodsForty-nine patients underwent 79 PI exams. Discordant findings on PI and CDI were assessed for clinical impact.ResultsFifteen of 79 PI-CDI pairs were discordant. Ten of 79 PI favorably and 5 of 79 unfavorably altered management. PI favorably altered management more often when ordered for therapy monitoring compared to staging [risk ratio 13.00 (95% CI 1.77–95.30)] or restaging [risk ratio 18.5 (95% CI 2.50–137.22)].ConclusionPI favorably alters management more often when used for therapy monitoring compared to staging or restaging.     

MRI of the liver and the pituitary gland in patients with beta-thalassemia major: does hepatic siderosis predict pituitary iron deposition?

Our objective was to study, in thalassemic patients, if hepatic siderosis evaluated by MRI could predict the pituitary iron overload. In 36 thalassemic patients (age range 6–44 years, mean age 21.7 years) the liver/fat ratio (L/F), the pituitary/fat ratio (P/F), the liver and pituitary T2 relaxation times were evaluated, by using a multiecho spin-echo sequence. Serum ferritin levels were measured and an extensive endocrine evaluation was performed. The L/F, the P/F and pituitary T2 showed a good correlation with serum ferritin (r=–0.55, r=–0.55 and r=–0.53, respectively; p<0.01). Liver T2 did not show significant correlation with serum ferritin. The variability of L/F explained only the 10.8% of the variability of pituitary T2 and of the P/F. When ferritin was added to the model it predicted only the 26.85% and the 30.8% of the variability of pituitary T2 and of the P/F, respectively. The P/F and pituitary T2 were lower in patients with hypogonadotropic hypogonadism (group 1) compared with those without pituitary dysfunction (group 2). No significant differences of L/F were found between the two groups. Hepatic iron overload evaluated by MR is a poor predictor of pituitary siderosis. The MR studies of the pituitary gland might be necessary to evaluate the pituitary iron overload. Electronic Publication     

Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal?

PURPOSE: To retrospectively determine what information, if any, magnetic resonance (MR) imaging of the cervical spine in obtunded and/or "unreliable" patients with blunt trauma adds to multi-detector row computed tomography (CT) of the entire cervical spine (including routine multiplanar sagittal and coronal reformations) when the CT findings are normal. MATERIALS AND METHODS: The study was HIPAA compliant and institutional review board approved. Informed consent was not required. From April 2001 to November 2003, 1400 trauma patients underwent MR imaging of the cervical spine to evaluate potential cervical spine injuries. Multi-detector row CT of the cervical spine was performed with a four- or 16-detector row scanner. MR imaging of the cervical spine was performed with transverse gradient-echo, sagittal intermediate-weighted, sagittal short inversion time inversion-recovery, and sagittal T1- and T2-weighted fast spin-echo sequences. Many MR examinations were performed to exclude soft-tissue injuries in the cervical spine of obtunded patients with blunt trauma in whom cervical spine injury could not be excluded with physical examination. Complete cervical spine MR studies were obtained to evaluate soft-tissue injuries in 366 obtunded patients with blunt trauma (281 male and 85 female patients; age range, 13-92 years; mean age, 42.1 years). The patients had previously undergone total cervical spine multi-detector row CT with normal findings. The results obtained with these two modalities were compared. RESULTS: MR images were negative for acute injury in 354 of the 366 patients and negative for cervical spine ligamentous injury in 362. Seven of the 366 patients had cervical cord contusions, four patients had ligamentous injuries, three patients had intervertebral disk edema, and one patient had a cord contusion, a ligamentous injury, and an intervertebral disk injury. Four patients had ligamentous injuries; however, all of these patients had ligament injuries limited to only one of the three columns of cervical spine ligament support. Multi-detector row CT had negative predictive values of 98.9% (362 of 366 patients) for ligament injury and 100% (366 of 366 patients) for unstable cervical spine injury. CONCLUSION: A normal multi-detector row CT scan of the total cervical spine in obtunded and/or "unreliable" patients with blunt trauma enabled the authors to exclude unstable injuries on the basis of findings at follow-up cervical spine MR imaging.     

Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear?

OBJECTIVE: The meniscus is considered "extruded" when it extends beyond the tibial margin. We hypothesize that severe degeneration, large radial tears, complex tears, and tears involving the meniscal root would alter meniscal stability and cause more substantial extrusion. MATERIALS AND METHODS: The knee MRI database at Thomas Jefferson University Hospital was searched for reports describing meniscal extrusion; MR images were reviewed retrospectively. On mid coronal images, extrusion of the medial meniscus was quantified in millimeters. A separate, independent review of the meniscus evaluated degeneration severity and tear (type and extent). Radial tears were divided into those involving more (large) or less (small) than 50% of the meniscal width. Tears that involved the "root" at the tibial spine were recorded. Chi-square analysis compared these findings with extrusion extent, divided into minor ( 3 mm) extrusion. RESULTS: One hundred five knees were reviewed (12 men and 93 women; age range, 34-83 years; mean age, 56 years). Distribution of medial meniscus extrusion was 2 mm (n = 17), 3 mm (n = 17), 4 mm (n = 27), 5 mm (n = 14), 6 mm (n = 16), and 7-10 mm (n = 14). Mild, moderate, or marked degeneration was seen in 47%, 26%, and 27% with minor extrusion, respectively, and in 17%, 41%, and 42% with major extrusion, respectively (p = 0.003). Tears were seen in 59% (20/34) with minor extrusion versus 89% (63/71) with major extrusion (p = 0.001). Tears involved one third, two thirds, or all of the meniscus in 75%, 25%, or 0%, respectively, with minor extrusion and 46%, 40%, or 14% with major extrusion, respectively (p = 0.014). Longitudinal (nonradial) and horizontal tears were not associated with extent of extrusion (p = 1.0). Oblique tears were significantly associated with minor extrusion (minor, 26% [9/34]; major, 4% [3/71]; p = 0.003). Radial tears were seen in 9% (3/34) with minor extrusion versus 21% (15/71) with major extrusion (p = 0.20). All three radial tears with minor extrusion were small; conversely, 87% (13/15) of radial tears with major extrusion were large (p = 0.019). Complex tears were seen in 18% (6/34) with minor extrusion versus 59% (42/71) with major extrusion (p < 0.001). Tears involving the meniscal root were seen in 3% (1/34) with minor extrusion and 42% (30/71) with major extrusion (p < 0.001). CONCLUSION: Substantial medial meniscus extrusion (> 3 mm) is associated with severe meniscal degeneration, extensive tear, complex tear, large radial tear, and tear involving the meniscal root.     

Clinical outcomes of medial patellofemoral ligament reconstruction in patients with an increased tibial tuberosity–trochlear groove distance

Purpose

Medial patellofemoral ligament (MPFL) reconstruction is performed to treat recurrent patellar dislocation (RPD). However, the effectiveness of MPFL reconstruction in patients with a severely lateralised tibial tuberosity remains unknown. In this study, the clinical outcomes of MPFL reconstruction in patients with an increased tibial tuberosity–trochlear groove (TT–TG) distance were examined.

Methods

A total of thirty-four patients who underwent MPFL reconstruction for RPD were retrospectively examined. Nineteen patients with a TT–TG distance of >20 mm (increased TT–TG distance group) were compared with 15 patients with a TT–TG distance of <20 mm (control group). Clinical outcomes of MPFL reconstruction were evaluated by occurrence of re-dislocation, Crosby and Insall grading system, apprehension sign, and Kujala and Lysholm scores.

Results

None of the patients reported re-dislocation. Apprehension sign remained in three patients in the increased TT–TG distance group and in one patient in the control group. According to the Crosby and Insall grading system, 9 patients (47 %) were excellent, 9 (47 %) were good, and 1 (5 %) was fair to poor in the increased TT–TG distance group, while 6 (40 %) were excellent and 9 (60 %) were good in the control group. Kujala and Lysholm scores were significantly improved post-operatively in both groups. No significant correlations were observed between TT–TG distance and post-operative Kujala or Lysholm score.

Conclusion

Overall clinical outcomes of MPFL reconstruction were favourable even in patients with an increased TT–TG distance. TT–TG distance of >20 mm may not be an absolute indication for medialisation of the tibial tuberosity when performing MPFL reconstruction.

Level of evidence

Case–control study, Level III.     

Bronchiolitis obliterans syndrome in lung transplant recipients: can thin-section CT findings predict disease before its clinical appearance?

PURPOSE: To determine whether there are thin-section computed tomographic (CT) features that predict bronchiolitis obliterans syndrome (BOS) in lung transplant recipients before the clinical appearance and during the early stages of the disease. MATERIALS AND METHODS: Two hundred ninety-eight thin-section CT scans obtained in 26 lung transplant recipients who did (study group) and 26 lung transplant recipients who did not (control group) develop BOS were reviewed for the presence of mosaic perfusion, bronchiectasis, bronchial wall thickening, and air trapping. BOS was defined by using the recently revised definition of the International Society for Heart and Lung Transplantation. CT scans obtained in the BOS group were divided into three groups: Group A consisted of the last scans obtained before the clinical appearance of BOS; groups B and C consisted of, respectively, the first and last scans obtained after the clinical appearance of BOS. Scans obtained in the control group were acquired during similar posttransplantation periods and matched to scans in each BOS group. Sensitivity, specificity, and positive and negative predictive values were calculated separately for each subgroup. The optimal threshold for each thin-section CT-depicted abnormality was defined by using receiver operating characteristics analysis. RESULTS: The sensitivities of air trapping for the diagnosis of BOS during the periods in which the scans in groups A, B, and C were obtained were 50%, 44%, and 64%, respectively; specificities were 80%, 100%, and 80% respectively. Sensitivities of mosaic perfusion were 4%, 20%, and 36%, respectively; specificities were 100%, 96%, and 96%, respectively. Sensitivities of bronchiectasis were 25%, 24%, and 32%, respectively; specificities were 80%, 80%, and 96%, respectively. Sensitivities of bronchial wall thickening were 4%, 24%, and 40%, respectively; specificities were 96%, 84%, and 80%, respectively. Air trapping was seen intermittently in nine (43%) of 21 patients with CT scans that depicted this finding at least once. CONCLUSION: The value of the finding of air trapping before the clinical appearance and during the early stages of BOS is lower than has been previously reported. When using the recently revised criteria for BOS, the role of thin-section CT as a screening test to evaluate patients with lung transplants appears to be limited.     

Can functional parameters from hepatobiliary phase of gadoxetate MRI predict clinical outcomes in patients with cirrhosis?

Objectives

To determine the value of quantitative parameters of gadoxetate-enhanced magnetic resonance imaging (MRI) in predicting prognosis in patients with cirrhosis.

Methods

A cohort of 63 cirrhotic patients who had gadoxetate MRI and 2-year clinical follow-up was enrolled. Enhancement ratio (ER), contrast enhancement index (CEI) and contrast enhancement spleen index (CES) were calculated. The usefulness of these parameters and clinical scores, such as Child-Pugh score (CPS) and model for end stage liver disease (MELD), in predicting adverse outcomes, such as variceal bleeding (VB), hepatic encephalopathy (HE) and mortality at 2 years were evaluated.

Results

Fifteen, 31 and 27 patients, respectively, had VB, HE and mortality within 2 years. The ER at 15 min (ER 15) and CES at 20 min (CES 20) were found to be the best MRI predictors. Areas under the receiver operating characteristic curve (AUC) for predicting VB were 0.785, 0.729, 0.673, 0.714, respectively, for ER 15, CES 20, CPS and MELD scores. ER 15 of less than 48 had sensitivity of 96% and specificity of 84% for predicting onset of HE within 2 years.

Conclusions

In patients with cirrhosis, ER 15 or CES 20 were equivalent or better predictors of major morbidity and mortality compared with commonly used clinical scores.

Key Points

? Gadoxetate parameters may identify cirrhotic patients at risk of adverse events. ? Gadoxetate parameters usually show superior predictive values compared to clinical scores. ? CES 20 score is associated with risk of mortality within 2 years.