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1.
Avneesh Chhabra Allan J Belzberg Gedge D Rosson Gaurav K Thawait M Chalian Sahar J Farahani Jaimie T Shores Gene Deune Shar Hashemi Shrey K Thawait Ty K Subhawong John A Carrino 《European radiology》2016,26(5):1235-1244
Objective
To evaluate the impact of magnetic resonance neurography (MRN) on diagnostic thinking and therapeutic choices in patients with suspected peripheral neuropathy.Methods
IRB approval was obtained for this HIPAA-compliant study. Questionnaires were administered to six surgeons regarding the diagnosis and treatment in 85 patients suspected of having peripheral neuropathy, before (pretest) and after (posttest) MRN. Multiple outcome measures related to diagnostic confidence and surgical decision-making were assessed.Results
The final cohort included 81 patients (30 men and 51 women, age 47?±?17 years). The following changes were observed from pretest to posttest questionnaires: 23 % in nerve involvement (P?<?0.05), 48 % in degree of confidence of nerve involvement (P?<?0.01), 27 % in grade of injury (P?<?0.05), 33 % in differential diagnosis (P?<?0.05), 63 % in degree of confidence in need for surgery (P?<?0.001), 41 % in timing of surgery (P?<?0.01), 30 % in approach to surgery (P?<?0.05), 58 % in degree of confidence in approach to surgery (P?<?0.001), 30 % in estimated length of surgery (P?<?0.05) and 27 % in length of incision (P?<?0.05). The dichotomous decision regarding surgical or nonsurgical treatment changed from pro to con in 17 %.Conclusion
MRN results significantly influenced the diagnostic thinking and therapeutic recommendations of peripheral nerve surgeons.Key Points
? In patients with peripheral neuropathy, MRN significantly impacts diagnostic thinking. ? In patients with peripheral neuropathy, MRN significantly impacts therapeutic choices. ? 3-T MRN should be considered in presurgical planning of patients with peripheral neuropathy.2.
Objectives
To prospectively evaluate the effect of hyoscine butylbromide (HBB) on visualisation of anatomical details and motion-related artefacts in mp-MRI of the prostate at 3.0 Tesla.Methods
One hundred and three consecutive patients (65?±?10 years) were included in this trial, powered to demonstrate an improvement of image quality after HBB administration, assessed on a 5-point scale by two blinded readers. All patients received high-spatial resolution axial T2-weighted TSE sequences at 3.0 T without spasmolytic agent, repeated after application of 40 mg HBB and followed by routine mp-MRI. Secondary endpoints were (1) susceptibility to side effects, (2) dependence of spasmolytic effect on patients´ weight, and (3) prostate volume.Results
In 68% of patients, HBB significantly improved the anatomic score (mean 3.4?±?0.9 before and 4.4?±?0.7 after HBB for both readers, p?=?<0.001). In 67%, HBB significantly enhanced the artefact score (mean 3.2?±?1 before and 4.2?±?0.8 after HBB for reader 1, p?=?<0.001; 3.2?±?1 and 4.1?±?0.8 for reader 2, p?=?<0.001). Subgroup analysis revealed no statistically significant difference between patients with different bodyweight or prostate volume. Inter-reader agreement was excellent (k?=?0.95–0.98).Conclusions
Hyoscine butylbromide significantly improves image quality and reduces motion-related artefacts in mp-MRI of the prostate independent of bodyweight or prostate volume. No side effects were reported.Key Points
? Hyoscine butylbromide (HBB) improved image quality in over 2/3 of patients. ? Severe artefacts were reduced after HBB in more than 20%. ? The number of non-diagnostic MRI was reduced to <1% after HBB. ? HBB effect was independent of bodyweight and prostate volume. ? No side effects of HBB were reported in this study population.3.
Objective
To evaluate the usefulness of 3D nerve-sheath signal increased with inked rest-tissue rapid acquisition of relaxation enhancement imaging (SHINKEI) in patients with chronic inflammatory demyelinating polyneuropathy (CIDP).Methods
This institutional review board-approved retrospective study included 14 CIDP patients and nine normal subjects. The signal-to-noise ratio (SNR), contrast ratio (CR), and the size of the cervical ganglions and roots were measured by two raters.Results
The SNRs of the ganglions and roots were larger in patients with CIDP (9.55?±?3.87 and 9.81?±?3.64) than in normal subjects (7.21?±?2.42 and 5.70?±?2.14, P?<?0.0001, respectively). The CRs of the ganglions and roots were larger in patients with CIDP (0.77?±?0.08 and 0.68?±?0.12) than in normal subjects (0.72?±?0.07 and 0.53?±?0.11, P?<?0.0001, respectively). The sizes of the ganglions and the roots were larger in patients with CIDP (6.44?±?1.61 mm and 4.89?±?1.94 mm) than in normal subjects (5.24?±?1.02 mm and 3.39?±?0.80 mm, P?<?0.0001, respectively).Conclusions
Patients with CIDP could be distinguished from controls on 3D SHINKEI.Key points
? 3D SHINKEI could visualize brachial plexus with high spatial resolution.? CIDP patients showed increased SNR, CR, and the size of brachial plexus.? 3D SHINKEI could discriminate CIDP patients from normal subjects.4.
Objective
To estimate the diagnostic accuracy of signal intensity of the lesion-to-spinal cord ratio (LSR) and apparent diffusion coefficient (ADC) in diffusion-weighted (DW) magnetic resonance imaging of pulmonary nodules suspicious for lung cancer in granulomatous lung disease-endemic regions.Methods
Forty-nine patients with indeterminate solitary pulmonary nodules detected by chest computed tomography and histopathologically confirmed diagnoses were included in the study. DW images were analysed semiquantitatively by focusing regions of interest on the lesion and spinal cord at the same level (for LSR calculation). ADCs were estimated from ratios of the two image signal intensities. Ratios of T1 and T2 signal intensity between nodules and muscle were calculated for comparison.Results
Mean ADCs?±?standard deviations for lung cancer and benign lesions were 0.9?±?0.2 and 1.3?±?0.2?×?10-3 mm2/s, respectively. Mean LSRs were 1.4?±?0.3 for lung cancer and 1?±?0.1 for benign lesions. ADCs and LSRs differed significantly between malignant and benign lesions (P?<?0.001). Mean T2 signal intensity ratios also differed significantly between benign and malignant lesions (0.8?±?0.2 vs. 1.6?±?0.2; P?<?0.05).Conclusions
DWI can help to differentiate malignant from benign lesions according to ADC and the LSR with good accuracy.Key Points
? DW imaging can help differentiate malignant from benign pulmonary nodules. ? ADC and LSR signal intensities had only small overlap between malignant and benign pulmonary nodules. ? Mean T2 signal intensity ratios differed significantly between benign and malignant lesions.5.
Objectives
In this study, we aimed to determine whether iterative model reconstruction designed for brain CT (IMR-neuro) would improve the accuracy of posterior fossa stroke diagnosis on brain CT.Methods
We enrolled 37 patients with ischaemic stroke in the posterior fossa and 37 patients without stroke (controls). Using axial images reconstructed using filtered back-projection (FBP) and IMR-neuro, we compared the CT numbers in infarcted areas, image noise in the pons, and contrast-to-noise ratios (CNRs) of infarcted and non-infarcted areas on scans subjected to IMR-neuro and FBP. To analyse the performance of hypo-attenuation detection, we used receiver-operating characteristic (ROC) curve techniques.Results
The image noise was significantly lower (2.2?±?0.5 vs. 5.1?±?0.9 Hounsfield units, p?<?0.01) and the difference in CNR between the infarcted and non-infarcted areas was significantly higher with IMR-neuro than with FBP (2.2?±?1.7 vs. 4.0?±?3.6, p?<?0.01). Furthermore, the average area under the ROC curve was significantly higher with IMR-neuro (0.90 vs. 0.86 for FBP, p?=?0.04).Conclusion
IMR-neuro yielded better image quality and improved hypo-attenuation detection in patients with ischaemic stroke.Key points
? Iterative model reconstruction of brain CT data can facilitate the diagnosis of ischaemic stroke.? IMR improved the detectability of low-contrast lesions in the posterior fossa.? IMR-neuro yielded better image quality and improved observer performance.6.
Objectives
We evaluated the effect of a single-energy metal artefact reduction (SEMAR) algorithm for metallic coil artefact reduction in body imaging.Methods
Computed tomography angiography (CTA) was performed in 30 patients with metallic coils (10 men, 20 women; mean age, 67.9?±?11 years). Non-SEMAR images were reconstructed with iterative reconstruction alone, and SEMAR images were reconstructed with the iterative reconstruction plus SEMAR algorithms. We compared image noise around metallic coils and the maximum diameters of artefacts from coils between the non-SEMAR and SEMAR images. Two radiologists visually evaluated the metallic coil artefacts utilizing a four-point scale: 1 = extensive; 2 = strong; 3 = mild; 4 = minimal artefacts.Results
The image noise and maximum diameters of the artefacts of the SEMAR images were significantly lower than those of the non-SEMAR images (65.1?±?33.0 HU vs. 29.7?±?10.3 HU; 163.9?±?54.8 mm vs. 10.3?±?19.0 mm, respectively; P?<?0.001). Better visual scores were obtained with the SEMAR technique (3.4?±?0.6 vs. 1.0?±?0.0, P?<?0.001).Conclusions
The SEMAR algorithm significantly reduced artefacts caused by metallic coils compared with the non-SEMAR algorithm. This technique can potentially increase CT performance for the evaluation of post-coil embolization complications.Key Points
? The new algorithm involves a raw data- and image-based reconstruction technique. ? The new algorithm mitigates artefacts from metallic coils on body CT images. ? The new algorithm significantly reduced artefacts caused by metallic coils. ? The metal artefact reduction algorithm improves CT image quality after coil embolization.7.
Ewelina?Kluza Jean-Paul?J.?E.?Kleijnen Milou?H.?Martens Dorit?Rennspiess Monique?Maas Cécile?R.?L.?P.?N.?Jeukens Robert?G.?Riedl Axel?zur?Hausen Geerard?L.?Beets Regina?G.?H.?Beets-Tan
Objectives
To evaluate the MRI macroscopic and microscopic parameters of mesorectal vasculature in rectal cancer patients.Methods
Thirteen patients with rectal adenocarcinoma underwent a dynamic contrast-enhanced MRI at 1.5 T using a blood pool agent at the primary staging. Mesorectal macrovascular features, i.e., the number of vascular branches, average diameter and length, were assessed from baseline-subtracted post-contrast images by two independent readers. Mesorectal microvascular function was investigated by means of area under the enhancement-time curve (AUC). Histopathology served as reference standard of the tumour response to CRT.Results
The average vessel branching in the mesorectum around the tumour and normal rectal wall was 8.2?±?3.8 and 1.7?±?1.3, respectively (reader1: p?=?0.001, reader2: p?=?0.002). Similarly, the tumour-surrounding mesorectum displayed circa tenfold elevated AUC (p?=?0.01). Interestingly, patients with primary node involvement had a twofold higher number of macrovascular branches compared to those with healthy nodes (reader1: p?=?0.005 and reader2: p?=?0.03). A similar difference was observed between good and poor responders to CRT, whose tumour-surrounding mesorectum displayed 10.7?±?3.4 and 5.6?±?1.5 vessels, respectively (reader1/reader2: p?=?0.02).Conclusions
We showed at baseline MRI of rectal tumours a significantly enhanced macrovascular structure and microvascular function in rectal tumour-surrounding mesorectum, and the association of primary mesorectal macrovascular parameters with node involvement and therapy response.Key Points
? Vascular MRI reveals macrovascular and microvascular abnormalities in the rectal tumour-surrounding mesorectum. ? Formation of highly vascular stroma precedes the actual tumour invasion. ? High macrovascular parameters are associated with node involvement. ? Mesorectal vascular network differs for good and poor responders.8.
Athina C. Tsili Alexandra Ntorkou Dimitrios Baltogiannis Anastasios Sylakos Sotirios Stavrou Loukas G. Astrakas Vasilios Maliakas Nikolaos Sofikitis Maria I. Argyropoulou 《European radiology》2016,26(3):613-621
Objectives
The aim was to determine the magnetization transfer ratio (MTR) of normal testes, possible variations with age and to assess the feasibility of MTR in characterizing various testicular lesions.Methods
Eighty-six men were included. A three-dimensional gradient-echo MT sequence was performed, with/without an on-resonance binomial prepulse. MTR was calculated as: (SIo-SIm)/(SIo)?×?100 %, where SIm and SIo refers to signal intensities with and without the saturation pulse, respectively. Subjects were classified as: group 1, 20-39 years; group 2, 40-65 years; and group 3, older than 65 years of age. Analysis of variance (ANOVA) followed by the least significant difference test was used to assess variations of MTR with age. Comparison between the MTR of normal testis, malignant and benign testicular lesions was performed using independent-samples t testing.Results
ANOVA revealed differences of MTR between age groups (F?=?7.51, P?=?0.001). Significant differences between groups 1, 2 (P?=?0.011) and 1, 3 (P?<?0.001) were found, but not between 2, 3 (P?=?0.082). The MTR (in percent) of testicular carcinomas was 55.0?±?3.2, significantly higher than that of benign lesions (50.3?±?4.0, P?=?0.02) and of normal testes (47.4?±?2.2, P?<?0.001).Conclusions
MTR of normal testes decreases with age. MTR might be helpful in the diagnostic work-up of testicular lesions.Key Points
? MTR of normal testes shows age-related changes. ? Testicular carcinomas have high MTR values. ? MTR may be useful in the diagnostic work-up of testicular lesions.9.
Brian Cox John R. Zuniga Neeraj Panchal Jonathan Cheng Avneesh Chhabra 《European radiology》2016,26(10):3392-3400
Objective
This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies.Materials and methods
Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed.Results
Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases.Conclusion
MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings.Key Points
? MRN substantially impacts diagnostic thinking and management in peripheral trigeminal neuropathy. ? MRN has moderate-to-excellent correlation with intra-operative findings. ? MRN should be considered in pre-surgical planning of peripheral trigeminal neuropathy subjects.10.
Kun Sun Weimin Chai Caixia Fu Ying Zhan Kunwei Shen Xianfu Luo Fuhua Yan 《European radiology》2016,26(6):1565-1574
Purpose
To investigate the feasibility and effectiveness of diffusion-weighted imaging (DWI)-guided magnetic resonance spectroscopy (MRS) using readout-segmented echo-planar imaging (RS-EPI) to characterise breast lesions.Materials and methods
A total of 258 patients with 258 suspicious breast lesions larger than 1 cm in diameter were examined using DWI-guided, single-voxel MRS with RS-EPI. The mean total choline-containing compound (tCho) signal-to-noise ratio (SNR) and concentration were used for the interpretation of MRS data. T-tests, χ2-tests, receiver operating characteristic (ROC) curve analyses and Pearson correlations were conducted for statistical analysis.Results
Histologically, 183 lesions were malignant, and 75 lesions were benign. Both the mean tCho SNR and concentration of malignant lesions were higher than those of benign lesions (6.23?±?3.30 AU/mL vs. 1.26?±?1.75 AU/mL and 3.17?±?2.03 mmol/kg vs. 0.86?±?0.83 mmol/kg, respectively; P?<?0.0001). For a tCho SNR of 2.0 AU/mL and a concentration of 1.76 mmol/kg, the corresponding areas under the ROC curves were 0.93 and 0.90, respectively. The mean tCho SNR and concentration negatively correlated with apparent diffusion coefficients calculated from RS-EPI, with correlation coefficients of ?0.54 and ?0.48, respectively.Conclusion
DWI-guided MRS using RS-EPI is feasible and accurate for characterising breast lesions.Key Points
? The mean tCho SNR and concentration negatively correlated with ADCs.? DWI-guided MRS using RS-EPI is feasible.? DWI-guided MRS using RS-EPI accurately characterises breast lesions.11.
Objectives
To analyze alterations in left ventricular (LV) myocardial T1 times in patients with pulmonary hypertension (PH) and to investigate their associations with ventricular function, mass, geometry and hemodynamics.Methods
Fifty-eight patients with suspected PH underwent right heart catheterization (RHC) and 3T cardiac magnetic resonance imaging. Ventricular function, geometry and mass were derived from cine real-time short-axis images. Myocardial T1 maps were acquired by a prototype modified Look-Locker inversion-recovery sequence in short-axis orientations. LV global, segmental and ventricular insertion point (VIP) T1 times were evaluated manually and corrected for blood T1.Results
Septal, lateral, global and VIP T1 times were significantly higher in PH than in non-PH subjects (septal, 1249?±?58 ms vs. 1186?±?33 ms, p?<?0.0001; lateral, 1190?±?45 ms vs. 1150?±?33 ms, p?=?0.0003; global, 1220?±?52 ms vs. 1171?±?29 ms, p?<?0.0001; VIP, 1298?±?78 ms vs. 1193?±?31 ms, p?<?0.0001). In PH, LV eccentricity index was the strongest linear predictor of VIP T1 (r?=?0.72). Septal, lateral and global T1 showed strong correlations with VIP T1 (r?=?0.81, r?=?0.59 and r?=?0.75, respectively).Conclusions
In patients with PH, T1 times in VIPs and in the entire LV myocardium are elevated. LV eccentricity strongly correlates with VIP T1 time, which in turn is strongly associated with T1 time changes in the entire LV myocardium.Key Points
? Native T1 mapping detects left ventricular myocardial alterations in pulmonary hypertension ? In pulmonary hypertension, native T1 times at ventricular insertion points are increased ? These T1 times correlate strongly with left ventricular eccentricity ? In pulmonary hypertension, global and segmental myocardial T1 times are increased ? Global, segmental and ventricular insertion point T1 times are strongly correlated12.
Bouchra Habib Geryes Raphael Calmon Diala Khraiche Nathalie Boddaert Damien Bonnet Francesca Raimondi 《European radiology》2016,26(7):2030-2038
Objectives
To assess the impact of different protocols on radiation dose and image quality for paediatric coronary computed tomography (cCT).Materials and methods
From January-2012 to June-2014, 140 children who underwent cCT on a 64-slice scanner were included. Two consecutive changes in imaging protocols were performed: 1) the use of adaptive statistical iterative reconstruction (ASIR); 2) the optimization of acquisition parameters. Effective dose (ED) was calculated by conversion of the dose-length product. Image quality was assessed as excellent, good or with significant artefacts.Results
Patients were divided in three age groups: 0–4, 5–7 and 8–18 years. The use of ASIR combined to the adjustment of scan settings allowed a reduction in the median ED of 58 %, 82 % and 85 % in 0–4, 5–7 and 8–18 years group, respectively (7.3?±?1.4 vs 3.1?±?0.7 mSv, 5.5?±?1.6 vs 1?±?1.9 mSv and 5.3?±?5.0 vs 0.8?±?2.0 mSv, all p?<?0,05). Prospective protocol was used in 51 % of children. The reduction in radiation dose was not associated with reduction in diagnostic image quality as assessed by the frequency of coronary segments with excellent or good image quality (88 %).Conclusions
cCT can be obtained at very low radiation doses in children using ASIR, and prospective acquisition with optimized imaging parameters.Key points
? Using ASIR allows 25?% to 41?% reduction in the ED.? Prospective protocol is used up to 51?% of children after premedication.? Low dose is possible using ASIR and optimized prospective paediatric cCT13.
Purpose
This aimed to evaluate the prevalence and extent of bilateral sigmoid sinus dehiscence (SSD) and to explore the presence of idiopathic intracranial hypertension (IIH) in patients with unilateral pulsatile tinnitus (PT) with CTA/V.Methods
Sixty PT patients (52 females; 40.4 ±?11.6 years [20–72]) who underwent CTA/V and 30 non-PT patients (27 females; 38.4 ±?14.7 years [12–62]) were enrolled in this study. The primary outcome measure was the radiographic presence of SSD. The index of transverse sinus stenosis (ITSS) was obtained by multiplying the stenosis scale values for each transverse sinus, and once was ≥?4, the presence of IIH was suspected.Results
The prevalence and extent of SSD on symptomatic side (78%; maximum transverse diameter, MTD 0.49?±?0.23; maximum vertical diameter, MVD 0.50?±?0.26 cm) were significantly higher and larger than those on asymptomatic side (50%, P?<?0.001; MTD 0.35?±?0.18, P?= 0.006; MVD 0.30?±?0.15 cm, P?<?0.001) in the study group and those (20%, P?<?0.001; MTD 0.36?±?0.18, P?= 0.073; MVD 0.30?±?0.22 cm, P?<?0.048) in the control group. The presence of SSD showed significant correlation with both PT (logistic regression analysis, OR 4.167 [1.450–11.97]; P?=?0.008) and suspected IIH (OR 16.25 [1.893–139.5]; P?=?0.011).Conclusion
In PT patients, SSD has a significant correlation with PT and a potential correlation with IIH.14.
Objective
To evaluate the clinical feasibility and image quality of breath-hold (BH) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP) using a gradient and spin-echo (GRASE) technique compared to the conventional 3D respiratory-triggered (RT)-MRCP using a turbo spin-echo (TSE) sequence at 3 T.Methods
Sixty-six patients underwent both 3D RT-TSE-MRCP and 3D BH-GRASE-MRCP at 3 T. Three radiologists independently reviewed the visualisation of biliary and pancreatic ducts, image blurring, and overall image quality of the two data sets using four- or five-point scales. The numbers of scans with non-diagnostic or poor image quality were compared between the two scans.Results
The 3D BH-GRASE-MRCP had a significantly better image quality (3.69 ± 0.77 vs. 3.30 ± 1.18, p = 0.005) and less image blurring (3.23 ± 0.94 vs. 3.65 ± 0.57, p = 0.0003) than the 3D RT-TSE-MRCP. In detail, 3D BH-GRASE-MRCP better depicted the common bile duct, cystic duct, and bilateral first intrahepatic duct (all ps < 0.05). The number of scans with non-diagnostic or poor image quality significantly decreased with 3D BH-GRASE-MRCP compared with 3D RT-TSE-MRCP [19.7% (13/66) vs. 1.5% (1/66), p = 0.002].Conclusion
The 3D BH-GRASE-MRCP provided better image quality and a reduced number of non-diagnostic images compared to 3D RT-TSE-MRCP.Key points
? The GRASE technique enabled 3D MRCP acquisition within a single breath-hold. ? The short acquisition time of 3D BH-GRASE-MRCP significantly reduced image blurring. ? The 3D BH-GRASE-MRCP had a better image quality than 3D RT-TSE-MRCP. ? The number of non-diagnostic scans was reduced with 3D BH-GRASE-MRCP.15.
Miriam Klauß Klaus Maier-Hein Christine Tjaden Thilo Hackert Lars Grenacher Bram Stieltjes 《European radiology》2016,26(7):2099-2106
Objectives
To evaluate IVIM DW-MRI for changes in IVIM-derived parameters during steroid treatment of autoimmune pancreatitis (AIP) and for the differentiation from pancreatic cancer (PC).Methods
Fifteen AIP-patients, 11 healthy patients and 20 PC-patients were examined with DWI-MRI using eight b-values (50, 100, 150, 200, 300, 400, 600, 800). 12 AIP-patients underwent follow-up examinations during treatment. IVIM-parameters and ADC800-values were tested for significant differences and an ROC analysis was performed.Results
The perfusion fraction f was significantly lower in patients with AIP at the time of diagnosis (10.5?±?4.3 %) than in patients without AIP (20.7?±?4.3 %). In AIP follow-up, f increased significantly to 17.1?±?7.0 % in the first and 21.0?±?4.1 % in the second follow up. In PC, the f-values were lower (8.2?±?4.0 %, n.s.) compared to initial AIP and were significantly lower compared to first and second follow-up examination. In the ROC-analysis AUC-values for f were 0.63, 0.88 and 0.98 for differentiation of PC from initial, first and second follow up AIP-examination.Conclusions
The found differences in f between AIP, AIP during steroid treatment and pancreatic cancer suggest that IVIM-diffusion MRI could serve as imaging biomarker during treatment in AIP-patients and as a helpful tool for differentiation between PC and AIP.Key Points
? MRI is used for follow-up examinations during therapy in AIP-patients ? IVIM-DWI-MRI offers parameters which reflect perfusion and true diffusion ? IVIM-parameters are helpful for differentiation between AIP and pancreatic cancer ? IVIM-parameters could serve as an imaging biomarker during steroid treatment16.
Jimi Huh Yoonseok Choi Dong-Cheol Woo Nieun Seo Bohyun Kim Chang Kyung Lee In Seong Kim Dominik Nickel Kyung Won Kim 《European radiology》2016,26(11):3949-3956
Objectives
To evaluate the feasibility of test-bolus dynamic contrast-enhanced (DCE) MRI with CAIPIRINHA-VIBE for pancreatic malignancies.Methods
Thirty-two patients underwent DCE-MRI with CAIPIRINHA-VIBE after injection of 2 mL gadolinium. From the resulting time–intensity curve (TIC), we estimated the arterial (AP) and portal venous phase (PVP) scan timing for subsequent multiphasic MRI. DCE-MRI perfusion maps were generated, and perfusion parameters were calculated. The image quality was rated on a 5-point scale (1: poor, 5: excellent). Goodness-of-fit of the TIC was evaluated by Pearson’s χ2 test.Results
Test-bolus DCE-MRIs with high temporal (3 s) and spatial resolution (1?×?1?×?4 mm3) were acquired with good-quality perfusion maps of Ktrans and iAUC (mean score 4.313?±?0.535 and 4.125?±?0.554, respectively). The mean χ2 values for fitted TICs were 0.115?±?0.082 for the pancreatic parenchyma and 0.784?±?0.074 for pancreatic malignancies, indicating an acceptable goodness-of-fit. Test-bolus DCE-MRI was highly accurate in estimating the proper timing of AP (90.6 %) and PVP (100 %) of subsequent multiphasic MRI. Between pancreatic adenocarcinomas and neuroendocrine tumours, there were significant differences in the Ktrans (0.073?±?0.058 vs. 0.308?±?0.062, respectively; p?=?0.007) and iAUC (1.501?±?0.828 vs. 3.378?±?0.378, respectively; p?=?0.045).Conclusions
Test-bolus DCE-MRI using CAIPIRINHA-VIBE is feasible for incorporating perfusion analysis of pancreatic tumours into routine multiphasic MRI.Key Points
? Test-bolus DCE-MRI using CAIPIRINHA-VIBE is feasible for perfusion analysis of pancreatic tumours. ? CAIPIRINHA-VIBE enables DCE-MRI with high temporal and spatial resolution. ? Test-bolus DCE-MRI is highly accurate in estimating the proper timing of multiphasic MRI.17.
Objectives
The aim of this study is to assess the effect of blood pressure (BP) on coronary computed tomography angiography (CTA) derived computational fractional flow reserve (CTA-FFR).Materials and methods
Twenty-one patients who underwent coronary CTA and invasive FFR were retrospectively identified. Ischemia was defined as invasive FFR ≤0.80. Using a work-in-progress computational fluid dynamics algorithm, CTA-FFR was computed with BP measured before CTA, and simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg respectively. Correlation between CTA-FFR and invasive FFR was assessed using Pearson test. The repeated measuring test was used for multiple comparisons of CTA-FFR values by simulated BP inputs.Results
Twenty-nine vessels (14 with invasive FFR?≤0.80) were assessed. The average CTA-FFR for measured BP (134?±?20/73?±?12 mmHg) was 0.77?±?0.12. Correlation between CTA-FFR by measured BP and invasive FFR was good (r?=?0.735, P?<?0.001). For simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg, the CTA-FFR increased: 0.69?±?0.13, 0.73?±?0.12, 0.75?±?0.12, 0.77?±?0.11, 0.79?±?0.11, and 0.81?±?0.10 respectively (P?<?0.05).Conclusion
Measurement of the BP just before CTA is preferred for accurate CTA-FFR simulation. BP variations in the common range slightly affect CTA-FFR. However, inaccurate BP assumptions differing from the patient-specific BP could cause misinterpretation of borderline significant lesions.Key Points
? The blood pressure (BP) affects the CTA-FFR computation. ? Measured BP before CT examination is preferable for accurate CTA-FFR simulation. ? Inaccurate BP assumptions can cause misinterpretation of borderline significant lesions.18.
Objectives
To investigate whether amide proton transfer (APT) MR imaging can differentiate high-grade gliomas (HGGs) from low-grade gliomas (LGGs) among gliomas without intense contrast enhancement (CE).Methods
This retrospective study evaluated 34 patients (22 males, 12 females; age 36.0?±?11.3 years) including 20 with LGGs and 14 with HGGs, all scanned on a 3T MR scanner. Only tumours without intense CE were included. Two neuroradiologists independently performed histogram analyses to measure the 90th-percentile (APT90) and mean (APTmean) of the tumours’ APT signals. The apparent diffusion coefficient (ADC) and relative cerebral blood volume (rCBV) were also measured. The parameters were compared between the groups with Student’s t-test. Diagnostic performance was evaluated with receiver operating characteristic (ROC) analysis.Results
The APT90 (2.80?±?0.59 % in LGGs, 3.72?±?0.89 in HGGs, P?=?0.001) and APTmean (1.87?±?0.49 % in LGGs, 2.70?±?0.58 in HGGs, P?=?0.0001) were significantly larger in the HGGs compared to the LGGs. The ADC and rCBV values were not significantly different between the groups. Both the APT90 and APTmean showed medium diagnostic performance in this discrimination.Conclusions
APT imaging is useful in discriminating HGGs from LGGs among diffuse gliomas without intense CE.Key Points
? Amide proton transfer (APT) imaging helps in grading non-enhancing gliomas ? High-grade gliomas showed higher APT signal than low-grade gliomas ? APT imaging showed better diagnostic performance than diffusion- and perfusion-weighted imaging19.
Objectives
The aim of the present study was to histologically compare chondrotoxicity in surgically harvested intervertebral discs (IVDs) of patients following discoblock, discography, or no preoperative intervention.Methods
Thirty patients (IVD degeneration Modic ≥ 2°, Pfirrmann 3° or 4°) at L4/5 or L5/S1 who were planned for anterior lumbar interbody fusion were randomly assigned to three groups (open MRI: group DG - discography with gadobutrol; group DB - discoblock with bupivacaine at 4 weeks prior to surgery; group C - no intervention). The intervertebral discs were histologically evaluated and compared using ANOVA and Bonferroni tests for cell count, apoptosis, and proliferation.Results
A reduced cell count (groups DG vs. DB vs. C: 14.9?±?7.1, 9.2?±?3.8, and 16.6?±?5.2 cells/mm2, respectively; p ANOVA?=?0.016), increased apoptosis (groups DG vs. DB vs. C: 34.9?±?10.2, 47.4?±?16.3, 32.6?±?12.2 %, respectively; p ANOVA?=?0.039) and increased cell proliferation (post hoc pDB vs. DG or C p?<?0.001; for 3-7 cell monoclonal cell nests: groups DG vs. DB vs. C: 2.4?±?1, 3.9?±?1, 2.2?±?1.1, respectively; p intervention x nest size?=?0.006) were found in the IVDs of patients in group DB.Conclusions
This in vivo study suggests that chondrotoxic effects occur in IVD cells after the intradiscal injection of bupivacaine but not after gadobutrol administration.Key Points
? Local bupivacaine administration to intervertebral discs leads to cell toxicity and proliferation.? Gadobutrol demonstrated no significant effect on cell count, apoptosis, or cell proliferation.? In vivo cytotoxicity was demonstrated histologically in humans for the first time.? Addition/administration of bupivacaine during discographies must be judged critically.20.