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Poetter-Lang S, Ambros R, Messner A, Kristic A, Hodge JC, Bastati N, Schima W, Chernyak V, Bashir MR, Ba-Ssalamah A. Are dilution, slow injection and care bolus technique the causal solution to mitigating arterial-phase artifacts on gadoxetic acid-enhanced MRI? A large-cohort study. Eur Radiol 2024; 34:5215-5227. [PMID: 38243134 PMCID: PMC11254987 DOI: 10.1007/s00330-024-10590-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVE Arterial-phase artifacts are gadoxetic acid (GA)-enhanced MRI's major drawback, ranging from 5 to 39%. We evaluate the effect of dilution and slow injection of GA using automated fluoroscopic triggering on liver MRI arterial-phase (AP) acquisition timing, artifact frequency, and lesion visibility. METHODS AND MATERIALS Saline-diluted 1:1 GA was injected at 1 ml/s into 1413 patients for 3 T liver MRI. Initially, one senior abdominal radiologist, i.e., principal investigator (PI), assessed all MR exams and compared them to previous and follow-up images, as well as the radiology report on record, determining the standard of reference for lesion detection and characterization. Then, three other readers independently evaluated the AP images for artifact type (truncation (TA), transient severe motion (TSM) or mixed), artifact severity (on a 5-point scale), acquisition timing (on a 4-point scale) and visibility (on a 5-point scale) of hypervascular lesions ≥ 5 mm, selected by the PI. Artifact score ≥ 4 and artifact score ≤ 3 were considered significant and non-significant artifacts, respectively. RESULTS Of the 1413 exams, diagnostic-quality arterial-phase images included 1100 (77.8%) without artifacts, 220 (15.6%) with minimal, and 77 (5.4%) with moderate artifacts. Only 16 exams (1.1%) had significant artifacts, 13 (0.9%) with severe artifacts (score 4), and three (0.2%) non-diagnostic artifacts (score 5). AP acquisition timing was optimal in 1369 (96.8%) exams. Of the 449 AP hypervascular lesions, 432 (96.2%) were detected. CONCLUSION Combined dilution and slow injection of GA with MR results in well-timed arterial-phase images in 96.8% and a reduction of exams with significant artifacts to 1.1%. CLINICAL RELEVANCE STATEMENT Hypervascular lesions, in particular HCC detection, hinge on arterial-phase hyperenhancement, making well-timed, artifact-free arterial-phase images a prerequisite for accurate diagnosis. Saline dilution 1:1, slow injection (1 ml/s), and automated bolus triggering reduce artifacts and optimize acquisition timing. KEY POINTS • There was substantial agreement among the three readers regarding the presence and type of arterial-phase (AP) artifacts, acquisition timing, and lesion visibility. • Impaired AP hypervascular lesion visibility occurred in 17 (3.8%) cases; in eight lesions due to mistiming and in nine lesions due to significant artifacts. • When AP timing was suboptimal, it was too late in 40 exams (3%) and too early in 4 exams (0.2%) of exams.
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Affiliation(s)
- Sarah Poetter-Lang
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Raphael Ambros
- Department of Diagnostic and Interventional Radiology, Clinic Donaustadt, Vienna Healthcare Group, Vienna, Austria
| | - Alina Messner
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Antonia Kristic
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jacqueline C Hodge
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Nina Bastati
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Wolfgang Schima
- Department of Diagnostic and Interventional Radiology, Goettlicher Heiland Krankenhaus, Barmherzige Schwestern Krankenhaus, and Sankt Josef Krankenhaus, Vienna, Austria
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University, General Hospital of Vienna (AKH), Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Dynamic Liver Magnetic Resonance Imaging During Free Breathing: A Feasibility Study With a Motion Compensated Variable Density Radial Acquisition and a Viewsharing High-Pass Filtering Reconstruction. Invest Radiol 2022; 57:470-477. [PMID: 35136004 DOI: 10.1097/rli.0000000000000859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Robust dynamic contrast-enhanced T1-weighted images are crucial for accurate detection and categorization of focal liver lesions in liver/abdominal magnetic resonance imaging (MRI). As optimal dynamic imaging usually requires multiple breath-holds, its inherent susceptibility to motion artifacts frequently results in degraded image quality in incompliant patients. Because free-breathing imaging may overcome this drawback, the intention of this study was to evaluate a dynamic MRI sequence acquired during free breathing using the variable density, elliptical centric golden angle radial stack-of-stars radial sampling scheme, which so far has not been implemented in 4-dimensional applications. MATERIALS AND METHODS In a prospective pilot study, 27 patients received a routine abdominal MRI protocol including the prototype free-breathing sequence (4DFreeBreathing) for dynamic imaging. This enables more convenient and faster reconstruction through variable density, elliptical centric golden angle radial stack-of-stars without the use of additional reconstruction hardware, and even higher motion robustness through soft-gating. A standard breath-hold sequence performed subsequently served as reference standard. Of the continuous dynamic data sets, each dynamic phase was analyzed regarding image quality, motion artifacts and vessel conspicuity using 5-point Likert scales. Furthermore, correct timing of the late arterial phase was compared with the preexaminations. RESULTS 4DFreeBreathing delivered motion-free dynamic images with high temporal resolution in each subject. Overall image quality scores were rated good or excellent for 4DFreeBreathing and the gold standard without significant differences (P = 0.34). There were significantly less motion artifacts in the 4DFreeBreathing sequence (P < 0.0001), whereas vessel conspicuity in each dynamic phase was comparable for both groups (P = 0.45, P > 0.99, P = 0.22, respectively). Correct timing of the late arterial phase could be achieved in 27 of 27 (100%) examinations using 4DFreeBreathing versus 35 of 53 (66%) preexaminations using gold standard (P < 0.001). CONCLUSION The benefit of convenient and fast image reconstruction combined with the superiority in motion robustness and timing compared with standard breath hold sequences renders 4DFreeBreathing an attractive alternative to existing free-breathing techniques in dynamic liver MRI.
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Time to peak enhancement of malignant hypervascular hepatic tumors versus that of the aorta evaluating by test bolus sequence of magnetic resonance imaging. Eur J Radiol 2020; 131:109211. [DOI: 10.1016/j.ejrad.2020.109211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/12/2020] [Accepted: 08/05/2020] [Indexed: 11/21/2022]
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Kang HJ, Lee JM, Jeon SK, Jang S, Park S, Joo I, Yoon JH, Han JK. Intra-individual comparison of dual portal venous phases for non-invasive diagnosis of hepatocellular carcinoma at gadoxetic acid-enhanced liver MRI. Eur Radiol 2020; 31:824-833. [PMID: 32845387 DOI: 10.1007/s00330-020-07162-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/18/2020] [Accepted: 08/06/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the diagnostic performances of first and second portal venous phases (PVP1 and PVP2) in revealing washout and capsule appearance for non-invasive HCC diagnoses in gadoxetic acid-enhanced MRI (Gd-EOB-MRI). METHODS This retrospective study included 123 at-risk patients with 160 hepatic observations (HCCs, n = 116; non-HCC malignancies, n = 18; benign, n = 26) showing arterial phase hyper-enhancement (APHE) ≥ 1 cm at Gd-EOB-MRI. The mean time intervals from gadoxetic acid injection to PVP1 and PVP2 acquisitions were 53 ± 2 s and 73 ± 3 s, respectively. After evaluating image findings independently, imaging findings and diagnoses were finalized by a consensus of two radiologists using either PVP1 or PVP2 image sets according to the LI-RADS v2018 or EASL criteria. Sensitivity, specificity, and accuracy were compared. RESULTS Among HCCs, more washout and enhancing capsule were observed in PVP2 (83.6% and 27.6%) than in PVP1 (50.9% and 19.8%) (p < 0.001, both). The PVP2 set presented significantly higher sensitivity (83.6% vs. 53.5%, LI-RADS; 82.8% vs. 50.0%, EASL; p < 0.001, both) and accuracy (0.88 vs. 0.73, LI-RADS; 0.88 vs. 0.72, EASL; p < 0.001, both) than the PVP1 set without significant specificity loss (93.2% vs. 93.2%, by LI-RADS or EASL; p = 0.32, both). None of the non-HCC malignancy was non-invasively diagnosed as HCC in both PVP image sets. CONCLUSION Late acquisition of PVP detected washout and enhancing capsule of HCC more sensitively than early acquisition, enabling accurate diagnoses of HCC, according to LI-RADS or EASL criteria. KEY POINTS • Among HCCs, more washout and enhancing capsules were observed in PVP2 than PVP1, quantitatively and qualitatively. • The portal venous phase acquired at around 70 s after contrast media administration (PVP2) provided significantly higher sensitivity and AUC value than PVP1 by using LI-RADS v2018 or EASL criteria. • More HCCs were categorized as LR-5 in PVP2 than in PVP1 images, and the specificity of PVP2 (93.5%) was comparable with PVP1 (93.5%).
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Affiliation(s)
- Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea. .,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea.
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Siwon Jang
- Department of Radiology, Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Sungeun Park
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea.,Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul, 03080, South Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, South Korea
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Guo LF, Gao G, Yuan Z. Detection of Dysplastic Liver Nodules in Patients with Cirrhosis Using the Multi-Arterial CAIPIRINHA-Dixon-TWIST-Volume-Interpolated Breath-Hold Examination (MA-CDT-VIBE) Technique in Dynamic Contrast-Enhanced Magnetic Resonance Imaging. Med Sci Monit 2020; 26:e922618. [PMID: 32562415 PMCID: PMC7331482 DOI: 10.12659/msm.922618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The multi-arterial CAIPIRINHA-Dixon-TWIST-volume-interpolated breath-hold examination (MA-CDT-VIBE) sequence has the advantage of detecting hypervascular lesions during the arterial phase of magnetic resonance imaging (MRI) of the liver. Liver cirrhosis may be associated with dysplastic nodules. This study aimed to compare the use of routine liver MRI sequences with the MA-CDT-VIBE sequence to identify dysplastic liver nodules in patients with liver cirrhosis. Material/Methods Between February 2016 and March 2017, there were 21 patients with liver cirrhosis who had 33 dysplastic liver nodules, which were detected by comprehensive multisequence MRI as the reference standard for nodule imaging. Liver MRI using edge sharpness assessment by parametric (ESAP) modeling was compared with five dynamic arterial subphases that were included in the MA-CDT-VIBE sequence with a temporal resolution of 2.8 s and an acquisition time of 20 s during one breath-hold. Results In the 21 patients included in the study, the MA-CDT-VIBE technique (30/33 for the first reading and 33/33 for the second reading) showed an improved lesion detection rate compared with the ESAP technique (27/33 for the first reading and 29/33 for the second reading), and for 73% of the patients, MA-CDT-VIBE imaging showed improved arterial parenchyma contrast. There was a high degree of interobserver agreement between the two reads (κ: 0.68–0.91; P<0.001). Conclusions The MA-CDT-VIBE sequence of MRI liver imaging improved the detection of dysplastic nodules in cirrhosis of the liver compared with routine liver MRI sequences.
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Affiliation(s)
- Ling Fei Guo
- Department of Magnetic Resonance Imaging (MRI), Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
| | - Guihua Gao
- Department of Radiology, Dongping Peoples' Hospital, Taian, Shandong, China (mainland)
| | - Zhenguo Yuan
- Department of Magnetic Resonance Imaging (MRI), Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China (mainland)
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Shahzadi I, Siddiqui MF, Aslam I, Omer H. Respiratory motion compensation using data binning in dynamic contrast enhanced golden-angle radial MRI. Magn Reson Imaging 2020; 70:115-125. [PMID: 32360531 DOI: 10.1016/j.mri.2020.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/12/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022]
Abstract
GRASP (Golden-Angle Radial Sparse Parallel MRI) is a data acquisition and reconstruction technique that combines parallel imaging and golden-angle radial sampling. The continuously acquired free breathing Dynamic Contrast Enhanced (DCE) golden-angle radial MRI data of liver and abdomen has artifacts due to respiratory motion, resulting in low vessel-tissue contrast that makes GRASP reconstructed images less suitable for diagnosis. In this paper, DCE golden-angle radial MRI data of abdomen and liver perfusion is sorted into different motion states using the self-gating property of radial acquisition and then reconstructed using GRASP. Three methods of amplitude-based data binning namely uniform binning, adaptive binning and optimal binning are applied on the DCE golden-angle radial data to extract different motion states and a comparison is performed with the conventional GRASP reconstruction. Also, a comparison among the amplitude-based data binning techniques is performed and benefits of each of these binning techniques are discussed from a clinical perspective. The image quality assessment in terms of hepatic vessel clarity, liver edge sharpness, contrast enhancement clarity and streaking artifacts is performed by a certified radiologist. The results show that DCE golden-angle radial trajectories benefit from all the three types of amplitude-based data binning methods providing improved reconstruction results. The choice of binning technique depends upon the clinical application e.g. uniform and adaptive binning are helpful for a detailed analysis of lesion characteristic and contrast enhancement in different motion states while optimal binning can be used when clinical analysis requires a single image per contrast enhancement phase with no motion blurring artifacts.
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Affiliation(s)
- Iram Shahzadi
- Medical Image Processing Research Group (MIPRG), Department of Electrical and Computer Engineering, COMSATS University Islamabad, Islamabad 45550, Pakistan
| | - Muhammad Faisal Siddiqui
- Medical Image Processing Research Group (MIPRG), Department of Electrical and Computer Engineering, COMSATS University Islamabad, Islamabad 45550, Pakistan.
| | - Ibtisam Aslam
- Department of Radiology & Medical Informatics, Hospital University of Geneva, Geneva, Switzerland
| | - Hammad Omer
- Medical Image Processing Research Group (MIPRG), Department of Electrical and Computer Engineering, COMSATS University Islamabad, Islamabad 45550, Pakistan
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Chaudhry M, McGinty KA, Mervak B, Lerebours R, Li C, Shropshire E, Ronald J, Commander L, Hertel J, Luo S, Bashir MR, Burke LMB. The LI-RADS Version 2018 MRI Treatment Response Algorithm: Evaluation of Ablated Hepatocellular Carcinoma. Radiology 2020; 294:320-326. [PMID: 31845843 DOI: 10.1148/radiol.2019191581] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) is used to assess presumed hepatocellular carcinoma (HCC) after local-regional therapy, but its performance has not been extensively assessed. Purpose To assess the performance of LI-RADS version 2018 TRA in the evaluation of HCC after ablation. Materials and Methods In this retrospective study, patients who underwent ablation therapy for presumed HCC followed by liver transplantation between January 2011 and December 2015 at a single tertiary care center were identified. Lesions were categorized as completely (100%) or incompletely (≤99%) necrotic based on transplant histology. Three radiologists assessed pre- and posttreatment MRI findings using LI-RADS version 2018 and the TRA, respectively. Interreader agreement was assessed by using the Fleiss κ test. Performance characteristics for predicting necrosis category based on LI-RADS treatment response (LR-TR) category (viable or nonviable) were calculated by using generalized mixed-effects models to account for clustering by subject. Results A total of 36 patients (mean age, 58 years ± 5 [standard deviation]; 32 men) with 53 lesions was included. Interreader agreement for pretreatment LI-RADS category was 0.40 (95% confidence interval [CI]: 0.15, 0.67; P < .01) and was lower than the interreader agreement for TRA category (κ = 0.71; 95% CI: 0.59, 0.84; P < .01). After accounting for clustering by subject, sensitivity of tumor necrosis across readers ranged from 40% to 77%, and specificity ranged from 85% to 97% when LR-TR equivocal assessments were treated as nonviable. When LR-TR equivocal assessments were treated as viable, sensitivity of tumor necrosis across readers ranged from 81% to 87%, and specificity ranged from 81% to 85% across readers. Six (11%) of 53 treated lesions were LR-TR equivocal by consensus, with most (five of six) incompletely necrotic at histopathology. Conclusion The Liver Imaging Reporting and Data System treatment response algorithm can be used to predict viable or nonviable hepatocellular carcinoma after ablation. Most ablated lesions rated as treatment response equivocal were incompletely necrotic at histopathology. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Do and Mendiratta-Lala in this issue.
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Affiliation(s)
- Mohammad Chaudhry
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Katrina A McGinty
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Benjamin Mervak
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Reginald Lerebours
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Cai Li
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Erin Shropshire
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - James Ronald
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Leah Commander
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Johann Hertel
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Sheng Luo
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Mustafa R Bashir
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Lauren M B Burke
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
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Kamali M, Clarke SE, Costa AF. Evaluation of liver MRI examinations with two dosages of gadobenate dimeglumine: a blinded intra-individual study. Abdom Radiol (NY) 2020; 45:36-44. [PMID: 31372778 DOI: 10.1007/s00261-019-02158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE There is discrepancy in the literature regarding the optimal dose of gadobenate for liver MRI. We evaluated the quality of liver MRIs performed in the same individual using two dosages. METHODS With ethics approval, this retrospective study evaluated sixty patients who underwent liver MRIs between July 2015 and May 2017 (low dose, 0.06 mmol/kg) and May 2017 and September 2018 (standard dose, 0.10 mmol/kg). Regions of interest were drawn over the aorta, portal veins, and liver on unenhanced and post-contrast phases; relative enhancement values were compared (paired t-tests). Two blinded radiologists graded the arterial and portal venous sequences of each MRI from 1 to 4 (1 = suboptimal, 2 = adequate, 3 = good, 4 = excellent); grades were compared overall and in cirrhotic and non-cirrhotic subgroups (Wilcoxon signed-rank test). Radiologists graded each MRI pair from 1 to 5 (1 = substantially inferior, 2 = slightly inferior, 3 = equivalent, 4 = slightly improved, 5 = substantially improved). Inter-reader agreement was assessed (kappa statistic). RESULTS Relative enhancement increased significantly with the standard dose for all structures on all phases (p < 0.05). For both radiologists and both post-contrast phases, individual grades of the low- and standard-dose MRIs were similar, including the cirrhotic and non-cirrhotic subgroups (p > 0.05). Compared to the low-dose MRIs, the number of standard-dose MRIs graded 1-5 were 9, 31, 97, 88, and 11 for all patients, and 6, 13, 26, 45, and 6 in cirrhotics. Inter-observer agreement was fair-moderate (Κ range 0.23-0.45). CONCLUSIONS Although the standard dose of gadobenate yields greater relative enhancement, there is overall little improvement in subjective imaging quality. A trend towards better image quality is observed in cirrhotics.
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Affiliation(s)
- Mahsa Kamali
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
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Yacoub JH, Elsayes KM, Fowler KJ, Hecht EM, Mitchell DG, Santillan C, Szklaruk J. Pitfalls in liver MRI: Technical approach to avoiding misdiagnosis and improving image quality. J Magn Reson Imaging 2018; 49:41-58. [DOI: 10.1002/jmri.26343] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/27/2022] Open
Affiliation(s)
- Joseph H Yacoub
- Department of Radiology; Medstar Georgetown University Hospital; Washington DC USA
| | - Khaled M. Elsayes
- Department of Diagnostic Radiology; University of Texas MD Anderson Cancer Center; Houston Texas USA
| | - Kathryn J. Fowler
- University of California San Diego Health System, Department of Radiology; San Diego California USA
| | - Elizabeth M. Hecht
- Department of Radiology; New York Presbyterian-Columbia University Medical Center; New York New York
| | - Donald G. Mitchell
- Department of Radiology; Thomas Jefferson University; Philadelphia Pennsylvania USA
| | - Cynthia Santillan
- Liver Imaging Group; University of California San Diego; San Diego California USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology; University of Texas MD Anderson Cancer Center; Houston Texas USA
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10
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Elsayes KM, Hooker JC, Agrons MM, Kielar AZ, Tang A, Fowler KJ, Chernyak V, Bashir MR, Kono Y, Do RK, Mitchell DG, Kamaya A, Hecht EM, Sirlin CB. 2017 Version of LI-RADS for CT and MR Imaging: An Update. Radiographics 2018; 37:1994-2017. [PMID: 29131761 DOI: 10.1148/rg.2017170098] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Liver Imaging Reporting and Data System (LI-RADS) is a reporting system created for the standardized interpretation of liver imaging findings in patients who are at risk for hepatocellular carcinoma (HCC). This system was developed with the cooperative and ongoing efforts of an American College of Radiology-supported committee of diagnostic radiologists with expertise in liver imaging and valuable input from hepatobiliary surgeons, hepatologists, hepatopathologists, and interventional radiologists. In this article, the 2017 version of LI-RADS for computed tomography and magnetic resonance imaging is reviewed. Specific topics include the appropriate population for application of LI-RADS; technical recommendations for image optimization, including definitions of dynamic enhancement phases; diagnostic and treatment response categories; definitions of major and ancillary imaging features; criteria for distinguishing definite HCC from a malignancy that might be non-HCC; management options following LI-RADS categorization; and reporting. ©RSNA, 2017.
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Affiliation(s)
- Khaled M Elsayes
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Jonathan C Hooker
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Michelle M Agrons
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Ania Z Kielar
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - An Tang
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Kathryn J Fowler
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Victoria Chernyak
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Mustafa R Bashir
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Yuko Kono
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Richard K Do
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Donald G Mitchell
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Aya Kamaya
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Elizabeth M Hecht
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
| | - Claude B Sirlin
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E.); Liver Imaging Group, Department of Diagnostic Radiology (J.C.H., C.B.S.), and Department of Medicine, Division of Gastroenterology and Hepatology (Y.K.), University of California San Diego, San Diego, Calif; Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Tex (M.M.A.); Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada (A.Z.K.); Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada (A.T.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (K.J.F.); Department of Radiology, Montefiore Medical Center, Bronx, NY (V.C.); Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, NC (M.R.B.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (R.K.D.); Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, Pa (D.G.M.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.); and Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY (E.M.H.)
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11
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Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, Ganesan K, Yaghmai V, Guimaraes AR, Sahani DV, Miller FH. LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY) 2018; 43:56-74. [PMID: 28940042 DOI: 10.1007/s00261-017-1325-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate detection and characterization of liver observations to enable HCC diagnosis and staging using LI-RADS requires a technically adequate imaging exam. To help achieve this objective, LI-RADS has proposed technical requirements for CT, MR, and contrast-enhanced ultrasound of liver. This article reviews the technical requirements for liver imaging, including the description of minimum acceptable technical standards, such as the scanner hardware requirements, recommended dynamic imaging phases, and common technical challenges of liver imaging.
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Affiliation(s)
- Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Weiss J, Notohamiprodjo M, Martirosian P, Taron J, Nickel MD, Kolb M, Bamberg F, Nikolaou K, Othman AE. Self-gated 4D-MRI of the liver: Initial clinical results of continuous multiphase imaging of hepatic enhancement. J Magn Reson Imaging 2017; 47:459-467. [DOI: 10.1002/jmri.25784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/19/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jakob Weiss
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - Mike Notohamiprodjo
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - Petros Martirosian
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - Jana Taron
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
| | | | - Manuel Kolb
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
| | - Ahmed E. Othman
- Department of Diagnostic and Interventional Radiology; Eberhard Karls University Tuebingen; Tuebingen Germany
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13
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Typical and atypical benign liver lesions: A review. Clin Imaging 2017; 44:79-91. [PMID: 28486156 DOI: 10.1016/j.clinimag.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/10/2017] [Accepted: 05/01/2017] [Indexed: 02/06/2023]
Abstract
Focal liver lesions are routinely encountered by clinical radiologists and represent a wide spectrum of pathology. Majority of these lesions are likely to be benign in nature, especially in the absence of chronic liver disease or primary cancer. A radiologist must be aware of common and uncommon imaging features of benign lesions across the various imaging modalities. This review discusses pathognomonic imaging features of common benign focal liver lesions seen on ultrasound, computed tomography and magnetic resonance, and adds to existing knowledge with the recent updates to have emerged in this area.
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14
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Granata V, Fusco R, Avallone A, Catalano O, Filice F, Leongito M, Palaia R, Izzo F, Petrillo A. Major and ancillary magnetic resonance features of LI-RADS to assess HCC: an overview and update. Infect Agent Cancer 2017; 12:23. [PMID: 28465718 PMCID: PMC5410075 DOI: 10.1186/s13027-017-0132-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/21/2017] [Indexed: 12/23/2022] Open
Abstract
Liver Imaging Reporting and Data System (LI-RADS) is a system for interpreting and reporting of imaging features on multidetector computed tomography (MDCT) and magnetic resonance (MR) studies in patients at risk for hepatocellular carcinoma (HCC). American College of Radiology (ACR) sustained the spread of LI-RADS to homogenizing the interpreting and reporting data of HCC patients. Diagnosis of HCC is due to the presence of major imaging features. Major features are imaging data used to categorize LI-RADS-3, LI-RADS-4, and LI-RADS-5 and include arterial-phase hyperenhancement, tumor diameter, washout appearance, capsule appearance and threshold growth. Ancillary are features that can be used to modify the LI-RADS classification. Ancillary features supporting malignancy (diffusion restriction, moderate T2 hyperintensity, T1 hypointensity on hapatospecifc phase) can be used to upgrade category by one or more categories, but not beyond LI-RADS-4. Our purpose is reporting an overview and update of major and ancillary MR imaging features in assessment of HCC.
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Affiliation(s)
- Vincenza Granata
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Roberta Fusco
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Antonio Avallone
- Abdominal Oncology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Orlando Catalano
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Francesco Filice
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Maddalena Leongito
- Hepatobiliary Surgery Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Raffaele Palaia
- Hepatobiliary Surgery Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Francesco Izzo
- Hepatobiliary Surgery Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
| | - Antonella Petrillo
- Radiology Division, "Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale", Via Mariano Semmola, Naples, Italy
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15
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Multiple arterial phase MRI of arterial hypervascular hepatic lesions: improved arterial phase capture and lesion enhancement. Abdom Radiol (NY) 2017; 42:870-876. [PMID: 27770162 DOI: 10.1007/s00261-016-0948-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To establish if triple-phase arterial imaging improves the detection of arterial phase hyperintense lesions based on arterial phase capture, motion artifact degradation, and lesion enhancement when compared to single-phase imaging. MATERIALS AND METHODS Patients at risk for hepatocellular carcinoma were imaged at 3.0T. Seventy-three consecutive patients with a standard single-phase MRI and eighty-five consecutive patients were imaged using extracellular contrast with triple arterial phase MRI using three sequential accelerated acquisitions of 8 s. Arterial phase capture and image quality were qualitatively categorized. Forty single-phase and forty-four triple-phase studies contained arterially enhancing lesions > 1 cm with washout appearance. The contrast-to-noise ratio (CNR) of the lesions was calculated. We compared the differences in means with Student t-tests and those in arterial phase capture with a Chi squared test with Yates correction. RESULTS The triple-phase acquisitions captured the early or late arterial phases more frequently than did the single-phase acquisition (99% vs 86%; P value = 0.006). Triple-phase also provided greater number of patients with early or late arterial phase imaging without motion artifact (92% vs 79%, P-value = 0.05). The lesion analysis revealed increased maximum CNR in the triple-phase imaging (704.4) vs. single-phase imaging (517.2), P-value < 0.001. CONCLUSION Triple-phase acquisition provides more robust arterial phase imaging for hepatic lesions, with increased lesion CNR, compared to standard single-phase arterial phase imaging.
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Comparison of the Timing of Hepatic Arterial Phase and Image Quality Using Test-Bolus and Bolus-Tracking Techniques in Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced Hepatic Dynamic Magnetic Resonance Imaging. J Comput Assist Tomogr 2017; 41:638-643. [PMID: 28240635 PMCID: PMC5516670 DOI: 10.1097/rct.0000000000000583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives The aim of this study was to compare the image quality, the degree of artifacts and the percentage of timing of the optimal hepatic arterial phase (HAP) between test-bolus and bolus-tracking methods on gadolinium–ethoxybenzyl–diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)–enhanced magnetic resonance imaging (MRI). Methods In this prospective study, 60 patients who underwent 3-dimensional dynamic Gd-EOB-DTPA–enhanced hepatic 3-T MRI were enrolled in this study. We randomly assigned the 30 patients to the bolus-tracking method, and another 30 patients to the test-bolus method. Signal-to-noise ratios of the liver and spleen in HAP were compared in the 2 groups. Two radiologists independently assessed the ratio of optimal timing of HAP and the degree of ringing and motion artifacts of the 2 protocols. Results The signal-to-noise ratios of the liver (24.0 [SD, 6.4] vs 20.4 [SD, 4.0]) and spleen (30.0 [SD, 13.3] vs 23.6 [SD, 9.9]) were significantly higher in the test-bolus protocol than in the bolus-tracking protocol. The ratio of optimal timing was also significantly higher with the test-bolus protocol than with the bolus-tracking protocol (76.7% vs 40.0%). The degree of ringing and motion artifacts of test-bolus protocol was significantly lower than that of the bolus-tracking protocol (P < 0.01). Conclusions The test-bolus protocol in dynamic 3-T MRI can yield better qualitative image quality and more optimal timing of HAP images, while reducing the degree of artifacts compared with the bolus-tracking protocol.
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Elsayes KM, Kielar AZ, Agrons MM, Szklaruk J, Tang A, Bashir MR, Mitchell DG, Do RK, Fowler KJ, Chernyak V, Sirlin CB. Liver Imaging Reporting and Data System: an expert consensus statement. J Hepatocell Carcinoma 2017; 4:29-39. [PMID: 28255543 PMCID: PMC5322844 DOI: 10.2147/jhc.s125396] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The increasing incidence and high morbidity and mortality of hepatocellular carcinoma (HCC) have inspired the creation of the Liver Imaging Reporting and Data System (LI-RADS). LI-RADS aims to reduce variability in exam interpretation, improve communication, facilitate clinical therapeutic decisions, reduce omission of pertinent information, and facilitate the monitoring of outcomes. LI-RADS is a dynamic process, which is updated frequently. In this article, we describe the LI-RADS 2014 version (v2014), which marks the second update since the initial version in 2011.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ania Z Kielar
- Department of Diagnostic Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Michelle M Agrons
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - An Tang
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mustafa R Bashir
- Department of Diagnostic Radiology, Duke University School of Medicine, Durham, NC
| | - Donald G Mitchell
- Department of Diagnostic Radiology, Thomas Jefferson University, Philadelphia, PA
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, MO
| | - Victoria Chernyak
- Department of Radiology Albert Einstein College of Medicine, Bronx, New York, NY
| | - Claude B Sirlin
- Department of Diagnostic Radiology, University of California, San Diego, CA, USA
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Respiratory motion artifacts during arterial phase imaging with gadoxetic acid: Can the injection protocol minimize this drawback? J Magn Reson Imaging 2017; 46:1107-1114. [DOI: 10.1002/jmri.25657] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 02/06/2023] Open
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Yoon JH, Lee JM, Yu MH, Kim EJ, Han JK. Triple Arterial Phase MR Imaging with Gadoxetic Acid Using a Combination of Contrast Enhanced Time Robust Angiography, Keyhole, and Viewsharing Techniques and Two-Dimensional Parallel Imaging in Comparison with Conventional Single Arterial Phase. Korean J Radiol 2016; 17:522-32. [PMID: 27390543 PMCID: PMC4936174 DOI: 10.3348/kjr.2016.17.4.522] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 04/07/2016] [Indexed: 01/25/2023] Open
Abstract
Objective To determine whether triple arterial phase acquisition via a combination of Contrast Enhanced Time Robust Angiography, keyhole, temporal viewsharing and parallel imaging can improve arterial phase acquisition with higher spatial resolution than single arterial phase gadoxetic-acid enhanced magnetic resonance imaging (MRI). Materials and Methods Informed consent was waived for this retrospective study by our Institutional Review Board. In 752 consecutive patients who underwent gadoxetic acid-enhanced liver MRI, either single (n = 587) or triple (n = 165) arterial phases was obtained in a single breath-hold under MR fluoroscopy guidance. Arterial phase timing was assessed, and the degree of motion was rated on a four-point scale. The percentage of patients achieving the late arterial phase without significant motion was compared between the two methods using the χ2 test. Results The late arterial phase was captured at least once in 96.4% (159/165) of the triple arterial phase group and in 84.2% (494/587) of the single arterial phase group (p < 0.001). Significant motion artifacts (score ≤ 2) were observed in 13.3% (22/165), 1.2% (2/165), 4.8% (8/165) on 1st, 2nd, and 3rd scans of triple arterial phase acquisitions and 6.0% (35/587) of single phase acquisitions. Thus, the late arterial phase without significant motion artifacts was captured in 96.4% (159/165) of the triple arterial phase group and in 79.9% (469/587) of the single arterial phase group (p < 0.001). Conclusion Triple arterial phase imaging may reliably provide adequate arterial phase imaging for gadoxetic acid-enhanced liver MRI.
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Affiliation(s)
- Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.; Department of Radiology, Seoul National University College of Medicine, Seoul 03087, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.; Department of Radiology, Seoul National University College of Medicine, Seoul 03087, Korea.; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03087, Korea
| | - Mi Hye Yu
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Korea
| | - Eun Ju Kim
- Philips Healthcare Korea, Seoul 04342, Korea
| | - Joon Koo Han
- Department of Radiology, Seoul National University Hospital, Seoul 03080, Korea.; Department of Radiology, Seoul National University College of Medicine, Seoul 03087, Korea.; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03087, Korea
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Agostini A, Kircher MF, Do RKG, Borgheresi A, Monti S, Giovagnoni A, Mannelli L. Magnetic Resonanance Imaging of the Liver (Including Biliary Contrast Agents)-Part 2: Protocols for Liver Magnetic Resonanance Imaging and Characterization of Common Focal Liver Lesions. Semin Roentgenol 2016; 51:317-333. [PMID: 27743568 DOI: 10.1053/j.ro.2016.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andrea Agostini
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, School of Radiology, Università Politecnica delle Marche, Ancona, Italy
| | - Moritz F Kircher
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Richard K G Do
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alessandra Borgheresi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, School of Radiology, Università degli Studi di Firenze, Firenze, Italy
| | | | - Andrea Giovagnoni
- Department of Radiology, School of Radiology, Università Politecnica delle Marche, Ancona, Italy
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.
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Tanabe M, Kanki A, Wolfson T, Costa EAC, Mamidipalli A, Ferreira MPFD, Santillan C, Middleton MS, Gamst AC, Kono Y, Kuo A, Sirlin CB. Imaging Outcomes of Liver Imaging Reporting and Data System Version 2014 Category 2, 3, and 4 Observations Detected at CT and MR Imaging. Radiology 2016; 281:129-39. [PMID: 27115054 DOI: 10.1148/radiol.2016152173] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the proportion of untreated Liver Imaging Reporting and Data System (LI-RADS) version 2014 category 2, 3, and 4 observations that progress, remain stable, or decrease in category and to compare the cumulative incidence of progression in category. Materials and Methods In this retrospective, longitudinal, single-center, HIPAA-compliant, institutional review board-approved study, 157 patients (86 men and 71 women; mean age ± standard deviation, 59.0 years ± 9.7) underwent two or more multiphasic computed tomographic (CT) or magnetic resonance (MR) imaging examinations for hepatocellular carcinoma surveillance, with the first examination in 2011 or 2012. One radiologist reviewed baseline and follow-up CT and MR images (mean follow-up, 614 days). LI-RADS categories issued in the clinical reports by using version 1.0 or version 2013 were converted to version 2014 retrospectively; category modifications were verified with another radiologist. For index category LR-2, LR-3, and LR-4 observations, the proportions that progressed, remained stable, or decreased in category were calculated. Cumulative incidence curves for progression were compared according to baseline LI-RADS category (by using log-rank tests). Results All 63 index LR-2 observations remained stable or decreased in category. Among 166 index LR-3 observations, seven (4%) progressed to LR-5, and eight (5%) progressed to LR-4. Among 52 index LR-4 observations, 20 (38%) progressed to a malignant category. The cumulative incidence of progression to a malignant category was higher for index LR-4 observations than for index LR-3 or LR-2 observations (each P < .001) but was not different between LR-3 and LR-2 observations (P = .155). The cumulative incidence of progression to at least category LR-4 was trend-level higher for index LR-3 observations than for LR-2 observations (P = .0502). Conclusion Observations classified according to LI-RADS version 2014 categories are associated with different imaging outcomes. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Masahiro Tanabe
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Akihiko Kanki
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Tanya Wolfson
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Eduardo A C Costa
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Adrija Mamidipalli
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Marilia P F D Ferreira
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Cynthia Santillan
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Michael S Middleton
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Anthony C Gamst
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Yuko Kono
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Alexander Kuo
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
| | - Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology (M.T., A.K., E.A.C.C., A.M., M.P.F.D.F., C.S., M.S.M., C.B.S.) and Division of Hepatology, Department of Medicine (Y.K., A.K.), University of California, San Diego, 408 Dickinson St, San Diego, CA 92103; and Computational and Applied Statistics Laboratory (CASL), SDSC-University of California, San Diego, La Jolla, Calif (T.W., A.C.G.)
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Rosenkrantz AB, Pinnamaneni N, Kierans AS, Ream JM. Hypovascular hepatic nodules at gadoxetic acid-enhanced MRI: whole-lesion hepatobiliary phase histogram metrics for prediction of progression to arterial-enhancing hepatocellular carcinoma. Abdom Radiol (NY) 2016; 41:63-70. [PMID: 26830613 DOI: 10.1007/s00261-015-0610-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore whole-lesion histogram analysis of the hepatobiliary phase (HBP) defect in indeterminate hypovascular liver lesions for predicting progression to arterial-enhancing hepatocellular carcinoma (HCC). METHODS Twenty patients undergoing gadoxetic acid-enhanced MRI for HCC screening with 12° and 25° flip angle (FA) HBP acquisitions demonstrating an indeterminate lesion showing HBP hypointensity but no arterial enhancement were included. Volumes-of-interest were placed on HBP defects, from which histogram metrics were obtained. Associations between these metrics and progression to arterial-enhancing HCC on follow-up imaging were investigated. Lesions were also assessed for the presence of a signal abnormality on conventional sequences. RESULTS 40% of lesions progressed to arterial-enhancing HCC; 60% were stable at ≥6 months follow-up. Neither T2-hyperintensity increased diffusion signal nor portal/equilibrium phase washout was different between progressing and nonprogressing lesions (p = 1.0). Among direct signal intensity-based measures (overall mean; mean of bottom 10th, 10-25th, and 25-50th percentiles), area-under-the-curve (AUC) for prediction of progression to arterial-enhancing HCC was consistently higher at 25° (range 0.619-0.657) than at 12° (range 0.512-0.548). However, at both FAs, the four measures with highest AUC were measures related to lesion texture and heterogeneity [standard deviation (SD), coefficient of variation (CV), skewness, and entropy], having AUC of 0.655-0.750 at 12° and 0.686-0.800 at 25. The metric with highest AUC at 12° was SD (AUC = 0.750) and at 25° was CV (AUC = 0.800). CONCLUSION Whole-lesion histogram HBP measures of indeterminate hypovascular liver lesions may help predict progression to arterial-enhancing HCC by reflecting greater lesion heterogeneity, particularly at higher FA. Larger studies are therefore warranted.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA.
| | - Niveditha Pinnamaneni
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
| | - Andrea S Kierans
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
| | - Justin M Ream
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
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Becker-Weidman D, Kalb B, Mittal PK, Harri PA, Arif-Tiwari H, Farris AB, Chen Z, Sungjin K, Martin DR. Differentiation of lipid-poor adrenal adenomas from non-adenomas with magnetic resonance imaging: Utility of dynamic, contrast enhancement and single-shot T2-weighted sequences. Eur J Radiol 2015; 84:2045-51. [DOI: 10.1016/j.ejrad.2015.06.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/25/2015] [Accepted: 06/28/2015] [Indexed: 11/27/2022]
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Improved detection of hypervascular liver lesions with CAIPIRINHA-Dixon-TWIST-volume-interpolated breath-hold examination. Invest Radiol 2015; 50:153-60. [PMID: 25478742 DOI: 10.1097/rli.0000000000000118] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic performance of a dynamic, multiphasic contrast-enhanced volume-interpolated sequence with advanced parallel imaging techniques, Dixon fat saturation, and view sharing with 5 hepatic arterial subphases for the detection of focal liver lesions. MATERIALS AND METHODS Twenty-four consecutive patients (13 females, 11 males; mean [SD] age, 58 [15] years) with focal liver lesions were included in this prospective study. The examination was performed at a 3-T magnetic resonance imaging system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). Five dynamic arterial subphases with a temporal resolution of 2.6 seconds, starting 17 seconds after injection of the hepatobiliary contrast agent gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Eovist; Bayer HealthCare, Leverkusen, Germany), were acquired using an accelerated parallel imaging volume-interpolated sequence with view sharing (multiarterial controlled aliasing in parallel imaging results in higher acceleration-Dixon-time-resolved angiography with interleaved stochastic trajectories-volumetric interpolated breath-hold examination [MA-CDT-VIBE]). The fourth of the 5 arterial acquisition phases (ie, at 24.8 seconds after the start of contrast agent injection) was considered the equivalent of a standard hepatic arterial phase (equivalent standard arterial phase [ESAP]). The diagnostic value of all 5 dynamic arterial phases for the detection of focal liver lesions, as compared with the single ESAP, was judged in 2 independent consensus readings. The 2 consensus reading groups were blinded to each others' results. The complete, comprehensive multisequence magnetic resonance imaging examination, including T1-weighted, T2-weighted, and multiphasic contrast-enhanced sequences, served as the standard of reference for lesion detection. RESULTS Forty-six percent of the patients (11/24) had hypervascular lesions. In 79 % of all patients (19/24), the best arterial parenchymal contrast of one of the MA-CDT-VIBE acquisition phases was considered better than that of the ESAP. In one third of all cases (8/24 for the first and 6/24 for the second consensus reading), MA-CDT-VIBE showed an improved lesion detection rate compared with ESAP, especially in hypervascular lesions (4/11, representing 36% of all patients with hypervascular lesions). There was a high degree of interrater agreement between the 2 consensus reading groups (the Cohen κ, 0.71-1.00; P < 0.001). CONCLUSIONS Compared with a standard hepatic arterial phase, MA-CDT-VIBE with 5 hepatic arterial subphases demonstrated greater diagnostic accuracy for the detection of hypervascular focal liver lesions and provided a robust and optimized hepatic arterial acquisition phase.
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Hope TA, Petkovska I, Saranathan M, Hargreaves BA, Vasanawala SS. Combined parenchymal and vascular imaging: High spatiotemporal resolution arterial evaluation of hepatocellular carcinoma. J Magn Reson Imaging 2015; 43:859-65. [PMID: 26340309 DOI: 10.1002/jmri.25042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 08/20/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To assess the ability of high-resolution arterial phase imaging of hepatocellular carcinoma (HCC) to provide combined vascular characterization and parenchymal evaluation. MATERIALS AND METHODS Thirty-eight consecutive studies in cirrhotic patients with HCC scanned with a view-shared 2-point-Dixon-based Differential Subsampling with Cartesian Ordering (DISCO) sequence were analyzed. Lesion contrast relative to precontrast and adjacent parenchyma was evaluated and compared using a Fisher's exact test. Visibility of hepatic arteries and tumor feeding vessels were graded on a 5-point scale. Catheter angiography was used as a reference standard for arterial anatomy. RESULTS The high spatiotemporal multiphasic acquisition allowed imaging of both the angiographic and late arterial phase in 30 of 38 studies with good image quality. Maximal lesion enhancement compared to precontrast occurred more frequently during the late arterial phase compared to maximal lesion-to-adjacent, which occurred more frequently during the early arterial phase (P < 0.001). Common and proper hepatic arteries were visualized adequately in 100%, right hepatic artery in 94-97%, left hepatic artery in 94%, and segmental vessel in 83% of cases. Arterial variants were detected with sensitivity of 87-100% and specificity of 100%. CONCLUSION High spatiotemporal resolution arterial phase imaging provides multiple angiographic and arterial phases in a single breath-hold, enabling accurate depiction of vascular anatomy while maintain optimal arterial phase imaging for characterization of focal lesions.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Iva Petkovska
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Manojkumar Saranathan
- Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona, USA.,Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Brian A Hargreaves
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Shreyas S Vasanawala
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Matos AP, Velloni F, Ramalho M, AlObaidy M, Rajapaksha A, Semelka RC. Focal liver lesions: Practical magnetic resonance imaging approach. World J Hepatol 2015; 7:1987-2008. [PMID: 26261689 PMCID: PMC4528273 DOI: 10.4254/wjh.v7.i16.1987] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Revised: 06/24/2015] [Accepted: 07/23/2015] [Indexed: 02/06/2023] Open
Abstract
With the widespread of cross-sectional imaging, a growth of incidentally detected focal liver lesions (FLL) has been observed. A reliable detection and characterization of FLL is critical for optimal patient management. Maximizing accuracy of imaging in the context of FLL is paramount in avoiding unnecessary biopsies, which may result in post-procedural complications. A tremendous development of new imaging techniques has taken place during these last years. Nowadays, Magnetic resonance imaging (MRI) plays a key role in management of liver lesions, using a radiation-free technique and a safe contrast agent profile. MRI plays a key role in the non-invasive correct characterization of FLL. MRI is capable of providing comprehensive and highly accurate diagnostic information, with the additional advantage of lack of harmful ionizing radiation. These properties make MRI the mainstay for the noninvasive evaluation of focal liver lesions. In this paper we review the state-of-the-art MRI liver protocol, briefly discussing different sequence types, the unique characteristics of imaging non-cooperative patients and discuss the role of hepatocyte-specific contrast agents. A review of the imaging features of the most common benign and malignant FLL is presented, supplemented by a schematic representation of a simplistic practical approach on MRI.
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Affiliation(s)
- António P Matos
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Fernanda Velloni
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Miguel Ramalho
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Mamdoh AlObaidy
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Aruna Rajapaksha
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
| | - Richard C Semelka
- António P Matos, Fernanda Velloni, Miguel Ramalho, Mamdoh AlObaidy, Aruna Rajapaksha, Richard C Semelka, Department of Radiology, University of North Carolina, Chapel Hill, NC 27599-7510, United States
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Chundru S, Kalb B, Arif-Tiwari H, Sharma P, Costello J, Martin DR. MRI of diffuse liver disease: characteristics of acute and chronic diseases. Diagn Interv Radiol 2015; 20:200-8. [PMID: 24808418 DOI: 10.5152/dir.2014.13170] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Diffuse liver disease, including chronic liver disease, affects tens of millions of people worldwide, and there is a growing need for diagnostic evaluation as treatments become more readily available, particularly for viral liver diseases. Magnetic resonance imaging (MRI) provides unique capabilities for noninvasive characterization of the liver tissue that rival or surpass the diagnostic utility of liver biopsies. There has been incremental improvement in the use of standardized MRI sequences, acquired before and after administration of a contrast agent, for the evaluation of diffuse liver disease and the study of the liver parenchyma and blood supply. More recent developments have led to methods for quantifying important liver metabolites, including lipids and iron, and liver fibrosis, the hallmark of chronic liver disease. Here, we review the MRI techniques and diagnostic features associated with acute and chronic liver disease.
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Affiliation(s)
- Surya Chundru
- Department of Medical Imaging University of Arizona College of Medicine, Tucson, Arizona, USA.
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Cornfeld D, Nowak M, Spektor M. Optimizing Liver Magnetic Resonance Imaging: Does Intuitive Protocol Management Software Save Time and Produce Better Scans than Manually Optimized Protocols? J Comput Assist Tomogr 2015; 39:702-8. [PMID: 26176426 DOI: 10.1097/rct.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study is to determine if a software package (Abdomen DOT; Siemens Medical Systems, Erlangen Germany) designed to automate magnetic resonance imaging (MRI) scans of the liver results in faster and higher quality examinations compared to optimized protocols performed by appropriately trained technologists. MATERIALS AND METHODS One hundred eight liver MRIs obtained using Abdomen DOT and 94 liver MRIs obtained without Abdomen DOT were retrospectively reviewed. Total scan time and the number of repeated sequences were objectively measured. Timing of the arterial phase, motion artifact, and quality of subtraction images were subjectively evaluated. RESULTS The examinations scanned using Abdomen DOT averaged 2 minutes and 2 seconds shorter than the examinations scanned without Abdomen DOT (P = 0.004) and on average, fewer sequences were repeated. The arterial phase was timed correctly 67% (63/94) of the time without using Abdomen DOT and 81% (87/108) of the time when using Abdomen DOT (P = 0.019). There was no difference in the amount of respiratory artifact. The subtraction images obtained using Abdomen DOT were considered slightly better (P < 0.005 for arterial, portal venous, and equilibrium phase images). CONCLUSIONS The Abdomen DOT software helped our technologists scan slightly faster and obtain correctly timed arterial phase images more often.
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Affiliation(s)
- Daniel Cornfeld
- From the *Department of Diagnostic Radiology, Yale School of Medicine, New Haven; and †Department of Medicine, St. Vincents Medical Center, Hartford, CT
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30
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Costello JR, Kalb B, Chundru S, Arif H, Petkovska I, Martin DR. MR Imaging of Benign and Malignant Biliary Conditions. Magn Reson Imaging Clin N Am 2014; 22:467-88. [DOI: 10.1016/j.mric.2014.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Pietryga JA, Burke LMB, Marin D, Jaffe TA, Bashir MR. Respiratory motion artifact affecting hepatic arterial phase imaging with gadoxetate disodium: examination recovery with a multiple arterial phase acquisition. Radiology 2014; 271:426-34. [PMID: 24475864 DOI: 10.1148/radiol.13131988] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine whether the use of a multiple arterial phase imaging technique provides adequate image quality in patients experiencing transient severe motion (TSM) in the arterial phase on abdominal magnetic resonance (MR) images obtained with gadoxetate disodium. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and was compliant with HIPAA. The requirement to obtain informed consent was waived. Five hundred forty-nine consecutive MR examinations were evaluated, 345 performed with gadoxetate disodium and 204 performed with gadobenate dimeglumine. All examinations included single-breath-hold triple arterial phase acquisition. Five radiologists blinded to the contrast material rated motion on a scale of 1 (no motion) to 5 (nondiagnostic images) for the precontrast phase, the three arterial phases, the portal venous phase, and the late dynamic phase. Adequacy of late hepatic arterial timing was also rated for the each of the three arterial phases. Mean motion scores were compared by using the Wilcoxon signed rank test. The number of patients with TSM, as well as the number of those with "adequate" arterial phases, was compared with the χ(2) or Fisher exact test, as appropriate. RESULTS Mean motion scores in all three arterial phases in the gadoxetate disodium cohort were significantly worse than those in the gadobenate dimeglumine cohort (P < .005). TSM occurred at a higher rate with gadoxetate disodium than with gadobenate dimeglumine (10.7% [37 of 345 examinations] vs 0.5% [one of 204 examinations], P < .001). However, 30 of 37 examinations affected by TSM had at least one well-timed arterial phase with a mean motion score of 3 or less and were thus considered adequate. CONCLUSION Use of single-breath-hold multiple arterial phase acquisition in abdominal MR imaging with gadoxetate disodium recovers most arterial phases that would otherwise have been compromised by transient motion.
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Affiliation(s)
- Jason A Pietryga
- From the Department of Radiology, Duke University Medical Center, DUMC 3808, Durham, NC 27710
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Kalb B, Martin DR, Sarmiento JM, Erickson SH, Gober D, Tapper EB, Chen Z, Adsay NV. Paraduodenal pancreatitis: clinical performance of MR imaging in distinguishing from carcinoma. Radiology 2013. [PMID: 23847255 DOI: 10.1148/radiol.13112056] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To evaluate the diagnostic performance of contrast material-enhanced magnetic resonance (MR) imaging for distinguishing paraduodenal pancreatitis (PDP) from pancreatic head duct adenocarcinoma (CA) in patients with diagnoses confirmed by histopathologic analysis. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and is HIPAA compliant. Between July 2007 and July 2010, 47 patients who underwent Whipple procedure and MR imaging less than 60 days before surgery were identified retrospectively. Two relatively inexperienced fellowship trainees with 9 months of body fellowship training were asked to record the presence or absence of three MR imaging features: focal thickening of the second portion of the duodenum; abnormal enhancement of the second portion of the duodenum; and cystic focus in the expected region of the accessory pancreatic duct. Strict criteria for diagnosis of PDP included presence of all three imaging features. Any case that did not fulfill the criteria was classified as CA. Sensitivity, specificity, positive predictive value, and negative predictive value for characterization of PDP was calculated for each reader with 95% confidence intervals. A κ test assessed level of agreement between readers. RESULTS Each reader correctly categorized 15 of 17 (88.2%) PDP cases when all three imaging criteria were met. Alternatively, 26 of 30 (86.7%) pancreatic duct CA were correctly categorized as inconsistent with PDP. Four patients with histopathologic diagnosis of CA were incorrectly classified as PDP by each reader. Agreement between the two readers showed substantial κ agreement for the diagnosis of PDP and differentiation from pancreatic duct CA. CONCLUSION Contrast-enhanced MR imaging may help accurately identify PDP and distinguish it from CA when strict diagnostic criteria are followed. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13112056/-/DC1.
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Affiliation(s)
- Bobby Kalb
- Department of Radiology, University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724; Departments of Surgery and Pathology, Emory University School of Medicine, Atlanta, Ga; Department of Radiology, University of Virginia School of Medicine, Charlottesville, Va; Rome Radiology Group, Rome, Ga; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
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Nakamura S, Nakaura T, Kidoh M, Utsunomiya D, Doi Y, Harada K, Uemura S, Yamashita Y. Timing of the hepatic arterial phase at Gd-EOB-DTPA-enhanced hepatic dynamic MRI: comparison of the test-injection and the fixed-time delay method. J Magn Reson Imaging 2013; 38:548-54. [PMID: 23744782 DOI: 10.1002/jmri.24017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 12/05/2012] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To compare the fixed-time- and the test-injection method with respect to the image quality of hypervascular hepatocellular carcinoma (HCC) and the adequacy of timing of the hepatic arterial phase (HAP) in Gd-EOB-DTPA (EOB) enhanced MRI. MATERIALS AND METHODS We studied 63 patients with computed tomography (CT) -proven hypervascular HCC: 30 (group 1) were scanned HAP using the fixed-time delay method (protocol 1); in the other 33 (group 2), we applied the test-injection method (protocol 2). We compared the protocols with respect with tumor-to-liver contrast (TLC), contrast-to-noise-ratio (CNR), and relative enhancement of the liver and tumor (REL , RET ) during HAP. Two radiologists compared the adequacy of HAP, image contrast, image noise, and overall image quality. RESULTS Under protocol 2, TLC, CNR, and REL and RET of hypervascular HCC were significantly higher (P < 0.01). The proportion of optimal HAP was significantly higher for protocol 2 than protocol 1 (P < 0.01). The visual score of the image contrast and the overall image quality were significantly higher in group 2 than group 1 (P = 0.02 and P = 0.01, respectively). CONCLUSION At EOB-enhanced hepatic dynamic MRI, the test-injection method yielded better image quality of hypervascular HCC and improved adequacy of timing of HAP.
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Affiliation(s)
- Shinichi Nakamura
- Department of Diagnostic Radiology, Amakusa Regional Medical Center, Kumamoto, Japan.
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Purysko AS, Remer EM, Coppa CP, Leão Filho HM, Thupili CR, Veniero JC. LI-RADS: a case-based review of the new categorization of liver findings in patients with end-stage liver disease. Radiographics 2013; 32:1977-95. [PMID: 23150853 DOI: 10.1148/rg.327125026] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Hepatocellular carcinoma (HCC) is a global health problem, with the burden of disease expected to increase in the coming years. Patients who are at increased risk for developing HCC undergo routine imaging surveillance, and once a focal abnormality is detected, evaluation with multiphasic contrast material-enhanced computed tomography or magnetic resonance imaging is necessary for diagnosis and staging. Currently, findings at liver imaging are inconsistently interpreted and reported by most radiologists. The Liver Imaging-Reporting and Data System (LI-RADS) is an initiative supported by the American College of Radiology that aims to reduce variability in lesion interpretation by standardizing report content and structure; improving communication with clinicians; and facilitating decision making (eg, for transplantation, ablative therapy, or chemotherapy), outcome monitoring, performance auditing, quality assurance, and research. Five categories that follow the diagnostic thought process are used to stratify individual observations according to the level of concern for HCC, with the most worrisome imaging features including a masslike configuration, arterial phase hyperenhancement, portal venous phase or later phase hypoenhancement, an increase of 10 mm or more in diameter within 1 year, and tumor within the lumen of a vein. LI-RADS continues to evolve and is expected to integrate a series of improvements in future versions that will positively affect the care of at-risk patients.
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Affiliation(s)
- Andrei S Purysko
- Abdominal Imaging Section, Imaging Institute, HB6, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA.
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Becker-Weidman DJS, Kalb B, Sharma P, Kitajima HD, Lurie CR, Chen Z, Spivey JR, Knechtle SJ, Hanish SI, Adsay NV, Farris AB, Martin DR. Hepatocellular carcinoma lesion characterization: single-institution clinical performance review of multiphase gadolinium-enhanced MR imaging--comparison to prior same-center results after MR systems improvements. Radiology 2011; 261:824-33. [PMID: 21969663 DOI: 10.1148/radiol.11110157] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To measure diagnostic performance in the detection of hepatocellular carcinoma (HCC) by using the most recent technology and multiphase gadolinium-enhanced magnetic resonance (MR) imaging and to compare with earlier results at the same institution. MATERIALS AND METHODS This retrospective study was institutional review board approved and HIPAA compliant. Informed consent was obtained. Between January 2008 and April 2010, 101 patients underwent liver transplantation and pretransplantation abdominal MR imaging within 90 days. Prospective image interpretations from the clinical record were reviewed for documentation of HCC, including size, number, and location. Liver explant histologic examination provided the reference standard for lesion analysis and was performed in axial gross slices in conjunction with the MR imaging report for direct comparison. Tumors were categorized according to size (≥ 2 cm or <2 cm), and MR imaging detection sensitivity, specificity, predictive values, and accuracy were calculated according to category. The Fisher exact test was used to compare results from this study against prior reported results. RESULTS Thirty-five (34.7%) of 101 patients had HCC at explant analysis. Patient-based analysis of all lesions showed a sensitivity and specificity of 97.1% (34 of 35) and 100% (66 of 66), respectively. For lesions 2 cm or larger, MR imaging had a sensitivity and specificity of 100% (23 of 23) and 100% (78 of 78), respectively. For lesions smaller than 2 cm, MR imaging had a sensitivity and specificity of 82.6% (19 of 23) and 100% (78 of 78), respectively. Lesion-based sensitivity for all tumors was 91.4% (53 of 58) in the current study, compared with 77.8% in 2007 (P = .07). For lesions smaller than 2 cm, the sensitivity was 87.5% (28 of 32) in the current study, compared with 55.6% previously (P = .02). CONCLUSION MR imaging remains a highly accurate diagnostic method for the preoperative evaluation of HCC, and detection of small (<2 cm) tumors has been significantly improved compared with that of earlier studies.
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