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Geng Z, Wang S, Ma L, Zhang C, Guan Z, Zhang Y, Yin S, Lian S, Xie C. Prediction of microvascular invasion in hepatocellular carcinoma patients with MRI radiomics based on susceptibility weighted imaging and T2-weighted imaging. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01845-4. [PMID: 38997568 DOI: 10.1007/s11547-024-01845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 07/01/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND The accurate identification of microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) is of great clinical importance. PURPOSE To develop a radiomics nomogram based on susceptibility-weighted imaging (SWI) and T2-weighted imaging (T2WI) for predicting MVI in early-stage (Barcelona Clinic Liver Cancer stages 0 and A) HCC patients. MATERIALS AND METHODS A prospective cohort of 189 participants with HCC was included for model training and testing, and an additional 34 participants were enrolled for external validation. ITK-SNAP was used to manually segment the tumour, and PyRadiomics was used to extract radiomic features from the SWI and T2W images. Variance filtering, student's t test, least absolute shrinkage and selection operator regression and random forest (RF) were applied to select meaningful features. Four machine learning classifiers, including K-nearest neighbour, RF, logistic regression and support vector machine-based models, were established. Independent clinical and radiological risk factors were also determined to establish a clinical model. The best radiomics and clinical models were further evaluated in the validation set. In addition, a nomogram was constructed from the radiomic model and independent clinical factors. Diagnostic efficacy was evaluated by receiver operating characteristic curve analysis with fivefold cross-validation. RESULTS AFP levels greater than 400 ng/mL [odds ratio (OR) 2.50; 95% confidence interval (CI) 1.239-5.047], tumour diameter greater than 5 cm (OR 2.39; 95% CI 1.178-4.839), and absence of pseudocapsule (OR 2.053; 95% CI 1.007-4.202) were found to be independent risk factors for MVI. The areas under the curve (AUCs) of the best radiomic model were 1.000 and 0.882 in the training and testing cohorts, respectively, while those of the clinical model were 0.688 and 0.6691. In the validation set, the radiomic model achieved better diagnostic performance (AUC = 0.888) than the clinical model (AUC = 0.602). The combination of clinical factors and the radiomic model yielded a nomogram with the best diagnostic performance (AUC = 0.948). CONCLUSION SWI and T2WI-derived radiomic features are valuable for noninvasively and accurately identifying MVI in early-stage HCC. Furthermore, the integration of radiomics and clinical factors yielded a predictive nomogram with satisfactory diagnostic performance and potential clinical benefits.
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Affiliation(s)
- Zhijun Geng
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Shutong Wang
- Department of Hepatic Surgery, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Lidi Ma
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Cheng Zhang
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Zeyu Guan
- Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China
| | - Yunfei Zhang
- United Imaging Healthcare Co., Ltd, Shanghai, 201807, China
| | - Shaohan Yin
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Shanshan Lian
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China
| | - Chuanmiao Xie
- Department of Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in Southern China, No. 651 Dongfeng East Road, Guangzhou, 510060, People's Republic of China.
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Yang Y, Liu C, Qi L, Zhao T, Feng Y, Ai X, Zhao X, Li J, Zhu Q. Diagnosis of Pre-HCC Disease by Hepatobiliary-Specific Contrast-Enhanced Magnetic Resonance Imaging: A Review. Dig Dis Sci 2020; 65:2492-2502. [PMID: 31808004 DOI: 10.1007/s10620-019-05981-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
We first proposed a new concept, pre-hepatocellular carcinoma (HCC) disease, to describe the precancerous condition of HCC, which has received scant attention from clinicians. Pre-HCC disease is defined as chronic liver injury concurrent with hepatic low- or high-grade dysplastic nodular lesions. Precise diagnosis of pre-HCC disease may prevent or arrest HCC and contribute to relieving the HCC burden worldwide, although noninvasive diagnosis is difficult and biopsy is generally required. Fortunately, recent advances and extensive applications of hepatobiliary-specific contrast-enhanced magnetic resonance imaging will facilitate the noninvasive identification and characterization of pre-HCC disease. This review briefly discusses the new concept of pre-HCC disease and offers an overview of the role of hepatobiliary-specific contrast-enhanced magnetic resonance imaging for the diagnosis of pre-HCC disease.
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Affiliation(s)
- Yao Yang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Chenxi Liu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Linyu Qi
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Tong Zhao
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Yuemin Feng
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Xin Ai
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Jie Li
- Department of Infectious Disease, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China
| | - Qiang Zhu
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, 324, Jing 5 Rd, Jinan, 250021, Shandong Province, China.
- Shandong Provincial Engineering and Technological Research Center for Liver Disease Prevention and Control, Jinan, Shandong Province, China.
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Abstract
OBJECTIVE To evaluate the visualization of gallbladder stones on susceptibility-weighted imaging (SWI). MATERIALS AND METHODS Imaging data from 47 patients who underwent clinically indicated cholecystectomy was reviewed. Breath-hold SWI was added to the magnetic resonance imaging protocol and magnitude and phase data was reviewed for gall-stones visualization. Phase signature, that is, diamagnetic, paramagnetic, or mixed, was also noted in the stones. Magnetic susceptibility value of surgically extracted gallstones were imaged ex vivo (n = 37). RESULTS In 45 of 47 cases, gallstones were surgically confirmed. In 43 cases, gallstones were visualized in the SWI. In 1 case, although routine imaging failed, stones were visualized on SWI. In 29 diamagnetic, 7 paramagnetic and 9 cases mixed phase were seen. In an ex vivo study, magnetic susceptibility of stones was found ranging between -0.102 and -0.916 ppm for diamagnetic and 0.203 and 486 ppm for paramagnetic stones. CONCLUSIONS Gallbladder stones can be visualized with SWI and may be added to the routine magnetic resonance imaging protocol for its evaluation.
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Ruetten PPR, Gillard JH, Graves MJ. Introduction to Quantitative Susceptibility Mapping and Susceptibility Weighted Imaging. Br J Radiol 2019; 92:20181016. [PMID: 30933548 DOI: 10.1259/bjr.20181016] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Quantitative Susceptibility Mapping (QSM) and Susceptibility Weighted Imaging (SWI) are MRI techniques that measure and display differences in the magnetization that is induced in tissues, i.e. their magnetic susceptibility, when placed in the strong external magnetic field of an MRI system. SWI produces images in which the contrast is heavily weighted by the intrinsic tissue magnetic susceptibility. It has been applied in a wide range of clinical applications. QSM is a further advancement of this technique that requires sophisticated post-processing in order to provide quantitative maps of tissue susceptibility. This review explains the steps involved in both SWI and QSM as well as describing some of their uses in both clinical and research applications.
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Affiliation(s)
- Pascal P R Ruetten
- 1Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan H Gillard
- 1Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Martin J Graves
- 2Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
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Liver MRI susceptibility-weighted imaging (SWI) compared to T2* mapping in the presence of steatosis and fibrosis. Eur J Radiol 2019; 118:66-74. [PMID: 31439261 DOI: 10.1016/j.ejrad.2019.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/22/2019] [Accepted: 07/01/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE To show that both susceptibility-weighted imaging (SWI) and T2*-mapping are dependent on liver steatosis, which should be taken into account when using these parameters to grade liver fibrosis and cirrhosis. METHODS In this prospective study, a total of 174 patients without focal liver disease underwent multiparametric MRI at 3 T including SWI, T1- and T2* mapping, proton density fat fraction (PDFF) quantification and MR elastography. SWI, T2* and T1 were measured in the liver (4 locations), as well as in paraspinal muscles, to calculate the liver-to-muscle ratio (LMR). Liver and LMR values were compared among patients with different steatosis grades (PDFF < 5%, 5-10%, 10-20% and >20%), patients with normal, slightly increased and increased liver stiffness (<2.8 kPa, 2.8-3.5 kPa and >3.5 kPa, respectively). ANOVA with Bonferroni-corrected post hoc tests as well as a multivariate analysis were used to compare values among groups and parameters. RESULTS SWI and T2* both differed significantly among groups with different steatosis grades (p < 0.001). However, SWI allowed a better differentiation among liver fibrosis grades (p < 0.001) than did T2* (p = 0.05). SWI LMR (p < 0.001) and T2* LMR (p = 0.036) showed a similar performance in differentiating among liver fibrosis grades. CONCLUSION SWI and T2*-mapping are strongly dependent on the liver steatosis grades. Nevertheless, both parameters are useful predictors for liver fibrosis when using a multiparametric approach.
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Yang X, Zhu J, Dai Y, Tian Z, Yang G, Shi H, Wu Y, Tao X. Multi-parametric effect in predicting tumor histological grade by using susceptibility weighted magnetic resonance imaging in tongue squamous cell carcinoma. BMC Med Imaging 2019; 19:24. [PMID: 30866854 PMCID: PMC6417004 DOI: 10.1186/s12880-019-0322-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 02/26/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Susceptibility weighted imaging (SWI) is helpful for depicting hemorrhage, calcification, and increased vascularity in some neoplasms, which may reflect tumor grade. In this study, we aimed to apply SWI in patients with oral tongue squamous cell carcinomas (OTSCCs) and relate multi-parametric effect to tumor histological grade prediction. METHODS Preoperative MR examinations were performed on a 1 .5T MRI scanner with T1-, T2- and contrast-enhanced (CE) T1-weighted imaging. In addition to routine head and neck MRI sequences, SWI was performed. Tumor thickness and volume were measured. Intratumoral susceptibility signal intensities (ITSSs), ITSS score and ITSS ratio on SWI were evaluated and recorded. Subjects were sub-grouped into low- and high-grade according to the histological findings post operation. Parameters such as tumor thickness, tumor volume and three ITSS related parameters were compared between low- and high-grade groups. ROC analysis was performed on above parameters to access the capability in predicting tumor histological grade. Different multi-parametric models were run to access multi-parametric combination effect. RESULTS Thirty patients with OTSCC were finally included in the study. Twenty of them were categorized as low-grade SCC and the other ten subjects were high-grade SCC according to the pathologic findings. No significant difference was seen for tumor thickness or tumor volume between two sub-groups. ITSSs were seen in 23/30 patients. Significant difference of ITSS scores between low- and high-grade OTSCCs was observed, with mean value of 0.95 ± 0.83 and 1.70 ± 0.95, respectively. Univariate ROC analysis demonstrated ITSSs, ITSS score and ITSS ratio were valuable parameters for predicting tumor histological grade and ITSSs was superior to the other two parameters, with an area under ROC curve of 0.790. Multi-parametric model using combination of ITSSs and tumor thickness would greatly improve the predictive capability in comparison with a univariate approach, yielding the area under ROC curve of 0.84(0.69,0.99). On contrast-enhanced SWI (CE-SWI), ITSSs were shown more clearly delineated in comparison with non-contrast enhanced SWI. CONCLUSIONS In conclusion, SWI was superior in depiction of internal characteristics of OTSCCs, which would potentially provide more diagnostic information. Multi-parametric model using combination of ITSSs and tumor thickness would be valuable in predicting tumor histological grade.
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Affiliation(s)
- Xing Yang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Jinyu Zhu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Yongming Dai
- United Imaging Healthcare, Shanghai, 201807, China
| | - Zhen Tian
- Department of Pathology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Gongxin Yang
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
| | - Huimin Shi
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China.
| | - Yingwei Wu
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China.
| | - Xiaofeng Tao
- Department of Radiology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, 200011, China
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Shetty AS, Sipe AL, Zulfiqar M, Tsai R, Raptis DA, Raptis CA, Bhalla S. In-Phase and Opposed-Phase Imaging: Applications of Chemical Shift and Magnetic Susceptibility in the Chest and Abdomen. Radiographics 2019; 39:115-135. [DOI: 10.1148/rg.2019180043] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Anup S. Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Adam L. Sipe
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Richard Tsai
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Demetrios A. Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Constantine A. Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110
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Sun J, Yu S, Chen J, Xing Z, Zha T, Fan M, Zeng D, Xing W. Assessment of delayed graft function using susceptibility-weighted imaging in the early period after kidney transplantation: a feasibility study. Abdom Radiol (NY) 2019; 44:218-226. [PMID: 30054685 DOI: 10.1007/s00261-018-1709-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE This study aimed to explore the feasibility of susceptibility-weighted imaging (SWI) for evaluating delayed graft function (DGF) during the early posttransplantation period. METHODS Sixty-nine recipients who accepted allograft renal transplantation underwent SWI during the second posttransplantation week. Renal allograft function was estimated via the glomerular filtration rate. Recipients with and without DGF were identified. For each transplanted kidney, the presence of abnormal signal intensity lesions (ASILs), excluding benign lesions, on SWI was assessed. Renal allograft function was compared between the recipients with and without ASILs. The correlation between ASILs and renal allograft function was tested by Spearman's rank correlation analysis. RESULTS Thirty-four recipients were diagnosed with DGF, while 35 recipients showed no DGF. In the DGF group, 16 recipients had low-intensity ASILs, primarily at the corticomedullary junction of transplanted kidneys on SWI, and no ASILs were found in 18 recipients. In the non-DGF group, none of the recipients showed ASILs on SWI. In the DGF group, the renal allograft function among the 16 recipients with low-intensity ASILs was significantly lower than that among the other 18 recipients (8.5 ± 4.2 vs. 19.7 ± 9.7 mL/min, P < 0.001). The presence of low-intensity ASILs on SWI showed a moderate negative correlation with renal allograft function in recipients with DGF (r = - 0.553, P = 0.001). CONCLUSION SWI can be used to evaluate DGF in the early post-kidney transplantation period.
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Cai Y, Huang MP, Wang XF, Lu X, Luo L, Shu J. Quantitative analysis of susceptibility-weighted magnetic resonance imaging in chronic hepatitis in rats. Magn Reson Imaging 2018; 54:71-76. [DOI: 10.1016/j.mri.2018.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 08/01/2018] [Accepted: 08/17/2018] [Indexed: 02/07/2023]
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Performance of Magnetic Resonance Susceptibility-Weighted Imaging for Detection of Calcifications in Patients With Hepatic Echinococcosis. J Comput Assist Tomogr 2018; 42:211-215. [PMID: 29189399 DOI: 10.1097/rct.0000000000000687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We evaluated the performance of susceptibility-weighted imaging (SWI) for identification of hepatic calcifications in alveolar echinococcosis and cystic echinococcosis. METHODS The SWI images of 58 lesions in 40 patients (age, 49 ± 14 y) with alveolar echinococcosis (n = 22) or cystic echinococcosis (n = 18) were reviewed for calcifications. First, calcifications were suggested by visual assessment. Second, ratios of minimum intralesional intensity and mean lumbar muscle intensity were recorded. Computed tomography (CT) served as the criterion standard. RESULTS Thirty-seven lesions showed calcifications on CT. Susceptibility-weighted imaging provided a sensitivity of 89.2% (95% confidence interval [CI], 50.1-75.7) and a specificity of 57.1% (95% CI, 34.4-77.4) for calcifications detected by visual assessment. Receiver operating characteristic curves demonstrated a sensitivity of 67.6% and a specificity of 85.0% for an intensity ratio of 0.61. A specificity of 100% (95% CI, 80.8-100) and a sensitivity of 84.5% (95% CI, 67.3-93.2) were achieved by SWI for calcifications with a density greater than 184 HU in CT. CONCLUSIONS Identification of hepatic calcifications is possible with SWI. Susceptibility-weighted imaging offers the potential to reduce the need for of CT imaging for evaluation of echinococcosis.
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Yang ZX, Liang HY, Hu XX, Huang YQ, Ding Y, Yang S, Zeng MS, Rao SX. Feasibility of histogram analysis of susceptibility-weighted MRI for staging of liver fibrosis. Diagn Interv Radiol 2017; 22:301-7. [PMID: 27113421 DOI: 10.5152/dir.2016.15284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE We aimed to evaluate whether histogram analysis of susceptibility-weighted imaging (SWI) could quantify liver fibrosis grade in patients with chronic liver disease (CLD). METHODS Fifty-three patients with CLD who underwent multi-echo SWI (TEs of 2.5, 5, and 10 ms) were included. Histogram analysis of SWI images were performed and mean, variance, skewness, kurtosis, and the 1st, 10th, 50th, 90th, and 99th percentiles were derived. Quantitative histogram parameters were compared. For significant parameters, further receiver operating characteristic (ROC) analyses were performed to evaluate the potential diagnostic performance for differentiating liver fibrosis stages. RESULTS The number of patients in each pathologic fibrosis grade was 7, 3, 5, 5, and 33 for F0, F1, F2, F3, and F4, respectively. The results of variance (TE: 10 ms), 90th percentile (TE: 10 ms), and 99th percentile (TE: 10 and 5 ms) in F0-F3 group were significantly lower than in F4 group, with areas under the ROC curves (AUCs) of 0.84 for variance and 0.70-0.73 for the 90th and 99th percentiles, respectively. The results of variance (TE: 10 and 5 ms), 99th percentile (TE: 10 ms), and skewness (TE: 2.5 and 5 ms) in F0-F2 group were smaller than those of F3/F4 group, with AUCs of 0.88 and 0.69 for variance (TE: 10 and 5 ms, respectively), 0.68 for 99th percentile (TE: 10 ms), and 0.73 and 0.68 for skewness (TE: 2.5 and 5 ms, respectively). CONCLUSION Magnetic resonance histogram analysis of SWI, particularly the variance, is promising for predicting advanced liver fibrosis and cirrhosis.
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Affiliation(s)
- Zhao Xia Yang
- Department of Radiology, Zhongshan Hospital of Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.
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Liu S, Buch S, Chen Y, Choi HS, Dai Y, Habib C, Hu J, Jung JY, Luo Y, Utriainen D, Wang M, Wu D, Xia S, Haacke EM. Susceptibility-weighted imaging: current status and future directions. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3552. [PMID: 27192086 PMCID: PMC5116013 DOI: 10.1002/nbm.3552] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 05/14/2023]
Abstract
Susceptibility-weighted imaging (SWI) is a method that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources and to facilitate diagnostic interpretation. It is also the precursor to the concept of the use of phase for quantitative susceptibility mapping (QSM). Nowadays, SWI has become a widely used clinical tool to image deoxyhemoglobin in veins, iron deposition in the brain, hemorrhages, microbleeds and calcification. In this article, we review the basics of SWI, including data acquisition, data reconstruction and post-processing. In particular, the source of cusp artifacts in phase images is investigated in detail and an improved multi-channel phase data combination algorithm is provided. In addition, we show a few clinical applications of SWI for the imaging of stroke, traumatic brain injury, carotid vessel wall, siderotic nodules in cirrhotic liver, prostate cancer, prostatic calcification, spinal cord injury and intervertebral disc degeneration. As the clinical applications of SWI continue to expand both in and outside the brain, the improvement of SWI in conjunction with QSM is an important future direction of this technology. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Saifeng Liu
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Sagar Buch
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Yongsheng Chen
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Hyun-Seok Choi
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yongming Dai
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Charbel Habib
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Joon-Yong Jung
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yu Luo
- Department of Radiology, the Branch of Shanghai First Hospital, Shanghai, China
| | - David Utriainen
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - E. Mark Haacke
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
- Department of Radiology, Wayne State University, Detroit, MI, US
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
- Address correspondence to: E. Mark Haacke, Ph.D., 3990 John R Street, MRI Concourse, Detroit, MI 48201. 313-745-1395,
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Improving Detection of Iron Deposition in Cirrhotic Liver Using Susceptibility-Weighted Imaging With Emphasis on Histopathological Correlation. J Comput Assist Tomogr 2017; 41:18-24. [PMID: 27893493 DOI: 10.1097/rct.0000000000000484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of susceptibility-weighted imaging (SWI) for detection and quantification of iron deposition in cirrhotic liver. METHODS Fifty-five cirrhotic patients underwent hepatic magnetic resonance imaging examination including SWI and multiecho T2*-weighted imaging (T2*WI). Detection of iron deposition and number of siderotic nodules were compared between SWI and T2*WI. Correlation among SWI phase value, T2* value, and hepatic iron concentration were determined. RESULTS Susceptibility-weighted imaging significantly improved detection of iron deposition compared with T2*WI (90.7% vs 66.7%, P = 0.002), attributing to grade 1 (73.3% vs 26.7%, P = 0.027) and grade 2 (93.8% vs 56.3%, P = 0.037). Iron deposition of grade 3 and 4 could be detected by both SWI and T2*WI. The number of siderotic nodules visualized on SWI was significantly larger than that on T2*WI (107.5 ± 7.4 vs 62.7 ± 4.6, P = 0.002). There were significantly negative correlation between phase value and iron score (r = -0.803), and positive correlation between phase value and T2* value (r = 0.771). CONCLUSIONS Susceptibility-weighted imaging can improve detection of minimal and mild iron deposition in cirrhotic liver.
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Sun J, Xing Z, Xing W, Zheng L, Chen J, Fan M, Chen T, Zhang Z. Intratumoral Macroscopic Fat and Hemorrhage Combination Useful in the Differentiation of Benign and Malignant Solid Renal Masses. Medicine (Baltimore) 2016; 95:e2960. [PMID: 26962796 PMCID: PMC4998877 DOI: 10.1097/md.0000000000002960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To evaluate the value of combining the detection of intratumoral macroscopic fat and hemorrhage in the differentiation of the benign from malignant solid renal masses.Conventional magnetic resonance imaging (MRI), chemical shift (CS)-MRI, and susceptibility-weighted imaging were performed in 152 patients with 152 solid renal masses, including 48 benign and 104 malignant masses all pathologically confirmed. The presence of macroscopic fat detected by CS-MRI and hemorrhage detected by susceptibility-weighted imaging were evaluated in all masses. The rates of macroscopic fat and hemorrhage observed between benign and malignant masses were compared by a χ test. All masses found to contain macroscopic fat with or without hemorrhage were considered to be benign. The remaining masses (without macroscopic fat) found not to contain hemorrhage were considered to be benign. Only those found to contain hemorrhage alone were considered to be malignant. The evaluation indexes for differentiating and forecasting the benign and malignant masses were calculated.Significant differences in the rate of macroscopic fat (observed in 85.42% of benign masses vs. 0% of malignant masses) and hemorrhage (observed in 4.17% of benign masses vs. 95.19% of malignant masses) were measured in the benign and malignant groups (P < 0.005, for both). The 41 masses containing macroscopic fat with or without hemorrhage and 11 masses containing neither macroscopic fat nor hemorrhage were considered to be benign. The 100 masses containing no macroscopic fat and only hemorrhage were considered to be malignant. By combining the results for the macroscopic fat and hemorrhage, the accuracy, sensitivity, and specificity in the differential diagnosis of the benign and malignant masses were 96.05%, 95.19%, and 97.92%, respectively, and the accuracy and error rate of forecasting the benign and malignant masses were 95.39% and 4.61%, respectively.Combining the detection intratumoral macroscopic fat and hemorrhage can be used to differentiate the benign from malignant solid renal masses.
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Affiliation(s)
- Jun Sun
- From the Department of Radiology (JS, WX, JC); Department of Urology (ZX, MF); Department of Pathology (TC), Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China; Department of Radiology (LZ, ZZ), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Radiology (LZ), Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China; and Robert H. Lurie Comprehensive Cancer Center (ZZ), Northwestern University Chicago, Chicago, IL
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Yang SH, Lin J, Lu F, Dai YY, Han ZH, Fu CX, Hu FL, Gu HC. Contrast-enhanced susceptibility weighted imaging with ultrasmall superparamagnetic iron oxide improves the detection of tumor vascularity in a hepatocellular carcinoma nude mouse model. J Magn Reson Imaging 2016; 44:288-95. [PMID: 26808392 DOI: 10.1002/jmri.25167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/11/2016] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To evaluate the effectiveness of contrast-enhanced susceptibility-weighted imaging with ultrasmall superparamagnetic iron oxide (USPIO-enhanced SWI) in the assessment of intratumoral vascularity in hepatocellular carcinoma (HCC). MATERIALS AND METHODS Orthotopic xenograft HCC nude mouse models were established first and magnetic resonance imaging (MRI) examinations were performed on a 1.5T MR scanner 28 days later. Three groups of mice, 10 in each, were imaged using unenhanced and USPIO-enhanced SWI at doses of 4, 8, and 12 mg Fe/kg. Intratumoral susceptibility signal intensity (ITSS) was scored. ITSS-to-tumor contrast-to-noise ratio (ITSST-CNR) was measured. These measurements were compared between unenhanced and USPIO-enhanced SWI at each dose and differences in the measurements between different dose groups were estimated. Correlation between ITSS and tumor microvessel density (MVD) was analyzed. RESULTS Compared with unenhanced SWI, significantly higher ITSS was identified on USPIO-enhanced SWI at doses of 8 mg Fe/kg (Z = -2.000, P = 0.046) and 12 mg Fe/kg (Z = -2.333, P = 0.020). Significantly higher ITSST-CNR was found on USPIO-enhanced SWI than that on unenhanced SWI (P < 0.05). Significantly higher ITSST-CNR at a dose of 8 mg Fe/kg was observed than that at 4 mg Fe/kg (Z = -3.326, P = 0.001). Positive correlation between ITSS on USPIO-enhanced SWI at a dose of 8 mg Fe/kg and tumor MVD was demonstrated (r = 0.817, P = 0.004). CONCLUSION USPIO-enhanced SWI at a dose of 8 mg Fe/kg greatly improves the detection of intratumoral vascularity in a xenograft HCC model. J. Magn. Reson. Imaging 2016;44:288-295.
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Affiliation(s)
- Shuo-Hui Yang
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, P.R. China.,Department of Radiology, Shuguang Hosipital, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Jiang Lin
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, P.R. China
| | - Fang Lu
- Department of Radiology, Shuguang Hosipital, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Yuan-Yuan Dai
- Department of Radiology, Zhongshan Hospital, Shanghai Medical College, Fudan University, and Shanghai Institute of Medical Imaging, Shanghai, P.R. China
| | - Zhi-Hong Han
- Department of Pathology, Shuguang Hosipital, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China
| | - Cai-Xia Fu
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, P.R. China
| | - Feng-Lin Hu
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Hong-Chen Gu
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, P.R. China
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Li RK, Palmer SL, Zeng MS, Qiang JW, Chen F, Rao SX, Chen LL, Dai YM. Detection of Endogenous Iron Reduction during Hepatocarcinogenesis at Susceptibility-Weighted MR Imaging: Value for Characterization of Hepatocellular Carcinoma and Dysplastic Nodule in Cirrhotic Liver. PLoS One 2015; 10:e0142882. [PMID: 26605946 PMCID: PMC4659660 DOI: 10.1371/journal.pone.0142882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/28/2015] [Indexed: 01/02/2023] Open
Abstract
Objective To investigate the value of susceptibility-weighted imaging (SWI) for characterization of hepatocellular carcinoma (HCC) and dysplastic nodule (DN). Materials and Methods Sixty-eight cirrhotic patients with 89 hepatocellular nodules underwent SWI. The radiological features of hepatocellular nodules on SWI were classified into three types: type A (iso- or hypointensity, and background liver siderosis), type B (hyperintensity, and background liver siderosis), or type C (hyperintensity, and no background liver siderosis). Intranodular and background liver iron content was quantified and correlated with SWI pattern. Prussian blue staining was performed to quantify intranodular and background liver iron content. Results Type A pattern (n = 12) contained 11 (91.7%) DNs and 1 (8.3%) HCC, Type B pattern (n = 66) comprised 1 (1.5%) DN and 65 (98.5%) HCCs (including 12 DN-HCCs and 53 overt HCCs), and type C pattern (n = 11) was exclusively seen in HCCs. The iron scores of DN-HCCs and overt HCCs were significantly lower than those of background livers [(0.091±0.30) VS (2.18±0.87), P = 0.000; (0.11±0.41) VS (2.16±0.97), P = 0.000; respectively]. There was no significant difference between iron scores of DNs and those of background livers [(1.92±0.29) VS (2.17±039), P = 0.191]. For lesion-based and patient-based analysis of HCCs (DN-HCCs and overt HCCs), type B pattern showed a sensitivity, specificity, accuracy, positive predicative value (PPV), and negative predicative value (NPV) of 84.4% and 84.4%, 91.7% and 75%, 85.4% and 83.8%, 98.5% and 98.2%, 47.8% and 23.1%, respectively. Conclusion SWI can provide valuable information for characterization of HCC and DN based on endogenous iron reduction during hepatocarcinogenesis.
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Affiliation(s)
- Ruo-kun Li
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Suzanne L. Palmer
- Department of Radiology, Keck Medical Center, University of Southern California, Los Angeles, California, United States of America
| | - Meng-su Zeng
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- * E-mail: (MSZ); (JWQ)
| | - Jin-wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- * E-mail: (MSZ); (JWQ)
| | - Frank Chen
- Department of Radiology, Keck Medical Center, University of Southern California, Los Angeles, California, United States of America
| | - Sheng-xiang Rao
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ling-li Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong-ming Dai
- Siemens Ltd, China Healthcare Sector MR Business, Shanghai, China
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Visualizing Central Vessels of Hepatic Angiomyolipoma Devoid of Fat Using a 2D Multi-Breath-Hold Susceptibility-Weighted Imaging. Case Rep Radiol 2015; 2015:197431. [PMID: 26114004 PMCID: PMC4465709 DOI: 10.1155/2015/197431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 05/24/2015] [Indexed: 11/18/2022] Open
Abstract
Epithelioid hepatic angiomyolipoma (Epi-HAML) is a rare benign mesenchymal tumor with malignant potential. Most of Epi-HAML contains no or only a minimal amount of adipose tissue and poses a diagnostic challenge. Central vessels are characteristic imaging finding of Epi-HAML, which usually were displayed by dynamic contrast imaging. In this paper, we displayed the central vessels of Epi-HAML invisible on conventional MR images using a new developed abdominal susceptibility-weighted imaging (SWI). To the best of our knowledge, this is the first description for the role of SWI in characterization of Epi-HAML.
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Borrelli P, Palma G, Tedeschi E, Cocozza S, Comerci M, Alfano B, Haacke EM, Salvatore M. Improving Signal-to-Noise Ratio in Susceptibility Weighted Imaging: A Novel Multicomponent Non-Local Approach. PLoS One 2015; 10:e0126835. [PMID: 26030293 PMCID: PMC4452483 DOI: 10.1371/journal.pone.0126835] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/08/2015] [Indexed: 01/14/2023] Open
Abstract
In susceptibility-weighted imaging (SWI), the high resolution required to obtain a proper contrast generation leads to a reduced signal-to-noise ratio (SNR). The application of a denoising filter to produce images with higher SNR and still preserve small structures from excessive blurring is therefore extremely desirable. However, as the distributions of magnitude and phase noise may introduce biases during image restoration, the application of a denoising filter is non-trivial. Taking advantage of the potential multispectral nature of MR images, a multicomponent approach using a Non-Local Means (MNLM) denoising filter may perform better than a component-by-component image restoration method. Here we present a new MNLM-based method (Multicomponent-Imaginary-Real-SWI, hereafter MIR-SWI) to produce SWI images with high SNR and improved conspicuity. Both qualitative and quantitative comparisons of MIR-SWI with the original SWI scheme and previously proposed SWI restoring pipelines showed that MIR-SWI fared consistently better than the other approaches. Noise removal with MIR-SWI also provided improvement in contrast-to-noise ratio (CNR) and vessel conspicuity at higher factors of phase mask multiplications than the one suggested in the literature for SWI vessel imaging. We conclude that a proper handling of noise in the complex MR dataset may lead to improved image quality for SWI data.
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Affiliation(s)
- Pasquale Borrelli
- Advanced Biomedical Sciences Department, University of Napoli “Federico II”, Napoli, Italy
- IRCCS SDN, Naples, Italy
- * E-mail:
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
| | - Enrico Tedeschi
- Advanced Biomedical Sciences Department, University of Napoli “Federico II”, Napoli, Italy
| | - Sirio Cocozza
- Advanced Biomedical Sciences Department, University of Napoli “Federico II”, Napoli, Italy
| | - Marco Comerci
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
| | - Bruno Alfano
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
| | - E. Mark Haacke
- The MRI Institute for Biomedical Research, Detroit, MI, United States of America
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Huber A, Ebner L, Heverhagen JT, Christe A. State-of-the-art imaging of liver fibrosis and cirrhosis: A comprehensive review of current applications and future perspectives. Eur J Radiol Open 2015; 2:90-100. [PMID: 26937441 PMCID: PMC4750581 DOI: 10.1016/j.ejro.2015.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/13/2015] [Accepted: 05/15/2015] [Indexed: 02/07/2023] Open
Abstract
MR elastography (MRE) appears to be the most reliable method for grading liver fibrosis. CT fibrosis score correlates with the stage of fibrosis. Caudate-to-right-lobe ratio and diameters of the liver veins contribute to the CT fibrosis score.
Objective The purpose of this article is to provide a comprehensive overview of imaging findings in patients with hepatic fibrosis and cirrhosis; and to describe which radiological/clinical modality is best for staging hepatic fibrosis. Conclusion MR elastography (MRE) appears to be the most reliable method for grading liver fibrosis, although the CT fibrosis score derived from the combination of caudate-to-right-lobe ratio and the diameters of the liver veins significantly correlates with the stage of fibrosis.
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Affiliation(s)
- Adrian Huber
- Department of Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Lukas Ebner
- Department of Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Johannes T Heverhagen
- Department of Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, CH-3010 Bern, Switzerland
| | - Andreas Christe
- Department of Radiology, University Hospital of Bern, Inselspital, Freiburgstrasse 10, CH-3010 Bern, Switzerland
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The diagnostic efficacy of quantitative liver MR imaging with diffusion-weighted, SWI, and hepato-specific contrast-enhanced sequences in staging liver fibrosis--a multiparametric approach. Eur Radiol 2015; 26:539-46. [PMID: 25991488 DOI: 10.1007/s00330-015-3830-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/01/2015] [Accepted: 04/28/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the diagnostic efficacy of multiparametric MRI using quantitative measurements of the apparent diffusion coefficient (ADC) of the liver parenchyma on diffusion-weighted imaging (DWI), signal intensity (SI) on susceptibility-weighted imaging (SWI), and gadoxetic acid-enhanced T1-weighted imaging during the hepatobiliary phase for the staging of liver fibrosis. MATERIALS AND METHODS Seventy-seven patients underwent a 3T MRI examination, including DWI/SWI sequences and gadoxetic acid-enhanced T1-weighted MRI. Liver fibrosis according to liver biopsy was staged using the Metavir fibrosis score: F0 (n = 21, 27.3%); F1 (n = 7, 9.1%); F2 (n = 8, 10.4%); F3 (n = 12, 15.6%); and F4 (n = 29, 37.7%). SI of the liver was defined using region-of-interest measurements to calculate the ADC values, the relative enhancement (RE) in the hepatobiliary phase, and the liver-to-muscle ratio (LMR) measurements for SWI. RESULTS The values of RE, LMR, and ADC measurements were statistically significantly different among the five fibrosis stages (p < 0.004). Combining the three parameters in a multiparametric approach, the AUC for detecting F1 stage or greater (≥ F1) was 94%, for F2 or greater (≥F2) was 95%, for F3 or greater (≥F3) was 90%, and for stage F4 was 93%. CONCLUSIONS Multiparametric MRI is an efficient non-invasive diagnostic tool for the staging of liver fibrosis. KEY POINTS • Multiparametric MRI has high accuracy in predicting moderate or greater liver fibrosis. • Relative enhancement post- gadoxetic acid is an independent predictor of liver fibrosis. • Liver SWI signal intensity and ADC values enhance the diagnostic ability.
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Siegelman ES, Chauhan A. MR characterization of focal liver lesions: pearls and pitfalls. Magn Reson Imaging Clin N Am 2015; 22:295-313. [PMID: 25086931 DOI: 10.1016/j.mric.2014.04.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Magnetic resonance (MR) can characterize specific tissue subtypes, thus facilitating focal liver lesion diagnosis. Focal liver lesions that are isointense to hyperintense to liver on T1-weighted images are usually hepatocellular in origin. Chemical shift imaging can narrow the differential diagnosis by detecting the presence of lipid or iron. T2 and heavily T2-weigthed fast spin echo imaging can differentiate solid from nonsolid focal liver lesions. The authors illustrate these MR imaging pearls and the uncommon exceptions (pitfalls). The authors hope that you will find this less traditional contribution to the Magnetic Resonance Clinics of North America helpful in clinical practice.
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Affiliation(s)
- Evan S Siegelman
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 34th and Spruce Streets, 1st Floor Silverstein, Philadelphia, PA 19104-4283, USA.
| | - Anil Chauhan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, 34th and Spruce Streets, 1st Floor Silverstein, Philadelphia, PA 19104-4283, USA
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Li C, Hu J, Zhou D, Zhao J, Ma K, Yin X, Wang J. Differentiation of bland from neoplastic thrombus of the portal vein in patients with hepatocellular carcinoma: application of susceptibility-weighted MR imaging. BMC Cancer 2014; 14:590. [PMID: 25123782 PMCID: PMC4141102 DOI: 10.1186/1471-2407-14-590] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/11/2014] [Indexed: 12/13/2022] Open
Abstract
Background Neoplastic and bland portal vein thrombi (PVT) are both common in patients with hepatocellular carcinoma (HCC). The correct discrimination of them is essential for therapeutic strategies planning and survival predicting. The current study aims to investigate the value of susceptibility-weighted imaging (SWI) in differentiating bland from neoplastic PVT in HCC patients. Methods 20 HCC patients with bland PVT and 22 HCC patients with neoplastic PVT were imaged with non-contrast SWI at 3.0 Tesla MRI. The signal intensity (SI) of the PVT and HCC lesions in the same patients was compared on SW images. The phase values of the PVT were compared between neoplastic and bland thrombi cohorts. Receiver operator characteristics (ROC) analysis was conducted to evaluate the diagnostic ability of the phase values for neoplastic and bland thrombi discrimination. Results 20 of 22 neoplastic PVT were judged similar SI and 2 were judged lower SI than their HCC. For 20 bland PVT, 19 were judged lower SI and 1 was judged similar SI as their HCC (P<0.001). The average phase values (0.361 ± 0.224) of the bland PVT were significantly higher than those of the neoplastic PVT (−0.328 ± 0.127, P<0.001). The AUC for phase values in differentiating bland from neoplastic PVT was 0.989. The best cut-off value was −0.195, which gave a sensitivity of 95% and a specificity of 95.5%. Conclusions SW imaging appears to be a promising new method for distinguishing neoplastic from bland PVT. The high sensitivity and specificity suggest its high value in clinical practice.
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Affiliation(s)
| | | | | | | | | | - Xuntao Yin
- Department of Radiology, Southwest Hospital, Third Military Medical University, 30 Gaotanyan Road, Chongqing 400038, China.
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Dai Y, Dong S, Zhu M, Wu D, Zhong Y. Visualizing cerebral veins in fetal brain using susceptibility-weighted MRI. Clin Radiol 2014; 69:e392-7. [PMID: 25060932 DOI: 10.1016/j.crad.2014.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/12/2023]
Abstract
AIM To explore the feasibility of two-dimensional (2D) susceptibility-weighted imaging (SWI) in the visualization of cerebral veins in the foetal brain. MATERIALS AND METHODS Forty-two pregnant healthy women (gestational age: 19-37 weeks, mean: 28.5 ± 7.1 weeks) underwent SWI examination using a 1.5 T MRI system. Two neurologists independently analysed all magnetic resonance imaging (MRI) studies. The relationship between the veins detected and the gestational age was investigated. The prominence of veins was assessed using a categorical score. RESULTS In total, 167 veins were detected by SWI in 29 subjects with a symmetric hemisphere distribution (p > 0.05). An additional vein was detected by SWI biweekly from 24 weeks of gestation. Most veins of Galen and internal cerebral veins on SWI images were prominent, whereas others were faint or moderate. CONCLUSION SWI appears to be a feasible method of detecting cerebral veins in the foetal brain.
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Affiliation(s)
- Y Dai
- Philips Healthcare, People's Republic of China
| | - S Dong
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, People's Republic of China
| | - M Zhu
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, People's Republic of China.
| | - D Wu
- Shanghai Key Laboratory of Magnetic Resonance, Department of Physics, East China Normal University, People's Republic of China
| | - Y Zhong
- Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, People's Republic of China
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Chen W, DelProposto Z, Liu W, Kassir M, Wang Z, Zhao J, Xie B, Wen Y, Wang J, Hu J. Susceptibility-weighted imaging for the noncontrast evaluation of hepatocellular carcinoma: a prospective study with histopathologic correlation. PLoS One 2014; 9:e98303. [PMID: 24879409 PMCID: PMC4039503 DOI: 10.1371/journal.pone.0098303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/01/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Specific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis. In this study, we compared susceptibility-weighted imaging (SWI) to conventional techniques and correlated our findings with histopathology to determine the role of SWI in assessing morphologic features of HCC without using a contrast agent. METHODS 86 consecutive patients with suspected HCC were imaged with MRI (including T1, T2, T2*, and SWI) and subsequently CT. 59 histologically-proven HCC lesions were identified in 53 patients. Each lesion on each imaging sequence was evaluated by two radiologists, and classified with respect to lesion morphology, signal intensity relative to surrounding hepatic parenchyma, presence of a pseudocapsule, presence of venous invasion, and internal homogeneity. RESULTS Histopathology confirmed pseudocapsules in 41/59 lesions. SWI was able to detect a pseudocapsule in 34/41 lesions; compared to conventional T1/T2 imaging (12/41) and T2* (27/41). Mosaic pattern was identified in 25/59 lesions by histopathology; SWI confirmed this in all 25 lesions, compared to T1/T2 imaging (13/25) or T2* (18/25). Hemorrhage was confirmed by histopathology in 43/59 lesions, and visible on SWI in 41/43 lesions, compared to T1/T2 (7/43) and T2* (38/43). Venous invasion was confirmed by histopathology in 31/59 patients; SWI demonstrated invasion in 28/31 patients, compared to T1/T2 (7/31) and T2* (24/31). CONCLUSIONS SWI is better at identifying certain morphologic features such as pseudocapsule and hemorrhage than conventional MRI without using a contrast agent in HCC patients.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zachary DelProposto
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Wei Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Mohammad Kassir
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Zhiyuan Wang
- Cancer Biotherapy Center, Hunan Provincial Tumor Hospital, Xiangya Medical School, Central South University, Hunan, China
| | - Jun Zhao
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bing Xie
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yaming Wen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (JH); (JW)
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (JH); (JW)
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Chen J, Sun J, Xing W, Ding J, Chen T, Dai Y, Sun J, Hu J. Prediction of nuclear grade of clear cell renal cell carcinoma with MRI: intratumoral susceptibility signal intensity versus necrosis. Acta Radiol 2014; 55:378-84. [PMID: 23946232 DOI: 10.1177/0284185113498076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND End-stage renal disease and dialysis patients have a higher incidence of renal cell carcinoma (RCC) than the general population. Preoperatively evaluating the biological behavior of RCC plays an important role in treatment decision-making. Susceptibility-weighted imaging (SWI) can visualize the distribution of microvenous structures and hemorrhage without contrast materials. PURPOSE To evaluate the feasibility of SWI in grading clear cell RCCs (CRCC) and compare the ability of SWI and necrosis for grading CRCCs. MATERIAL AND METHODS Retrospective reviews of 35 patients with pathologically-proven CRCCs were performed. All patients underwent both conventional magnetic resonance imaging (MRI) and SWI examinations. The morphology of the intratumoral susceptibility signal intensities (ITSS) was classified into hemorrhage and microvessels. The differences of ITSSs on SWI and necrosis between low- and high-grade CRCCs were assessed. The diagnostic values of ITSSs and necrosis in differentiating low- from high-grade CRCCs were compared by receiver-operating characteristics. RESULTS ITSSs were seen in 31 of 35 patients. No ITSSs were seen in four patients with low-grade CRCCs. Mean scores of ITSSs on SWI were significantly lower for low-grade CRCCs (1.24 ± 0.72) than that for the high-grade CRCCs (2.70 ± 0.48). No significant necrosis was seen in 10 patients with low-grade CRCCs. There was a significant difference of the presence of intratumoral necrosis between low- and high-grade CRCCs. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were for ITSSs: 70%, 100%, 100%, and 89.3%, respectively; for necrosis: 100%, 40%, 40%, and 100%. CONCLUSION SWI can evaluate ITSSs without contrast materials and can be an alternative to grading CRCCs preoperatively for some special patients.
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Affiliation(s)
- Jie Chen
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Jun Sun
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Jiule Ding
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Tongbing Chen
- Department of Pathology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | | | - Jingyi Sun
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, USA
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Comparison between multi-echo T2* with and without fat saturation pulse for quantification of liver iron overload. Magn Reson Imaging 2013; 31:1704-8. [DOI: 10.1016/j.mri.2013.07.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 07/02/2013] [Accepted: 07/21/2013] [Indexed: 01/08/2023]
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Balassy C, Feier D, Peck-Radosavljevic M, Wrba F, Witoszynskyj S, Kiefer B, Reiter G, Dai Y, Ba-Ssalamah A. Susceptibility-weighted MR imaging in the grading of liver fibrosis: a feasibility study. Radiology 2013; 270:149-58. [PMID: 23925270 DOI: 10.1148/radiol.13122440] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the feasiblity of magnetic resonance (MR) susceptibility-weighted (SW) imaging as a tool to evaluate liver fibrosis grades in patients with chronic liver diseases (CLD) utilizing signal intensity (SI) measurements, with histopathologic findings as the reference standard. MATERIALS AND METHODS This retrospective study was approved by the local ethics committee. All subjects gave written informed consent. Eighty consecutive patients (mean age, 56.8 years), 60% of whom were male [n = 48] and 40% of whom were female [n = 32], with CLD due to various underlying causes and histopathologically proved liver fibrosis were included. Biopsies were evaluated for liver fibrosis and necroinflammatory activity (according to METAVIR scoring system), iron load, and steatosis. Two radiologists, blinded to the clinical data, assessed regions of interest in the liver and spinal muscle in consensus. Liver-to-muscle SI ratios were calculated and correlated to histopathologic findings and clinical data by using univariate and multivariate regression analysis. RESULTS Liver-to-muscle SI ratio decreased in parallel with the increasing grade of liver fibrosis and correlated strongly with liver fibrosis (r = -0.81, P < .0001) and moderately with necroinflammatory activity (r = -0.52, P < .0001) and iron load (r = -0.37, P = .0002) but did not correlate with steatosis (r = -0.18, P = .11). In multiple regression analysis, liver fibrosis and iron load independently influenced SW imaging measurements, explaining 69% of the variance of liver-to-muscle SI ratio (R(2) = 0.69, P < .001). Liver-to-muscle SI ratio performed well in grading liver fibrosis, with an area under the receiver operating characteristic curve of 0.92 for scores of F2 or higher and 0.93 for score of F4 (liver cirrhosis). CONCLUSION SW imaging is a feasible noninvasive tool to detect moderate and advanced liver fibrosis in CLD patients.
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Affiliation(s)
- Csilla Balassy
- From the Departments of Radiology (C.B., D.F., A.B.), Gastroenterology (M.P.), Pathology (F.W.), and Nuclear Medicine (S.W.), Medical University of Vienna, General Hospital of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Department of Radiology, Medical University of Cluj Napoca, Cluj Napoca, Romania (D.F.); Siemens Healthcare, Erlangen, Germany (B.K.); Siemens Healthcare, Graz, Austria (G.R.); and Siemens Healthcare, Shanghai, China (Y.D.)
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Chang SX, Li GW, Chen Y, Bao H, Zhou L, Yuan J, Wu DM, Dai YM. Characterizing venous vasculatures of hepatocellular carcinoma using a multi-breath-hold two-dimensional susceptibility weighted imaging. PLoS One 2013; 8:e65895. [PMID: 23799060 PMCID: PMC3683022 DOI: 10.1371/journal.pone.0065895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 04/30/2013] [Indexed: 02/07/2023] Open
Abstract
The aim of our study is to characterize the venous vasculatures of hepatocellular carcinoma (HCC) using a multi-breath-hold two-dimensional (2D) susceptibility weighted imaging (SWI) in comparison with conventional Magnetic Resonance Imaging (MRI) sequences. Twenty-nine patients with pathologically confirmed HCC underwent MR examination at a 3.0 T scanner. The number of venous vascularity in or around the lesion was counted and the image quality was subjectively evaluated by two experienced radiologists independently based on four image sets: 1) SWI, 2) T1-weighted sequence, 3) T2-weighted sequence, and 4) T1-weighted dynamic contrast-enhanced (DCE) sequence. Of the 29 patients, a total of 33 liver lesions were detected by both SWI and conventional MR sequences. In the evaluation of the conspicuity of venous vascularity, a mean of 10.7 tumor venous vessels per mass was detected by the SWI and 3.9 tumor vasculatures were detected by T1-weighted DCE (P<0.0001), while none was detected by T1-, T2-weighted sequences. The Pearson correlation coefficients between the lesion sizes and the number of tumor vasculatures detected by T1-weighted DCE was 0.708 (P<0.001), and 0.883 by SWI (P<0.001). Our data suggest that SWI appears to be a more sensitive tool compared to T1-weighted DCE sequence to characterize venous vasculature in liver lesions.
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Affiliation(s)
- Shi-Xin Chang
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guan-Wu Li
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yao Chen
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hong Bao
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lei Zhou
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jun Yuan
- Department of Radiology, Yueyang Hospital of Integrated Traditional Chinese & Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Dong-Mei Wu
- Shanghai Key Lab of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Yong-Ming Dai
- Siemens Healthcare China, MR Collaboration NE Asia, Shanghai, China
- * E-mail:
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Chen J, Ding J, Dai Y, Xing W, Sun J, Zhang Z, Xuan Y, Pilli V, Haacke EM, Hu J. Assessment of intratumoral micromorphology for patients with clear cell renal cell carcinoma using susceptibility-weighted imaging. PLoS One 2013; 8:e65866. [PMID: 23755287 PMCID: PMC3675045 DOI: 10.1371/journal.pone.0065866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/29/2013] [Indexed: 12/01/2022] Open
Abstract
Background Multiple treatment options exist for the management of renal cell carcinomas. Preoperative evaluation of clear cell renal cell carcinoma (CRCC) grades is important for deciding upon the appropriate method of therapy. We hypothesize that susceptibility weighted imaging (SWI) is sensitive enough to detect intratumoral microvessles and microbleeding in renal cell carcinoma, which can be used to grade CRCC. Material and Methods Retrospective reviews of 37 patients with pathologically proven CRCCs were evaluated. All patients underwent SWI examinations. The characteristics of intratumoral susceptibility signal intensity (ITSS) includes the likelihood of the presence of ITSS, morphology of ITSS, dominant structure of ITSS and ratio of ITSS area to tumor area, which were all assessed on SWI. The results were compared using the nonparametric Mann-Whitney test. Results ITSS was seen in all patients except 4 patients with low-grade CRCCs. There was no significant difference between low and high-grade CRCCs when looking at the likelihood of the presence of ITSS. There was a significant difference in the mean score of dominant structures between low and high-grade CRCCs. Specifically, more dominant vascular structures and less hemorrhage were seen in low-grade tumors (2.15±1.05) compared to high-grade tumors (1.27±0.47) (P<0.005). The ratio of ITSS area to tumor area was also significantly higher for the high-grade group (1.55±0.52) than that for the low-grade group (0.88±0.43) on SWI (P<0.005). Conclusion SWI is useful for grading CRCCs.
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Affiliation(s)
- Jie Chen
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jiule Ding
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Yongming Dai
- Siemens Healthcare China, MR Collaboration NE Asia, Shanghai, China
| | - Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- * E-mail: (WX); (JH)
| | - Jun Sun
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Zishu Zhang
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yang Xuan
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Vasuki Pilli
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (WX); (JH)
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Ouyang HQ, Gong ZJ, Zha YF, Liu CS, Yang ZH. Splenic siderotic nodules in patients with liver cirrhosis. Exp Ther Med 2013; 6:445-450. [PMID: 24137205 PMCID: PMC3786845 DOI: 10.3892/etm.2013.1135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/14/2013] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to investigate the interrelation between splenic siderotic nodules, hypersplenism and liver function in patients with liver cirrhosis. The splenic enhanced susceptibility-weighted angiography (ESWAN) and conventional magnetic resonance images of 33 patients with liver cirrhosis were retrospectively studied and the ESWAN images were graded. The distribution and prevalence of the image grades for patients with and without hypersplenism were evaluated. In addition, the splenic volume and the distribution of Child-Pugh and albumin scores were compared between patients with and without siderotic nodules, and the correlation between splenic volume and the ESWAN image grades were evaluated in the patients with siderotic nodules. The ESWAN images revealed splenic siderotic nodules in 24 patients. The distribution and prevalence of the ESWAN image grades were demonstrated to be significantly different (P<0.001) between patients with and without hypersplenism. Furthermore, significant differences were observed between patients with and without siderotic nodules with regard to splenic volume and the distribution of Child-Pugh and serum albumin scores (P<0.001). No significant correlation was demonstrated between splenic volume and the ESWAN image grades (P>0.05). In conclusion, a higher prevalence of splenic siderotic nodules (72.7%) was observed using the ESWAN sequence, in comparison with results from previous studies, obtained using the T1-spoiled gradient echo sequence. The presence of splenic siderotic nodules was consistent with the occurrence of hypersplenism and was interrelated with reserved liver function.
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Affiliation(s)
- Huang-Qing Ouyang
- Departments of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Lobsien D, Dreyer AY, Stroh A, Boltze J, Hoffmann KT. Imaging of VSOP labeled stem cells in agarose phantoms with susceptibility weighted and T2* weighted MR Imaging at 3T: determination of the detection limit. PLoS One 2013; 8:e62644. [PMID: 23667503 PMCID: PMC3648551 DOI: 10.1371/journal.pone.0062644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 03/22/2013] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the detectability of stem cells labeled with very small iron oxide particles (VSOP) at 3T with susceptibility weighted (SWI) and T2* weighted imaging as a methodological basis for subsequent examinations in a large animal stroke model (sheep). MATERIALS AND METHODS We examined ovine mesenchymal stem cells labeled with VSOP in agarose layer phantoms. The experiments were performed in 2 different groups, with quantities of 0-100,000 labeled cells per layer. 15 different SWI- and T2*-weighted sequences and 3 RF coils were used. All measurements were carried out on a clinical 3T MRI. Images of Group A were analyzed by four radiologists blinded for the number of cells, and rated for detectability according to a four-step scale. Images of Group B were subject to a ROI-based analysis of signal intensities. Signal deviations of more than the 0.95 confidence interval in cell containing layers as compared to the mean of the signal intensity of non cell bearing layers were considered significant. RESULTS GROUP A 500 or more labeled cells were judged as confidently visible when examined with a SWI-sequence with 0.15 mm slice thickness. Group B: 500 or more labeled cells showed a significant signal reduction in SWI sequences with a slice thickness of 0.25 mm. Slice thickness and cell number per layer had a significant influence on the amount of detected signal reduction. CONCLUSION 500 VSOP labeled stem cells could be detected with SWI imaging at 3 Tesla using an experimental design suitable for large animal models.
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Affiliation(s)
- Donald Lobsien
- Department of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
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Xing W, He X, Kassir MA, Chen J, Ding J, Sun J, Hu J, Zhang Z, Haacke EM, Dai Y. Evaluating hemorrhage in renal cell carcinoma using susceptibility weighted imaging. PLoS One 2013; 8:e57691. [PMID: 23451259 PMCID: PMC3581533 DOI: 10.1371/journal.pone.0057691] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 01/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background Intratumoral hemorrhage is a frequent occurrence in renal cell carcinoma and is an indicator of tumor subtype. We hypothesize that susceptibility weighted imaging (SWI) is sensitive to hemorrhage in renal cell carcinoma and can give a more diagnostic image when compared to conventional imaging techniques. Materials and Methods A retrospective review of 32 patients with clear cell renal cell carcinoma was evaluated. All patients underwent magnetic resonance imaging (MRI) and 22 out of 32 patients also underwent a computed tomography (CT) scan. Hemorrhage was classified into 3 different categories according to shape and distribution. Histopathology was obtained from all masses by radical nephrectomy. The ability to detect the presence of hemorrhage using CT, non-contrast conventional MRI and SWI was evaluated, and the patterns of hemorrhage were compared. Results Using pathologic results as the gold standard, the sensitivities of non-contrast conventional MRI, SWI and CT in detecting hemorrhage in clear cell renal cell carcinoma were 65.6%, 100% and 22.7%, respectively. Accuracy of non-contrast conventional MRI and SWI in evaluating hemorrhagic patterns were 31.3% and 100%, respectively. Conclusion These results demonstrate that SWI can better reveal hemorrhage and characterize the pattern more accurately than either non-contrast conventional MRI or CT. This suggests that SWI is the technique of choice for detecting hemorrhagic lesions in patients with renal cancer.
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Affiliation(s)
- Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- * E-mail:
| | - Mohammad A. Kassir
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jie Chen
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Jiule Ding
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Jun Sun
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Zishu Zhang
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Yongming Dai
- Siemens Healthcare China, MR Collaboration NE Asia, Shanghai, China
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Gamna-Gandy bodies of the spleen detected with susceptibility weighted imaging: maybe a new potential non-invasive marker of esophageal varices. PLoS One 2013; 8:e55626. [PMID: 23383250 PMCID: PMC3561306 DOI: 10.1371/journal.pone.0055626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 12/30/2012] [Indexed: 12/27/2022] Open
Abstract
Background/Objectives Portal hypertension (PH) is a clinical sequelae of liver cirrhosis, and bleeding from esophageal varices (EV) is a serious complication of PH with significant morbidity and mortality. The aims of this study were to assess the ability of 2D multislice breath-hold susceptibility weighted imaging (SWI) to detect Gamna-Gandy bodies (GGBs) in the spleens of patients with PH and to evaluate the potential role of GGB number as a non-invasive marker of PH and EV. Materials and Methods T1-, T2- and T2*- weighted imaging and SWI were performed on 135 patients with PH and on 37 control individuals. Platelet counts were collected from all PH patients. Two radiologists analyzed all magnetic resonance imaging (MRI) data, and measured the portal vein diameter, splenic index (SI), and platelet count/spleen diameter ratio. The numbers of patients with GGBs in the spleen were determined, and the numbers of GGB were counted in the four MRI sequences in GGB-positive patients. The portal vein diameter, SI, platelet count, and platelet count/spleen diameter ratio of control individuals were compared with those of GGB-negative and GGB-positive patients on SWI images. The correlations among GGB numbers, the portal vein diameter, the SI, the platelet count, and the platelet count/spleen diameter ratio were analyzed. Results The GGB detection rate and the detected GGB number by using SWI were significantly greater than those by using T1-, T2-, and T2*- weighted images. The number of GGBs in the SWI images correlated positively with the portal vein diameter and SI and correlated negatively with the platelet count and platelet count/spleen diameter ratio. Conclusion SWI provided more accurate information of GGBs in patients with PH. The number of GGB may be a non-invasive predictor of improving the selection for endoscopic screening of PH patients at risk of EV.
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Lv W, Yan F, Zeng M, Zhang J, Yuan Y, Ma J. Value of abdominal susceptibility-weighted magnetic resonance imaging for quantitative assessment of hepatic iron deposition in patients with chronic hepatitis B: comparison with serum iron markers. J Int Med Res 2013; 40:1005-15. [PMID: 22906273 DOI: 10.1177/147323001204000319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To assess hepatic iron deposition quantitatively in patients with chronic hepatitis B (HBV) infection, using abdominal susceptibility-weighted magnetic resonance imaging (SWI). METHODS Patients with HBV infection and healthy controls underwent abdominal SWI and were assessed for serum iron markers. Phase values were measured and five grades of hepatic iron deposition were described by SWI. RESULTS Patients with HBV infection (n = 327) and healthy controls (n = 50) were prospectively enrolled. In total, 77 (25.4%) patients with HBV infection had hepatic iron deposition as determined by SWI. Phase values were significantly different between patients with hepatic iron deposition compared with patients without hepatic iron deposition or controls, and were significantly different across different grades of hepatic iron deposition. Serum iron, ferritin, transferrin and transferrin saturation were significantly higher in patients with, versus those without, hepatic iron deposition. Only serum ferritin was significantly different across different grades of hepatic iron deposition, and there was a low inverse correlation between serum ferritin and phase values. CONCLUSIONS Compared with serum iron markers, abdominal SWI may represent a powerful tool to assess hepatic iron deposition quantitatively in patients with chronic HBV infection.
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Affiliation(s)
- W Lv
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
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An in vitro and in vivo analysis of the correlation between susceptibility-weighted imaging phase values and R2* in cirrhotic livers. PLoS One 2012; 7:e45477. [PMID: 23029037 PMCID: PMC3445544 DOI: 10.1371/journal.pone.0045477] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 08/21/2012] [Indexed: 01/28/2023] Open
Abstract
Objective To establish a baseline of susceptibility-weighted imaging (SWI) phase value as a means of detecting iron abnormalities in cirrhotic liver and to analyze its relationship with R2*. Materials and Methods Sixteen MnCl2 phantoms, thirty-seven healthy individuals and 87 cirrhotic patients were performed SWI and multi-echo T2*-weighted imaging, and the signal processing in NMR (SPIN) software was used to measure the radian on SWI phase images and the R2* on T2* maps. The mean minus two times standard deviation (SD) of Siemens Phase Unit (SPU) in healthy individuals was designated as a threshold to separate the regions of interest (ROIs) into high- and low-iron areas in healthy participants and cirrhotic patients. The SWI phase values of high-iron areas were calculated. The R2* values was measured in the same ROI in both healthy participants and patients. Results SWI phase values correlated linearly with R2* values in cases of MnCl2 concentrations lower than 2.3 mM in vitro (r = −0.996, P<0.001). The mean value and SD of 37 healthy participants were 2003 and 15 (SPU), respectively. A threshold of 1973 SPU (−0.115 radians) was determined. The SWI phase value and R2* values had a negative correlation in the cirrhotic patients (r = −0.742, P<0.001). However, no similar relationship was found in the healthy individuals (r = 0.096, P = 0.576). Both SWI phase values and R2* values were found to have significant correlations with serum ferritin concentrations in 42 patients with blood samples (r = −0.512, P = 0.001 and r = 0.641, P<0.001, respectively). Conclusion SWI phase values had significant correlations with R2* after the establishment of a baseline on the phase image. SWI phase images may be used for non-invasive quantitative measurement of mild and moderate iron deposition in hepatic cirrhosis in vivo.
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Tao R, Zhang J, Dai Y, You Z, Fan Y, Cui J, Wang J. Characterizing hepatocellular carcinoma using multi-breath-hold two-dimensional susceptibility-weighted imaging: comparison to conventional liver MRI. Clin Radiol 2012; 67:e91-7. [PMID: 22981726 DOI: 10.1016/j.crad.2012.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Revised: 07/22/2012] [Accepted: 08/06/2012] [Indexed: 11/25/2022]
Abstract
AIM To characterize the imaging manifestations of hepatocellular carcinoma (HCC) using multi-breath-hold two-dimensional susceptibility-weighted imaging (SWI) and compare to conventional liver magnetic resonance imaging (MRI). MATERIALS AND METHODS Forty-three patients with histopathologically confirmed HCC underwent conventional liver MRI, multi-breath-hold two-dimensional SWI, and contrast-enhanced CT preoperatively. The T1-weighted imaging (WI), T2WI, and SWI images were evaluated in consensus by two experienced radiologists. The tumour boundaries, blood products in the tumour, venous vessels, and non-tumour liver parenchyma were compared. RESULTS SWI demonstrated significantly better tumour boundary detection than T1WI and T2WI imaging (67.4 and 25.6%, respectively). The detection rate for intra-tumoural blood products using SWI was higher than that of T1WI and T2WI (76.7 and 16.3%, respectively). The detection rate for tumour venous vessels using SWI was 72.1%, while none was detected with conventional T1WI and T2WI. The detection rate for siderotic nodules in non-tumour liver parenchyma using SWI was higher than that of conventional T1WI and T2WI (65.1 and 20.9%, respectively). CONCLUSIONS SWI can provide more detailed information than conventional liver MRI in evaluation of tumour boundaries, blood products, venous vasculature, and non-tumour liver parenchyma. SWI is a valuable complement to conventional liver MRI.
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Affiliation(s)
- R Tao
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
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Li RK, Zeng MS, Rao SX, Qiang JW, Dai YM, Ji Y, Chen CZ, Renate J. Using a 2D multibreath-hold susceptibility-weighted imaging to visualize intratumoral hemorrhage of hepatocellular carcinoma at 3T MRI: Correlation with pathology. J Magn Reson Imaging 2012; 36:900-6. [PMID: 22744981 DOI: 10.1002/jmri.23734] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 05/11/2012] [Indexed: 01/04/2023] Open
Affiliation(s)
- Ruo-Kun Li
- Department of Diagnostic Radiology, Zhongshan Hospital, Shanghai Medical School, Fudan University, Shanghai, China
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