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Bächler P, Baladron MJ, Menias C, Beddings I, Loch R, Zalaquett E, Vargas M, Connolly S, Bhalla S, Huete Á. Multimodality Imaging of Liver Infections: Differential Diagnosis and Potential Pitfalls. Radiographics 2016; 36:1001-23. [PMID: 27232504 DOI: 10.1148/rg.2016150196] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Imaging plays an important role in the diagnosis, characterization, and management of infectious liver disease. In clinical practice, the main contributions of imaging are in detecting early disease, excluding other entities with a similar presentation, establishing a definitive diagnosis when classic findings are present, and guiding appropriate antimicrobial, interventional, or surgical treatment. The most common imaging features of bacterial, viral, parasitic, and fungal hepatic infections are described, and key imaging and clinical manifestations are reviewed that may be useful to narrow the differential diagnosis and avoid pitfalls in image interpretation. Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging allow accurate detection of most hepatic infections and, in some circumstances, may provide specific signs to identify the underlying pathogen and exclude other entities with similar imaging features. In bacterial and parasitic infections, specific imaging features may be enough to exclude a neoplasm and, occasionally, to identify the underlying infectious agent. US and CT are important means to guide percutaneous aspiration or drainage when needed. In viral infections, imaging is critical to exclude entities that may manifest with similar clinical and laboratory findings. Disseminated fungal infections require early detection at imaging because they can be fatal if not promptly treated. Familiarity with the epidemiology, pathogenesis, clinical manifestations, imaging features, and treatment of hepatic infections can aid in radiologic diagnosis and guide appropriate patient care. (©)RSNA, 2016.
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Affiliation(s)
- Pablo Bächler
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - María José Baladron
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Christine Menias
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Ignacio Beddings
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Ron Loch
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Eugenio Zalaquett
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Matías Vargas
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Sarah Connolly
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Sanjeev Bhalla
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
| | - Álvaro Huete
- From the Department of Radiology, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 367, 2nd Floor, Santiago 8330024, Chile (P.B., M.J.B., I.B., E.Z., M.V., A.H.); Department of Radiology, Mayo Clinic, Scottsdale, Ariz (C.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.L., S.C., S.B.)
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Wang T, Li W, Wu X, Yin B, Chu C, Ding M, Cui Y. Tubo-Ovarian Abscess (with/without Pseudotumor Area) Mimicking Ovarian Malignancy: Role of Diffusion-Weighted MR Imaging with Apparent Diffusion Coefficient Values. PLoS One 2016; 11:e0149318. [PMID: 26894926 PMCID: PMC4760735 DOI: 10.1371/journal.pone.0149318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/29/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the added value of diffusion-weighted magnetic resonance imaging (DWI) with apparent diffusion coefficient (ADC) values compared to MRI, for characterizing the tubo-ovarian abscesses (TOA) mimicking ovarian malignancy. Materials and Methods Patients with TOA (or ovarian abscess alone; n = 34) or ovarian malignancy (n = 35) who underwent DWI and MRI were retrospectively reviewed. The signal intensity of cystic and solid component of TOAs and ovarian malignant tumors on DWI and the corresponding ADC values were evaluated, as well as clinical characteristics, morphological features, MRI findings were comparatively analyzed. Receiver operating characteristic (ROC) curve analysis based on logistic regression was applied to identify different imaging characteristics between the two patient groups and assess the predictive value of combination diagnosis with area under the curve (AUC) analysis. Results The mean ADC value of the cystic component in TOA was significantly lower than in malignant tumors (1.04 ± 0 .41 × 10−3 mm2/s vs. 2.42 ± 0.38 × 10−3 mm2/s; p < 0.001). The mean ADC value of the enhanced solid component in 26 TOAs was 1.43 ± 0.16×10−3mm2/s, and 46.2% (12 TOAs; pseudotumor areas) showed significantly higher signal intensity on DW-MRI than in ovarian malignancy (mean ADC value 1.44 ± 0.20×10−3 mm2/s vs.1.18 ± 0.36 × 10−3 mm2/s; p = 0.043). The combination diagnosis of ADC value and dilated tubal structure achieved the best AUC of 0.996. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of MRI vs. DWI with ADC values for predicting TOA were 47.1%, 91.4%, 84.2%, 64%, and 69.6% vs. 100%, 97.1%, 97.1%, 100%, and 98.6%, respectively. Conclusions DW-MRI is superior to MRI in the assessment of TOA mimicking ovarian malignancy, and the ADC values aid in discriminating the pseudotumor area of TOA from the solid portion of ovarian malignancy.
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Affiliation(s)
- Tingting Wang
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Wenhua Li
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
- * E-mail:
| | - Xiangru Wu
- Department of Pathology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Bing Yin
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Caiting Chu
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Ming Ding
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
| | - Yanfen Cui
- Department of Radiology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kong Jiang Road, Shanghai 200092, China
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