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Chen L, Xu J, Liu D, Ji B, Wang J, Zeng X, Zhang J, Feng L. High-resolution free-breathing hepatobiliary phase MRI of the liver using XD-GRASP. Magn Reson Imaging 2024; 109:42-48. [PMID: 38447629 DOI: 10.1016/j.mri.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/25/2024] [Accepted: 03/01/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE To evaluate the performance of high-resolution free-breathing (FB) hepatobiliary phase imaging of the liver using the eXtra-Dimension Golden-angle RAdial Sparse Parallel (XD-GRASP) MRI technique. METHODS Fifty-eight clinical patients (41 males, mean age = 52.9 ± 12.9) with liver lesions who underwent dynamic contrast-enhanced MRI with a liver-specific contrast agent were prospectively recruited for this study. Both breath-hold volumetric interpolated examination (BH-VIBE) imaging and FB imaging were performed during the hepatobiliary phase. FB images were acquired using a stack-of-stars golden-angle radial sequence and were reconstructed using the XD-GRASP method. Two experienced radiologists blinded to acquisition schemes independently scored the overall image quality, liver edge sharpness, hepatic vessel clarity, conspicuity of lesion, and overall artifact level of each image. The non-parametric paired two-tailed Wilcoxon signed-rank test was used for statistical analysis. RESULTS Compared to BH-VIBE images, XD-GRASP images received significantly higher scores (P < 0.05) for the liver edge sharpness (4.83 ± 0.45 vs 4.29 ± 0.46), the hepatic vessel clarity (4.64 ± 0.67 vs 4.15 ± 0.56) and the conspicuity of lesion (4.75 ± 0.53 vs 4.31 ± 0.50). There were no significant differences (P > 0.05) between BH-VIBE and XD-GRASP images for the overall image quality (4.61 ± 0.50 vs 4.74 ± 0.47) and the overall artifact level (4.13 ± 0.44 vs 4.05 ± 0.61). CONCLUSION Compared to conventional BH-VIBE MRI, FB radial acquisition combined with XD-GRASP reconstruction facilitates higher spatial resolution imaging of the liver during the hepatobiliary phase. This enhancement can significantly improve the visualization and evaluation of the liver.
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Affiliation(s)
- Lihua Chen
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Jian Xu
- Department of General Surgery, 904th Hospital, Wuxi, Jiangsu, China
| | - Daihong Liu
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China
| | - Bing Ji
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xianchun Zeng
- Department of Radiology, Guizhou Provincial People's Hospital, Guizhou, China.
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, School of Medicine, Chongqing University, Chongqing, China.
| | - Li Feng
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
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Afat S, Wessling D, Afat C, Nickel D, Arberet S, Herrmann J, Othman AE, Gassenmaier S. Analysis of a Deep Learning-Based Superresolution Algorithm Tailored to Partial Fourier Gradient Echo Sequences of the Abdomen at 1.5 T: Reduction of Breath-Hold Time and Improvement of Image Quality. Invest Radiol 2022; 57:157-162. [PMID: 34510101 DOI: 10.1097/rli.0000000000000825] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the feasibility and impact of a novel deep learning superresolution algorithm tailored to partial Fourier allowing retrospectively theoretical acquisition time reduction in 1.5 T T1-weighted gradient echo imaging of the abdomen. MATERIALS AND METHODS Fifty consecutive patients who underwent a 1.5 T contrast-enhanced magnetic resonance imaging examination of the abdomen between April and May 2021 were included in this retrospective study. After acquisition of a conventional T1-weighted volumetric interpolated breath-hold examination using Dixon for water-fat separation (VIBEStd), the acquired data were reprocessed including a superresolution algorithm that was optimized for partial Fourier acquisitions (VIBESR). To accelerate theoretically the acquisition process, a more aggressive partial Fourier setting was applied in VIBESR reconstructions practically corresponding to a shorter acquisition for the data included in the retrospective reconstruction. Precontrast, dynamic contrast-enhanced, and postcontrast data sets were processed. Image analysis was performed by 2 radiologists independently in a blinded random order without access to clinical data regarding the following criteria using a Likert scale ranging from 1 to 4 with 4 being the best: noise levels, sharpness and contrast of vessels, sharpness and contrast of organs and lymph nodes, overall image quality, diagnostic confidence, and lesion conspicuity.Wilcoxon signed rank test for paired data was applied to test for significance. RESULTS Mean patient age was 61 ± 14 years. Mean acquisition time for the conventional VIBEStd sequence was 15 ± 1 seconds versus theoretical 13 ± 1 seconds of acquired data used for the VIBESR reconstruction. Noise levels were evaluated to be better in VIBESR with a median of 4 (4-4) versus a median of 3 (3-3) in VIBEStd by both readers (P < 0.001). Sharpness and contrast of vessels as well as organs and lymph nodes were also evaluated to be superior in VIBESR compared with VIBEStd with a median of 4 (4-4) versus a median of 3 (3-3) (P < 0.001). Diagnostic confidence was also rated superior in VIBESR with a median of 4 (4-4) versus a median of 3.5 (3-4) in VIBEStd by reader 1 and with a median of 4 (4-4) for VIBESR and a median of 4 (4-4) for VIBEStd by reader 2 (both P < 0.001). CONCLUSIONS Image enhancement using deep learning-based superresolution tailored to partial Fourier acquisitions of T1-weighted gradient echo imaging of the abdomen provides improved image quality and diagnostic confidence in combination with more aggressive partial Fourier settings leading to shorter scan time.
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Affiliation(s)
- Saif Afat
- From the Departments of Diagnostic and Interventional Radiology
| | - Daniel Wessling
- From the Departments of Diagnostic and Interventional Radiology
| | - Carmen Afat
- Internal Medicine I, Eberhard Karls University Tuebingen, Tuebingen
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | - Simon Arberet
- Digital Technology and Innovation, Siemens Healthineers, Princeton, NJ
| | - Judith Herrmann
- From the Departments of Diagnostic and Interventional Radiology
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Gassenmaier S, Herrmann J, Nickel D, Kannengiesser S, Afat S, Seith F, Hoffmann R, Othman AE. Image Quality Improvement of Dynamic Contrast-Enhanced Gradient Echo Magnetic Resonance Imaging by Iterative Denoising and Edge Enhancement. Invest Radiol 2021; 56:465-470. [PMID: 33645949 DOI: 10.1097/rli.0000000000000761] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of a novel edge enhancement and iterative denoising algorithm in 1.5-T T1-weighted dynamic contrast-enhanced (DCE) gradient echo (GRE) magnetic resonance imaging of the abdomen on image quality, noise levels, diagnostic confidence, and lesion detectability. MATERIALS AND METHODS Fifty patients who underwent a clinically indicated magnetic resonance imaging with DCE imaging of the abdomen between June and August 2020 were included in this retrospective, monocentric, institutional review board-approved study. For DCE imaging, a series of 3 volume interpolated breath-hold examinations (VIBEs) was performed. The raw data of all DCE imaging studies were processed twice, once using standard reconstruction (DCES) and again using an edge enhancement and iterative denoising approach (DCEDE). All imaging studies were randomly reviewed by 2 radiologists independently regarding noise levels, arterial contrast, sharpness of vessels, overall image quality, and diagnostic confidence using a Likert scale ranging from 1 to 4, with 4 being the best. Furthermore, lesion detectability was evaluated using the same ranking system. RESULTS All 50 imaging studies were successfully reconstructed with both methods. Interreader agreement (Cohen κ) was substantial to perfect for both readers. Arterial contrast and sharpness of vessels were rated superior by both readers with a median of 4 in DCEDE versus a median of 3 in DCES (P < 0.001). Furthermore, noise levels as well as overall image quality were rated higher with a median of 4 in DCEDE compared with a median of 3 in DCES (P < 0.001). Lesion detectability was evaluated to be superior in DCEDE with a median of 4 versus DCES with a median of 3 (P < 0.001). Consequently, diagnostic confidence was also rated to be superior in DCEDE with a median of 4 versus DCES with a median of 3 (P < 0.001). CONCLUSIONS Iterative denoising and edge enhancement are feasible in DCE imaging of the abdomen providing superior arterial contrast, noise levels, and overall image quality. Furthermore, lesion detectability and diagnostic confidence were significantly improved using this novel reconstruction method. Further reduction of acquisition time might be possible via reduction of increased noise levels using this presented method.
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Affiliation(s)
- Sebastian Gassenmaier
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Judith Herrmann
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | | | - Saif Afat
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Ferdinand Seith
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Rüdiger Hoffmann
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Ahmed E Othman
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
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Harder FN, Budjan J, Nickel MD, Grimm R, Pietsch H, Schoenberg SO, Jost G, Attenberger UI. Intraindividual Comparison of Compressed Sensing-Accelerated Cartesian and Radial Arterial Phase Imaging of the Liver in an Experimental Tumor Model. Invest Radiol 2021; 56:433-441. [PMID: 33813577 DOI: 10.1097/rli.0000000000000767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to intraindividually compare the performance of 2 compressed sensing (CS)-accelerated magnetic resonance imaging (MRI) sequences, 1 featuring Cartesian (compressed sensing volumetric interpolated breath-hold examination [CS-VIBE]) and the other radial (golden-angle radial sparse parallel [GRASP]) k-space sampling in continuous dynamic imaging during hepatic vascular phases, using extracellular and hepatocyte-specific contrast agents. MATERIALS AND METHODS Seven New Zealand white rabbits, with induced VX2 liver tumors (median number of lesions, 2 ± 0.83; range, 1-3), received 2 continuously acquired T1-weighted prototype CS-accelerated MRI sequences (CS-VIBE and GRASP) with high spatial (0.8 × 0.8 × 1.5 mm) and temporal resolution (3.5 seconds) in randomized order on 2 separate days using a 1.5-T scanner. In all animals, imaging was performed using first gadobutrol at a dose of 0.1 mmol/kg and, then 45 minutes later, gadoxetic acid at a dose of 0.025 mmol/kg.The following qualitative parameters were assessed using 3- and 5-point Likert scales (3 and 5 being the highest scores respectively): image quality (IQ), arterial and venous vessel delineation, tumor enhancement, motion artifacts, and sequence-specific artifacts. Furthermore, the following quantitative parameters were obtained: relative peak signal enhancement, time to peak, mean transit time, and plasma flow ratios. Paired sampled t tests and Wilcoxon signed rank tests were used for intraindividual comparison. Image analysis was performed by 2 radiologists. RESULTS Six of 7 animals underwent the full imaging protocol and obtained data were analyzed statistically. Overall IQ was rated moderate to excellent, not differing significantly between the 2 sequences.Gadobutrol-enhanced CS-VIBE examinations revealed the highest mean Likert scale values in terms of vessel delineation and tumor enhancement (arterial 4.4 [4-5], venous 4.3 [3-5], and tumor 2.9 [2-3]). Significantly, more sequence-specific artifacts were seen in GRASP examinations (P = 0.008-0.031). However, these artifacts did not impair IQ. Excellent Likert scale ratings were found for motion artifacts in both sequences. In both sequences, a maximum of 4 hepatic arterial dominant phases were obtained. Regarding the relative peak signal enhancement, CS-VIBE and GRASP showed similar results. The relative peak signal enhancement values did not differ significantly between the 2 sequences in the aorta, the hepatic artery, or the inferior vena cava (P = 0.063-0.536). However, significantly higher values were noted for CS-VIBE in gadoxetic acid-enhanced examinations in the portal vein (P = 0.031) and regarding the tumor enhancement (P = 0.005). Time to peak and mean transit time or plasma flow ratios did not differ significantly between the sequences. CONCLUSIONS Both CS-VIBE and GRASP provide excellent results in dynamic liver MRI using extracellular and hepatocyte-specific contrast agents, in terms of IQ, peak signal intensity, and presence of artifacts.
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Affiliation(s)
- Felix N Harder
- From the Department of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich
| | | | | | | | | | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim
| | - Gregor Jost
- MR and CT Contrast Media Research, Bayer AG, Berlin
| | - Ulrike I Attenberger
- Department of Diagnostic and Interventional Radiology, University of Bonn, Bonn, Germany
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Gassenmaier S, Afat S, Nickel D, Kannengiesser S, Herrmann J, Hoffmann R, Othman AE. Application of a Novel Iterative Denoising and Image Enhancement Technique in T1-Weighted Precontrast and Postcontrast Gradient Echo Imaging of the Abdomen: Improvement of Image Quality and Diagnostic Confidence. Invest Radiol 2021; 56:328-334. [PMID: 33214390 DOI: 10.1097/rli.0000000000000746] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the impact of a novel iterative denoising and image enhancement technique in T1-weighted precontrast and postcontrast volume-interpolated breath-hold examination (VIBE) of the abdomen on image quality, noise levels, and diagnostic confidence without change of acquisition parameters. MATERIALS AND METHODS Fifty patients were included in this retrospective, monocentric, institutional review board-approved study after clinically indicated magnetic resonance imaging of the abdomen including T1-weighted precontrast and postcontrast imaging. After acquisition of the standard VIBE (VIBES), images were processed with a novel reconstruction algorithm using the same raw data as for VIBES, resulting in a denoised and enhanced dataset (VIBEDE). Two different radiologists evaluated both datasets in a randomized order regarding sharpness of organs as well as vessels, noise levels, artifacts, overall image quality, and diagnostic confidence using a Likert scale ranging from 1 to 4 with 4 being the best. Furthermore, in the presence of focal liver lesions, the largest lesion was measured in the postcontrast dataset, and lesion detectability was analyzed using a Likert scale (1-4). RESULTS Precontrast and postcontrast sharpness of organs and sharpness of vessels were rated significantly superior by both readers in VIBEDE with a median of 4 (interquartile range, 0) compared with VIBES with a median of 3 (1) (all P's < 0.0001). Precontrast and postcontrast noise levels were also rated superior by both readers in VIBEDE with a median of 4 (0) compared with VIBES with a median of 3 (1) for precontrast and a median of 3 (0) (median of 3 [1] for reader 2) for postcontrast imaging (all P's < 0.0001).Overall image quality was also rated higher with a median of 4 (0) in VIBEDE versus 3 (1) in VIBES (P < 0.0001). Twenty-seven imaging studies contained liver lesions. There was no difference regarding the number and localization between the readers and between VIBES and VIBEDE. Lesion detectability was rated by both readers significantly better in VIBEDE with a median of 4 (0) compared with a median of 4 (1) for reader 1 and a median of 3 (1) for reader 2 (P = 0.001 for reader 1; P < 0.001 for reader 2). Consequently, diagnostic confidence was also significantly superior in VIBEDE versus VIBES with a median of 4 (0) for both (P = 0.001). Interreader agreement resulted in a Cohen κ of 0.76 for precontrast analysis as well as of 0.76 for postcontrast analysis. CONCLUSIONS Application of a novel iterative denoising and image enhancement technique in T1-weighted VIBE precontrast and postcontrast imaging of the abdomen is feasible, providing superior image quality, noise levels, and diagnostic confidence.
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Affiliation(s)
- Sebastian Gassenmaier
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Saif Afat
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Dominik Nickel
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | | | - Judith Herrmann
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Rüdiger Hoffmann
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
| | - Ahmed E Othman
- From the Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tuebingen
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Almeida MC, Netto RORF, Melo JIF, Fernandes VAR, Manfredini RC, Dutra LD. Evaluation of hepatic findings by magnetic resonance after use of gadoxetic acid. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | | | - Luiz Dias Dutra
- Radiology and Diagnostic Imaging Center‐CERDIL Dourados Mato Grosso do Sul Brazil
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Assessment of the hepatic tumor extracellular matrix using elastin-specific molecular magnetic resonance imaging in an experimental rabbit cancer model. Sci Rep 2020; 10:20785. [PMID: 33247185 PMCID: PMC7695832 DOI: 10.1038/s41598-020-77624-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 10/29/2020] [Indexed: 01/03/2023] Open
Abstract
To investigate the imaging performance of an elastin-specific molecular magnetic resonance imaging (MRI) probe with respect to the extracellular matrix (ECM) in an experimental hepatic cancer model. Twelve rabbits with hepatic VX2 tumors were examined using 3 T MRI 14, 21, and 28 days after tumor implantation for two subsequent days (gadobutrol, day 1; elastin-specific probe, day 2). The relative enhancement (RE) of segmented tumor regions (central and margin) and the peritumoral matrix was calculated using pre-contrast and delayed-phase T1w sequences. MRI measurements were correlated to histopathology and element-specific and spatially resolved mass spectrometry (MS). Mixed-model analysis was performed to assess the performance of the elastin-specific probe. In comparison to gadobutrol, the elastin probe showed significantly stronger RE, which was pronounced in the tumor margin (day 14–28: P ≤ 0.007). In addition, the elastin probe was superior in discriminating between tumor regions (χ2(4) = 65.87; P < 0.001). MRI-based measurements of the elastin probe significantly correlated with the ex vivo elastinstain (R = .84; P <0 .001) and absolute gadolinium concentrations (ICP-MS: R = .73, P <0 .01). LA-ICP-MS imaging confirmed the colocalization of the elastin-specific probe with elastic fibers. Elastin-specific molecular MRI is superior to non-specific gadolinium-based contrast agents in imaging the ECM of hepatic tumors and the peritumoral tissue.
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Abstract
PURPOSE The aim of this study was to demonstrate the feasibility of hepatic perfusion imaging using dynamic contrast-enhanced (DCE) golden-angle radial sparse parallel (GRASP) magnetic resonance imaging (MRI) for characterizing liver parenchyma and hepatocellular carcinoma (HCC) before and after transarterial chemoembolization (TACE) as a potential alternative to volume perfusion computed tomography (VPCT). METHODS AND MATERIALS Between November 2017 and September 2018, 10 patients (male = 8; mean age, 66.5 ± 8.6 years) with HCC were included in this prospective, institutional review board-approved study. All patients underwent DCE GRASP MRI with high spatiotemporal resolution after injection of liver-specific MR contrast agent before and after TACE. In addition, VPCT was acquired before TACE serving as standard of reference. From the dynamic imaging data of DCE MRI and VPCT, perfusion maps (arterial liver perfusion [mL/100 mL/min], portal liver perfusion [mL/100 mL/min], hepatic perfusion index [%]) were calculated using a dual-input maximum slope model and compared with assess perfusion measures, lesion characteristics, and treatment response using Wilcoxon signed-rank test. To evaluate interreader agreement for measurement repeatability, the interclass correlation coefficient (ICC) was calculated. RESULTS Perfusion maps could be successfully generated from all DCE MRI and VPCT data. The ICC was excellent for all perfusion maps (ICC ≥ 0.88; P ≤ 0.001). Image analyses revealed perfusion parameters for DCE MRI and VPCT within the same absolute range for tumor and liver tissue. Dynamic contrast-enhanced MRI further enabled quantitative assessment of treatment response showing a significant decrease (P ≤ 0.01) of arterial liver perfusion and hepatic perfusion index in the target lesion after TACE. CONCLUSIONS Dynamic contrast-enhanced GRASP MRI allows for a reliable and robust assessment of hepatic perfusion parameters providing quantitative results comparable to VPCT and enables characterization of HCC before and after TACE, thus posing the potential to serve as an alternative to VPCT.
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Emara DM, El Shafei MM, El-Gendi A, Yousif AA. Is ultrasound elastography adding value in diagnosis of focal hepatic lesions? Our experience in a single-center study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0113-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The aim of this study was to assess the use of ultrasound elastography in differentiating hepatic lesions in order to increase the sensitivity and specificity of grey-scale ultrasound.
Methods
This study included 104 patients who were referred to the radiology department at Alexandria Main University Hospital for focal hepatic lesions detected by grey-scale ultrasound and were recommended to undergo further evaluation by ultrasound elastography. All studied patients were subjected to the following: (1) grey-scale ultrasound and ultrasound elastography using semiquantitative technique and (2) triphasic MDCT of the liver. MRI was done in 11 patients with malignant lesions; further confirmation with histopathological assessment was conducted.
Results
Benign lesions showed a low strain ratio, while malignant lesions showed a high strain ratio. The mean ratio in the benign lesions was 1.08 ± 0.40, while the mean ratio in the malignant lesions was 4.14 ± 1.25. The cut-off value used to diagnose the malignant lesions and differentiate these lesions from the benign lesions was 1.7, which had a sensitivity of 100%, specificity of 93.10%, PPV of 97.40% and NPV of 100%.
Conclusion
Ultrasound elastography is a promising non-invasive, non-contrast technique that can be added to routine grey-scale sonographic examinations of the liver to characterize hepatic lesions.
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Wáng YXJ, Wang X, Wu P, Wang Y, Chen W, Chen H, Li J. Topics on quantitative liver magnetic resonance imaging. Quant Imaging Med Surg 2019; 9:1840-1890. [PMID: 31867237 DOI: 10.21037/qims.2019.09.18] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Liver magnetic resonance imaging (MRI) is subject to continuous technical innovations through advances in hardware, sequence and novel contrast agent development. In order to utilize the abilities of liver MR to its full extent and perform high-quality efficient exams, it is mandatory to use the best imaging protocol, to minimize artifacts and to select the most adequate type of contrast agent. In this article, we review the routine clinical MR techniques applied currently and some latest developments of liver imaging techniques to help radiologists and technologists to better understand how to choose and optimize liver MRI protocols that can be used in clinical practice. This article covers topics on (I) fat signal suppression; (II) diffusion weighted imaging (DWI) and intravoxel incoherent motion (IVIM) analysis; (III) dynamic contrast-enhanced (DCE) MR imaging; (IV) liver fat quantification; (V) liver iron quantification; and (VI) scan speed acceleration.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | | | - Peng Wu
- Philips Healthcare (Suzhou) Co., Ltd., Suzhou 215024, China
| | - Yajie Wang
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Weibo Chen
- Philips Healthcare, Shanghai 200072, China.,Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai 200062, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing 100084, China
| | - Jianqi Li
- Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Electronic Science, East China Normal University, Shanghai 200062, China
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Jansen MJA, Kuijf HJ, Niekel M, Veldhuis WB, Wessels FJ, Viergever MA, Pluim JPW. Liver segmentation and metastases detection in MR images using convolutional neural networks. J Med Imaging (Bellingham) 2019; 6:044003. [PMID: 31620549 DOI: 10.1117/1.jmi.6.4.044003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 09/17/2019] [Indexed: 12/19/2022] Open
Abstract
Primary tumors have a high likelihood of developing metastases in the liver, and early detection of these metastases is crucial for patient outcome. We propose a method based on convolutional neural networks to detect liver metastases. First, the liver is automatically segmented using the six phases of abdominal dynamic contrast-enhanced (DCE) MR images. Next, DCE-MR and diffusion weighted MR images are used for metastases detection within the liver mask. The liver segmentations have a median Dice similarity coefficient of 0.95 compared with manual annotations. The metastases detection method has a sensitivity of 99.8% with a median of two false positives per image. The combination of the two MR sequences in a dual pathway network is proven valuable for the detection of liver metastases. In conclusion, a high quality liver segmentation can be obtained in which we can successfully detect liver metastases.
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Affiliation(s)
- Mariëlle J A Jansen
- UMC Utrecht and Utrecht University, Image Sciences Institute Utrecht, The Netherlands
| | - Hugo J Kuijf
- UMC Utrecht and Utrecht University, Image Sciences Institute Utrecht, The Netherlands
| | - Maarten Niekel
- UMC Utrecht, Department of Radiology Utrecht, The Netherlands
| | | | - Frank J Wessels
- UMC Utrecht, Department of Radiology Utrecht, The Netherlands
| | - Max A Viergever
- UMC Utrecht and Utrecht University, Image Sciences Institute Utrecht, The Netherlands
| | - Josien P W Pluim
- UMC Utrecht and Utrecht University, Image Sciences Institute Utrecht, The Netherlands
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12
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Jansen MJA, Kuijf HJ, Veldhuis WB, Wessels FJ, Viergever MA, Pluim JPW. Automatic classification of focal liver lesions based on MRI and risk factors. PLoS One 2019; 14:e0217053. [PMID: 31095624 PMCID: PMC6522218 DOI: 10.1371/journal.pone.0217053] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 05/03/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Accurate classification of focal liver lesions is an important part of liver disease diagnostics. In clinical practice, the lesion type is often determined from the abdominal MR examination, which includes T2-weighted and dynamic contrast enhanced (DCE) MR images. To date, only T2-weighted images are exploited for automatic classification of focal liver lesions. In this study additional MR sequences and risk factors are used for automatic classification to improve the results and to make a step forward to a clinically useful aid for radiologists. MATERIALS AND METHODS Clinical MRI data sets of 95 patients with in total 125 benign lesions (40 adenomas, 29 cysts and 56 hemangiomas) and 88 malignant lesions (30 hepatocellular carcinomas (HCC) and 58 metastases) were included in this study. Contrast curve, gray level histogram, and gray level co-occurrence matrix texture features were extracted from the DCE-MR and T2-weighted images. In addition, risk factors including the presence of steatosis, cirrhosis, and a known primary tumor were used as features. Fifty features with the highest ANOVA F-score were selected and fed to an extremely randomized trees classifier. The classifier evaluation was performed using the leave-one-out principle and receiver operating characteristic (ROC) curve analysis. RESULTS The overall accuracy for the classification of the five major focal liver lesion types is 0.77. The sensitivity/specificity is 0.80/0.78, 0.93/0.93, 0.84/0.82, 0.73/0.56, and 0.62/0.77 for adenoma, cyst, hemangioma, HCC, and metastasis, respectively. CONCLUSION The proposed classification system using features derived from clinical DCE-MR and T2-weighted images, with additional risk factors is able to differentiate five common types of lesions and is a step forward to a clinically useful aid for focal liver lesion diagnosis.
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Affiliation(s)
- Mariëlle J. A. Jansen
- Image Sciences Institute, University Medical Center Utrecht & Utrecht University, Utrecht, the Netherlands
- * E-mail:
| | - Hugo J. Kuijf
- Image Sciences Institute, University Medical Center Utrecht & Utrecht University, Utrecht, the Netherlands
| | - Wouter B. Veldhuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank J. Wessels
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Max A. Viergever
- Image Sciences Institute, University Medical Center Utrecht & Utrecht University, Utrecht, the Netherlands
| | - Josien P. W. Pluim
- Image Sciences Institute, University Medical Center Utrecht & Utrecht University, Utrecht, the Netherlands
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Abstract
OBJECTIVE The purposes of this article are to review a variety of pitfalls in liver imaging that can lead to the inaccurate diagnosis of focal hepatic lesions in cirrhosis, to describe the pathophysiologic processes of these pitfalls, and to provide specific clues for achieving the correct diagnoses. CONCLUSION Cirrhosis complicates liver imaging. The distortion and replacement of normal liver parenchyma by fibrous and regenerative tissue can change the typical appearance of many benign lesions, causing them to be misinterpreted as malignancy. In addition, the high incidence and prevalence of hepatocellular carcinoma among patients with cirrhosis put radiologists on high alert for any suspicious findings, especially because not all hepatocellular carcinomas have a typical imaging appearance.
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Comparison of End-Expiration Versus End-Inspiration Breath-Holds With Respect to Respiratory Motion Artifacts on T1-Weighted Abdominal MRI. AJR Am J Roentgenol 2019; 212:1024-1029. [PMID: 30835515 DOI: 10.2214/ajr.18.20239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE. The purpose of this study was to compare respiratory motion artifact and diagnostic image quality between end-inspiration and end-expiration breath-holding techniques on unenhanced and contrast-enhanced axial T1-weighted MRI of the liver. MATERIALS AND METHODS. This retrospective observational study included 50 consecutive subjects undergoing axial T1-weighted liver MRI, with unenhanced images acquired with both end-inspiration and end-expiration breath-holding techniques, and with contrast-enhanced images acquired for 47 of the subjects with either the end-inspiration or the end-expiration breath-holding technique. Three radiologists performed blinded independent evaluations of each unenhanced sequence, contrast-enhanced sequence, and subtraction (contrast-enhanced minus unenhanced) image, using a scale ranging from 1 point (denoting nondiagnostic imaging) to 5 points (denoting no artifacts). Blinded side-by-side assessment of each pair of unenhanced sequences was also performed. Two-tailed Wilcoxon signed rank and Wilcoxon rank sum tests were used to assess statistical significance. RESULTS. A significant improvement in motion scores was noted for sequences acquired in end-expiration, compared with those acquired in end-inspiration, for unenhanced sequences (mean, 3.35 vs 2.80; p < 0.00001), contrast-enhanced sequences (mean, 4.02 vs 3.46; p = 0.0003), and subtraction images (mean, 3.67 vs 2.41; p < 0.00001). Severe degradation of image quality or nondiagnostic image quality was noted for 15% of unenhanced images (23/150), 0% of contrast-enhanced images, and 8% (5/63) of subtraction images acquired on end-expiration, whereas it was noted for 36% (54/150) of unenhanced images, 13% (10/78) of contrast-enhanced images, and 59% (46/78) of subtraction images acquired on end-inspiration. When side-by-side assessment of paired unenhanced sequences was performed, images acquired in end-expiration were significantly favored in 59% of paired sequences (88/150) (p < 0.00001), and no difference between images acquired with both breath-hold techniques was noted for 21% (32/150) of paired sequences. CONCLUSION. The end-expiration breath-holding technique leads to significant decreases in respiratory motion artifacts, compared with the end-inspiration technique, on unenhanced and contrast-enhanced T1-weighted liver MRI.
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Chen J, Si Y, Zhao K, Shi X, Bi W, Liu SE, Hua H. Evaluation of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging in qualitative diagnosis of hepatic masses. BMC Med Imaging 2018; 18:56. [PMID: 30587152 PMCID: PMC6307244 DOI: 10.1186/s12880-018-0299-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 12/13/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To explore the value of parameters of multiphase dynamic contrast-enhanced magnetic resonance imaging (MDCE-MRI) in the qualitative diagnosis of hepatic masses. METHODS Eighty patients with hepatic masses were retrospectively analyzed. All the patients underwent MDCE-MRI at 3.0 T MR before treatment. Mean enhancement time (MET), positive enhancement integral (PEI), a maximum slope of increase (MSI), and a maximum slope of decrease (MSD) were measured. RESULTS There were significant differences between benign and malignant hepatic masses with respect to MET, PEI, and MSI values. The PEI and MSI values between hemangiomas, hepatocellular carcinomas (HCCs), cholangiocarcinomas, and metastatic tumors had significant differences. The MSD value between metastatic tumors, HCCs, and hemangiomas were significantly different. The area under the curve (AUC) values of the receiver operator characteristic curves for MET, PEI, and MSI were 0.70, 0.72, and 0.80, respectively. The specificity of MET, PEI, and MSI were all 77%, and the sensitivities of MSI was the highest, of which was 82.40%. Logistic regression analysis showed the regression equation to be P = 1/[1 + e0.008 × 1 + 0.007 × 2-6.707], and taking the Youden index maximum points as a diagnostic point was 0.2946. CONCLUSION Some parameters of MDCE-MRI have significant roles in differentiating hepatic masses.
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Affiliation(s)
- Jingjing Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Youjiao Si
- Department of Radiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong Province, China
| | - Kaikai Zhao
- Department of Oncology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, 264100, Shandong Province, China
| | - Xianglong Shi
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Weiqun Bi
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Shi-En Liu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong Province, China
| | - Hui Hua
- Department of Thyroid Surgery, The Affiliated Hospital of Qingdao University, No. 16 Jiangsu Road, Qingdao, 266000, Shandong Province, China.
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16
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Continuous Hepatic Arterial Multiphase Magnetic Resonance Imaging During Free-Breathing. Invest Radiol 2018; 53:596-601. [DOI: 10.1097/rli.0000000000000459] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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17
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Esteves C, Maia T, Lopes JM, Pimenta M. Malignant Solitary Fibrous Tumor of the Liver: AIRP Best Cases in Radiologic-Pathologic Correlation. Radiographics 2018; 37:2018-2025. [PMID: 29131777 DOI: 10.1148/rg.2017160200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Editor's Note.-RadioGraphics continues to publish radiologic-pathologic case material selected from the American Institute for Radiologic Pathology (AIRP) "best case" presentations. The AIRP conducts a 4-week Radiologic Pathology Correlation Course, which is offered five times per year. On the penultimate day of the course, the best case presentation is held at the American Film Institute Silver Theater and Cultural Center in Silver Spring, Md. The AIRP faculty identifies the best cases, from each organ system, brought by the resident attendees. One or more of the best cases from each of the five courses are then solicited for publication in RadioGraphics. These cases emphasize the importance of radiologic-pathologic correlation in the imaging evaluation and diagnosis of diseases encountered at the institute and its predecessor, the Armed Forces Institute of Pathology (AFIP).
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Affiliation(s)
- Cátia Esteves
- From the Departments of Radiology (C.E., M.P.) and Pathology (T.M., J.M.L.), Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; and Department of Pathology, Medical Faculty, Institute of Molecular Pathology and Immunology and the Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal (J.M.L.)
| | - Tiago Maia
- From the Departments of Radiology (C.E., M.P.) and Pathology (T.M., J.M.L.), Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; and Department of Pathology, Medical Faculty, Institute of Molecular Pathology and Immunology and the Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal (J.M.L.)
| | - José Manuel Lopes
- From the Departments of Radiology (C.E., M.P.) and Pathology (T.M., J.M.L.), Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; and Department of Pathology, Medical Faculty, Institute of Molecular Pathology and Immunology and the Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal (J.M.L.)
| | - Madalena Pimenta
- From the Departments of Radiology (C.E., M.P.) and Pathology (T.M., J.M.L.), Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; and Department of Pathology, Medical Faculty, Institute of Molecular Pathology and Immunology and the Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal (J.M.L.)
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18
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Zarghampour M, Fouladi DF, Pandey A, Ghasabeh MA, Pandey P, Varzaneh FN, Khoshpouri P, Shao N, Pan L, Grimm R, Kamel IR. Utility of volumetric contrast-enhanced and diffusion-weighted MRI in differentiating between common primary hypervascular liver tumors. J Magn Reson Imaging 2018; 48:1080-1090. [DOI: 10.1002/jmri.26032] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/15/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
- Manijeh Zarghampour
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Daniel F. Fouladi
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Ankur Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Mounes Aliyari Ghasabeh
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Pallavi Pandey
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Farnaz Najmi Varzaneh
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Pegah Khoshpouri
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Nannan Shao
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
| | - Li Pan
- Siemens Healthcare; Baltimore Maryland USA
| | | | - Ihab R. Kamel
- Russell H. Morgan Department of Radiology and Radiological Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland USA
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19
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Pahwa S, Liu H, Chen Y, Dastmalchian S, O'Connor G, Lu Z, Badve C, Yu A, Wright K, Chalian H, Rao S, Fu C, Vallines I, Griswold M, Seiberlich N, Zeng M, Gulani V. Quantitative perfusion imaging of neoplastic liver lesions: A multi-institution study. Sci Rep 2018; 8:4990. [PMID: 29563601 PMCID: PMC5862961 DOI: 10.1038/s41598-018-20726-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/16/2018] [Indexed: 12/14/2022] Open
Abstract
We describe multi-institutional experience using free-breathing, 3D Spiral GRAPPA-based quantitative perfusion MRI in characterizing neoplastic liver masses. 45 patients (age: 48–72 years) were prospectively recruited at University Hospitals, Cleveland, USA on a 3 Tesla (T) MRI, and at Zhongshan Hospital, Shanghai, China on a 1.5 T MRI. Contrast-enhanced volumetric T1-weighted images were acquired and a dual-input single-compartment model used to derive arterial fraction (AF), distribution volume (DV) and mean transit time (MTT) for the lesions and normal parenchyma. The measurements were compared using two-tailed Student’s t-test, with Bonferroni correction applied for multiple-comparison testing. 28 hepatocellular carcinoma (HCC) and 17 metastatic lesions were evaluated. No significant difference was noted in perfusion parameters of normal liver parenchyma and neoplastic masses at two centers (p = 0.62 for AF, 0.015 for DV, 0.42 for MTT for HCC, p = 0.13 for AF, 0.97 for DV, 0.78 for MTT for metastases). There was statistically significant difference in AF, DV, and MTT of metastases and AF and DV of HCC compared to normal liver parenchyma (p < 0.5/9 = 0.0055). A statistically significant difference was noted in the MTT of metastases compared to hepatocellular carcinoma (p < 0.001*10-5). In conclusion, 3D Spiral-GRAPPA enabled quantitative free-breathing perfusion MRI exam provides robust perfusion parameters.
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Affiliation(s)
- Shivani Pahwa
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Hao Liu
- Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Chen
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Sara Dastmalchian
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Gregory O'Connor
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Ziang Lu
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Chaitra Badve
- Radiology, University Hospitals, Cleveland, OH, United States
| | - Alice Yu
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Katherine Wright
- Radiology, Case Western Reserve University, Cleveland, OH, United States
| | - Hamid Chalian
- Radiology, University Hospitals, Cleveland, OH, United States
| | - Shengxiang Rao
- Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Caixia Fu
- Siemens Shenzhen Magnetic Resonance Ltd, Shenzhen, China
| | | | - Mark Griswold
- Radiology, Case Western Reserve University, Cleveland, OH, United States.,Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Nicole Seiberlich
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Mengsu Zeng
- Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Vikas Gulani
- Radiology, Case Western Reserve University, Cleveland, OH, United States. .,Radiology, University Hospitals, Cleveland, OH, United States.
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20
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Khalil A, Elgedawy J, Faramawi MF, Elfert A, Salama I, Abbass A, Elsaid H, Elsebaai H. Plasma Osteopontin Level as a Diagnostic Marker of Hepatocellular Carcinoma in Patients with Radiological Evidence of Focal Hepatic Lesions. TUMORI JOURNAL 2018; 99:100-7. [DOI: 10.1177/030089161309900117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims Hepatocellular carcinoma is one of the most aggressive malignant tumors and has limited treatment options. Needle-guided biopsies have been utilized as a tool to diagnose malignant focal hepatic lesions. These techniques are discouraged because of their complications. Nowadays, alpha fetoprotein is the most widely used tumor marker for screening and diagnosis of hepatocellular carcinoma. Nevertheless, this marker has limitations. The diagnostic role of plasma osteopontin as an adjuvant or alternative marker to alpha fetoprotein to detect hepatocellular carcinoma in Egyptian patients with focal hepatic lesions was evaluated in this study. Subject and methods Eighty participants were recruited from the Egyptian National Liver Institute and were self-assigned to three groups, namely, focal hepatic lesions (n = 40), liver cirrhosis (n = 20), and controls (n = 20). Participants' plasma osteopontin and serum alpha fetoprotein levels were determined and were compared across the three groups. Results The discriminatory ability of plasma osteopontin for hepatocellular carcinoma was lower than that of alpha fetoprotein. Osteopontin and alpha fetoprotein were not correlated with each other. Neither the gender nor the age of the patients showed a significant association with plasma osteopontin level. Conclusion Measuring plasma osteopontin level alone has no advantage over serum alpha fetoprotein in patients with focal hepatic lesions due to chronic liver disease.
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Affiliation(s)
- Ashraf Khalil
- Department of Biochemistry, National Liver Institute, Menoufiya University, Shebin Elkom
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia, Charlottesville, VA, USA
| | - Jamalat Elgedawy
- Department of Biochemistry, National Liver Institute, Menoufiya University, Shebin Elkom
| | - Mohammed F Faramawi
- Department of Epidemiology, National Liver Institute, Menoufiya University, Shebin Elkom, Egypt
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ashraf Elfert
- Department of Biochemistry, National Liver Institute, Menoufiya University, Shebin Elkom
| | - Ibrahim Salama
- Department of Hepatobillary Surgery, National Liver Institute, Menoufiya University, Shebin Elkom, Egypt
| | - Ahmed Abbass
- Department of Biochemistry, National Liver Institute, Menoufiya University, Shebin Elkom
| | - Hala Elsaid
- Department of Biochemistry, National Liver Institute, Menoufiya University, Shebin Elkom
| | - Hatem Elsebaai
- Department of Biochemistry, College of Medicine, Menoufiya University, Shebin Elkom
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21
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Zhang H, Wu Y, Xue W, Zuo P, Oesingmann N, Gan Q, Huang Z, Wu M, Hu F, Kuang M, Song B. Arterial spin labelling MRI for detecting pseudocapsule defects and predicting renal capsule invasion in renal cell carcinoma. Clin Radiol 2017; 72:936-943. [PMID: 28673449 DOI: 10.1016/j.crad.2017.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/06/2017] [Accepted: 06/06/2017] [Indexed: 02/08/2023]
Abstract
AIM To evaluate prospectively the performance of combining morphological and arterial spin labelling (ASL) magnetic resonance imaging (MRI) for detecting pseudocapsule defects in renal cell carcinoma (RCC), and to predict renal capsule invasion confirmed histopathologically. MATERIALS AND METHODS Twenty consecutive patients with suspicious renal tumours underwent MRI. Renal ASL imaging was performed and renal blood flow was measured quantitatively. The diagnostic performance of T2-weighted images alone, and a combination of T2-weighted and ASL images for predicting renal capsule invasion were assessed. RESULTS Twenty renal lesions were evaluated in 20 patients. All lesions were clear cell RCCs (ccRCCs) confirmed at post-surgical histopathology. Fifteen ccRCCs showed pseudocapsule defects on T2-weighted images, of which 12 cases showed existing blood flow in defect areas on perfusion images. To predict renal capsule invasion, the sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 71.4%, 86.7%, 100%, respectively, for T2-weighted images alone, and 92.3%, 100%, 100%, 87.5%, respectively, for the combination of T2-weighted and ASL images. CONCLUSION ASL images can reflect the perfusion of pseudocapsule defects and as such, the combination of T2-weighted and ASL images produces promising diagnostic accuracy for predicting renal capsule invasion.
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Affiliation(s)
- H Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Y Wu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu 611137, China
| | - W Xue
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - P Zuo
- Siemens Healthcare, MR Collaborations NE Asia, No. 7, Wangjing Zhonghuan Nanlu, Chaoyang District, Beijing 100102, China
| | - N Oesingmann
- Siemens HC, No. 511, Benedict Avenue, Tarrytown, NY 10591-5097, USA
| | - Q Gan
- Department of Neurosurgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - Z Huang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - M Wu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - F Hu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China
| | - M Kuang
- Department of Radiology, The Second Clinical Medicine School, Chengdu University of Traditional Chinese Medicine, No. 15, Section 4, Renmin South Road, Chengdu, Sichuan 610041, China
| | - B Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan 610041, China.
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Primary Hepatic Neoplasms of Vascular Origin: Key Imaging Features and Differential Diagnoses With Radiology-Pathology Correlation. AJR Am J Roentgenol 2017; 209:W350-W359. [PMID: 29023152 DOI: 10.2214/ajr.17.18100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This article describes, illustrates, and correlates imaging and pathologic features of primary vascular mesenchymal neoplasms of the liver, which arise from the vascular endothelium and perivascular epithelioid cells. CONCLUSION Familiarity with the spectrum of benign, malignant-potential and malignant vascular neoplasms, and nonneoplastic mimickers allows consideration in the differential diagnosis of enhancing hepatic masses. Understanding relevant pathologic features facilitates recognition of key imaging features, specifically dynamic contrast enhancement patterns on CT and MRI, which provide a useful classification system.
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23
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Burrowes DP, Medellin A, Harris AC, Milot L, Wilson SR. Contrast-enhanced US Approach to the Diagnosis of Focal Liver Masses. Radiographics 2017; 37:1388-1400. [DOI: 10.1148/rg.2017170034] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- David P. Burrowes
- From the Department of Radiology, University of Calgary, Calgary, Alberta, Canada (D.P.B., A.M., S.R.W.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (A.C.H.); and Department of Radiology, University of Toronto, Toronto, Ontario, Canada (L.M.). Recipient of a Magna Cum Laude award for an education exhibit at the 2016 RSNA Annual Meeting
| | - Alexandra Medellin
- From the Department of Radiology, University of Calgary, Calgary, Alberta, Canada (D.P.B., A.M., S.R.W.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (A.C.H.); and Department of Radiology, University of Toronto, Toronto, Ontario, Canada (L.M.). Recipient of a Magna Cum Laude award for an education exhibit at the 2016 RSNA Annual Meeting
| | - Allison C. Harris
- From the Department of Radiology, University of Calgary, Calgary, Alberta, Canada (D.P.B., A.M., S.R.W.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (A.C.H.); and Department of Radiology, University of Toronto, Toronto, Ontario, Canada (L.M.). Recipient of a Magna Cum Laude award for an education exhibit at the 2016 RSNA Annual Meeting
| | - Laurent Milot
- From the Department of Radiology, University of Calgary, Calgary, Alberta, Canada (D.P.B., A.M., S.R.W.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (A.C.H.); and Department of Radiology, University of Toronto, Toronto, Ontario, Canada (L.M.). Recipient of a Magna Cum Laude award for an education exhibit at the 2016 RSNA Annual Meeting
| | - Stephanie R. Wilson
- From the Department of Radiology, University of Calgary, Calgary, Alberta, Canada (D.P.B., A.M., S.R.W.); Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada (A.C.H.); and Department of Radiology, University of Toronto, Toronto, Ontario, Canada (L.M.). Recipient of a Magna Cum Laude award for an education exhibit at the 2016 RSNA Annual Meeting
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Gatos I, Tsantis S, Karamesini M, Spiliopoulos S, Karnabatidis D, Hazle JD, Kagadis GC. Focal liver lesions segmentation and classification in nonenhanced T2-weighted MRI. Med Phys 2017; 44:3695-3705. [PMID: 28432822 DOI: 10.1002/mp.12291] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/11/2017] [Accepted: 04/14/2017] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To automatically segment and classify focal liver lesions (FLLs) on nonenhanced T2-weighted magnetic resonance imaging (MRI) scans using a computer-aided diagnosis (CAD) algorithm. METHODS 71 FLLs (30 benign lesions, 19 hepatocellular carcinomas, and 22 metastases) on T2-weighted MRI scans were delineated by the proposed CAD scheme. The FLL segmentation procedure involved wavelet multiscale analysis to extract accurate edge information and mean intensity values for consecutive edges computed using horizontal and vertical analysis that were fed into the subsequent fuzzy C-means algorithm for final FLL border extraction. Texture information for each extracted lesion was derived using 42 first- and second-order textural features from grayscale value histogram, co-occurrence, and run-length matrices. Twelve morphological features were also extracted to capture any shape differentiation between classes. Feature selection was performed with stepwise multilinear regression analysis that led to a reduced feature subset. A multiclass Probabilistic Neural Network (PNN) classifier was then designed and used for lesion classification. PNN model evaluation was performed using the leave-one-out (LOO) method and receiver operating characteristic (ROC) curve analysis. RESULTS The mean overlap between the automatically segmented FLLs and the manual segmentations performed by radiologists was 0.91 ± 0.12. The highest classification accuracies in the PNN model for the benign, hepatocellular carcinoma, and metastatic FLLs were 94.1%, 91.4%, and 94.1%, respectively, with sensitivity/specificity values of 90%/97.3%, 89.5%/92.2%, and 90.9%/95.6% respectively. The overall classification accuracy for the proposed system was 90.1%. CONCLUSIONS Our diagnostic system using sophisticated FLL segmentation and classification algorithms is a powerful tool for routine clinical MRI-based liver evaluation and can be a supplement to contrast-enhanced MRI to prevent unnecessary invasive procedures.
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Affiliation(s)
- Ilias Gatos
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR, 26504, Greece
| | - Stavros Tsantis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR, 26504, Greece
| | - Maria Karamesini
- Department of Radiology, Magnitiki Patron Diagnostic Center, 105 Othonos-Amalias st, Patras, GR, 26222, Greece
| | - Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, University of Athens, Athens, GR, 12461, Greece
| | - Dimitris Karnabatidis
- Department of Radiology, School of Medicine, University of Patras, Rion, GR, 26504, Greece
| | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - George C Kagadis
- Department of Medical Physics, School of Medicine, University of Patras, Rion, GR, 26504, Greece
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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Fang J, Ma X, Yu D, Ma X, Xiang Y, Guo L. Specific imaging characteristic of solitary necrotic nodule of the liver: Marked peripheral rim-like enhancement with internal hypointensity on longer delayed MRI. Eur Radiol 2017; 27:3563-3573. [PMID: 28124105 DOI: 10.1007/s00330-017-4731-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 12/21/2016] [Accepted: 01/02/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To obtain specific imaging findings of solitary necrotic nodule of the liver (SNNL) using longer delayed contrast-enhanced MRI and compare them with those of three mimic hepatic diseases. METHODS Sixteen patients with SNNL underwent plain and contrast-enhanced triphasic CT and multiphasic MRI with delayed time prolonged to 2 h after contrast bolus injection. Twenty-three patients with mimic lesions including seven with eight HCCs, five with five iCCs and 11 with metastatic lesions served as the control group. Those patients also received plain and multiphasic contrast-enhanced MRI. Imaging features of lesions such as peripheral wash-out time were evaluated. RESULTS Among the 16 SNNLs, with a prolonged delayed MRI time, the enhancement degree of tumour periphery increased gradually. When it was up to 1 h, all lesions represented moderate/marked peripheral enhancement with internal hypointensity. However, the peripheral wash-out in seven HCCs (87.5%) and all metastatic lesions except three appeared at 10 or 15 min, one iCC (20%) at 30 min and the other lesions at 1 h. CONCLUSIONS Longer MRI with a delayed time of 1-2 h may be useful in diagnosis SNNL, revealing the specific imaging characteristic of SNNL as pronounced peripheral enhancement with internal hypointensity. KEY POINTS • Longer delayed MRI plays an important role in the diagnosis of SNNL. • Characteristic imaging feature of SNNL is pronounced peripheral enhancement with internal hypointensity. • Periphery wash-out time can differentiate SNNL from mimic diseases. • Imaging findings of SNNL on routine CT and MRI are unspecific.
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Affiliation(s)
- Jiayang Fang
- Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Ji'nan City, Shandong, China, 250012
| | - Xiaoyuan Ma
- Department of Orthopaedics, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Ji'nan City, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Ji'nan City, Shandong, China, 250012.
| | - Xiangxing Ma
- Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Ji'nan City, Shandong, China, 250012
| | - Ying Xiang
- Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Ji'nan City, Shandong, China, 250012
| | - Lijuan Guo
- Department of Radiology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Ji'nan City, Shandong, China, 250012
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Chavhan GB, Shelmerdine S, Jhaveri K, Babyn PS. Liver MR Imaging in Children: Current Concepts and Technique. Radiographics 2016; 36:1517-32. [DOI: 10.1148/rg.2016160017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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27
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Schernthaner RE, Haroun RR, Duran R, Lee H, Sahu S, Sohn JH, Chapiro J, Zhao Y, Gorodetski B, Fleckenstein F, Smolka S, Radaelli A, van der Bom IM, Lin M, Geschwind JF. Improved Visibility of Metastatic Disease in the Liver During Intra-Arterial Therapy Using Delayed Arterial Phase Cone-Beam CT. Cardiovasc Intervent Radiol 2016; 39:1429-37. [PMID: 27380872 PMCID: PMC5009166 DOI: 10.1007/s00270-016-1406-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 05/31/2016] [Indexed: 12/26/2022]
Abstract
Purpose To compare the visibility of liver metastases on dual-phase cone-beam CT (DP-CBCT) and digital subtraction angiography (DSA), with reference to preinterventional contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver. Methods This IRB-approved, retrospective study included 28 patients with neuroendocrine (NELM), colorectal (CRCLM), or sarcoma (SLM) liver metastases who underwent DP-CBCT during intra-arterial therapy (IAT) between 01/2010 and 10/2014. DP-CBCT was acquired after a single contrast agent injection in the tumor-feeding arteries at early and delayed arterial phases (EAP and DAP). The visibility of each lesion was graded by two radiologists in consensus on a three-rank scale (complete, partial, none) on DP-CBCT and DSA images using CE-MRI as reference. Results 47 NELM, 43 CRCLM, and 16 SLM were included. On DSA 85.1, 44.1, and 37.5 % of NELM, CRCLM, and SLM, were at least partially depicted, respectively. EAP-CBCT yielded significantly higher sensitivities of 88.3 and 87.5 % for CRCLM and SLM, respectively (p < 0.01), but not for NELM (89.4 %; p = 1.0). On DAP-CBCT all NELM, CRCLM, and SLM were visible (p < 0.001). Complete depiction was achieved on DSA for 59.6, 16.3, and 18.8 % of NELM, CRCLM, and SLM, respectively. The complete depiction rate on EAP-CBCT was significantly higher for CRCLM (46.5 %; p < 0.001), lower for NELM (40.4 %; p = 0.592), and similar for SLM (25 %, p = 0.399). On DAP-CBCT however, the highest rates of complete depiction were found—NELM (97.8 %; p = 0.008), CRCLM (95.3 %; p = 0.008), and SLM (100 %; p < 0.001). Conclusion DAP-CBCT substantially improved the visibility of liver metastases during IAT. Future studies need to evaluate the clinical impact.
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Affiliation(s)
- Ruediger E Schernthaner
- Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Reham R Haroun
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Rafael Duran
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Howard Lee
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Sonia Sahu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Jae Ho Sohn
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Julius Chapiro
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Yan Zhao
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Boris Gorodetski
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Florian Fleckenstein
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | - Susanne Smolka
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA
| | | | | | - MingDe Lin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.,U/S Imaging and Interventions, Philips Research North America, Cambridge, MA, USA
| | - Jean Francois Geschwind
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
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Cheung HMC, Law C, Shoichet M, Karanicolas PJ, Coburn N, Milot L. Appearance of Focal Liver Lesions Using Contrast-Enhanced Magnetic Resonance Imaging Using Gadofosveset Trisodium, an Intravascular (Blood-Pool) Contrast Agent: A Pictorial Essay. Can Assoc Radiol J 2016; 67:242-9. [PMID: 27318891 DOI: 10.1016/j.carj.2015.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 08/07/2015] [Accepted: 09/22/2015] [Indexed: 12/23/2022] Open
Affiliation(s)
- H M C Cheung
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - C Law
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - M Shoichet
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - P J Karanicolas
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - N Coburn
- Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - L Milot
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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Weiss J, Taron J, Othman AE, Grimm R, Kuendel M, Martirosian P, Ruff C, Schraml C, Nikolaou K, Notohamiprodjo M. Feasibility of self-gated isotropic radial late-phase MR imaging of the liver. Eur Radiol 2016; 27:985-994. [DOI: 10.1007/s00330-016-4433-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/15/2016] [Accepted: 05/20/2016] [Indexed: 12/13/2022]
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Agostini A, Kircher MF, Do RKG, Borgheresi A, Monti S, Giovagnoni A, Mannelli L. Magnetic Resonanance Imaging of the Liver (Including Biliary Contrast Agents)-Part 2: Protocols for Liver Magnetic Resonanance Imaging and Characterization of Common Focal Liver Lesions. Semin Roentgenol 2016; 51:317-333. [PMID: 27743568 DOI: 10.1053/j.ro.2016.05.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andrea Agostini
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, School of Radiology, Università Politecnica delle Marche, Ancona, Italy
| | - Moritz F Kircher
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Richard K G Do
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Alessandra Borgheresi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Radiology, School of Radiology, Università degli Studi di Firenze, Firenze, Italy
| | | | - Andrea Giovagnoni
- Department of Radiology, School of Radiology, Università Politecnica delle Marche, Ancona, Italy
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY.
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Abstract
The liver normally produces a large amount of lymph. It is estimated that between 25% and 50% of the lymph received by the thoracic duct comes from the liver. In normal conditions, hepatic lymphatics are not depicted on cross-sectional imaging. They are divided in lymphatics of deep system (lymphatics following the hepatic veins and the portal tract) and those of superficial system (convex surface and inferior surface). A variety of diseases may affect hepatic lymphatics and in general they manifest as lymphedema, lymphatic mass, or cystic lesions. Abnormal distended lymphatics are especially seen in periportal spaces as linear hypoattenuations on CT or strong linear hyperintensities on heavily T2-weighted MR imaging. Lymphatic tumor spread as in lymphoma and lymphangitic carcinomatosis manifests as periportal masses and regional lymph node enlargement. Lymphatic disruption after trauma or surgery is depicted as perihepatic fluid collections of lymph (lymphocele). Lymphatic malformation such as lymphangioma is seen on imaging as cystic spaces of variable size.
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32
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Kim R, Lee JM, Joo I, Lee DH, Woo S, Han JK, Choi BI. Differentiation of lipid poor angiomyolipoma from hepatocellular carcinoma on gadoxetic acid-enhanced liver MR imaging. ACTA ACUST UNITED AC 2015; 40:531-41. [PMID: 25231411 DOI: 10.1007/s00261-014-0244-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate magnetic resonance (MR) findings of angiomyolipoma (AML) on gadoxetic acid-enhanced MR imaging, and to identify features that differentiate AML from hepatocellular carcinoma (HCC) in patients with a low risk of HCC development. METHODS This retrospective study was institutional review board approved, and the requirement for informed consent was waived. Twelve patients with hepatic AML who underwent gadoxetic acid-enhanced MRI with no risk factors for HCC development were recruited. Twenty-seven patients with HCC under the same inclusion criteria were recruited as control. Two radiologists analyzed the images in consensus for morphologic features, enhancement patterns, and hepatobiliary phase (HBP) findings. All results were analyzed using the Mann-Whitney test, two-tailed Fisher exact test, and chi-square test. RESULTS Patients with AML were younger than those with HCC (48.8 ± 15 years for AML vs. 62.7 ± 14.2 years for HCC, p = 0.008) with female predominance, while most HCC patients were male (75% (9/12) vs. 15% (4/27), p < 0.001). The most prevalent enhancement pattern was arterial enhancement followed by hypointensity at portal or transitional phases for both AMLs (58% (7/12)) and HCCs (74% (20/27)) (p = 0.455). However, during the HBP, AMLs frequently showed more homogeneous hypointensity than HCCs (83% (10/12) vs. 41% (11/27), p = 0.018). When compared with the signal intensity of the spleen, the mean relative signal intensity of the AML was 91.2 ± 15.4%, while in HCCs, it was 128.7 ± 40% (p < 0.001). CONCLUSIONS Although AMLs showed similar enhancement patterns to HCCs during the dynamic phases of gadoxetic acid-enhanced MRI, using characteristic MR features of AML during the HBP and demographic differences, one can better differentiate AML from HCC.
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Affiliation(s)
- Rihyeon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Korea
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Jerraya H, Zidi-Mouaffek Y, Dokmak S, Dziri C. Insulinoma with focal hepatic lesions: malignant insulinoma? BMJ Case Rep 2015; 2015:bcr-2015-212811. [PMID: 26670896 DOI: 10.1136/bcr-2015-212811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Insulinoma is a rare tumour that is malignant in only 10% of cases. We report a case of insulinoma in a 59-year-old woman, associated with focal liver lesions, which raised the suspicion of malignancy of a pancreatic tumour. Enucleation of the insulinoma was performed with wedge resection of one hepatic nodule. Pathological examination indicated that the pancreatic tumour was compatible with insulinoma whereas the hepatic lesion was related to focal nodular hyperplasia. This clinical case highlights the need for histopathological proof of malignancy before selecting therapeutic strategies for insulinomas.
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Affiliation(s)
- Hichem Jerraya
- Faculty of Medicine, Department of Surgery, Tunis El Manar University, Tunis, Tunisia
| | - Yossra Zidi-Mouaffek
- Department of Pathology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Paris, Texas, USA
| | - Chadli Dziri
- Department "B" of General Surgery, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis, Tunisia
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Affiliation(s)
- Rafel Tappouni
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC.
| | - Michelle D Sakala
- Department of Radiology, Wake Forest University School of Medicine, Winston-Salem, NC
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Improved detection of hypervascular liver lesions with CAIPIRINHA-Dixon-TWIST-volume-interpolated breath-hold examination. Invest Radiol 2015; 50:153-60. [PMID: 25478742 DOI: 10.1097/rli.0000000000000118] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic performance of a dynamic, multiphasic contrast-enhanced volume-interpolated sequence with advanced parallel imaging techniques, Dixon fat saturation, and view sharing with 5 hepatic arterial subphases for the detection of focal liver lesions. MATERIALS AND METHODS Twenty-four consecutive patients (13 females, 11 males; mean [SD] age, 58 [15] years) with focal liver lesions were included in this prospective study. The examination was performed at a 3-T magnetic resonance imaging system (MAGNETOM Skyra; Siemens Healthcare, Erlangen, Germany). Five dynamic arterial subphases with a temporal resolution of 2.6 seconds, starting 17 seconds after injection of the hepatobiliary contrast agent gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Eovist; Bayer HealthCare, Leverkusen, Germany), were acquired using an accelerated parallel imaging volume-interpolated sequence with view sharing (multiarterial controlled aliasing in parallel imaging results in higher acceleration-Dixon-time-resolved angiography with interleaved stochastic trajectories-volumetric interpolated breath-hold examination [MA-CDT-VIBE]). The fourth of the 5 arterial acquisition phases (ie, at 24.8 seconds after the start of contrast agent injection) was considered the equivalent of a standard hepatic arterial phase (equivalent standard arterial phase [ESAP]). The diagnostic value of all 5 dynamic arterial phases for the detection of focal liver lesions, as compared with the single ESAP, was judged in 2 independent consensus readings. The 2 consensus reading groups were blinded to each others' results. The complete, comprehensive multisequence magnetic resonance imaging examination, including T1-weighted, T2-weighted, and multiphasic contrast-enhanced sequences, served as the standard of reference for lesion detection. RESULTS Forty-six percent of the patients (11/24) had hypervascular lesions. In 79 % of all patients (19/24), the best arterial parenchymal contrast of one of the MA-CDT-VIBE acquisition phases was considered better than that of the ESAP. In one third of all cases (8/24 for the first and 6/24 for the second consensus reading), MA-CDT-VIBE showed an improved lesion detection rate compared with ESAP, especially in hypervascular lesions (4/11, representing 36% of all patients with hypervascular lesions). There was a high degree of interrater agreement between the 2 consensus reading groups (the Cohen κ, 0.71-1.00; P < 0.001). CONCLUSIONS Compared with a standard hepatic arterial phase, MA-CDT-VIBE with 5 hepatic arterial subphases demonstrated greater diagnostic accuracy for the detection of hypervascular focal liver lesions and provided a robust and optimized hepatic arterial acquisition phase.
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Cancer therapy related complications in the liver, pancreas, and biliary system: an imaging perspective. Insights Imaging 2015; 6:665-77. [PMID: 26443452 PMCID: PMC4656242 DOI: 10.1007/s13244-015-0436-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/14/2015] [Accepted: 09/18/2015] [Indexed: 02/08/2023] Open
Abstract
UNLABELLED Awareness of cancer therapy-induced toxicities is important for all clinicians treating patients with cancer. Cancer therapy has evolved to include classic cytotoxic agents in addition to newer options such as targeted agents and catheter-directed chemoembolisation. Several adverse affects can result from the wide array of treatments including effects on the liver, pancreas, and biliary system that can be visualised on imaging. These complications include sinusoidal obstruction syndrome, fatty liver, pseudocirrhosis, acute hepatitis, pancreatitis, pancreatic atrophy, cholecystitis, biliary sclerosis, and biliary stasis. Many of these toxicities are manageable and reversible with supportive therapies and/or cessation of cancer therapy. The objective of this review is to discuss the imaging findings associated with cancer therapy-induced toxicity of the liver, biliary system, and pancreas. TEACHING POINTS • Cancer therapy can have adverse effects on the hepatobiliary system and pancreas. • Cancer therapy-induced toxicities can be visualised on imaging. • Knowledge of imaging changes associated with cancer therapy complications can improve treatment.
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Kwon HJ, Byun JH, Kim JY, Hong GS, Won HJ, Shin YM, Kim PN. Differentiation of small (≤2 cm) hepatocellular carcinomas from small benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted magnetic resonance images. ACTA ACUST UNITED AC 2015; 40:64-75. [PMID: 24997560 DOI: 10.1007/s00261-014-0188-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To identify imaging characteristics that differentiate small (≤2 cm) HCCs from small (≤2 cm) benign nodules in cirrhotic liver on gadoxetic acid-enhanced and diffusion-weighted (DW) magnetic resonance (MR) images. MATERIALS AND METHODS On gadoxetic acid-enhanced and DW MR images, we analysed signal intensity of 222 small HCCs and 61 benign nodules (diameter, 0.5-2 cm) at each sequence and rim enhancement during portal or equilibrium phases. Univariate and multivariate logistic regression analyses identified predictors of HCC. Combinations of significant MR findings in multivariate analysis were compared with American Association for the Study of Liver Disease (AASLD) practice guidelines. RESULTS In multivariate analysis, arterial enhancement (adjusted odds ratio [aOR], 8.6), T2 hyperintensity (aOR, 5.8), and hyperintensity on DW images (aOR, 3.8) were significant for differentiating small HCCs from benign nodules (p ≤ 0.004). When two or all three findings were applied as diagnostic criteria for differentiating small HCCs from benign nodules, sensitivity and accuracy were significantly higher compared with AASLD practice guidelines (91% vs. 78% and 89% vs. 81%, respectively; each p < 0.0001). CONCLUSION On gadoxetic acid-enhanced MR imaging, arterial enhancement and hyperintensity on T2-weighted and DW MR images are helpful for differentiating small HCCs from benign nodules in liver cirrhosis.
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Affiliation(s)
- Heon-Ju Kwon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Asanbyeongwon-gil 86, Songpa-ku, Seoul, 138-736, Korea
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Bae J, Lim HK, Park HY. Imaging findings for intravascular large B-cell lymphoma of the liver. Clin Mol Hepatol 2015; 21:295-9. [PMID: 26523272 PMCID: PMC4612291 DOI: 10.3350/cmh.2015.21.3.295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma that most commonly involves the central nervous system and skin. To our knowledge, no state-of-the art imaging findings have been reported for hepatic IVLBCL in the English literature. We report the first case of hepatic involvement of IVLBCL along with a literature review.
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Affiliation(s)
- Jungmin Bae
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Young Park
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Pötter-Lang S, Brancatelli G, Bastati-Huber N, Ba-Ssalamah A. [Modern diagnostics of cystic liver lesions and hemangiomas]. Radiologe 2015; 55:9-17. [PMID: 25575722 DOI: 10.1007/s00117-014-2703-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
CLINICAL ISSUE Cystic liver lesions incorporate a broad heterogeneous group of mostly benign but also malignant abnormalities. The radiological aim is the non-invasive diagnosis with the use of different imaging modalities to determine the type of lesion. STANDARD RADIOLOGICAL METHODS The common generally asymptomatic incidental findings of cystic lesions on ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) must be classified on the basis of specific imaging features. Such a differentiation is essential because the clinical consequences and the appropriate therapy can vary depending on the underlying pathology. Due to the morphological overlap of many cystic lesions, conventional radiological methods are often insufficient. METHODICAL INNOVATIONS The huge advances in cross-sectional imaging (multidetector CT, MRI with special sequences and different contrast agents and MR cholangiopancreatography) in combination with the clinical history usually enable a non-invasive diagnosis. Pathognomonic morphological and hemodynamic lesion features, as well as a knowledge of the pathomechanisms, help to differentiate this broad spectrum of entities. ACHIEVEMENTS In this article the different entities of cystic liver lesions, together with the appropriate diagnostic method for detection and distinction and including their strengths and limitations, are demonstrated. PRACTICAL RECOMMENDATIONS A well-founded knowledge about the development of various cystic liver lesions and the suitable choice of imaging method facilitate a non-invasive diagnosis.
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Affiliation(s)
- S Pötter-Lang
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Wien, Österreich,
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Gatos I, Tsantis S, Karamesini M, Skouroliakou A, Kagadis G. Development of a Support Vector Machine - Based Image Analysis System for Focal Liver Lesions Classification in Magnetic Resonance Images. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/1742-6596/633/1/012116] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cornfeld D, Nowak M, Spektor M. Optimizing Liver Magnetic Resonance Imaging: Does Intuitive Protocol Management Software Save Time and Produce Better Scans than Manually Optimized Protocols? J Comput Assist Tomogr 2015; 39:702-8. [PMID: 26176426 DOI: 10.1097/rct.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of this study is to determine if a software package (Abdomen DOT; Siemens Medical Systems, Erlangen Germany) designed to automate magnetic resonance imaging (MRI) scans of the liver results in faster and higher quality examinations compared to optimized protocols performed by appropriately trained technologists. MATERIALS AND METHODS One hundred eight liver MRIs obtained using Abdomen DOT and 94 liver MRIs obtained without Abdomen DOT were retrospectively reviewed. Total scan time and the number of repeated sequences were objectively measured. Timing of the arterial phase, motion artifact, and quality of subtraction images were subjectively evaluated. RESULTS The examinations scanned using Abdomen DOT averaged 2 minutes and 2 seconds shorter than the examinations scanned without Abdomen DOT (P = 0.004) and on average, fewer sequences were repeated. The arterial phase was timed correctly 67% (63/94) of the time without using Abdomen DOT and 81% (87/108) of the time when using Abdomen DOT (P = 0.019). There was no difference in the amount of respiratory artifact. The subtraction images obtained using Abdomen DOT were considered slightly better (P < 0.005 for arterial, portal venous, and equilibrium phase images). CONCLUSIONS The Abdomen DOT software helped our technologists scan slightly faster and obtain correctly timed arterial phase images more often.
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Affiliation(s)
- Daniel Cornfeld
- From the *Department of Diagnostic Radiology, Yale School of Medicine, New Haven; and †Department of Medicine, St. Vincents Medical Center, Hartford, CT
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Alqatie A, Mann E, Moineddin R, Kamath BM, Chavhan GB. Solitary liver lesions in children: interobserver agreement and accuracy of MRI diagnosis. Clin Imaging 2015; 39:442-8. [DOI: 10.1016/j.clinimag.2014.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 10/27/2014] [Accepted: 11/17/2014] [Indexed: 12/15/2022]
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Abstract
Different imaging modalities including ultrasonography, computed tomography (CT), and MR imaging may be used in the liver depending on the clinical situation. The ability of dedicated contrast-enhanced liver MR imaging or CT to definitively characterize lesions as benign is crucial in avoiding unnecessary biopsy. Liver imaging surveillance in patients with cirrhosis may allow for detection of hepatocellular carcinoma at an earlier stage, and therefore may improve outcome. This article reviews the different imaging modalities used to evaluate the liver and focal benign and malignant hepatic lesions, and the basic surveillance strategy for patients at increased risk for hepatocellular carcinoma.
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Affiliation(s)
- Erin K O'Neill
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA
| | - Jonathan R Cogley
- Department of Radiology, VA Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215, USA
| | - Frank H Miller
- Body Imaging Section, Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street, Suite 800, Chicago, IL 60611, USA.
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Koenigkam-Santos M, Optazaite E, Sommer G, Safi S, Heussel CP, Kauczor HU, Puderbach M. Contrast-enhanced magnetic resonance imaging of pulmonary lesions: Description of a technique aiming clinical practice. Eur J Radiol 2015; 84:185-192. [DOI: 10.1016/j.ejrad.2014.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/04/2014] [Accepted: 10/08/2014] [Indexed: 12/26/2022]
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Mungai F, Morone M, Villanacci A, Bondioni MP, Mazzoni LN, Grazioli L, Colagrande S. Diffusion weighted MR and apparent diffusion coefficient measurement in classification and characterization of noncystic focal liver lesions: does a clinical role exist? Medicine (Baltimore) 2014; 93:e40. [PMID: 25058143 PMCID: PMC4602426 DOI: 10.1097/md.0000000000000040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The objective of this study was to assess the clinical role of apparent diffusion coefficient (ADC) analysis in noncystic focal liver lesion (FLL) classification/characterization.Six hundred liver magnetic resonances with multi-b (b = 50, 400, 800 s/mm) diffusion-weighted imaging (DwI) were retrospectively reviewed. Mean ADC was measured in 388 lesions (195 benign and 193 malignant) excluding internal necrotic areas. Cystic benign lesions were excluded from analysis. Sensitivity and specificity in distinguishing benign from malignant lesions were calculated. Analysis of variance was performed to detect differences among subgroups of solid lesions.Mean ADC of malignant lesions was 0.980 × 10 mm/s, significantly (P < 0.05) lower than mean ADC of benign lesions (1.433 × 10 mm/s). Applying an ADC cutoff of 1.066 × 10 mm/s, specificity and sensitivity for malignancy were respectively 86.6% and 73.6%. Of all lesions, >1/3 (39.5%) presented values lower than 1 × 10 mm/s, with 90.0% chance of malignancy. Above 1.5 × 10 mm/s (about 20% of all lesions) chance of malignancy was 9.5%.DwI cannot assist in noncystic FLL characterization, but can help in FLL classification in about half the cases.
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Affiliation(s)
- Francesco Mungai
- Department of Radiology (MM, MPB, LG), Institute of Hygiene, Epidemiology and Public Health, University of Brescia, Spedali Civili di Brescia, Piazzale Spedali Civili 1, Brescia, Department of Radiology (AV), Ospedale S. Cuore di Gesù, Viale Principe di Napoli, 14/A, Benevento, and Department of Experimental and Clinical Biomedical Sciences (FM, SC), Radiodiagnostic Unit no. 2 and Department of Physics (LNM), University of Florence, Azienda Ospedaliero, Universitaria Careggi, Largo Brambilla 3, Florence, Italy
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Roy S, Chi Y, Liu J, Venkatesh SK, Brown MS. Three-dimensional spatiotemporal features for fast content-based retrieval of focal liver lesions. IEEE Trans Biomed Eng 2014; 61:2768-78. [PMID: 24919041 DOI: 10.1109/tbme.2014.2329057] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Content-based image retrieval systems for 3-D medical datasets still largely rely on 2-D image-based features extracted from a few representative slices of the image stack. Most 2 -D features that are currently used in the literature not only model a 3-D tumor incompletely but are also highly expensive in terms of computation time, especially for high-resolution datasets. Radiologist-specified semantic labels are sometimes used along with image-based 2-D features to improve the retrieval performance. Since radiological labels show large interuser variability, are often unstructured, and require user interaction, their use as lesion characterizing features is highly subjective, tedious, and slow. In this paper, we propose a 3-D image-based spatiotemporal feature extraction framework for fast content-based retrieval of focal liver lesions. All the features are computer generated and are extracted from four-phase abdominal CT images. Retrieval performance and query processing times for the proposed framework is evaluated on a database of 44 hepatic lesions comprising of five pathological types. Bull's eye percentage score above 85% is achieved for three out of the five lesion pathologies and for 98% of query lesions, at least one same type of lesion is ranked among the top two retrieved results. Experiments show that the proposed system's query processing is more than 20 times faster than other already published systems that use 2-D features. With fast computation time and high retrieval accuracy, the proposed system has the potential to be used as an assistant to radiologists for routine hepatic tumor diagnosis.
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Schmid-Tannwald C, Thomas S, Ivancevic MK, Dahi F, Rist C, Sethi I, Oto A. Diffusion-weighted MRI of metastatic liver lesions: is there a difference between hypervascular and hypovascular metastases? Acta Radiol 2014; 55:515-23. [PMID: 23986455 DOI: 10.1177/0284185113501493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Different perfusion characteristics and histopathologic features of liver metastasis may potentially lead to different diffusion-weighted magnetic resonance imaging (DW-MRI) characteristics which can affect the performance of DW-MRI in their diagnosis. PURPOSE To compare ADC values of hypervascular and hypovascular metastases and the added value of DW-MRI to T2-weighted (T2-w) images in their detection. MATERIAL AND METHODS In this retrospective study, 46 patients (21 with hypervascular, 25 with hypovascular liver metastases) who had undergone abdominal MRI were included. Two independent observers first reviewed T2-w images only and then T2-w+DW-MR images and recorded number of metastases in each session. Lesion detection rate was compared using McNemar test. ADC of metastases in each patient was measured and compared between hypo- and hypervascular lesions using t-test. RESULTS A total of 153 hypervascular and 187 hypovascular metastases were detected at consensus review. Two observers detected significantly more hypervascular metastases on T2-w+DW-MR image review session compared to T2-w image only review session (reader 1: 148 [96.7%] vs. 129 [84.3%], P=0.002; reader 2: 125 [81.9%] vs. 113 [73.8%], P=0.004). Detection rate of hypovascular metastases was similar between two sessions for both observers (reader 1: 180 [96.2%] vs. 184 [98.4%]; reader 2: 176 [94.1%] vs. 180 [96.2%], P>0.05). The mean ADC value of hypervascular metastases was significantly lower than mean ADC value of hypovascular metastases (1.23+/-0.31 × 10(-3)mm(2)/s vs. 1.49+/-0.19 × 10(-3)mm(2)/s) (P=0.001). CONCLUSION Liver metastases are not a homogenous group of lesions with uniform DW-MRI features. Hypervascular metastases demonstrate significantly lower ADC values compared to hypovascular metastases. DW-MRI improved detection of hypervascular metastases compared to T2-w images alone and is a useful adjunct to T2-w images for their detection.
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Affiliation(s)
- Christine Schmid-Tannwald
- The University of Chicago, Department of Radiology, Chicago, IL, USA
- Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich, Germany
| | - Stephen Thomas
- The University of Chicago, Department of Radiology, Chicago, IL, USA
| | - Marko K Ivancevic
- The University of Chicago, Department of Radiology, Chicago, IL, USA
- Philips Healthcare, MR Clinical Science, Cleveland, OH, USA
| | - Farid Dahi
- The University of Chicago, Department of Radiology, Chicago, IL, USA
| | - Carsten Rist
- Ludwig-Maximilians-University Hospital Munich, Institute for Clinical Radiology, Munich, Germany
| | - Ila Sethi
- The University of Chicago, Department of Radiology, Chicago, IL, USA
| | - Aytekin Oto
- The University of Chicago, Department of Radiology, Chicago, IL, USA
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Lin YH, Hwang RM, Chen BB, Hsu CY, Yu CW, Kao JH, Lee HS, Liang PC, Wei SY, Shih TTF. Vascular and hepatic enhancements at MR imaging: comparison of Gd-EOB-DTPA and Gd-DTPA in the same subjects. Clin Imaging 2014; 38:287-91. [DOI: 10.1016/j.clinimag.2014.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/19/2013] [Accepted: 01/06/2014] [Indexed: 12/14/2022]
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Roth CG, Mitchell DG. Hepatocellular carcinoma and other hepatic malignancies: MR imaging. Radiol Clin North Am 2014; 52:683-707. [PMID: 24889167 DOI: 10.1016/j.rcl.2014.02.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Magnetic resonance (MR) imaging surpasses all other imaging modalities in characterizing liver lesions by virtue of the exquisite tissue contrast, specificity for various tissue types, and extreme sensitivity to contrast enhancement. In addition to differentiating benign from malignant lesions, MR imaging generally discriminates between the various malignant liver lesions. Hepatocellular carcinoma constitutes most primary malignant liver lesions and usually arises in the setting of cirrhosis. Intrahepatic cholangiocarcinoma is a distant second and features distinctly different imaging features. Overall, metastases are the most common malignant liver lesions and arise from several primary neoplasms; most commonly gastrointestinal, lung, breast, and genitourinary.
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Affiliation(s)
- Christopher G Roth
- Department of Radiology, TJUH, Methodist, Thomas Jefferson University, 2301 South Broad Street, Philadelphia, PA 19148, USA.
| | - Donald G Mitchell
- Department of Radiology, Thomas Jefferson University, 1094 Main Building, 132 South 10th Street, Philadelphia, PA 19107, USA
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Qian LJ, Zhu J, Zhuang ZG, Xia Q, Liu Q, Xu JR. Spectrum of multilocular cystic hepatic lesions: CT and MR imaging findings with pathologic correlation. Radiographics 2014; 33:1419-33. [PMID: 24025933 DOI: 10.1148/rg.335125063] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A multilocular cystic hepatic lesion detected at computed tomography (CT) and magnetic resonance (MR) imaging is a common but nonspecific radiologic finding that can cause potential challenges for differential diagnosis. This imaging pattern may be observed in a wide spectrum of common and uncommon neoplastic or nonneoplastic entities. Neoplastic lesions include cystadenoma, cystadenocarcinoma, hepatocellular carcinoma (HCC), metastases, mesenchymal hamartoma, and inflammatory myofibroblastic tumor. Nonneoplastic lesions include hepatic abscess, echinococcal cyst, intrahepatic hematoma, and biloma. The multiple coalescent cysts seen in polycystic liver disease may exhibit an imaging pattern similar to that of a multilocular cystic lesion. Mural nodularity, irregular thickness of the septa, ragged inner surface, and typical enhancement pattern in the solid portion of the lesion are often indicative of malignancy, although multilocular primary or secondary malignant tumors are uncommon. Recognition of the more common necrosis or cystic change of HCC and metastases induced by locoregional or systemic treatment also is important. The nonenhanced cystic component may be composed of different types of fluids (eg, serous, mucinous, proteinaceous, hemorrhagic, bilious, or mixed) or spontaneous or treatment-related necrosis, whereas the septa may be formed by a wide range of tissues depending on the lesion type. An understanding of the CT and MR imaging findings of these lesions and their respective pathologic correlation aids in accurate diagnosis.
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Affiliation(s)
- Li Jun Qian
- Departments of Radiology, Hepatic Surgery, and Pathology, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 1630 Dongfang Rd, Pudong, Shanghai 200127, P.R. China
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