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Renzulli M, Brandi N, Argalia G, Brocchi S, Farolfi A, Fanti S, Golfieri R. Morphological, dynamic and functional characteristics of liver pseudolesions and benign lesions. Radiol Med 2022; 127:129-144. [PMID: 35028886 DOI: 10.1007/s11547-022-01449-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/30/2021] [Indexed: 12/21/2022]
Abstract
Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related deaths worldwide and one of the most common causes of death among patients with cirrhosis, developing in 1-8% of them every year, regardless of their cirrhotic stage. The radiological features of HCC are almost always sufficient for reaching the diagnosis; thus, histological confirmation is rarely needed. However, the study of cirrhotic livers remains a challenge for radiologists due to the developing of fibrous and regenerative tissue that cause the distortion of normal liver parenchyma, changing the typical appearances of benign lesions and pseudolesions, which therefore may be misinterpreted as malignancies. In addition, a correct distinction between pseudolesions and malignancy is crucial to allow appropriate targeted therapy and avoid treatment delays.The present review encompasses technical pitfalls and describes focal benign lesions and pseudolesions that may be misinterpreted as HCC in cirrhotic livers, providing the imaging features of regenerative nodules, large regenerative nodules, siderotic nodules, hepatic hemangiomas (including rapidly filling and sclerosed hemangiomas), segmental hyperplasia, arterioportal shunts, focal confluent fibrosis and focal fatty changes. Lastly, the present review explores the most promising new imaging techniques that are emerging and that could help radiologists differentiate benign lesions and pseudolesions from overt HCC.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia.
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia
| | - Giulia Argalia
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefano Brocchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia
| | - Andrea Farolfi
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Stefano Fanti
- Division of Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Via Albertoni 15, Bologna, Italia
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Pan L, Chen J, Xing W, Xing Z, Zhang J, Peng Y, Zhang Z. Magnetic resonance imaging evaluation of renal ischaemia-reperfusion injury in a rabbit model. Exp Physiol 2017; 102:1000-1006. [PMID: 28470945 DOI: 10.1113/ep086203] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 04/24/2017] [Indexed: 02/06/2023]
Abstract
NEW FINDINGS What is the central question of this study? Renal ischaemia-reperfusion injury occurs in various clinical settings. The clinical diagnosis of ischaemia-reperfusion injury is routinely based on biochemical and haematological tests, which cannot evaluate the function of a single kidney. New magnetic resonance imaging techniques to identify the pathophysiological changes in the renal outer medulla were evaluated. What is the main finding and its importance? This study demonstrated that susceptibility-weighted imaging is a feasible non-invasive tool for imaging and evaluating physipathological changes in the renal outer medulla after ischaemia-reperfusion injury. The aim was to evaluate the feasibility of susceptibility-weighted imaging (SWI) as a tool to identify the changes in the renal outer medulla (OM) in a rabbit model of renal ischaemia-reperfusion injury (IRI). New Zealand rabbits were used (control group n = 10; IRI group n = 40). The rabbits in the IRI group were subjected to left renal artery clamping for 60 min. T2-weighted (T2WI) and SWI examinations were performed at 1, 12, 24 or 48 h after reperfusion (each n = 10). After the examinations, the kidneys were submitted to histological evaluation. The contrast-to-noise ratio (CNR) for the left renal OM was measured using T2WI and SWI. The T2WI and SWI scores of the integrity of the renal OM were evaluated. There were significant differences between T2WI CNRs and SWI CNRs in the control group and the IRI 1, 12 and 48 h time points (all P < 0.05). No significant difference was found between T2WI and SWI CNRs at IRI 24 h (P > 0.05). The mean SWI scores of renal OM in the IRI 1 and 12 h subgroups were both significantly lower than that in the control group (all P < 0.05). The only significant difference in the mean T2WI scores of renal OM was observed between the control and IRI 1 h groups (P < 0.05). Susceptibility-weighted imaging has a significant advantage in evaluation of healthy renal OM over conventional magnetic resonance imaging, and it is a feasible non-invasive tool for imaging and evaluating changes in the renal OM after IRI.
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Affiliation(s)
- Liang Pan
- Department of Radiology, the Third Affiliated Hospital of Suzhou University, Changzhou, People's Republic of China
| | - Jie Chen
- Department of Radiology, the Third Affiliated Hospital of Suzhou University, Changzhou, People's Republic of China.,Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China
| | - Wei Xing
- Department of Radiology, the Third Affiliated Hospital of Suzhou University, Changzhou, People's Republic of China
| | - Zhaoyu Xing
- Department of Urology, the Third Affiliated Hospital of Suzhou University, Changzhou, People's Republic of China
| | - Jinggang Zhang
- Department of Radiology, the Third Affiliated Hospital of Suzhou University, Changzhou, People's Republic of China
| | - Yan Peng
- Department of Pathology, the Third Affiliated Hospital of Suzhou University, Changzhou, People's Republic of China
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Yang ZX, Liang HY, Hu XX, Huang YQ, Ding Y, Yang S, Zeng MS, Rao SX. Feasibility of histogram analysis of susceptibility-weighted MRI for staging of liver fibrosis. Diagn Interv Radiol 2017; 22:301-7. [PMID: 27113421 DOI: 10.5152/dir.2016.15284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE We aimed to evaluate whether histogram analysis of susceptibility-weighted imaging (SWI) could quantify liver fibrosis grade in patients with chronic liver disease (CLD). METHODS Fifty-three patients with CLD who underwent multi-echo SWI (TEs of 2.5, 5, and 10 ms) were included. Histogram analysis of SWI images were performed and mean, variance, skewness, kurtosis, and the 1st, 10th, 50th, 90th, and 99th percentiles were derived. Quantitative histogram parameters were compared. For significant parameters, further receiver operating characteristic (ROC) analyses were performed to evaluate the potential diagnostic performance for differentiating liver fibrosis stages. RESULTS The number of patients in each pathologic fibrosis grade was 7, 3, 5, 5, and 33 for F0, F1, F2, F3, and F4, respectively. The results of variance (TE: 10 ms), 90th percentile (TE: 10 ms), and 99th percentile (TE: 10 and 5 ms) in F0-F3 group were significantly lower than in F4 group, with areas under the ROC curves (AUCs) of 0.84 for variance and 0.70-0.73 for the 90th and 99th percentiles, respectively. The results of variance (TE: 10 and 5 ms), 99th percentile (TE: 10 ms), and skewness (TE: 2.5 and 5 ms) in F0-F2 group were smaller than those of F3/F4 group, with AUCs of 0.88 and 0.69 for variance (TE: 10 and 5 ms, respectively), 0.68 for 99th percentile (TE: 10 ms), and 0.73 and 0.68 for skewness (TE: 2.5 and 5 ms, respectively). CONCLUSION Magnetic resonance histogram analysis of SWI, particularly the variance, is promising for predicting advanced liver fibrosis and cirrhosis.
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Affiliation(s)
- Zhao Xia Yang
- Department of Radiology, Zhongshan Hospital of Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.
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Liu S, Buch S, Chen Y, Choi HS, Dai Y, Habib C, Hu J, Jung JY, Luo Y, Utriainen D, Wang M, Wu D, Xia S, Haacke EM. Susceptibility-weighted imaging: current status and future directions. NMR IN BIOMEDICINE 2017; 30:10.1002/nbm.3552. [PMID: 27192086 PMCID: PMC5116013 DOI: 10.1002/nbm.3552] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 04/01/2016] [Accepted: 04/11/2016] [Indexed: 05/14/2023]
Abstract
Susceptibility-weighted imaging (SWI) is a method that uses the intrinsic nature of local magnetic fields to enhance image contrast in order to improve the visibility of various susceptibility sources and to facilitate diagnostic interpretation. It is also the precursor to the concept of the use of phase for quantitative susceptibility mapping (QSM). Nowadays, SWI has become a widely used clinical tool to image deoxyhemoglobin in veins, iron deposition in the brain, hemorrhages, microbleeds and calcification. In this article, we review the basics of SWI, including data acquisition, data reconstruction and post-processing. In particular, the source of cusp artifacts in phase images is investigated in detail and an improved multi-channel phase data combination algorithm is provided. In addition, we show a few clinical applications of SWI for the imaging of stroke, traumatic brain injury, carotid vessel wall, siderotic nodules in cirrhotic liver, prostate cancer, prostatic calcification, spinal cord injury and intervertebral disc degeneration. As the clinical applications of SWI continue to expand both in and outside the brain, the improvement of SWI in conjunction with QSM is an important future direction of this technology. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Saifeng Liu
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Sagar Buch
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
| | - Yongsheng Chen
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Hyun-Seok Choi
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yongming Dai
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Charbel Habib
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, US
| | - Joon-Yong Jung
- Department of Radiology, St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yu Luo
- Department of Radiology, the Branch of Shanghai First Hospital, Shanghai, China
| | - David Utriainen
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People’s Hospital, Zhengzhou, Henan, China
| | - Dongmei Wu
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Shuang Xia
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - E. Mark Haacke
- The MRI Institute for Biomedical Research, Waterloo, ON, Canada
- Department of Radiology, Wayne State University, Detroit, MI, US
- The MRI Institute of Biomedical Research, Detroit, Michigan, US
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
- Address correspondence to: E. Mark Haacke, Ph.D., 3990 John R Street, MRI Concourse, Detroit, MI 48201. 313-745-1395,
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Improving Detection of Iron Deposition in Cirrhotic Liver Using Susceptibility-Weighted Imaging With Emphasis on Histopathological Correlation. J Comput Assist Tomogr 2017; 41:18-24. [PMID: 27893493 DOI: 10.1097/rct.0000000000000484] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the value of susceptibility-weighted imaging (SWI) for detection and quantification of iron deposition in cirrhotic liver. METHODS Fifty-five cirrhotic patients underwent hepatic magnetic resonance imaging examination including SWI and multiecho T2*-weighted imaging (T2*WI). Detection of iron deposition and number of siderotic nodules were compared between SWI and T2*WI. Correlation among SWI phase value, T2* value, and hepatic iron concentration were determined. RESULTS Susceptibility-weighted imaging significantly improved detection of iron deposition compared with T2*WI (90.7% vs 66.7%, P = 0.002), attributing to grade 1 (73.3% vs 26.7%, P = 0.027) and grade 2 (93.8% vs 56.3%, P = 0.037). Iron deposition of grade 3 and 4 could be detected by both SWI and T2*WI. The number of siderotic nodules visualized on SWI was significantly larger than that on T2*WI (107.5 ± 7.4 vs 62.7 ± 4.6, P = 0.002). There were significantly negative correlation between phase value and iron score (r = -0.803), and positive correlation between phase value and T2* value (r = 0.771). CONCLUSIONS Susceptibility-weighted imaging can improve detection of minimal and mild iron deposition in cirrhotic liver.
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Ba-Ssalamah A, Bastati N, Wibmer A, Fragner R, Hodge JC, Trauner M, Herold CJ, Bashir MR, Van Beers BE. Hepatic gadoxetic acid uptake as a measure of diffuse liver disease: Where are we? J Magn Reson Imaging 2016; 45:646-659. [PMID: 27862590 DOI: 10.1002/jmri.25518] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/05/2016] [Indexed: 02/06/2023] Open
Abstract
MRI has emerged as the most comprehensive noninvasive diagnostic tool for focal liver lesions and diffuse hepatobiliary disorders. The introduction of hepatobiliary contrast agents, most notably gadoxetic acid (GA), has expanded the role of MRI, particularly in the functional imaging of chronic liver diseases, such as nonalcoholic fatty liver disease (NAFLD). GA-enhanced MRI (GA-MRI) may help to distinguish between the two subgroups of NAFLD, simple steatosis and nonalcoholic steatohepatitis. Furthermore, GA-MRI can be used to stage fibrosis and cirrhosis, predict liver transplant graft survival, and preoperatively estimate the risk of liver failure should major resection be undertaken. The amount of GA uptake can be estimated, using static images, by the relative liver enhancement, hepatic uptake index, and relaxometry of T1-mapping during the hepatobiliary phase. On the contrary, the hepatic extraction fraction and liver perfusion can be measured on dynamic imaging. Importantly, there is currently no clear consensus as to which of these MR-derived parameters is the most suitable for assessing liver dysfunction. This review article aims to describe the current role of GA-enhanced MRI in quantifying liver function, primarily in diffuse hepatobiliary disorders. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:646-659.
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Affiliation(s)
- Ahmed Ba-Ssalamah
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Nina Bastati
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, General Hospital of Vienna (AKH), Austria
| | - Andreas Wibmer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Romana Fragner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Jacqueline C Hodge
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, General Hospital of Vienna (AKH), Austria
| | - Christian J Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University Vienna, Austria
| | - Mustafa R Bashir
- Department of Radiology and Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA.,Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Bernard E Van Beers
- Laboratory of Imaging Biomarkers, UMR 1149, INSERM - University Paris Diderot and Department of Radiology, University Hospital Paris Nord - Beaujon, France
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Sun J, Xing Z, Xing W, Zheng L, Chen J, Fan M, Chen T, Zhang Z. Intratumoral Macroscopic Fat and Hemorrhage Combination Useful in the Differentiation of Benign and Malignant Solid Renal Masses. Medicine (Baltimore) 2016; 95:e2960. [PMID: 26962796 PMCID: PMC4998877 DOI: 10.1097/md.0000000000002960] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
To evaluate the value of combining the detection of intratumoral macroscopic fat and hemorrhage in the differentiation of the benign from malignant solid renal masses.Conventional magnetic resonance imaging (MRI), chemical shift (CS)-MRI, and susceptibility-weighted imaging were performed in 152 patients with 152 solid renal masses, including 48 benign and 104 malignant masses all pathologically confirmed. The presence of macroscopic fat detected by CS-MRI and hemorrhage detected by susceptibility-weighted imaging were evaluated in all masses. The rates of macroscopic fat and hemorrhage observed between benign and malignant masses were compared by a χ test. All masses found to contain macroscopic fat with or without hemorrhage were considered to be benign. The remaining masses (without macroscopic fat) found not to contain hemorrhage were considered to be benign. Only those found to contain hemorrhage alone were considered to be malignant. The evaluation indexes for differentiating and forecasting the benign and malignant masses were calculated.Significant differences in the rate of macroscopic fat (observed in 85.42% of benign masses vs. 0% of malignant masses) and hemorrhage (observed in 4.17% of benign masses vs. 95.19% of malignant masses) were measured in the benign and malignant groups (P < 0.005, for both). The 41 masses containing macroscopic fat with or without hemorrhage and 11 masses containing neither macroscopic fat nor hemorrhage were considered to be benign. The 100 masses containing no macroscopic fat and only hemorrhage were considered to be malignant. By combining the results for the macroscopic fat and hemorrhage, the accuracy, sensitivity, and specificity in the differential diagnosis of the benign and malignant masses were 96.05%, 95.19%, and 97.92%, respectively, and the accuracy and error rate of forecasting the benign and malignant masses were 95.39% and 4.61%, respectively.Combining the detection intratumoral macroscopic fat and hemorrhage can be used to differentiate the benign from malignant solid renal masses.
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Affiliation(s)
- Jun Sun
- From the Department of Radiology (JS, WX, JC); Department of Urology (ZX, MF); Department of Pathology (TC), Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China; Department of Radiology (LZ, ZZ), Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Radiology (LZ), Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China; and Robert H. Lurie Comprehensive Cancer Center (ZZ), Northwestern University Chicago, Chicago, IL
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Li RK, Palmer SL, Zeng MS, Qiang JW, Chen F, Rao SX, Chen LL, Dai YM. Detection of Endogenous Iron Reduction during Hepatocarcinogenesis at Susceptibility-Weighted MR Imaging: Value for Characterization of Hepatocellular Carcinoma and Dysplastic Nodule in Cirrhotic Liver. PLoS One 2015; 10:e0142882. [PMID: 26605946 PMCID: PMC4659660 DOI: 10.1371/journal.pone.0142882] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/28/2015] [Indexed: 01/02/2023] Open
Abstract
Objective To investigate the value of susceptibility-weighted imaging (SWI) for characterization of hepatocellular carcinoma (HCC) and dysplastic nodule (DN). Materials and Methods Sixty-eight cirrhotic patients with 89 hepatocellular nodules underwent SWI. The radiological features of hepatocellular nodules on SWI were classified into three types: type A (iso- or hypointensity, and background liver siderosis), type B (hyperintensity, and background liver siderosis), or type C (hyperintensity, and no background liver siderosis). Intranodular and background liver iron content was quantified and correlated with SWI pattern. Prussian blue staining was performed to quantify intranodular and background liver iron content. Results Type A pattern (n = 12) contained 11 (91.7%) DNs and 1 (8.3%) HCC, Type B pattern (n = 66) comprised 1 (1.5%) DN and 65 (98.5%) HCCs (including 12 DN-HCCs and 53 overt HCCs), and type C pattern (n = 11) was exclusively seen in HCCs. The iron scores of DN-HCCs and overt HCCs were significantly lower than those of background livers [(0.091±0.30) VS (2.18±0.87), P = 0.000; (0.11±0.41) VS (2.16±0.97), P = 0.000; respectively]. There was no significant difference between iron scores of DNs and those of background livers [(1.92±0.29) VS (2.17±039), P = 0.191]. For lesion-based and patient-based analysis of HCCs (DN-HCCs and overt HCCs), type B pattern showed a sensitivity, specificity, accuracy, positive predicative value (PPV), and negative predicative value (NPV) of 84.4% and 84.4%, 91.7% and 75%, 85.4% and 83.8%, 98.5% and 98.2%, 47.8% and 23.1%, respectively. Conclusion SWI can provide valuable information for characterization of HCC and DN based on endogenous iron reduction during hepatocarcinogenesis.
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Affiliation(s)
- Ruo-kun Li
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Suzanne L. Palmer
- Department of Radiology, Keck Medical Center, University of Southern California, Los Angeles, California, United States of America
| | - Meng-su Zeng
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
- * E-mail: (MSZ); (JWQ)
| | - Jin-wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
- * E-mail: (MSZ); (JWQ)
| | - Frank Chen
- Department of Radiology, Keck Medical Center, University of Southern California, Los Angeles, California, United States of America
| | - Sheng-xiang Rao
- Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ling-li Chen
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong-ming Dai
- Siemens Ltd, China Healthcare Sector MR Business, Shanghai, China
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The diagnostic efficacy of quantitative liver MR imaging with diffusion-weighted, SWI, and hepato-specific contrast-enhanced sequences in staging liver fibrosis--a multiparametric approach. Eur Radiol 2015; 26:539-46. [PMID: 25991488 DOI: 10.1007/s00330-015-3830-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/01/2015] [Accepted: 04/28/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE To assess the diagnostic efficacy of multiparametric MRI using quantitative measurements of the apparent diffusion coefficient (ADC) of the liver parenchyma on diffusion-weighted imaging (DWI), signal intensity (SI) on susceptibility-weighted imaging (SWI), and gadoxetic acid-enhanced T1-weighted imaging during the hepatobiliary phase for the staging of liver fibrosis. MATERIALS AND METHODS Seventy-seven patients underwent a 3T MRI examination, including DWI/SWI sequences and gadoxetic acid-enhanced T1-weighted MRI. Liver fibrosis according to liver biopsy was staged using the Metavir fibrosis score: F0 (n = 21, 27.3%); F1 (n = 7, 9.1%); F2 (n = 8, 10.4%); F3 (n = 12, 15.6%); and F4 (n = 29, 37.7%). SI of the liver was defined using region-of-interest measurements to calculate the ADC values, the relative enhancement (RE) in the hepatobiliary phase, and the liver-to-muscle ratio (LMR) measurements for SWI. RESULTS The values of RE, LMR, and ADC measurements were statistically significantly different among the five fibrosis stages (p < 0.004). Combining the three parameters in a multiparametric approach, the AUC for detecting F1 stage or greater (≥ F1) was 94%, for F2 or greater (≥F2) was 95%, for F3 or greater (≥F3) was 90%, and for stage F4 was 93%. CONCLUSIONS Multiparametric MRI is an efficient non-invasive diagnostic tool for the staging of liver fibrosis. KEY POINTS • Multiparametric MRI has high accuracy in predicting moderate or greater liver fibrosis. • Relative enhancement post- gadoxetic acid is an independent predictor of liver fibrosis. • Liver SWI signal intensity and ADC values enhance the diagnostic ability.
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Chen W, Zhao J, Wen Y, Xie B, Zhou X, Guo L, Yang L, Wang J, Dai Y, Zhou D. Accuracy of 3-T MRI using susceptibility-weighted imaging to detect meniscal tears of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:198-204. [PMID: 24819177 DOI: 10.1007/s00167-014-3035-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 04/22/2014] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of susceptibility-weighted imaging (SWI) at 3-T magnetic resonance imaging for the assessment of meniscal tears. METHODS Ninety-four patients with tears in the medial meniscus (31) or lateral meniscus (64) imaged with conventional magnetic resonance imaging and SWI followed by knee arthroscopy within 1 month were selected. The diagnostic values of SWI for the detection of meniscal tears were evaluated using arthroscopy as the reference standard. The sensitivity, specificity and accuracy between spin-echo T1-weighted imaging (T1WI) and fat-suppressed proton density-weighted imaging (FS-PDWI) were compared. The diagnosis consistency with two radiologists was also compared. Receiver operating characteristic curve analyses were performed for each individual sequence to estimate their diagnostic performance in meniscal tear. RESULTS Analyses from 31 patients of medial meniscus tears showed that SWI achieved comparable performance with T1WI and FS-PDWI with respect to sensitivity (96.8 vs. 93.5 and 89.2%), specificity (66.7 vs. 66.7 and 66.7%) and accuracy (91.9 vs. 89.2 and 93.5%). In 64 patients of lateral meniscus tears, SWI was found to be a superior method over T1WI and FS-PDWI with regard to sensitivity (98.4 vs. 92.2 and 95.3%), specificity (100 vs. 100 and 100%) and accuracy (98.5 vs. 92.5 and 95.5%). Upon combination of these patients, SWI is similar or superior to T1WI and FS-PDWI with sensitivity (97.9 vs. 92.6 and 94.7%), specificity (77.8 vs. 77.8 and 77.8%) and accuracy (96.2 vs. 89.2 and 93.3%). SWI exhibited similar or better results with respect to sensitivity (97.9 vs. 92.6 and 94.7%), specificity (77.8 vs. 77.8 and 77.8%) and accuracy (96.2 vs. 89.2 and 93.3%) over T1WI and FS-PDWI. CONCLUSIONS These data suggest that SWI can be used for the diagnosis of meniscal tears. The sensitivity, accuracy and negative predictive value were same as those of T1WI and FS-PDWI according to the present study. LEVEL OF EVIDENCE Diagnostic study, Level II.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Southwest Hospital, The Third Military Medical University, Chongqing, 400038, China,
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Chen W, DelProposto Z, Liu W, Kassir M, Wang Z, Zhao J, Xie B, Wen Y, Wang J, Hu J. Susceptibility-weighted imaging for the noncontrast evaluation of hepatocellular carcinoma: a prospective study with histopathologic correlation. PLoS One 2014; 9:e98303. [PMID: 24879409 PMCID: PMC4039503 DOI: 10.1371/journal.pone.0098303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 05/01/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Specific morphologic features of hepatocellular carcinoma (HCC) on imaging have identifiable pathologic correlates as well as implications for altering surgical management and defining prognosis. In this study, we compared susceptibility-weighted imaging (SWI) to conventional techniques and correlated our findings with histopathology to determine the role of SWI in assessing morphologic features of HCC without using a contrast agent. METHODS 86 consecutive patients with suspected HCC were imaged with MRI (including T1, T2, T2*, and SWI) and subsequently CT. 59 histologically-proven HCC lesions were identified in 53 patients. Each lesion on each imaging sequence was evaluated by two radiologists, and classified with respect to lesion morphology, signal intensity relative to surrounding hepatic parenchyma, presence of a pseudocapsule, presence of venous invasion, and internal homogeneity. RESULTS Histopathology confirmed pseudocapsules in 41/59 lesions. SWI was able to detect a pseudocapsule in 34/41 lesions; compared to conventional T1/T2 imaging (12/41) and T2* (27/41). Mosaic pattern was identified in 25/59 lesions by histopathology; SWI confirmed this in all 25 lesions, compared to T1/T2 imaging (13/25) or T2* (18/25). Hemorrhage was confirmed by histopathology in 43/59 lesions, and visible on SWI in 41/43 lesions, compared to T1/T2 (7/43) and T2* (38/43). Venous invasion was confirmed by histopathology in 31/59 patients; SWI demonstrated invasion in 28/31 patients, compared to T1/T2 (7/31) and T2* (24/31). CONCLUSIONS SWI is better at identifying certain morphologic features such as pseudocapsule and hemorrhage than conventional MRI without using a contrast agent in HCC patients.
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Affiliation(s)
- Wei Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zachary DelProposto
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Wei Liu
- Department of Hepatobiliary Surgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Mohammad Kassir
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Zhiyuan Wang
- Cancer Biotherapy Center, Hunan Provincial Tumor Hospital, Xiangya Medical School, Central South University, Hunan, China
| | - Jun Zhao
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Bing Xie
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yaming Wen
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
- * E-mail: (JH); (JW)
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (JH); (JW)
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Chen J, Sun J, Xing W, Ding J, Chen T, Dai Y, Sun J, Hu J. Prediction of nuclear grade of clear cell renal cell carcinoma with MRI: intratumoral susceptibility signal intensity versus necrosis. Acta Radiol 2014; 55:378-84. [PMID: 23946232 DOI: 10.1177/0284185113498076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND End-stage renal disease and dialysis patients have a higher incidence of renal cell carcinoma (RCC) than the general population. Preoperatively evaluating the biological behavior of RCC plays an important role in treatment decision-making. Susceptibility-weighted imaging (SWI) can visualize the distribution of microvenous structures and hemorrhage without contrast materials. PURPOSE To evaluate the feasibility of SWI in grading clear cell RCCs (CRCC) and compare the ability of SWI and necrosis for grading CRCCs. MATERIAL AND METHODS Retrospective reviews of 35 patients with pathologically-proven CRCCs were performed. All patients underwent both conventional magnetic resonance imaging (MRI) and SWI examinations. The morphology of the intratumoral susceptibility signal intensities (ITSS) was classified into hemorrhage and microvessels. The differences of ITSSs on SWI and necrosis between low- and high-grade CRCCs were assessed. The diagnostic values of ITSSs and necrosis in differentiating low- from high-grade CRCCs were compared by receiver-operating characteristics. RESULTS ITSSs were seen in 31 of 35 patients. No ITSSs were seen in four patients with low-grade CRCCs. Mean scores of ITSSs on SWI were significantly lower for low-grade CRCCs (1.24 ± 0.72) than that for the high-grade CRCCs (2.70 ± 0.48). No significant necrosis was seen in 10 patients with low-grade CRCCs. There was a significant difference of the presence of intratumoral necrosis between low- and high-grade CRCCs. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were for ITSSs: 70%, 100%, 100%, and 89.3%, respectively; for necrosis: 100%, 40%, 40%, and 100%. CONCLUSION SWI can evaluate ITSSs without contrast materials and can be an alternative to grading CRCCs preoperatively for some special patients.
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Affiliation(s)
- Jie Chen
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Jun Sun
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Jiule Ding
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | - Tongbing Chen
- Department of Pathology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, PR China
| | | | - Jingyi Sun
- Department of Radiology, Wayne State University, Detroit, MI, USA
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, MI, USA
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13
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Balassy C, Feier D, Peck-Radosavljevic M, Wrba F, Witoszynskyj S, Kiefer B, Reiter G, Dai Y, Ba-Ssalamah A. Susceptibility-weighted MR imaging in the grading of liver fibrosis: a feasibility study. Radiology 2013; 270:149-58. [PMID: 23925270 DOI: 10.1148/radiol.13122440] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess the feasiblity of magnetic resonance (MR) susceptibility-weighted (SW) imaging as a tool to evaluate liver fibrosis grades in patients with chronic liver diseases (CLD) utilizing signal intensity (SI) measurements, with histopathologic findings as the reference standard. MATERIALS AND METHODS This retrospective study was approved by the local ethics committee. All subjects gave written informed consent. Eighty consecutive patients (mean age, 56.8 years), 60% of whom were male [n = 48] and 40% of whom were female [n = 32], with CLD due to various underlying causes and histopathologically proved liver fibrosis were included. Biopsies were evaluated for liver fibrosis and necroinflammatory activity (according to METAVIR scoring system), iron load, and steatosis. Two radiologists, blinded to the clinical data, assessed regions of interest in the liver and spinal muscle in consensus. Liver-to-muscle SI ratios were calculated and correlated to histopathologic findings and clinical data by using univariate and multivariate regression analysis. RESULTS Liver-to-muscle SI ratio decreased in parallel with the increasing grade of liver fibrosis and correlated strongly with liver fibrosis (r = -0.81, P < .0001) and moderately with necroinflammatory activity (r = -0.52, P < .0001) and iron load (r = -0.37, P = .0002) but did not correlate with steatosis (r = -0.18, P = .11). In multiple regression analysis, liver fibrosis and iron load independently influenced SW imaging measurements, explaining 69% of the variance of liver-to-muscle SI ratio (R(2) = 0.69, P < .001). Liver-to-muscle SI ratio performed well in grading liver fibrosis, with an area under the receiver operating characteristic curve of 0.92 for scores of F2 or higher and 0.93 for score of F4 (liver cirrhosis). CONCLUSION SW imaging is a feasible noninvasive tool to detect moderate and advanced liver fibrosis in CLD patients.
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Affiliation(s)
- Csilla Balassy
- From the Departments of Radiology (C.B., D.F., A.B.), Gastroenterology (M.P.), Pathology (F.W.), and Nuclear Medicine (S.W.), Medical University of Vienna, General Hospital of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria; Department of Radiology, Medical University of Cluj Napoca, Cluj Napoca, Romania (D.F.); Siemens Healthcare, Erlangen, Germany (B.K.); Siemens Healthcare, Graz, Austria (G.R.); and Siemens Healthcare, Shanghai, China (Y.D.)
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Chen J, Ding J, Dai Y, Xing W, Sun J, Zhang Z, Xuan Y, Pilli V, Haacke EM, Hu J. Assessment of intratumoral micromorphology for patients with clear cell renal cell carcinoma using susceptibility-weighted imaging. PLoS One 2013; 8:e65866. [PMID: 23755287 PMCID: PMC3675045 DOI: 10.1371/journal.pone.0065866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 04/29/2013] [Indexed: 12/01/2022] Open
Abstract
Background Multiple treatment options exist for the management of renal cell carcinomas. Preoperative evaluation of clear cell renal cell carcinoma (CRCC) grades is important for deciding upon the appropriate method of therapy. We hypothesize that susceptibility weighted imaging (SWI) is sensitive enough to detect intratumoral microvessles and microbleeding in renal cell carcinoma, which can be used to grade CRCC. Material and Methods Retrospective reviews of 37 patients with pathologically proven CRCCs were evaluated. All patients underwent SWI examinations. The characteristics of intratumoral susceptibility signal intensity (ITSS) includes the likelihood of the presence of ITSS, morphology of ITSS, dominant structure of ITSS and ratio of ITSS area to tumor area, which were all assessed on SWI. The results were compared using the nonparametric Mann-Whitney test. Results ITSS was seen in all patients except 4 patients with low-grade CRCCs. There was no significant difference between low and high-grade CRCCs when looking at the likelihood of the presence of ITSS. There was a significant difference in the mean score of dominant structures between low and high-grade CRCCs. Specifically, more dominant vascular structures and less hemorrhage were seen in low-grade tumors (2.15±1.05) compared to high-grade tumors (1.27±0.47) (P<0.005). The ratio of ITSS area to tumor area was also significantly higher for the high-grade group (1.55±0.52) than that for the low-grade group (0.88±0.43) on SWI (P<0.005). Conclusion SWI is useful for grading CRCCs.
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Affiliation(s)
- Jie Chen
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jiule Ding
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Yongming Dai
- Siemens Healthcare China, MR Collaboration NE Asia, Shanghai, China
| | - Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- * E-mail: (WX); (JH)
| | - Jun Sun
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Zishu Zhang
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States of America
| | - Yang Xuan
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Vasuki Pilli
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
- * E-mail: (WX); (JH)
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15
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Xing W, He X, Kassir MA, Chen J, Ding J, Sun J, Hu J, Zhang Z, Haacke EM, Dai Y. Evaluating hemorrhage in renal cell carcinoma using susceptibility weighted imaging. PLoS One 2013; 8:e57691. [PMID: 23451259 PMCID: PMC3581533 DOI: 10.1371/journal.pone.0057691] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 01/28/2013] [Indexed: 11/30/2022] Open
Abstract
Background Intratumoral hemorrhage is a frequent occurrence in renal cell carcinoma and is an indicator of tumor subtype. We hypothesize that susceptibility weighted imaging (SWI) is sensitive to hemorrhage in renal cell carcinoma and can give a more diagnostic image when compared to conventional imaging techniques. Materials and Methods A retrospective review of 32 patients with clear cell renal cell carcinoma was evaluated. All patients underwent magnetic resonance imaging (MRI) and 22 out of 32 patients also underwent a computed tomography (CT) scan. Hemorrhage was classified into 3 different categories according to shape and distribution. Histopathology was obtained from all masses by radical nephrectomy. The ability to detect the presence of hemorrhage using CT, non-contrast conventional MRI and SWI was evaluated, and the patterns of hemorrhage were compared. Results Using pathologic results as the gold standard, the sensitivities of non-contrast conventional MRI, SWI and CT in detecting hemorrhage in clear cell renal cell carcinoma were 65.6%, 100% and 22.7%, respectively. Accuracy of non-contrast conventional MRI and SWI in evaluating hemorrhagic patterns were 31.3% and 100%, respectively. Conclusion These results demonstrate that SWI can better reveal hemorrhage and characterize the pattern more accurately than either non-contrast conventional MRI or CT. This suggests that SWI is the technique of choice for detecting hemorrhagic lesions in patients with renal cancer.
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Affiliation(s)
- Wei Xing
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Xiaozhou He
- Department of Urology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
- * E-mail:
| | - Mohammad A. Kassir
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Jie Chen
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Jiule Ding
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Jun Sun
- Department of Radiology, Affiliated Third Hospital of Suzhou University, Changzhou, Jiangsu, China
| | - Jiani Hu
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Zishu Zhang
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - E. Mark Haacke
- Department of Radiology, Wayne State University, Detroit, Michigan, United States of America
| | - Yongming Dai
- Siemens Healthcare China, MR Collaboration NE Asia, Shanghai, China
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