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Wei H, Yoon JH, Jeon SK, Choi JW, Lee J, Kim JH, Nickel MD, Song B, Duan T, Lee JM. Enhancing gadoxetic acid-enhanced liver MRI: a synergistic approach with deep learning CAIPIRINHA-VIBE and optimized fat suppression techniques. Eur Radiol 2024; 34:6712-6725. [PMID: 38492004 PMCID: PMC11399219 DOI: 10.1007/s00330-024-10693-9] [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: 09/18/2023] [Revised: 02/02/2024] [Accepted: 02/18/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To investigate whether a deep learning (DL) controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA)-volumetric interpolated breath-hold examination (VIBE) technique can improve image quality, lesion conspicuity, and lesion detection compared to a standard CAIPIRINHA-VIBE technique in gadoxetic acid-enhanced liver MRI. METHODS This retrospective single-center study included 168 patients who underwent gadoxetic acid-enhanced liver MRI at 3 T using both standard CAIPIRINHA-VIBE and DL CAIPIRINHA-VIBE techniques on pre-contrast and hepatobiliary phase (HBP) images. Additionally, high-resolution (HR) DL CAIPIRINHA-VIBE was obtained with 1-mm slice thickness on the HBP. Three abdominal radiologists independently assessed the image quality and lesion conspicuity of pre-contrast and HBP images. Statistical analyses involved the Wilcoxon signed-rank test for image quality assessment and the generalized estimation equation for lesion conspicuity and detection evaluation. RESULTS DL and HR-DL CAIPIRINHA-VIBE demonstrated significantly improved overall image quality and reduced artifacts on pre-contrast and HBP images compared to standard CAIPIRINHA-VIBE (p < 0.001), with a shorter acquisition time (DL vs standard, 11 s vs 17 s). However, the former presented a more synthetic appearance (both p < 0.05). HR-DL CAIPIRINHA-VIBE showed superior lesion conspicuity to standard and DL CAIPIRINHA-VIBE on HBP images (p < 0.001). Moreover, HR-DL CAIPIRINHA-VIBE exhibited a significantly higher detection rate of small (< 2 cm) solid focal liver lesions (FLLs) on HBP images compared to standard CAIPIRINHA-VIBE (92.5% vs 87.4%; odds ratio = 1.83; p = 0.036). CONCLUSION DL and HR-DL CAIPIRINHA-VIBE achieved superior image quality compared to standard CAIPIRINHA-VIBE. Additionally, HR-DL CAIPIRINHA-VIBE improved the lesion conspicuity and detection of small solid FLLs. DL and HR-DL CAIPIRINHA-VIBE hold the potential clinical utility for gadoxetic acid-enhanced liver MRI. CLINICAL RELEVANCE STATEMENT DL and HR-DL CAIPIRINHA-VIBE hold promise as potential alternatives to standard CAIPIRINHA-VIBE in routine clinical liver MRI, improving the image quality and lesion conspicuity, enhancing the detection of small (< 2 cm) solid focal liver lesions, and reducing the acquisition time. KEY POINTS • DL and HR-DL CAIPIRINHA-VIBE demonstrated improved overall image quality and reduced artifacts on pre-contrast and HBP images compared to standard CAIPIRINHA-VIBE, in addition to a shorter acquisition time. • DL and HR-DL CAIPIRINHA-VIBE yielded a more synthetic appearance than standard CAIPIRINHA-VIBE. • HR-DL CAIPIRINHA-VIBE showed improved lesion conspicuity than standard CAIPIRINHA-VIBE on HBP images, with a higher detection of small (< 2 cm) solid focal liver lesions.
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Affiliation(s)
- Hong Wei
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Jae Won Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
- Department of Radiology, Armed Forces Yangju Hospital, Yangju, 482863, Republic of Korea
| | - Jihyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea
| | - Marcel Dominik Nickel
- MR Application Predevelopment, Siemens Healthcare GmbH, Henkestr. 127, 91052, Erlangen, Germany
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- Department of Radiology, Sanya People's Hospital, Sanya, 572000, Hainan, China
| | - Ting Duan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea.
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Matteini F, Cannella R, Garzelli L, Dioguardi Burgio M, Sartoris R, Brancatelli G, Vilgrain V, Ronot M, Vernuccio F. Benign and malignant focal liver lesions displaying rim arterial phase hyperenhancement on CT and MRI. Insights Imaging 2024; 15:178. [PMID: 39020233 PMCID: PMC11254889 DOI: 10.1186/s13244-024-01756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/22/2024] [Indexed: 07/19/2024] Open
Abstract
Rim arterial phase hyperenhancement is an imaging feature commonly encountered on contrast-enhanced CT and MRI in focal liver lesions. Rim arterial phase hyperenhancement is a subtype of arterial phase hyperenhancement mainly present at the periphery of lesions on the arterial phase. It is caused by a relative arterialization of the periphery compared with the center of the lesion and needs to be differentiated from other patterns of peripheral enhancement, including the peripheral discontinuous nodular enhancement and the corona enhancement. Rim arterial phase hyperenhancement may be a typical or an atypical imaging presentation of many benign and malignant focal liver lesions, challenging the radiologists during imaging interpretation. Benign focal liver lesions that may show rim arterial phase hyperenhancement may have a vascular, infectious, or inflammatory origin. Malignant focal liver lesions displaying rim arterial phase hyperenhancement may have a vascular, hepatocellular, biliary, lymphoid, or secondary origin. The differences in imaging characteristics on contrast-enhanced CT may be subtle, and a multiparametric approach on MRI may be helpful to narrow the list of differentials. This article aims to review the broad spectrum of focal liver lesions that may show rim arterial phase hyperenhancement, using an approach based on the benign and malignant nature of lesions and their histologic origin. CRITICAL RELEVANCE STATEMENT: Rim arterial phase hyperenhancement may be an imaging feature encountered in benign and malignant focal liver lesions and the diagnostic algorithm approach provided in this educational review may guide toward the final diagnosis. KEY POINTS: Several focal liver lesions may demonstrate rim arterial phase hyperenhancement. Rim arterial phase hyperenhancement may occur in vascular, inflammatory, and neoplastic lesions. Rim arterial phase hyperenhancement may challenge radiologists during image interpretation.
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Affiliation(s)
- Francesco Matteini
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Roberto Cannella
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy
| | - Lorenzo Garzelli
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Riccardo Sartoris
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Giuseppe Brancatelli
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy
| | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, Paris, France
- Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation"; CRI, Paris, France
| | - Federica Vernuccio
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University Hospital of Palermo, Palermo, Italy.
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Rushbrook SM, Kendall TJ, Zen Y, Albazaz R, Manoharan P, Pereira SP, Sturgess R, Davidson BR, Malik HZ, Manas D, Heaton N, Prasad KR, Bridgewater J, Valle JW, Goody R, Hawkins M, Prentice W, Morement H, Walmsley M, Khan SA. British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma. Gut 2023; 73:16-46. [PMID: 37770126 PMCID: PMC10715509 DOI: 10.1136/gutjnl-2023-330029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. The guideline writing committee included a multidisciplinary team of experts from various specialties involved in the management of CCA, as well as patient/public representatives from AMMF (the Cholangiocarcinoma Charity) and PSC Support. Quality of evidence is presented using the Appraisal of Guidelines for Research and Evaluation (AGREE II) format. The recommendations arising are to be used as guidance rather than as a strict protocol-based reference, as the management of patients with CCA is often complex and always requires individual patient-centred considerations.
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Affiliation(s)
- Simon M Rushbrook
- Department of Hepatology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Timothy James Kendall
- Division of Pathology, University of Edinburgh, Edinburgh, UK
- University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | - Yoh Zen
- Department of Pathology, King's College London, London, UK
| | - Raneem Albazaz
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Richard Sturgess
- Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Brian R Davidson
- Department of Surgery, Royal Free Campus, UCL Medical School, London, UK
| | - Hassan Z Malik
- Department of Surgery, University Hospital Aintree, Liverpool, UK
| | - Derek Manas
- Department of Surgery, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Nigel Heaton
- Department of Hepatobiliary and Pancreatic Surgery, King's College London, London, UK
| | - K Raj Prasad
- John Goligher Colorectal Unit, St. James University Hospital, Leeds, UK
| | - John Bridgewater
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust/University of Manchester, Manchester, UK
| | - Rebecca Goody
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Maria Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Wendy Prentice
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Shahid A Khan
- Hepatology and Gastroenterology Section, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Li Y, He K, Hao X, Morelli JN, Shen Y, Hu X, Hu D, Li Z. Gastrointestinal tumor-related perihepatic fluorouracil encapsulated lesions and liver metastases: a diagnostic imaging study based on contrast-enhanced computed tomography and magnetic resonance imaging. Quant Imaging Med Surg 2023; 13:7236-7246. [PMID: 37869297 PMCID: PMC10585562 DOI: 10.21037/qims-22-1315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 08/10/2023] [Indexed: 10/24/2023]
Abstract
Background Perihepatic fluorouracil encapsulated lesions (FELs) can result in potentially confusing computed tomography (CT) and magnetic resonance imaging (MRI) features in postoperative examinations of gastrointestinal tumors. This retrospective study aimed to summarize the typical imaging features of FELs and determine the best imaging modality to distinguish FELs from liver metastases for junior residents. Methods Patients with FELs who had undergone gastrointestinal tumor surgery in Tongji Hospital from January 2016 to June 2022 were evaluated. The imaging features of FELs were summarized by two senior radiologists. Contrast-enhanced CT (CECT) was used as the primary follow-up tool for postoperative gastrointestinal tumor patients. Patients with FELs and available CECT and MRI examinations were matched with patients with liver metastases based on gender and age and presented in chronological order in a 2:1 ratio. Different imaging modality combinations were used for further evaluation, including a CECT group (modality Ⅰ), CECT and nonenhanced MRI group (modality Ⅱ) and CECT with all MRI sequences group (modality Ⅲ). Subsequently, two junior residents blindly evaluated three groups following a 4-week interval based on a 5-point scale (1= definite benign lesion, 2= probable benign lesion, 3= indeterminate, 4= probable liver metastasis, 5= definite liver metastasis). Results Imaging features of 33 patients with 36 FELs were analyzed. CECT and dynamic contrast-enhanced MRI (DCE-MRI) showed no enhancement in most lesions. Additionally, 20 patients with FELs meeting the requirements were matched with 40 patients with liver metastases. The highest sensitivity, specificity, and consistency for identifying liver metastases were achieved using a combination of CECT and MRI encompassing all sequences yielded, including modality Ⅰ (reader 1: 72.0% and 17.4%; reader 2: 62.0% and 17.4%; kappa value 0.295), modality Ⅱ (reader 1: 88.0% and 8.7%; reader 2: 92.0% and 34.8%; kappa value 0.259), and modality Ⅲ (reader 1: 98.0% and 34.8%; reader 2: 92.0% and 39.1%; kappa value 0.680). Conclusions FELs are typically non-enhancing lesions. In our study, two junior residents could best distinguish FELs from liver metastases using CECT with all MRI sequences.
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Affiliation(s)
- Yuanqiu Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kangwen He
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinyueyuan Hao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - John N. Morelli
- Department of Radiology, St. John’s Medical Center, Tulsa, OK, USA
| | - Yaqi Shen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuemei Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daoyu Hu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Park SH, Yoon JH, Park JY, Shim YS, Lee SM, Choi SJ, Nickel MD, Lee JM. Performance of free-breathing dynamic T1-weighted sequences in patients at risk of developing motion artifacts undergoing gadoxetic acid–enhanced liver MRI. Eur Radiol 2022; 33:4378-4388. [PMID: 36512042 DOI: 10.1007/s00330-022-09336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/27/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the recall rate and performance of free-breathing T1W dynamic imaging in patients who underwent gadoxetic acid-enhanced liver MRI. METHODS We retrospectively reviewed patients who underwent free-breathing dynamic T1WI liver MRI using Cartesian (XD-VIBE) or self-gated radial (SG-GRASP) sequences at two institutions. Four radiologists independently reviewed the overall image quality, streak, and motion artifacts for precontrast, arterial, and portal venous phases on a 4-point scale. Hepatic observations were annotated and assessed according to LI-RADS v2018. RESULTS In total, 360 patients were included (XD-VIBE [n = 253], SG-GRASP [n = 107]). The overall image quality of free-breathing T1WI was 3.4 ± 0.4, 3.2 ± 0.4, and 3.5 ± 0.4 for precontrast, arterial, and portal venous phases, respectively. The actual recall rate was 0.6% (2/360). The SG-GRASP group showed fewer motion artifacts and more streak artifacts than the XD-VIBE group in all phases (p < 0.001 for all). The overall image quality was not significantly different between the two sequences in arterial (3.2 ± 0.4 in both, p = 0.607) and portal venous phases (3.5 ± 0.4 in XD-VIBE, 3.4 ± 0.4 in SG-GRASP, p = 0.214). Two sequences did not show significant differences in the lesion detection rate (figure of merit, FOM: 0.67 vs. 0.68, p = 0.876) or diagnostic performance for hepatocellular carcinoma (FOM: 0.55 vs. 0.62, p = 0.105). CONCLUSIONS Both XD-VIBE and SG-GRASP provided sufficient image quality for patients at risk of developing motion artifacts, without significant differences in image quality or the lesion detection rate between sequences. KEY POINTS • The overall image quality of free-breathing T1-weighted images using Cartesian or radial sequences was 3.4 ± 0.4, 3.2 ± 0.4, and 3.5 ± 0.4 for precontrast, arterial, and portal venous phases, respectively. • Only 0.3% (1/360) had undiagnostic exams and the actual recall rate was 0.6% (2/360) in patients who underwent free-breathing dynamic T1WI. • The overall lesion detection rate was 0.67 without a significant difference between Cartesian and radial sequences (figure of merit: 0.67 vs. 0.68, respectively, p = 0.876).
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Affiliation(s)
- So Hyun Park
- Department of Radiology, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea.
| | - Jin Young Park
- Department of Radiology, Inje University Busan Paik Hospital, Bokji-ro 75, Busangjin-gu, Busan, 47392, Republic of Korea
| | - Young Sup Shim
- Department of Radiology, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Sang Min Lee
- Department of Radiology, CHA Gangnam Medical Center, CHA University, 566 Nonhyun-ro, Gangnam-gu, Seoul, 06135, Republic of Korea
| | - Seung Joon Choi
- Department of Radiology, Gachon University Gil Medical Center, 21 Namdong-daero 774 beon-gil, Namdong-gu, Incheon, 21565, South Korea
| | - Marcel Dominik Nickel
- MR Application Predevelopment, Siemens Healthcare GmbH, Allee am Roethelheimpark 2, 91052, Erlangen, Germany
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 03087, Republic of Korea
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Kalor A, Girometti R, Maheshwari E, Kierans AS, Pugliesi RA, Buros C, Furlan A. Update on MR Contrast Agents for Liver Imaging. Radiol Clin North Am 2022; 60:679-694. [DOI: 10.1016/j.rcl.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Recomendaciones de expertos sobre el uso de ácido gadoxético en pacientes con metástasis hepáticas en España. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Borrego Gómez J, Romera N, Tellado J, del Campo L, Díaz Formoso J, Fuster M, Vivas I, Ramón Botella E, Menéndez de Llano Ortega R. Expert recommendations about the use of gadoxetic acid in patients with liver metastases in Spain. RADIOLOGIA 2022; 64:300-309. [DOI: 10.1016/j.rxeng.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 09/03/2021] [Indexed: 10/15/2022]
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Lee T, Lee JM, Yoon JH, Joo I, Bae JS, Yoo J, Kim JH, Ahn C, Kim JH. Deep learning-based image reconstruction of 40-keV virtual monoenergetic images of dual-energy CT for the assessment of hypoenhancing hepatic metastasis. Eur Radiol 2022; 32:6407-6417. [PMID: 35380228 DOI: 10.1007/s00330-022-08728-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/19/2022] [Accepted: 03/10/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the diagnostic value of deep learning model (DLM) reconstructed dual-energy CT (DECT) low-keV virtual monoenergetic imaging (VMI) for assessing hypoenhancing hepatic metastases. METHODS This retrospective study included 131 patients who underwent contrast-enhanced DECT (80-kVp and 150-kVp with a tin filter) in the portal venous phase for hepatic metastasis surveillance. Linearly blended images simulating 100-kVp images (100-kVp), standard 40-keV VMI images (40-keV VMI), and post-processed 40-keV VMI using a vendor-agnostic DLM (i.e., DLM 40-keV VMI) were reconstructed. Lesion conspicuity and diagnostic acceptability were assessed by three independent reviewers and compared using the Wilcoxon signed-rank test. The contrast-to-noise ratios (CNRs) were also measured placing ROIs in metastatic lesions and liver parenchyma. The detection performance of hepatic metastases was assessed by using a jackknife alternative free-response ROC method. The consensus by two independent radiologists was used as the reference standard. RESULTS DLM 40-keV VMI, compared to 40-keV VMI and 100-kVp, showed a higher lesion-to-liver CNR (8.25 ± 3.23 vs. 6.05 ± 2.38 vs. 5.99 ± 2.00), better lesion conspicuity (4.3 (4.0-4.7) vs. 3.7 (3.7-4.0) vs. 3.7 (3.3-4.0)), and better diagnostic acceptability (4.3 (4.0-4.3) vs. 3.0 (2.7-3.3) vs. 4.0 (4.0-4.3)) (p < 0.001 for all). For lesion detection (246 hepatic metastases in 68 patients), the figure of merit was significantly higher with DLM 40-keV VMI than with 40-keV VMI (0.852 vs. 0.822, p = 0.012), whereas no significant difference existed between DLM 40-keV VMI and 100-kVp (0.852 vs. 0.842, p = 0.31). CONCLUSIONS DLM 40-keV VMI provided better image quality and comparable diagnostic performance for detecting hypoenhancing hepatic metastases compared to linearly blended images. KEY POINTS • DLM 40-keV VMI provides a superior image quality compared with 40-keV or 100-kVp for assessing hypoenhancing hepatic metastasis. • DLM 40-keV VMI has the highest CNR and lesion conspicuity score for hypoenhancing hepatic metastasis due to noise reduction and structural preservation. • DLM 40-keV VMI provides higher lesion detectability than standard 40-keV VMI (p = 0.012).
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Affiliation(s)
- Taehee Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. .,Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Chulkyun Ahn
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Korea
| | - Jong Hyo Kim
- Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.,Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Korea.,Center for Medical-IT Convergence Technology Research, Advanced Institutes of Convergence Technology, Suwon, 16229, Korea
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Freitas PS, Janicas C, Veiga J, Matos AP, Herédia V, Ramalho M. Imaging evaluation of the liver in oncology patients: A comparison of techniques. World J Hepatol 2021; 13:1936-1955. [PMID: 35069999 PMCID: PMC8727197 DOI: 10.4254/wjh.v13.i12.1936] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/26/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
The liver is commonly affected by metastatic disease. Therefore, it is essential to detect and characterize liver metastases, assuming that patient management and prognosis rely on it. The imaging techniques that allow non-invasive assessment of liver metastases include ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)/CT, and PET/MRI. In this paper, we review the imaging findings of liver metastases, focusing on each imaging modality’s advantages and potential limitations. We also assess the importance of different imaging modalities for the management, follow-up, and therapy response of liver metastases. To date, both CT and MRI are the most appropriate imaging methods for initial lesion detection, follow-up, and assessment of treatment response. Multiparametric MRI is frequently used as a problem-solving technique for liver lesions and has evolved substantially over the past decade, including hardware and software developments and specific intravenous contrast agents. Several studies have shown that MRI performs better in small-sized metastases and moderate to severe liver steatosis cases. Although state-of-the-art MRI shows a greater sensitivity for detecting and characterizing liver metastases, CT remains the chosen method. We also present the controversial subject of the "economic implication" to use CT over MRI.
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Affiliation(s)
- Patrícia S Freitas
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon 1150-199, Portugal
| | - Catarina Janicas
- Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - José Veiga
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Lisbon 1150-199, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital CUF Tejo, Lisbon 1350-352, Portugal
| | - Vasco Herédia
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital Espírito Santo de Évora-EPE, Évora 7000-811, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, EPE, Almada 2805-267, Portugal
- Department of Radiology, Hospital da Luz, Lisbon 1500-650, Portugal
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11
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Zhuo LY, Xing LH, Ma X, Zhang Y, Ma ZP, Yin XP, Wang JN. Differentiating Between an Atypical Hepatic Abscess and Tumor Metastasis Using Magnetic Resonance Imaging and Hepatobiliary Phase Imaging. Infect Drug Resist 2021; 14:3263-3274. [PMID: 34429624 PMCID: PMC8380289 DOI: 10.2147/idr.s318291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To identify diffusion-weighted imaging (DWI) patterns and conspicuity discrepancies on hepatobiliary phase imaging (HBPI) to distinguish atypical hepatic abscesses from hepatic metastases. Materials and Methods This retrospective study recruited 31 patients with 43 atypical hepatic abscesses and 32 patients with 35 hepatic metastases who underwent gadobenate dimeglumine-enhanced magnetic resonance imaging. All lesions were confirmed by pathological or clinical diagnosis. For the qualitative and quantitative analyses, the signal intensity, DWI pattern, apparent diffusion coefficient, degree of perilesional edema, perilesional hyperemia, perilesional signal on HBPI, conspicuity, size discrepancy between sequences, contrast-to-noise ratio, signal-to-noise ratio, and relative enhancement ratio on dynamic phases were independently assessed by two radiologists. Significant findings for differentiating the two groups were identified via univariate and multivariate analyses with a nomogram for predicting atypical hepatic abscesses. The interobserver agreement was also analyzed for each variable. Results The multivariate analysis revealed that the conspicuity discrepancy (odds ratio [OR] 34.78, 95% confidence interval [CI] 2.09–579.47, p = 0.013) and non-peripheral high signal intensity (SI) rim on DWI (OR 67.46, 95% CI 2.64, 1723.20, p = 0.011) were significant independent factors for predicting atypical hepatic abscesses. They were also shown to be high predictor points on the nomogram. When any of the set criteria were satisfied, 97.7% of atypical hepatic abscesses were correctly identified, with a specificity of 65.7%. When both criteria were combined, the specificity was up to 100%, with a sensitivity of 44.9%. Conclusion Conspicuity discrepancy and a non-peripheral high SI rim on DWI are reliable and meaningful features that can distinguish atypical hepatic abscesses from hepatic metastases.
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Affiliation(s)
- Li-Yong Zhuo
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Li-Hong Xing
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Xi Ma
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Yu Zhang
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Ze-Peng Ma
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Xiao-Ping Yin
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
| | - Jia-Ning Wang
- Department of CT-MRI Diagnostic, Affiliated Hospital of Hebei University, Baoding, People's Republic of China
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12
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胡 斯, 杨 康, 汪 昕, 文 大, 夏 春, 李 昕, 李 真. [Application of MRI-based Radiomics Models in the Assessment of Hepatic Metastasis of Rectal Cancer]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2021; 52:311-318. [PMID: 33829708 PMCID: PMC10408915 DOI: 10.12182/20210360202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Indexed: 02/05/2023]
Abstract
OBEJECTIVE To explore the clinical value of using radiomics models based on different MRI sequences in the assessment of hepatic metastasis of rectal cancer. METHODS 140 patients with pathologically confirm edrectal cancer were included in the study. They underwent baseline magnetic resonance imaging (MRI) between April 2015 and May 2018 before receiving any treatment. According to the results of liver biopsy, surgical pathology, and imaging, patients were put into two groups, the patients with hepatic metastasis and those without. T2 weighted images (T2WI), diffusion weighted images (DWI) and apparent diffusion coefficient (ADC) images were used to draw the region of interest (ROI) of primary lesions on consecutive slices on ITK-SNAP. 3-D ROIs were generated and loaded into Artificial Intelligent Kit for extraction of radiomics features and 396 features were extracted for each sequence. The feature data were preprocessed on Python and the samples were oversampled, using Support Vector Machine-Synthetic Minority Over-Sampling Technique (SVM-SMOTE) to balance the number of samples in the group with liver metastasis and the group with no liver metastasis at the end of the follow-up. Then, the samples were divided into the training cohort and the test cohort at a ratio of 2∶1. The logistic regression models were developed with selected radionomic features on R software. The receiver operating characteristics (ROC) curves and calibration curves were used to evaluate the performance of the models. RESULTS In total, 52 patients with liver metastasis and 88 patients without liver metastasis at the end of follow-up were enrolled. Carcinoembryonic antigen (CEA) and T stage and N stage evaluated on the MRI images showed statistically significant difference between the two groups ( P<0.05). After data preprocessing and selecting, except for 17 non-radiomic features, the model combining T2WI, DWI and ADC features, the model of T2WI features alone, the model of DWI features alone and the model of ADC features alone were developed with 32 features, 10 features, 30 features and 15 features, respectively. The combined model (T2WI+DWI+ADC), the T2WI model, and the ADC model can assess hepatic metastasis accurately, with the area under curve ( AUC) on the train set reaching 93.5%, 89.2%, 90.6% and that of the test set reaching 80.8%, 80.5%, 81.4%, respectively. The combined model did not show a higher AUC than those of the T2WI and ADC alone models. Model based on DWI features has a slightly insufficient AUC of 90.3% in the train set and 75.1% in the test set. The calibration curve showed the smallest fluctuation in the combined model, which is closest fit to the diagonal reference line. The fluctuation in the three independent data set models were similar. The calibration curves of all the four models showed that as the risk increased, the prediction of the models turned from an underestimation to an overestimating the risk. In brief, the combined model showed the best performance, with the best fit to the diagonal reference line in calibration curve and high AUC comparable to the AUC of the T2WI model and ADC model. The performance of T2WI and ADC alone models were second to that of the combined model, while the DWI alone model showed relatively poor performance. CONCLUSION Radiomics models based on MRI could be effectively used in assessing liver metastasis in rectal cancer, which may help determine clinical staging and treatment.
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Affiliation(s)
- 斯娴 胡
- 四川大学华西医院 放射科 (成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 康 杨
- 四川大学华西医院 放射科 (成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 昕蓉 汪
- 四川大学华西医院 放射科 (成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 大光 文
- 四川大学华西医院 放射科 (成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 春潮 夏
- 四川大学华西医院 放射科 (成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 昕 李
- 四川大学华西医院 放射科 (成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 真林 李
- 四川大学华西医院 放射科 (成都 610041)Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
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13
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Shear-wave velocity for colorectal cancer liver metastases as a potential prognostic factor after chemotherapy: a preliminary study. Clin Radiol 2021; 76:224-232. [PMID: 33402260 DOI: 10.1016/j.crad.2020.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/30/2020] [Indexed: 11/21/2022]
Abstract
AIM To evaluate whether shear-wave velocity (SWV) can be used for predicting the prognoses of patients with colorectal cancer liver metastases (CRLMs) after chemotherapy. MATERIALS AND METHODS Our institutional review board approved this prospective study, and written informed consent was obtained. SWV of CRLMs were obtained using point shear-wave elastography using acoustic radiation force impulse from 25 patients prior to and 2, 7, and 14 days after chemotherapy. Progression-free survival (PFS) after chemotherapy was estimated using the Kaplan-Meier method. The Cox proportional hazard regression model was used to determine significant predictive factors for PFS. For measurement reproducibility, an additional 37 patients with CRLMs were enrolled and assessed using intraclass correlation coefficients (ICCs). RESULTS After chemotherapy, 10 and 15 patients were classified into responder and non-responder groups, respectively. The estimated 1- and 3-year PFS values in the whole cohort were 36% and 8%, respectively. A decrease in the SWV value on day 2 relative to the initial value was a significant predictive factor for better PFS outcome (hazard ratio = 0.20, 95% confidence interval = 0.07-0.57, p=0.003). The estimated 1 and 3-year PFS rates were 66.7% and 22.2%, respectively, in nine patients with decreased SWV values on day 2 and significantly higher than 18.8% and 0% of 16 patients with increased SWV values on day 2. The ICC value of SWV of CRLMs in the additional 37 patients was 0.823 (95% CI = 0.685-0.905), indicating good agreement. CONCLUSION SWV values of CRLMs could provide prognostic information in patients with CRLMs treated with chemotherapy, as decreased SWV values on day 2 after chemotherapy was a significant predictive factor for better PFS.
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14
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Lee JE, Kim SH, Lee SJ, Choi SY, Lee S, Lee BR. A Comparative Study of Survivor Outcomes between Preoperative Evaluation Using CT Alone and Combined CT and MRI in Patients with Pancreatic Ductal Adenocarcinoma. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:638-653. [PMID: 36238786 PMCID: PMC9432452 DOI: 10.3348/jksr.2020.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/09/2020] [Accepted: 07/04/2020] [Indexed: 11/15/2022]
Abstract
Purpose Materials and Methods Results Conclusion
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Affiliation(s)
- Ji Eun Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soon Jin Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Sunyoung Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Bo Ra Lee
- Department of Biomedical Statistics, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
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15
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Structured reporting of CT or MRI for perihilar cholangiocarcinoma: usefulness for clinical planning and interdisciplinary communication. Jpn J Radiol 2020; 39:349-356. [PMID: 33175312 DOI: 10.1007/s11604-020-01068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/27/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE To compare the content and communication between the radiologist and the clinicians for treatment planning of structured reports (SRs) and narrative reports (NRs) for reporting CT/MRI findings in patients with perihilar cholangiocarcinoma. MATERIALS AND METHOD This retrospective study included 54 patients with perihilar cholangiocarcinoma who underwent CT/MRI before ERCP or surgery. For all patients, we generated both NRs and SRs for perihilar cholangiocarcinoma and compared the number of key features between NRs and SRs. In addition, three clinicians performed a questionnaire evaluation that included three questions regarding assessment of the sufficiency of information for surgical or procedural planning, the effort required for information extraction, and the report quality rated on a Likert scale. RESULTS SRs included significantly more predefined key features (6.89 ± 0.31) than NRs (5.87 ± 0.70) (p < 0.001). SRs provided greater sufficiency of information for clinical planning than NRs (89.9% vs. 18.5% of the cases, respectively; p < 0.001). Extraction of information was easier from SRs than NRs (94.4% vs. 9.3%, respectively) (p < 0.001). SRs received a higher overall report quality rating (5.96 ± 0.19) than NRs (4.31 ± 0.77) (p < 0.001). CONCLUSIONS SRs of CT/MRI findings for hilar cholangiocarcinoma can reveal more predefined key features, provide more sufficiency of information, and yield higher satisfaction levels, in comparison with NRs.
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16
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Walker E, Liu Y, Kim I, Biro M, Iyer SR, Ezaldein H, Scott J, Merati M, Mistur R, Zhou B, Straight B, Yim JJ, Bogyo M, Mann M, Wilson DL, Basilion JP, Popkin DL. A Protease-Activated Fluorescent Probe Allows Rapid Visualization of Keratinocyte Carcinoma during Excision. Cancer Res 2020; 80:2045-2055. [PMID: 32132111 DOI: 10.1158/0008-5472.can-19-3067] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/10/2020] [Accepted: 02/24/2020] [Indexed: 12/26/2022]
Abstract
Keratinocyte carcinomas, including basal and squamous cell carcinomas, are the most common human cancers worldwide. While 75% of all keratinocyte carcinoma (4 million annual cases in the United States) are treated with conventional excision, this surgical modality has much lower cure rates than Mohs micrographic surgery, likely due to the bread-loaf histopathologic assessment that visualizes <1% of the tissue margins. A quenched protease-activated fluorescent probe 6qcNIR, which produces a signal only in the protease-rich tumor microenvironment, was topically applied to 90 specimens ex vivo immediately following excision. "Puzzle-fit" analysis was used to correlate the fluorescent images with histology. Probe-dependent fluorescent images correlated with cancer determined by conventional histology. Point-of-care fluorescent detection of skin cancer had a clinically relevant sensitivity of 0.73 and corresponding specificity of 0.88. Importantly, clinicians were effectively trained to read fluorescent images within 15 minutes with reliability and confidence, resulting in sensitivities of 62%-78% and specificities of 92%-97%. Fluorescent imaging using 6qcNIR allows 100% tumor margin assessment by generating en face images that correlate with histology and may be used to overcome the limitations of conventional bread-loaf histology. The utility of 6qcNIR was validated in a busy real-world clinical setting, and clinicians were trained to effectively read fluorescent margins with a short guided instruction, highlighting clinical adaptability. When used in conventional excision, this approach may result in higher cure rates at a lower cost by allowing same-day reexcision when needed, reducing patient anxiety and improving compliance by expediting postsurgical specimen assessment. SIGNIFICANCE: A fluorescent-probe-tumor-visualization platform was developed and validated in human keratinocyte carcinoma excision specimens that may provide simple, rapid, and global assessment of margins during skin cancer excision, allowing same-day reexcision when needed.
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Affiliation(s)
- Ethan Walker
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Yiqiao Liu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - InYoung Kim
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Mark Biro
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sukanya Raj Iyer
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Harib Ezaldein
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey Scott
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Miesha Merati
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Rachel Mistur
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio.,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - Bo Zhou
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | | | - Joshua J Yim
- Chemical and Systems Biology, Stanford University, Palo Alto, California
| | - Matthew Bogyo
- Chemical and Systems Biology, Stanford University, Palo Alto, California.,Department of Pathology, Stanford University, Palo Alto, California.,Department of Microbiology and Immunology, Stanford University, Palo Alto, California
| | - Margaret Mann
- Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - David L Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio.,Department of Radiology, Case Western Reserve University, Cleveland, Ohio
| | - James P Basilion
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio. .,Department of Radiology, Case Western Reserve University, Cleveland, Ohio.,Fellow, National Foundation for Cancer Research, Case Western Reserve University, Cleveland, Ohio
| | - Daniel L Popkin
- Department of Dermatology, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio. .,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
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Shur J, Orton M, Connor A, Fischer S, Moulton CA, Gallinger S, Koh DM, Jhaveri KS. A clinical-radiomic model for improved prognostication of surgical candidates with colorectal liver metastases. J Surg Oncol 2020; 121:357-364. [PMID: 31797378 DOI: 10.1002/jso.25783] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/17/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Colorectal cancer with liver metastases is potentially curable with surgical resection however clinical prognostic factors can insufficiently stratify patients. This study aims to assess whether radiomic features are prognostic and can inform clinical decision making. METHODS This single-site retrospective study included 102 patients who underwent colorectal liver metastases resection with preoperative computed tomography (CT), magnetic resonance imaging (MRI) with gadoxetic acid (EOB) and clinical covariates. A lasso-regularized multivariate Cox proportional hazards model was applied to 114 features (10 clinical, 104 radiomic) to determine association with disease-free survival (DFS). A prognostic index was derived using the significant Cox regression coefficients and their corresponding input features and a threshold was determined to classify patients into high- and low-risk groups, and DFS compared using log-rank tests. RESULTS Four covariates were significantly associated with DFS; bilobar disease (hazard ratio [HR]= 1.56; P = .0043), complete pathological response (HR= 0.67; P = .025), minimum pixel value (HR= 1.66; P = .00016), and small area emphasis (HR= 0.62; P = .0013) from the EOB-MRI data. Radiomic CT features were not prognostic. The prognostic index strongly stratified high- and low-risk prognostic groups (HR = 0.31; P = .00068). CONCLUSION Radiomic MRI features provided meaningful prognostic information above clinical covariates alone. This merits further validation for potential clinical implementation to inform management.
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Affiliation(s)
- Joshua Shur
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Matthew Orton
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Ashton Connor
- Department of Surgery, Duke University Hospital, Durham, North Carolina
| | - Sandra Fischer
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Carol-Anne Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Steven Gallinger
- Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Celebi F, Cindil E, Sarsenov D, Unalan B, Balcı C. Added Value of Contrast Medium in Whole-Body Hybrid Positron Emission Tomography/Magnetic Resonance Imaging: Comparison between Contrast-Enhanced and Non-Contrast-Enhanced Protocols. Med Princ Pract 2020; 29:54-60. [PMID: 31203290 PMCID: PMC7024881 DOI: 10.1159/000501497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 06/16/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To compare the diagnostic ability and time efficiency of contrast-enhanced (CE) whole body fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI) protocol and non-CE (NCE) protocol. SUBJECTS AND METHODS Ninety-three patients with known primary tumors underwent whole-body hybrid FDG PET/MRI during the follow-up of their malignancies with the use of NCE and CE protocols. The NCE PET/MRI protocol consisted of diffusion-weighted (b = 0 and 800 s/mm2) and T1-weighted Turbo Flash in the axial plane and T2-weighted HASTE sequence in the coronal planes (Σ = 25 min). The CE PET/MRI protocol was performed by acquiring axial serial CE 3D FS VIBE images in the upper abdomen, completing the whole body in the late phase in the axial plane (Σ = 30 min). RESULTS There was a statistically significant difference between the total number of lesions detected by the CE protocol (median 2, interquartile range (IQR) 0-14) and that detected by the NCE protocol (median 1, IQR 0-5; p < 0.001). More malignancies were detected in the abdomen (p < 0.001) and brain (p < 0.001) with the CE PET/MRI protocol, whereas no significant difference was present when comparing the 2 protocols in the detection of malignancies in the head and neck (p = 0.356), thorax (p = 0.09), lymph nodes (p = 0.196), and bone (p = 0.414). CONCLUSION The CE FDG PET/MRI protocol enables fast and accurate detection of malignancies compared to the NCE FDG PET/MRI protocol, particularly in the upper abdomen and brain. Diagnostic ability and time efficiency can be increased with the proposed short CE protocol in place of the whole body PET/MRI protocol including both NCE and CE imaging sequences.
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Affiliation(s)
- Filiz Celebi
- Department of Radiology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey,
| | - Emetullah Cindil
- Department of Radiology, Gazi University School of Medicine, Istanbul, Turkey
| | - Dauren Sarsenov
- Department of General Surgery, Florence Nightingale Hospital, Istanbul, Turkey
| | - Bulent Unalan
- Department of Nuclear Medicine, Florence Nightingale Hospital, Istanbul, Turkey
| | - Cem Balcı
- Department of Radiology, Cleveland Clinic, Lerner School of Medicine, Abu Dhabi, United Arab Emirates
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Li Y, Eresen A, Shangguan J, Yang J, Lu Y, Chen D, Wang J, Velichko Y, Yaghmai V, Zhang Z. Establishment of a new non-invasive imaging prediction model for liver metastasis in colon cancer. Am J Cancer Res 2019; 9:2482-2492. [PMID: 31815048 PMCID: PMC6895455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/12/2019] [Indexed: 06/10/2023] Open
Abstract
The aim of this study was to develop and validate a new non-invasive artificial intelligence (AI) model based on preoperative computed tomography (CT) data to predict the presence of liver metastasis (LM) in colon cancer (CC). A total of forty-eight eligible CC patients were enrolled, including twenty-four patients with LM and twenty-four patients without LM. Six clinical factors and one hundred and fifty-two tumor image features extracted from CT data were utilized to develop three models: clinical, radiomics, and hybrid (a combination of clinical and radiomics features) using support vector machines with 5-fold cross-validation. The performance of each model was evaluated in terms of accuracy, specificity, sensitivity, and area under the curve (AUC). For the radiomics model, a total of four image features utilized to construct the model resulting in an accuracy of 83.87% for training and 79.50% for validation. The clinical model that employed two selected clinical variables had an accuracy of 69.82% and 69.50% for training and validation, respectively. The hybrid model that combined relevant image features and clinical variables improved accuracy of both training (90.63%) and validation (85.50%) sets. In terms of AUC, hybrid (0.96; 0.87) and radiomics models (0.91; 0.85) demonstrated a significant improvement compared with the clinical model (0.71; 0.69), and the hybrid model had the best prediction performance. In conclusion, the AI model developed using preoperative conventional CT data can accurately predict LM in CC patients without additional procedures. Furthermore, combining image features with clinical characteristics greatly improved the model's prediction performance. We have thus generated a promising tool that allows guidance and individualized surveillance of CC patients with high risks of LM.
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Affiliation(s)
- Yu Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Aydin Eresen
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Junjie Shangguan
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Jia Yang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Yun Lu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
- Shandong Key Laboratory of Digital Medicine and Computer Assisted SurgeryQingdao, Shandong, China
| | - Dong Chen
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao UniversityQingdao, Shandong, China
| | - Jian Wang
- Department of Radiological Sciences, School of Medicine, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Yury Velichko
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
| | - Vahid Yaghmai
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
- Department of Radiology, University of CaliforniaIrvine, Orange, CA, USA
| | - Zhuoli Zhang
- Department of Radiology, Feinberg School of Medicine, Northwestern UniversityChicago, IL, USA
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Hwang JA, Kim YK, Min JH, Song KD, Sohn I, Ahn HS. Non-contrast liver MRI as an alternative to gadoxetic acid-enhanced MRI for liver metastasis from colorectal cancer. Acta Radiol 2019; 60:441-450. [PMID: 30130970 DOI: 10.1177/0284185118788901] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Liver magnetic resonance imaging (MRI) provides reliable diagnostic performance for detecting liver metastasis but is costly and time-consuming. PURPOSE To compare the diagnostic performance of non-contrast liver MRI to whole MRI using gadoxetic acid for detecting liver metastasis in patients with colorectal cancer (CRC). MATERIAL AND METHODS We included 175 patients with histologically confirmed 401 liver metastases and 73 benign liver lesions. A non-contrast MRI (T1-weighted, T2-weighted, and diffusion-weighted images) with or without multidetector computed tomography (MDCT) and a whole MRI (gadoxetic acid-enhanced and non-contrast MRI) were analyzed independently by two observers to detect liver metastasis using receiver operating characteristic analysis. RESULTS We found no significant differences in Az value (range = 0.914-0.997), sensitivity (range = 95.2-99.6%), specificity (range = 77.3-100%), or positive (range = 92.9-100%) or negative predictive value (range = 87.5-95.7%) between the non-contrast MRI with or without MDCT and the whole MRI for both observers for all lesions as well as lesions ≤1.0 cm and lesions >1.0 cm in size ( P = 0.203-1.000). Combined MDCT and non-contrast MRI led to similar numbers of false-positive diagnosis to the whole MRI (eight for Observers 1 and 4 vs. 3 for Observer 2). CONCLUSION Non-contrast liver MRI may serve as an alternative to gadoxetic acid-enhanced MRI for detecting and characterizing liver metastasis from CRC, at least in patients with relatively high risk of liver metastasis who underwent MDCT. Non-contrast liver MRI could be beneficial especially for patients with lesions that are already documented as benign but require additional follow-up MRIs.
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Affiliation(s)
- Jeong Ah Hwang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan hospital, Cheonan, Republic of Korea
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Radiology, Chungnam National University Hospital, Chungnam National University of College of Medicine, Daejeon, Republic of Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Insuk Sohn
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Hyeon Seon Ahn
- Statistics and Data Center, Samsung Medical Center, Seoul, Republic of Korea
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Shu Z, Fang S, Ding Z, Mao D, Cai R, Chen Y, Pang P, Gong X. MRI-based Radiomics nomogram to detect primary rectal cancer with synchronous liver metastases. Sci Rep 2019; 9:3374. [PMID: 30833648 PMCID: PMC6399278 DOI: 10.1038/s41598-019-39651-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 01/29/2019] [Indexed: 12/30/2022] Open
Abstract
Synchronous liver metastasis (SLM) remains a major challenge for rectal cancer. Early detection of SLM is a key factor to improve the survival rate of rectal cancer. In this radiomics study, we predicted the SLM based on the radiomics of primary rectal cancer. A total of 328 radiomics features were extracted from the T2WI images of 194 patients. The least absolute shrinkage and selection operator (LASSO) regression was used to reduce the feature dimension and to construct the radiomics signature. after LASSO, principal component analysis (PCA) was used to sort the features of the surplus characteristics, and selected the features of the total contribution of 85%. Then the prediction model was built by linear regression, and the decision curve analysis was used to judge the net benefit of LASSO and PCA. In addition, we used two independent cohorts for training (n = 135) and validation (n = 159). We found that the model based on LASSO dimensionality construction had the maximum net benefit (in the training set (AUC [95% confidence interval], 0.857 [0.787–0.912]) and in the validation set (0.834 [0.714–0.918]). The radiomics nomogram combined with clinical risk factors and LASSO features showed a good predictive performance in the training set (0.921 [0.862–0.961]) and validation set (0.912 [0.809–0.97]). Our study indicated that radiomics based on primary rectal cancer could provide a non-invasive way to predict the risk of SLM in clinical practice.
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Affiliation(s)
- Zhenyu Shu
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Songhua Fang
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Zhongxiang Ding
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Dewang Mao
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Rui Cai
- Department of Anorectal, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China
| | | | | | - Xiangyang Gong
- Department of Radiology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital of Hangzhou Medical College, Hangzhou, China.
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Diagnostic performance of [18F]FDG-PET/MRI for liver metastasis in patients with primary malignancy: a systematic review and meta-analysis. Eur Radiol 2019; 29:3553-3563. [DOI: 10.1007/s00330-018-5909-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/18/2018] [Accepted: 11/22/2018] [Indexed: 12/21/2022]
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23
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Non-hypervascular hepatobiliary phase hypointense nodules on gadoxetic acid-enhanced MR can help determine the treatment method for HCC. Eur Radiol 2019; 29:3122-3131. [DOI: 10.1007/s00330-018-5941-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/25/2018] [Accepted: 11/30/2018] [Indexed: 12/12/2022]
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Galgano S, Viets Z, Fowler K, Gore L, Thomas JV, McNamara M, McConathy J. Practical Considerations for Clinical PET/MR Imaging. PET Clin 2018; 13:97-112. [PMID: 29157390 DOI: 10.1016/j.cpet.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Clinical PET/MR imaging is currently performed at a number of centers around the world as part of routine standard of care. This article focuses on issues and considerations for a clinical PET/MR imaging program, focusing on routine standard-of-care studies. Although local factors influence how clinical PET/MR imaging is implemented, the approaches and considerations described here intend to apply to most clinical programs. PET/MR imaging provides many more options than PET/computed tomography with diagnostic advantages for certain clinical applications but with added complexity. A recurring theme is matching the PET/MR imaging protocol to the clinical application to balance diagnostic accuracy with efficiency.
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Affiliation(s)
- Samuel Galgano
- Department of Radiology, University of Alabama at Birmingham (UAB), 619 19th Street South, Birmingham, AL 35249, USA
| | - Zachary Viets
- Department of Radiology, Washington University in St Louis, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
| | - Kathryn Fowler
- Department of Radiology, Washington University in St Louis, 510 South Kingshighway Boulevard, St. Louis, MO 63110, USA
| | - Lael Gore
- Department of Radiology, University of Alabama at Birmingham (UAB), 619 19th Street South, Birmingham, AL 35249, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham (UAB), 619 19th Street South, Birmingham, AL 35249, USA
| | - Michelle McNamara
- Department of Radiology, University of Alabama at Birmingham (UAB), 619 19th Street South, Birmingham, AL 35249, USA
| | - Jonathan McConathy
- Department of Radiology, University of Alabama at Birmingham (UAB), 619 19th Street South, Birmingham, AL 35249, USA.
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Joo I, Lee JM, Yoon JH. Imaging Diagnosis of Intrahepatic and Perihilar Cholangiocarcinoma: Recent Advances and Challenges. Radiology 2018; 288:7-13. [DOI: 10.1148/radiol.2018171187] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Ijin Joo
- From the Department of Radiology (I.J., J.M.L., J.H.Y.) and Institute of Radiation Medicine (J.M.L.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea; and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (I.J., J.M.L., J.H.Y.)
| | - Jeong Min Lee
- From the Department of Radiology (I.J., J.M.L., J.H.Y.) and Institute of Radiation Medicine (J.M.L.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea; and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (I.J., J.M.L., J.H.Y.)
| | - Jeong Hee Yoon
- From the Department of Radiology (I.J., J.M.L., J.H.Y.) and Institute of Radiation Medicine (J.M.L.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea; and Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (I.J., J.M.L., J.H.Y.)
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26
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Evaluation of Transient Motion During Gadoxetic Acid-Enhanced Multiphasic Liver Magnetic Resonance Imaging Using Free-Breathing Golden-Angle Radial Sparse Parallel Magnetic Resonance Imaging. Invest Radiol 2018; 53:52-61. [PMID: 28902723 DOI: 10.1097/rli.0000000000000409] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aims of this study were to observe the pattern of transient motion after gadoxetic acid administration including incidence, onset, and duration, and to evaluate the clinical feasibility of free-breathing gadoxetic acid-enhanced liver magnetic resonance imaging using golden-angle radial sparse parallel (GRASP) imaging with respiratory gating. MATERIALS AND METHODS In this institutional review board-approved prospective study, 59 patients who provided informed consents were analyzed. Free-breathing dynamic T1-weighted images (T1WIs) were obtained using GRASP at 3 T after a standard dose of gadoxetic acid (0.025 mmol/kg) administration at a rate of 1 mL/s, and development of transient motion was monitored, which is defined as a distinctive respiratory frequency alteration of the self-gating MR signals. Early arterial, late arterial, and portal venous phases retrospectively reconstructed with and without respiratory gating and with different temporal resolutions (nongated 13.3-second, gated 13.3-second, gated 6-second T1WI) were evaluated for image quality and motion artifacts. Diagnostic performance in detecting focal liver lesions was compared among the 3 data sets. RESULTS Transient motion (mean duration, 21.5 ± 13.0 seconds) was observed in 40.0% (23/59) of patients, 73.9% (17/23) of which developed within 15 seconds after gadoxetic acid administration. On late arterial phase, motion artifacts were significantly reduced on gated 13.3-second and 6-second T1WI (3.64 ± 0.34, 3.61 ± 0.36, respectively), compared with nongated 13.3-second T1WI (3.12 ± 0.51, P < 0.0001). Overall, image quality was the highest on gated 13.3-second T1WI (3.76 ± 0.39) followed by gated 6-second and nongated 13.3-second T1WI (3.39 ± 0.55, 2.57 ± 0.57, P < 0.0001). Only gated 6-second T1WI showed significantly higher detection performance than nongated 13.3-second T1WI (figure of merit, 0.69 [0.63-0.76]) vs 0.60 [0.56-0.65], P = 0.004). CONCLUSIONS Transient motion developed in 40% (23/59) of patients shortly after gadoxetic acid administration, and gated free-breathing T1WI using GRASP was able to consistently provide acceptable arterial phase imaging in patients who exhibited transient motion.
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27
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Joo I, Lee JM, Lee ES, Ahn SJ, Lee DH, Kim SW, Ryu JK, Oh DY, Kim K, Lee KB, Jang JY. Preoperative MDCT Assessment of Resectability in Borderline Resectable Pancreatic Cancer: Effect of Neoadjuvant Chemoradiation Therapy. AJR Am J Roentgenol 2018; 210:1059-1065. [DOI: 10.2214/ajr.17.18310] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Ijin Joo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eun Sun Lee
- Department of Radiology, Chung-Ang University Hospital, Seoul, Korea
| | - Su Joa Ahn
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-gu, Seoul 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Sun-Whe Kim
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Ji Kon Ryu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Woman's University School of Medicine, Seoul, Korea
| | - Kyoung-Bun Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
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28
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Jhaveri KS, Fischer SE, Hosseini-Nik H, Sreeharsha B, Menezes RJ, Gallinger S, Moulton CAE. Prospective comparison of gadoxetic acid-enhanced liver MRI and contrast-enhanced CT with histopathological correlation for preoperative detection of colorectal liver metastases following chemotherapy and potential impact on surgical plan. HPB (Oxford) 2017; 19:992-1000. [PMID: 28760631 DOI: 10.1016/j.hpb.2017.06.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 04/20/2017] [Accepted: 06/28/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To prospectively compare the diagnostic performance of gadoxetic acid-enhanced MRI (EOB-MRI) and contrast-enhanced CT (CECT) for preoperative detection of colorectal liver metastases (CRLM) following chemotherapy and to evaluate the potential change in the hepatic resection plan. METHODS 51 patients with CRLM treated with preoperative chemotherapy underwent liver imaging by EOB-MRI and CECT prospectively. Two independent blinded readers characterized hepatic lesions on each imaging modality using a 5-point scoring system. 41 patients underwent hepatic resection and histopathological evaluation. RESULTS 151 CRLM were confirmed by histology. EOB-MRI, compared to CECT, had significantly higher sensitivity in detection of CRLM ≤1.0 cm (86% vs. 45.5%; p < 0.001), significantly lower indeterminate lesions diagnosis (7% vs. 33%; p < 0.001) and significantly higher interobserver concordance rate in characterizing the lesions ≤1.0 cm (72% vs. 51%; p = 0.041). The higher yield of EOB-MRI could have changed the surgical plan in 45% of patients. CONCLUSION Following preoperative chemotherapy, EOB-MRI is superior to CECT in detection of small CRLM (≤1 cm) with significantly higher sensitivity and diagnostic confidence and interobserver concordance in lesion characterization. This improved diagnostic performance can alter the surgical plan in almost half of patients scheduled for liver resection.
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Affiliation(s)
- Kartik S Jhaveri
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
| | - Sandra E Fischer
- Department of Pathology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Hooman Hosseini-Nik
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Boraiah Sreeharsha
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Ravi J Menezes
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Steven Gallinger
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carol-Anne E Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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29
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Lincke T, Zech CJ. Liver metastases: Detection and staging. Eur J Radiol 2017; 97:76-82. [PMID: 29153371 DOI: 10.1016/j.ejrad.2017.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 09/27/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
The liver is more often involved with metastatic disease than primary liver tumors. The accurate detection and characterization of liver metastases are crucial since patient management depends on it. The imaging options, mainly consisting of contrast-enhanced ultrasound (CEUS), multidetector computed tomography (CT), magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI), extra-cellular contrast media and liver-specific contrast media as well as positron emission tomography/computed tomography (PET/CT), are constantly evolving. PET/MRI is a more recent hybrid method and a topic of major interest concerning liver metastases detection and characterization. This review gives a brief overview about the spectrum of imaging findings and focus on an update about the performance, advantages and potential limitations of each modality as well as current developments and innovations.
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Affiliation(s)
- Therese Lincke
- Clinic of Radiology und Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland.
| | - Christoph J Zech
- Clinic of Radiology und Nuclear Medicine, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland
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Saing S, Haywood P, Duncan JK, Ma N, Cameron AL, Goodall S. Cost-effective imaging for resectability of liver lesions in colorectal cancer: an economic decision model. ANZ J Surg 2017; 88:E507-E511. [PMID: 28982209 DOI: 10.1111/ans.14194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/28/2017] [Accepted: 07/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study aimed to determine the cost-effectiveness of contrast-enhanced magnetic resonance imaging (CE-MRI) compared with multiphase CE computed tomography (CE-CT) scan to characterize suspected liver lesions in patients with known colorectal carcinoma. METHODS A decision analytic model linking diagnostic accuracy to health outcomes in patients with colorectal carcinoma was constructed. The model assumed that CE-MRI has superior sensitivity and equivalent specificity to CE-CT, and patients with a colorectal liver metastasis could be eligible for curative surgery or chemotherapy and palliation. Delayed diagnosis or misdiagnosis was associated with worse health outcomes (disutility). Cost-effectiveness was calculated as the incremental cost relative to the incremental benefit, the benefit was estimated using quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of the results. RESULTS The clinical evidence supports increased sensitivity of CE-MRI compared with CE-CT (0.943 versus 0.768). CE-MRI was more effective and more costly than CE-CT. The incremental cost-effectiveness ratio was estimated to be $40 548 per quality-adjusted life year gained. The model is most sensitive to the cost of MRI, cost of palliative treatment and the disutility associated with delayed palliative care. The results were also sensitive to the assumptions made about the clinical algorithm. CONCLUSION The results provide evidence of the potential cost-effectiveness associated with CE-MRI for the diagnosis of liver metastases in patients with identified colorectal carcinoma. CE-MRI can be recommended as cost-effective provided it replaces CE-CT and that improved diagnostic accuracy results in earlier, curative, disease management.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Phil Haywood
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S), Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, New South Wales, Australia
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Application of High-Speed T1 Sequences for High-Quality Hepatic Arterial Phase Magnetic Resonance Imaging. Invest Radiol 2017; 52:605-611. [DOI: 10.1097/rli.0000000000000378] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Park JE, Han K, Sung YS, Chung MS, Koo HJ, Yoon HM, Choi YJ, Lee SS, Kim KW, Shin Y, An S, Cho HM, Park SH. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal. Korean J Radiol 2017; 18:888-897. [PMID: 29089821 PMCID: PMC5639154 DOI: 10.3348/kjr.2017.18.6.888] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To evaluate the frequency and adequacy of statistical analyses in a general radiology journal when reporting a reliability analysis for a diagnostic test. Materials and Methods Sixty-three studies of diagnostic test accuracy (DTA) and 36 studies reporting reliability analyses published in the Korean Journal of Radiology between 2012 and 2016 were analyzed. Studies were judged using the methodological guidelines of the Radiological Society of North America-Quantitative Imaging Biomarkers Alliance (RSNA-QIBA), and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) initiative. DTA studies were evaluated by nine editorial board members of the journal. Reliability studies were evaluated by study reviewers experienced with reliability analysis. Results Thirty-one (49.2%) of the 63 DTA studies did not include a reliability analysis when deemed necessary. Among the 36 reliability studies, proper statistical methods were used in all (5/5) studies dealing with dichotomous/nominal data, 46.7% (7/15) of studies dealing with ordinal data, and 95.2% (20/21) of studies dealing with continuous data. Statistical methods were described in sufficient detail regarding weighted kappa in 28.6% (2/7) of studies and regarding the model and assumptions of intraclass correlation coefficient in 35.3% (6/17) and 29.4% (5/17) of studies, respectively. Reliability parameters were used as if they were agreement parameters in 23.1% (3/13) of studies. Reproducibility and repeatability were used incorrectly in 20% (3/15) of studies. Conclusion Greater attention to the importance of reporting reliability, thorough description of the related statistical methods, efforts not to neglect agreement parameters, and better use of relevant terminology is necessary.
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Affiliation(s)
- Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Mi Sun Chung
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul 06973, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Youngbin Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Suah An
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyo-Min Cho
- Korea Research Institute of Standards and Science, Daejeon 34113, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Kirchner J, Sawicki LM, Deuschl C, Grüneisen J, Beiderwellen K, Lauenstein TC, Herrmann K, Forsting M, Heusch P, Umutlu L. 18 F-FDG PET/MR imaging in patients with suspected liver lesions: Value of liver-specific contrast agent Gadobenate dimeglumine. PLoS One 2017; 12:e0180349. [PMID: 28683109 PMCID: PMC5500282 DOI: 10.1371/journal.pone.0180349] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/14/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate the added value of the application of the liver-specific contrast phase of Gadobenate dimeglumine (Gd-BOPTA) for detection and characterization of liver lesions in 18F-FDG PET/MRI. METHODS 41 patients with histologically confirmed solid tumors and known / suspected liver metastases or not classifiable lesions in 18F-FDG PET/CT were included in this study. All patients underwent a subsequent Gd-BOPTA enhanced 18F-FDG PET/MRI examination. MRI without liver-specific contrast phase (MRI1), MRI with liver-specific contrast phase (MRI2), 18F-FDG PET/MRI without liver-specific contrast phase (PET/MRI1) and with liver-specific contrast phase (PET/MRI2) were separately evaluated for suspect lesions regarding lesion dignity, characterization, conspicuity and confidence. RESULTS PET/MRI datasets enabled correct identification of 18/18 patients with malignant lesions; MRI datasets correctly identified 17/18 patients. On a lesion-based analysis PET/MRI2 provided highest accuracy for differentiation of lesions into malignant and benign lesions of 98% and 100%. Respective values were 95% and 100% for PET/MRI1, 93% and 96% for MRI2 and 91% and 93% for MRI1. Statistically significant higher diagnostic confidence was found for PET/MRI2 and MRI2 datasets compared to PET/MRI1 and MRI1, respectively (p < 0.001). CONCLUSION The application of the liver-specific contrast phase in 18F-FDG PET/MRI further increases the diagnostic accuracy and diagnostic confidence for correct assessment of benign and malignant liver lesions.
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Affiliation(s)
- Julian Kirchner
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
- * E-mail:
| | - Lino M. Sawicki
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Duisburg-Essen, Germany
| | - Johannes Grüneisen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Duisburg-Essen, Germany
| | - Karsten Beiderwellen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Duisburg-Essen, Germany
| | - Thomas C. Lauenstein
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Duisburg-Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Duisburg-Essen, Germany
| | - Philipp Heusch
- Department of Diagnostic and Interventional Radiology, University Dusseldorf, Medical Faculty, Dusseldorf, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Duisburg-Essen, Germany
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Galgano S, Viets Z, Fowler K, Gore L, Thomas JV, McNamara M, McConathy J. Practical Considerations for Clinical PET/MR Imaging. Magn Reson Imaging Clin N Am 2017; 25:281-296. [DOI: 10.1016/j.mric.2016.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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The value of gadoxetic acid-enhanced MRI for differentiation between hepatic microabscesses and metastases in patients with periampullary cancer. Eur Radiol 2017; 27:4383-4393. [PMID: 28342102 DOI: 10.1007/s00330-017-4782-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to identify features that differentiate hepatic microabscess from hepatic metastasis on gadoxetic acid-enhanced MRI in patients with periampullary cancer. METHODS We included 72 patients (31 patients with 83 hepatic microabscesses and 41 patients with 71 hepatic metastases) who had a history of periampullary cancer and underwent gadoxetic acid-enhanced MRI. Image analysis was performed for margin, signal intensity, rim enhancement, perilesional hyperaemia, pattern on DWI and dynamic phases, and size discrepancy between sequences by consensus of two observers. RESULTS Multivariate analysis revealed that the following significant parameters favour microabscess: a history of bile duct cancer, perilesional hyperaemia, persistent arterial rim enhancement through the transitional phase (TP), and size discrepancy between T1WI and T2WI and between T1WI and hepatobiliary phase image (HBPI). The diagnostic accuracy for microabscess was highest (90.9%) when showing a size discrepancy ≥30% between T1WI and HBPI or persistent arterial rim enhancement through the TP. When the lesion was positive for both these variables, specificity reached 100%. CONCLUSION The combination of a size discrepancy between T1WI and HBPI and persistent arterial rim enhancement through the TP represents a reliable MRI feature for distinguishing between hepatic microabscess and metastasis in patients with periampullary cancer. KEY POINTS • Gadoxetic acid-enhanced MRI is useful for distinguishing hepatic microabscess from metastasis. • Hepatic microabscess showed significant size discrepancy ≥30% between T1WI and HBPI. • Arterial rim enhancement persistent through the TP indicates hepatic microabscess.
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Kang KA, Jang KM, Kim SH, Kang TW, Cha DI. Risk factor assessment to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography in patients with rectal cancer. Clin Radiol 2017; 72:473-481. [PMID: 28258741 DOI: 10.1016/j.crad.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/12/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022]
Abstract
AIM To assess the significant factors on rectal magnetic resonance imaging (MRI) to predict the likelihood of a diagnosis of metastasis for indeterminate hepatic lesions found at computed tomography (CT) in patients with rectal cancer. MATERIALS AND METHODS A total of 207 patients with rectal cancer who underwent preoperative contrast-enhanced abdominopelvic CT, and rectal and liver MRI were included. Univariate analysis and multivariate logistic regression were used to evaluate the determining factors for the significance of indeterminate hepatic lesions on CT in patients with rectal cancer. RESULTS Hepatic metastases were diagnosed in 29 (20.9%) of 139 patients who had indeterminate hepatic lesions on preoperative CT obtained for rectal cancer. On univariate analysis, carcinoembryonic antigen level, N stage, mesorectal fascia (MRF) invasion, diameter of superior haemorrhoidal vein, and mesorectal vascular lesion (MVL) grade on rectal MRI (p<0.05) were associated with the possibility of metastasis for indeterminate hepatic lesions on CT. On multivariate analysis, MVL grade and MRF invasion on rectal MRI were independent factors associated with the possibility of metastasis for indeterminate hepatic lesions on CT (p<0.0005 and p=0.0066, respectively). CONCLUSION MVL grade and MRF invasion on rectal MRI are independent factors for estimating hepatic metastasis among indeterminate hepatic lesions on CT in patients with rectal cancer.
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Affiliation(s)
- K A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K M Jang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea.
| | - S H Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - T W Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
| | - D I Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Republic of Korea
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Dulku G, Dhillon R, Goodwin M, Cheng W, Kontorinis N, Mendelson R. The role of imaging in the surveillance and diagnosis of hepatocellular cancer. J Med Imaging Radiat Oncol 2016; 61:171-179. [DOI: 10.1111/1754-9485.12568] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/05/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Gurjeet Dulku
- Department of Diagnostic and Interventional Radiology; Royal Perth Hospital; Perth Western Australia Australia
| | - Ravinder Dhillon
- Radiology Department; Sir Charles Gairdner Hospital; Nedlands Western Australia Australia
| | - Mark Goodwin
- Radiology Department; Austin Hospital; Melbourne Victoria Australia
| | - Wendy Cheng
- Department of Gastroenterology; Royal Perth Hospital; Perth Western Australia Australia
| | - Nick Kontorinis
- Department of Gastroenterology; Royal Perth Hospital; Perth Western Australia Australia
| | - Richard Mendelson
- Department of Diagnostic and Interventional Radiology; Royal Perth Hospital; Perth Western Australia Australia
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Vreugdenburg TD, Ma N, Duncan JK, Riitano D, Cameron AL, Maddern GJ. Comparative diagnostic accuracy of hepatocyte-specific gadoxetic acid (Gd-EOB-DTPA) enhanced MR imaging and contrast enhanced CT for the detection of liver metastases: a systematic review and meta-analysis. Int J Colorectal Dis 2016; 31:1739-1749. [PMID: 27682648 DOI: 10.1007/s00384-016-2664-9] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE This systematic review evaluated the diagnostic accuracy and impact on patient management of hepatocyte-specific gadoxetic acid enhanced magnetic resonance imaging (GA-MRI) compared to contrast enhanced computed tomography (CE-CT) in patients with liver metastases. METHOD Four biomedical databases (PubMed, EMBASE, Cochrane Library, York CRD) were searched from January 1991 to February 2016. Studies investigating the accuracy or management impact of GA-MRI compared to CE-CT in patients with known or suspected liver metastases were included. Bias was evaluated using QUADAS-II. Univariate meta-analysis of sensitivity ratios (RR) were conducted in the absence of heterogeneity, calculated using I 2 , Tau values (τ) and prediction intervals. RESULTS Nine diagnostic accuracy studies (537 patients with 1216 lesions) and four change in management studies (488 patients with 281 lesions) were included. Per-lesion sensitivity and specificity estimates for GA-MRI ranged from 86.9-100.0 % and 80.2-98.0 %, respectively, compared to 51.8-84.6 % and 77.2-98.0 % for CE-CT. Meta-analysis found GA-MRI to be significantly more sensitive than CE-CT (RR = 1.29, 95 % CI = 1.18-1.40, P < 0.001), with equivalent specificity (RR = 0.97, 95 % CI 0.910-1.042, P = 0.44). The largest difference was observed for lesions smaller than 10 mm for which GA-MRI was significantly more sensitive (RR = 2.21, 95 % CI = 1.47-3.32, P < 0.001) but less specific (RR = 0.92, 95 % CI 0.87-0.98, P = 0.008). GA-MRI affected clinical management in 26 of 155 patients (16.8 %) who had a prior CE-CT; however, no studies investigated the consequences of using GA-MRI instead of CE-CT. CONCLUSION GA-MRI is significantly more sensitive than CE-CT for detecting liver metastases, which leads to a modest impact on patient management in the context of an equivocal CE-CT result.
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Affiliation(s)
- Thomas D Vreugdenburg
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia.
| | - Ning Ma
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Joanna K Duncan
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Dagmara Riitano
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Alun L Cameron
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
| | - Guy J Maddern
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), The Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, South Australia, 5006, Australia
- Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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Matos AP, Altun E, Ramalho M, Velloni F, AlObaidy M, Semelka RC. An overview of imaging techniques for liver metastases management. Expert Rev Gastroenterol Hepatol 2016; 9:1561-76. [PMID: 26414180 DOI: 10.1586/17474124.2015.1092873] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Evaluation of liver metastases is one of the most common indications for liver imaging. Imaging plays a key role in the of assessment liver metastases. A variety of imaging techniques, including ultrasonography, computed tomography, MRI and PET combined with CT scan are available for diagnosis, planning treatment, and follow-up treatment response. In this paper, the authors present the role of imaging for the assessment of liver metastases and the contribution of each of the different imaging techniques for their evaluation and management. Following recent developments in the field of oncology, the authors also present the importance of imaging for the assessment of liver metastases response to therapy. Finally, future perspectives on imaging of liver metastases are presented.
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Affiliation(s)
- António P Matos
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Ersan Altun
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Miguel Ramalho
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Fernanda Velloni
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
| | - Mamdoh AlObaidy
- a University of North Carolina, Department of Radiology, Chapel Hill, NC, USA
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Lee DH, Lee JM, Hur BY, Joo I, Yi NJ, Suh KS, Kang KW, Han JK. Colorectal Cancer Liver Metastases: Diagnostic Performance and Prognostic Value of PET/MR Imaging. Radiology 2016; 280:782-92. [DOI: 10.1148/radiol.2016151975] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Choi YJ, Chung MS, Koo HJ, Park JE, Yoon HM, Park SH. Does the Reporting Quality of Diagnostic Test Accuracy Studies, as Defined by STARD 2015, Affect Citation? Korean J Radiol 2016; 17:706-14. [PMID: 27587959 PMCID: PMC5007397 DOI: 10.3348/kjr.2016.17.5.706] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 05/29/2016] [Indexed: 01/30/2023] Open
Abstract
Objective To determine the rate with which diagnostic test accuracy studies that are published in a general radiology journal adhere to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015, and to explore the relationship between adherence rate and citation rate while avoiding confounding by journal factors. Materials and Methods All eligible diagnostic test accuracy studies that were published in the Korean Journal of Radiology in 2011–2015 were identified. Five reviewers assessed each article for yes/no compliance with 27 of the 30 STARD 2015 checklist items (items 28, 29, and 30 were excluded). The total STARD score (number of fulfilled STARD items) was calculated. The score of the 15 STARD items that related directly to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 was also calculated. The number of times each article was cited (as indicated by the Web of Science) after publication until March 2016 and the article exposure time (time in months between publication and March 2016) were extracted. Results Sixty-three articles were analyzed. The mean (range) total and QUADAS-2-related STARD scores were 20.0 (14.5–25) and 11.4 (7–15), respectively. The mean citation number was 4 (0–21). Citation number did not associate significantly with either STARD score after accounting for exposure time (total score: correlation coefficient = 0.154, p = 0.232; QUADAS-2-related score: correlation coefficient = 0.143, p = 0.266). Conclusion The degree of adherence to STARD 2015 was moderate for this journal, indicating that there is room for improvement. When adjusted for exposure time, the degree of adherence did not affect the citation rate.
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Affiliation(s)
- Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Mi Sun Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
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Lee DH, Lee JM. Whole-body PET/MRI for colorectal cancer staging: Is it the way forward? J Magn Reson Imaging 2016; 45:21-35. [DOI: 10.1002/jmri.25337] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/24/2016] [Indexed: 12/22/2022] Open
Affiliation(s)
- Dong Ho Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
| | - Jeong Min Lee
- Department of Radiology; Seoul National University Hospital; Seoul Korea
- Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
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Vilgrain V, Esvan M, Ronot M, Caumont-Prim A, Aubé C, Chatellier G. A meta-analysis of diffusion-weighted and gadoxetic acid-enhanced MR imaging for the detection of liver metastases. Eur Radiol 2016; 26:4595-4615. [PMID: 26883327 DOI: 10.1007/s00330-016-4250-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To obtain the diagnostic performance of diffusion-weighted (DW) and gadoxetic-enhanced magnetic resonance (MR) imaging in the detection of liver metastases. METHODS A comprehensive search (EMBASE, PubMed, Cochrane) was performed to identify relevant articles up to June 2015. Inclusion criteria were: liver metastases, DW-MR imaging and/or gadoxetic acid-enhanced MR imaging, and per-lesion statistics. The reference standard was histopathology, intraoperative observation and/or follow-up. Sources of bias were assessed using the QUADAS-2 tool. A linear mixed-effect regression model was used to obtain sensitivity estimates. RESULTS Thirty-nine articles were included (1,989 patients, 3,854 metastases). Sensitivity estimates for DW-MR imaging, gadoxetic acid-enhanced MR imaging and the combined sequence for detecting liver metastases on a per-lesion basis was 87.1 %, 90.6 % and 95.5 %, respectively. Sensitivity estimates by gadoxetic acid-enhanced MR imaging and the combined sequence were significantly better than DW-MR imaging (p = 0.0001 and p < 0.0001, respectively), and the combined MR sequence was significantly more sensitive than gadoxetic acid-enhanced MR imaging (p < 0.0001). Similar results were observed in articles that compared the three techniques simultaneously, with only colorectal liver metastases and in liver metastases smaller than 1 cm. CONCLUSIONS In patients with liver metastases, combined DW-MR and gadoxetic acid-enhanced MR imaging has the highest sensitivity for detecting liver metastases on a per-lesion basis. KEY POINTS • DW-MRI is less sensitive than gadoxetic acid-enhanced MRI for detecting liver metastases • DW-MRI and gadoxetic acid-enhanced MRI is the best combination • Same results are observed in colorectal liver metastases • Same results are observed in liver metastases smaller than 1 cm • Same results are observed when histopathology alone is the reference standard.
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Affiliation(s)
- Valérie Vilgrain
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France. .,University Paris Diderot, Sorbonne Paris Cité, Paris, France. .,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France.
| | - Maxime Esvan
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Maxime Ronot
- Department of Radiology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France.,University Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France
| | - Aurore Caumont-Prim
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France
| | - Christophe Aubé
- Department of Radiology, CHU d'Angers, Angers, France.,Laboratoire HIFIH, LUNAM, Université d'Angers, Angers, France
| | - Gilles Chatellier
- Hôpital européen Georges-Pompidou, Unité d'Épidémiologie et de Recherche Clinique, 75015, Paris, France.,INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, 75015, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, 75006, Paris, France
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Added Value of Integrated Whole-Body PET/MRI for Evaluation of Colorectal Cancer: Comparison With Contrast-Enhanced MDCT. AJR Am J Roentgenol 2016; 206:W10-20. [DOI: 10.2214/ajr.14.13818] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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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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Michaels AY, Keraliya AR, Tirumani SH, Shinagare AB, Ramaiya NH. Systemic treatment in breast cancer: a primer for radiologists. Insights Imaging 2015; 7:131-44. [PMID: 26567115 PMCID: PMC4729711 DOI: 10.1007/s13244-015-0447-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/24/2015] [Accepted: 10/21/2015] [Indexed: 12/22/2022] Open
Abstract
Abstract Cytotoxic chemotherapy, hormonal therapy and molecular targeted therapy are the three major classes of drugs used to treat breast cancer. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), 18F-FDG positron emission tomography (PET)/CT and bone scintigraphy each have a distinct role in monitoring response and detecting drug toxicities associated with these treatments. The purpose of this article is to elucidate the various systemic therapies used in breast cancer, with an emphasis on the role of imaging in assessing treatment response and detecting treatment-related toxicities. Teaching Points • Cytotoxic chemotherapy is often used in combination with HER2-targeted and endocrine therapies. • Endocrine and HER2-targeted therapies are recommended in hormone-receptor- and HER2-positive cases. • CT is the workhorse for assessment of treatment response in breast cancer metastases. • Alternate treatment response criteria can help in interpreting pseudoprogression in metastasis. • Unique toxicities are associated with cytotoxic chemotherapy and with endocrine and HER2-targeted therapies.
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Affiliation(s)
- Aya Y Michaels
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Abhishek R Keraliya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Sree Harsha Tirumani
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA. .,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA.
| | - Atul B Shinagare
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Nikhil H Ramaiya
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.,Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
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Navigated three-dimensional T1-weighted gradient-echo sequence for gadoxetic acid liver magnetic resonance imaging in patients with limited breath-holding capacity. ACTA ACUST UNITED AC 2015; 40:278-88. [PMID: 25112454 DOI: 10.1007/s00261-014-0214-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To determine whether a navigator-gated three-dimensional T1-weighted gradient-echo sequence (T1W-GRE, navigated LAVA) can improve diagnostic performance for the detection of focal liver lesions (FLLs) compared to standard breath-hold (BH) T1W-GRE breath-hold LAVA (BH-LAVA) during the hepatobiliary phase (HBP) of gadoxetic acid liver magnetic resonance imaging (MRI) in patients with limited breath-holding capacity. MATERIALS AND METHODS This retrospective study was approved by our institutional review board and the requirement for informed consent was waived. We included 372 patients who underwent liver MRI including both navigated LAVA and BH-LAVA sequences. Overall image quality of the two HBP image sets was compared. In patients with limited breath-holding capacity, diagnostic performances in detecting FLLs on the two HBP images were compared using jackknife-alternative free-response receiver-operating characteristic (JAFROC) analysis by two reviewers. RESULTS There were 13 cases (13/372; 3.5%) of image acquisition failure using the navigated LAVA sequence due to severe irregular breathing, and 50 of 359 patients had limited breath-holding capacity. In these patients, overall image quality of navigated LAVA (2.78 ± 0.95) was significantly better than that of BH-LAVA (2.42 ± 0.81, P < 0.005), and both readers showed significantly higher JAFROC figure-of-merit values with navigated LAVA compared to BH-LAVA (0.94 and 0.86 in reviewer 1, respectively; 0.89 and 0.83 in reviewer 2, respectively, P < 0.005). Overall image quality of navigated LAVA was also better than that of BH-LAVA in patients with sufficient breath-holding capacity (n = 309, 3.96 ± 0.88, 3.81 ± 0.66, respectively, P < 0.001). CONCLUSION The navigated LAVA sequence could provide better image quality and diagnostic performance in detecting FLLs than BH-LAVA in patients with limited breath-holding capacity during HBP of gadoxetic acid MRI.
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Park M, Chung YE, Kim KA, Chung WS, Lee HS, Han KH, Kim MJ, Kim KW. Added value of arterial enhancement fraction color maps for the characterization of small hepatic low-attenuating lesions in patients with colorectal cancer. PLoS One 2015; 10:e0114819. [PMID: 25706878 PMCID: PMC4338035 DOI: 10.1371/journal.pone.0114819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 10/19/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the added value of arterial enhancement fraction (AEF) color maps for the differentiation of small metastases from hepatic benign lesions. SUBJECTS AND METHODS We retrospectively analyzed 46 patients with colorectal cancer who underwent multiphasic liver CT imaging and had low-attenuating liver lesions smaller than 3 cm (123 total lesions; metastasis: benign = 32:91). AEF color maps of the liver were created from multiphasic liver CT images using dedicated software. Two radiologists independently reviewed multiphasic CT image sets alone and in combination with image sets with AEF color maps using a five-point scale. The additional diagnostic value of the color maps was assessed by means of receiver-operating characteristic (ROC) analysis. RESULTS The area under the ROC curve (Az) increased when multiphasic CT images were combined with AEF color map analysis as compared with evaluation based only on multiphasic CT images (from 0.698 to 0.897 for reader 1, and from 0.825 to 0.945 for reader 2; P < 0.001 and 0.002, respectively). The increase Az was especially significant for lesions less than 1 cm (from 0.702 to 0.888 for reader 1, and from 0.768 to 0.958 for reader 2; P = 0.001 and P = 0.001, respectively). The mean AEF of tumor-adjacent parenchyma (35.07 ± 27.2) was significantly higher than that of tumor-free liver parenchyma (27.3 ± 20.6) (P = 0.04). CONCLUSIONS AEF color mapping can improve the diagnostic performance for small hepatic metastases from colorectal cancer and may allow for the elimination of additional examinations.
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Affiliation(s)
- Mina Park
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Yong Eun Chung
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
- * E-mail:
| | - Kyung Ah Kim
- Department of Radiology, St. Vincent’s Hospital, The Catholic University of Korea, Suwon, Korea
| | - Woo-Suk Chung
- Department of Radiology, Konyang University College of Medicine, Daejon, Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Hwa Han
- Biostatistics Collaboration Unit, Medical Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong-Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
| | - Ki Whang Kim
- Department of Radiology, Research Institute of Radiological Science, Yonsei University, College of Medicine, Seoul, Korea
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Molecular imaging: from bench to clinic. BIOMED RESEARCH INTERNATIONAL 2014; 2014:357258. [PMID: 25610862 PMCID: PMC4295132 DOI: 10.1155/2014/357258] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 09/16/2014] [Indexed: 12/31/2022]
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Chen J, Yin HB. Dynamic contrast-enhanced magnetic resonance imaging of the liver: Applications in treatment of hepatic malignancies with vascular targeting agents. Shijie Huaren Xiaohua Zazhi 2014; 22:4928-4933. [DOI: 10.11569/wcjd.v22.i32.4928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging of the liver as a trendy technique can be applied in various kinds of liver diseases to evaluate perfusion and vascular characteristics of liver tissue and tumor. It has been proved that DCE-MR imaging plays an important role in the treatment of liver malignancies with vascular targeting agents. This review aims to give an overview of DCE-MR imaging of the liver in terms of semi-quantitative analysis methods, common quantitative analysis models and contrast agents and discuss its application value in the treatment of liver malignancies with vascular targeting agents.
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