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Nickles TM, Kim Y, Lee PM, Chen HY, Ohliger M, Bok RA, Wang ZJ, Larson PEZ, Vigneron DB, Gordon JW. Hyperpolarized 13 C metabolic imaging of the human abdomen with spatiotemporal denoising. Magn Reson Med 2024; 91:2153-2161. [PMID: 38193310 PMCID: PMC10950515 DOI: 10.1002/mrm.29985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/27/2023] [Accepted: 12/05/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Improving the quality and maintaining the fidelity of large coverage abdominal hyperpolarized (HP) 13 C MRI studies with a patch based global-local higher-order singular value decomposition (GL-HOVSD) spatiotemporal denoising approach. METHODS Denoising performance was first evaluated using the simulated [1-13 C]pyruvate dynamics at different noise levels to determine optimal kglobal and klocal parameters. The GL-HOSVD spatiotemporal denoising method with the optimized parameters was then applied to two HP [1-13 C]pyruvate EPI abdominal human cohorts (n = 7 healthy volunteers and n = 8 pancreatic cancer patients). RESULTS The parameterization of kglobal = 0.2 and klocal = 0.9 denoises abdominal HP data while retaining image fidelity when evaluated by RMSE. The kPX (conversion rate of pyruvate-to-metabolite, X = lactate or alanine) difference was shown to be <20% with respect to ground-truth metabolic conversion rates when there is adequate SNR (SNRAUC > 5) for downstream metabolites. In both human cohorts, there was a greater than nine-fold gain in peak [1-13 C]pyruvate, [1-13 C]lactate, and [1-13 C]alanine apparent SNRAUC . The improvement in metabolite SNR enabled a more robust quantification of kPL and kPA . After denoising, we observed a 2.1 ± 0.4 and 4.8 ± 2.5-fold increase in the number of voxels reliably fit across abdominal FOVs for kPL and kPA quantification maps. CONCLUSION Spatiotemporal denoising greatly improves visualization of low SNR metabolites particularly [1-13 C]alanine and quantification of [1-13 C]pyruvate metabolism in large FOV HP 13 C MRI studies of the human abdomen.
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Affiliation(s)
- Tanner M Nickles
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
| | - Yaewon Kim
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Philip M Lee
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
| | - Hsin-Yu Chen
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Michael Ohliger
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Robert A Bok
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Zhen J Wang
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
| | - Peder E Z Larson
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
| | - Daniel B Vigneron
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
| | - Jeremy W Gordon
- Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
- UC Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, California, USA
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Feister K, Konstantinoff K, Hamade M, Mellnick V. Pearls and Pitfalls of Imaging Small Bowel Obstruction. Can Assoc Radiol J 2024:8465371241230276. [PMID: 38414182 DOI: 10.1177/08465371241230276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Small bowel obstruction (SBO) is a common condition encountered by radiologists in the evaluation of patients with abdominal pain, and is an important diagnosis to be comfortable with given substantial associated morbidity and mortality. In this review, we summarize an imaging approach to evaluating patients with suspected SBO, discuss the role of certain imaging modalities such as radiography and small bowel follow through, CT, and MRI, as well as review some common and also less common causes of SBO such as internal hernia. We will also discuss tailoring the imaging approach to address specific clinical questions and special patient populations such as imaging the pregnant patient with suspected SBO, and the inflammatory bowel disease patient.
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Affiliation(s)
- Katharina Feister
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, Saint Louis, MO, USA
| | - Katerina Konstantinoff
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, Saint Louis, MO, USA
| | | | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, Saint Louis, MO, USA
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Wolf M, Darwish O, Neji R, Eder M, Sunder-Plassmann G, Heinz G, Robinson SD, Schmid AI, Moser EV, Sinkus R, Meyerspeer M. Magnetic resonance elastography resolving all gross anatomical segments of the kidney during controlled hydration. Front Physiol 2024; 15:1327407. [PMID: 38384795 PMCID: PMC10880033 DOI: 10.3389/fphys.2024.1327407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction: Magnetic resonance elastography (MRE) is a non-invasive method to quantify biomechanical properties of human tissues. It has potential in diagnosis and monitoring of kidney disease, if established in clinical practice. The interplay of flow and volume changes in renal vessels, tubule, urinary collection system and interstitium is complex, but physiological ranges of in vivo viscoelastic properties during fasting and hydration have never been investigated in all gross anatomical segments simultaneously. Method: Ten healthy volunteers underwent two imaging sessions, one following a 12-hour fasting period and the second after a drinking challenge of >10 mL per kg body weight (60-75 min before the second examination). High-resolution renal MRE was performed using a novel driver with rotating eccentric mass placed at the posterior-lateral wall to couple waves (50 Hz) to the kidney. The biomechanical parameters, shear wave speed (cs in m/s), storage modulus (Gd in kPa), loss modulus (Gl in kPa), phase angle ( Υ = 2 π atan G l G d ) and attenuation (α in 1/mm) were derived. Accurate separation of gross anatomical segments was applied in post-processing (whole kidney, cortex, medulla, sinus, vessel). Results: High-quality shear waves coupled into all gross anatomical segments of the kidney (mean shear wave displacement: 163 ± 47 μm, mean contamination of second upper harmonics <23%, curl/divergence: 4.3 ± 0.8). Regardless of the hydration state, median Gd of the cortex and medulla (0.68 ± 0.11 kPa) was significantly higher than that of the sinus and vessels (0.48 ± 0.06 kPa), and consistently, significant differences were found in cs, Υ , and Gl (all p < 0.001). The viscoelastic parameters of cortex and medulla were not significantly different. After hydration sinus exhibited a small but significant reduction in median Gd by -0.02 ± 0.04 kPa (p = 0.01), and, consequently, the cortico-sinusoidal-difference in Gd increased by 0.04 ± 0.07 kPa (p = 0.05). Only upon hydration, the attenuation in vessels became lower (0.084 ± 0.013 1/mm) and differed significantly from the whole kidney (0.095 ± 0.007 1/mm, p = 0.01). Conclusion: High-resolution renal MRE with an innovative driver and well-defined 3D segmentation can resolve all renal segments, especially when including the sinus in the analysis. Even after a prolonged hydration period the approach is sensitive to small hydration-related changes in the sinus and in the cortico-sinusoidal-difference.
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Affiliation(s)
- Marcos Wolf
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Omar Darwish
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, Frimley, United Kingdom
| | - Radhouene Neji
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Michael Eder
- Department of Medicine III, Division of Nephrology and Dialysis, General Hospital and Medical University of Vienna, Vienna, Austria
| | - Gere Sunder-Plassmann
- Department of Medicine III, Division of Nephrology and Dialysis, General Hospital and Medical University of Vienna, Vienna, Austria
| | - Gertraud Heinz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum St. Pölten, Sankt Pölten, Austria
| | - Simon Daniel Robinson
- High Field MR Centre, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Centre of Advanced Imaging, University of Queensland, Brisbane, QLD, Australia
| | - Albrecht Ingo Schmid
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ewald V. Moser
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Ralph Sinkus
- Institut National de La Santé et de La Recherche Médicale, U1148, Laboratory for Vascular Translational Science, Paris, France
| | - Martin Meyerspeer
- High Field MR Center, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
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Doran E, Naim I, Bowtell R, Gowland PA, Glover PM, Bawden S. The impact of variations in subject geometry, respiration and coil repositioning on the specific absorption rate in parallel transmit abdominal imaging at 7 T. NMR Biomed 2024; 37:e5032. [PMID: 37654051 DOI: 10.1002/nbm.5032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/14/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
Parallel transmit MRI at 7 T has increasingly been adopted in research projects and provides increased signal-to-noise ratios and novel contrasts. However, the interactions of fields in the body need to be carefully considered to ensure safe scanning. Recent advances in physically flexible body coils have allowed for high-field abdominal imaging, but the effects of increased variability on energy deposition need further exploration. The aim of this study was to assess the impact of subject geometry, respiration phase and coil positioning on the specific absorption rate (SAR). Ten healthy subjects (body mass index [BMI] = 25 ± 5 kg m-2 ) were scanned (at 3 T) during exhale breath-hold and images used to generate body models. Seven of these subjects were also scanned during inhale. Simplifications of the coil and body models were first explored, and then finite-difference time-domain simulations were run with a typical eight-channel parallel transmit coil positioned over the abdomen. Simulations were used to generate 10 g averaged SAR (SAR10g ) maps across 100,000 phase settings, and the worst-case scenario 10 g averaged SAR (wocSAR10g ) was identified using trigonometric maximisation. The average maximum SAR10g across the 10 subjects with 1 W input power per channel was 1.77 W kg-1 . Hotspots were always close to the body surface near the muscle wall boundary. The wocSAR10g across the 10 subjects ranged from 2.3 to 3.2 W kg-1 and was inversely correlated to fat volume percentage (R = 8) and BMI (R = 0.6). The coefficient of variation values in SAR10g due to variations in subject geometry, respiration phase and realistic coil repositioning were 12%, 4% and 12%, respectively. This study found that the variability due to realistic coil repositioning was similar to the variability due to differing healthy subject geometries for abdominal imaging. This is important as it suggests that population-based modelling is likely to be more useful than individual modelling in setting safe thresholds for abdominal imaging.
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Affiliation(s)
- Emma Doran
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Iyad Naim
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Richard Bowtell
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Penny A Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Paul M Glover
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - Stephen Bawden
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Rao AK, Anthony T, Ravenel J, Kosko J, Whitaker I. A Rare Case of Terminal Ileum Gastrointestinal Stromal Tumor in a Young Caucasian Adult. Cureus 2023; 15:e51340. [PMID: 38288239 PMCID: PMC10824467 DOI: 10.7759/cureus.51340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare in young individuals and typically affect older adults. We present the case of a previously healthy male who presented with severe hematochezia, fatigue, and dizziness. Colonoscopy did not demonstrate any colonic mass. CT of the pelvis with contrast revealed a pelvic mass measuring 7.4 cm. Biopsy confirmed a low-grade mixed-type GIST of the terminal ileum. Surgical resection was successfully performed. Histopathological analysis further characterized the tumor, and the patient was discharged with consideration of adjuvant imatinib therapy. This case underscores the importance of thorough diagnostic evaluation and multidisciplinary management for atypical presentations of gastrointestinal bleeding in young patients.
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Affiliation(s)
- Abhinav K Rao
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - Theshali Anthony
- Internal Medicine, Trident Medical Center, North Charleston, USA
| | - James Ravenel
- Radiology, Charleston Imaging Specialists, Charleston, USA
| | - Joanna Kosko
- Pathology, Trident Medical Center, North Charleston, USA
| | - Ian Whitaker
- Internal Medicine, Trident Medical Center, North Charleston, USA
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Harris S, Hall AB, Derr C. Esophageal Stent Migration Diagnosed With Point-of-Care Ultrasound. Cureus 2023; 15:e49418. [PMID: 38149125 PMCID: PMC10750131 DOI: 10.7759/cureus.49418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/28/2023] Open
Abstract
This unique case depicts the first published report of a physician using point-of-care ultrasound to diagnose an esophageal stent migration. Discussed in this article are the sonographic findings that clinicians should be familiar with when evaluating patients with abdominal pain or chest pain who have a history of an esophageal stent. When coupled with a high index of suspicion, ultrasound can be one of the most portable, readily available, low-cost, and minimally invasive techniques for making a rapid diagnosis of esophageal stent migration.
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Affiliation(s)
- Samuel Harris
- Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
| | - A Brad Hall
- Emergency Medicine, Lakeland Regional Health, Lakeland, USA
| | - Charlotte Derr
- Emergency Medicine, University of South Florida Morsani College of Medicine, Tampa, USA
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Mathew M, Virarkar M, Sun J, Thai K, Saleh M, Menendez-Santos M, Bedi D, Lee JE, Katz M, Kundra V, Bhosale P. Real-Time Ultrasound-Computed Tomography Fusion with Volume Navigation to Assess Pancreatic Cystic Lesions. Curr Oncol 2023; 30:8375-8385. [PMID: 37754523 PMCID: PMC10529455 DOI: 10.3390/curroncol30090608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
Transabdominal ultrasound is a promising imaging modality for pancreatic cystic lesions. This study aims to determine if transabdominal ultrasonography with CT fusion (TAUS-f) using volume navigation can be used to measure pancreatic cystic lesions (PCLs) compared to CT alone. We evaluated 33 patients prospectively with known PCLs. The readers evaluated each PCL's size and imaging characteristics on TAUS-f and CT alone. These were compared to endoscopic ultrasonography reports. A total of 43 PCLs from 32 patients were evaluated. The detection rate by TAUS-f was 93%. Two of the three undetected PCLs were in the tail of the pancreas. Inter-reader variabilities for TAUS-f and CT were 0.005 cm and 0.03 cm, respectively. Subgroup analysis by size and location demonstrated that inter-modality variability between TAUS-f and CT was smallest for lesions < 1.5 cm with a size difference of -0.13 cm for each reader and smallest in the pancreatic head with a size difference of -0.16 cm and -0.17 cm for readers 1 and 2. We found that TAUS-f effectively evaluates PCLs compared to CT alone, thus suggesting that it should be considered part of the surveillance algorithm for a subset of patients.
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Affiliation(s)
- Manoj Mathew
- Department of Radiology, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA;
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA;
| | - Jia Sun
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.S.); (M.K.)
| | - Khoan Thai
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (M.S.); (D.B.); (V.K.); (P.B.)
| | - Mohammed Saleh
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (M.S.); (D.B.); (V.K.); (P.B.)
| | - Manuel Menendez-Santos
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, USA;
| | - Deepak Bedi
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (M.S.); (D.B.); (V.K.); (P.B.)
| | - Jeffrey E. Lee
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Matthew Katz
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (J.S.); (M.K.)
| | - Vikas Kundra
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (M.S.); (D.B.); (V.K.); (P.B.)
| | - Priya Bhosale
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA (M.S.); (D.B.); (V.K.); (P.B.)
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Mervak BM, Fried JG, Wasnik AP. A Review of the Clinical Applications of Artificial Intelligence in Abdominal Imaging. Diagnostics (Basel) 2023; 13:2889. [PMID: 37761253 PMCID: PMC10529018 DOI: 10.3390/diagnostics13182889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/23/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Artificial intelligence (AI) has been a topic of substantial interest for radiologists in recent years. Although many of the first clinical applications were in the neuro, cardiothoracic, and breast imaging subspecialties, the number of investigated and real-world applications of body imaging has been increasing, with more than 30 FDA-approved algorithms now available for applications in the abdomen and pelvis. In this manuscript, we explore some of the fundamentals of artificial intelligence and machine learning, review major functions that AI algorithms may perform, introduce current and potential future applications of AI in abdominal imaging, provide a basic understanding of the pathways by which AI algorithms can receive FDA approval, and explore some of the challenges with the implementation of AI in clinical practice.
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Affiliation(s)
| | | | - Ashish P. Wasnik
- Department of Radiology, University of Michigan—Michigan Medicine, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA; (B.M.M.); (J.G.F.)
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Wu X, Yan H, Zhao S, Zhang X, Zhu K. Clip migration complicated by choledocholithiasis after laparoscopic biliary surgery: a report of four cases. J Int Med Res 2023; 51:3000605231190766. [PMID: 37590427 PMCID: PMC10467417 DOI: 10.1177/03000605231190766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/12/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Migration of tissue clips into the common bile duct and formation of common bile duct stones after laparoscopic biliary surgery are extremely rare complications, and their etiologies remain elusive. We herein report four cases of migrated clips complicated by stones after laparoscopic biliary surgery. CASE PRESENTATION Two patients (72- and 62-year-old women) were admitted because of varying degrees of epigastric pain, and two patients (88- and 69-year-old men) were admitted because of epigastric pain with chills and fever. They had previously undergone laparoscopic cholecystectomy (LC) plus laparoscopic common bile duct exploration (LCBDE) in our hospital. In Cases 1, 2, and 4, surgery revealed gallbladder triangle adhesion, inflamed dilated bile ducts, and fragile tissues. Blood tests showed elevated liver enzymes and bilirubin. Imaging indicated common bile duct stones. All patients underwent successful surgery with Hem-o-lok clips. No postoperative pain recurred. CONCLUSION Clip migration after laparoscopic biliary surgery may be associated with preoperative biliary duct inflammation, improper use of tissue clips, and postoperative biliary leak-induced inflammation. The clinical presentation is similar to that of calculous cholangitis. Once symptoms of cholangitis appear in patients with a history of LC or LCBDE, the possibility of clip migration and stone formation should be considered.
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Affiliation(s)
- Xudong Wu
- Department of Hepatopancreatobiliary Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Huanjun Yan
- Department of Hepatopancreatobiliary Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Shuangying Zhao
- Department of Hepatopancreatobiliary Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Xiaodong Zhang
- Department of Hepatopancreatobiliary Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
| | - Kelei Zhu
- Department of Hepatopancreatobiliary Surgery, The Affiliated People’s Hospital of Ningbo University, Ningbo, China
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Tong M, Gao Y, Jia F, Liu J. Pericholecystic varices as the predominant manifestation in cryptogenic portal hypertension: A case report. Curr Med Imaging 2023:CMIR-EPUB-130807. [PMID: 37038299 DOI: 10.2174/1573405620666230410085206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/20/2022] [Accepted: 03/01/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Portal hypertension has various manifestations, and varices are a common manifestation. Varices can appear in any vein in the body associated with the portal venous system. CASE PRESENTATION Herein, we report a case of portal hypertension with gallbladder varices as the main manifestation, which was confirmed by abdominal contrast-enhanced CT with three-dimensional reconstruction and color Doppler ultrasonography. The patient had concomitant liver cirrhosis and portal vein thrombosis. Various auxiliary examinations and biochemical indicators of the patient confirmed liver cirrhosis, portal vein thrombosis, and portal hypertension, all of which were mild and did not reach the decompensation stage. CONCLUSION As illustrated by this case, when there is an embolism in certain parts of the portal system, portal hypertension can appear during the compensatory period and transition into severe varices in the thrombotic part during the de-compensatory period.
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Affiliation(s)
- Meng Tong
- Department of General Surgery, Jinzhou Medical University, Jinzhou 121001, China
| | - Yanli Gao
- Da Zhongcun Central Health Center of Lanling Country, Linyi 276000, China
| | - Feiyu Jia
- Graduate Management Office, Education and Teaching Department, Linyi People's Hospital, Linyi 276000, China
| | - Jinghua Liu
- Department of Hepatobiliary Surgery and Minimally Invasive Institute of Digestive Surgery and Prof. Cai's Laboratory, Linyi People's Hospital, Linyi 276000, China
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Obara M, Kwon J, Yoneyama M, Ueda Y, Cauteren MV. Technical Advancements in Abdominal Diffusion-weighted Imaging. Magn Reson Med Sci 2023; 22:191-208. [PMID: 36928124 PMCID: PMC10086402 DOI: 10.2463/mrms.rev.2022-0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Since its first observation in the 18th century, the diffusion phenomenon has been actively studied by many researchers. Diffusion-weighted imaging (DWI) is a technique to probe the diffusion of water molecules and create a MR image with contrast based on the local diffusion properties. The DWI pixel intensity is modulated by the hindrance the diffusing water molecules experience. This hindrance is caused by structures in the tissue and reflects the state of the tissue. This characteristic makes DWI a unique and effective tool to gain more insight into the tissue's pathophysiological condition. In the past decades, DWI has made dramatic technical progress, leading to greater acceptance in clinical practice. In the abdominal region, however, acquiring DWI with good quality is challenging because of several reasons, such as large imaging volume, respiratory and other types of motion, and difficulty in achieving homogeneous fat suppression. In this review, we discuss technical advancements from the past decades that help mitigate these problems common in abdominal imaging. We describe the use of scan acceleration techniques such as parallel imaging and compressed sensing to reduce image distortion in echo planar imaging. Then we compare techniques developed to mitigate issues due to respiratory motion, such as free-breathing, respiratory-triggering, and navigator-based approaches. Commonly used fat suppression techniques are also introduced, and their effectiveness is discussed. Additionally, the influence of the abovementioned techniques on image quality is demonstrated. Finally, we discuss the current and future clinical applications of abdominal DWI, such as whole-body DWI, simultaneous multiple-slice excitation, intravoxel incoherent motion, and the use of artificial intelligence. Abdominal DWI has the potential to develop further in the future, thanks to scan acceleration and image quality improvement driven by technological advancements. The accumulation of clinical proof will further drive clinical acceptance.
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Affiliation(s)
| | | | | | - Yu Ueda
- MR Clinical Science, Philips Japan Ltd
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12
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Huflage H, Grunz JP, Patzer TS, Pannenbecker P, Feldle P, Sauer ST, Petritsch B, Ergün S, Bley TA, Kunz AS. Potential of Unenhanced Ultra-Low-Dose Abdominal Photon-Counting CT with Tin Filtration: A Cadaveric Study. Diagnostics (Basel) 2023; 13. [PMID: 36832091 DOI: 10.3390/diagnostics13040603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/28/2023] [Accepted: 02/04/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVES This study investigated the feasibility and image quality of ultra-low-dose unenhanced abdominal CT using photon-counting detector technology and tin prefiltration. MATERIALS AND METHODS Employing a first-generation photon-counting CT scanner, eight cadaveric specimens were examined both with tin prefiltration (Sn 100 kVp) and polychromatic (120 kVp) scan protocols matched for radiation dose at three different levels: standard-dose (3 mGy), low-dose (1 mGy) and ultra-low-dose (0.5 mGy). Image quality was evaluated quantitatively by means of contrast-to-noise-ratios (CNR) with regions of interest placed in the renal cortex and subcutaneous fat. Additionally, three independent radiologists performed subjective evaluation of image quality. The intraclass correlation coefficient was calculated as a measure of interrater reliability. RESULTS Irrespective of scan mode, CNR in the renal cortex decreased with lower radiation dose. Despite similar mean energy of the applied x-ray spectrum, CNR was superior for Sn 100 kVp over 120 kVp at standard-dose (17.75 ± 3.51 vs. 14.13 ± 4.02), low-dose (13.99 ± 2.6 vs. 10.68 ± 2.17) and ultra-low-dose levels (8.88 ± 2.01 vs. 11.06 ± 1.74) (all p ≤ 0.05). Subjective image quality was highest for both standard-dose protocols (score 5; interquartile range 5-5). While no difference was ascertained between Sn 100 kVp and 120 kVp examinations at standard and low-dose levels, the subjective image quality of tin-filtered scans was superior to 120 kVp with ultra-low radiation dose (p < 0.05). An intraclass correlation coefficient of 0.844 (95% confidence interval 0.763-0.906; p < 0.001) indicated good interrater reliability. CONCLUSIONS Photon-counting detector CT permits excellent image quality in unenhanced abdominal CT with very low radiation dose. Employment of tin prefiltration at 100 kVp instead of polychromatic imaging at 120 kVp increases the image quality even further in the ultra-low-dose range of 0.5 mGy.
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13
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection caused the pandemic of coronavirus disease 2019 (COVID-19). Gastrointestinal (GI) involvement is common among patients with COVID-19, and GI symptoms can appear earlier than respiratory symptoms. Except for direct infectious effects, patients infected with SARS-CoV-2 are at risk of complications requiring gastroenterological management. Diarrhea is the most common GI symptom in patients with COVID-19 and occurs in up to half of them. Other GI symptoms, such as anorexia, discomfort, nausea, abdominal pain, loss of taste sensation, and vomiting, have been reported. GI symptoms are associated with a poor prognosis. Fecal viral excretion may have clinical significance because of the possible fecal-oral transmission of infection. In the present narrative review article, six different aspects of studies published to date are summarized as follows: GI manifestations of COVID-19, the roles of fecal-oral transmission, poor prognosis of GI symptoms; abnormal abdominal imaging findings, COVID-19 in patients with irritable bowel disease, and prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. Timely understanding of the association between COVID-19 and the digestive system and effective preventive measures are critical to improve this disease and help clinicians take appropriate measures to mitigate further transmission.
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Affiliation(s)
- Shuxun Jin
- Department of Breast and Thyroid Surgery, Affiliated Jinhua
Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang
Province, China,Department of Breast and Thyroid Surgery, Shaoxing People's
Hospital, Shaoxing 312000, Zhejiang Province, China
| | - Xiaofeng Lu
- Department of Breast and Thyroid Surgery, Affiliated Jinhua
Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang
Province, China
| | - Chaoyang Xu
- Department of Breast and Thyroid Surgery, Affiliated Jinhua
Hospital, Zhejiang University School of Medicine, Jinhua 321000, Zhejiang
Province, China,Department of Breast and Thyroid Surgery, Shaoxing People's
Hospital, Shaoxing 312000, Zhejiang Province, China,Chaoyang Xu, Department of Breast and
Thyroid Surgery, Jinhua Central Hospital, Building 365 Renmin East Road, Jinhua
City, Zhejiang 321000, China.
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14
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Fu Z, Johnson K, Altbach MI, Bilgin A. Cancellation of streak artifacts in radial abdominal imaging using interference null space projection. Magn Reson Med 2022; 88:1355-1369. [PMID: 35608238 PMCID: PMC9973517 DOI: 10.1002/mrm.29285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/03/2022] [Accepted: 04/13/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE In radial abdominal imaging, it has been commonly observed that signal from the arms cause streaks due to system imperfections. We previously introduced a streak removal technique (B-STAR), which is inherently spatially variant and limited to work in image space. In this work, we propose a spatially invariant streak cancellation technique (CACTUS), which can be applied in either image space or k-space and is compatible with iterative reconstructions. THEORY AND METHODS Streak sources are typically spatially localized and can be represented using a low-dimensional subspace. CACTUS identifies the streak subspace by leveraging the spatial redundancy of receiver coils and projects the data onto the streak null space to eliminate the streaks. When applied in k-space, CACTUS can be combined with iterative reconstructions. CACTUS was tested in phantoms and in vivo abdominal imaging using a radial turbo spin-echo pulse sequence. RESULTS In phantoms, CACTUS improved T2 estimation in comparison to previous de-streaking methods. In vivo experiments showed that CACTUS reduced streaks and yielded T2 estimation, in regions affected by streaks, closer to a streak-free reference. Evaluation using a clinical abdominal dataset (n = 20) showed that CACTUS is comparable to B-STAR and yields significantly better signal preservation and streak cancellation than coil removal and suppression methods. CONCLUSION CACTUS provides superior signal preservation and streak reduction performance compared to coil removal and suppression methods. As a clear advantage over B-STAR, CACTUS can be integrated with iterative reconstruction methods. In abdominal T2 mapping, CACTUS improves the accuracy of parameter estimation in areas affected by streaks.
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Affiliation(s)
- Zhiyang Fu
- Department of Medical Imaging, The University of Arizona, Tucson, Arizona, USA
- Department of Electrical and Computer Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Kevin Johnson
- Department of Medical Imaging, The University of Arizona, Tucson, Arizona, USA
| | - Maria I. Altbach
- Department of Medical Imaging, The University of Arizona, Tucson, Arizona, USA
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona, USA
| | - Ali Bilgin
- Department of Medical Imaging, The University of Arizona, Tucson, Arizona, USA
- Department of Electrical and Computer Engineering, The University of Arizona, Tucson, Arizona, USA
- Department of Biomedical Engineering, The University of Arizona, Tucson, Arizona, USA
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15
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Wu J, Masuy I, Biesiekierski JR, Fitzke HE, Parikh C, Schofield L, Shaikh H, Bhagwanani A, Aziz Q, Taylor SA, Tack J, Van Oudenhove L. Gut-brain axis dysfunction underlies FODMAP-induced symptom generation in irritable bowel syndrome. Aliment Pharmacol Ther 2022; 55:670-682. [PMID: 35166384 DOI: 10.1111/apt.16812] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND FODMAPs produce similar small bowel water and colonic gas in patients with irritable bowel syndrome (IBS) and healthy controls (HCs), despite IBS patients reporting increased gastrointestinal (GI) symptoms. AIM To unravel the mechanisms underlying FODMAP-induced symptom reporting, we investigated gut and brain responses to fructan administration in IBS patients and HC. METHODS This randomised, double-blind, cross-over study consisted of three visits where fructans (40 g/500 mL saline), glucose (40 g/500 mL saline) or saline (500 mL) were infused intragastrically during 1 h MR brain scanning; abdominal MRI was performed before, 1 h, and 2 h post-infusion. Symptoms were rated using validated scales. RESULTS In IBS (n = 13), fructans induced more cramps, pain, flatulence and nausea compared to glucose (P = 0.03, 0.001, 0.009 and <0.001 respectively), contrary to HC (n = 13) (all P > 0.14), with between-group differences for cramps and nausea (P = 0.004 and 0.023). Fructans increased small bowel motility and ascending colonic gas and volume equally in IBS and HC (between-group P > 0.25). The difference in colonic gas between fructans and saline covaried with differences in bloating and cramps in IBS (P = 0.008 and 0.035 respectively). Pain-related brain regions responded differentially to fructans in IBS compared to HC, including the cerebellum, supramarginal gyrus, anterior and midcingulate cortex, insula and thalamus (pFWE-corrected < 0.05); these brain responses covaried with symptom responses in IBS. CONCLUSIONS Fructans increase small bowel motility and colon gas and volume similarly in IBS patients and HC. Increased symptom responses to fructans in IBS covary with altered brain responses in pain-related regions, indicating that gut-brain axis dysregulation may drive FODMAP-induced symptom generation in IBS.
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Affiliation(s)
- Jie Wu
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Imke Masuy
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Jessica R Biesiekierski
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Department of Dietetics, Nutrition & Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Heather E Fitzke
- The Wingate Institute for Neurogastroenterology, Queen Mary University London, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | - Chinar Parikh
- Medical School, University College London, London, UK
| | | | - Hafsa Shaikh
- Medical School, University College London, London, UK
| | | | - Qasim Aziz
- The Wingate Institute for Neurogastroenterology, Queen Mary University London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK.,University College London Hospital, London, UK
| | - Jan Tack
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium
| | - Lukas Van Oudenhove
- Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium.,Cognitive & Affective Neuroscience Lab, Department of Psychological & Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
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16
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Qureshi TA, Javed S, Sarmadi T, Pandol SJ, Li D. Artificial intelligence and imaging for risk prediction of pancreatic cancer: a narrative review. Chin Clin Oncol 2022; 11:1. [PMID: 35144387 DOI: 10.21037/cco-21-117] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To emphasize the importance of pancreatic imaging and the application of artificial intelligence (AI) for enhanced risk prediction of pancreatic ductal adenocarcinoma (PDAC). BACKGROUND Detecting PDAC at the early stage is challenging as the disease either remains asymptomatic or presents nonspecific symptoms. Risk prediction of PDAC is an efficient strategy as subsequent targeted screening can assist in diagnosing cancer at the early stage even before the symptoms appear. However, the lack of specific clinical and epidemiological predictors of PDAC makes prediction a highly challenging task. Detecting precursor changes in the pancreas can potentially assist in the risk prediction of PDAC as the precancerous pancreas evolves through biological adaptations-presented as morphological and textural changes on abdominal imaging. However, such microlevel "clues" usually remain unnoticed or unappreciated, partly due to the unavailability of tools to detect and interpret such complex measurements, making the risk prediction of PDAC an unresolved problem. METHODS This review study highlights the limitations of the current risk prediction models of PDAC and the importance of abdominal imaging for predicting PDAC. A suggestive narrative is made as to how recent AI tools can assist in extracting precise measurements of biomarkers, detecting early signs and precancerous abnormalities, quantifying tissue characteristics, and revealing complex features potentially indicative of future incidence of pancreatic cancer (PC) using abdominal imaging. With the help of peer examples of other cancers, a case is built about the application of AI in utilizing image features of the pancreas to enhance risk prediction of PDAC. Furthermore, the challenges of AI applications including insufficient data for model training, risk of data privacy violation, inconsistent data labeling, and limited computational resources, and their potential solutions are also discussed. CONCLUSIONS The recent advancement in the domain of AI is a potential opportunity to utilize automated tools for the identification of imaging-based indicators of PDAC and perform enhanced risk prediction of cancer. With this awareness and motivation, better management of PDAC has expected.
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Affiliation(s)
- Touseef Ahmad Qureshi
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Sehrish Javed
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Stephen Jacob Pandol
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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17
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Keerthivasan MB, Galons JP, Johnson K, Umapathy L, Martin DR, Bilgin A, Altbach MI. Abdominal T2-Weighted Imaging and T2 Mapping Using a Variable Flip Angle Radial Turbo Spin-Echo Technique. J Magn Reson Imaging 2022; 55:289-300. [PMID: 34254382 PMCID: PMC8678192 DOI: 10.1002/jmri.27825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND T2 mapping is of great interest in abdominal imaging but current methods are limited by low resolution, slice coverage, motion sensitivity, or lengthy acquisitions. PURPOSE Develop a radial turbo spin-echo technique with refocusing variable flip angles (RADTSE-VFA) for high spatiotemporal T2 mapping and efficient slice coverage within a breath-hold and compare to the constant flip angle counterpart (RADTSE-CFA). STUDY TYPE Prospective technical efficacy. SUBJECTS Testing performed on agarose phantoms and 12 patients. Focal liver lesion classification tested on malignant (N = 24) and benign (N = 11) lesions. FIELD STRENGTH/SEQUENCE 1.5 T/RADTSE-VFA, RADTSE-CFA. ASSESSMENT A constrained objective function was used to optimize the refocusing flip angles. Phantom and/or in vivo data were used to assess relative contrast, T2 estimation, specific absorption rate (SAR), and focal liver lesion classification. STATISTICAL TESTS: t-Tests or Mann-Whitney Rank Sum tests were used. RESULTS Phantom data did not show significant differences in mean relative contrast (P = 0.10) and T2 accuracy (P = 0.99) between RADTSE-VFA and RADTSE-CFA. Adding noise caused T2 overestimation predominantly for RADTSE-CFA and low T2 values. In vivo results did not show significant differences in mean spleen-to-liver (P = 0.62) and kidney-to-liver (P = 0.49) relative contrast between RADTSE-VFA and RADTSE-CFA. Mean T2 values were not significantly different between the two techniques for spleen (T2VFA = 109.2 ± 12.3 msec; T2CFA = 110.7 ± 11.1 msec; P = 0.78) and kidney-medulla (T2VFA = 113.0 ± 8.7 msec; T2CFA = 114.0 ± 8.6 msec; P = 0.79). Liver T2 was significantly higher for RADTSE-CFA (T2VFA = 52.6 ± 6.6 msec; T2CFA = 60.4 ± 8.0 msec) consistent with T2 overestimation in the phantom study. Focal liver lesion classification had comparable T2 distributions for RADTSE-VFA and RADTSE-CFA for malignancies (P = 1.0) and benign lesions (P = 0.39). RADTSE-VFA had significantly lower SAR than RADTSE-CFA increasing slice coverage by 1.5. DATA CONCLUSION RADTSE-VFA provided noise-robust T2 estimation compared to the constant flip angle counterpart while generating T2-weighted images with comparable contrast. The VFA scheme minimized SAR improving slice efficiency for breath-hold imaging. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Mahesh B Keerthivasan
- Medical Imaging, University of Arizona, Tucson, Arizona,Electrical and Computer Engineering, University of Arizona, Tucson, Arizona
| | | | - Kevin Johnson
- Medical Imaging, University of Arizona, Tucson, Arizona
| | - Lavanya Umapathy
- Medical Imaging, University of Arizona, Tucson, Arizona,Electrical and Computer Engineering, University of Arizona, Tucson, Arizona
| | - Diego R Martin
- Medical Imaging, University of Arizona, Tucson, Arizona,Electrical and Computer Engineering, University of Arizona, Tucson, Arizona
| | - Ali Bilgin
- Medical Imaging, University of Arizona, Tucson, Arizona,Electrical and Computer Engineering, University of Arizona, Tucson, Arizona,Biomedical Engineering, University of Arizona, Tucson, Arizona
| | - Maria I Altbach
- Medical Imaging, University of Arizona, Tucson, Arizona,Biomedical Engineering, University of Arizona, Tucson, Arizona
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18
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Garbino N, Brancato V, Salvatore M, Cavaliere C. A Systematic Review on the Role of the Perfusion Computed Tomography in Abdominal Cancer. Dose Response 2021; 19:15593258211056199. [PMID: 34880716 PMCID: PMC8647276 DOI: 10.1177/15593258211056199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Perfusion Computed Tomography (CTp) is an imaging technique which allows
quantitative and qualitative evaluation of tissue perfusion through dynamic
CT acquisitions. Since CTp is still considered a research tool in the field
of abdominal imaging, the aim of this work is to provide a systematic
summary of the current literature on CTp in the abdominal region to clarify
the role of this technique for abdominal cancer applications. Materials and Methods A systematic literature search of PubMed, Web of Science, and Scopus was
performed to identify original articles involving the use of CTp for
clinical applications in abdominal cancer since 2011. Studies were included
if they reported original data on CTp and investigated the clinical
applications of CTp in abdominal cancer. Results Fifty-seven studies were finally included in the study. Most of the included
articles (33/57) dealt with CTp at the level of the liver, while a low
number of studies investigated CTp for oncologic diseases involving UGI
tract (8/57), pancreas (8/57), kidneys (3/57), and colon–rectum (5/57). Conclusions Our study revealed that CTp could be a valuable functional imaging tool in
the field of abdominal oncology, particularly as a biomarker for monitoring
the response to anti-tumoral treatment.
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19
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Overhoff D, Jost G, McDermott M, Weber O, Pietsch H, Schoenberg SO, Attenberger U. Low kV Computed Tomography of Parenchymal Abdominal Organs-A Systematic Animal Study of Different Contrast Media Injection Protocols. Tomography 2021; 7:815-28. [PMID: 34941641 DOI: 10.3390/tomography7040069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 01/14/2023] Open
Abstract
Objectives: To evaluate multiphase low kV computed tomography (CT) imaging of the abdomen with reduced contrast media (CM) dose using different injection protocols. Methods: Two injection protocols were evaluated for use with low kV (80 kV) multiphase abdominal imaging in comparison to the standard procedure acquired at 120 kV (500 mgI/kg; 5 mL/s). This evaluation was conducted in a highly standardized animal study (5 Goettingen minipigs). The low kV protocols consisted of (a) a single-flow (SF) injection with 40% reduced CM dose and injection rate (300 mgI/kg; 3 mL/s) and (b) a DualFlow (DF) injection protocol consisting of 60%/40% contrast to saline ratio administered at 5 mL/s. Dynamic CT was first performed within representative liver regions to determine optimal contrast phases, followed by evaluation of the three protocols in multiphase abdominal CT imaging. The evaluation criteria included contrast enhancement (CE) of abdominal organs and vasculature. Results: The 80 kV DF injection protocol showed similar CE of the abdominal parenchymatous organs and vessels to the 120 kV reference and the 80 kV SF protocol. Hepatic parenchyma showed comparable CT values for all contrast phases. In particular, in the portal venous parenchymal phase, the 80 kV DF protocol demonstrated higher hepatic parenchymal enhancement; however, results were statistically non-significant. Similarly, CE of the kidney, pancreas, and abdominal arterial/venous vessels showed no significant differences between injection protocols. Conclusions: Adapted SF and DF injection protocols with reduced IDR/iodine load offer the potential to calibrate optimal CM doses to the tube voltage in abdominal multiphase low kV CT imaging. The data suggest that the DF approach allows the use of predefined injection protocols and adaption of the contrast to saline ratio to an individualized kV setting and yields the potential for patient-individualized CM adaption.
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20
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Kreul DA, Kubik-Huch RA, Froehlich J, Thali MJ, Niemann T. Spectral Properties of Abdominal Tissues on Dual-energy Computed Tomography and the Effects of Contrast Agent. In Vivo 2021; 35:3277-3287. [PMID: 34697159 DOI: 10.21873/invivo.12623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/19/2021] [Accepted: 07/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Multiparametric dual energy comptuted tomography (CT) imaging allows for multidimensional tissue characterization beyond the measurement of Hounsfield units. The purpose of this study was to evaluate multiple imaging parameters for different abdominal organs in dual energy CT (DECT) and analyze the effects of the contrast agent on these different parameters and provide normal values for characterization of parenchymatous organs. PATIENTS AND METHODS This retrospective analysis included a total of 484 standardized DECT scans of the abdomen. Hounsfield Units (HU), rho (electron density relative to water), Zeff (effective atomic number) and FF (fat fraction) were evaluated for liver, spleen, kidney, muscle, fat-tissue. Independent generalized estimation equation models were fitted. RESULTS In DECT imaging there is only little difference in mean HUmixed for parenchymatous abdominal organs. Analysis including Zeff, rho and FF allows for better discrimination while a large overlap remains for liver, spleen and muscle. Including multidimensional analysis and the effects of contrast medium further enhances tissue characterization. Small differences remain for liver and spleen. CONCLUSION Organ characterization using multiparametric dual energy CT analysis is possible. An increased number of parameters obtained from DECT improves organ characterization. To our knowledge this is the first attempt to provide normal values for characterization of parenchymatous organs.
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Affiliation(s)
- Diana A Kreul
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland.,Institute of Forensic Medicine, Zürich, Switzerland
| | | | | | | | - Tilo Niemann
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland;
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21
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Gelston D, Brosler SC, Vazquez J, Sorci O, Griffith AH, Chatterjee S, Buchner A, Høilund-Carlsen PF, Alavi A, Rajapakse CS. Utility of FDG PET/CT in assessing bowel inflammation. Am J Nucl Med Mol Imaging 2021; 11:271-279. [PMID: 34513280 PMCID: PMC8414397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE To develop a methodology for the quantification of gastrointestinal (GI) inflammation as indicated by 2-deoxy-2-(18F)fluoro-D-glucose (FDG) uptake on positron-emissions tomography/computed tomography (PET/CT) imaging. This is intended to investigate the feasibility of using standard uptake value (SUV) levels to assess levels of GI inflammation in humans. METHODS 131 participants were injected with a weight-controlled dose of FDG 180 minutes prior to PET/CT scanning. Operator-guided software was used to segment the GI tract and perform (SUV) calculations. Regions of interest (ROIs) were created using CT images and stacked to create three dimensional volumes of interest (VOIs). These VOIs defined 6 sections of the GI tract: esophagus, stomach, descending colon, ascending and transverse colon, bowel below the ilium and small bowel above the ilium. RESULTS This study found a significant correlation between age and average FDG uptake (avg-SUV) of the GI tract (P=.0003) with the esophagus showing the highest significance. Correlations were found between avg-SUV of the sigmoid segment and the group average (P<.0001), and between the descending colon VOI and the group (P<.0001). Intra-operator reproducibility over 3 trials showed a coefficient of variation (CV) of .63%. Inter-operator CV over 5 randomly selected patients was 5.6% over the entire GI tract. CONCLUSION This study shows that FDG-PET/CT imaging is a promising technique for quantifying bowel inflammation, despite the fact that age related inflammation may not be of clinical utility. The fact that we were able to detect these subtle changes indicates this as an avenue for potential future investigation.
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Affiliation(s)
- David Gelston
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | - Samantha C Brosler
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | - Jennifer Vazquez
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | - Olivia Sorci
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | | | - Shampa Chatterjee
- Department of Physiology, University of PennsylvaniaPhiladelphia, PA, USA
| | - Anna Buchner
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
| | | | - Abass Alavi
- Department of Nuclear Medicine, Odense University HospitalOdense, Denmark, USA
| | - Chamith S Rajapakse
- Department of Radiology, University of PennsylvaniaPhiladelphia, PA, USA
- Department of Orthopaedic Surgery, University of PennsylvaniaPhiladelphia, PA, USA
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22
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Vorobyev V, Shchelokova A, Efimtcev A, Baena JD, Abdeddaim R, Belov P, Melchakova I, Glybovski S. Improving B 1 + homogeneity in abdominal imaging at 3 T with light, flexible, and compact metasurface. Magn Reson Med 2021; 87:496-508. [PMID: 34314033 DOI: 10.1002/mrm.28946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE Radiofrequency field inhomogeneity is a significant issue in imaging large fields of view in high- and ultrahigh-field MRI. Passive shimming with coupled coils or dielectric pads is the most common approach at 3 T. We introduce and test light and compact metasurface, providing the same homogeneity improvement in clinical abdominal imaging at 3 T as a conventional dielectric pad. METHODS The metasurface comprising a periodic structure of copper strips and parallel-plate capacitive elements printed on a flexible polyimide substrate supports propagation of slow electromagnetic waves similar to a high-permittivity slab. We compare the metasurface operating inside a transmit body birdcage coil to the state-of-the-art pad by numerical simulations and in vivo study on healthy volunteers. RESULTS Numerical simulations with different body models show that the local minimum of B 1 + causing a dark void in the abdominal domain is removed by the metasurface with comparable resulting homogeneity as for the pad with decreasing maximum and whole-body SAR values. In vivo results confirm similar homogeneity improvement and demonstrate the stability to body mass index. CONCLUSION The light, flexible, and inexpensive metasurface can replace a relatively heavy and expensive pad based on the aqueous suspension of barium titanate in abdominal imaging at 3 T.
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Affiliation(s)
- Vsevolod Vorobyev
- School of Physics and Engineering, ITMO University, Saint Petersburg, Russia
| | - Alena Shchelokova
- School of Physics and Engineering, ITMO University, Saint Petersburg, Russia
| | - Alexander Efimtcev
- School of Physics and Engineering, ITMO University, Saint Petersburg, Russia.,Department of Radiology, Federal Almazov North-West Medical Research Center, Saint Petersburg, Russia
| | - Juan D Baena
- Department of Physics, Universidad Nacional de Colombia, Bogota, Colombia
| | - Redha Abdeddaim
- CNRS, Aix Marseille University, Marseille, France.,Institut Fresnel, Marseille, France
| | - Pavel Belov
- School of Physics and Engineering, ITMO University, Saint Petersburg, Russia
| | - Irina Melchakova
- School of Physics and Engineering, ITMO University, Saint Petersburg, Russia
| | - Stanislav Glybovski
- School of Physics and Engineering, ITMO University, Saint Petersburg, Russia
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23
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Mowrey K, Northrup H, Rougeau P, Hashmi SS, Krueger DA, Ebrahimi-Fakhari D, Towbin AJ, Trout AT, Capal JK, Franz DN, Rodriguez-Buritica D. Frequency, Progression, and Current Management: Report of 16 New Cases of Nonfunctional Pancreatic Neuroendocrine Tumors in Tuberous Sclerosis Complex and Comparison With Previous Reports. Front Neurol 2021; 12:627672. [PMID: 33897589 PMCID: PMC8062856 DOI: 10.3389/fneur.2021.627672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Tuberous sclerosis complex (TSC) is a genetic condition that causes benign tumors to grow in multiple organ systems. Nonfunctional pancreatic neuroendocrine tumors (PNETs) are a rare clinical feature of TSC with no specific guidelines outlined for clinical management at this time. Our purpose is to calculate the frequency of nonfunctional PNETs as well as characterize the presentation, current clinical management, and assess the impact of systemic mammalian target of rapamycin (mTOR) on nonfunctional PNETs in TSC. Methods: This retrospective chart review was performed by a query of the TS Alliance's Natural History Database and the Cincinnati Children's Hospital TSC Database for patients with nonfunctional PNET. Clinical data from these two groups was summarized for patients identified to have a nonfunctional PNET and compared to previously reported cases with TSC and nonfunctional PNETs. Results: Our calculated frequency of nonfunctional PNETs is 0.65%. We identified 16 individuals, nine males and seven females, with a median age of 18.0 years (interquartile range: −15.5 to 25.5). Just over half (56.3%, n = 9) of the patients provided results from genetic testing. Six had pathogenic variants in TSC2 whereas three had pathogenic variants in TSC1. The average age at PNET diagnosis was 15.0 years (range: 3–46 years). Almost all individuals were diagnosed with a PNET during routine TSC surveillance, 56.3% (n = 9) by MRI, 12.5% (n = 2) by CT, 25% (n = 4) by ultrasound, and 6.2% (n = 1) through a surgical procedure. Follow up after diagnosis involved 68.8% (n = 11) having serial imaging and nine of the sixteen individuals proceeding with surgical removal of the PNET. Eight individuals had a history of using systemic mTOR inhibitors. Tumor growth rate was slightly less in individuals taking an mTOR inhibitor (−0.8 mm/yr, IQR: −2.3 to 2.2) than those without (1.6 mm/yr; IQR: −0.99 to 5.01, p > 0.05). Conclusions: Nonfunctional PNETs occurred at younger ages in our TSC cohort and more commonly compared to ages and prevalence reported for the general population. PNETs in patients on systemic mTOR inhibitors had lower rates of growth. The outcome of this study provides preliminary evidence supporting the use of mTOR inhibitor therapy in conjunction with serial imaging as medical management for nonfunctional PNETs as an alternative option to invasive surgical removal.
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Affiliation(s)
- Kate Mowrey
- Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hope Northrup
- Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Peyton Rougeau
- Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - S Shahrukh Hashmi
- Department of Pediatrics, Pediatric Research Center, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Darcy A Krueger
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Neurology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Daniel Ebrahimi-Fakhari
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of General Pediatrics, University Children's Hospital Muenster, Muenster, Germany
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Jamie K Capal
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Neurology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David Neal Franz
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Neurology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - David Rodriguez-Buritica
- Division of Medical Genetics, Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States
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24
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Reghunath A, Kabilan K, Mittal MK. Exploring the neglected segment of the intestine: the duodenum and its pathologies. Pol J Radiol 2020; 85:e230-44. [PMID: 32612721 DOI: 10.5114/pjr.2020.95477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022] Open
Abstract
Herein we reviewed the computed tomography (CT) findings of a spectrum of pathological entities affecting the duodenum. We discuss the CT findings of some congenital, inflammatory, traumatic, and neoplastic pathologies of the duodenum along with the conventional barium studies of selected conditions. Pathologies of this C-shaped intestinal segment, derived from both foregut and midgut, are often overlooked in clinical practice and radiological literature. While congenital anomalies like duplication cysts and diverticula are usually asymptomatic, annular pancreas and malrotation may manifest in the first decade of life. Primary as well as secondary involvement of the duodenum by various disease processes can be evaluated by careful CT technique and proper attention to the duodenum. Among congenital conditions, annular pancreas, duplication cyst, superior mesenteric artery syndrome, midgut volvulus, and diverticula are presented. Duodenal involvement in adenocarcinoma, lymphoma, gastrointestinal stromal tumours, Crohn’s disease, and groove pancreatitis are discussed. Duodenal wall haematoma and traumatic duodenal perforation causing pneumoretroperitoneum in two patients after blunt trauma of the abdomen are also illustrated. CT provides superb anatomic detail and offers high diagnostic specificity for the detection of duodenal pathologies because it allows direct imaging of the intestinal wall, secondary signs of bowel disease within the surrounding mesentery, and abnormal findings in adjacent structures. Primary duodenal malignancies and local extension from adjacent malignancies can be diagnosed by CT reliably. CT also plays a vital role in the diagnosis of traumatic duodenal injury by differentiating between mural haematoma and a duodenal perforation because the latter requires immediate surgical intervention.
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25
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Iwadate Y, Nozaki A, Nunokawa Y, Okuda S, Kabasawa H, Jinzaki M. Comparison of Silent Navigator Waveform Generation Methods. Magn Reson Med Sci 2020; 19:154-158. [PMID: 31142703 PMCID: PMC7232032 DOI: 10.2463/mrms.tn.2018-0168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/04/2019] [Indexed: 11/13/2022] Open
Abstract
The silent navigator technique utilizes a non-selective excitation and an appropriate respiratory waveform generation method is necessary for an accurate motion detection. We compared three methods for silent navigator waveform generation. The profile generation method with coil selection (prof-selection) resulted in a high cross correlation with bellows signals and a large respiration amplitude. The prof-selection method should be used for silent navigator waveform generation.
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Affiliation(s)
- Yuji Iwadate
- Global MR Applications and Workflow, GE Healthcare Japan, 4-7-127 Asahigaoka, Hino, Tokyo 191-8503, Japan
| | - Atsushi Nozaki
- Global MR Applications and Workflow, GE Healthcare Japan, 4-7-127 Asahigaoka, Hino, Tokyo 191-8503, Japan
| | | | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Kabasawa
- Global MR Applications and Workflow, GE Healthcare Japan, 4-7-127 Asahigaoka, Hino, Tokyo 191-8503, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
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26
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Satiya J, Mousa OY, Gupta K, Trivedi S, Oman SP, Wijarnpreecha K, Harnois DM, Corral JE. Diagnostic yield of magnetic resonance imaging for cholangiocarcinoma in primary sclerosing cholangitis: a meta-analysis. Clin Exp Hepatol 2020; 6:35-41. [PMID: 32166122 DOI: 10.5114/ceh.2020.93054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/07/2019] [Indexed: 02/07/2023] Open
Abstract
Aim of the study Combined magnetic resonance imaging and magnetic resonance cholangiopancreatography (MRI/MRCP) can identify biliary strictures and diagnose primary sclerosing cholangitis (PSC). Diagnosis of cholangiocarcinoma in patients with PSC remains challenging, and the accuracy of MRI/MRCP has not been completely established. We aimed to determine the sensitivity and specificity of MRI/MRCP in the diagnosis of cholangiocarcinoma among patients with PSC from the published literature. Material and methods We searched Embase, PubMed, Cochrane, Scopus, ClinicalTrials.gov, and abstracts from relevant scientific meetings and performed a systematic review and meta-analysis to estimate the diagnostic yield of MRI/MRCP in patients with PSC. Sensitivity and specificity were calculated from pooled estimates of cholangiocarcinoma cases identified and lesions missed. Modifying variables were included in a meta-regression model. Results Our literature search yielded 302 articles and 9 conference abstracts; 8 studies involving 846 liver patients from 5 countries were included in the final analysis. Of those, 531 had PSC and received MRI/MRCP. Thirty-six (6.8%) patients were diagnosed with cholangiocarcinoma (33 true positive, 3 false negative and 1 false positive). Pooled sensitivity was 98.9% (95% CI: 98.6-99.3%). Cholangiocarcinoma cases missed by MRI/MRCP were diagnosed as beading irregularities of the central hepatic ducts, or PSC-related diffuse stricture. Metaregression revealed that neither publication year, study design, nor sample size had a significant effect on observed cancer rates (p = 0.9, 0.3, and 0.3, respectively). Conclusions MRI/MRCP followed by endoscopic retrograde cholangiopancreatography (ERCP) is a sensitive and specific tool to diagnose cholangiocarcinoma among patients with PSC. Further research should estimate MRI/MRCP diagnostic accuracy for cholangiocarcinoma using prospective methodology and longer term outcomes.
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27
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Devos H, Goethals L, Belsack D, Brucker Y, Allemeersch GJ, Ilsen B, Vandenbroucke F, de Mey J. Fat misbehaving in the abdominal cavity: a pictorial essay. Pol J Radiol 2020; 85:e32-8. [PMID: 32180852 DOI: 10.5114/pjr.2020.93070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 11/27/2022] Open
Abstract
Intra-abdominal fat is abundantly present in both the peritoneum and retroperitoneum. Fat necrosis or inflammation are common findings in abdominal imaging. The most common pathologies that we encounter are epiploic appendagitis, omental infarction, mesenteric panniculitis, and encapsulated fat necrosis. Less common entities that can occur are pancreatic saponification, heterotopic mesenteric ossification, and pseudolipoma of the capsule of Glisson. These entities can mimic more urgent pathologies such as appendicitis, diverticulitis, or malignancies.
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Abstract
The dilemma of acute non-traumatic abdominal pathologies in the pediatric population depends on the age of the patients and symptoms. Surgical etiologies in patients younger than 2 years of age include intussusception, pyloric stenosis, malrotation and midgut volvulus. In older patients, considerations become closer to differential etiologies in adults including acute appendicitis. Ultrasound and fluoroscopic examinations remain the mainstay for diagnosis that may even be therapeutic such as contrast/air enemas in intussusception reduction. There is an increasing role for CT in appendicitis and renal colic especially in assessing complications; however, it is less favored because it incurs radiation to the patient. This article summarizes the imaging approach to pediatric patients with acute abdominal pathologies presenting to the emergency department, and how imaging is instrumental in guiding diagnosis and treatment, with emphasis on radiation safety, in the context of providing typical imaging findings of each pathology in this pictorial review.
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Affiliation(s)
- Lena Naffaa
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrew Barakat
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amro Baassiri
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lamya Ann Atweh
- Department of Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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29
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Mandava S, Keerthivasan MB, Martin DR, Altbach MI, Bilgin A. Radial streak artifact reduction using phased array beamforming. Magn Reson Med 2019; 81:3915-3923. [PMID: 30756432 PMCID: PMC10188278 DOI: 10.1002/mrm.27689] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE A new method for streak artifact reduction in radial MRI based on phased array filtering. THEORY Radial imaging in applications that require large fields-of-view can be susceptible to streaking artifacts due to gradient nonlinearities. Coil removal methods prune the coils contributing the most to streaking artifacts at the expense of signal loss. Phased array beamforming is a form of spatial filtering used to suppress unwanted signals. The proposed method uses interference covariance generated from the streaking artifact samples which are manually extracted with phased array beamforming to suppress streaking in the images. METHODS The performance of the proposed method was evaluated on abdomen radial fast spin echo images acquired on a 1.5T Siemens scanner and compared with previously proposed methods. RESULTS Our results demonstrate that the proposed method can effectively suppress streaking artifacts without any noticeable loss in signal levels. Coil removal methods can suppress streaks as well but they may incur significant signal loss due to coil pruning. Quantitative metrics also demonstrate the superiority of the proposed method over earlier methods. CONCLUSION The use of interference covariance with phased array beamforming can help reduce streaking artifacts.
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Affiliation(s)
- Sagar Mandava
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, Arizona.,Department of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Mahesh B Keerthivasan
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, Arizona.,Department of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Diego R Martin
- Department of Medical Imaging, University of Arizona, Tucson, Arizona
| | - Maria I Altbach
- Department of Medical Imaging, University of Arizona, Tucson, Arizona.,Department of Biomedical Engineering, University of Arizona, Tucson, Arizona
| | - Ali Bilgin
- Department of Electrical and Computer Engineering, University of Arizona, Tucson, Arizona.,Department of Medical Imaging, University of Arizona, Tucson, Arizona.,Department of Biomedical Engineering, University of Arizona, Tucson, Arizona
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30
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Herts BR, Gandhi NS, Schneider E, Coppa CP, Mody RN, Baker ME, Remer EM. How We Do It: Creating Consistent Structure and Content in Abdominal Radiology Report Templates. AJR Am J Roentgenol 2019; 212:490-6. [PMID: 30620681 DOI: 10.2214/AJR.18.20368] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purposes of this article are to describe the creation of template report formats and content for a variety of abdominal and pelvic CT and MRI examinations and discuss a review-of-systems approach to text and avoidance of pitfalls of report templates. CONCLUSION Organ system-specific report templates for CT and MRI incorporate radiologist preferences. Disease-specific report templates are created from these reports to provide a consistent radiologist and referring physician experience across the report templates.
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31
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Noël PB, Engels S, Köhler T, Muenzel D, Franz D, Rasper M, Rummeny EJ, Dobritz M, Fingerle AA. Evaluation of an iterative model-based CT reconstruction algorithm by intra-patient comparison of standard and ultra-low-dose examinations. Acta Radiol 2018; 59:1225-1231. [PMID: 29320863 DOI: 10.1177/0284185117752551] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The explosive growth of computer tomography (CT) has led to a growing public health concern about patient and population radiation dose. A recently introduced technique for dose reduction, which can be combined with tube-current modulation, over-beam reduction, and organ-specific dose reduction, is iterative reconstruction (IR). Purpose To evaluate the quality, at different radiation dose levels, of three reconstruction algorithms for diagnostics of patients with proven liver metastases under tumor follow-up. Material and Methods A total of 40 thorax-abdomen-pelvis CT examinations acquired from 20 patients in a tumor follow-up were included. All patients were imaged using the standard-dose and a specific low-dose CT protocol. Reconstructed slices were generated by using three different reconstruction algorithms: a classical filtered back projection (FBP); a first-generation iterative noise-reduction algorithm (iDose4); and a next generation model-based IR algorithm (IMR). Results The overall detection of liver lesions tended to be higher with the IMR algorithm than with FBP or iDose4. The IMR dataset at standard dose yielded the highest overall detectability, while the low-dose FBP dataset showed the lowest detectability. For the low-dose protocols, a significantly improved detectability of the liver lesion can be reported compared to FBP or iDose4 ( P = 0.01). The radiation dose decreased by an approximate factor of 5 between the standard-dose and the low-dose protocol. Conclusion The latest generation of IR algorithms significantly improved the diagnostic image quality and provided virtually noise-free images for ultra-low-dose CT imaging.
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Affiliation(s)
- Peter B Noël
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
- Physics Department & Munich School of BioEngineering, Technische Universität München, Garching, Germany
| | - Stephan Engels
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | | | - Daniela Muenzel
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
- Physics Department & Munich School of BioEngineering, Technische Universität München, Garching, Germany
| | - Daniela Franz
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Michael Rasper
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Ernst J Rummeny
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Martin Dobritz
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
| | - Alexander A Fingerle
- Department of Diagnostic and Interventional Radiology, Technische Universität München, Munich, Germany
- Physics Department & Munich School of BioEngineering, Technische Universität München, Garching, Germany
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32
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Benkert T, Mugler JP, Rigie DS, Sodickson DK, Chandarana H, Block KT. Hybrid T 2 - and T 1 -weighted radial acquisition for free-breathing abdominal examination. Magn Reson Med 2018; 80:1935-1948. [PMID: 29656522 DOI: 10.1002/mrm.27200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/14/2018] [Accepted: 03/09/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Most clinical MR examinations require acquisition of different image contrasts. For abdominal exams, the scans are conventionally performed as separate acquisitions using respiratory gating or repeated breath holding, which can be time-inefficient and challenging for patients. Here, a hybrid imaging approach is described that creates T2 - and T1 -weighted images from a single scan and allows for free-breathing acquisition. THEORY AND METHODS T2 -weighted data is collected using 3D fast spin-echo (FSE) acquisition with motion-robust radial stack-of-stars sampling. The wait time between the FSE trains is used to acquire T1 -weighted gradient-echo (GRE) data. Improved robustness is achieved by extracting a respiratory signal from the GRE data and using it for motion-weighted reconstruction. RESULTS As validated in simulations and phantom scans, GRE acquisition in the wait time has minor effect on the signal strength and contrast. Volunteer scans at 1.5T showed that T2 - and T1 -weighted hybrid imaging is feasible during free-breathing. Furthermore, it has been demonstrated in a patient that hybrid imaging with T1 -weighted Dixon acquisition is possible. CONCLUSION The described hybrid sequence enables comprehensive T2 - and T1 -weighted imaging in a single scan. In addition to free-breathing abdominal examination, it promises value for clinical applications that are frequently affected by motion artifacts.
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Affiliation(s)
- Thomas Benkert
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - John P Mugler
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
| | - David S Rigie
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Daniel K Sodickson
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
| | - Kai Tobias Block
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York
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Gibbons EK, Le Roux P, Vasanawala SS, Pauly JM, Kerr AB. Robust Self-Calibrating nCPMG Acquisition: Application to Body Diffusion-Weighted Imaging. IEEE Trans Med Imaging 2018; 37:200-209. [PMID: 28829307 PMCID: PMC5784776 DOI: 10.1109/tmi.2017.2741421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This paper demonstrates a robust diffusion-weighted single-shot fast spin echo (SS-FSE) sequence in the presence of significant off-resonance, which includes a variable-density acquisition and a self-calibrated reconstruction as improvements. A non-Carr-Purcell-Meiboom-Gill (nCPMG) SS-FSE acquisition stabilizes both the main and parasitic echo families for each echo. This preserves both the in-phase and quadrature components of the magnetization throughout the echo train. However, nCPMG SS-FSE also promotes aliasing of the quadrature component, which complicates reconstruction. A new acquisition and reconstruction approach is presented here, where the field-of-view is effectively doubled, but a partial k-space and variable density sampling is used to improve scan efficiency. The technique is presented in phantom scans to validate SNR and robustness against rapidly varying object phase. In vivo healthy volunteer examples and the clinical cases are demonstrated in abdominal imaging. This new approach provides comparable SNR to previous nCPMG acquisition techniques as well as providing more uniform apparent diffusion coefficient maps in phantom scans. In vivo scans suggest that this method is more robust against motion than previous approaches. The proposed reconstruction is an improvement to the nCPMG sequence as it is auto-calibrating and is justified to accurately treat the signal model for the nCPMG SS-FSE sequence.
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Paška J, Cloos MA, Wiggins GC. A rigid, stand-off hybrid dipole, and birdcage coil array for 7 T body imaging. Magn Reson Med 2017; 80:822-832. [PMID: 29250833 DOI: 10.1002/mrm.27048] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/23/2017] [Accepted: 11/24/2017] [Indexed: 11/11/2022]
Abstract
PURPOSE To design a robust and patient friendly radiofrequency coil array (8-channel transmit and 16-channel receive) for cross-sectional body imaging at 7 T, and to improve our understanding of the combination of dipole and loop like elements for ultra high field strengths. METHODS The hybrid coil array was optimized in eletromagnetic simulations. Considered array candidates were the dipole, loop and birdcage array. The winning design was constructed and the signal-to-noise (SNR) was compared to a close fitting array at 3 T. Transmit and receive properties for different body sizes were assessed, and multi-parametric maps were acquired with the Plug-and-Play MRF method. RESULTS The winning design consists of a dipole array for transceive combined with a birdcage array for receive only. The central SNR improved by a factor of 3 as compared to a 3 T system with a local receive array. A transmit efficiency between 2.4 and 3.9 μT/kW, a specific absorption rate efficiency of 0.25 to 0.53 μT/W/kg, and a high SNR was achieved in the center for the targeted patient population. CONCLUSION The constructed coil array is easy to handle, safe, and patient friendly, allowing further development of abdominal imaging at 7 T. Quantitative MRI in the abdomen is possible with Plug-and-Play MRF using the designed coil array. Magn Reson Med 80:822-832, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Jan Paška
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Martijn A Cloos
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Graham C Wiggins
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York, USA
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35
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Chen F, Zhang T, Cheng JY, Shi X, Pauly JM, Vasanawala SS. Autocalibrating motion-corrected wave-encoding for highly accelerated free-breathing abdominal MRI. Magn Reson Med 2017; 78:1757-1766. [PMID: 27943402 PMCID: PMC5466545 DOI: 10.1002/mrm.26567] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/26/2016] [Accepted: 11/10/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE To develop a motion-robust wave-encoding technique for highly accelerated free-breathing abdominal MRI. METHODS A comprehensive 3D wave-encoding-based method was developed to enable fast free-breathing abdominal imaging: (a) auto-calibration for wave-encoding was designed to avoid extra scan for coil sensitivity measurement; (b) intrinsic butterfly navigators were used to track respiratory motion; (c) variable-density sampling was included to enable compressed sensing; (d) golden-angle radial-Cartesian hybrid view-ordering was incorporated to improve motion robustness; and (e) localized rigid motion correction was combined with parallel imaging compressed sensing reconstruction to reconstruct the highly accelerated wave-encoded datasets. The proposed method was tested on six subjects and image quality was compared with standard accelerated Cartesian acquisition both with and without respiratory triggering. Inverse gradient entropy and normalized gradient squared metrics were calculated, testing whether image quality was improved using paired t-tests. RESULTS For respiratory-triggered scans, wave-encoding significantly reduced residual aliasing and blurring compared with standard Cartesian acquisition (metrics suggesting P < 0.05). For non-respiratory-triggered scans, the proposed method yielded significantly better motion correction compared with standard motion-corrected Cartesian acquisition (metrics suggesting P < 0.01). CONCLUSION The proposed methods can reduce motion artifacts and improve overall image quality of highly accelerated free-breathing abdominal MRI. Magn Reson Med 78:1757-1766, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Feiyu Chen
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Tao Zhang
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Joseph Y. Cheng
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Xinwei Shi
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - John M. Pauly
- Department of Electrical Engineering, Stanford University, Stanford, California, USA
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Stemkens B, Benkert T, Chandarana H, Bittman ME, Van den Berg CA, Lagendijk JJ, Sodickson DK, Tijssen RH, Block KT. Adaptive bulk motion exclusion for improved robustness of abdominal magnetic resonance imaging. NMR Biomed 2017; 30:e3830. [PMID: 28885742 PMCID: PMC5643254 DOI: 10.1002/nbm.3830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 08/03/2017] [Accepted: 08/14/2017] [Indexed: 05/09/2023]
Abstract
Non-Cartesian magnetic resonance imaging (MRI) sequences have shown great promise for abdominal examination during free breathing, but break down in the presence of bulk patient motion (i.e. voluntary or involuntary patient movement resulting in translation, rotation or elastic deformations of the body). This work describes a data-consistency-driven image stabilization technique that detects and excludes bulk movements during data acquisition. Bulk motion is identified from changes in the signal intensity distribution across different elements of a multi-channel receive coil array. A short free induction decay signal is acquired after excitation and used as a measure to determine alterations in the load distribution. The technique has been implemented on a clinical MR scanner and evaluated in the abdomen. Six volunteers were scanned and two radiologists scored the reconstructions. To show the applicability to other body areas, additional neck and knee images were acquired. Data corrupted by bulk motion were successfully detected and excluded from image reconstruction. An overall increase in image sharpness and reduction of streaking and shine-through artifacts were seen in the volunteer study, as well as in the neck and knee scans. The proposed technique enables automatic real-time detection and exclusion of bulk motion during MR examinations without user interaction. It may help to improve the reliability of pediatric MRI examinations without the use of sedation.
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Affiliation(s)
- Bjorn Stemkens
- Department of RadiotherapyUniversity Medical Center Utrechtthe Netherlands
| | - Thomas Benkert
- Center for Advanced Imaging Innovation and Research (CAIR), Department of RadiologyNew York University School of MedicineNew YorkNYUSA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of RadiologyNew York University School of MedicineNew YorkNYUSA
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAIR), Department of RadiologyNew York University School of MedicineNew YorkNYUSA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of RadiologyNew York University School of MedicineNew YorkNYUSA
| | - Mark E. Bittman
- Center for Advanced Imaging Innovation and Research (CAIR), Department of RadiologyNew York University School of MedicineNew YorkNYUSA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of RadiologyNew York University School of MedicineNew YorkNYUSA
| | | | - Jan J.W. Lagendijk
- Department of RadiotherapyUniversity Medical Center Utrechtthe Netherlands
| | - Daniel K. Sodickson
- Center for Advanced Imaging Innovation and Research (CAIR), Department of RadiologyNew York University School of MedicineNew YorkNYUSA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of RadiologyNew York University School of MedicineNew YorkNYUSA
| | - Rob H.N. Tijssen
- Department of RadiotherapyUniversity Medical Center Utrechtthe Netherlands
| | - Kai Tobias Block
- Center for Advanced Imaging Innovation and Research (CAIR), Department of RadiologyNew York University School of MedicineNew YorkNYUSA
- Bernard and Irene Schwartz Center for Biomedical Imaging, Department of RadiologyNew York University School of MedicineNew YorkNYUSA
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Iwadate Y, Nozaki A, Nunokawa Y, Okuda S, Jinzaki M, Kabasawa H. Silent navigator-triggered silent MRI of the abdomen. Magn Reson Med 2017; 79:2170-2175. [PMID: 28782173 DOI: 10.1002/mrm.26869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 07/15/2017] [Accepted: 07/19/2017] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop and demonstrate the feasibility of a silent respiratory navigator technique for prospective triggering, which was incorporated into a three-dimensional radial zero-echo-time sequence for respiratory navigated silent abdominal imaging. METHODS A nonselective hard excitation radiofrequency pulse was used for the navigator sequence with a derated readout gradient, to avoid generation of high levels of acoustic noise. The acquired navigator signals were processed in real time and used for prospective triggering of the zero-echo-time sequence. Ten healthy volunteers were scanned using the proposed and conventional techniques at 1.5 T. An acoustic noise measurement with A-weighted continuous equivalent sound pressure level was also performed. RESULTS The sound pressure-level values of the background noise, zero-echo-time imaging, conventional, and silent navigators were 68.3, 68.4, 102.5, and 69.4 dBA, respectively. Excellent correlation with correlation coefficients greater than 0.9 was observed between the bellows signals and displacement values calculated from the navigators. Sharpness of the portal vein of both conventional and silent navigator-triggered images was significantly higher than those of nontriggered images. CONCLUSIONS The silent navigator-triggered zero-echo-time technique is feasible and might improve image quality and workflow of abdominal MRI of patients who are prone to acoustic noise. Magn Reson Med 79:2170-2175, 2018. © 2017 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Yuji Iwadate
- Global MR Applications and Workflow, GE Healthcare Japan, Hino, Tokyo, Japan
| | - Atsushi Nozaki
- Global MR Applications and Workflow, GE Healthcare Japan, Hino, Tokyo, Japan
| | | | - Shigeo Okuda
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Kabasawa
- Global MR Applications and Workflow, GE Healthcare Japan, Hino, Tokyo, Japan
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Gong J, Mei D, Yang M, Xu J, Zhou Y. Emergency CT of blunt abdominal trauma: experience from a large urban hospital in Southern China. Quant Imaging Med Surg 2017; 7:461-468. [PMID: 28932702 DOI: 10.21037/qims.2017.08.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Trauma is one of the leading causes of death for men and women under the age of 45 years old, and abdominal injuries contribute to a large number of these deaths. Prompt diagnosis is very important for treatment decision making and can be life-saving. CT has become an essential imaging modality in emergency medicine. In this pictorial review, we present our experience of CT in blunt abdominal trauma and describe CT findings of common injuries, including hemoperitoneum, solid viscera, hollow viscera, mesenteric and diaphragmatic injuries. Unenhanced CT is routinely used, tailored protocols should be reserved for patients with questionable or subtle findings at unenhanced CT, especially for bowel and mesenteric injuries. The decision can be made by radiologists based on initial findings or by referring clinicians based by clinical presentations or deterioration of patients' condition.
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Affiliation(s)
- Jingshan Gong
- Department of Radiology, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University, Shenzhen 518020, China
| | - Dongdong Mei
- Department of Radiology, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University, Shenzhen 518020, China
| | - Minjie Yang
- Department of Radiology, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University, Shenzhen 518020, China
| | - Jianmin Xu
- Department of Radiology, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University, Shenzhen 518020, China
| | - Yangyang Zhou
- Department of Radiology, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University, Shenzhen 518020, China
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Weingärtner S, Zimmer F, Metzger GJ, Uğurbil K, Van de Moortele PF, Akçakaya M. Motion-robust cardiac B1+ mapping at 3T using interleaved bloch-siegert shifts. Magn Reson Med 2017; 78:670-677. [PMID: 27599782 PMCID: PMC5340643 DOI: 10.1002/mrm.26395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/15/2016] [Accepted: 08/06/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To develop and evaluate a robust motion-insensitive Bloch-Siegert shift based B1+ mapping method in the heart. METHODS Cardiac Bloch-Siegert B1+ mapping was performed with interleaved positive and negative off-resonance shifts and diastolic spoiled gradient echo imaging in 12 heartbeats. Numerical simulations were performed to study the impact of respiratory motion. The method was compared with three-dimensional (3D) actual flip angle imaging (AFI) and two-dimensional (2D) saturated double angle method (SDAM) in phantom scans. Cardiac B1+ maps of three different views were acquired in six healthy volunteers using Bloch-Siegert and SDAM during breath-hold and free breathing. In vivo maps were evaluated for inter-view consistency using the correlation coefficients of the B1+ profiles along the lines of intersection between the views. RESULTS For the Bloch-Siegert sequence, numerical simulations indicated high similarity between breath-hold and free breathing scans, and phantom results indicated low deviation from the 3D AFI reference (normalized root mean square error [NRMSE] = 2.0%). Increased deviation was observed with 2D SDAM (NRMSE = 5.0%) due to underestimation caused by imperfect excitation slice profiles. Breath-hold and free breathing Bloch-Siegert in vivo B1+ maps were visually comparable with no significant difference in the inter-view consistency (P > 0.36). SDAM showed strongly impaired B1+ map quality during free breathing. Inter-view consistency was significantly lower than with the Bloch-Siegert method (breath-hold: P = 0.014, free breathing: P < 0.0001). CONCLUSION The proposed interleaved Bloch-Siegert sequence enables cardiac B1+ mapping with improved inter-view consistency and high resilience to respiratory motion. Magn Reson Med 78:670-677, 2017. © 2016 International Society for Magnetic Resonance in Medicine.
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Affiliation(s)
- Sebastian Weingärtner
- Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
- Computer Assisted Clinical Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Zimmer
- Computer Assisted Clinical Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Gregory J Metzger
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kâmil Uğurbil
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Mehmet Akçakaya
- Electrical and Computer Engineering, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota, USA
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Smereka P, Doshi AM, Ream JM, Rosenkrantz AB. The American College of Radiology Incidental Findings Committee Recommendations for Management of Incidental Lymph Nodes: A Single-Center Evaluation. Acad Radiol 2017; 24:603-608. [PMID: 28169142 DOI: 10.1016/j.acra.2016.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the American College of Radiology Incidental Findings Committee's (ACR-IFC) recommendations for defining and following up abnormal incidental abdominopelvic lymph nodes. MATERIALS AND METHODS A total of 59 lymph nodes satisfying ACR-IFC criteria as incidental (no malignancy or lymphoproliferative disorder) and with sufficient follow-up to classify as benign (biopsy, decreased size, ≥12-month stability) or malignant (biopsy, detection of primary malignancy combined with either fluorodeoxyglucose hyperactivity or increase in size of the node) were included. Two radiologists independently assessed nodes for suspicious features by ACR-IFC criteria (round with indistinct hilum, hypervascularity, necrosis, cluster ≥3 nodes, cluster ≥2 nodes in ≥2 stations, size ≥1 cm in retroperitoneum). Outcomes were assessed with attention to ACR-IFC's recommendation for initial 3-month follow-up. RESULTS A total of 8.5% of nodes were malignant; 91.5% were benign. Two of six malignant nodes were stable at 3 to <6-month follow-up before diagnosis; diagnosis of four of five malignant nodes was facilitated by later development of non-nodal sites of tumor. A total of 13, 5, 8, and 9 nodes were deemed benign given a decrease at <3 months, 3-5 months, 6-11 months, or ≥12 months of follow-up. No ACR-IFC feature differentiated benign and malignant nodes (P = 0.164-1.0). A cluster ≥3 nodes was present in 88.1%-93.2% of nodes. A total of 96.6%-98.3% had ≥1 suspicious feature for both readers. Necrosis and hypervascularity were not identified in any node. CONCLUSIONS ACR-IFC imaging features overwhelmingly classified incidental nodes as abnormal, although did not differentiate benign and malignant nodes. Nodes stable at the ACR-IFC's advised initial 3-month follow-up were occasionally proven malignant or decreased on further imaging. Refinement of imaging criteria to define nodes of particularly high risk, integrated with other clinical criteria, may help optimize the follow-up of incidental abdominopelvic lymph nodes.
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Abstract
SS-FSE is a fast technique that does not suffer from off-resonance distortions to the degree that EPI does. Unlike EPI, SS-FSE is ill-suited to diffusion weighted imaging (DWI) due to the Carr-Purcell-Meiboom-Geill (CPMG) condition. Non-CPMG phase cycling does accommodate SS-FSE and DWI but places constraints on reconstruction, which are resolved here through parallel imaging. Additionally, improved echo stability can be achieved by using short duration and highly selective DIVERSE radiofrequency pulses. Here, signal-to-noise ratio (SNR) comparisons between EPI and nCPMG SS-FSE acquisitions and reconstruction techniques give similar values. Diffusion imaging with nCPMG SS-FSE gives similar SNR to an EPI acquisition, though apparent diffusion coefficient values are higher than seen with EPI. In vivo images have good image quality with little distortion. This method has the ability to capture distortion-free DWI images near areas of significant off-resonance as well as preserve adequate SNR. Parallel imaging and DIVERSE refocusing RF pulses allow shorter ETL compared to previous implementations and thus reduces phase encode direction blur and SAR accumulation.
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Becker AS, Wagner MW, Wurnig MC, Boss A. Diffusion-weighted imaging of the abdomen: Impact of b-values on texture analysis features. NMR Biomed 2017; 30:e3669. [PMID: 27898201 DOI: 10.1002/nbm.3669] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 09/20/2016] [Accepted: 10/12/2016] [Indexed: 06/06/2023]
Abstract
The purpose of this work was to systematically assess the impact of the b-value on texture analysis in MR diffusion-weighted imaging (DWI) of the abdomen. In eight healthy male volunteers, echo-planar DWI sequences at 16 b-values ranging between 0 and 1000 s/mm2 were acquired at 3 T. Three different apparent diffusion coefficient (ADC) maps were computed (0, 750/100, 390, 750 s/mm2 /all b-values). Texture analysis of rectangular regions of interest in the liver, kidney, spleen, pancreas, paraspinal muscle and subcutaneous fat was performed on DW images and the ADC maps, applying 19 features computed from the histogram, grey-level co-occurrence matrix (GLCM) and grey-level run-length matrix (GLRLM). Correlations between b-values and texture features were tested with a linear and an exponential model; the best fit was determined by the smallest sum of squared residuals. Differences between the ADC maps were assessed with an analysis of variance. A Bonferroni-corrected p-value less than 0.008 (=0.05/6) was considered statistically significant. Most GLCM and GLRLM-derived texture features (12-18 per organ) showed significant correlations with the b-value. Four texture features correlated significantly with changing b-values in all organs (p < 0.008). Correlation coefficients varied between 0.7 and 1.0. The best fit varied across different structures, with fat exhibiting mostly exponential (17 features), muscle mostly linear (12 features) and the parenchymatous organs mixed feature alterations. Two GLCM features showed significant variability in the different ADC maps. Several texture features vary systematically in healthy tissues at different b-values, which needs to be taken into account if DWI data with different b-values are analyzed. Histogram and GLRLM-derived texture features are stable on ADC maps computed from different b-values.
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Affiliation(s)
- Anton S Becker
- Institute of Diagnostic and Interventional Radiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Matthias W Wagner
- Institute of Diagnostic and Interventional Radiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Moritz C Wurnig
- Institute of Diagnostic and Interventional Radiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Andreas Boss
- Institute of Diagnostic and Interventional Radiology, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
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Abstract
This report details a 58-year-old gentleman who presented to his outpatient primary care physician's clinic several times over four weeks for ongoing epigastric pain radiating into his left flank, dry heaving, and constipation. He was presumed to have gastritis at each visit and prescribed escalating doses of proton pump inhibitors. Due to the unrelenting pain, he eventually was admitted to the hospital and diagnosed with splenic vein thrombosis after computed tomography imaging of the abdomen. Our literature search revealed that pancreatic pathology is overwhelmingly the contributing factor to splenic vein thrombosis. Our patient had prominent collateral vasculature, suggesting that his splenic vein thrombosis was chronic in nature and likely the cause of his ongoing abdominal pain. Splenic vein thrombosis is an uncommon cause of abdominal pain, but one that should be included in the treating physician's differential diagnoses when abdominal pain is ongoing despite medical therapy. Although he had no evidence of initial findings on radiography, our patient was eventually diagnosed with biopsy-proven pancreatic cancer. Our case report demonstrates how patients presenting with persistent or worsening abdominal pain despite the use of proton pump inhibitors or other acid reducing agents and potential 'red flag' findings such as decreased appetite and weight loss should be worked up for other potential sources of abdominal pathology.
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Affiliation(s)
- Brittany McIntyre
- a Family Medicine Residency , Moses Cone Health System Ringgold standard institution , Greensboro , NC , USA
| | - Melanie Marsh
- a Family Medicine Residency , Moses Cone Health System Ringgold standard institution , Greensboro , NC , USA
| | - Jeffrey Walden
- a Family Medicine Residency , Moses Cone Health System Ringgold standard institution , Greensboro , NC , USA.,b Department of Family Medicine , University of North Carolina at Chapel Hill School of Medicine Ringgold standard institution , Chapel Hill , NC , USA
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Kinner S, Repplinger MD, Pickhardt PJ, Reeder SB. Contrast-Enhanced Abdominal MRI for Suspected Appendicitis: How We Do It. AJR Am J Roentgenol 2016; 207:49-57. [PMID: 27065072 DOI: 10.2214/AJR.15.15948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of this article is to describe our approach to contrast-enhanced abdominal MRI in patients with nontraumatic abdominal pain and suspected appendicitis. We aim to share our experience on the advantages, pearls, and pitfalls of MRI in this clinical setting, in comparison with CT and ultrasound. CONCLUSION We present some typical cases of appendicitis and alternative diagnoses in patients presenting with acute nontraumatic abdominal pain.
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Jerome NP, Orton MR, d'Arcy JA, Feiweier T, Tunariu N, Koh DM, Leach MO, Collins DJ. Use of the temporal median and trimmed mean mitigates effects of respiratory motion in multiple-acquisition abdominal diffusion imaging. Phys Med Biol 2015; 60:N9-20. [PMID: 25559552 PMCID: PMC4655443 DOI: 10.1088/0031-9155/60/2/n9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Respiratory motion commonly confounds abdominal diffusion-weighted magnetic resonance imaging, where averaging of successive samples at different parts of the respiratory cycle, performed in the scanner, manifests the motion as blurring of tissue boundaries and structural features and can introduce bias into calculated diffusion metrics. Storing multiple averages separately allows processing using metrics other than the mean; in this prospective volunteer study, median and trimmed mean values of signal intensity for each voxel over repeated averages and diffusion-weighting directions are shown to give images with sharper tissue boundaries and structural features for moving tissues, while not compromising non-moving structures. Expert visual scoring of derived diffusion maps is significantly higher for the median than for the mean, with modest improvement from the trimmed mean. Diffusion metrics derived from mono- and bi-exponential diffusion models are comparable for non-moving structures, demonstrating a lack of introduced bias from using the median. The use of the median is a simple and computationally inexpensive alternative to complex and expensive registration algorithms, requiring only additional data storage (and no additional scanning time) while returning visually superior images that will facilitate the appropriate placement of regions-of-interest when analysing abdominal diffusion-weighted magnetic resonance images, for assessment of disease characteristics and treatment response.
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Affiliation(s)
- N P Jerome
- Cancer Research UK and EPSRC Cancer Imaging Centre at the Institute of Cancer Research, London, SM2 5NG, UK
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Springer DA, Allen M, Hoffman V, Brinster L, Starost MF, Bryant M, Eckhaus M. Investigation and identification of etiologies involved in the development of acquired hydronephrosis in aged laboratory mice with the use of high-frequency ultrasound imaging. Pathobiol Aging Age Relat Dis 2014; 4:24932. [PMID: 25143818 PMCID: PMC4119937 DOI: 10.3402/pba.v4.24932] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/16/2014] [Indexed: 11/14/2022]
Abstract
Laboratory mice develop naturally occurring lesions that affect biomedical research. Hydronephrosis is a recognized pathologic abnormality of the mouse kidney. Acquired hydronephrosis can affect any mouse, as it is caused by any naturally occurring disease that impairs free urine flow. Many etiologies leading to this condition are of particular significance to aging mice. Non-invasive ultrasound imaging detects renal pelvic dilation, renal enlargement, and parenchymal loss for pre-mortem identification of this condition. High-frequency ultrasound transducers produce high-resolution images of small structures, ideal for detecting organ pathology in mice. Using a 40 MHz linear array transducer, we obtained high-resolution images of a diversity of pathologic lesions occurring within the abdomen of seven geriatric mice with acquired hydronephrosis that enabled a determination of the underlying etiology. Etiologies diagnosed from the imaging results include pyelonephritis, neoplasia, urolithiasis, mouse urologic syndrome, and spontaneous hydronephrosis, and were confirmed at necropsy. A retrospective review of abdominal scans from an additional 149 aging mice shows that the most common etiologies associated with acquired hydronephrosis are mouse urologic syndrome and abdominal neoplasia. This report highlights the utility of high-frequency ultrasound for surveying research mice for age-related pathology, and is the first comprehensive report of multiple cases of acquired hydronephrosis in mice.
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Affiliation(s)
- Danielle A Springer
- Murine Phenotyping Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michele Allen
- Murine Phenotyping Core, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Victoria Hoffman
- Office of Research Services, Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Lauren Brinster
- Office of Research Services, Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Matthew F Starost
- Office of Research Services, Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Mark Bryant
- Office of Research Services, Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
| | - Michael Eckhaus
- Office of Research Services, Division of Veterinary Resources, National Institutes of Health, Bethesda, MD, USA
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Karwacki GM, Stöckli M, Kettelhack C, Mengiardi B, Studler U. Radiographic diagnosis and differentiation of an aggressive angiomyxoma in a male patient. J Radiol Case Rep 2014; 7:1-6. [PMID: 24421942 DOI: 10.3941/jrcr.v7i7.1154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aggressive angiomyxoma is a rare soft-tissue tumor which usually occurs in female patients of reproductive age. Its occurrence in men is even more unusual and as illustrated in this case the difference between pathology suggested by a physical examination and its actual extent can be quite striking. We present a case report of an 81-year-old man with the typical MRI appearances of a pelvic aggressive angiomyxoma, describe imaging and histopathologic features of this rarely seen locally infiltrative neoplasm and also discuss therapeutic options for patients with an aggressive angiomyxoma.
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Affiliation(s)
- Grzegorz Marek Karwacki
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Martin Stöckli
- Institute of Pathology, University of Basel Hospital, Basel, Switzerland
| | | | | | - Ueli Studler
- Department of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
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Kerner C, Carey K, Baillie C, Mills AM, Yang W, Hilton S, Synnestvedt MB, Weiner MG, Lewis JD. Clinical predictors of urgent findings on abdominopelvic CT in emergency department patients with Crohn's disease. Inflamm Bowel Dis 2013; 19:1179-85. [PMID: 23552763 DOI: 10.1097/MIB.0b013e31828133ad] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with Crohn's disease (CD) are frequently exposed to diagnostic radiation in emergency departments (EDs). We aimed to examine clinical predictors of urgent abdominopelvic computed tomography (APCT) findings in this population. METHODS A retrospective cross-sectional study was performed among adults with CD presenting to 2 emergency departments with a gastrointestinal chief complaint. The outcome, APON (abscess, perforation, obstruction, new or worsening non-CD-related findings), included APCTs with new or worsening CD-related or non-CD-related urgent findings. Variables with P < 0.05 in bivariate analyses were included in a multivariable logistic regression model, which was also used to develop a risk score for APON. RESULTS A total of 481 APCTs were performed and 166 (34.5%) identified APON. Variables retained in the final model were history of intestinal obstruction (odds ratio [OR]: 3.78, 95% confidence interval [CI]: 2.27-6.28), history of intraabdominal abscess (OR: 2.64, 95% CI: 1.43 to 4.88), current hematochezia (OR: 0.38, 95% CI: 0.21 to 0.68), and white blood cell count >12,000/μL (OR: 2.49, 95% CI: 1.63 to 3.84). The c-statistic was 0.72. The risk score subtracts 1 point for hematochezia, and adds 1 point for each of the other variables. Among patients with a risk score of -1, the predicted and observed risk for APON was 9% and 6%, respectively. Any score greater than -1 had a predicted and observed risk of 19.8% and higher. CONCLUSIONS An APON risk score of -1 is associated with a low risk of urgent APCT findings in patients with CD in the emergency department. Implementation of such a tool may support clinical decision-making in the ED setting.
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Hansen ML, Norling R, Lauridsen C, Fallentin E, Bæksgaard L, Kofoed KF, Svendsen LB, Nielsen MB. Computed Tomography (CT) Perfusion in Abdominal Cancer: Technical Aspects. Diagnostics (Basel) 2013; 3:261-70. [PMID: 26835679 DOI: 10.3390/diagnostics3020261] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 12/22/2022] Open
Abstract
Computed Tomography (CT) Perfusion is an evolving method to visualize perfusion in organs and tissue. With the introduction of multidetector CT scanners, it is now possible to cover up to 16 cm in one rotation, and thereby making it possible to scan entire organs such as the liver with a fixed table position. Advances in reconstruction algorithms make it possible to reduce the radiation dose for each examination to acceptable levels. Regarding abdominal imaging, CT perfusion is still considered a research tool, but several studies have proven it as a reliable non-invasive technique for assessment of vascularity. CT perfusion has also been used for tumor characterization, staging of disease, response evaluation of newer drugs targeted towards angiogenesis and as a method for early detection of recurrence after radiation and embolization. There are several software solutions available on the market today based on different perfusion algorithms. However, there is no consensus on which protocol and algorithm to use for specific organs. In this article, the authors give an introduction to CT perfusion in abdominal imaging introducing technical aspects for calculation of perfusion parameters, and considerations on patient preparation. This article also contains clinical cases to illustrate the use of CT perfusion in abdominal imaging.
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Abstract
The technique of MR elastography (MRE) has emerged as a useful modality for quantitatively imaging the mechanical properties of soft tissues in vivo. Recently, MRE has been introduced as a clinical tool for evaluating chronic liver disease, but many other potential applications are being explored. These applications include measuring tissue changes associated with diseases of the liver, breast, brain, heart, and skeletal muscle including both focal lesions (e.g., hepatic, breast, and brain tumors) and diffuse diseases (e.g., fibrosis and multiple sclerosis). The purpose of this review article is to summarize some of the recent developments of MRE and to highlight some emerging applications.
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Affiliation(s)
| | - Armando Manduca
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
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