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Yang R, Hamilton AM, Sun H, Rawji KS, Sarkar S, Mirzaei R, Pike GB, Yong VW, Dunn JF. Detecting monocyte trafficking in an animal model of glioblastoma using R 2* and quantitative susceptibility mapping. Cancer Immunol Immunother 2023; 72:733-742. [PMID: 36194288 DOI: 10.1007/s00262-022-03297-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/07/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The role of tumor-associated macrophages (TAMs) in glioblastoma (GBM) disease progression has received increasing attention. Recent advances have shown that TAMs can be re-programmed to exert a pro-inflammatory, anti-tumor effect to control GBMs. However, imaging methods capable of differentiating tumor progression from immunotherapy treatment effects have been lacking, making timely assessment of treatment response difficult. We showed that tracking monocytes using iron oxide nanoparticle (USPIO) with MRI can be a sensitive imaging method to detect therapy response directed at the innate immune system. METHODS We implanted syngeneic mouse glioma stem cells into C57/BL6 mice and treated the animals with either niacin (a stimulator of innate immunity) or vehicle. Animals were imaged using an anatomical MRI sequence, R2* mapping, and quantitative susceptibility mapping (QSM) before and after USPIO injection. RESULTS Compared to vehicles, niacin-treated animals showed significantly higher susceptibility and R2*, representing USPIO and monocyte infiltration into the tumor. We observed a significant reduction in tumor size in the niacin-treated group 7 days later. We validated our MRI results with flow cytometry and immunofluoresence, which showed that niacin decreased pro-inflammatory Ly6C high monocytes in the blood but increased CD16/32 pro-inflammatory macrophages within the tumor, consistent with migration of these pro-inflammatory innate immune cells from the blood to the tumor. CONCLUSION MRI with USPIO injection can detect therapeutic responses of innate immune stimulating agents before changes in tumor size have occurred, providing a potential complementary imaging technique to monitor cancer immunotherapies. MANUSCRIPT HIGHLIGHT We show that iron oxide nanoparticles (USPIOs) can be used to label innate immune cells and detect the trafficking of pro-inflammatory monocytes into the glioblastoma. This preceded changes in tumor size, making it a more sensitive imaging technique.
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Affiliation(s)
- Runze Yang
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A Max Hamilton
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Hongfu Sun
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia
| | - Khalil S Rawji
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Susobhan Sarkar
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Reza Mirzaei
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - G Bruce Pike
- Department of Radiology, Cumming School of Medicine, University of Calgary, N.W. Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - V Wee Yong
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Oncology, Cumming School of Medicine, Calgary, Canada
| | - Jeff F Dunn
- Department of Radiology, Cumming School of Medicine, University of Calgary, N.W. Calgary, 3330 Hospital Drive, Calgary, AB, T2N 4N1, Canada.
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
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Siedek F, Muehe AM, Theruvath AJ, Avedian R, Pribnow A, Spunt SL, Liang T, Farrell C, Daldrup-Link HE. Comparison of ferumoxytol- and gadolinium chelate-enhanced MRI for assessment of sarcomas in children and adolescents. Eur Radiol 2019; 30:1790-1803. [PMID: 31844962 DOI: 10.1007/s00330-019-06569-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/12/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We compared the value of ferumoxytol (FMX)- and gadolinium (Gd)-enhanced MRI for assessment of sarcomas in paediatric/adolescent patients and hypothesised that tumour size and morphological features can be equally well assessed with both protocols. METHODS We conducted a retrospective study of paediatric/adolescent patients with newly diagnosed bone or soft tissue sarcomas and both pre-treatment FMX- and Gd-MRI scans, which were maximal 4 weeks apart. Both protocols included T1- and T2-weighted sequences. One reader assessed tumour volumes, signal-to-noise ratios (SNR) of the primary tumour and adjacent tissues and contrast-to-noise ratios (CNR) of FMX- and Gd-MRI scans. Additionally, four readers scored FMX- and Gd-MRI scans according to 15 diagnostic parameters, using a Likert scale. The results were pooled across readers and compared between FMX- and Gd-MRI scans. Statistical methods included multivariate analyses with different models. RESULTS Twenty-two patients met inclusion criteria (16 males, 6 females; mean age 15.3 ± 5.0). Tumour volume was not significantly different on T1-LAVA (p = 0.721), T1-SE (p = 0.290) and T2-FSE (p = 0.609) sequences. Compared to Gd-MRI, FMX-MRI demonstrated significantly lower tumour SNR on T1-LAVA (p < 0.001), equal tumour SNR on T1-SE (p = 0.104) and T2-FSE (p = 0.305), significantly higher tumour-to-marrow CNR (p < 0.001) on T2-FSE as well as significantly higher tumour-to-liver (p = 0.021) and tumour-to-vessel (p = 0.003) CNR on T1-LAVA images. Peritumoural and marrow oedema enhanced significantly more on Gd-MRI compared to FMX-MRI (p < 0.001/p = 0.002, respectively). Tumour thrombi and neurovascular bundle involvement were assessed with a significantly higher confidence on FMX-MRI (both p < 0.001). CONCLUSIONS FMX-MRI provides equal assessment of the extent of bone and soft tissue sarcomas compared to Gd-MRI with improved tumour delineation and improved evaluation of neurovascular involvement and tumour thrombi. Therefore, FMX-MRI is a possible alternative to Gd-MRI for tumour staging in paediatric/adolescent sarcoma patients. KEY POINTS • Ferumoxytol can be used as an alterative to gadolinium chelates for MRI staging ofpaediatric sarcomas. • Ferumoxytol-enhanced MRI provides equal assessment of tumour size and other diagnostic parameters compared to gadolinium chelate-enhanced MRI. • Ferumoxytol-enhanced MRI provides improved delineation of sarcomas from bone marrow, liver and vessels compared to gadolinium chelate-enhanced MRI.
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Affiliation(s)
- Florian Siedek
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PedsMIPS), Stanford University, Stanford, CA, USA
- Institute of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anne M Muehe
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PedsMIPS), Stanford University, Stanford, CA, USA
| | - Ashok J Theruvath
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PedsMIPS), Stanford University, Stanford, CA, USA
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz, Mainz, Germany
| | - Raffi Avedian
- Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - Allison Pribnow
- Department of Pediatrics, Hematology and Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Sheri L Spunt
- Department of Pediatrics, Hematology and Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA
| | - Tie Liang
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PedsMIPS), Stanford University, Stanford, CA, USA
| | - Crystal Farrell
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PedsMIPS), Stanford University, Stanford, CA, USA
| | - Heike E Daldrup-Link
- Department of Radiology, Pediatric Molecular Imaging Program at Stanford (PedsMIPS), Stanford University, Stanford, CA, USA.
- Department of Pediatrics, Hematology and Oncology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA, USA.
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Yang R, Sarkar S, Korchinski DJ, Wu Y, Yong VW, Dunn JF. MRI monitoring of monocytes to detect immune stimulating treatment response in brain tumor. Neuro Oncol 2017; 19:364-371. [PMID: 27571884 DOI: 10.1093/neuonc/now180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 07/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background Glioblastoma (GBM) is an aggressive brain cancer with a poor prognosis. The use of immune therapies to treat GBM has become a promising avenue of research. It was shown that amphotericin B (Amp B) can stimulate the innate immune system and suppress the growth of brain tumor initiating cells (BTICs). However, it is not feasible to use histopathology to determine immune activation in patients. We developed an MRI technique that can rapidly detect a therapeutic response in animals treated with drugs that stimulate innate immunity. Ultra-small iron oxide nanoparticles (USPIOs) are MRI contrast agents that have been widely used for cell tracking. We hypothesized that the increased monocyte infiltration into brain tumors due to Amp B can be detected using USPIO-MRI, providing an indicator of early drug response. Methods We implanted human BTICs into severe combined immunodeficient mice and allowed the tumor to establish before treating the animals with either Amp B or vehicle and then imaged them using MRI with USPIO (ferumoxytol) contrast. Results After 7 days of treatment, there was a significantly decreased T2* in the tumor of Amp B but not vehicle animals, suggesting that USPIO is carried into the tumor by monocytes. We validated our MRI results with histopathology and confirmed that Amp B-treated animals had significantly higher levels of macrophage/microglia that were colocalized with iron staining in their brain tumor compared with vehicle mice. Conclusion USPIO-MRI is a promising method of rapidly assessing the efficacy of anticancer drugs that stimulate innate immunity.
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Affiliation(s)
- Runze Yang
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Susobhan Sarkar
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J Korchinski
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Ying Wu
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - V Wee Yong
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jeff F Dunn
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Maurea S, Mainenti PP, Tambasco A, Imbriaco M, Mollica C, Laccetti E, Camera L, Liuzzi R, Salvatore M. Diagnostic accuracy of MR imaging to identify and characterize focal liver lesions: comparison between gadolinium and superparamagnetic iron oxide contrast media. Quant Imaging Med Surg 2014; 4:181-9. [PMID: 24914419 DOI: 10.3978/j.issn.2223-4292.2014.01.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/14/2014] [Indexed: 12/24/2022]
Abstract
To compare the diagnostic value of gadolinium (Gd) and ultrasmall superparamagnetic iron oxide (SPIO) contrast media for characterization of focal liver lesions (FLL), we retrospectively evaluated the results of magnetic resonance (MR) imaging in 68 patients (40 M, 28 F, age from 22 to 81 yrs) of which 36 with diagnosis of colo-rectal cancer, 26 with hepatic cirrhosis and 6 with incidental imaging detection of FLL. MR (Gyroscan Intera 1.5 T, Philips Medical Systems) study was performed using T1 and T2 fast-field-echo (FFE) and T2 turbo-spin-echo (TSE) sequences in axial and coronal views. Dynamic multi-phases gadolinium Gd-enhanced T1-FFE-Bh images were obtained in arterial, portal and equilibrium phases, followed by SPIO-enhanced T2-FFE scans. A qualitative analysis of pre- and post-contrast MR images to classify FLL as benign or malignant was performed using a 3-point scoring system: 0= benign; 1= suspicious for malignancy; 2= malignant. A total of 118 lesions were evaluated. In particular, histology (n=18), cytology (n=14) or clinical-imaging follow-up data (n=86) demonstrated 4 adenomas, 29 cysts, 3 focal steatosis, 25 hemangiomas, 1 focal vascular abnormality, 5 fibrotic lesions as well as 13 regenerative nodules, 6 dysplastic, 14 hepatocellular carcinomas (HCC), 17 metastasis and 1 cholangiocarcinoma. For MR imaging, diagnostic accuracy, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values of Gd vs. SPIO images were respectively 83% vs. 92%, 79% vs. 74%, 85% vs. 99% (P=0.002), 68% vs. 96% (P=0.005) and 91% vs. 90%, respectively. The results suggest that SPIO-MR provides a diagnostic incremental value, as specificity and PPV, particularly to characterize FLL compared to Gd-MR; thus, we strongly recommend the use of SPIO when liver lesion characterization is requested and Gd images are uncertain.
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Affiliation(s)
- Simone Maurea
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Pier Paolo Mainenti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Annamaria Tambasco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Massimo Imbriaco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Carmine Mollica
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Ettore Laccetti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Luigi Camera
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Raffaele Liuzzi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
| | - Marco Salvatore
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II (UNINA), Istituto di Biostrutture e Bioimmagini-Consiglio Nazionale delle Ricerche (IBB-CNR); Fondazione SDN (IRCCS), Napoli, Italy
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Chan VO, Das JP, Gerstenmaier JF, Geoghegan J, Gibney RG, Collins CD, Skehan SJ, Malone DE. Diagnostic performance of MDCT, PET/CT and gadoxetic acid (Primovist®)-enhanced MRI in patients with colorectal liver metastases being considered for hepatic resection: initial experience in a single centre. Ir J Med Sci 2012; 181:499-509. [DOI: 10.1007/s11845-012-0805-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 02/02/2012] [Indexed: 01/11/2023]
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Hong HS, Byun JH, Won HJ, Kim KW, Lee SS, Lee MG, Yun SC. Characterization of liver metastases: the efficacy of biphasic magnetic resonance imaging with ferucarbotran-enhancement. Clin Radiol 2010; 65:701-7. [PMID: 20696297 DOI: 10.1016/j.crad.2010.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 04/19/2010] [Accepted: 04/25/2010] [Indexed: 11/26/2022]
Abstract
AIM To retrospectively evaluate the efficacy of biphasic magnetic resonance imaging (MRI) of the liver with ferucarbotran-enhancement for the characterization of hepatic metastases. MATERIALS AND METHODS Thirty-six patients underwent MRI of the liver with separate acquisition of double-contrast enhancement consisting of gadolinium and ferucarbotran. A total of 106 focal hepatic lesions (51 metastases, 31 cysts, 23 haemangiomas, and one eosinophilic abscess) were included. Two sets of MRI were analysed: (1) ferucarbotran set: ferucarbotran-enhanced T1-weighted (T1W) dynamic imaging combined with ferucarbotran-enhanced T2*-weighted (T2*W) delayed imaging and (2) double set: gadolinium-enhanced T1W dynamic imaging combined with ferucarbotran-enhanced T2*W delayed imaging. The diagnostic accuracy of the two sets was evaluated using alternative free-response receiver operating characteristic curve analysis. Sensitivity and specificity were compared using the McNemar test. The enhancement pattern of focal hepatic lesions was analysed on gadolinium and ferucarbotran-enhanced T1W dynamic imaging. RESULTS There was no significant difference in the accuracy of characterizing hepatic metastases between the two sets. Sensitivity and specificity were not significantly different between the sets (p>0.05). Peripheral rim enhancement was exhibited in 57% of metastatic lesions on ferucarbotran-enhanced T1W dynamic imaging. The majority (96%) of hepatic haemangiomas demonstrated typical peripheral nodular enhancement with progression on ferucarbotran-enhanced T1W dynamic imaging and were easily differentiated from metastases. CONCLUSION Biphasic MRI of the liver with ferucarbotran-enhancement alone provided comparable diagnostic efficacy to double-contrast MRI for the characterization of hepatic metastases.
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Affiliation(s)
- H S Hong
- Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
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Mantatzis M, Kakolyris S, Amarantidis K, Karayiannakis A, Prassopoulos P. Treatment response classification of liver metastatic disease evaluated on imaging. Are RECIST unidimensional measurements accurate? Eur Radiol 2009; 19:1809-16. [PMID: 19238395 DOI: 10.1007/s00330-009-1327-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 12/07/2008] [Accepted: 01/05/2009] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate the accuracy of unidimensional measurements (response evaluation criteria in solid tumors, RECIST) compared with volumetric measurements in patients with liver metastases undergoing chemotherapy. Forty-four patients with newly diagnosed liver lesions underwent three MRI examinations at treatment initiation, during chemotherapy, and immediately post-treatment. Measurements based on RECIST guidelines and volume calculations were performed on the "target" lesions (TLs). The two methods were in agreement in 64/77 of patients and 253/301 of individual lesions classification in response categories ("good" agreement, Cohen kappa = 0.735 and 0.741, respectively). In 16.88% of the comparisons the two methods stratified patients to a different response category; 27.6% of TLs did not follow the response category of the patient in whom lesions were located. The actual volume of TLs differs from the calculated volume of a sphere with the same diameter. Our study supports the use of volumetric techniques that may overcome certain disadvantages of unidimensional measurements.
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Affiliation(s)
- Michael Mantatzis
- Department of Radiology, University Hospital of Alexandroupolis, Opsikiou 1, 681 00, Alexandroupolis, Greece.
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Guiu B, Loffroy R, Ben Salem D, Lepage C, Guiu S, Aho S, Jouve JL, Krausé D, Cercueil JP. Combined SPIO-gadolinium magnetic resonance imaging in cirrhotic patients: negative predictive value and role in screening for hepatocellular carcinoma. ACTA ACUST UNITED AC 2008; 33:520-8. [PMID: 17912584 DOI: 10.1007/s00261-007-9327-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The objective of our study was to assess the negative predictive value (NPV) of double-contrast MRI (DC-MRI) with SPIO and gadolinium, and to determine the role of DC-MRI in screening for hepatocellular carcinoma (HCC) in cirrhotic patients. METHODS We retrospectively included 160 DC-MRI scans done as second-line investigations in 119 patients with cirrhosis over a 25-month period. Two radiologists independently classified the MRI scans as strongly suggesting HCC (HCC Group), showing benign nodules (benign nodules Group), showing no nodules (no-nodules Group) or indeterminate; they assigned a diagnostic confidence score (DCS) using a 0-10 scale. The reference standard was histology or results of follow-up investigations. Mean follow-up was 16.9 months (12-28 months). RESULTS The radiologists disagreed for two scans (kappa = 0.98). Of 112 scans [benign nodules Group (n = 32) and no-nodules Group (n = 80)], 11 were excluded (3 patients lost to follow-up and 8 who died with no known cancer) while a HCC was detected during follow-up in 8 patients, yielding a NPV of 92% (93/101) (95% confidence interval, 85%-97%). The DCS was in the 4-6 range (indicating uncertainty) for only 6 (3.75%) scans. CONCLUSIONS DC-MRI is reliable and reproducible. Its high NPV suggests a role as a second-line investigation after ultrasonography, for HCC screening.
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Affiliation(s)
- Boris Guiu
- Radiology Departement, CHU le Bocage, University Hospital of Dijon, Boulevard Maréchal de Lattre de Tassigny, Dijon, 21000, France.
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Terkivatan T, van den Bos IC, Hussain SM, Wielopolski PA, de Man RA, IJzermans JNM. Focal nodular hyperplasia: lesion characteristics on state-of-the-art MRI including dynamic gadolinium-enhanced and superparamagnetic iron-oxide-uptake sequences in a prospective study. J Magn Reson Imaging 2007; 24:864-72. [PMID: 16947339 DOI: 10.1002/jmri.20705] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To image a cohort of patients with pathology-proven focal nodular hyperplasia (FNH) to assess which characteristics of state-of-the-art magnetic resonance imaging (MRI) of the liver are the most useful for improving the detection and characterization of FNH. MATERIALS AND METHODS In 14 patients, pathology-proven FNH (N=33) were prospectively examined using gadolinium (Gd) and superparamagnetic iron-oxide (SPIO) contrast media. All lesions were evaluated for signal intensity (SI), fatty infiltration, central scar, mode of enhancement with Gd, and uptake of SPIO. The percentage of dynamic contrast enhancement in the arterial, portal, and delayed phases was assessed. The contrast-to-noise ratio (CNR) before and after administration of SPIO contrast was calculated. RESULTS The SI of the lesions was low to isointense on T1-weighted (T1W) images, and intermediate to isointense on T2W images. Fatty infiltration of the lesions was present in 6%. The percentages of enhancement in the liver and lesion were 110%, 115%, and 95%, and 151%, 182%, and 160%, respectively (P<0.0001). All lesions showed uptake of SPIO with improved conspicuity of the central scar and septa. The CNR values precontrast and post-Gd/SPIO were significantly different for T1 in- and opposed-phase and black-blood echo-planar imaging (BBEPI). CONCLUSION Combining dynamic Gd-enhanced imaging with T1W and T2W sequences after administration of SPIO facilitates comprehensive evaluation of FNH.
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Affiliation(s)
- Türkan Terkivatan
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Savranoglu P, Obuz F, Karasu S, Coker A, Secil M, Sagol O, Igci E, Dicle O, Astarcioglu I. The role of SPIO-enhanced MRI in the detection of malignant liver lesions. Clin Imaging 2007; 30:377-81. [PMID: 17101405 DOI: 10.1016/j.clinimag.2006.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 06/02/2006] [Indexed: 01/09/2023]
Abstract
The aim of this study was to evaluate the efficacy of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance imaging (MRI) in the detection of malignant liver tumors. MRI, using fast spin-echo T(2)-weighted and gradient-echo T(1)-weighted imagings before and after SPIO infusion, was performed in 32 patients with known or suspected hepatic lesions. Statistical analysis was performed using lesion-by-lesion analysis. SPIO-enhanced T(2)-weighted MRI showed results comparable to those of unenhanced T(2)-weighted MRI in the detection of focal liver lesions.
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Affiliation(s)
- Pelin Savranoglu
- Department of Radiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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Abstract
It is well established that hepatic resection improves the long-term prognosis of many patients with liver metastases. However, incomplete resection does not prolong survival, so knowledge of the exact extent of intra-hepatic disease is crucially important in determining patient management and outcome. MR imaging is well recognised as one of the most sensitive methods for detecting metastases. Recent developments in gradient coil design, the use of body phased array coils and the availability of novel MR contrast agents have resulted in MR being recognised as the pre-operative standard in this group of patients. However, diagnostic efficacy is extremely dependent on the choice and optimisation of pulse sequences and the appropriate use of MR contrast agents. This article reviews current MR imaging techniques for the detection and characterisation of metastases and discusses the relative capability of different techniques for detecting small lesions.
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Affiliation(s)
- J Ward
- Department of Clinical Radiology, St James's University Hospital, Leeds, UK.
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Schnorr J, Wagner S, Abramjuk C, Drees R, Schink T, Schellenberger EA, Pilgrimm H, Hamm B, Taupitz M. Focal liver lesions: SPIO-, gadolinium-, and ferucarbotran-enhanced dynamic T1-weighted and delayed T2-weighted MR imaging in rabbits. Radiology 2006; 240:90-100. [PMID: 16684917 DOI: 10.1148/radiol.2393040884] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To compare a superparamagnetic iron oxide (SPIO), VSOP-C184, with a gadopentetate dimeglumine with regard to signal-enhancing effects on T1-weighted dynamic magnetic resonance (MR) images and with another SPIO contrast medium with regard to signal-reducing effects on delayed T2-weighted MR images. MATERIALS AND METHODS All experiments were approved by the responsible Animal Care Committee. Twenty rabbits (five for each contrast agent and dose) implanted with VX-2 carcinoma were imaged at 1.5 T. VSOP-C184 at 0.015 and 0.025 mmol Fe/kg was compared with gadopentetate dimeglumine at 0.15 mmol Gd/kg and ferucarbotran at 0.015 mmol Fe/kg. The imaging protocol comprised a T1-weighted dynamic gradient-echo (GRE) MR before injection and at 6-second intervals for up to 42 seconds after injection and a T2-weighted turbo spin-echo MR before and 5 minutes after injection. Images were evaluated quantitatively, and contrast media were compared by using nonparametric analysis of variance. RESULTS At dynamic T1-weighted GRE MR imaging with 0.015-mmol Fe/kg VSOP-C184, 0.025-mmol Fe/kg VSOP-C184, gadopentetate dimeglumine, and ferucarbotran, the median peak contrast-to-noise ratio (CNR) was 20.7 (25th percentile, 16.3; 75th percentile, 22.6), 24.2 (25th percentile, 19.3; 75th percentile, 28.5), 16.4 (25th percentile, 13.7; 75th percentile, 20.3), and 14.0 (25th percentile, 11.4; 75th percentile, 16.8), respectively. Both doses of VSOP-C184 yielded significantly higher CNR (P < .05) than the other two agents. At T2-weighted turbo spin-echo imaging with 0.015-mmol Fe/kg VSOP-C184, 0.025-mmol Fe/kg VSOP-C184, gadopentetate dimeglumine, and ferucarbotran, the median CNR was 15.0 (25th percentile, 13.4; 75th percentile, 21.3), 15.7 (25th percentile, 14.5; 75th percentile, 19.8), 11.3 (25th percentile, 8.2; 75th percentile, 12.2), and 15.7 (25th percentile, 12.5; 75th percentile, 22.4), respectively. There was no significant difference between VSOP-C184 and ferucarbotran; both had a significantly higher CNR than did gadopentetate dimeglumine. CONCLUSION VSOP-C184 produces higher liver-to-tumor contrast at dynamic T1-weighted imaging than does gadopentetate dimeglumine; at delayed T2-weighted imaging, the contrast is comparable to that achieved with ferucarbotran.
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Affiliation(s)
- Jörg Schnorr
- Department of Radiology, Charité-Universitätsmedizin Berlin, Schumannstrasse 20/21, 10098 Berlin, Germany.
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Wersebe A, Wiskirchen J, Decker U, Schick F, Dietz K, Müller-Schimpfle M, Claussen CD, Pereira PL. Comparison of Gadolinium-BOPTA and Ferucarbotran-Enhanced Three-Dimensional T1-Weighted Dynamic Liver Magnetic Resonance Imaging in the Same Patient. Invest Radiol 2006; 41:264-71. [PMID: 16481909 DOI: 10.1097/01.rli.0000188359.72928.0f] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES We sought to compare signal changes using Ferucarbotran and gadobenate dimeglumine (Gd-BOPTA) in dynamic 3D T1-weighted (T1w) GRE imaging of the liver. MATERIAL AND METHODS Thirty patients were prospectively included in the study. All patients underwent 2 high-field magnetic resonance (MR) examinations: first with Gd-BOPTA (Gd) and then after a mean interval of 4 days with ferucarbotran (Feru). Dynamic MRI was obtained with a 3D T1w GRE sequence (TR 6.33, TE 2.31, flip angle 20 degrees ). Contrast enhanced scans were assessed before intravenous injection of the contrast agent (precontrast), and postcontrast during the arterial phase (30 seconds), portal venous phase (60 seconds), and equilibrium phase (120 seconds). The signal intensities (SIs) of liver, spleen, aorta, and portal vein were defined by region of interest measurements. Signal intensity changes (SICs) and percentage signal intensity change (PSIC) were calculated using the formulas SIC=(SI pre - SI post)/SI pre and PSIC=SIC x 100%. RESULTS Positive signal enhancement was observed after intravenous injection of Feru during all dynamic measurements, whereas the mean SI values were lower compared with Gd. During the portal venous phase the mean SI of Gd was up to a factor of 2.1 higher (portal vein). The widest difference of SIC was observed during the equilibrium phase for liver parenchyma (Gd, 1.03; Feru, 0.24). The dynamic signal courses were similar for liver, portal vein and aorta. Different signal courses were obtained for the spleen. CONCLUSIONS Feru-enhanced T1w dynamic images demonstrated significant signal increases for liver, vessels, and spleen but overall lower signal intensities than Gd-BOPTA. The dynamic signal courses of ferucarbotran were similar to that of Gd-BOPTA during ll perfusion phases except in the spleen. Thus, it may be possible to detect typical enhancement pattern of focal liver lesions with Feru-enhanced dynamic T1w MRI.
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Affiliation(s)
- Annika Wersebe
- Department of Diagnostic Radiology, University Hospital Tübingen, Germany.
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Kim YK, Ko SW, Hwang SB, Kim CS, Yu HC. Detection and characterization of liver metastases: 16-slice multidetector computed tomography versus superparamagnetic iron oxide-enhanced magnetic resonance imaging. Eur Radiol 2006; 16:1337-45. [PMID: 16453115 DOI: 10.1007/s00330-005-0140-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 11/17/2005] [Accepted: 12/16/2005] [Indexed: 12/24/2022]
Abstract
The aim of our study was to compare the diagnostic performance of 16--slice multidetector computed tomography with that of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging in the detection of small hepatic metastases and in the differentiation of hepatic metastases from cysts. Twenty-three patients with 55 liver metastases and 14 liver cysts underwent SPIO-enhanced MR imaging and multiphasic CT using 16-MDCT. Two observers independently analyzed each image, in random order. Sensitivity and diagnostic accuracy for lesion detection and differentiation as metastases or cysts for MDCT and SPIO-enhanced MR imaging were calculated using receiver operating characteristic analysis. For all observers, the Az values of SPIO-enhanced MR imaging for lesion detection and differentiation of liver metastases from cysts (mean 0.955, 0.999) were higher than those of MDCT (mean 0.925, 0.982), but not statistically significantly so (P > 0.05). Sensitivity of SPIO-enhanced MR imaging with regard to the detection of liver metastases (mean 94.5%) was significantly higher than that of MDCT (mean 80.0%) (P < 0.05). SPIO-enhanced MR imaging and 16-MDCT showed similar diagnostic accuracies for detection and differentiation of liver metastases from cysts, but sensitivity of SPIO-enhanced imaging in the detection of liver metastases was superior to that of 16-MDCT.
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Affiliation(s)
- Young Kon Kim
- Department of Diagnostic Radiology, Chonbuk National University Hospital and Medical School, Keum Am Dong, Jeon Ju, South Korea.
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Tanimoto A, Kuribayashi S. Application of superparamagnetic iron oxide to imaging of hepatocellular carcinoma. Eur J Radiol 2006; 58:200-16. [PMID: 16414230 DOI: 10.1016/j.ejrad.2005.11.040] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 11/25/2005] [Accepted: 11/29/2005] [Indexed: 11/24/2022]
Abstract
Superparamagnetic iron oxide (SPIO) particles are as MR contrast media composed of iron oxide crystals coated with dextran or carboxydextran. These particles are sequestered by phagocytic Kupffer cells in normal reticuloendothelial system (RES), but are not retained in tumor tissue. Consequently, there are significant differences in T2/T2* relaxation between normal RES tissue and tumors, which result in increased lesion conspicuity and detectability. The introduction of SPIO has been expected to substantially increase the detectability of hepatic metastases. For focal hepatocellular lesions, it has been documented that SPIO-enhanced MR imaging exhibits slightly better diagnostic performance than dynamic helical CT in the detection of hypervascular hepatocellular carcinoma (HCC). A combination of dynamic and static MR imaging technique using T1- and T2 imaging criteria appears to provide clinically more useful patterns of enhancement. SPIO-enhanced MR imaging also provides information useful for differential diagnosis, via enhancement of RES-containing tumors. With the exploitation of rapid T2*-sensitive sequences, SPIO-enhanced dynamic MR imaging may become comparable to gadolinium-enhanced dynamic MR imaging and dynamic studies with multidetector-row CT. SPIO-enhanced MR imaging plays an important role in therapeutic decision-making for patients with HCC.
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Affiliation(s)
- Akihiro Tanimoto
- Department of Diagnostic Radiology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
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Ward J, Robinson PJ, Guthrie JA, Downing S, Wilson D, Lodge JPA, Prasad KR, Toogood GJ, Wyatt JI. Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology 2005; 237:170-80. [PMID: 16126930 DOI: 10.1148/radiol.2371041444] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To prospectively compare accuracy of dynamic contrast material-enhanced thin-section multi-detector row helical computed tomography (CT), high-spatial-resolution three-dimensional (3D) dynamic gadolinium-enhanced magnetic resonance (MR) imaging, and superparamagnetic iron oxide (SPIO)-enhanced MR imaging with optimized gradient-echo (GRE) sequence for depiction of hepatic lesions; surgery and histologic analysis were the reference standard. MATERIALS AND METHODS Local ethics committee approval was granted, and written informed consent was obtained. Fifty-eight patients (45 men, 13 women; age range, 47-82 years) with hepatic metastases were imaged with multi-detector row CT (3.2-mm section thickness), 3D dynamic gadolinium-enhanced MR imaging (2.5-mm effective section thickness), and SPIO-enhanced MR by using an optimized T2-weighted GRE sequence. Images were reviewed independently by two blinded observers who identified and localized lesions with a four-point confidence scale. Accuracy of each technique was measured with alternative free-response receiver operating characteristic analysis. Results were correlated with findings at surgery with intraoperative ultrasonography or histopathologic examination. Statistical differences among techniques for each observer were measured. RESULTS Accuracy values for each observer for all metastases (n = 215) and 1.0-cm or smaller metastases (n = 80), respectively, follow: For CT, those for reader 1 were 0.82 and 0.65; for reader 2, 0.81 and 0.68. For gadolinium-enhanced MR imaging, those for reader 1 were 0.92 and 0.79; for reader 2, 0.90 and 0.76. For SPIO-enhanced MR imaging, those for reader 1 were 0.92 and 0.83; for reader 2, 0.92 and 0.81. For all metastases for both observers, there was no significant difference between MR techniques, but both were significantly more accurate than CT (P < .01). For metastases 1.0 cm or smaller and one observer, there was no significant difference between MR techniques, but both were more accurate than CT (P < .01); for the other observer, SPIO-enhanced MR imaging was more accurate than gadolinium-enhanced MR imaging (P < .05) and CT (P < .02), but there was no significant difference between gadolinium-enhanced MR imaging and CT (P = .2). CONCLUSION Accuracy for gadolinium-enhanced MR imaging and SPIO-enhanced MR imaging was similar. Both techniques were significantly more accurate than CT.
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Affiliation(s)
- Janice Ward
- MRI Department, Clinical Radiology, St James's University Hospital, Beckett Street, Leeds LS9 7TF, England.
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Tanimoto A, Wakabayashi G, Shinmoto H, Okuda S, Kuribayashi S, Mukai M. The mechanism of ring enhancement in hepatocellular carcinoma on superparamagnetic iron oxide-enhanced T1-weighted images: an investigation into peritumoral Kupffer cells. J Magn Reson Imaging 2005; 21:230-6. [PMID: 15723373 DOI: 10.1002/jmri.20263] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the mechanism of ring enhancement on ferumoxides-enhanced T1-weighted (T1W) gradient echo images in malignant focal hepatic lesions. MATERIALS AND METHODS Eighteen patients with hepatocellular carcinoma (HCC) underwent breath-hold T1-, T2-, and T2*-weighted magnetic resonance (MR) images at 1.5-Tesla after ferumoxides administration. The existence of ring enhancement on T1W, and the maximum size of the area showing decreased phagocytic activity on T2W and T2*W, and that of the area showing ring enhancement on T1W were evaluated. The Kupffer cell (KC) density of HCC itself and peritumoral liver parenchyma was assessed with KC stain sections. RESULTS Ring enhancement was noted in 13 of 18 HCC (72%). Peritumoral KC density was increased in the ring enhancement (+) group as compared with the ring enhancement (-) group. In the ring enhancement (+) group, the tumor size measured on T2W was smaller than that measured on either T1W or T2*W, suggesting a sustained T1 relaxation effect and a decreased T2* relaxation effect in the peritumoral regions. CONCLUSION Ring enhancement on superparamagnetic iron oxide (SPIO)-enhanced T1W may correlate with increased KC density and decreased SPIO clustering in KC in peritumoral regions.
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Affiliation(s)
- Akihiro Tanimoto
- Department of Diagnostic Radiology, School of Medicine, Keio University, Tokyo, Japan.
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Abstract
This review focuses on the clinical impact of different modalities to image primary and secondary malignant biliary obstruction. The detection and staging of cancers of the pancreatic and biliary tract are best accomplished with endoscopic ultrasound, contrast-enhanced computed tomography, and magnetic resonance cholangiopancreatography. Three-dimensional ultrasound is a new noninvasive method that may be used increasingly as an initial test to select patients who require further diagnostic evaluation by magnetic resonance cholangiopancreatography or therapeutic endoscopic retrograde cholangiopancreatography. All-in-one computed tomography including three-dimensional reconstructions of the biliary tree may be competitive against all-in-one magnetic resonance imaging for diagnosis and staging of pancreatic tumors. Magnetic resonance cholangiopancreatography is excellent for identifying the presence and the level of biliary obstruction. With newer diagnostic imaging technologies emerging, endoscopic retrograde cholangiopancreatography is evolving into a predominantly therapeutic procedure.
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Affiliation(s)
- C Stroszczynski
- Radiology Charité Campus Virchow, Medical Faculty, Humboldt University, Augustenburger Platz 1, 13353 Berlin, Germany.
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