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Yang T, Wei H, Chen J, Jiang H, Chen Y, Song B. The value of contrast-enhanced magnetic resonance imaging for diagnosis of extrahepatic cholangiocarcinoma. Heliyon 2024; 10:e23448. [PMID: 38169769 PMCID: PMC10758830 DOI: 10.1016/j.heliyon.2023.e23448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Rationale and objectives To establish a diagnostic model based on contrast-enhanced magnetic resonance imaging (MRI) and clinical characteristics for diagnosing extrahepatic cholangiocarcinoma (eCCA). Materials and methods From April 2014 to September 2021, consecutive patients with extrahepatic bile duct lesions who underwent contrast-enhanced MRI within 1 month before pathological examination were retrospectively enrolled. Two radiologists blinded to clinicopathological information independently evaluated MR images. Univariable and multivariable logistic regression analyses were performed to identify significant clinicoradiological features associated with eCCA, which were subsequently incorporated into a diagnostic model. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve. Results A total of 182 patients (mean age, 60.8 ± 10.0 years, 117 men) were included, 144 (79 %) of whom had pathologically confirmed eCCA. Diffusion restriction (odds ratio [OR], 8.32; 95 % confidence interval [CI]: 2.88, 25.82; P < 0.001), indistinct outer margin (OR, 4.01; 95 % CI: 1.40, 11.84; P = 0.010), cholelithiasis (OR, 0.34; 95 % CI: 0.12, 1.00; P = 0.049), serum ln(carbohydrate antigen 125) (OR, 4.95; 95 % CI: 1.61, 18.55; P = 0.010), and serum ln(direct bilirubin) (OR, 1.82; 95 % CI: 1.29, 2.63; P < 0.001) were independently associated with eCCA. Incorporating the above 5 variables, a diagnostic model achieved an AUC of 0.912 (95 % CI: 0.859, 0.965), with well-fitted calibration curve (P = 0.815) and good clinical utility. Additionally, the sensitivity, specificity and accuracy of the model were 83.33 %, 86.84 %, and 84.07 %, respectively. Conclusion The proposed model integrating two MRI features (i.e., indistinct outer margin and diffusion restriction) and three clinical characteristics (i.e., cholelithiasis, lnCA125 and lnDBIL) enabled accurate diagnosis of eCCA. This tool holds the potential to facilitate an early diagnosis and thereby allow timely treatment interventions and improved clinical outcomes for patients with eCCA.
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Affiliation(s)
- Ting Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yidi Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China
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Rushbrook SM, Kendall TJ, Zen Y, Albazaz R, Manoharan P, Pereira SP, Sturgess R, Davidson BR, Malik HZ, Manas D, Heaton N, Prasad KR, Bridgewater J, Valle JW, Goody R, Hawkins M, Prentice W, Morement H, Walmsley M, Khan SA. British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma. Gut 2023; 73:16-46. [PMID: 37770126 PMCID: PMC10715509 DOI: 10.1136/gutjnl-2023-330029] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. The guideline writing committee included a multidisciplinary team of experts from various specialties involved in the management of CCA, as well as patient/public representatives from AMMF (the Cholangiocarcinoma Charity) and PSC Support. Quality of evidence is presented using the Appraisal of Guidelines for Research and Evaluation (AGREE II) format. The recommendations arising are to be used as guidance rather than as a strict protocol-based reference, as the management of patients with CCA is often complex and always requires individual patient-centred considerations.
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Affiliation(s)
- Simon M Rushbrook
- Department of Hepatology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Timothy James Kendall
- Division of Pathology, University of Edinburgh, Edinburgh, UK
- University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | - Yoh Zen
- Department of Pathology, King's College London, London, UK
| | - Raneem Albazaz
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Richard Sturgess
- Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Brian R Davidson
- Department of Surgery, Royal Free Campus, UCL Medical School, London, UK
| | - Hassan Z Malik
- Department of Surgery, University Hospital Aintree, Liverpool, UK
| | - Derek Manas
- Department of Surgery, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Nigel Heaton
- Department of Hepatobiliary and Pancreatic Surgery, King's College London, London, UK
| | - K Raj Prasad
- John Goligher Colorectal Unit, St. James University Hospital, Leeds, UK
| | - John Bridgewater
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust/University of Manchester, Manchester, UK
| | - Rebecca Goody
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Maria Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Wendy Prentice
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Shahid A Khan
- Hepatology and Gastroenterology Section, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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3
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Yang C, Zhou Q, Li M, Xu L, Zeng Y, Liu J, Wei Y, Shi F, Chen J, Li P, Shu Y, Yang L, Shu J. MRI-based automatic identification and segmentation of extrahepatic cholangiocarcinoma using deep learning network. BMC Cancer 2023; 23:1089. [PMID: 37950207 PMCID: PMC10636947 DOI: 10.1186/s12885-023-11575-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Accurate identification of extrahepatic cholangiocarcinoma (ECC) from an image is challenging because of the small size and complex background structure. Therefore, considering the limitation of manual delineation, it's necessary to develop automated identification and segmentation methods for ECC. The aim of this study was to develop a deep learning approach for automatic identification and segmentation of ECC using MRI. METHODS We recruited 137 ECC patients from our hospital as the main dataset (C1) and an additional 40 patients from other hospitals as the external validation set (C2). All patients underwent axial T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), and diffusion-weighted imaging (DWI). Manual delineations were performed and served as the ground truth. Next, we used 3D VB-Net to establish single-mode automatic identification and segmentation models based on T1WI (model 1), T2WI (model 2), and DWI (model 3) in the training cohort (80% of C1), and compared them with the combined model (model 4). Subsequently, the generalization capability of the best models was evaluated using the testing set (20% of C1) and the external validation set (C2). Finally, the performance of the developed models was further evaluated. RESULTS Model 3 showed the best identification performance in the training, testing, and external validation cohorts with success rates of 0.980, 0.786, and 0.725, respectively. Furthermore, model 3 yielded an average Dice similarity coefficient (DSC) of 0.922, 0.495, and 0.466 to segment ECC automatically in the training, testing, and external validation cohorts, respectively. CONCLUSION The DWI-based model performed better in automatically identifying and segmenting ECC compared to T1WI and T2WI, which may guide clinical decisions and help determine prognosis.
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Affiliation(s)
- Chunmei Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Qin Zhou
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Mingdong Li
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Lulu Xu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Yanyan Zeng
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Jiong Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Ying Wei
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Jing Chen
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Pinxiong Li
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Yue Shu
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Lu Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, 646000, China.
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4
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Factors influencing apparent diffusion coefficient value in extrahepatic cholangiocarcinoma: A retrospective study. Eur J Radiol 2022; 157:110603. [DOI: 10.1016/j.ejrad.2022.110603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022]
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Endoscopic Evaluation and Management of Cholangiocarcinoma. Gastroenterol Clin North Am 2022; 51:519-535. [PMID: 36153108 DOI: 10.1016/j.gtc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Cholangiocarcinoma is a rare malignancy of the biliary tract with a relatively poor prognosis. As a gastroenterologist, our main role is to differentiate between benign and malignant biliary disease, help achieve a diagnosis, and palliate jaundice related to biliary obstruction. This article focuses on summarizing the various tools currently available for endoscopic evaluation and management of cholangiocarcinoma.
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Xing LH, Zhuo LY, Wang JN, Zhang Y, Zhu FY, Wang C, Yin XP, Gao BL. Values of MRI Imaging Presentations in the Hepatobiliary Phase, DWI and T2WI Sequences in Predicting Pathological Grades of Intrahepatic Mass-Forming Cholangiocarcinoma. Front Oncol 2022; 12:867702. [PMID: 35747789 PMCID: PMC9209728 DOI: 10.3389/fonc.2022.867702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/18/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To retrospectively investigate the value of various MRI image menifestations in the hepatobiliary phase (HBP), DWI and T2WI sequences in predicting the pathological grades of intrahepatic mass-forming cholangiocarcinoma (IMCC). Materials and Methods Forty-three patients of IMCCs confirmed by pathology were enrolled including 25 cases in well- or moderately-differentiated group and 18 cases in poorly-differentiated group. All patients underwent DWI, T2WI and HBP scan. The Chi square test was used to compare the differences in the general information. Logistic regression analysis was used to analyze the risk factors in predicting the pathological grade of IMCCs. Results The maximal diameter of the IMCC lesion was < 3 cm in 11 patients, between 3 cm and 6 cm in 15, and > 6 cm in 17. Sixteen cases had intrahepatic metastasis, including 5 in the well- or moderately-differentiated group and 11 in the poorly-differentiated group. Seventeen (39.5%) patients presented with target signs in the DWI sequence, including 9 in the well- or moderately-differentiated group and 8 in the poorly-differentiated group. Twenty (46.5%) patients presented with target signs in the T2WI sequence, including 8 in the well- or moderately-differentiated group and 12 in the poorly-differentiated group. Nineteen cases (54.3%) had a complete hypointense signal ring, including 13 in the well- or moderately-differentiated group and 6 in the poorly-differentiated group. Sixteen (45.7%) cases had an incomplete hypointense signal ring, including 5 in the well- or moderately-differentiated group and 11 in the poorly-differentiated group. The lesion size, intrahepatic metastasis, T2WI signal, and integrity of a hypointense signal ring in HBP were statistically significantly different between two gourps. T2WI signal, presence or non-presence of intrahepatic metastasis, and integrity of hypointense signal ring were the independent influencing factors for pathological grade of IMCC. Conclusion Target sign in T2WI sequence, presence of intrahepatic metastasis and an incomplete hypointense-signal ring in HBP are more likely to be present in poorly-differentiated IMCCs.
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Affiliation(s)
- Li-Hong Xing
- Affiliated Hospital of Hebei University/ School of Clinical Medicine of Hebei University, Baoding, China
| | - Li-Yong Zhuo
- Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) Room, Affiliated Hospital of Hebei University, Baoding, China
| | - Jia-Ning Wang
- Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) Room, Affiliated Hospital of Hebei University, Baoding, China
| | - Yan Zhang
- Department of Radiology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Feng-Ying Zhu
- Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) Room, Affiliated Hospital of Hebei University, Baoding, China
| | - Chu Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xiao-Ping Yin
- Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) Room, Affiliated Hospital of Hebei University, Baoding, China
- *Correspondence: Xiao-Ping Yin, ;
| | - Bu-Lang Gao
- Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) Room, Affiliated Hospital of Hebei University, Baoding, China
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7
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Liu J, Ren WX, Shu J. Multimodal molecular imaging evaluation for early diagnosis and prognosis of cholangiocarcinoma. Insights Imaging 2022; 13:10. [PMID: 35050416 PMCID: PMC8776965 DOI: 10.1186/s13244-021-01147-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 12/15/2021] [Indexed: 11/23/2022] Open
Abstract
Cholangiocarcinoma (CCA) is an aggressive and lethal malignancy with limited therapeutic options. Despite recent advances in diagnostic imaging for CCA, the early diagnosis of CCA and evaluation of tumor invasion into the bile duct and its surrounding tissues remain challenging. Most patients with CCA are diagnosed at an advanced stage, at which treatment options are limited. Molecular imaging is a promising diagnostic method for noninvasive imaging of biological events at the cellular and molecular level in vivo. Molecular imaging plays a key role in the early diagnosis, staging, and treatment-related evaluation and management of cancer. This review will describe different methods for molecular imaging of CCA, including nuclear medicine, magnetic resonance imaging, optical imaging, and multimodal imaging. The main challenges and future directions in this field are also discussed.
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Affiliation(s)
- Jiong Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, No 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Wen Xiu Ren
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China.,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, No 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, People's Republic of China. .,Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, No 25 Taiping St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
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8
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Tang Y, Yang CM, Su S, Wang WJ, Fan LP, Shu J. Machine learning-based Radiomics analysis for differentiation degree and lymphatic node metastasis of extrahepatic cholangiocarcinoma. BMC Cancer 2021; 21:1268. [PMID: 34819043 PMCID: PMC8611922 DOI: 10.1186/s12885-021-08947-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/01/2021] [Indexed: 12/15/2022] Open
Abstract
Background Radiomics may provide more objective and accurate predictions for extrahepatic cholangiocarcinoma (ECC). In this study, we developed radiomics models based on magnetic resonance imaging (MRI) and machine learning to preoperatively predict differentiation degree (DD) and lymph node metastasis (LNM) of ECC. Methods A group of 100 patients diagnosed with ECC was included. The ECC status of all patients was confirmed by pathology. A total of 1200 radiomics features were extracted from axial T1 weighted imaging (T1WI), T2-weighted imaging (T2WI), diffusion weighted imaging (DWI), and apparent diffusion coefficient (ADC) images. A systematical framework considering combinations of five feature selection methods and ten machine learning classification algorithms (classifiers) was developed and investigated. The predictive capabilities for DD and LNM were evaluated in terms of area under precision recall curve (AUPRC), area under the receiver operating characteristic (ROC) curve (AUC), negative predictive value (NPV), accuracy (ACC), sensitivity, and specificity. The prediction performance among models was statistically compared using DeLong test. Results For DD prediction, the feature selection method joint mutual information (JMI) and Bagging Classifier achieved the best performance (AUPRC = 0.65, AUC = 0.90 (95% CI 0.75–1.00), ACC = 0.85 (95% CI 0.69–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.88 (95% CI 0.64–0.97)), and the radiomics signature was composed of 5 selected features. For LNM prediction, the feature selection method minimum redundancy maximum relevance and classifier eXtreme Gradient Boosting achieved the best performance (AUPRC = 0.95, AUC = 0.98 (95% CI 0.94–1.00), ACC = 0.90 (95% CI 0.77–1.00), sensitivity = 0.75 (95% CI 0.30–0.95), and specificity = 0.94 (95% CI 0.72–0.99)), and the radiomics signature was composed of 30 selected features. However, these two chosen models were not significantly different to other models of higher AUC values in DeLong test, though they were significantly different to most of all models. Conclusion MRI radiomics analysis based on machine learning demonstrated good predictive accuracies for DD and LNM of ECC. This shed new light on the noninvasive diagnosis of ECC.
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Affiliation(s)
- Yong Tang
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, 610054, Sichuan, China
| | - Chun Mei Yang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, and Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, China
| | - Song Su
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, China
| | - Wei Jia Wang
- School of Information and Software Engineering, University of Electronic Science and Technology of China, No. 4, Section 2, North Jianshe Road, Chengdu, 610054, Sichuan, China
| | - Li Ping Fan
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan, China.
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, and Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, 646000, Sichuan, China.
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Saleh M, Virarkar M, Bura V, Valenzuela R, Javadi S, Szklaruk J, Bhosale P. Intrahepatic cholangiocarcinoma: pathogenesis, current staging, and radiological findings. Abdom Radiol (NY) 2020; 45:3662-3680. [PMID: 32417933 DOI: 10.1007/s00261-020-02559-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To this date, it is a major oncological challenge to optimally diagnose, stage, and manage intrahepatic cholangiocarcinoma (ICC). Imaging can not only diagnose and stage ICC, but it can also guide management. Hence, imaging is indispensable in the management of ICC. In this article, we review the pathology, epidemiology, genetics, clinical presentation, staging, pathology, radiology, and treatment of ICC.
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Affiliation(s)
- Mohammed Saleh
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Mayur Virarkar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Vlad Bura
- Department of Radiology, County Clinical Emergency Hospital, 400006, Cluj-Napoca, Cluj, Romania
| | - Raul Valenzuela
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sanaz Javadi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Janio Szklaruk
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
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10
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Radiomics model of magnetic resonance imaging for predicting pathological grading and lymph node metastases of extrahepatic cholangiocarcinoma. Cancer Lett 2020; 470:1-7. [DOI: 10.1016/j.canlet.2019.11.036] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023]
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11
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Lewis S, Besa C, Wagner M, Jhaveri K, Kihira S, Zhu H, Sadoughi N, Fischer S, Srivastava A, Yee E, Mortele K, Babb J, Thung S, Taouli B. Prediction of the histopathologic findings of intrahepatic cholangiocarcinoma: qualitative and quantitative assessment of diffusion-weighted imaging. Eur Radiol 2017; 28:2047-2057. [PMID: 29234913 DOI: 10.1007/s00330-017-5156-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To correlate qualitative and quantitative diffusion weighted imaging (DWI) characteristics of intrahepatic cholangiocarcinoma (ICC) with histopathologic tumour grade and fibrosis content. METHODS Fifty-one patients (21M/30F; mean age 61y) with ICC and MRI including DWI were included in this IRB-approved multicentre retrospective study. Qualitative tumour features were assessed. Tumour apparent diffusion coefficient (ADC) mean, minimum, and normalized (nADCliver) values were computed. Tumour grade [well(G1), moderately(G2), or poorly differentiated(G3)] and tumour fibrosis content [minimal(1), moderate(2), or abundant(3)] were categorized pathologically. Imaging findings and ADC values were compared with pathologic measures. Utility of ADC values for predicting tumour grade was assessed using ROC analysis. RESULTS 51 ICCs (mean size 6.5±1.1 cm) were assessed. 33/51(64%) of ICCs demonstrated diffuse hyperintensity and 15/51(29%) demonstrated target appearance on DWI. Infiltrative morphology (p=0.02) and tumour size (p=0.04) were associated with G3. ADCmean and nADCmean of G3 (1.32±0.47x10-3 mm2/sec and 0.97±0.95) were lower than G1+G2 (1.57±0.39x10-3 mm2/sec and 1.24±0.49; p=0.03 and p=0.04). ADCmean and nADCmean were inversely correlated with tumour grade (p<0.025). No correlation was found between ADC and tumour fibrosis content. AUROC, sensitivity and specificity of nADCmean for G3 versus G1+G2 were 0.71, 89.5% and 55.5%. CONCLUSION ADC quantification has reasonable accuracy for predicting ICC grade. KEY POINTS • ADC quantification was useful for predicting ICC tumour grade. • Infiltrative tumour morphology and size were associated with poorly differentiated ICCs. • ADC values depended more on ICC tumour grade than fibrosis content. • Ability to predict ICC tumour grade non-invasively could impact patient management.
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Affiliation(s)
- Sara Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Cecilia Besa
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mathilde Wagner
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Radiology, Sorbonne Universités, UPMC, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kartik Jhaveri
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
| | - Shingo Kihira
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hongfa Zhu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nima Sadoughi
- Department of Radiology, University of Toronto, Toronto, Ontario, Canada
- Department of Radiology, University of Ottawa and The Ottawa Hospital, Ottawa, Canada
| | - Sandra Fischer
- Department of Pathology, University of Toronto, Ontario, Canada
| | - Amogh Srivastava
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Eric Yee
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Koenraad Mortele
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - James Babb
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Swan Thung
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bachir Taouli
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Translational and Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Sade R, Kantarci M, Ogul H, Gundogdu B, Aydınlı B. Differentiation between hepatic alveolar echinococcosis and primary hepatic malignancy with diffusion-weighted magnetic resonance imaging. Diagn Interv Imaging 2017; 99:169-177. [PMID: 29110943 DOI: 10.1016/j.diii.2017.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/03/2017] [Accepted: 09/20/2017] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the value of diffusion-weighted magnetic resonance imaging (DW-MRI) in discriminating between hepatic alveolar echinococcosis (AE) and hepatocellular carcinoma and intrahepatic cholangiocarcinoma. METHODS We included 49 patients (27 men, 22 women; mean age: 52.02±9.76 [SD] years; range: 25-72years) with 57 histopathologically confirmed hepatic AE lesions. Fifty patients (18 men, 32 women; mean age: 58.93±8.42 [SD] years; range: 42-71years) with 61 histopathologically confirmed hepatocellular carcinoma and 50 patients (24 men, 26 women; mean age: 50.11±7.70 [SD] years; range: 38-69years) with 54 histopathologically confirmed intrahepatic cholangiocarcinoma lesions were used as control groups. All patients had MRI examination of the liver that included conventional MRI sequences and DW-MRI using b values of 50, 400 and 800s/mm2. Two radiologists evaluated conventional MRI and DW-MRI images and calculated ADC values of hepatic lesions. RESULTS The mean ADC value of solid components of hepatic AE lesions was 1.34±0.41×10-3 mm2/s (range: 0.9-1.59×10-3 mm2/s) and was significantly higher than that of the solid components of hepatocellular carcinoma lesions (mean ADC value, 0.99±0.29×10-3 mm2/s; range: 0.7-1.15×10-3 mm2/s) and of intrahepatic cholangiocarcinoma lesions (mean ADC value, 1.05±0.22×10-3 mm2/s; range: 0.86-1.18×10-3 mm2/s) (P<0.001). CONCLUSION In general ADC values can help discriminate between AE and hepatocellular carcinoma and intrahepatic cholangiocarcinoma. However, the use of ADC values cannot help differentiating Type 4 AE from hepatocellular carcinoma or intrahepatic cholangiocarcinoma.
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Affiliation(s)
- R Sade
- Ataturk University, School of Medicine, Department of Radiology, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey
| | - M Kantarci
- Ataturk University, School of Medicine, Department of Radiology, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey.
| | - H Ogul
- Ataturk University, School of Medicine, Department of Radiology, 200 Evler Mah. 14. Sok No 5, Dadaskent, Erzurum, Turkey
| | - B Gundogdu
- Ataturk University, School of Medicine, Department of Pathology, Erzurum, Turkey
| | - B Aydınlı
- Akdeniz University, School of Medicine, Department of General Surgery, Antalya, Turkey
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Rahnemai-Azar AA, Pandey P, Kamel I, Pawlik TM. Monitoring outcomes in intrahepatic cholangiocarcinoma patients following hepatic resection. Hepat Oncol 2017; 3:223-239. [PMID: 30191045 DOI: 10.2217/hep-2016-0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 11/04/2016] [Indexed: 02/07/2023] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is one of the fatal gastrointestinal cancers with increasing incidence and mortality. Although surgery offers the only potential for cure in iCCA patients, the prognosis is not optimal with low overall survival rate and high disease recurrence. Hence, adjuvant therapy is generally recommended in the management of high-risk patients. Identifying factors associated with disease recurrence and survival of the iCCA patients after resection will improve understanding of disease prognosis and help in selecting patients who will benefit from surgical resection or stratifying them for clinical trials. Despite development of new methods for early detection of tumor recurrence, effective prognostic models and nomograms, and recent advances in management, significant challenges remain in improving the prognosis of iCCA patients.
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Affiliation(s)
- Amir A Rahnemai-Azar
- Department of Surgery, University of Washington Medical Center, University of Washington School of Medicine, Seattle, WA, USA.,Department of Surgery, University of Washington Medical Center, University of Washington School of Medicine, Seattle, WA, USA
| | - Pallavi Pandey
- Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Surgery, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ihab Kamel
- Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Radiology, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Timothy M Pawlik
- Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA.,Department of Surgery, Wexner Medical Center, Ohio State University, Columbus, OH, USA
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14
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Herek D, Karabulut N, Kocyıgıt A, Yagcı AB. Evaluation of Free Breathing Versus Breath Hold Diffusion Weighted Imaging in Terms Apparent Diffusion Coefficient (ADC) and Signal-to-Noise Ratio (SNR) Values for Solid Abdominal Organs. Pol J Radiol 2016; 81:502-506. [PMID: 27822326 PMCID: PMC5083043 DOI: 10.12659/pjr.895868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 03/28/2016] [Indexed: 01/23/2023] Open
Abstract
Background Our aim was to compare the apparent diffusion coefficient (ADC) values of normal abdominal parenchymal organs and signal-to-noise ratio (SNR) measurements in the same patients with breath hold (BH) and free breathing (FB) diffusion weighted imaging (DWI). Material/Methods Forty-eight patients underwent both BH and FB DWI. Spherical region of interest (ROI) was placed on the right hepatic lobe, spleen, pancreas, and renal cortices. ADC values were calculated for each organ on each sequence using an automated software. Image noise, defined as the standard deviation (SD) of the signal intensities in the most artifact-free area of the image background was measured by placing the largest possible ROI on either the left or the right side of the body outside the object in the recorded field of view. SNR was calculated using the formula: SNR=signal intensity (SI)(organ)/standard deviation (SD)(noise). Results There were no statistically significant differences in ADC values of the abdominal organs between BH and FB DWI sequences (p>0.05). There were statistically significant differences between SNR values of organs on BH and FB DWIs. SNRs were found to be better on FB DWI than BH DWI (p<0.001). Conclusions Free breathing DWI technique reduces image noise and increases SNR for abdominal examinations. Free breathing technique is therefore preferable to BH DWI in the evaluation of abdominal organs by DWI.
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Affiliation(s)
- Duygu Herek
- Department of Radiology, Pamukkale University, School of Medicine, Denizli, Turkey
| | - Nevzat Karabulut
- Department of Radiology, Pamukkale University, School of Medicine, Denizli, Turkey
| | - Ali Kocyıgıt
- Department of Radiology, Pamukkale University, School of Medicine, Denizli, Turkey
| | - Ahmet Baki Yagcı
- Department of Radiology, Pamukkale University, School of Medicine, Denizli, Turkey
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15
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Differentiation grade for extrahepatic bile duct adenocarcinoma: Assessed by diffusion-weighted imaging at 3.0-T MR. Eur J Radiol 2016; 85:1980-1986. [PMID: 27776649 DOI: 10.1016/j.ejrad.2016.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/29/2016] [Accepted: 09/07/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE- To assess the pathological differentiation grade in the patients with extrahepatic bile duct adenocarcinoma (EBDA) using diffusion-weighted imaging (DWI) at 3.0-T MR. METHODS- Sixty-eight patients who were clinically and histologically diagnosed with EBDA underwent abdominal DWI within 2 weeks before surgery. The lesion signal intensity, signal intensity ratio of the lesion and hepar (SIR-LH) value, and apparent diffusion coefficient (ADC) value in patients with EBDA were retrospectively analysed. RESULTS -In the 68 patients, 22 well-differentiated, 36 moderately-differentiated, and 10 poorly-differentiated EBDAs were histopathological confirmed. These EBDAs exhibited hyper-intensity on DWI in 95.59% of patients. Hyper-intensity lesions were found in 90.91% of patients with good-differentiation, in 97.22% with moderate-differentiation and in 100% with poor-differentiation. There showed no statistical difference for the lesion signal intensity (P=0.426) and SIR-LH value (P=0.766) on DWI among three groups. The median ADC value of the well-differentiated, moderately-differentiated and poorly-differentiated EBDAs were 1.506×10-3mm2/s, 1.275×10-3mm2/s and 1.154×10-3mm2/s, respectively. As the pathological differentiation grade decreased, the lesion ADC value of EBDA gradually declined (x2=51.220, P=0.000). The ADC value <1.184×10-3mm2/s can predict the poorly-differentiated EBDA with a sensitivity of 100% and a specificity of 94.83%. The ADC value >1.316×10-3mm2/s can forecast the well-differentiated EBDA with a sensitivity of 100% and a specificity of 84.78%. CONCLUSIONS- The histopathological differentiation grade of EBDA can be detected non-invasively using DWI at 3.0-T MR.
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16
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Lee J, Kim SH, Kang TW, Song KD, Choi D, Jang KT. Mass-forming Intrahepatic Cholangiocarcinoma: Diffusion-weighted Imaging as a Preoperative Prognostic Marker. Radiology 2016; 281:119-28. [PMID: 27115053 DOI: 10.1148/radiol.2016151781] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To assess the value of diffusion-weighted (DW) imaging as a prognostic marker in preoperative evaluation of patients with mass-forming intrahepatic cholangiocarcinoma (ICC). Materials and Methods This retrospective study was approved by the institutional review board, and the informed consent requirement was waived. A total of 91 patients who underwent hepatic resection and DW imaging for mass-forming ICC were included. Two radiologists evaluated the degree of diffusion restriction of the tumors by using qualitative (visual) interpretation combined with quantitative analysis by volumetric evaluation of the whole tumor on DW images. Patients were classified into two groups: those in whom less than one-third of the tumor showed diffusion restriction (group 1) and those in whom more than one-third of the tumor showed diffusion restriction (group 2). Imaging findings in tumors were compared with pathology findings. Disease-free and overall survival rates were compared between the two groups by using the Kaplan-Meier method with the log-rank test. Results There were 43 patients in group 1 and 48 patients in group 2. The 1- and 3-year disease-free survival rates were 30% and 16%, respectively, in group 1 and 75% and 64%, respectively, in group 2 (P < .001). The 1- and 3-year overall survival rates were 77% and 26%, respectively, in group 1 and 92% and 67%, respectively, in group 2 (P = .001). Multivariate analysis revealed that diffusion restriction (P = .024), differentiation (P = .030), and intrahepatic metastasis (P = .001) were independent prognostic factors for overall survival. Conclusion The degree of diffusion restriction on DW images may be a prognostic marker in preoperative evaluation of patients with mass-forming ICC. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jisun Lee
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Seong Hyun Kim
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Tae Wook Kang
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Kyoung Doo Song
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Dongil Choi
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
| | - Kee Taek Jang
- From the Department of Radiology and Center for Imaging Science (J.L., S.H.K., T.W.K., K.D.S., D.C.) and Department of Pathology (K.T.J.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-Ro, Gangnam-gu, Seoul, Korea
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17
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Tsai TH, Hsu JS, Lai ML, Liu GC, Shih MCP, Chen CY. Added value of diffusion-weighted imaging to MR cholangiopancreatography for the diagnosis of bile duct dilatations. Abdom Radiol (NY) 2016; 41:485-92. [PMID: 27039319 DOI: 10.1007/s00261-015-0612-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To investigate the added value of diffusion-weighted imaging (DWI) when used with conventional T2-weighted magnetic resonance (MR) imaging (T2WI) and MR cholangiopancreatography (MRCP) for diagnosing bile duct dilatations. METHODS Our institutional review board approved this retrospective study protocol and waived the informed consent requirement. The study included 151 consecutive patients (70 men, 81 women) with intra- and/or extra-hepatic bile duct dilatation examined using MR imaging. Two radiologists independently and randomly reviewed 3 image sets (A: MRCP and T2WI; B: DWI; and C: combined T2WI, MRCP, and DWI) at different occasions to differentiate between malignancy, biliary lithiasis, and benign dilatation. The sensitivity, specificity, and diagnostic accuracy of these imaging sets were calculated and compared. RESULTS For both readers, combined T2WI, MRCP, and DWI exhibited significantly higher sensitivity and diagnostic accuracy for malignant dilatation, compared with conventional T2WI and MRCP (P < 0.01 for both readers). However, DWI did not significantly affect the sensitivity and diagnostic accuracy for biliary lithiasis or benign dilatation. CONCLUSION The addition of DWI to T2WI and MRCP sequences yields significantly higher sensitivity and diagnostic accuracy when examining bile duct dilatations, particularly malignant dilatations.
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Affiliation(s)
- Tzu-Hsueh Tsai
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No. 100 Tz You 1st Road, Kaohsiung, 807, Taiwan
| | - Jui-Sheng Hsu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No. 100 Tz You 1st Road, Kaohsiung, 807, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lai Lai
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No. 100 Tz You 1st Road, Kaohsiung, 807, Taiwan
| | - Gin-Chung Liu
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No. 100 Tz You 1st Road, Kaohsiung, 807, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Chen Paul Shih
- Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Imaging, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chiao-Yun Chen
- Department of Medical Imaging, Kaohsiung Medical University Hospital, No. 100 Tz You 1st Road, Kaohsiung, 807, Taiwan. .,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. .,Department of Radiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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18
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Luna A, Pahwa S, Bonini C, Alcalá-Mata L, Wright KL, Gulani V. Multiparametric MR Imaging in Abdominal Malignancies. Magn Reson Imaging Clin N Am 2016; 24:157-186. [PMID: 26613880 PMCID: PMC4974463 DOI: 10.1016/j.mric.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Modern MR imaging protocols can yield both anatomic and functional information for the assessment of hepatobiliary and pancreatic malignancies. Diffusion-weighted imaging is fully integrated into state-of-the-art protocols for tumor detection, characterization, and therapy monitoring. Hepatobiliary contrast agents have gained ground in the evaluation of focal liver lesions during the last years. Perfusion MR imaging is expected to have a central role for monitoring therapy in body tumors treated with antivascular drugs. Approaches such as Magnetic resonance (MR) elastography and (1)H-MR spectroscopy are still confined to research centers, but with the potential to grow in a short time frame.
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Affiliation(s)
- Antonio Luna
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain; Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
| | - Shivani Pahwa
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lidia Alcalá-Mata
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain
| | - Katherine L Wright
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Gulani
- Department of Radiology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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19
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Fattach HE, Dohan A, Guerrache Y, Dautry R, Boudiaf M, Hoeffel C, Soyer P. Intrahepatic and hilar mass-forming cholangiocarcinoma: Qualitative and quantitative evaluation with diffusion-weighted MR imaging. Eur J Radiol 2015; 84:1444-1451. [PMID: 26022518 DOI: 10.1016/j.ejrad.2015.05.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/11/2015] [Accepted: 05/02/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To qualitatively and quantitatively analyze the presentation of intrahepatic and hilar mass-forming cholangiocarcinoma with diffusion-weighted magnetic resonance imaging (DW-MRI). MATERIALS AND METHODS Twenty-eight patients with histopathologically proven mass-forming cholangiocarcinoma (hilar, n=17; intrahepatic, n=11) underwent hepatic DW-MRI at 1.5-T using free-breathing acquisition and three b-values (0,400,800s/mm(2)). Cholangiocarcinomas were evaluated qualitatively using visual analysis of DW-MR images and quantitatively with conventional ADC and normalized ADC measurements using liver and spleen as reference organs. RESULTS All cholangiocarcinomas (28/28; 100%) were visible on DW-MR images. DW-MRI yielded best conspicuity of cholangiocarcinomas than the other MRI sequences (P<0.001). Seven cholangiocarcinomas (7/11; 64%) showed hypointense central area on DW-MR images. Conventional ADC value of cholangiocarcinomas (1.042×10(-3)mm(2)/s±0.221×10(-3)mm(2)/s; range: 0.616×10(-3)mm(2)/s to 2.050×10(-3)mm(2)/s) was significantly lower than that of apparently normal hepatic parenchyma (1.362×10(-3)mm(2)/s±0.187×10(-3)mm(2)/s) (P<0.0001), although substantial overlap was found. No significant differences in ADC and normalized ADC values were found between intrahepatic and hilar cholangiocarcinomas. The use of normalized ADC using the liver as reference organ resulted in the most restricted distribution of ADC values of cholangiocarcinomas (variation coefficient=16.6%). CONCLUSION There is a trend towards a common appearance of intrahepatic and hilar mass-forming cholangiocarcinomas on DW-MRI but variations may be observed. Familiarity with these variations may improve the diagnosis of mass-forming cholangiocarcinoma.
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Affiliation(s)
- Hassan El Fattach
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France.
| | - Anthony Dohan
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010 Paris, France; UMR INSERM 965-Paris 7 "Angiogenèse et recherche translationnelle", 2 rue Amboise Paré, 75010 Paris, France.
| | - Youcef Guerrache
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France.
| | - Raphael Dautry
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010 Paris, France.
| | - Mourad Boudiaf
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France.
| | - Christine Hoeffel
- Department of Radiology, Hôpital Robert Debré, 11 Boulevard Pasteur, 51092 Reims Cedex, France.
| | - Philippe Soyer
- Department of Abdominal Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010 Paris, France; Université Paris-Diderot, Sorbonne Paris Cité, 10 Avenue de Verdun, 75010 Paris, France; UMR INSERM 965-Paris 7 "Angiogenèse et recherche translationnelle", 2 rue Amboise Paré, 75010 Paris, France.
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De Robertis R, Tinazzi Martini P, Demozzi E, Puntel G, Ortolani S, Cingarlini S, Ruzzenente A, Guglielmi A, Tortora G, Bassi C, Pederzoli P, D’Onofrio M. Prognostication and response assessment in liver and pancreatic tumors: The new imaging. World J Gastroenterol 2015; 21:6794-6808. [PMID: 26078555 PMCID: PMC4462719 DOI: 10.3748/wjg.v21.i22.6794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/25/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.
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21
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Delgado Cordón F, Vizuete del Río J, Martín-Benítez G, Ripollés González T, Martínez Pérez M. Bile duct tumors. RADIOLOGIA 2015. [DOI: 10.1016/j.rxeng.2014.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Delgado Cordón F, Vizuete Del Río J, Martín-Benítez G, Ripollés González T, Martínez Pérez MJ. Bile duct tumors. RADIOLOGIA 2015; 57:101-12. [PMID: 25554118 DOI: 10.1016/j.rx.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 10/07/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023]
Abstract
Bile duct tumors are benign or malignant lesions which may be associated to risk factors or potentially malignant lesions. They constitute an heterogenous entities group with a different biological behavior and prognosis according to location and growth pattern. We revise the role of the radiologist in order to detect, characterize and stage these tumors, specially the importance of their classification when deciding an appropriate management and treatment.
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23
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Jhaveri KS, Hosseini-Nik H. MRI of cholangiocarcinoma. J Magn Reson Imaging 2014; 42:1165-79. [PMID: 25447417 DOI: 10.1002/jmri.24810] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/21/2014] [Indexed: 12/12/2022] Open
Abstract
Cholangiocarcinomas are the second most common primary hepatobiliary tumors after hepatocellular carcinomas. They can be categorized either based on their location (intrahepatic/perihilar/extrahepatic distal) or their growth characteristics (mass-forming/periductal-infiltrating/intraductal) because they exhibit varied presentations and outcomes based on their location and or pattern of growth. The increased risk of cholangiocarcinoma in PSC necessitates close surveillance of these patients by means of imaging and laboratory measures; and because currently surgical resection is the only effective treatment for cholangiocarcinoma, the need for accurate pre-operative staging and assessment of resectability has emphasized the role of high quality imaging in management. Today magnetic resonance imaging (MRI) is the modality of choice for detection, pre-operative staging and surveillance of cholangiocarcinoma.
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Affiliation(s)
- Kartik S Jhaveri
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, Toronto, Ontario, Canada
| | - Hooman Hosseini-Nik
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, Toronto, Ontario, Canada
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24
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Schmidt S, Becce F. Response to "diffusion-weighted MR imaging findings in a growing problem: hepatic alveolar echinococcosis". Eur J Radiol 2014; 83:1993-4. [PMID: 25112670 DOI: 10.1016/j.ejrad.2014.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Becce F, Pomoni A, Uldry E, Halkic N, Yan P, Meuli R, Schmidt S. Alveolar echinococcosis of the liver: diffusion-weighted MRI findings and potential role in lesion characterisation. Eur J Radiol 2014; 83:625-31. [PMID: 24457140 DOI: 10.1016/j.ejrad.2013.12.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To report the diffusion-weighted MRI findings in alveolar echinococcosis (AE) of the liver and evaluate the potential role of apparent diffusion coefficients (ADCs) in the characterisation of lesions. MATERIALS AND METHODS We retrospectively included 22 patients with 63 AE liver lesions (≥1 cm), examined with 3-T liver MRI, including a free-breathing diffusion-weighted single-shot echo-planar imaging sequence (b-values=50, 300 and 600 s/mm(2)). Two radiologists jointly assessed the following lesion features: size, location, presence of cystic and/or solid components (according to Kodama's classification system), relative contrast enhancement, and calcifications (on CT). The ADC(total), ADC(min) and ADC(max) were measured in each lesion and the surrounding liver parenchyma. RESULTS Three type 1, 19 type 2, 17 type 3, three type 4 and 21 type 5 lesions were identified. The mean (±SD) ADC(total), ADC(min) and ADC(max) for all lesions were 1.73 ± 0.50, 0.76 ± 0.38 and 2.63 ± 0.76 × 10(-3)mm(2)/s, respectively. The mean ADC(total) for type 1, type 2, type 3, type 4 and type 5 lesions were 1.97 ± 1.01, 1.76 ± 0.53, 1.73 ± 0.41, 1.15 ± 0.42 and 1.76 ± 0.44 × 10(-3)mm(2)/s, respectively. No significant differences were found between the five lesion types, except for type 4 (p=0.0363). There was a significant correlation between the presence of a solid component and low ADCmin (r=0.39, p=0.0016), whereas an inverse correlation was found between the relative contrast enhancement and ADCtotal (r=-0.34, p=0.0072). CONCLUSION The ADCs of AE lesions are relatively low compared to other cystic liver lesions, which may help in the differential diagnosis. Although ADCs are of little use to distinguish between the five lesion types, their low value reflects the underlying solid component.
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Affiliation(s)
- Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Anastasia Pomoni
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Emilie Uldry
- Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nermin Halkic
- Department of Visceral Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Pu Yan
- University Institute of Pathology, Lausanne University Hospital, Rue du Bugnon 25, 1011 Lausanne, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Sabine Schmidt
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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Sugita R. Magnetic resonance evaluations of biliary malignancy and condition at high-risk for biliary malignancy: Current status. World J Hepatol 2013; 5:654-665. [PMID: 24432183 PMCID: PMC3888665 DOI: 10.4254/wjh.v5.i12.654] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 07/26/2013] [Accepted: 12/11/2013] [Indexed: 02/06/2023] Open
Abstract
Tumors of the biliary tree are relatively rare; but their incidence is rising worldwide. There are several known risk factors for bile duct cancers, and these are seem to be associated with chronic inflammation of the biliary epithelium. Herein, 2 risk factors have been discussed, primary sclerosing cholangitis and reflux of pancreatic juice into the bile duct, as seen in such as an abnormal union of the pancreatic-biliary junction because magnetic resonance imaging (MRI) is used widely and effectively in the diagnosis of these diseases. When biliary disease is suspected, MRI can often help differentiate between benignity and malignancy, stage tumors, select surgical candidates and guide surgical planning. MRI has many advantages over other modalities. Therefore, MRI is a reliable noninvasive imaging tool for diagnosis and pre-surgical evaluation of bile duct tumors. Nowadays remarkable technical advances in magnetic resonance technology have expanded the clinical applications of MRI in case of biliary diseases. In this article, it is also discussed how recent developments in MRI contributes to the diagnosis of the bile duct cancer and the evaluation of patients with risk factors affecting bile duct cancer.
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Maarouf RA, Zidan DZ, El-Shinnawy MA. The added value of diffusion-weighted MR imaging to MR cholangiopancreatography in differentiating malignant from benign extrahepatic biliary strictures. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Liu K, Peng W, Zhou Z. The effect of gadolinium chelate contrast agent on diffusion-weighted imaging of pancreatic ductal adenocarcinoma. Acta Radiol 2013; 54:364-8. [PMID: 23386737 DOI: 10.1177/0284185112471795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are only two studies that discuss the effect of a gadolinium chelate contrast agent on pancreatic diffusion-weighted imaging (DWI). However, both studies only included normal pancreas and/or pancreas with pancreatitis and did not include pancreatic ductal adenocarcinoma (PDA). PURPOSE To investigate the effect of gadolinium chelate contrast agent on DWI of PDA. MATERIAL AND METHODS Twenty-two patients (13 men, 9 women; mean age 62 years) with histopathologically proven PDA were included in this study. DWI was acquired before and after administration of gadopentetate dimeglumine (Magnevist) with two b-values: 0 and 1000 s/mm(2). The signal intensity (SI), signal-to-noise ratio (SNR), and the apparent diffusion coefficient (ADC) of the lesion were recorded for comparison. RESULTS The mean time interval between the initiation of contrast administration and the start of the postcontrast DWI series was 393 s (range, 350-510 s). The SIs and SNRs of lesions of b1000 and b0 images of enhanced images were significantly higher than non-enhanced images (P < 0.001, P < 0.001 for b1000 s/mm(2); P = 0.001, P = 0.001 for b0 s/mm(2)). The ADC of all PDAs revealed no statistically significant difference between non-enhanced and enhanced images (P = 0.709). There was also no significant difference between non-enhanced and enhanced images in subgroups based on grades of differentiation and locations of lesion. CONCLUSION With increasing SI and SNR of PDA, intravenous contrast administration does not result in a significant difference in quantitative ADC measurements when comparing precontrast to postcontrast DWI when acquired approximately 6-7 min after administration.
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Affiliation(s)
- Kefu Liu
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengrong Zhou
- Department of Radiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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