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Barabino G, Porcheron J, Cottier M, Cuilleron M, Coutard JG, Berger M, Molliex S, Beauchesne B, Phelip JM, Grichine A, Coll JL. Improving Surgical Resection of Metastatic Liver Tumors With Near-Infrared Optical-Guided Fluorescence Imaging. Surg Innov 2016; 23:354-9. [DOI: 10.1177/1553350615618287] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective. The aim of this study was to investigate the feasibility and future clinical applications of near-infrared (NIR) fluorescence imaging to guide liver resection surgery for metastatic cancer to improve resection margins. Summary Background Data. A subset of patients with metastatic hepatic tumors can be cured by surgery. The degree of long-term and disease-free survival is related to the quality of surgery, with the best resection defined as “R0” (complete removal of all tumor cells, as evidenced by microscopic examination of the margins). Although intraoperative ultrasonography can evaluate the surgical margins, surgeons need a new tool to perfect the surgical outcome. Methods. A preliminary study was performed on 3 patients. We used NIR imaging postoperatively “ex vivo” on the resected liver tissue. The liver tumors were preoperatively labelled by intravenously injecting the patient with indocyanine green (ICG), a NIR fluorescent agent (24 hours before surgery, 0.25 mg/kg). Fluorescent images were obtained using a miniaturized fluorescence imaging system (FluoStic, Fluoptics, Grenoble, France). Results. After liver resection, the surgical specimens from each patient were sliced into 10-mm sections in the operating room and analyzed with the FluoStic. All metastatic tumors presented rim-type fluorescence. Two specimens had incomplete rim fluorescence. The pathologist confirmed the presence of R1 margins (microscopic residual resection), even though the ultrasonographic analysis indicated that the result was R0. Conclusions. Surgical liver resection guided by NIR fluorescence can help detect potentially uncertain anatomical areas that may be missed by preoperative imaging and by ultrasonography during surgery. These preliminary results will need to be confirmed in a larger prospective patient series.
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Affiliation(s)
- Gabriele Barabino
- Université Jean Monnet, Saint Etienne, France
- Saint Etienne University Hospital, Saint Etienne, France
- INSERM-UJF U823, Institut Albert Bonniot, Grenoble, France
| | - Jack Porcheron
- Saint Etienne University Hospital, Saint Etienne, France
| | | | | | | | | | - Serge Molliex
- Saint Etienne University Hospital, Saint Etienne, France
| | | | | | | | - Jean-Luc Coll
- INSERM-UJF U823, Institut Albert Bonniot, Grenoble, France
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Venkatesh SK, Chandan V, Roberts LR. Liver masses: a clinical, radiologic, and pathologic perspective. Clin Gastroenterol Hepatol 2014; 12:1414-29. [PMID: 24055987 DOI: 10.1016/j.cgh.2013.09.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 08/26/2013] [Accepted: 09/06/2013] [Indexed: 02/07/2023]
Abstract
Liver masses present a relatively common clinical dilemma, particularly with the increasing use of various imaging modalities in the diagnosis of abdominal and other symptoms. The accurate and reliable determination of the nature of the liver mass is critical, not only to reassure individuals with benign lesions but also, and perhaps more importantly, to ensure that malignant lesions are diagnosed correctly. This avoids the devastating consequences of missed diagnosis and the delayed treatment of malignancy or the unnecessary treatment of benign lesions. With appropriate interpretation of the clinical history and physical examination, and the judicious use of laboratory and imaging studies, the majority of liver masses can be characterized noninvasively. Accurate characterization of liver masses by cross-sectional imaging is particularly dependent on an understanding of the unique phasic vascular perfusion of the liver and the characteristic behaviors of different lesions during multiphasic contrast imaging. When noninvasive characterization is indeterminate, a liver biopsy may be necessary for definitive diagnosis. Standard histologic examination usually is complemented by immunohistochemical analysis of protein biomarkers. Accurate diagnosis allows the appropriate selection of optimal management, which is frequently reassurance or intermittent follow-up evaluations for benign masses. For malignant lesions or those at risk of malignant transformation, management depends on the tumor staging, the functional status of the uninvolved liver, and technical surgical considerations. Unresectable metastatic masses require oncologic consultation and therapy. The efficient characterization and management of liver masses therefore requires a multidisciplinary collaboration between the gastroenterologist/hepatologist, radiologist, pathologist, hepatobiliary or transplant surgeon, and medical oncologist.
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Huang C, Galons JP, Graff CG, Clarkson EW, Bilgin A, Kalb B, Martin DR, Altbach MI. Correcting partial volume effects in biexponential T2 estimation of small lesions. Magn Reson Med 2014; 73:1632-42. [PMID: 24753061 DOI: 10.1002/mrm.25250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/27/2014] [Accepted: 03/20/2014] [Indexed: 12/20/2022]
Abstract
PURPOSE T2 mapping provides a quantitative approach for focal liver lesion characterization. For small lesions, a biexponential model should be used to account for partial volume effects (PVE). However, conventional biexponential fitting suffers from large uncertainty of the fitted parameters when noise is present. The purpose of this work is to develop a more robust method to correct for PVE affecting small lesions. METHODS We developed a region of interest-based joint biexponential fitting (JBF) algorithm to estimate the T2 of lesions affected by PVE. JBF takes advantage of the lesion fraction variation among voxels within a region of interest. JBF is compared to conventional approaches using Cramér-Rao lower bound analysis, numerical simulations, phantom, and in vivo data. RESULTS JBF provides more accurate and precise T2 estimates in the presence of PVE. Furthermore, JBF is less sensitive to region of interest drawing. Phantom and in vivo results show that JBF can be combined with a reconstruction method for highly undersampled data, enabling the characterization of small abdominal lesions from data acquired in a single breath hold. CONCLUSION The JBF algorithm provides more accurate and stable T2 estimates for small structures than conventional techniques when PVE is present. It should be particularly useful for the characterization of small abdominal lesions.
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Affiliation(s)
- Chuan Huang
- Department of Mathematics, University of Arizona, Tucson, Arizona, USA; Department of Imaging, Center for Advanced Medical Imaging Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sasaki Y, Sakamoto J, Otonari-Yamamoto M, Nishikawa K, Sano T. Potential of fluid-attenuated inversion recovery MRI as an alternative to contrast-enhanced MRI for oral and maxillofacial vascular malformations: experimental and clinical studies. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:503-10. [PMID: 24035116 DOI: 10.1016/j.oooo.2013.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 05/27/2013] [Accepted: 06/13/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the potential of fluid-attenuated inversion recovery (FLAIR) imaging of oral and maxillofacial vascular malformations as an alternative to contrast-enhanced magnetic resonance imaging (MRI), we investigated the influence of differences in T1 and T2 values on image contrast in FLAIR images and evaluated the diagnostic utility of such images. STUDY DESIGN FLAIR imaging and heavily T2-weighted (hT2-weighted) imaging were performed using a phantom. FLAIR and hT2-weighted images of 32 lesions (11 mucous cysts, 12 vascular malformations, and 9 tumors) were also studied retrospectively. The contrast-to-noise ratios (CNRs) and CNR change ratios were compared. RESULTS All aqueous solutions except those with a short T2 value were discriminated by CNR change ratio (P < .05). All 3 types of lesions were discriminated by CNR change ratio (P < .05). CONCLUSION FLAIR imaging has potential as an alternative to contrast-enhanced MRI in differentiating vascular malformations from other types of lesions in the oral and maxillofacial region.
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Xu LH, Cai SJ, Cai GX, Peng WJ. Imaging diagnosis of colorectal liver metastases. World J Gastroenterol 2011; 17:4654-9. [PMID: 22180707 PMCID: PMC3237298 DOI: 10.3748/wjg.v17.i42.4654] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Revised: 06/15/2011] [Accepted: 06/22/2011] [Indexed: 02/06/2023] Open
Abstract
Rapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases. Multi-modality imaging approach is usually the more useful in diagnosis colorectal liver metastases. 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. The diagnosis of liver metastases relies first and totally on imaging to decide which patients may be surgical candidates. This review will discuss the imaging options and their appropriate indications. Imaging and evaluating of colorectal liver metastases (CRLM) have been performed with contrast-enhanced ultrasound, multi-detector computed tomography, magnetic resonance imaging (MRI) with extra-cellular contrast media and liver-specific contrast media MRI, and positron emission tomography/computed tomography. This review will concentrate on the imaging approach of CRLM, and also discuss certain characteristics of some liver lesions. We aim to highlight the advantages of each imaging technique, as well as underscoring potential pitfalls and limitations.
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Lee HY, Lee JM, Kim SH, Shin KS, Lee JY, Han JK, Choi BI. Detection and characterization of focal hepatic lesions: comparative study of MDCT and gadobenate dimeglumine-enhanced MR imaging. Clin Imaging 2008; 32:287-95. [PMID: 18603184 DOI: 10.1016/j.clinimag.2007.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Accepted: 11/30/2007] [Indexed: 01/16/2023]
Abstract
The aim of this study was to compare the diagnostic performance of multidetector row helical CT (MDCT) and gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging (in the detection and characterization of focal liver lesions. Two blind reviewers analyzed the MDCT and MR images of a total of 44 malignant and 85 benign lesions in 46 patients independently. Receiver operating characteristic curves were established to analyze the results for each reviewer and modality.
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Affiliation(s)
- Ho Yun Lee
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul National University Hospital, Seoul 110-744, Korea
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Chang SD, Thoeni RF. Effect of T1 Shortening on T2-Weighted MRI Sequences: Comparison of Hepatic Mass Conspicuity on Images Acquired Before and After Gadolinium Enhancement. AJR Am J Roentgenol 2008; 190:1318-23. [DOI: 10.2214/ajr.07.2696] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Evaluation of the liver and biliary system is a frequent indication for abdominal MRI. Hepatobiliary MRI comprises a set of noninvasive techniques that are usually very effective in answering most clinical questions. There are significant limitations, however, as well as considerable variation and disagreement regarding the optimal protocols for standard hepatic MRI and magnetic resonance cholangiopancreaticography (MRCP). This review discusses pulse sequences most often used in hepatic MRI and MRCP, examines a few sources of controversy in the current literature, and summarizes some recent and future developments in the field.
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Affiliation(s)
- James F Glockner
- Department of Radiology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Farraher SW, Jara H, Chang KJ, Ozonoff A, Soto JA. Differentiation of hepatocellular carcinoma and hepatic metastasis from cysts and hemangiomas with calculated T2 relaxation times and the T1/T2 relaxation times ratio. J Magn Reson Imaging 2007; 24:1333-41. [PMID: 17083093 DOI: 10.1002/jmri.20758] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To determine the diagnostic capability of the T1 and T2 relaxation times and the T1/T2 relaxation times ratio generated with the mixed turbo spin echo (mixed-TSE) pulse sequence, in order to discriminate between hepatocellular carcinoma (HCC)/metastases and hemangiomas/cysts. MATERIALS AND METHODS A retrospective review of 36 MR examinations implementing the mixed-TSE pulse sequence demonstrated 70 focal hepatic lesions. Quantitative MR algorithms were used to generate T1 and T2 relaxation times, and the T1/T2 relaxation times ratio for each lesion. A two-sample t-test compared mean T1 and T2 relaxation times, and the T1/T2 relaxation times ratio, by lesion type: carcinoma/metastases and hemangiomas/cysts. Sensitivity and specificity for discriminating carcinoma/metastases from hemangiomas/cysts with T2 relaxation time thresholds of 112 and 125 msec, as well as a ratio of T1/T2 relaxation times of 5.8, were calculated. RESULTS Using a T2 relaxation time threshold of 112 msec, 92% sensitivity and 100% specificity discriminating cysts/hemangiomas from HCC/liver metastasis was demonstrated. With a threshold of 125 msec, 96% sensitivity and 98% specificity was demonstrated. There was no correlation between calculated T1 relaxation times and type of lesion. Using a T1/T2 relaxation times ratio of 5.8, 100% sensitivity and specificity were demonstrated. CONCLUSION Although there is high sensitivity and specificity associated with the use of T2 relaxation times alone to discriminate carcinoma/metastases from hemangiomas/cysts, using the T1/T2 relaxation times ratio threshold of 5.8 allowed proper classification of all lesions.
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Affiliation(s)
- Steven W Farraher
- Boston University Medical Center, Department of Radiology, Boston, Massachusetts 02118, USA.
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Elsayes KM, Leyendecker JR, Menias CO, Oliveira EP, Narra VR, Chapman WC, Hassanien MH, Elsharkawy MS, Brown JJ. MRI characterization of 124 CT-indeterminate focal hepatic lesions: evaluation of clinical utility. HPB (Oxford) 2007; 9:208-15. [PMID: 18333224 PMCID: PMC2063603 DOI: 10.1080/13651820701216950] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the diagnostic yield of MRI performed for characterization of focal hepatic lesions that are interpreted as indeterminate on CT. PATIENTS AND METHODS In a retrospective investigation, 124 indeterminate focal hepatic lesions in 96 patients were identified on CT examinations over 5 years from 1997 to 2001. All patients had MRI performed for the liver within 6 weeks of their CT examination. CT and MR images were reviewed independently by two separate groups of two radiologists. The value of MRI in characterizing these lesions was assessed. Diagnoses were confirmed based on histology, characteristic imaging features, and clinical follow-up. RESULTS MRI definitely characterized 73 lesions (58%) that were indeterminate on CT. MRI was accurate in 72/73 of these lesions. MRI could not definitely characterize 51 lesions (42%). Ten lesions were not visualized on MRI, and follow-up imaging confirmed that no lesion was present in eight of these cases (pseudolesions). CONCLUSION MRI is valuable for the characterization of indeterminate focal hepatic lesions detected on CT.
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Affiliation(s)
- Khaled M. Elsayes
- Department of Radiology, University of Michigan Health CenterAnn Arbor USA,Department of Radiology, Theodore Bilharz InstituteGizaEgypt
| | | | | | - Erica P. Oliveira
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
| | - Vamsidhar R. Narra
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
| | | | | | | | - Jeffrey J. Brown
- Mallinckrodt Institute of Radiology, Washington University in St LouisUSA
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Abstract
In contrast to other extrahepatic malignancies many colorectal cancers can be cured even when there is metastatic spread to the liver. The diagnosis of liver metastases relies totally on imaging to decide which patients may be surgical candidates. The diagnostic value of ultrasound with contrast agents, multidetector CT and MR imaging with non-specific gadolinium chelates and liver-specific contrast agent is discussed. Nowadays MDCT is the mainstay of staging and follow-up of these patients, because it provides good coverage of the liver and the complete abdomen and the chest in one session. MR imaging has been shown to be superior to helical CT in the preoperative assessment of colorectal liver metastases. Large studies are needed to define the role of MDCT vs. MRI staging in patients referred for resection of liver metastases.
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Affiliation(s)
- Wolfgang Schima
- Department of Radiology, Medical University of Vienna, Waehringer Guertel 10-20, 1090 Vienna, Austria.
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Abstract
OBJECTIVE To determine the relative value of qualitative (reader opinion) and quantitative (values derived from dual echo T2 fast spin echo [FSE]) measures in distinguishing hepatic metastases from hemangiomas. METHODS Forty-nine patients with hemangiomas and 23 with metastases were studied with dual echo respiratory-triggered FSE and dynamic 2-dimensional spoiled gradient echo (GRE) imaging. Lesion T2 was estimated from signal intensity ratios on the first and second echoes. Two experienced radiologists independently evaluated groups of images based on 5 separate qualitative measures: first echo FSE, second echo FSE, first and second echo FSE, dynamic GRE, and all images together. RESULTS The mean calculated T2s were 226 +/- 74 milliseconds for hemangiomas and 105 +/- 22 milliseconds for metastases (P < 0.001). A T2 cutoff of 130 milliseconds distinguished metastases from hemangiomas with a sensitivity of 94%, specificity of 91%, and accuracy of nearly 94%. There was no significant difference between the best quantitative measure and the best qualitative measure for either reader. CONCLUSION Liver lesion T2 relaxation times calculated from dual echo FSE images provide information useful in discriminating metastases from hemangiomas, as does reader opinion.
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Affiliation(s)
- Young H Kim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Goshima S, Kanematsu M, Matsuo M, Murakami T, Hori M, Takamura M, Kondo H, Kako N, Moriyama N, Nakamura H, Hoshi H. Detection of malignant hepatic tumors with ferumoxide-enhanced MR imaging: usefulness of multishot and single-shot fast spin echo sequences. Magn Reson Imaging 2004; 22:379-88. [PMID: 15062933 DOI: 10.1016/j.mri.2004.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2003] [Accepted: 01/26/2004] [Indexed: 11/23/2022]
Abstract
The purpose of our study was to assess whether respiratory-triggered multishot fast spin echo (MS-FSE) and breath-hold half-Fourier single-shot fast spin echo (SS-FSE) images, in addition to breath-hold T(2)*-weighted gradient recalled echo (GRE) images, increase observer performance in the detection of malignant hepatic tumors with ferumoxide-enhanced magnetic resonance (MR) imaging. Ferumoxide-enhanced MR images obtained from 48 patients with 83 malignant hepatic tumors were retrospectively reviewed by three independent off-site readers. In the first image review, GRE images alone were reviewed. Then, MS-FSE images were added for the first combination review. Finally, SS-FSE images were added for the second combination review. Observer performances were tested by McNemar's test and receiver-operating-characteristic analysis for the clustered data. Sensitivity for hepatocellular carcinomas, metastases, and malignant hepatic tumors overall was significantly (p < 0.05) higher with GRE and MS-FSE combined and GRE, MS-FSE and SS-FSE combined than with GRE alone. For metastases, the Az value was significantly (p < 0.05) higher with GRE and MS-FSE combined, and GRE, MS-FSE and SS-FSE combined than with GRE alone. We confirmed the incremental value of ferumoxide-enhanced MR imaging by obtaining MS-FSE and SS-FSE images in addition to GRE images in the detection of malignant hepatic tumors.
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Affiliation(s)
- Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan
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Abbehusen CL, D'Ippolito G, Palácio GA, Szejnfeld J. Estudo comparativo das seqüências rápidas ponderadas em T2, utilizando-se sincronização respiratória, apnéia, supressão de gordura, bobina de corpo e bobina de sinergia para a avaliação do fígado pela ressonância magnética. Radiol Bras 2003. [DOI: 10.1590/s0100-39842003000500003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Comparar, qualitativa e quantitativamente, as imagens de ressonância magnética do fígado, ponderadas em T2, utilizando-se seqüências rápidas, diferenciadas pela técnica de controle respiratório, pela utilização de supressão de gordura e pelo tipo de bobina de radiofreqüência. MATERIAIS E MÉTODOS: Estudo prospectivo em 71 pacientes consecutivos, sendo realizadas seis seqüências para comparação: 1) supressão de gordura com sincronização respiratória e bobina de corpo; 2) supressão de gordura em apnéia e bobina de corpo; 3) sem supressão de gordura com sincronização respiratória e bobina de corpo; 4) sem supressão de gordura em apnéia e bobina de corpo; 5) com supressão de gordura com sincronização respiratória e bobina de sinergia; 6) com supressão de gordura em apnéia e bobina de sinergia. A avaliação qualitativa foi baseada em três critérios: detecção de determinadas estruturas anatômicas do fígado, definição dos contornos hepáticos, e presença de artefatos de respiração. A análise quantitativa foi obtida através da relação das intensidades de sinal do fígado e do ruído de fundo. RESULTADOS: O valor médio dos índices globais de qualidade de imagem para cada uma das seis seqüências supracitadas foi de 7,8, 4,6, 7,9, 5,2, 6,7 e 4,6, respectivamente. As seqüências obtidas com sincronização respiratória apresentaram melhor qualidade de imagem e relação sinal/ruído superiores às seqüências com apnéia (p < 0,001). As seqüências realizadas com e sem supressão de gordura apresentaram qualidade de imagem e relação sinal/ruído semelhantes (p > 0,05). As seqüências obtidas com bobina de sinergia apresentaram qualidade de imagem semelhante (p > 0,05) e relação sinal/ruído inferior àquelas com bobina de corpo (p < 0,001). CONCLUSÃO: Associando-se as análises qualitativa e quantitativa das imagens, as melhores seqüências foram aquelas obtidas com sincronização respiratória e bobina de corpo, utilizando-se ou não supressão de gordura.
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Kanematsu M, Matsuo M, Yamada Y, Semelka RC, Kondo H, Goshima S, Hoshi H, Moriyama N. Perilesional hyperintense rim of malignant hepatic tumors on ferumoxide-enhanced T1-weighted gradient-echo MR images: correlation between MR imaging and histopathologic findings. J Magn Reson Imaging 2003; 18:40-8. [PMID: 12815638 DOI: 10.1002/jmri.10328] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To correlate the perilesional hyperintense rim of malignant hepatic tumors seen on ferumoxide-enhanced T1-weighted gradient-echo (GE) MR images with histopathologic findings. MATERIALS AND METHODS In 13 tumors in 12 patients, T1-weighted GE images (TE of 1.4 msec, flip angle of 90 degrees) obtained after IV administration of ferumoxide were evaluated. MR imaging was initiated within one hour of the completion of ferumoxide administration. Surgical resection for tumors was performed within an interval of two weeks of the MR imaging. Resected specimens were histopathologically examined for peritumoral sinusoidal congestion, desmoplastic reaction, compressed hepatic parenchyma, lymphocytic infiltration, and vascular proliferation. RESULTS In twelve tumors (92%), prominently (N = 2), moderately (N = 5), and mildly to minimally (N = 5), a perilesional hyperintense rim was observed. Among histopathologic findings, the degree of peritumoral sinusoidal congestion correlated (R =.75, P <.04) with the degree of perilesional hyperintense rim. The thickness of the perilesional hyperintense rim showed a moderate positive correlation (R =.65, P <.02) with the thickness of peritumoral area with sinusoidal congestion. CONCLUSION Perilesional hyperintense rim of malignant hepatic tumors on ferumoxide-enhanced T1-weighted GE images may correlate with sinusoidal congestion surrounding malignant hepatic tumors.
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Numminen K, Halavaara J, Isoniemi H, Tervahartiala P, Kivisaari L, Numminen J, Höckerstedt K. Magnetic resonance imaging of the liver: true fast imaging with steady state free precession sequence facilitates rapid and reliable distinction between hepatic hemangiomas and liver malignancies. J Comput Assist Tomogr 2003; 27:571-6. [PMID: 12886146 DOI: 10.1097/00004728-200307000-00022] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the capability of the true fast imaging with steady state free precession (true FISP) sequence in the distinction between hemangiomas and malignant liver lesions. METHODS Sixty-eight patients with 45 hemangiomas and 51 liver malignancies were included in this study. A 1.5-T magnetic resonance system and a phased-array body coil were used. In addition to true FISP, breath-hold and fat-suppressed, T2-weighted, half-Fourier single-shot turbo spin echo (HASTE) and both unenhanced and gadolinium (Gd)-enhanced T1-weighted sequences were acquired. Two radiologists evaluated the magnetic resonance images independently in a blinded fashion. Interobserver variations with true FISP and HASTE were determined. Lesion contrast-to-noise ratios were calculated from true FISP images. RESULTS With true FISP, readers 1 and 2 made a correct distinction between hemangiomas and liver malignancies in 43 of 45 (96%) cases and 40 of 45 (89%) cases, respectively. The kappa value was 0.65. With HASTE, the success rates were 40 of 45 cases (89%) and 36 of 45 cases (80%), respectively, and the kappa value was 0.33. With a Gd-enhanced T1-weighted sequence, the correct classifications were 35 of 45 cases (78%) and 37 of 45 cases (82%), respectively. All hemangiomas appeared as bright and well-demarcated lesions on true FISP images. Malignant liver foci were heterogeneous with unsharp margins and nearly isointense relative to liver. The specificities of true FISP in lesion differentiation were 100% and 98% for readers 1 and 2, respectively. The mean contrast to noise ratio value of hemangiomas was 21.2 (standard deviation [SD] = 9.2), and that of malignant lesions was 4.9 (SD = 3.9). This difference was highly significant (P < 0.0001). CONCLUSION Noninvasive, rapid, and reliable differentiation between hemangiomas and malignant liver lesions is possible by using the true FISP sequence.
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Affiliation(s)
- Kirsti Numminen
- Department of Radiology, Helsinki University Central Hospital, Kasarmikatu 11, 00130 Helsinki, Finland.
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Eberhardt SC, Choi PH, Bach AM, Funt SA, Felderman HE, Hann LE. Utility of sonography for small hepatic lesions found on computed tomography in patients with cancer. J Ultrasound Med 2003; 22:335-346. [PMID: 12693617 DOI: 10.7863/jum.2003.22.4.335] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess the performance of sonography in evaluating small indeterminate liver lesions detected on computed tomography in patients with cancer. METHODS Radiology database review from January 1, 1998, to August 4, 2000, identified 76 patients with 124 indeterminate hepatic lesions smaller than 1.5 cm on computed tomography who had abdominal sonography within 3 months. Sonographic reports and images were reviewed to assess whether lesions were referenced or specifically sought and to verify lesion correspondence, detection, and characterization. The validity of sonographic characterization was determined by histopathologic examination or follow-up imaging (mean time to follow up, 17 months; range, 6.5-38.8 months). RESULTS Sixty (48%) of 124 indeterminate lesions were evident on sonography. Detection improved when lesions were specifically sought and lesion size was greater than 0.5 cm. Forty (66%) of 61 lesions were detected when the radiologist referenced the preceding computed tomography versus 20 (32%) of 63 lesions when the computed tomographic findings were not referenced (P = .0004). Fifty-one (67%) of 76 lesions measuring 0.6 to 1.5 cm were detected on sonography versus 9 (19%) of 48 lesions measuring 0.1 to 0.5 cm. Lesion size (P < .0001) and body habitus (P = .02) were significant factors influencing lesion detection. Sonography characterized 56 (93%) of 60 detected lesions (33 cysts, 18 solid lesions/metastases, and 5 hemangiomas). Sonographic diagnoses were supported in 42 (93%) of 45 lesions by follow-up imaging (37 of 40) or histopathologic examination (5 of 5). CONCLUSIONS Sonography may be useful in cancer patients with average body habitus to characterize small (0.6- to 1.5-cm) indeterminate liver lesions detected on computed tomography.
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Affiliation(s)
- Steven C Eberhardt
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York New York 10021, USA
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Mueller GC, Hussain HK, Carlos RC, Nghiem HV, Francis IR. Effectiveness of MR imaging in characterizing small hepatic lesions: routine versus expert interpretation. AJR Am J Roentgenol 2003; 180:673-80. [PMID: 12591673 DOI: 10.2214/ajr.180.3.1800673] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of our study was to compare the effectiveness of MR imaging characterization of small (<or=2 cm) hepatic lesions made in a routine clinical setting with the effectiveness of such characterization made under standardized conditions by radiologists who are expert interpreters of MR imaging. MATERIALS AND METHODS Forty-eight patients with 69 small (<or=2 cm) hepatic lesions considered indeterminate on a prior routine CT scan were included in the study. The diagnosis for all lesions had been verified by histology (n = 10), surgery and intraoperative sonography (n = 5), imaging follow-up (n = 35), or clinical follow-up (n = 19). Using the initial radiology reports, the diagnoses based on MR imaging were rated on a 5-point confidence scale. In addition, two radiologists experienced in MR imaging who were unaware of the initial interpretations of the images or the clinical histories of the patients independently analyzed the MR imaging studies and characterized the lesions using the same 5-point scale. The observer performance for the initial MR imaging interpretations and the expert interpretations were measured using receiver operating characteristic analysis. Interobserver agreement was determined with weighted kappa statistics. RESULTS Fifty-eight lesions were benign (six cysts, 22 hemangiomas, four regenerating nodules, two steatohepatitic lesions, one atypical blood vessel, three focal fat and five focal fat-sparing lesions, 13 flow-related pseudolesions, one diaphragmatic insertion, and one unspecified lesion), and 11 lesions were malignant (nine metastases and two hepatocellular carcinoma). The areas under the curve were 0.94 (initial reports), 0.88 (observer 1), and 0.84 (observer 2). Substantial agreement was found between the expert interpreters (kappa = 0.74), and moderate agreement, between the expert interpreters and initial interpreters (kappa = 0.44 each). CONCLUSION MR imaging is an effective method of characterizing small (<or=2 cm) hepatic lesions in routine clinical practice.
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Affiliation(s)
- Gisela C Mueller
- Department of Radiology/MRI B2B311, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0030, USA
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Abstract
OBJETIVO: Estudar as características morfológicas e quantitativas dos hemangiomas hepáticos na ressonância magnética. MATERIAL E MÉTODOS: Foram estudados, prospectivamente, 57 hemangiomas hepáticos presentes em 27 pacientes, com ressonância magnética de alto campo (1,5 T) utilizando seqüência spin-eco, imagens ponderadas em T1 e T2, com tempos de eco de até 160 ms. Foram avaliadas as características morfológicas dos hemangiomas, classificando-os em típicos ou atípicos. Também foram avaliadas características quantitativas das lesões (relação intensidade de sinal lesão/fígado, valores de tempo de relaxação T2 e índice simplificado T2) e feitas comparações entre tais características nos hemangiomas morfologicamente típicos e atípicos, e naqueles com dimensões <FONT FACE=Symbol>£</FONT> 2,0 cm e > 2,0 cm. RESULTADOS: Do total de hemangiomas estudados, 78,9% apresentaram características morfológicas típicas. Não houve diferença significante entre as características quantitativas de hemangiomas morfologicamente típicos e atípicos. Hemangiomas com dimensões <FONT FACE=Symbol>£</FONT> 2,0 cm e > 2,0 cm apresentaram comportamento semelhante em relação ao tempo de relaxação T2 e ao índice simplificado T2. Valores da relação intensidade de sinal lesão/fígado apresentaram diferenças significantes entre esses dois grupos. Os valores do tempo de relaxação T2, do índice simplificado T2 e da relação intensidade de sinal lesão/fígado caracterizaram corretamente 96,5%, 93% e 89,5% de todos os hemangiomas, respectivamente. CONCLUSÃO: A avaliação quantitativa dos hemangiomas hepáticos nas imagens por ressonância magnética é um método simples e, conjuntamente com a análise morfológica, propicia maior confiança para o diagnóstico.
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Kim JH, Kim MJ, Suh SH, Chung JJ, Yoo HS, Lee JT. Characterization of focal hepatic lesions with ferumoxides-enhanced MR imaging: utility of T1-weighted spoiled gradient recalled echo images using different echo times. J Magn Reson Imaging 2002; 15:573-83. [PMID: 11997899 DOI: 10.1002/jmri.10102] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To evaluate the different signal characteristics of focal hepatic lesions on ferumoxides-enhanced MR imaging, including T1-weighted spoiled gradient recalled echo (GRE) images using different echo times (TE) and T2- and T2*-weighted images. MATERIALS AND METHODS Ferumoxides-enhanced MR imaging was performed using a 1.5-T system in 46 patients who were referred for evaluation of known or suspected hepatic malignancies. One hundred and seven lesions (42 hepatocellular carcinomas [HCC], 40 metastases, 13 cysts, eight hemangiomas, three focal nodular hyperplasias [FNHs], and one cholangiocarcinoma) were evaluated. Postcontrast MR imaging included 1) T2-weighted FSE; 2) T2*-weighted GRE; 3) T1-weighted spoiled GRE using moderate (TE = 4.2-4.4 msec) TE; and 4) minimum (TE = 1.8-2.1 msec) TE. Signal intensities of the focal lesions were rated by two radiologists in conference as follows: hypointense, isointense or invisible, hyperintense, and markedly hyperintense. Lesion-to-liver contrast-to-noise ratio (C/N) was measured by one radiologist for a quantitative assessment. RESULTS On ferumoxides-enhanced FSE images, 92% of cysts were "markedly hyperintense" and most of the other lesions were "hyperintense", and the mean C/N of cysts was significantly higher than that of other focal lesions. T2*-weighted GRE images showed most lesions with similar hyperintensities and the mean C/N was not significantly different between any two types of lesion. T1-weighted GRE images using moderate TE showed all FNHsand hemangiomas, 29 (69%) HCCs and eight (20%) metastases as "hyperintense". On T1-weighted GRE images using minimum TE, however, all HCCs and metastasis except one were iso- or hypointense, while all of the FNHs and hemangiomas were hyperintense. Ring enhancement was highly suggestive of malignant lesions, and was more commonly seen on the minimum TE images than on the moderate TE images. CONCLUSION Addition of T1-weighted GRE images using minimum and moderate TE is helpful for characterizing focal lesions in ferumoxides-enhanced MR imaging.
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Affiliation(s)
- Joo Hee Kim
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea
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Chan YL, Lee SF, Yu SCH, Lai P, Ching ASC. Hepatic malignant tumour versus cavernous haemangioma: differentiation on multiple breath-hold turbo spin-echo MRI sequences with different T2-weighting and T2-relaxation time measurements on a single slice multi-echo sequence. Clin Radiol 2002; 57:250-7. [PMID: 12014868 DOI: 10.1053/crad.2001.0763] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM We evaluated the signal intensity change on breath-hold turbo spin-echo (TSE) T2-weighted sequences using different echo times (TE) and T2-relaxation time measurements on a single slice eight-echo sequence in the differentiation of hepatic malignancy from cavernous haemangioma. MATERIALS AND METHODS Breath-hold TSE T2-weighted axial images of the liver were performed at TEs of 80, 120 and 160 ms in 34 patients with focal liver lesions (13 with cavernous haemangiomas, 14 with hepatocellular carcinomas and seven with metastases). The lesion percentage signal intensity change on the lower TE image to the higher TE image was calculated. T2-relaxation time was measured on a single slice eight-echo sequence. RESULTS The TE pair 80/160 ms on breath-hold TSE T2-weighted sequences gave a performance (100% sensitivity, 92% specificity, 95% positive predictive value and 100% negative predictive value) better than other TE pairs in differentiating haemangioma from malignancy. Addition of fat-suppression compromised the diagnostic performance for all TE-pairs. The use of T2 relaxation time threshold of < 112 ms as indicative of malignant lesion achieved a 100% sensitivity, 77% specificity, 88% positive predictive value and 100% negative predictive value. CONCLUSION Percentage signal intensity change on breath-hold TSE T2-weighted sequences at TE 80/160 ms appears to be a quick and potentially useful means of differentiating hepatic malignancy from haemangioma.
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Affiliation(s)
- Y L Chan
- Department of Diagnostic Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Abstract
In this article we describe state-of-the art techniques for magnetic resonance imaging of the liver. T1-weighted, T2-weighted, and heavily T2-weighted pulse sequences are discussed. Gadolinium-enhanced hepatic parenchymal imaging and magnetic resonance angiography are also described. A comprehensive MR imaging examination of the liver affords evaluation of focal and diffuse hepatic parenchymal disease, biliary disease, and vascular pathology.
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Affiliation(s)
- Adam R Fisher
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Jeong YY, Mitchell DG, Holland GA. Liver lesion conspicuity: T2-weighted breath-hold fast spin-echo MR imaging before and after gadolinium enhancement--initial experience. Radiology 2001; 219:455-60. [PMID: 11323472 DOI: 10.1148/radiology.219.2.r01ma09455] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the effect of a gadolinium chelate on T2-weighted breath-hold fast spin-echo magnetic resonance images of focal hepatic lesions. MATERIALS AND METHODS In 21 patients with focal hepatic lesions, identical T2-weighted breath-hold fast spin-echo images were obtained before and after gadolinium enhancement and were compared regarding lesion-to-liver contrast-to-noise ratio, signal-to-noise ratio, lesion conspicuity, and vascular pulsation artifact. Image review was performed independently, in random order, by two experienced radiologists. RESULTS For solid lesions, the lesion-to-liver contrast-to-noise ratio on enhanced images was significantly higher (P <.05) than that on nonenhanced images. For nonsolid lesions, however, there was no significant difference (P =.07). For both readers, lesion conspicuity for solid lesions on enhanced images was significantly higher than on nonenhanced images (P <.05). Severity of vascular pulsation artifact was not significantly different. CONCLUSION Solid-lesion contrast on T2-weighted breath-hold fast spin-echo images improves after administration of a gadolinium chelate. These images should be obtained after, rather than before, gadolinium enhancement.
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Affiliation(s)
- Y Y Jeong
- Department of Radiology, Thomas Jefferson University Hospital, 132 S 10th St, 1096 Main Bldg, Philadelphia, PA 19107, USA
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Tello R, Fenlon HM, Gagliano T, deCarvalho VL, Yucel EK. Prediction rule for characterization of hepatic lesions revealed on MR imaging: estimation of malignancy. AJR Am J Roentgenol 2001; 176:879-84. [PMID: 11264070 DOI: 10.2214/ajr.176.4.1760879] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our aims were to establish factors that are most predictive of hepatic lesion malignancy and to formulate a prediction rule. MATERIALS AND METHODS A cross-sectional study of 227 abdominal MR imaging examinations revealed 85 lesions in 67 patients (29 men, 38 women; age range, 29-78 years; mean age, 51.4 years) who were being examined for primary malignancy (n = 42) or unknown lesion characterization (n = 25). All were referred for MR imaging after CT or sonography. Patient demographics (age, sex, history of malignancy), lesion size and morphology, quantitative T2 calculation, and pattern of enhancement on gadopentetate dimeglumine administration were evaluated for predictive ability. RESULTS Thirty-two liver lesions were malignant (eight colon cancer, five breast cancer, four cervical cancer, three renal cancer, three lung cancer, and nine miscellaneous cancers), 53 were benign (37 hemangiomas, 15 cysts, and one focal nodular hyperplasia). Calculated T2 relaxation times (mean +/- standard deviation [SD]) were as follows: malignant tumors (91.72 +/- 21.9 msec), hemangiomas (136.1 +/- 26.3 msec), cysts (284.1 +/- 38.2 msec) (p < 0.001). Logistic regression analysis indicated that lesion size and sex and age of patient were not significant independent predictors (p > 0.05). However, the combination of a history of malignancy, T2 value, and gadopentetate dimeglumine-enhancement pattern allowed generation of a prediction rule with an area under the receiver operating characteristic curve of 0.95. The patient's weight, lesion morphology, and cell type of the primary malignancy did not provide additional predictive information (p > 0.2). CONCLUSION We recommend using the combination of T2 quantification and patient history of malignancy before deciding to administer gadopentetate dimeglumine for optimal lesion characterization, especially for equivocal lesions with T2 values between 90 and 130 msec. These factors allowed the construction of a prediction rule for lesion characterization.
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Affiliation(s)
- R Tello
- Department of Radiology, Boston University School of Medicine, Boston Medical Center, 88 E. Newton St., Atrium 2, , MA 02118, USA
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26
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Kanematsu M, Itoh K, Matsuo M, Maetani Y, Ametani F, Kondo H, Kato H, Hoshi H. Malignant hepatic tumor detection with ferumoxides-enhanced MR imaging with a 1.5-T system: comparison of four imaging pulse sequences. J Magn Reson Imaging 2001; 13:249-57. [PMID: 11169831 DOI: 10.1002/1522-2586(200102)13:2<249::aid-jmri1036>3.0.co;2-c] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of our study was to compare observer performance in the detection of malignant hepatic tumors with ferumoxides-enhanced magnetic resonance (MR) images obtained with proton density-weighted spin-echo (SE), T2-weighted fast SE, T2*-weighted gradient-recalled-echo (GRE), and proton density-weighted echo-planar (EP) sequences. Ferumoxides-enhanced MR images obtained with the four sequences in 50 patients with 92 solid malignant and 64 nonsolid benign lesions were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; a total of 397 liver segments was reviewed separately for solid and nonsolid lesions by three independent readers. Observer performance was evaluated with receiver operating characteristic analysis. Lesion-to-liver contrast-to-noise ratio was higher with SE and EP than with GRE and fast SE images for solid lesions (P < 0.05), and higher with fast SE and SE than with GRE images for nonsolid lesions (P < 0.01). Proton density-weighted SE and T2-weighted fast-SE images were superior to T2*-weighted GRE and proton density-weighted EP images for detection of malignant hepatic tumors. T2-weighted fast SE images were the best for detection of nonsolid lesions. T2-weighted fast SE images that were comparable to proton density-weighted SE images for solid tumor detection, that were the best for nonsolid lesion detection, and that had an acquisition time of one third to half of that of SE imaging may be able to replace SE images for ferumoxides-enhanced liver imaging.
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Affiliation(s)
- M Kanematsu
- Department of Radiology, Gifu University School of Medicine, Gifu 500-8705, Japan.
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Matsuo M, Kanematsu M, Murakami T, Kim T, Hori M, Kondo H, Nakamura H, Hoshi H. T2-weighted MR imaging for focal hepatic lesion detection: supplementary value of breath-hold imaging with half-Fourier single-shot fast spin-echo and multishot spin-echo echoplanar sequences. J Magn Reson Imaging 2000; 12:444-52. [PMID: 10992312 DOI: 10.1002/1522-2586(200009)12:3<444::aid-jmri10>3.0.co;2-#] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The purpose of our study was to evaluate the supplementary value of breath-hold fat-suppressed T2-weighted magnetic resonance (MR) imaging with half-Fourier single-shot fast spin-echo (SE) or multishot SE echoplanar (EP) sequences combined with respiratory-triggered fat-suppressed fast SE T2-weighted MR imaging for detection and characterization of focal hepatic lesions. MR images in 42 patients with 82 solid, malignant and 77 nonsolid, benign lesions were analyzed. Image review was conducted on a segment-by-segment basis; in all, 333 liver segments were reviewed separately for solid and nonsolid lesions by three independent radiologists. For solid lesions, observer performance with receiver-operating-characteristic (ROC) analysis in one radiologist and specificity in another significantly improved after adding single-shot fast SE images. For nonsolid lesions, observer performance with ROC analysis in one radiologist and specificity in another significantly improved after adding single-shot fast SE images. Combining breath-hold half-Fourier single-shot fast SE imaging with respiratory-triggered fast SE imaging may be recommended for improved detection and characterization of focal hepatic lesions. J. Magn. Reson. Imaging 2000;12:444-452.
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Affiliation(s)
- M Matsuo
- Department of Radiology, Gifu University School of Medicine, Gifu 500-8705, Japan
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Abstract
OBJECTIVE The purpose of this study was to evaluate whether ferumoxides-enhanced MR imaging of focal hepatic lesions provides distinctive signal intensity and lesion-to-liver contrast changes for benign and malignant lesions, helping to further characterize and differentiate these lesions. MATERIALS AND METHODS Data analysis was performed on 70 patients, with previously identified focal hepatic lesions, who underwent MR imaging of the liver before and after IV administration of ferumoxides (10 micromol Fe/kg). Lesions analyzed with pathologically proven diagnoses included metastases (n = 40), hepatocellular carcinoma (n = 11), cholangiocarcinoma (n = 6), hemangioma (n = 4), focal nodular hyperplasia (n = 6), and hepatocellular adenoma (n = 3). Response variables measured and statistically compared included the percentage of signal-intensity change and lesion-to-liver contrast. RESULTS Focal nodular hyperplasia showed significant signal intensity loss on ferumoxides-enhanced T2-weighted images (mean, -43%+/-6.7%, p < 0.01). All other lesion groups showed no statistically significant change in signal intensity on ferumoxides-enhanced T2-weighted images, although signal intensity loss was seen in some individual hepatocellular adenomas (mean, -6.6%+/-24.0%) and hepatocellular carcinomas (mean, -3.3%+/-10.3%). All lesions, with the exception of hepatocellular carcinoma, had a marked increase in lesion-to-liver contrast on ferumoxides-enhanced T2-weighted images, which was statistically significant for metastases and hemangioma (p < 0.02). CONCLUSION Focal nodular hyperplasia shows significant decrease in signal intensity on ferumoxides-enhanced T2-weighted images, which may aid in the differentiation of focal nodular hyperplasia from other focal hepatic lesions. Other lesions, namely, hepatocellular adenoma and carcinoma, can have reticuloendothelial uptake, but usually to a lesser degree than that of focal nodular hyperplasia.
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Affiliation(s)
- M R Paley
- Department of Radiology, University of Florida College of Medicine, Gainesville 32610, USA
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Fenlon HM, Tello R, deCarvalho VL, Yucel EK. Signal characteristics of focal liver lesions on double echo T2-weighted conventional spin echo MRI: observer performance versus quantitative measurements of T2 relaxation times. J Comput Assist Tomogr 2000; 24:204-11. [PMID: 10752879 DOI: 10.1097/00004728-200003000-00004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this work was to evaluate the ability of expert readers to differentiate benign from malignant liver lesions based on visual assessment of lesion signal intensity on double echo T2-weighted conventional spin echo (CSE) MR images and to compare reader performance with quantitative measurements of T2 relaxation times. METHOD Sixty-seven MR examinations demonstrating 85 liver lesions (37 hemangiomas, 32 malignancies, 15 cysts, and 1 focal nodular hyperplasia) on double echo T2-weighted CSE sequences (TR 3,600 ms/TE 50, 160 ms) were qualitatively reviewed by three independent readers. T2 relaxation times were calculated for each lesion. Receiver operating characteristic (ROC) analyses of expert readers were compared with calculated T2 relaxation times. RESULTS T2 values performed significantly better than subjective reader analysis for liver lesion characterization (area under ROC = 0.93 vs. 0.81, 0.78, and 0.75; p < 0.0001). With use of a T2 threshold of 125 ms, the sensitivity of T2 values for malignant lesions was 100%, specificity 71%, and accuracy 84%. By comparison, the sensitivity of the three readers for malignant lesions was 76-83%, with a specificity of 61-72% and an overall accuracy of 71-80%. CONCLUSION Despite expert reader analyses, subjective evaluations of liver lesion signal characteristics are prone to inaccuracy and lack certainty and consistency when intermediate TEs (50/160 ms) are used. Quantitative measurements of T2 relaxation times should be performed to accurately and confidently differentiate benign from malignant liver lesions. Use of a higher T2 threshold than previously recommended is required to avoid misclassification of malignancies.
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Affiliation(s)
- H M Fenlon
- Department of Radiology, Boston University School of Medicine, Boston Medical Center, MA 02118, USA
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Bennett GL, Petersein A, Mayo-Smith WW, Hahn PF, Schima W, Saini S. Addition of gadolinium chelates to heavily T2-weighted MR imaging: limited role in differentiating hepatic hemangiomas from metastases. AJR Am J Roentgenol 2000; 174:477-85. [PMID: 10658728 DOI: 10.2214/ajr.174.2.1740477] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether the addition of gadolinium-enhanced imaging to heavily T2-weighted MR imaging of the liver is valuable in differentiating hemangiomas from metastases. The T2 relaxation time was also included in our analysis. SUBJECTS AND METHODS Fifty-one patients with 52 proven liver lesions (24 hemangiomas and 28 metastases) larger than 1 cm underwent MR imaging at 1.5 T with T2-weighted spin-echo (TR/TE, 3000/80, 160) and gadolinium chelate-enhanced dynamic T1-weighted gradient-recalled echo (80/2.6, 80) pulse sequences. Images were reviewed by observers who were unaware of the patients' clinical history; first, only T2-weighted images were reviewed and then T2-weighted plus dynamic images were reviewed together. The T2 relaxation times were calculated for each lesion. Diagnostic accuracy by each method was compared using receiver operating characteristic analysis. RESULTS Mean T2 relaxation times were 76 +/- 26 msec for metastases and 133 +/- 25 msec for hemangiomas. The addition of dynamic scanning to the T2-weighted sequence made a statistically significant difference for only one observer (p = 0.03). However, it did not make a statistically significant contribution for either observer when compared with the T2 relaxation time. Although addition of the dynamic images resulted in correct diagnosis of six lesions, three lesions were misdiagnosed after having been correctly characterized on the T2-weighted images alone. CONCLUSION When optimized T2-weighted images are obtained and the T2 relaxation time is calculated, routine use of gadolinium enhancement for differentiation of hemangiomas from metastases is unnecessary although dynamic scanning is valuable in selected cases.
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Affiliation(s)
- G L Bennett
- Department of Diagnostic Imaging, Brown University School of Medicine, Rhode Island Hospital, Providence 02903, USA
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Kanematsu M, Hoshi H, Murakami T, Itoh K, Hori M, Inaba Y, Kondo H, Yokoyama R, Nakamura H. Fat-suppressed T2-weighted MR imaging of hepatocellular carcinoma and metastases: comparison of conventional spin-echo, fast spin-echo, and echoplanar pulse sequences. J Magn Reson Imaging 1999; 10:25-32. [PMID: 10398974 DOI: 10.1002/(sici)1522-2586(199907)10:1<25::aid-jmri4>3.0.co;2-r] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The purpose of our study was to compare the diagnostic accuracy of fat-suppressed T2-weighted magnetic resonance (MR) images obtained with conventional spin-echo (SE), respiratory-triggered fast SE, and breath-hold multishot SE echoplanar (EP) sequences for the detection of hepatocellular carcinoma and metastases. Images obtained with the three sequences in 17 patients (15 with cirrhosis) with 31 hepatocellular carcinomas and 14 patients with 45 metastases were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; in all, 248 liver segments were reviewed separately and independently for detection of solid, malignant lesions. Diagnostic accuracy was evaluated with receiver-operating-characteristic (ROC) curve analysis. Diagnostic accuracy for hepatocellular carcinoma as determined by ROC curve analysis was better by a statistically significant amount for conventional SE (Az = 0.95) images when compared with respiratory-triggered fast SE (Az = 0.83, P < 0.05) and breath-hold multishot SE EP (Az = 0.80, P < 0.05) images. Conventional SE MR sequences should not be replaced with respiratory-triggered fast SE or breath-hold multishot SE EP sequences for T2-weighted MR imaging of patients with hepatocellular carcinoma in cirrhosis, unless sufficient contrast-enhanced dynamic MR imaging is subsequently performed.
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Affiliation(s)
- M Kanematsu
- Department of Radiology, Gifu University School of Medicine, Japan.
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Kanematsu M, Hoshi H, Itoh K, Murakami T, Hori M, Kondo H, Yokoyama R, Nakamura H. Focal hepatic lesion detection: comparison of four fat-suppressed T2-weighted MR imaging pulse sequences. Radiology 1999; 211:363-71. [PMID: 10228515 DOI: 10.1148/radiology.211.2.r99ma23363] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate fat-suppressed T2-weighted magnetic resonance (MR) imaging with conventional spin-echo (SE), breath-hold fast SE, respiratory-triggered fast SE, and breath-hold multishot SE echo-planar sequences for the detection of focal hepatic lesions. MATERIALS AND METHODS Fat-suppressed T2-weighted MR images obtained with the four sequences in 55 patients with 81 solid and 129 nonsolid lesions were retrospectively analyzed. Image review was conducted on a segment-by-segment basis; a total of 440 liver segments were reviewed separately for solid and nonsolid lesions by three independent radiologists. Diagnostic accuracy was evaluated with receiver operating characteristic analysis. RESULTS The mean lesion-to-liver contrast-to-noise ratio was highest on the multishot SE echo-planar images of both solid and nonsolid lesions. Fat-suppressed respiratory-triggered fast SE images had significantly better (P < .05) or comparative detectability of both solid and nonsolid lesions compared with the other types of images. Image quality was best on the respiratory-triggered fast SE images. CONCLUSION Fat-suppressed respiratory-triggered fast SE imaging should replace fat-suppressed conventional SE imaging as a standard T2-weighted imaging examination in the detection of focal hepatic lesions.
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Affiliation(s)
- M Kanematsu
- Department of Radiology, Gifu University School of Medicine, Japan
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Fujita T, Ito K, Honjo K, Okazaki H, Matsumoto T, Matsunaga N. Detection of hepatocellular carcinoma: comparison of T2-weighted breath-hold fast spin-echo sequences and high-resolution dynamic MR imaging with a phased-array body coil. J Magn Reson Imaging 1999; 9:274-9. [PMID: 10077024 DOI: 10.1002/(sici)1522-2586(199902)9:2<274::aid-jmri18>3.0.co;2-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The purpose of our study was to compare T2-weighted breath-hold fast spin-echo sequence (BHFSE) and high-resolution dynamic MR imaging (HR-DMRI) in the detection of hepatocellular carcinoma (HCC). Short and long T2-weighted BHFSE sequences and biphasic HR-DMRI including arterial-dominant and delayed phase images with a phased-array body coil were performed in 30 consecutive patients with 37 HCCs. The lesion-to-liver contrast-to-noise ratio (CNR) was quantitatively measured. The lesion conspicuity and delineation was qualitatively rated according to a four-point scale. The lesion-to-liver CNR was highest with the arterial-dominant phase HR-DMRI and was significantly higher than those obtained with both short and long T2-weighted BHFSE and those obtained with unenhanced and delayed HR-DMRI. The CNR obtained with short T2-weighted BHFSE was significantly higher than those obtained with long T2-weighted BHFSE and with unenhanced and delayed HR-DMRI. The sensitivity for the sequences was 78.4% (29/37) for short T2-weighted BHFSE, 67.6% (25/37) for long T2-weighted BHFSE, 37.8% (14/37) for unenhanced HR-DMRI, 97.3% (36/37) for arterial-dominant phase HR-DMRI, and 43.2% (16/37) for delayed HR-DMRI. The sensitivity of serial dynamic MR imaging combined with unenhanced, arterial-dominant phase imaging and delayed phase imaging was 100% (37/37). The score in the qualitative analysis of the lesion conspicuity and delineation was highest for the arterial-dominant phase HR-DMRI and was significantly higher than that for the short T2-weighted BHFSE. The score for the short T2-weighted BHFSE was significantly higher than that for the long T2-weighted BHFSE and that for the unenhanced HR-DMRI. Arterial-dominant phase HR-DMRI is superior to the T2-weighted BHFSE technique, and also HR-DMRI combined with unenhanced, arterial-dominant and delayed phases is the most sensitive technique in the detection of HCC.
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Affiliation(s)
- T Fujita
- Department of Radiology, Yamaguchi University School of Medicine, Ube, Japan
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Okada Y, Ohtomo K, Kiryu S, Sasaki Y. Breath-hold T2-weighted MRI of hepatic tumors: value of echo planar imaging with diffusion-sensitizing gradient. J Comput Assist Tomogr 1998; 22:364-71. [PMID: 9606375 DOI: 10.1097/00004728-199805000-00005] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of our study was to evaluate the efficacy of echo planar imaging (EPI) as a breath-holding T2-weighted technique for imaging focal hepatic lesions. METHOD Forty-eight patients with focal hepatic lesions (9 metastases, 21 hepatocellular carcinomas, 1 cholangiocarcinoma, 16 hemangiomas, and 2 cysts) underwent single shot EPI with and without a small diffusion-sensitizing gradient (DSG) (beta values = 55 s/mm2) at 1.5 T. Comparison was made with breath-holding T2-weighted fast SE (FSE) sequences. RESULTS Lesion-to-liver signal intensity ratio of EPI was significantly better than that of T2-weighted FSE (p < 0.05) in patients with metastasis. Use of DSG suppressed bright signals from vessels or periportal tissue, resulting in better conspicuity of small lesions. EPI with DSG visualized more metastatic deposits than T2-weighted FSE (p < 0.01). CONCLUSION EPI with a small DSG is helpful for detection of small hepatic metastases.
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Affiliation(s)
- Y Okada
- Department of Radiology, University of Tokyo, Japan
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Abstract
This article reviews the currently available MR imaging techniques that are useful for the detection and characterization of focal and diffuse liver pathology. The implementation and clinical utility of various T1-weighted, T2-weighted, T2*-weighted, and MR angiographic sequences are described.
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Affiliation(s)
- E S Siegelman
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania Medical Center, Philadelphia, USA
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