Prediction of early response to radiotherapy of uterine carcinoma with dynamic contrast-enhanced MR imaging using pixel analysis of MR perfusion imaging

Purpose

To assess the predictability of the response to radiotherapy of uterine carcinoma, this study retrospectively analyzed dynamic contrast-enhanced magnetic resonance images (DCE-MRI) taken before radiotherapy.

Materials and Methods

Forty-two patients with uterine carcinoma were studied, of whom 22 had adenocarcinoma and 20 had squamous cell carcinoma (SCC). In DCE-MRI analysis, two parameters, SIe and R_down, were measured. SIe is a median value for the degree of signal intensity change in all selected pixels in the tumor at 1–2 min after contrast agent injection. R_down is the ratio of the number of down-sloped pixels to that of all selected pixels 3–7 min after injection. The tumor volume reduction rate (TVRR) was measured by MRI-based volumetry in pre- and post-radiotherapy transverse T2-weighted images.

Results

Overall, TVRR was significantly correlated to both SIe (r=0.37, P=.015) and R_down (r=0.73, P<.0001). In the separate patient groups, SIe but not R_down was significantly different between the adenocarcinoma and SCC patients (t=3.64, P<.001). TVRR was not correlated to SIe in any group. TVRR was significantly correlated to R_down in adenocarcinoma patients (r=0.78, P<.001) but not in SCC patients.

Conclusion

SIe may reflect differences in histological characteristics. R_down may be useful for predicting the response to radiotherapy of uterine carcinoma.     

Diffusion-weighted magnetic resonance imaging of human skeletal muscles: gender-, age- and muscle-related differences in apparent diffusion coefficient

Purpose

To evaluate the apparent diffusion coefficient (ADC) of skeletal muscle based on signal intensity (SI) attenuation vs. increasing b values and to determine ADC differences in skeletal muscles between genders, age groups and muscles.

Materials and Methods

Diffusion-weighted images (b values in the range of 0–750 s/mm² at increments of 50 s/mm²) of the ankle dorsiflexors (116 subjects) and the erector spinae muscles (86 subjects) were acquired with a 1.5-T MR device. From the two different slopes obtained in SI vs. b-value logarithmic plots, ADC^b0–50 (b values=0 and 50 s/mm²) reflected diffusion and perfusion, while ADC^b50–750 (b values in the range of 50–750 s/mm² at increments of 50 s/mm²) approximated the true diffusion coefficient. Moreover, to evaluate whether this b-value combination is appropriate for assessing the flow component within muscles, diffusion-weighted images of the ankle dorsiflexors (10 subjects) were obtained before and during temporal arterial occlusion.

Results

ADC^b0–50 and ADC^b50–750 were found to be 2.64×10^–3 and 1.44×10^–3 mm²/s in the ankle dorsiflexors, and 3.02×10^–3 and 1.49×10^–3 mm²/s in the erector spinae muscles, respectively. ADC^b0–50 was significantly higher than ADC^b50–750 in each muscle (P<.01). The erector spinae muscles showed significantly higher ADC values than the ankle dorsiflexors (P<.01). However, for each muscle, there were few significant gender- and age-related ADC differences. Following temporal occlusion, ADC^b0–50 of the ankle dorsiflexors decreased significantly from 2.49 to 1.6×10^–3 mm²/s (P<.01); however, ADC^b50–750 showed no significant change.

Conclusion

Based on the SI attenuation pattern, muscle ADC could be divided into ADC that reflects both diffusion and perfusion, and ADC that approximates a true diffusion coefficient. There were significant differences in ADC of functionally distinct muscles. However, we barely found any gender- or age-related ADC differences for each muscle.     

MRI findings in nonalcoholic steatohepatitis: correlation with histopathology and clinical staging

Purpose

To evaluate magnetic resonance imaging (MRI) findings of nonalcoholic steatohepatitis (NASH) and to determine the correlation of MRI findings with histopathology and Mayo End-Stage Liver Disease (MELD) score.

Materials and Methods

Thirty patients (18 males, 12 females; mean age: 57±8.9 years; age range: 35–71 years) with histopathologically proven NASH who underwent MRI examinations between January 2001 and October 2005 were included in the study. Two radiologists retrospectively reviewed all magnetic resonance (MR) examinations in consensus to evaluate the presence and extent of predetermined findings of NASH including liver steatosis, early patchy liver enhancement indicating inflammation and liver fibrosis. The findings detected on MRI were correlated and compared to histopathological findings and MELD score by using nonparametric Spearman correlation coefficient and Kruskal–Wallis analysis of variance.

Results

Liver steatosis was observed in 10 of 30 patients; early patchy liver enhancement, in 8 of 30 patients and liver fibrosis in 19 of 30 patients on MR images. Liver fibrosis was reticular in all these patients. There were statistically significant moderate correlations between MRI findings of liver steatosis and histopathologic grades of steatosis (r=0.43; P<.05), and between MRI findings of fibrosis and histopathologic stages of fibrosis (r=0.61; P<.001). Early patchy enhancement did not demonstrate statistically significant correlation with inflammation (P=.28). There was no statistically significant overall correlation between MRI findings of NASH and MELD score.

Conclusion

MRI findings of liver steatosis and fibrosis in NASH showed moderate correlations with histopathologic grades of steatosis and stages of fibrosis, but MRI findings of NASH did not demonstrate any significant correlations with MELD score.     

Central neurocytoma: proton MR spectroscopy and diffusion weighted MR imaging findings

Purpose

To present proton magnetic resonance spectroscopy and diffusion-weighted imaging (DWI) findings of central neurocytoma (CN).

Methods and Materials

Imaging findings of seven patients with the histopathological diagnosis of CN (five male and two female; age range, 21–28 years of age) were evaluated retrospectively. In addition to conventional magnetic resonance imaging features, we also assessed the metabolite ratios and tumor normalized apparent diffusion coefficient (NADC), which was calculated by dividing the tumor apparent diffusion coefficient (ADC) values by normal ADC. Approval from our institutional review board was obtained for this review.

Results

The tumor choline/creatine ratios were 5.17±2.38, while N-acetyl aspartate/choline and N-acetyl aspartate/creatine ratios were 0.33±0.15 and 1.84±1.38, respectively. On DWI, tumors had heterogeneous hyperintense appearances when compared with the contralateral parietal lobe white matter and tumor NADC values were 0.63±0.05.

Conclusion

Significantly increased choline/creatine and decreased N-acetyl aspartate/choline ratios with lower NADC values in CN resemble high-grade gliomas and complicate the diagnosis. Familarity its physiologic features would help to presurgical diagnosis of ventricular and exraventricular CNs.     

Preoperative demonstration of neurovascular relationship in trigeminal neuralgia by using 3D FIESTA sequence

Purpose

The purpose of the study was to evaluate the value of high-resolution three-dimensional fast imaging employing steady-state acquisition (3D FIESTA) imaging in the visualization of neurovascular relationship in patients with trigeminal neuralgia (TN).

Methods

Thirty-seven patients with unilateral typical TN underwent 3D FIESTA imaging. Neurovascular relationship at the trigeminal root entry zone was reviewed by an experienced neuroradiologist, who was blinded to the clinical details. The imaging results were compared with the operative findings in all patients.

Results

In 37 patients with TN, 3D FIESTA imaging identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves. Based on surgical findings, the sensitivity and specificity of magnetic resonance (MR) imaging were 97.2% and 100%, respectively. Agreement between the position (medial, lateral, superior and inferior) of the compressing vessel relative to the trigeminal nerve identified by MR imaging and surgery was excellent (K=0.81; 95% confidence interval, 0.56–1.00). A statistically significant difference was found between the site of neurovascular contact and the clinical symptom related to the trigeminal branch (Fisher's Exact Test, P<.001).

Conclusions

Use of 3D FIESTA sequence enables accurate visualization of neurovascular contact in patients with TN. Anatomic relationships defined by this method can be useful in surgical planning and predicting surgical findings.     

Feasibility of post-gadolinium three-dimensional gradient-echo sequence to evaluate the pulmonary arterial vasculature

Purpose

To determine the feasibility of post-gadolinium three-dimensional gradient-echo (3D-GE) sequence for the evaluation of the pulmonary arterial vasculature in patients with suspected pulmonary embolism (PE) and in patients with a variety of other disease processes.

Materials and Methods

Twenty-six consecutive patients (18 females, 8 males; mean age±S.D., 46.6±21.1 years) who underwent chest magnetic resonance imaging (MRI) including post-gadolinium 3D-GE sequence for the evaluation of PE (Group A, n=13) and a variety of other disease processes (Group B, n=13) were included in the study. Post-gadolinium 3D-GE MR sequences were retrospectively, independently and blindly evaluated by two reviewers for the image quality of pulmonary arterial vasculature, and findings of PE and other disease processes. Clinical and imaging follow-up data for all patients were obtained. Interobserver agreement was calculated by kappa statistics.

Results

All central and lobar pulmonary arteries, 71.4–89.6% of segmental arteries and 46.7–52.7% of subsegmental arterial units in both groups were visualized with sufficient diagnostic image quality on post-gadolinium 3D-GE sequences. PE involving lobar and segmental arteries was diagnosed in two patients in each group. Other disease processes including pneumonia, lung nodules, superior vena cava stenosis, lung metastases, chronic lymphocytic leukemia and aortic aneurysm were detected in 10 of 26 patients. There was good to excellent interobserver agreement (0.73 to 1.00) for all findings.

Conclusion

Post-gadolinium 3D-GE sequence may be an alternative technique for the visualization of central, lobar and segmental arteries, and may diagnose PE and other pathologies involving the chest in different patient populations.     

Impact of diffusion-weighted MR imaging on the characterization of small hepatocellular carcinoma in the cirrhotic liver

Purpose

The purpose of this study was to determine whether or not adding diffusion-weighted magnetic resonance imaging (DWI) to conventional magnetic resonance (MR) imaging sequences improves the characterization of small hepatocellular carcinoma (HCC) (≤2 cm) in the setting of cirrhotic liver compared to conventional sequences alone.

Materials and Methods

A total of 62 cirrhotic liver patients with 82 nodules smaller than 2 cm in diameter were enrolled, and all lesions were pathologically confirmed. For the first reading session, which included precontrast T1- and T2-weighted images and T1 dynamic contrast-enhanced images, preindicated lesions by a study coordinator were characterized by two radiologists. They determined the confidence levels in consensus for the presence of small HCC into four grades. In another session, respiratory-triggered diffusion-weighted MR images (b factor=50, 400 and 800 s/mm²) were added to the previously reviewed images, and the same two radiologists again determined the confidence levels. The diagnostic performance of the combined DWI–conventional sequences set and the conventional sequences alone set was evaluated using receiver operating characteristic curves. Sensitivity and specificity values for characterizing small HCCs were also calculated.

Results

The area under the receiver operating characteristic curve for the second interpretation session (0.86) was significantly higher (P=.038) than that of the first session (0.76). The sensitivity was significantly increased from 75.7% to 87.8% by adding DWI to the conventional sequences (P=.015). No significant differences were observed for specificity values.

Conclusion

Adding DWI to conventional imaging modalities improves the diagnosis of small HCCs in the cirrhotic liver in terms of diagnostic performance and sensitivity by increasing reader confidence.     

Prominent signal intensity of T1/T2 prolongation in subcortical white matter of the anterior temporal region on conventional screening MRI of late preterm infants with normal development

Purpose

This study discusses prominent signal intensity of T₁/T₂ prolongation of subcortical white matter within the anterior temporal region in premature infant brains that radiologists may encounter when interpreting conventional screening MRIs.

Materials and Methods

T₁- and T₂-weighted images of 69 preterm and term infants with no neurological abnormalities or developmental delays were evaluated retrospectively for areas of prominent signal intensity of T₁/T₂ prolongation in white matter. We measured signal intensities of anterior temporal white matter, deep temporal white matter, frontopolar white matter and subcortical white matter of the precentral gyrus. We accessed chronological changes in signal intensity in the anterior and deep temporal white matter. We also analyzed variance tests among the signal intensity ratios to the ipsilateral thalamus of white matter areas by gestational age.

Results

There was high frequency of prominent signal intensity of T₁/T₂ prolongation in the temporal tip, particularly at a gestational age of 36–38 weeks. Signal intensity ratio of the anterior temporal white matter was lower on T₁-weighted images and higher on T₂-weighted images, and the finding became less prominent with increasing gestational age. The signal intensity ratios of anterior temporal white matter at a gestational age of 36–37 weeks and 38–39 weeks were significantly different from other regions.

Conclusion

Prominent signal intensity of T₁/T₂ prolongation of subcortical white matter of the anterior temporal region is seen in normal premature infants, especially those at 36–39 gestational weeks. Although it is a prominent finding, radiologists should understand that these findings do not represent a pathological condition.     

Contrast changes in portal vein and bile duct between centric and linear k-space ordering on three-dimensional segmented true fast imaging with steady-state precession magnetic resonance imaging

Purpose

To compare the degree of visualization of the bile duct and portal vein in terms of the difference in k-space ordering on a three-dimensional (3D) segmented true fast imaging with steady-state precession (trueFISP) sequence.

Materials and Methods

A breath-hold coronal 3D segmented trueFISP sequence was prospectively performed on 14 healthy volunteers. Images obtained with centric and linear k-space ordering in the k(x)–k(y) plane were compared by two independent radiologists qualitatively with depiction scores on a five-point scale (1=not seen to 5=excellent depiction) using the Wilcoxon signed-rank test. Images were also compared quantitatively using relative contrast values for the bile duct and portal vein against the hepatic parenchyma using a paired t-test.

Results

With centric ordering, both the mean depiction scores and relative contrast values for the portal vein were significantly lower than those with linear ordering (1.5 vs. 3.5, P<.01; and 0.08±0.19 vs. 0.51±0.10, P<.01, respectively). However, in the bile duct, there were no significant differences, only slight differences were found among the results obtained with centric and linear ordering (3.9 vs. 3.8, P=.72; and 0.59±0.06 vs. 0.68±0.06, P<.01, respectively).

Conclusion

For visualizing the bile duct, centric k-space ordering on 3D segmented trueFISP sequence is recommended, while linear ordering is recommended for portal vein visualization.     

Isotropic proton-density-weighted high-resolution MRI for volume measurement of reconstructed orbital fractures--a comparison with multislice CT

Objective

The cause of enophthalmos as a late complication after orbital reconstruction is poorly investigated. Multislice CT (MSCT) is usually employed for its assessment, in spite of limitations regarding soft tissue depiction/imaging, as well as the implication of radiation and production of artifacts. Magnetic resonance imaging (MRI) has been shown to be a valuable alternative. The aim of this study was to establish a bony and soft tissue orbital volume calculation method based on different high-resolution MRI sequences compared to MSCT.

Materials and Methods

Thirty-seven patients were included in this prospective study investigating the origin of enophthalmos present 3–4 months after complex orbital reconstruction. Morphological and dimensional changes of the orbit, eye globes, extraocular muscles and fat content were investigated 3–4 months after surgery. To assess the site and size of bony and soft tissue changes in the traumatized orbits, we used MSCT and MR images as well as corresponding 3-D reconstructions.

Results

All enophthalmic orbits revealed a significant bony volume increase compared to the contralateral side as well as a reduced sagittal eye projection. Mean orbital volume enlargements of 1.0 cm³ lead to 0.93 mm enophthalmos (P<.05). Hardly any fatty atrophy could be depicted by the different MRI techniques.

Conclusions

For soft tissue depiction of the orbit, MRI was superior to MSCT. Particularly, proton density weighting proved to be the best sequence for soft tissue volume segmentation, allowing determination of the cause and degree of posttraumatic enophthalmos in reconstructed orbits.     

Visualization of liver uptake function using the uptake contrast-enhanced ratio in hepatobiliary phase imaging

Purpose

To visualize liver uptake function using the uptake contrast-enhanced ratio in hepatobiliary phase (uptake CERH) magnetic resonance imaging.

Materials and methods

Thirty-seven patients with hepatocellular carcinoma (HCC) and 23 with metastatic liver cancer were evaluated. Hepatobiliary phase images were acquired 20 min after an intravenous bolus injection of gadoxetic acid disodium. We assumed that the contrast-enhanced ratio in the hepatobiliary phase (CERH) in the spleen was similar to the contrast-enhanced ratio in the extracellular matrix (CEREM). The Uptake CERH value was defined as the percentage signal gain between the precontrast and hepatobiliary phase images (without CEREM). The Uptake CERH value measured the tumor-free liver parenchyma. The association of the uptake CERH value with the biochemical liver function test results, and hepatocellular density in the liver parenchyma was assessed. Correlations were examined using Pearson correlation coefficient and the Mann–Whitney test.

Results

The uptake CERH value was correlated with albumin, bilirubin, indocyanine green retention rate at 15 min, prothrombin activity(%), platelet count, and cellular density in the liver parenchyma (p < 0.01).

Conclusions

Uptake CERH images are useful for visualizing liver uptake function.     

Assessment of early response to concurrent chemoradiotherapy in cervical cancer: value of diffusion-weighted and dynamic contrast-enhanced MR imaging

Purpose

To investigate diffusion-weighted (DWI) and dynamic contrast-enhanced MR imaging (DCE-MRI) as early response predictors in cervical cancer patients who received concurrent chemoradiotherapy (CCRT).

Materials and methods

Sixteen patients with cervical cancer underwent DWI and DCE-MRI before CCRT (preTx), at 1 week (postT1) and 4 weeks (postT2) after initiating treatment, and 1 month after the end of treatment (postT3). At each point, apparent diffusion coefficient (ADC) and DCE-MRI parameters were measured in tumors and gluteus muscles (GM). Tumor response was correlated with imaging parameters or changes in imaging parameters at each point.

Results

At each point, ADC, K^trans and V_e in tumors showed significant changes (P < 0.05), as compared with those of GM (P > 0.05). PostT1 tumor ADCs showed a significant correlation with tumor size response at postT2 (P = 0.041), and changes in tumor ADCs at postT1 had a significant correlation with tumor size (P = 0.04) and volume response (P = 0.003) at postT2. In tumors, preTx K^trans and V_e showed significant correlations with tumor size at postT3 (P = 0.011) and tumor size response at postT2 (P = 0.019), respectively.

Conclusion

DWI and DCE-MRI, as early biomarkers, have the potential to evaluate therapeutic responses to CCRT in cervical cancers.     

Bi-exponential diffusion signal decay in normal appearing white matter of multiple sclerosis

Purpose

Our aim was to characterize bi-exponential diffusion signal changes in normal appearing white matter of multiple sclerosis (MS) patients.

Methods

Diffusion parameters were measured using mono-exponential (0–1000 s/mm²) and bi-exponential (0–5000 s/mm²) approaches from 14 relapsing-remitting subtype of MS patients and 14 age- and sex-matched controls after acquiring diffusion-weighted images on a 3T MRI system. The results were analyzed using parametric or nonparametric tests and multiple linear regression models.

Results

Mono-exponential apparent diffusion coefficient (ADC) slightly increased in controls (P=.09), but decreased significantly in MS as a function of age, nonetheless an elevated ADC was observed with increasing lesion number in patients. Bi-exponential analyses showed that the increased ADC is the result of decreased relative volume fraction of slow diffusing component (f_s). However, the fast and slow diffusion components (ADC_f, ADC_s) did not change as a function of either age in controls or lesion number and age in MS patients.

Conclusions

These data demonstrated that the myelin content of the white matter affects diffusion in relapsing-remitting subtype of multiple sclerosis that is possibly a consequence of the shift between different water fractions.     

Pulse wave velocity with 4D flow MRI: Systematic differences and age-related regional vascular stiffness

Purpose

The objective of this study was to compare multiple methods for estimation of PWV from 4D flow MRI velocity data and to investigate if 4D flow MRI-based PWV estimation with piecewise linear regression modeling of travel-distance vs. travel time is sufficient to discern age-related regional differences in PWV.

Methods

4D flow MRI velocity data were acquired in 8 young and 8 older (age: 23 ± 2 vs. 58 ± 2 years old) normal volunteers. Travel-time and travel-distance were measured throughout the aorta and piecewise linear regression was used to measure global PWV in the descending aorta and regional PWV in three equally sized segments between the top of the aortic arch and the renal arteries. Six different methods for extracting travel-time were compared.

Results

Methods for estimation of travel-time that use information about the whole flow waveform systematically overestimate PWV when compared to methods restricted to the upslope-portion of the waveforms (p < 0.05). In terms of regional PWV, a significant interaction was found between age and location (p < 0.05). The age-related differences in regional PWV were greater in the proximal compared to distal descending aorta.

Conclusion

Care must be taken as different classes of methods for the estimation of travel-time produce different results. 4D flow MRI-based PWV estimation with piecewise linear regression modeling of travel-distance vs. travel time can discern age-related differences in regional PWV well in line with previously reported data.     

Early contrast enhancement of the liver: exact description of subphases using MRI

Purpose

The purpose of this study was to describe the subphases of early post-contrast enhancement of the liver, using vessel enhancement patterns, and correlate these findings with enhancement patterns of abdominal organs.

Materials and Methods

A total of 114 patients who underwent gadolinium-enhanced abdominal magnetic resonance imaging examinations constituted the final study group, of which 56 were women (age range, 3–94 years; mean, 50 years) and 58 were men (age range, 6–85 years; mean, 54 years). Early post-contrast sequences in all patients were evaluated retrospectively by two reviewers for the determination of the presence of contrast enhancement in predetermined major vessels of the abdomen and qualitative and quantitative extent of enhancement of the renal cortex, spleen, pancreas and liver. Based on the overall findings, subphases of early contrast enhancement of the liver were described and quantitative extent of enhancement of organs was correlated with subphases of early contrast enhancement of the liver. Mann–Whitney U test and one-way unbalanced analysis of variance tests were used for the comparisons.

Results

Early hepatic arterial phase was observed in 14/114 patients, mid-hepatic arterial phase in 23/114 patients, late hepatic arterial phase in 33/114 patients, splenic vein only hepatic arterial dominant phase in 20/114 patients and hepatic arterial dominant phase in 24/114 patients. There was an overall association between the subphases of enhancement and the quantitative extent of enhancement for all studied organs (P<.0001).

Conclusion

The evaluation of vessel and organ enhancement patterns has allowed the characterization of five different subphases in early post-contrast enhancement of the liver. The quantitative extent of enhancement of abdominal organs also demonstrated significant correlation with these five subphases.     

Magnetic resonance T1ρ imaging of osteoarthritis: a rabbit ACL transection model

Objective

The objective of this study was to develop quantitative T_1ρ-weighted magnetic resonance imaging methodology for the detection and characterization of cartilage degeneration in a rabbit anterior cruciate ligament (ACL) transection model.

Methods

The right knee ACLs of 18 adult female New Zealand white rabbits were transected. The left knee joint served as a sham control. The rabbits were euthanized at 3 (Group 1), 6 (Group 2) and 12 (Group 3) weeks postoperatively. High-resolution 3D fat-saturated spoiled gradient echo images and T_1ρ-weighted images were obtained in both the sagittal and axial planes at 3 T using a quadrature wrist coil. Following MR analysis, histological slides from the lateral femoral condyle cartilage were graded using the Mankin grading system.

Results

For all three groups, the average overall T_1ρ values were significantly higher in the ACL-transected knee compared to control knee, and the percentage differences in T_1ρ values between ACL-transected and control increased with the duration of time after transection. The average Mankin score for ACL-transected knees was higher than that for control for each time point, but this difference was statistically significant only for all groups combined.

Conclusions

This study demonstrates the feasibility of using T_1ρ-weighted imaging as a useful tool in the detection and quantification of cartilage damage in all knee compartments in an ACL-transected rabbit model of cartilage degeneration.     

Guided e-MRI prostate biopsy can solve the discordance between Gleason score biopsy and radical prostatectomy pathology

Introduction

The aim of this study is to examine if guided prostate biopsies based on abnormalities detected by conventional and functional endorectal magnetic resonance imaging (MRI) yield a more reliable representation of the radical prostatectomy pathology and to identify probable preoperative clinical variables that stratified patients likely to harbor significant upgrading.

Patients and Methods

From April 2004 to April 2009, a review of N=70 patients records diagnosed with prostate cancer by a 3-6 core guided transrectal ultrasound (TRUS) prostate biopsy based on abnormalities detected by conventional and functional endorectal MRI and who subsequently underwent radical prostatectomy and exhibited a significant upgrading was conducted. Additionally, a multivariate analysis with a significant upgrading as the outcome was performed including the following parameters: prostate specific antigen (PSA) level, clinical stage, prostate size and duration from biopsy to radical prostatectomy.

Results

A significant upgrading was noted in only 8.5% of patients, with 1.4% exhibiting a significant downgrading and the rest 90.1% exhibiting an exact Gleason score match. No preoperative clinical variables that stratified patients likely to harbour significant upgrading were identified.

Conclusions

This type of biopsy method seems to solve the discordance between the biopsy Gleason score and radical prostatectomy pathology regardless of known preoperative clinical variables that can affect it.     

Pediatric abdominal masses: diagnostic accuracy of diffusion weighted MRI

Purpose

To retrospectively identify apparent diffusion coefficient (ADC) values of pediatric abdominal mass lesions, to determine whether measured ADC of the lesions and signal intensity on diffusion-weighted (DW) images allow discrimination between benign and malignant mass lesions.

Materials and Methods

Approval for this retrospective study was obtained from the institutional review board. Children with abdominal mass lesions, who were examined by DW magnetic resonance imaging (MRI) were included in this study. DW MR images were obtained in the axial plane by using a non breath-hold single-shot spin-echo sequence on a 1.5-T MR scanner. ADCs were calculated for each lesion. ADC values were compared with Mann–Whitney U test. Receiver operating characteristic curve analysis was performed to determine cut-off values for ADC. The results of visual assessment on b800 images and ADC map images were compared with chi-square test.

Results

Thirty-one abdominal mass lesions (16 benign, 15 malignant) in 26 patients (15 girls, 11 boys, ranging from 2 days to 17 years with 6.9 years mean) underwent MRI. Benign lesions had significantly higher ADC values than malignant ones (P<.001). The mean ADCs of malignant lesions were 0.84±1.7×10⁻³ mm²/s, while the mean ADCs of the benign ones were 2.28±1.00×10⁻³ mm²/s. With respect to cutoff values of ADC: 1.11×10⁻³ mm²/s, sensitivity and negative predictive values were 100%, specificity was 78.6% and positive predictive value was 83.3%. For b800 and ADC map images, there were statistically significant differences on visual assessment. All malignant lesions had variable degrees of high signal intensity whereas eight of the 16 benign ones had low signal intensities on b800 images (P<.001). On ADC map images, all malignant lesions were hypointense and most of the benign ones (n=11, 68.7%) were hyperintense (P<.001).

Conclusion

DW imaging can be used for reliable discrimination of benign and malignant pediatric abdominal mass lesions based on considerable differences in the ADC values and signal intensity changes.     

3D sensitivity encoded ellipsoidal MR spectroscopic imaging of gliomas at 3T

Purpose

The goal of this study was to implement time efficient data acquisition and reconstruction methods for 3D magnetic resonance spectroscopic imaging (MRSI) of gliomas at a field strength of 3T using parallel imaging techniques.

Methods

The point spread functions, signal to noise ratio (SNR), spatial resolution, metabolite intensity distributions and Cho:NAA ratio of 3D ellipsoidal, 3D sensitivity encoding (SENSE) and 3D combined ellipsoidal and SENSE (e-SENSE) k-space sampling schemes were compared with conventional k-space data acquisition methods.

Results

The 3D SENSE and e-SENSE methods resulted in similar spectral patterns as the conventional MRSI methods. The Cho:NAA ratios were highly correlated (P<.05 for SENSE and P<.001 for e-SENSE) with the ellipsoidal method and all methods exhibited significantly different spectral patterns in tumor regions compared to normal appearing white matter. The geometry factors ranged between 1.2 and 1.3 for both the SENSE and e-SENSE spectra. When corrected for these factors and for differences in data acquisition times, the empirical SNRs were similar to values expected based upon theoretical grounds. The effective spatial resolution of the SENSE spectra was estimated to be same as the corresponding fully sampled k-space data, while the spectra acquired with ellipsoidal and e-SENSE k-space samplings were estimated to have a 2.36–2.47-fold loss in spatial resolution due to the differences in their point spread functions.

Conclusion

The 3D SENSE method retained the same spatial resolution as full k-space sampling but with a 4-fold reduction in scan time and an acquisition time of 9.28 min. The 3D e-SENSE method had a similar spatial resolution as the corresponding ellipsoidal sampling with a scan time of 4:36 min. Both parallel imaging methods provided clinically interpretable spectra with volumetric coverage and adequate SNR for evaluating Cho, Cr and NAA.     

Enhancement of abdominal organs on hepatic arterial phase: quantitative comparison between 1.5- and 3.0-T magnetic resonance imaging

Purpose

To compare the extent of enhancement of abdominal organs as shown on subphases of hepatic arterial phase quantitatively between 1.5- and 3.0-T MRI among patients with various abdominal conditions.

Materials and Methods

A total of 126 patients, of whom 68 were women (age range, 3–82 years; mean age, 48 years) and 58 were men (age range, 6–73 years; mean age, 50 years), were included in the study. Of 126 patients, 98 were scanned at 1.5 T and 28 were scanned at 3.0 T. The presence of one of three predefined subphases of hepatic arterial phase was determined on early post-gadolinium sequence in each patient by two reviewers in consensus. Extent of enhancement of the kidney, pancreas, spleen and liver on these subphases was determined quantitatively by measuring the signal intensities. Mann Whitney–Wilcoxon test was used to compare the contrast enhancement of organs on each subphase between 1.5- and 3.0-T MRI.

Results

The kidney, spleen, pancreas and liver demonstrated 1.79- to 2.45-, 1.65- to 1.97-, 1.66- to 1.8- and 1.1- to 2.02-fold higher enhancement on the subphases of hepatic arterial phase at 3.0 T compared to 1.5 T, respectively. The differences in contrast enhancement were significant for the kidney, pancreas and spleen on all subphases between 1.5 and 3.0 T.

Conclusion

The relative enhancement of the kidney, spleen and pancreas is consistently and significantly higher at 3.0 T than at 1.5 T in matched subphases of hepatic arterial enhancement.