Abnormal uterine cavity: differential diagnosis with MR imaging

The objective of the study was to assess the usefulness of magnetic resonance (MR) imaging in distinguishing malignant from benign conditions in patients with an abnormal uterine cavity. Fifty-four patients that were suspected of having abnormal uterine cavities were retrospectively evaluated by using MR imaging. The diagnosis of an abnormal uterine cavity included a thickened endometrium, and/or a endometrial mass, and/or a submucosal mass. Threshold values to classify the uterine cavity as abnormal on sagittal T₂-weighted images were >10 mm for premenopausal women and >5 mm for postmenopausal women. Malignancy was diagnosed when lesions invaded the myometrial/junctional zone, and/or lesion enhancement was lower than that of the adjacent myometrium. The results found that histology confirmed 18 malignant and 37 benign lesions. Twelve of 15 endometrial carcinomas and 3 malignant mixed mesodermal tumors (MMMT) were correctly characterized as malignant on enhanced T₁-weighted images; whereas 6 of 15 endometrial carcinomas and 3 MMMT were correctly characterized on T₂-weighted images. Thirty-four of 37 benign cases were correctly characterized as not malignant on enhanced T₁-weighted images. One of 14 submucosal leiomyomas, one endometrial stromal metaplasia, and one of ten pathologically normal endometria were misdiagnosed on enhanced T₁-weighted images but were correctly diagnosed on T₂-weighted images. The overall sensitivity, specificity, and accuracy for distinguishing malignant from benign central uterine masses were 83%, 92%, and 89% for enhanced T₁-weighted image, and 50%, 97%, and 82% for T₂-weighted image, respectively. We came to the conclusion that in diagnosing patients with abnormal uterine cavity, MR imaging may help differentiate malignant from benign disorders.     

Acute and subacute liver-related hemorrhage: MRI findings

We retrospectively reviewed the MR studies on all patients with liver-related fluid collections compatible with acute or early subacute hemorrhage, who underwent MR imaging at our center between June 1994 and January 1998. All patients had a clinical history of an underlying liver lesion or injury with a duration of symptomatology of less than 5 days. In three patients with only 2-3 days of symptoms, the liver-related hemorrhagic fluid was hypointense on T1-weighted images and markedly hypointense on T2-weighted images relative to liver, consistent with intracellular deoxyhemoglobin. The fluid was relatively homogeneous in signal intensity. In three patients with 3-5 days of symptoms, the majority of liver-related fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images relative to liver, consistent with intracellular methemoglobin. Three of these latter four patients also had fluid collections of varying T1-and T2-weighted signal intensity consistent with blood breakdown products of varying ages. Clinical findings matched the MR findings of acute/early subacute blood in all cases. Our results describe the findings of acute and early subacute liver hemorrhage. The most helpful MR feature of bleeding of recent origin is very low signal intensity of the fluid on T2-weighted imaging.     

Metastatic Gastric Leiomyoblastoma: A Case Report

Gastric leiomyoblastoma is a rare entity. In this report, we describe the magnetic resonance (MR) appearance of a recurrent gastric leiomyoblastoma 14 years after initial presentation. This tumor was heterogeneous and moderately low signal intensity on T₁-weighted images and heterogeneous and moderately high signal intensity on T₂-weighted images. The tumor also contained foci of low signal intensity on the post gadolinium images, consistent with areas of necrosis. The mass enhanced mildly and increased in enhancement on the delayed images, consistent with a hypovascular mass. Multiple liver metastases were noted. Magnetic resonance findings were confirmed with surgical specimens.     

MR imaging findings in recurrent primary osseous Ewing sarcoma

The objective of this study was to determine the value of magnetic resonance (MR) imaging in diagnosing local recurrence of Ewing sarcoma. We retrospectively reviewed radiographs, Tc^99m-methylene diphosphonate (MDP) skeletal scintigraphy, computed tomography scans, and MR studies of 11 patients who had local recurrences of osseous Ewing sarcoma following initial responses to chemotherapy and local radiation. The MR images were compared to those of a control group of nine patients who had no evidence of relapse. T₁- and T₂-weighted MR images identified 9 of the 11 recurrences. Computed tomography was diagnostic in 4 of 6 cases evaluated, Tc^99m-MDP bone scintigraphy in 4 of 11 cases, and plain radiographs in 2 of 10. MR findings at relapse included changes in signal intensity, increased extent of abnormal marrow signal on T₁- and T₂-weighted images, and identification of a new soft tissue mass. These findings suggest that MR imaging is valuable in the routine follow-up of parimary osseous Ewing sarcoma.     

MRI appearance of the pelvis in the post cesarean-section patient

Fever in the post-cesarean section patient may indicate the presence of a potentially life-threatening complication, including abscess, ovarian vein thrombosis, and uterine dehiscence. Imaging findings are often utilized to ascertain the presence or absence of such complications. Familiarity with the normal findings in the post-operative period is essential in making this determination. The purpose of this investigation is to describe the MRI appearance of the post-cesarean section pelvis. Over a 67-month period, 50 patients with persistent low-grade fevers following c-section were referred for MR imaging. Imaging was performed 3-10 days post-operatively. Axial T1-weighted and T2-weighted images were acquired in addition to sagittal T2-weighted images. Coronal images were obtained in some cases. Clinical correlation was obtained through the patients charts, confirming discharge of the patients in stable condition. The uterine incision site usually demonstrated findings consistent with subacute hematoma. The anterior uterine myometrium demonstrated enlargement relative to the posterior uterine wall. Bladder flap hematomas were seen in 64% of cases. Three cases (6%) demonstrated parametrial edema and none of these patients demonstrated ovarian vein thrombosis. Two cases of pelvic hematoma were noted. The normal post-c-section incision site may demonstrate increased or decreased signal intensity on T2-weighted images and intact endometrial and serosal layers mitigate against the diagnosis of incisional dehiscence. Bladder flap hematomas occurred in slightly more than half the cases. Parametrial edema and pelvic hematoma can be seen as post-surgical changes.     

Hepatic alveolar echinococcosis: MRI findings

The purpose of this study was to describe the magnetic resonance imaging (MRI) appearance of hepatic alveolar echinococcosis (HAE) on T(1)-weighted, T(2)-weighted and postgadolinium images. A total of 13 lesions were demonstrated in 13 patients. All patients underwent MR examination at 1 T imager. MR examinations included precontrast T(1)-weighted breathing averaged spin echo (SE), breath-hold spoiled gradient echo, T(2)-weighted TSE sequences with and without fat suppression, and T(1)-weighted breath-hold spoiled gradient echo (SGE) sequence following i.v. after gadolinium administration. All lesions were confirmed with histopathology. HAE hepatic lesions revealed geographic patterns of variable signal intensities on noncontrast T(1)- and T(2)-weighted images. Slightly hyperintense, iso- and hypointense signal on T(1)-weighted images corresponded to calcified regions, which appeared hypo-isointense signal on T(2)-weighted images. Necrotic areas were hypointense signal on T(1)-weighted and hyperintense signal on T(2)-weighted images. On postgadolinium images, lesions did not reveal enhancement. Dilatation of intrahepatic bile ducts distal to HAE abscesses were observed in five patients and portal vein invasion or compression was observed in four patients, lobar atrophy of the liver was coexistent finding in cases with portal vein compression. The MRI appearance of HAE abscesses included large irregularly marginated masses with heterogenous signal on T(1)- and T(2)-weighted images and lack of enhancement with gadolinium.     

MR imaging of radiation osteitis in the sacroiliac joints

The purpose of this study was to analyze magnetic resonance (MR) images of radiation osteitis of sacroiliac joints, retrospectively. Seven patients with radiation osteitis, which was diagnosed by pelvic plain radiographs and CT images, underwent MRI. T(1)-weighted spin echo images and T(2)-weighted fast spin echo images were obtained in all patients. Four patients were examined after gadolinium injection. Major signal changes of radiation osteitis were distributed on the iliac side. T(1)-weighted images showed diffuse low intensity both in sacral and iliac sides. T(2)-weighted images showed very low intensity adjacent to sacroiliac joints, but mixed intensity was illustrated apart from joints, and high intensity in the peripheral areas. Radiation osteitis showed slight to mild, but irregular enhancement in four patients after gadolinium administration. MRI can illustrate abnormal bone change distribution and is useful for diagnosing this entity by characteristic intensity patterns on T(1)-weighted images with and without gadolinium and T(2)-weighted image. However, the diagnosis of accompanied insufficiency fractures in the area of radiation osteitis is occasionally difficult with conventional MRI.     

Recurrent hepatocellular carcinoma versus radiation-induced hepatic injury: differential diagnosis with MR imaging

The objective of this study was to assess the value of MR imaging in the differentiation between a recurrent hepatocellular carcinoma (HCC) and a radiation-induced hepatic injury. Nine male patients with suspected recurrence after radiotherapy for HCC underwent T(2)-, T(1)-weighted imaging and Gd-DTPA enhanced dynamic studies. T(2) relaxation times, signal intensity ratios in T(1)-weighted images (WI) and the relative enhancement of the dynamic study were calculated. Recurrent tumors and the irradiated area showed similar image characteristics: hypointense in T(1)-WI and hyperintense in T(2)-WI. T(2) values and signal intensity ratios in the T(1)-WI were not significantly different. In the gadolinium-enhanced dynamic study, a recurrent HCC showed early enhancement, followed by a rapid washout. However, the irradiated liver parenchyma showed hyperintensity from an early phase, and contrast enhancement tended to be more prominent and prolonged at the end of the dynamic studies. The characteristic findings of the dynamic MR study enable us to distinguish between a recurrent HCC and a radiation-induced hepatic injury.     

MR imaging findings of infectious cholangitis

The purpose of this study was to evaluate the appearance of infectious cholangitis on MRI. The MR images of 13 patients (9 women, 4 men; age range, 14-79 years) with clinically confirmed infectious cholangitis, who represent our complete 9.5 year experience with this entity, were retrospectively evaluated. All MR studies were performed at 1.5 T and included: in-phase and out-of-phase T(1)-weighted spoiled gradient echo (SGE), T(2)-weighted fat-suppressed echo train spin echo, single shot T(2)-weighted sequences, and serial postgadolinium T(1)-weighted SGE sequences without and with fat-suppression. The biliary ductal system was evaluated regarding presence of dilatation, stenosis, wall irregularities, wall thickening, and gadolinium enhancement of duct walls. The liver parenchyma was evaluated regarding focal signal abnormalities on precontrast and serial postgadolinium images. Biliary ductal dilatation was observed in 100% of patients. Mild to moderate thickening of bile duct walls combined with increased enhancement on postgadolinium images was observed in 92% of patients. The liver parenchyma showed periportal or wedge-shaped areas of hyperintense signal on T(2)-weighted images in 69% of patients. On T(1)-weighted images, 54% of patients showed areas of hypointense signal and 15% of patients showed wedge-shaped hyperintense areas. Areas with increased enhancement on immediate postgadolinium SGE were observed in 58% of patients, and in 42% of patients increased enhancement persisted on 2 min postgadolinium fat-suppressed images. Distinctive MRI findings on pre- and postgadolinium images are appreciated for infectious cholangitis.     

Focal fat deposition at liver MRI with gadobenate dimeglumine and gadoxetic acid: Quantitative and qualitative analysis

Objective

To evaluate the image findings of focal fat deposition (FFD) in the liver on gadobenate dimeglumine (Gd-BOPTA)- and gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI, particularly during the hepatobiliary phase (HBP), and the relationship between relative enhancement (RE) and fat signal fraction (FSF) of FFD.

Subjects and Methods

Twenty-one patients with 27 FFDs (mean diameter, 21.9 mm), which showed low signal intensity on opposed-phase compared with in-phase MRI, were retrospectively evaluated. RE of the liver (RE_liver) and FFD (RE_FFD) and liver-to-lesion contrast-to-noise ratio (CNR) of FFD were measured on dynamic phases and HBP images with fat-saturated in-phase gradient-echo sequence. The FSF of each FFD was measured on in- and opposed-phase dual gradient-echo images. We qualitatively analyzed imaging findings of FFDs, including signal intensity, shape, margin, and homogeneity on HBP images, and enhancement pattern during dynamic phases. The correlations between RE_FFD and FSF and between CNR and FSF on HBP images were evaluated using Pearson’s correlation tests and a simple linear regression model.

Results

There were no significant differences between RE_FFD and RE_liver in dynamic phases and HBP, regardless of contrast agents (p ≥ 0.075). On HBP images, CNR (p = 0.008) but not RE_FFD (p = 0.122) was significantly correlated with FSF of FFDs (mean FSF, 19%). On HBP images, 21 of the 27 (77.8%) FFDs were hypointense, and 17 (63%) were homogeneous. Of the 21 hypointense FFDs, 12 (57.1%) had an ovoid shape and 11 (52.4%) were well margined. Although the 27 FFDs showed various enhancement patterns, 17 (63%) showed no enhancement.

Conclusion

Most FFDs appeared as hypointense lesions on Gd-BOPTA- and Gd-EOB-DTPA-enhanced MRI during HBP, with various enhancement patterns during dynamic contrast-enhanced phases. RE_FFD on HBP images was not significantly correlated with FSF of low grade FFDs.     

MR findings of focal eosinophilic liver disease using gadoxetic acid

Purpose

The purpose of this study was to describe magnetic resonance (MR) findings of focal eosinophilic liver disease using gadoxetic acid (Gd-EOB-DTPA).

Materials and Methods

Nineteen patients (M:F=14:5; age range, 26–66 years; mean age, 50 years) with 35 focal eosinophilic liver lesions were included after reviewing the medical records of 482 patients who underwent Gd-EOB-DTPA-enhanced MR imaging (MRI) on a 3.0-T unit between April 2008 and June 2009. The diagnosis of focal eosinophilic liver disease was established by means of percutaneous liver biopsy or surgery and consistent clinical findings. Two radiologists retrospectively reviewed MR images with consensus. Margin, shape and distribution of the lesions were analyzed. We also evaluated signal intensity of focal hepatic lesions on T₁- and T₂-weighted images and patterns of enhancement in dynamic contrast study.

Results

The mean diameter of the lesions was 1.7 cm (range, 0.7–6.1 cm). Most of the focal eosinophilic liver lesions [n=31/35 (88.6%)] had poorly defined margins. They were usually isointense or slightly hypointense [n=34/35 (97.2%)] on T₁-weighted images and hyperintense [n=32/35 (91.4%)] on T₂-weighted images. Dynamic study showed enhancement (rim or homogeneous) on the arterial phase [n=21/35 (60%)] and hypointensity on the late venous phase [n=31/35 (88.6%)]. All the lesions were hypointense on the hepatobiliary phase images.

Conclusion

Focal eosinophilic liver lesions tend to be hyperintense on the arterial phase and hypointense on the late venous phase during dynamic study of Gd-EOB-DTPA-enhanced MRI. Although these findings mimic other focal hepatic lesions, poorly defined margins of the lesions and peripheral eosinophilia might help distinguish focal eosinophilic liver disease from other hepatic lesions.     

Plexiform neurofibroma of the pelvis: CT and MRI findings

We present a case of plexiform neurofibroma of the pelvis in a patient with neurofibromatosis using magnetic resonance imaging (MRI) with computed tomography (CT) correlation. We discovered an extensive pelvic mass with a slightly greater signal intensity than muscle in T1-weighted images and a marked increased signal intensity in T2-weighted images. Multiple hypointense septations were identified throughout the tumor, particularly in the T2-weighted images. The MR appearance of pelvic plexiform neurofibroma is identical to those found in spinal and paraspinal locations. In the presence of an extensive pelvic mass in a patient with neurofibromatosis, MRI is recommended in evaluating and diagnosing plexiform neurofibroma. Since the MRI appearance of this tumor is characteristic, other lesions can possibly be ruled out. In addition, MRI's multiplanar capability is ideally suited to demonstrate the extension of these large tumors.     

Giant hemangioma of the liver: MR imaging characteristics in 24 patients

We retrospectively reviewed the magnetic resonance imaging (MRI) of giant hemangiomas in 24 patients. MRI studies comprised T1-weighted, T2-weighted and serial gadolinium-enhanced spoiled gradient echo (SGE) images. Morphologic features, signal characteristics and enhancement patterns were assessed. Histopathologic evaluation was obtained in nine patients. On T2-weighted images all lesions (size 5.7-24 cm) were hyperintense relative to the spleen and two dominant patterns of heterogeneity were demonstrated: a central heterogeneous area of either bright, dark, or mixed signal intensity, and a network of multiple fibrous septa of low signal intensity. Histopathologic evaluation of two lesions with a central bright area demonstrated the presence of hypocellular myxoid tissue. Central enhancement (9 lesions) and an irregular flame-shaped peripheral pattern of enhancement (12 lesions) were present in lesions with a mean diameter greater than 10 cm. Although giant hemangiomas show greater variability in their MR imaging appearance, an accurate diagnosis can be made through still characteristic features of high signal intensity on T2-weighted images and discontinuous peripheral enhancement.     

Synovial sarcoma: MR imaging

Ten patients with biopsy-proved synovial sarcoma were evaluated by magnetic resonance (MR) imaging on a 1.5-T unit. The lesions showed intermediate signal intensity on T1-weighted images and heterogeneous high signal intensity on T2-weighted images. Tumors were well-demarcated from normal tissues. Additional information included adjacent bone involvement (one case), femoral vein invasion by tumor (one case), and hemorrhage within the tumors (one case). Four patients underwent a repeat MR examination following chemotherapy. This showed a decrease in size and increase in the signal intensity of three tumors on T2-weighted images, proven to be due to necrosis in one. These changes correlated with clinical regression of disease. While MR in synovial sarcoma does not have any specific signal intensity, it proved to be useful in defining the extent of disease and in determining the response to chemotherapy.     

Femoral head avascular necrosis in sickle cell anemia: MR characteristics

Since considerable expansion of hematopoietic marrow occurs in patients with sickle cell anemia (SCA), magnetic resonance images of 20 hips in 10 patients with known homozygous SCA were reviewed to determine a) if low signal hematopoietic marrow extended into the femoral capital epiphysis and b) if the MR characteristics of avascular necrosis (AVN) differed depending on the type of epiphyseal marrow. Our results revealed variable epiphyseal marrow type; mixed (fatty and hematopoietic) marrow (42%), fatty marrow (32%), hematopoietic marrow (16%) and hemosiderotic marrow (10%). AVN occurred irrespective of the underlying marrow. Segmental areas of low signal intensity in variable shapes (ring, band, crescent or large homogeneous area) was the most consistent MR manifestation of AVN in SCA. A low signal intensity peripheral rim surrounding a central zone, isointense with epiphyseal marrow on T₁ and T₂ weighted images, was most frequently observed similar to that described in patients without hemoglobinopathy. The notable difference, however, was of segmental areas within the same femoral head that demonstrated variable central zone signal on T₂ weighted images. Further, while an increase in hip joint fluid is commonly seen with both early and advanced AVN in patients without hemoglobinopathy; it was increased in only one hip in patients with SCA. The observed differences in MR characteristics may be due to different pathophysiology of AVN in patients with SCA.     

磁共振成象诊断出血性胆囊炎——离体及活体研究

在离体研究的基础上,对三个出血性胆囊炎的病人术前做出诊断,出血性胆囊炎可分为混合性及非混合性.在离体实验中,如果血液未与胆汁混合,T₁加权象可发现加于10mL胆汁中的0.2mL的血液表现为高信号区;质子密度加权象可发现加于10mL,胆汁中的0.4mL血液表现为稍高信号区;T₂加权象对此不敏感.如果血液与胆汁完全混合,在所有采用的磁共振成象上均使胆汁信号增高.非混合性出血性胆囊炎的磁共振成象具有特征性:在T₁加权象及质子密度加权象胆囊内有高信号区,T₂加权象此区为等信号、低信号或其中心为低信号周围与胆汁相接的为高信号。混合性出血性胆囊炎在所采用的磁共振成象图象中,相对于肝脏,胆囊内容物表现为均匀高信号,临床资料及胆囊壁、胆囊周围渗出有助于这种出血性胆囊炎的诊断.     

Research and progress in magnetic resonance imaging of triple-negative breast cancer

Triple-negative breast cancer (TNBC), which characterized by distinct biological and clinical pathological features, has a worse prognosis because the lack of effective therapeutic targets. Breast MR is the most accurate imaging modality for diagnosis of breast cancer currently. MR imaging recognition could assist in diagnosis, pretreatment planning and prognosis evaluation of TNBC. MR findings of a larger solitary lesion, mass with smooth mass margin, high signal intensity on T₂-weighted images and rim enhancement are typical MRI features associated with TNBC. Further work is necessary about the clinical application of dynamic contrast-enhanced MR imaging (DCE-MRI), DWI and MRS.     

Small hyperintense hepatic lesions on T1-weighted images in patients with cirrhosis: evaluation with serial MRI and imaging features for clinical benignity

PURPOSE: The aim of this study was to evaluate the frequency and magnetic resonance imaging (MRI) features of clinically benign, small (<2 cm) hyperintense hepatic lesions in the cirrhotic liver on T1-weighted MR images seen at serial MRI. MATERIALS AND METHODS: This study included 189 patients with cirrhosis, who underwent hepatic MRI more than twice with an interval of at least 12 months. The initial MR images were reviewed for the presence of small hyperintense lesions on T1-weighted images. The size, location and signal intensity on T2-weighted images as well as enhancement patterns of the corresponding lesions were recorded. RESULTS: On the initial T1-weighted MR images, 43 small hyperintense hepatic lesions were detected in 23 (12%) of 189 patients. Twelve (28%) of 43 lesions showed early enhancement and were pathologically diagnosed as hepatocellular carcinoma (HCC) during the follow-up period. Thirty-one (72%) of 43 lesions showed no early enhancement with various signal intensity on T2-weighted images (hyperintensity=4, isointensity=20, hypointensity=7). Among these 31 lesions, 12 showed no interval change, while 11 disappeared (n=10) or decreased in size (n=1). In the remaining eight lesions, seven were diagnosed as HCC on the basis of pathologic confirmation or the interval growth. CONCLUSION: Small hyperintense hepatic lesions on T1-weighted magnetic resonance (MR) images without early enhancement on the arterial-phase contrast-enhanced dynamic studies in patients with cirrhosis usually showed no interval growth or disappeared during the serial MRI. These lesions with additional findings of iso- or hypointensity on the T2-weighted MR images without "washout effect" on the contrast-enhanced equilibrium-phase images may more frequently be clinically benign or hyperplastic nodules than HCCs.     

MR imaging of non-cancerous hepatic lesions in Long-Evans Cinnamon rats

We measured MR images of the liver of Long-Evans Cinnamon (LEC) rats with pathologic correlation and assessed the effectiveness of MR imaging (MRI) for diagnosis of noncancerous hepatic lesions. T₁- and T₂-weighted images of their livers were obtained, and the dynamic and delayed studies after intravenous gadolinium injection were also performed. Cholangiofibrosis showed low signal intensity on T₁-weighted images and high signal intensity on T₂-weighted images. The T₂ relaxation time of cholangiofibrosis was significantly prolonged (p < .01), and the signal intensity ratio of this lesion to muscle on T₁-weighted images was significantly lower than that of normal liver parenchyma to muscle (p < .01). The lesion was enhanced immediately after gadolinium injection and the enhancement was prolonged. Among three cases of peliosis hepatis identified, one showed heterogeneous intensities on both T₁- and T₂-weighted images and the other two showed similar intensity pattern to cholangiofibrosis. The characteristic MR appearance of cholangiofibrosis may be useful to distinguish it from hepatocellular carcinoma (HCC).     

Magnetic resonance imaging features in melanoma

T1 and T2 relaxation time shortening secondary to paramagnetic compounds has been described in melanoma. The purpose of this paper is to evaluate the signal behavior of melanoma involved in various body areas using short TR, TE and long TR, TE sequences. Twenty-seven sites of melanoma were evaluated with MR using T1 weighted and T2-weighted techniques. Using fat and muscle signal intensities as references tissues, lesions were graded into high, low or intermediate intensity categories for each of the sequences. Four signal patterns emerged. The typical pattern characterized by high signal on T1-weighted images and low signal on T2-weighted images reflected T1 and T2 shortening. The other pattern categories comprised of lesions demonstrating low signal T1-weighted images and high signal on T2-weighted images, high signal on both T1- and T2-weighted images and lesions showing intermediate signal on either T1- or T2-weighted images. We observed a tendency away from the typical signal pattern in extraocular melanoma cases with only one of 14 demonstrating this pattern. Moreover, only seven of thirteen ocular melanomas exhibited such behavior. Possible explanations for this findings as well as the existence of a variety of MR appearances to melanoma are offered. We conclude that while signal patterns showing T1 and T2 shortening are typical of melanoma, the absence of these does not exclude the diagnosis.