Exophytic benign tumors of the liver: appearance on MRI.

The purpose of our study was to determine the MR imaging appearance of exophytic benign liver tumors on precontrast and postgadolinium images. We reviewed our 9.5 year experience with MRI of the liver with dynamic gadolinium enhanced imaging to identify four patients with five histologically proven exophytic benign liver tumors. The histological diagnoses were cavernous hemangioma (2), focal nodular hyperplasia (FNH) (1), and hepatocellular adenoma (HCA) (2 exophytic adenomas in a patient with adenomatosis of the liver). All MRI studies were performed at 1.5 T and included: in-phase and out-of-phase T1-weighted spoiled gradient echo (SGE), T2-weighted fat-suppressed echo train spin echo, single shot T2-weighted sequences, and serial postgadolinium T1-weighted SGE sequences without and with fat-suppression. Prospective interpretations were reviewed and retrospective consensus readings of all MR images were performed assessing location, size, origin, morphology, visibility of the connection to the liver, signal characteristics on precontrast T1-weighted and T2-weighted images, and enhancement patterns on serial postgadolinium images. Three of the five tumors were pedunculated and connected to the liver by a thin stalk, which was prospectively identified in one patient. On precontrast and serial postgadolinium images, all exophytic tumors showed signal characteristics comparable to imaging features of standard intraparenchymal benign liver tumors. Our findings illustrate that the characteristic T1, T2, and postgadolinium imaging findings of these tumors permit correct identification of their liver origin despite their exophytic location, even if their connection with liver is not visualized.     

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.     

Evaluation of Crohn's disease using half-fourier RARE and gadolinium-enhanced SGE sequences: initial results

To assess the bowel changes in Crohn's disease, 11 consecutive patients underwent magnetic resonance imaging (MRI) study using T(2)-weighted half-Fourier rapid acquisition with relaxation enhancement (RARE) and gadolinium-enhanced standard and fat suppressed spoiled gradient echo (SGE) sequences. Comparison was made between MR findings of disease extent, severity, and complications and clinical data, endoscopic findings and/or surgical specimens in all patients. We found that the half-Fourier RARE images showed bowel wall thickening, dilatation of bowel and bowel obstruction well in all patients, however severity of bowel disease could not be determined as the signal intensity of diseased bowel was comparable to normal bowel in 10/11 patients. Gadolinium-enhanced fat suppressed SGE demonstrated variations of mural enhancement that correlated well with extent of disease severity in 10/11 patients. Complications such as intraperitoneal (i. p.) abscess (2 patients), gastric outlet obstruction (1 patient), bowel obstruction (2 patients), and fistula formation (3 patient), were accurately shown. We conclude that T(2)-weighted half-Fourier RARE and gadolinium-enhanced fat suppressed SGE sequences are complementary techniques that possess different imaging features that are of value for assessing bowel changes in Crohn's disease.     

Granulomatous hepatitis: MRI findings.

The purpose of this study was to describe the magnetic resonance imaging findings of granulomatous hepatitis on T1-weighted, T2-weighted and postgadolinium images. Eight patients with histopathological diagnosis of granulomatous hepatitis were evaluated in this study. MRI examinations included precontrast T1-weighted breath-hold spoiled gradient echo, breathing independent STIR sequences, and T1-weighted breath-hold spoiled gradient-echo sequence following after i.v. gadolinium administration in arterial, intermediate and late phases. Diffuse nodular liver involvement was visualized in all patients. Nodules were consistent with granulomas and were 0.5-4.5 cm in diameter. Caseating granulomas were intermediate and high signal on T2-weighted, low signal on T1-weighted images. They revealed no enhancement in two patients, and enhanced in one patient. Noncaseating granulomas revealed intermediate signal on T1, and T2-weighted images and increased enhancement on arterial phase images with persisting enhancement in late phase images. Portal lymph nodes were visible in five patients. Splenomegaly was present in five patients. Granulomatous hepatitis has spectrum of MRI features, to be considered in differential diagnosis with other diffuse nodular liver pathologies.     

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.     

Bowel-related abscesses: MR demonstration preliminary results

The purpose of this study is to describe the appearance of bowel-related abscesses on magnetic resonance (MR) images. Sixteen consecutive patients who had bowel-related abscesses underwent MR examination at 1.5T. MR sequences included T₁-weighted fat-suppressed imaging pre- and post-intravenous gadolinium chelate administration (all patients) and breathing-independent single-shot T₂-weighted half Fourier turbo (fast) spin echo (6 patients). Patients with pelvic abscesses also underwent sagittal imaging with post-gadolinium T₁-weighted images (9 patients) and T₂-weighted turbo (fast) spin echo (8 patients). Abscesses were confirmed by open surgery or surgical drainage (6 patients), percutaneous drainage (8 patients), or combined physical examination, fluoroscopic fistulogram, and clinical follow-up (2 patients). Oval-shaped fluid collections were identified in all of the patients, which ranged in diameter from 2 cm to 18 cm, mean: 8 cm. Abscesses were low to intermediate in signal on T₁-weighted images, heterogenous and moderately high signal on T₂-weighted images, and low signal on post-gadolinium images. A layering effect of lower signal material in the dependent portion of the abscess was noted in abscesses in 6 of 14 patients on T₂-weighted images. Post-gadolinium images demonstrated a definable 3- to 7-mm thick abscess wall, which enhanced substantially with contrast. Definition of the wall was best shown on fat-suppressed images post-gadolinium. Substantial enhancement of surrounding periabscess tissues was demonstrated in all cases and was most clearly defined on fat-suppressed images. Image acquisition in two orthogonal planes was of value to demonstrate that fluid collections were oval, and separate from bowel. Image acquisition in the sagittal plane was useful in the evaluation of pelvic abscesses. The results from this preliminary study show that bowel-related abscesses are demonstrable on MR images using gadolinium-enhanced fat-suppressed T₁-weighted and turbo (fast) spin-echo T₂-weighted sequences. The presence of a thickened, enhancing lesion wall and enhancement of perilesional tissues on T₁-weighted fat-suppressed images were observed in all abscesses. A layering effect of low signal intensity material in the dependent portion of the abscess was an important ancillary feature.     

MRI of acute cholecystitis: Comparison with the normal gallbladder and other entities

Our purpose was to prospectively compare MRI findings with histopathologic findings in the evaluation of suspected acute cholecystitis. Fourteen patients with clinically suspected acute cholecystitis were entered into the study. MR sequences included T₁-weighted fat-suppression and breath-hold spoiled gradient echo (SGE) before and after intravenous gadolinium chelate administration. Percent contrast enhancement (%CE) of the gallbladder wall and gallbladder wall thickness (WT) were measured and liver enhancement patterns determined prospectively on MR images. Correlation was obtained with pathological findings at cholecytectomy in all patients. In a second phase of the study MR images on 10 additional subjects who underwent MR examination for reasons other than hepatobiliary disease were analyzed to determine normal values for %CE and gallbladder wall thickness. Mean %CE was 124.0% in patients with acute cholecystitis (10 patients), 58.0% in patients with chronic cholecystitis (2 patients), and 73.0% in patients with gallbladder malignancy (2 patients). Mean gallbladder WT was 6.1 mm in acute cholecystitis, 4.5 mm in chronic cholecystitis, and 6.0 mm in malignant disease. There was a significant difference in %CE between acute and chronic cholecystitis (p = 0.03); no other significant differences in %CE or WT were observed among the patients with gallbladder disease. Patients without biliary disease had %CE of 37.3% and WT of 2.9 mm, which were both significantly less (p < 0.001) than in patients with acute cholecystitis. Transient enhancement of pericholecystic hepatic parenchyma on immediate postgadolinium SGE images was seen in 7 of 10 patients with acute cholecystitis, and not observed in other patients. Patients with acute cholecystitis had increased %CE and WT on MR images that were significantly greater than normal and %CE that was significantly greater than in patients with chronic cholecystitis. Transient increased pericholecystic hepatic enhancement was observed in 70% of acute cholecystitis patients and in no other patient groups.     

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.     

3.0-T MRI evaluation of patients with chronic liver diseases: initial observations

PURPOSE: To describe the use of 3.0-T magnetic resonance imaging (MRI) for the evaluation of chronic liver diseases. MATERIALS AND METHODS: Two groups of patients who had chronic liver diseases and underwent 3.0-T MRI for evaluation of the liver were included in the study. The first group of patients included 66 consecutive patients (33 male, 33 female; mean age+/-standard deviation, 56+/-11). The second group of patients included 30 consecutive patients (18 males, 12 females; mean age+/-standard deviation, 53+/-10) in whom Variable-Rate Selective Excitation (VERSE) pulses and improved adjustments procedure were used during the acquisitions. Imaging findings of chronic liver diseases, predetermined artifacts and image quality of all individual sequences in the first group and predetermined artifacts and image quality of T2-weighted sequences in the second group were reviewed retrospectively and independently by two reviewers. chi-Square tests were used to compare the findings between two groups of patients and individual sequences. Kappa statistics were used to determine the extent of agreement between the reviewers. RESULTS: Fifteen dysplastic nodules in 6 of 66 (9%) patients and 12 hepatocellular carcinomas in 11 of 66 (17%) patients were detected. Excluding motion artifacts, three-dimensional (3D) T1-weighted gradient-echo (GE) sequence was the least affected sequence by the artifacts. Image quality of T1-weighted 3D-GE sequences was excellent in 43 of 66 (65%) patients. In-phase and out-of-phase T1-weighted spoiled GE (SGE) images were fair in 62 of 66 (94%) and 61 of 66 (92%) patients, respectively. The image quality of short tau inversion recovery (STIR) and half-Fourier rapid acquisition with relaxation enhancement (RARE) sequences were fair in 31 of 66 (47%) and 53 of 66 (80%) patients. STIR and half-Fourier RARE sequences in the second group demonstrated significantly better image quality (P=.03 and P<.0001). CONCLUSION: 3.0-T MRI allows the acquisition of very high quality postgadolinium 3D-GE sequence, which permitted the detection and characterization of lesions in the setting of chronic liver diseases. The use of VERSE pulses and improved adjustments procedure improved the image quality of T2-weighted sequences. In-phase/out-of-phase SGE sequences are at present of fair quality.     

Magnetic resonance imaging of the abdominal aorta and iliac vessels using combined 3-D gadolinium-enhanced MRA and gadolinium-enhanced fat-suppressed spoiled gradient echo sequences.

This study evaluates a combined protocol consisting of breath hold immediate post gadolinium 3-D gradient echo MR angiography and blood pool phase gadolinium-enhanced breath hold 2-D fat-suppressed spoiled gradient echo (SGE) sequences in the examination of diseases of the abdominal aorta and iliac vessels. Thirty-two patients with suspected disease of the abdominal aorta, major aortic branches, or iliac vessels underwent MR angiographic study from January 1996 to January 1997. Examinations were performed on a 1.5 T MR imager using 2-D axial SGE, coronal 3-D fast imaging in steady state precession (3-D FISP) following bolus administration of 40 mL of gadolinium, and axial and coronal blood pool phase gadolinium-enhanced fat-suppressed SGE. Post-processed data, including 3-D reconstructions using maximum intensity projection (MIP), targeted MIP, and multiplanar reconstruction (MPR) were evaluated. MR findings in all patients were correlated as follows: surgery (13 patients), angiography (11 patients), contrast enhanced CT (3 patients), non-contrast enhanced CT (1 patient), color doppler US (2 patients), and previous MR study (2 patients). MR findings correlated closely with findings at surgery or other imaging studies in 31 of 32 patients. One patient had renal artery occlusion that was misinterpreted as mild stenosis. The following vascular diseases were present: aneurysm disease [10 patients: aortic aneurysm (8 patients), inflammatory aneurysm (2 patients)], thoracoabdominal aortic dissection (2 patients), arteriovenous fistula (1 patient), stenoses and/or occlusion of the abdominal aorta, major aortic branches and iliac vessels [12 patients: stenoses and/or occlusion of the abdominal aorta with stenoses of the iliac vessels (9 patients), renal artery stenosis (2 patients), occlusion of the abdominal aorta (1 patient)], and occluded artery to pancreatic transplant artery (1 patient). Five patients had normal studies. The 3-D FISP technique accurately defined the luminal contours of vessels, allowing precise depiction of vessel stenosis (i.e., renal artery stenosis or common iliac artery stenosis) and clear demonstration of relationship of aortic branch vessels (i.e., renal arteries) to underlying aortic pathology (i.e., aortic aneurysm or dissection). Blood pool phase gadolinium-enhanced fat-suppressed SGE images were useful in the evaluation of the external surface of vessel walls, and providing accurate measurement of aneurysm diameter and other associated vascular entities (i.e., inflammatory aneurysm, left-sided IVC). Targeted MIP or MPR reconstruction were important for assessing stenoses of medium sized vessels such as renal arteries and branches of the iliac arteries, and for identifying accessory arteries. The combination of immediate post gadolinium 3-D FISP and blood pool phase gadolinium-enhanced fat-suppressed SGE is useful in the evaluation of the abdominal aorta, major aortic branches and iliac vessels. Immediate post gadolinium 3-D FISP images provides diagnostically useful information regarding vessel luminal contour, while blood pool phase gadolinium-enhanced fat-suppressed SGE provides ancillary information on the vessel wall and surrounding tissue.     

Liver imaging at 1.5 tesla: pulse sequence optimization based on improved measurement of tissue relaxation times

In order to predict the most sensitive MR imaging sequence for detecting liver metastases at 1.5 T, in vivo measurements of T1 and T2 relaxation times and proton density were obtained using multipoint techniques. Based on these measurements, two-dimensional contrast contour plots were constructed demonstrating signal intensity contrast between hepatic lesions and surrounding liver parenchyma for different pulse sequences and pulse timing parameters. The data predict that inversion recovery spin echo (IRSE) imaging should yield the greatest contrast between liver metastases and liver parenchyma at 1.5 T, followed by short tau inversion recovery (STIR) and spin-echo (SE) pulse sequences. T2-weighted SE images provided greater liver/lesion contrast than T1-weighted SE pulse sequences. Calculated T1, T2, and proton density values of the spleen were similar to those of hepatic metastatic lesions, indicating that the signal intensity of the spleen may be used as an internal standard to predict the signal intensity of hepatic metastases on T1- and T2-weighted images at 1.5 T.     

Comparison of gadolinium chelates with manganese-DPDP for liver lesion detection and characterization: Preliminary results

Nonspecific extracellular gadolinium chelate (NEGd) was prospectively compared with manganese (Mn)-DPDP (Mn) for the detection and characterization of focal liver lesions of various histology. Seventeen patients with known or suspected focal liver lesions underwent NEGd and Mn-enhanced studies at 1.5 T. Study findings were correlated with histology (five patients), computed tomography (CT) examinations (17 patients), and 4- to 13-month imaging follow-up by CT and/or MR (five patients). NEGd studies were performed as serial postcontrast spoiled gradient echo (SGE) sequences, and Mn studies were performed as SGE sequences 15 and 30 min postcontrast and T₁-weighted, fat-suppressed spin echo at 16 min. NEGd and Mn images were prospectively interpreted in a separate blinded fashion. Lesion detection and characterization were determined. NEGd and Mn-enhanced images demonstrated 61 and 49 lesions, respectively (p = .1, NS). A total of 60 and 33 lesions were characterized on NEGd and Mn images, respectively, which was significantly different (p = .008). No differences were observed for the detection and characterization of liver metastases; whereas there was a trend for superior detection and characterization for hepatocellular carcinoma with NEGA.     

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.     

Feasibility of fat-saturated T2-weighted magnetic resonance imaging with slice encoding for metal artifact correction (SEMAC) at 3T

Background and Purpose

Fluid-sensitive MR imaging in postoperative evaluation is important, however, metallic artifacts is inevitable. The purpose is to investigate the feasibility of fat-saturated slice encoding for metal artifact correction (SEMAC)-corrected T2-weighted magnetic resonance (MR) at 3T in patients with spinal prostheses.

Methods

Following institutional review board approval, 27 SEMAC-encoded spinal MRs between September 2012 and October 2013 in patients with spinal metallic prostheses were analyzed. The MR images were scanned on a 3T MR system including SEMAC-corrected and uncorrected fast spin echo (FSE) T2-weighted MR images with fat-saturation. Two musculoskeletal radiologists compared the image sets and qualitatively analyzed the images using a five-point scale in terms of artifact reduction around the prosthesis, visualization of the prosthesis and pedicle, and intervertebral neural foramina. Quantitative assessments were performed by calculating the ratio of signal intensity from the fixated vertebra and that from upper level vertebra. For statistical analyses, paired t-test was used.

Results

Fat-saturated SEMAC-corrected T2-weighted MR images enabled significantly improved metallic artifact reduction (P < 0.05). Quantitative evaluation of the signal intensity ratio of screw-fixated vertebra and upper level vertebra showed a significantly lower ratio on fat-saturated SEMAC images (P < 0.05), however, the high signal intensity of signal pile-up could be not completely corrected.

Conclusion

SEMAC correction in fat-suppressed T2-weighted MR images can overcome the signal loss of metallic artifacts and provide improved delineation of the pedicle screw and peri-prosthetic region. Signal pile-up, however, could not be corrected completely, therefore readers should be cautious in the evaluation of marrow around the prosthesis.     

Hepatic angiomyolipoma with minimal fat content: MR demonstration

Hepatic angiomyolipoma is a rare entity. In this report, we describe the unusual MR findings of an angiomyolipoma with minimal fat content with histopathology correlation. This tumor had signal intensity features on various MR sequences including intense heterogeneous enhancement on immediate postgadolinium spoiled gradient echo images that resembled the appearance of a well-differentiated primary hepatocellular carcinoma. Angiomyolipoma with minimal fat content should be considered in the differential diagnosis of tumors with early diffuse heterogeneous enhancement on contrast enhanced images.     

Ovarian Brenner tumors: MR imaging characteristics

This study describes the appearance of Brenner tumors on MR imaging and compares quantitative signal intensity measurements of Brenner tumors with that of other ovarian tumors. A search of pathologic and MR records disclosed patients who had MRIs showing Brenner tumors prior to surgical excision. Patients (21) with other surgically proven ovarian masses were randomly selected for comparison. MR imaging was performed at 1.5 T with phased array multicoils and fast spin echo T2-weighted images. Region-of-interest measurements of signal intensity (SI) were made to calculate signal intensity ratios (SIR = mass SI/muscle SI). Brenner tumors showed significantly lower SIR than other tumors on T2-weighted images (p = 0 .004) and similar SIR on T1-weighted images. Brenner tumors show lower signal intensity on T2-weighted images than other non-fibrous ovarian tumors. This lower signal intensity may result from the extensive fibrous content of these tumors.     

Detection of biliary complications after orthotopic liver transplantation with MR cholangiography.

To assess the diagnostic value of magnetic resonance cholangiography (MRC) when evaluating biliary complications in the follow-up of liver transplant patients. One hundred and thirteen patients prospectively underwent MR imaging and MR cholangiography at 1.5-T unit after orthotopic liver transplantation (OLT). After the acquisition of axial T1- and T2-weighted sequences, MRC involved a coronal, non breath-hold, respiratory-triggered, fat-suppressed, two-dimensional, thin-slab, heavily T2-weighted fast spin-echo sequence, and coronal breath-hold, thick-slab, single-shot T2-weighted sequences. The images and maximum intensity projections were evaluated by two readers in order to determine biliary anatomy and the presence of complications, whose final diagnosis was based on endoscopic retrograde cholangiography (ERC) in 50 patients, percutaneous trans-hepatic cholangiography (PTC) in five, and by integrating clinical follow-up with ultrasound and MR findings in 58 cases. MRC had a sensitivity of 93%, a specificity of 92%, a positive predictive value of 86%, a negative predictive value of 96%, and a global diagnostic accuracy of 93% in detecting all types of biliary complications in OLT patients. MRC is a reliable technique for detecting post-OLT biliary complications. We now restrict the use of ERC to patients for whom therapeutic procedures are advocated or whose MRC results are equivocal.     

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.     

Primary epiploic appendagitis: MRI findings

Primary epiploic appendagitis (PEA) occurs secondary to inflammation of an epiploic appendage, and is considered to be a rare cause of acute abdomen. In this case report, we describe the magnetic resonance imaging (MRI) findings of PEA correlated with computed tomographic (CT) findings. MRI findings included an oval shaped fat intensity mass with a central dot on T1- and T2-weighted images, which possessed an enhancing rim on postgadolinium T1-weighted fat saturated images. The lesion was best visualized on postcontrast T1-weighted fat saturated images. MRI findings of PEA should be considered in the differential diagnosis with the other causes of acute abdominal pain.     

Hepatocellular lesions with increased iron uptake on superparamagnetic iron oxide-enhanced magnetic resonance imaging in cirrhosis or chronic hepatitis: comparison of four magnetic resonance sequences for lesion conspicuity

Purpose

The aim of this study was to determine the adequate MR sequence for the lesion conspicuity of hepatocellular lesions with increased iron uptake on superparamagnetic iron oxide (SPIO)-enhanced MRI.

Materials and Methods

SPIO-enhanced MRI was performed using a 1.5-T system. Among 25 patients with hypovascular hepatocellular nodules on contrast-enhanced dynamic CT (no early enhancement at arterial phase and hypoattenuation at equilibrium phase), 39 lesions with increased iron uptake on SPIO-enhanced MRI were evaluated. SPIO-enhanced MRI included (1) T1-weighted in-phase gradient recalled echo (GRE) images, (2) T2-weighted fast spin echo (FSE) images, (3) T2*-weighted GRE with moderate TE (7 ms) and (4) long TE (12 ms). The lesion-to-liver contrast-to-noise ratios of the hepatocellular nodule and the signal-to-noise ratio (SNR) of the hepatic parenchyma were calculated by one radiologist for a quantitative assessment. MR images were reviewed retrospectively by two independent radiologists to compare the subjective lesion conspicuity in each image set based on a four-point rating scale.

Result

The mean lesion-to-liver contrast-to-noise ratios with T2*-weighted GRE with moderate TE (7 ms) was highest (5.79±3.71) and was significantly higher than those with T1-weighted, in-phase images (3.79±3.23, P<.01), T2-weighted images (2.72±1.52, P<.001) and T2*-weighted GRE with long TE (12 ms) (3.93±2.69, P<.05). The subjective rating of lesion conspicuity was best on the T2*-weighted GRE with moderate TE (7 ms), followed by that on the T2*-weighted GRE with moderate TE (7 ms; P<.05).

Conclusion

T2*-weighted GRE sequence with moderate TE (7 ms) showed high lesion-to-liver contrast-to-noise ratios in hepatocellular lesions with increased iron uptake on SPIO-enhanced MRI, indicating better lesion conspicuity of hypointense hepatocellular nodules in cirrhosis or chronic hepatitis.