High resolution MRI relaxation measurements of water in the articular cartilage of the meniscectomized rat knee at 4.7 T

Measurements by magnetic resonance imaging (MRI) of the spin-spin (T2), spin-lattice (T1) and spin-density (M0) parameters of water protons, optimized by using the Cramér-Rao Lower Bound (CRLB) theory, were made to quantify the effect of surgically induced osteoarthritis on rat knee cartilage at 4.7 T. Partial meniscectomy was performed on the right medial condyle of four Sprague Dawley rats, leaving the left medial condyle as a control. The animals were euthanized 3 weeks after the operation; the entire limbs were removed and T2 and T1 relaxation measurements and M0 measurements of the protons of water were obtained using conventional Carr-Purcell-Meiboom-Gill (CPMG) and saturation recovery methods. M0 was normalized with respect to a water phantom, to obtain the relative spin-density M0%. Weight-bearing cartilage areas on the meniscectomized medial condyles exhibited a significant increase of T2 relaxation time (p < 0.001) and of M0% (p < 0.01) with respect to the control; T1 relaxation times did not show any statistically significant changes. CRLB-based sampling optimization offered an insight to improved measurement precision and a reduction of scanning time against conventional sampling methods methods. Quantitative MRI assessment of the meniscectomized rat knee shows that cartilage exhibits changes in T2 and M0 values 3 weeks after operation.     

Paramagnetic enhanced proton magnetic resonance measurement in rats: correlates with renal function

Renal cortical, medullar and papillary T1 and T2 relaxation times were measured in rats with normal (n = 13) and impaired renal function (n = 11) with a Bruker Multispec, 20 MHz at 37 degrees C. In one group of seven rats, decreased renal function was obtained by 50% glycerol solution administration (10 ml/kg-body weight) 24 hours before the experiment, while in another group of four rats the renal function was decreased, by ureteral ligation for 72 hours. Immediately after the excision of one kidney, Gadolinium-DTPA (70 mumole/kg body weight) was injected intravenously. The second kidney was excised 5 min later. From the T1 and T2 relaxation times measured in the cortex, medulla, and papilla, their respective ratios before and after GdDTPA administration were calculated and correlated with GFR determined by creatinine clearance (Ccr range was between 0 and 850 microliters/min/g kidney weight). For T1: the ratios in the cortex, medulla, and papilla the correlation coefficients were r = 0.81 (p less than 0.001), r = 0.85 (p less than 0.001), and r = 0.87 (p less than 0.0001), respectively. The respective correlation coefficient r values for T2 were r = 0.38 (NS), r = 0.76 (p less than 0.001), and r = 0.73 (p less than 0.001). The present study indicates that a combination of MR measurements, with and without GdDTPA paramagnetic enhancement, can offer a new possibility for obtaining information on renal function and suggest the possibility of concomitant anatomo functional magnetic resonance imaging.     

Clinical value of routine use of thin-section 3D MRI using 3D FSE sequences with a variable flip angle technique for internal derangements of the knee joint at 3T

PurposeTo determine the clinical value of routine use of thin-section 3D MRI using 3D FSE sequences with a variable flip angle technique for internal derangements of the knee joint at 3 T.Method and MaterialsThirty-four knees in 34 patients suspected of having internal derangements of the knee joint were included. Following standard 2D MRI protocol including sagittal PDWI, T1WI and T2*WI, coronal fat-suppressed PDWI, and axial fat-suppressed PDWI with 3-4 mm thicknesses, fat-suppressed and water-excitation PDWI using 3D FSE sequences with a variable flip angle technique with 0.6 mm thickness were obtained in coronal plane and the three major planes with 1 mm thickness (3D MRI) was reformatted. The standard 2D MRI protocol and reformatted 3D MRI protocol (three sagittal 2D sequence images plus 3D MRI) were independently analyzed by two radiologists concerning presence or absence of lesions in the menisci, cartilage, and ligament. Interobserver agreements in both the MRI protocols were assessed by weighted-kappa coefficients. Regarding diagnostic accuracy, areas under the receiver operating characteristic curves (Az values) of both the MRI protocols were compared.ResultsThirty-eight meniscal lesions, 39 cartilage lesions, and 20 ligamentous lesions were surgically detected. Excellent interobserver agreements (kappa = 0.91–0.98) were seen in both the MRI protocols, with a slightly better tendency in the reformatted 3D MRI protocol. Average Az values in detection of the meniscal, cartilage, and ligamentous lesions were significantly higher in the reformatted 3D MRI protocol than in the standard 2D MRI protocol (p < 0.01 or p < 0.001).ConclusionRoutine use of reformatted thin-section 3D MRI using 3D FSE sequences with a variable flip angle technique may improve diagnostic accuracy and confidence in detection of internal derangements of the knee joint.     

MRI of blood volume with superparamagnetic iron in choroidal melanoma treated with thermotherapy

Functional magnetic resonance imaging (MRI) with a new intravascular contrast agent, monocrystalline iron oxide nanoparticles (MION), was applied to assess the effect of transpupillary thermotherapy in a rabbit model of choroidal melanoma. 3D-spoiled gradient recalled sequences were used for quantitative assessment of blood volume. The MRI-parameters were 5/22/35 degrees (time of repetition (TR)/echo delay (TE)/flip angle (FA)) for T(1)- and 50/61/10 degrees for T(2)-weighted sequences. Images were collected before and at different times after MION injection. In all untreated tissues studied, MION reduced the T(2)-weighted signal intensity within 0.5 h and at 24 h (all p <== 0.012), whereas no significant changes were detected in treated tumors. T(1)-weighted images also revealed differences of MION-related signal changes between treated tumors and other tissues, yet at lower sensitivity and specificity than T(2). The change of T(2)-weighted MRI signal caused by intravascular MION allows early distinction of laser-treated experimental melanomas from untreated tissues. Further study is necessary to determine whether MRI can localize areas of tumor regrowth within tumors treated incompletely.     

MR imaging of cervical spine motion with HASTE

The HASTE (half-Fourier acquisition single-shot turbo spin-echo) technique delivers images with T2-weighting in about half a second and could be ideal for fast dynamic studies when T2-weighting is needed. We evaluated cardiac-triggered HASTE to study cervical spine flexion/extension. The cervical spines of ten asymptomatic volunteers were studied during flexion/extension motion on a 1.5 Tesla imager using a cardiac triggered version of the HASTE technique. Midline sagittal images were acquired every 2 to 3 s during neck flexion and extension. Image quality was compared to traditional T2-weighted Turbo spin-echo. The study duration per flexion/ extension was typically less than 20 seconds and well tolerated. The cardiac-gated T2-weighted HASTE images compared favorably to the traditional T2-weighted TSE images in quality and overall anatomic detail. Range of motion averaged: flexion 30 degrees (range 8 degrees -48 degrees) and extension 23 degrees (range 0 degrees -57 degrees ). Greatest motion occurred in the lower cervical spine (C4-C7). At the intervertebral discs the canal diameter, anterior and posterior CSF spaces were widest in neutral position and decreased with flexion and extension. Therefore, Cardiac-gated T2 HASTE sequences provide diagnostic and time-efficient dynamic MR images of cervical spine motion.     

Age-related changes in the pediatric brain: proton T1 in healthy children and in children with sickle cell disease

The goal of this study was to characterize the expected range of variation in T1 (spin-lattice relaxation time) of brain tissue in vivo, as a function of age, and to use these maturational norms to study children with sickle cell disease (SCD). A well-validated method (TurboPAIR) was used to measure T1 in 10 tissues in a study group of 200 healthy subjects (ages 4.5 to 79.3; 101 male and 99 female), in a transverse slice at the level of the basal ganglia. Brain T1 was significantly related to age in every tissue characterized (p < 0.001), including the splenium (p < 0.01). Quantitative MRI suggests that brain T1 continues to change throughout the lifespan of healthy subjects free of neurologic complaints. Age-related changes follow a different schedule in each tissue, and age is a stronger determinant of T1 in gray matter than in white matter. Analysis of 141 patients with SCD shows that patients have lower T1 than normal, in both the caudate and the cortex (p < 0.001).     

Study on the variations of the apparent diffusion coefficient in areas of solid tumor in high grade gliomas

Present knowledge suggests that in glioblastoma multiforme the value of the apparent diffusion coefficient (ADC) is elevated in the solid part and hyperintense in T1, in spite of the elevated cellularity, and also in areas where peritumoral vasogenic edema is present. The purpose of our study has been to verify in vivo if the ADC increases in areas of solid tumor because of an increased presence of edema, like it happens in areas surrounding the tumor. Sixteen patients with histologically verified glioblastoma multiforme underwent a magnetic resonance (MR) examination with sequences: T1-weighted pre and post contrast, diffusion-weighted at b = 0 and b = 1000 s/mm(2), perfusion-weighted. One hundred sixty-five regions of interest (ROI) have been obtained for all set of patients. In each ROI we have estimated 4 parameters: ADC, intensity of T2-signal normalised to the white matter (SI(T2W)(n)), regional cerebral blood volume (rCBV), T1-signal enhancement (E%). With the SI(T2W)(n) the presence of edema was estimated. For each pair of measured parameters a statistical test of linear regression on the set of all ROI was made. A directed linear correlation between: ADC and SI(T2W)(n) (p 相似文献   

Dependence of residual dipolar couplings on foot angle in H MR spectra from skeletal muscle

Foot dorsi and plantar flexion affects the pennation angle of skeletal muscle fibers and changes the fiber direction with respect to the main magnetic field, thereby affecting MR spectrum of the muscle. In order to analyze the effect that foot flexion has on the MR spectrum, tibialis anterior (TA) and soleus muscles were studied in humans and rats. Localized MRS was performed at different foot angles in clinical and pre-clinical settings using a 3 T MRI/MRS GE Excite HD and 7 T Bruker Clinscan scanner, respectively. In this study we show the effect of foot angle variation on total Creatine (tCr) resonance of ¹H spectrum at 3.03 and 3.93 ppm for TA and soleus muscles. In addition to this, we observe a 4-line splitting pattern for methylene resonance of tCr in the rat TA spectrum for a specific foot angle. This observation is attributed to the individual splitting of creatine and phosphocreatine of the tCr signal. Novel hydrogel application is demonstrated and used to support our in vivo observations and for the first time splitting of individual resonances of Cr and PCr has been shown in an in vitro set-up.     

Inter-ELM power decay length for JET and ASDEX upgrade: measurement and comparison with heuristic drift-based model

Experimental measurements of the SOL power decay length (λ(q)) estimated from analysis of fully attached divertor heat load profiles from two tokamaks, JET and ASDEX Upgrade, are presented. Data was measured by means of infrared thermography. An empirical scaling reveals parametric dependency λ(q) in mm = 0.73B(T)(-0.78)q(cyl)(1.2)P(SOL)(0.1)R(geo)(0), where B(T)(T) describes the toroidal magnetic field, q(cyl) the cylindrical safety factor, P(SOL)(MW) the power crossing the separatrix and R(geo)(m) the major radius of the device. A comparison of these measurements to a heuristic particle drift-based model shows satisfactory agreement in both absolute magnitude and scaling. Extrapolation to ITER gives λ(q) ? 1 mm.     

MRI in the study of distal primary myopathopies and of muscular alterations due to peripheral neuropathies: possible diagnostic capacities of MR equipment with low intensity field (0.2 T) dedicated to peripheral limbs

The purpose of this work was to investigate whether or not an magnetic resonance imaging (MRI) equipment with a low field intensity (O.2 T) used in the study of muscular alterations can diagnose primary or secondary myopathies, due to peripheral neuropathies. In this study the peripheral areas of all patients were examined. A total of 40 patients (23 males and 17 females) were tested. Their age ranged from 10 to 78 years age (mean age 40.8, SD ± 19,45 years). The group includes 23 patients: 18 with Stainert Myotonic Distrophy, 5 were myositic, and the remaining 17 had peropheral neuropathies. Every patient received a clinic examination, followed by EMG and MRI. The MRI study was done with a system dedicated to the study of limbs (Artoscan, Esaote Biomedica) that used a 0.2 T permanent magnet. Spin-echo T₁, T₂-weighted, multiple-echo, and STIR sequences were used. A good correspondence was found between clinical and MRI data. Specifically, in the group of 23 myopathies, Sperman’s index was found to be 0.80 in its correlation between the clinical examination and MRI; in the group of 17 myopathies it was found to be 0.63. A discrepancy was found among clinical examination, EMG, and MRI in patients with neuropathies who were showing a lack of myelin and mixed ones. The T2-weighted and STIR sequences had great sensitivity in showing initial changes in the muscles. The SE T1-weighted sequence was especially useful in detecting degeneration in the fibrous adipose tissue. The STIR sequence because of its high sensitivity and greater speed of response could be used instead of the SE T2 weighted particularly in the study of patients, who were noted to tolerate a prolonge period of scanning. However, because these sequences have a low signal noise ratio, they must always be associated with a SE sequence, whenever there would be need of a precise determination of the structures under study. The MRI low field intensity was also found to be a useful technique in screening familial groups having a great number of myotonic distrophies. It can have a great clinical role in revealing muscular alterations, even in asymptomatic patients.     

T2 relaxation time measurements in osteoarthritis

Quantification of changes in T(2) relaxation time, in human cartilage, with progression of osteoarthritis (OA), and evaluation of qualitative correlations with clinical evaluation, histology and polarized light microscopy (PLM). Cartilage-bone plugs were harvested from fresh cadaveric knees (n = 10) and specimens after surgical knee replacement (n = 2) at 12 locations, including lateral and medial sides of tibia, femora and patella. Magnetic resonance imaging was performed at 1.5 Tesla using a.2D spin echo sequence. Histological slices were assessed for OA severity through a grading scale based on combined histological and PLM results. T(2) values in clinically moderate OA were generally higher than in severe OA and normal cartilage. Significant association was established between normal and early OA subjects and T(2) variation, in the medial compartment of the knee (p < 0.05) but especially in the medial tibial cartilage (p < 0.00005). As expected, medial and lateral tibio-femoral compartments underwent more severe degeneration. Additionally, there were intracompartmental variation of the relaxation times and histological patterns, which demonstrate the underlying focal involvement of OA in the knee. Furthermore, T(2) values reflected OA pathogenesis with a positive correlation with histology grading scale. Finally, increased T(2) is correlated to histological degeneration of cartilage and may be a good marker for early OA in tibial articular cartilage.     

Simultaneous BOLD/perfusion measurement using dual-echo FAIR and UNFAIR: sequence comparison at 1.5T and 3.0T.

Functional MRI (fMRI) studies designed for simultaneously measuring Blood Oxygenation Level Dependent (BOLD) and Cerebral Blood Flow (CBF) signal often employ the standard Flow Alternating Inversion Recovery (FAIR) technique. However, some sensitivity is lost in the BOLD data due to inherent T1 relaxation. We sought to minimize the preceding problem by employing a modified UN-inverted FAIR (UNFAIR) technique, which (in theory) should provide identical CBF signal as FAIR with minimal degradation of the BOLD signal. UNFAIR BOLD maps acquired from human subjects (n = 8) showed significantly higher mean z-score of approximately 17% (p < 0.001), and number of activated voxels at 1.5T. On the other hand, the corresponding FAIR perfusion maps were superior to the UNFAIR perfusion maps as reflected in a higher mean z-score of approximately 8% (p = 0.013), and number of activated voxels. The reduction in UNFAIR sensitivity for perfusion is attributed to increased motion sensitivity related to its higher background signal, and, T2 related losses from the use of an extra inversion pulse. Data acquired at 3.0T demonstrating similar trends are also presented.     

Correlation between MRI and clinico-pathological manifestations in Lewis rats protected from experimental allergic encephalomyelitis by acylated synthetic peptide of myelin basic protein.

Experimental allergic encephalomyelitis (EAE) is an autoimmune disease of the central nervous system which constitutes an accepted animal model for multiple sclerosis (MS). The disease can take an acute or chronic form depending on the injection route, animal strain and nature of the disease-inducing antigen administered. The neuroinflammation associated with the acute form can be detected with T2-weighted, T1-weighted and diffusion MRI, and blood-brain barrier changes can be investigated with Gd-DTPA-enhanced T1-weighted imaging, similar to that of MS patients. A synthetic peptide of myelin basic protein (MBP) encephalitogenic for the Lewis rat (MBP 68-86) was acylated by the attachment of a palmitoyl residue (PAL68-86), and was shown to confer almost complete protection against EAE, when administered to rats before and after an encephalitogenic challenge. In this study, treatment of Lewis rats with PAL68-86 prevented the appearance of clinical signs (p < 0.0001) after challenge with the native peptide (p68-86) in complete Freund's adjuvant (CFA), and reduced considerably the MRI and histopathological signs of the disease (p < 0.0001). Measurement of the gadolinium leakage due to neuroinflammation revealed a significant decrease in permeability from 4.09 +/- 2.1 to 2.95 +/- 1.79% pixels > mean + 2 SD (p = 0.011). Therefore, quantitative MRI measurements correlate very well with the reduced cellular infiltration in the CNS and the absence of clinical signs in the EAE-protected animal.     

Comparison of PD BLADE with fat saturation (FS), PD FS and T2 3D DESS with water excitation (WE) in detecting articular knee cartilage defects

The purpose of this study, is to compare the sequences: 1) proton density (PD) BLADE (BLADE is a PROPELLER-equivalent implementation of the Siemens Medical System) with fat saturation (FS) coronal (COR), 2) PD FS COR, 3) multi-planar reconstruction (MPR) with 3 mm slice thickness and 4) multi-planar reconstruction (MPR) with 1.5 mm slice thickness, both from the T2 3D-double-echo steady state (DESS) with water excitation (WE) sagittal (SAG), regarding their abilities to identify changes in the femorotibial condyle cartilage in knee MRI examinations. Thirty three consecutive patients with osteoarthritis (18 females, 15 males; mean age 56 years, range 37–71 years), who had been routinely scanned for knee examination using the previously mentioned image acquisition techniques, participated in the study. A quantitative analysis was performed based on the relative contrast (ReCON) measurements, which were taken both on normal tissues as well as on pathologies. Additionally, a qualitative analysis was performed by two radiologists. Motion and pulsatile flow artifacts were evaluated. The PD BLADE FS COR sequence produced images of higher contrast between Menisci and Cartilage, Fluid and Cartilage, Pathologies and Cartilage as well as of the Conspicuousness Superficial Cartilage and it was found to be superior to the other sequences (p < 0.001). The sequences T2 3D DESS 1.5 mm and T2 3D DESS 3 mm were significantly superior to the PD BLADE FS COR and the PD FS COR sequences in the visualization of Bone and Cartilage and the Conspicuousness Deep Surface Cartilage. This pattern of results is also confirmed by the quantitative analysis. PD FS BLADE sequences are ideal for the depiction of the cartilage pathologies compared to the conventional PD FS and T2 3D DESS sequences.     

用MRI无损检测胆囊中的胆汁成

为了探索用磁共振成象方法无损伤检测胆囊中的胆汁成分的可能性,我们用0.5T的磁共振成象仪,对38例禁食期胆囊疾病患者(12例急性无并发症胆囊炎及胆结石,1例化浓性胆囊炎,2例急性出血性胆囊炎,14例慢性胆囊炎及胆结石,5例胆囊息肉,4例障碍性黄疸进行了轴向腹部胆囊部位T1-加权自旋-回波成象.结果表明:禁食或胆囊疾病患者胆汁中胆固醇(p=0.014),脂肪酸(p=0.001),和铁(p<0.001)的浓度对T₁-加权成象(TR/TE=620/25ms)的肝-胆信号强度比有明显的负影响,同时发现总蛋白质,总胆红素及Na⁺,K⁺,Cl^-,Mg⁺⁺离子的浓度对肝-胆MRI信号强度比无显著影响,由此可见,T₁-加权MRI中的肝-胆信号强度比反映了胆囊中的胆汁成分,其中影响肝-胆信号强度比的最重要因素是胆囊中胆汁所含胆固醇、脂肪酸和铁的浓度.     

Clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty: A prospective cohort study

Objective: To derive a clinical prediction rule for early recovery of knee range of motion after total knee arthroplasty. Methods: This prospective cohort study evaluated the data of 273 individuals undergoing primary total knee arthroplasty. The individual factors, the physical and motor function data were assessed preoperatively upon admission as a baseline survey. The knee joint extension angle and knee joint flexion angle were re-evaluated on postoperative day 14 as a follow-up. The recovery group comprised individuals with a knee joint extension angle of more than -5 degrees and knee joint flexion angle of more than 110 degrees on postoperative day 14. The other patients constituted the non-recovery group. Multivariate logistic regression analysis was used for deriving a clinical prediction rule. Results: The results indicated that the use of a cane, knee joint extension and flexion angles, and Timed Up and Go test time were significant factors for predicting early recovery of knee range of motion after total knee arthroplasty. Furthermore, a clinical prediction rule was derived and included the use of a cane, knee joint extension angle ≥ -15 degrees, knee joint flexion angle ≥ 125 degrees, and a Timed Up and Go test time < 11.2 s. A total clinical prediction rule score ≥ 8 indicated a positive likelihood ratio of more than 10 for a successful outcome and the post-test probability was approximately 95%. Conclusions: The derived clinical prediction rule might be a useful screening tool for proper postoperative goal setting and the establishment of individualized physical therapy programs.     

Importance of knee flexion range of motion during the acute phase after total knee arthroplasty

Background: We investigate the association with knee flexion range of motion (ROM) during the acute phases and that at 12 months after total knee arthroplasty (TKA). We also clarified the cut-off ROM during the acute phases in predicting the goal of knee flexion ROM at 12 months. Methods: In this retrospective study, 193 patients with knee osteoarthritis (female:144 patients, age:73.2 ± 7.7 years) who underwent unilateral TKA at an orthopedic clinic were recruited. They underwent assessments of knee flexion ROM at 5 days, 1 month, and 12 months after TKA. The goal of knee flexion ROM at 12 months after TKA was set at 120°. Single and logistic-regression analyses were performed with the dependent variables including the outcome of the goal of knee flexion ROM at 12 months, and the independent variables included knee flexion ROM at 5 days and 1 month, separately. We calculated the cut-off ROM at 5 days and 1 month for predicting the goal of knee flexion ROM at 12 months with receiver operating curve analysis. Results: Knee flexion ROM at 5 days and 1 month were significantly associated with the goal of that at 12 months (p < 0.01). The cut-off ROM were 85° at 5 days and 105° at 1 month separately. Conclusions: Our results suggest the importance of early improvement in knee flexion ROM after TKA, and that at 1 month postoperatively indicates the likelihood of achievement of the goal of knee flexion ROM at 12 months after TKA.     

Triple-negative breast cancer: Pretreatment magnetic resonance imaging features and clinicopathological factors associated with recurrence

PurposeWe aimed to investigate the magnetic resonance imaging (MRI) features and clinicopathologic factors with recurrence of triple-negative breast cancer (TNBC).Patients and methodsWe identified 281 patients with 288 surgically confirmed TNBC lesions who underwent pretreatment MRI between 2009 and 2015. The presence of intratumoral high signal on T2-weighted images, high-signal rim on diffusion-weighted images (DWI), and rim enhancement on the dynamic contrast-enhanced MRI and clinicopathological data were collected. Cox proportional analysis was performed.ResultsOf the 288 lesions, 36 (12.5%) recurred after a median follow-up of 18 months (range, 3.6–68.3 months). Rim enhancement (hazard ratio [HR] = 3.15; 95% confidence interval [CI] = 1.01, 9.88; p = .048), and lymphovascular invasion (HR = 2.73, 95% CI = 1.20, 6.23; p = .016) were independently associated with disease recurrence. While fibroglandular volume, background parenchymal enhancement, intratumoral T2 high signal, and high-signal rim on DWI, were not found to be risk factors for recurrence.ConclusionPretreatment MRI features may help predict a high risk of recurrence in patients with TNBC.     

MRI-based quantification of cerebral edema in individual SHRSP rats using averaged criteria determined before the occurrence of edema.

This study evaluated whether it is possible with T2-weighted MRI to quantitatively relate image-outcome in a single, individual case with that of a standardized control group that did not show these pathologies. An animal model of hypertension-related cerebral damage, the salt-loaded, stroke-prone spontaneously hypertensive rat (SHRSP), was applied. Very similar values for cerebral edema were found when using either the individual or the averaged threshold. The values were positively correlated with each, as edema(averaged threshold) = 0.12 + 0.99 x edema(individual threshold) (Pearsons coefficient = 0.99, p < 0.0001). This line was virtually congruent with the line of identity. Thus, by determination of the averaged threshold in the healthy salt-loaded SHRSP, a parameter was obtained to calculate cerebral edema with the specifically used T2-weighted MRI protocol, in any rat.     

Noncontrast MRI with diffusion-weighted imaging as the sole imaging modality for detecting liver malignancy in patients with high risk for hepatocellular carcinoma

Purpose

To compare the diagnostic performance of the noncontrast MRI including DWI to the standard MRI for detecting hepatic malignancies in patients with chronic liver disease.

Materials and methods

We included 135 patients with 136 histologically-confirmed hepatocellular carcinomas (HCCs), 12 cholangiocarcinomas, and 34 benign lesions (≤ 2.0 cm), and 22 patients with cirrhosis but no focal liver lesion who underwent 3.0 T liver MRI. Noncontrast MRI set (T1- and T2-weighted images and DWI) and standard MRI set (gadoxetic acid-enhanced and noncontrast MRI) were analyzed independently by three observers to detect liver malignancies using receiver operating characteristic analysis.

Results

The Az value of the noncontrast MRI (mean, 0.906) was not inferior to that of the combined MRI (mean, 0.924) for detecting malignancies by all observers (P > 0.05). For each observer, no significant difference was found in the sensitivity and specificity between the two MRI sets for detecting liver malignancies and distinguishing them from benign lesions (P > 0.05), whereas negative predictive value was higher with the combined MRI than with the noncontrast MRI (P = 0.0001). When using pooled data, the sensitivity of the combined MRI (mean 94.8%) was higher than that of the noncontrast MRI (mean, 91.7%) (P = 0.001), whereas specificity was equivalent (78.6% vs 77.5%).

Conclusion

Noncontrast MRI including DWI showed reasonable performance compared to the combined gadoxetic acid-enhanced and noncontrast MRI set for detecting HCC and cholangiocarcinoma and differentiating them from benign lesions in patients with chronic liver disease.