MRI findings of gastric metastases from breast carcinoma

We describe the MR appearance of breast cancer metastases to the stomach. The stomach wall was diffusely thickened with loss of the regular fold pattern best shown on the single shot T2-weighted images and enhanced with moderate mural enhancement on early and late post gadolinium images. The combination of gastric wall thickening and abnormal enhancement should suggest the diagnosis of diffuse mural metastases in a woman with a history of breast cancer.     

MR Imaging of metastatic pancreatic VIPoma

The MR findings in a 32-year-old man with pancreatic VIPoma and liver metastases are described. A 2-cm mass was present in the region of the tail of the pancreas that was best shown on T₁-weighted fat-suppressed images as a low-signal intensity mass. Multiple liver metastases were present that showed intense peripheral ring enhancement on immediate post gadolinium spoiled gradient echo images.     

Active intrahepatic gadolinium extravasation following TIPS

A 31-year-old male patient had a transjugular intrahepatic portal systemic shunt (TIPS) placed for acute Budd-Chiari syndrome secondary to paroxysmal nocturnal hemoglobinuria (PNH). Post-procedure, he was anticoagulated for his underlying paroxysmal nocturnal hemoglobinuria. After 11 days, he complained of upper abdominal pain and underwent magnetic resonance imaging (MRI). On immediate post-gadolinium spoiled-gradient-echo (SGE) images, active extravasation of gadolinium was depicted in one of two intrahepatic hematomas. Progression of layering of high signal gadolinium was shown from early to later phase post-gadolinium images. The active arterial bleeding was confirmed by conventional angiography performed immediately following the magnetic resonance imaging.     

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.     

Disappearance of tumor contrast on contrast-enhanced FLAIR imaging of cerebral gliomas

Contrast-enhanced fluid-attentuated inversion recovery (FLAIR) magnetic resonance (MR) imaging has shown to be a valuable diagnostic modality in the assessment of cerebral gliomas. In this study we report of a potential pitfall regarding the delineation of enhancing tumor parts on contrast enhanced FLAIR imaging. In a limited number of patients, the administration of gadolinium obscures the area of contrast enhancement on contrast enhanced FLAIR images. Therefore the delineation of the macroscopic tumor parts, which are of great importance for the treatment planning is substantially worsened.     

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.     

Renal cell carcinoma in a transplanted kidney: MR imaging findings

We report the MR findings of a 42-year-old man who developed renal cell carcinoma in an allograft kidney, 10 years after transplantation. The lower pole of the transplant kidney showed a solid lesion which was well shown on the post gadolinium fat suppressed images as a heterogeneously enhancing 2 cm mass lesion.     

Renal malacoplakia: demonstration by MR imaging

We report herein a case of histologically verified bilateral renal malacoplakia. MRI features were distinctive and include multiple nodules 1-2 cm in diameter that were low in signal on T1, T2 and early and late post gadolinium images with intervening fibrous stroma. Demonstration of renal malacoplakia on MR images may obviate the need for major surgery and rapidly direct patients to appropriate antimicrobial therapy for treatment.     

Microbubbles containing gadolinium as contrast agents for both phase contrast and magnetic resonance imaging

Portal vein imaging is an important method for investigating portal venous disorders. However, the diagnostic requirements are not usually satisfied when using single imaging techniques. Diagnostic accuracy can be improved by combining different imaging techniques. Contrast agents that can be used for combined imaging modalities are needed. In this study, the feasibility of using microbubbles containing gadolinium (MCG) as contrast agents for both phase contrast imaging (PCI) and magnetic resonance imaging (MRI) are investigated. MCG were made by encapsulating sulfur hexafluoride (SF₆) gas with gadolinium and lyophilized powder. Absorption contrast imaging (ACI) and PCI of MCG were performed and compared in vitro. MCG were injected into the main portal trunk of living rats. PCI and MRI were performed at 2 min and 10 min after MCG injection, respectively. PCI exploited the differences in the refractive index and visibly showed the MCG, which were not detectable by ACI. PCI could facilitate clear revelation of the MCG‐infused portal veins. The diameter of the portal veins could be determined by the largest MCG in the same portal vein. The minimum diameter of clearly detected portal veins was about 300 µm by MRI. These results indicate that MCG could enhance both PCI and MRI for imaging portal veins. The detection sensitivity of PCI and MRI could compensate for each other when using MCG contrast agents for animals.     

Peliosis hepatis and neoplastic/dysplastic lesions in aged male Long-Evans Cinnamon rats: MR imaging with pathologic correlation

The Long-Evans Cinnamon (LEC) rat, an animal model of Wilson's disease, abnormally accumulates copper in the liver. There have been a lot of reports on preneoplastic and neoplastic hepatic tumors in LEC rats, but few studies have been focused on other lesions. The aim of this study was to describe the MR findings of the liver of LEC rats with pathologic correlation to characterize the hepatic lesions developed in them. We measured MR images of the liver of six aged (over the age of 70 weeks old) male LEC rats. Measurements of T(1), T(2)-weighted images, and the dynamic and delayed studies after i.v. gadolinium injection were performed. The rats were sacrificed immediately after the measurements, and the diagnosis was histologically made. We identified seven lesions of peliosis hepatis, three neoplastic/dysplastic lesions, three cysts and one cholangiofibrosis. Peliosis hepatis was characterized as showing a significantly long T(2) relaxation time of 57.9 +/- 13.3 ms (mean +/- standard deviation) compared with 41.3 +/- 1.7 ms in normal liver, and prolonged enhancement after a gadolinium injection. Neoplastic/dysplastic lesions tended to show prolonged T(2), and they showed isointensity on T(1)-weighted images. They were best characterized by early enhancement followed by a rapid wash-out after a gadolinium injection. In conclusions, the frequent occurrence of peliosis hepatis observed in the present study suggests this can be a characteristic lesion in aged LEC rats. The characteristic MR findings enable us to distinguish between peliosis hepatis and neoplastic/dysplastic lesions.     

Macroscopic tumor volume of malignant glioma determined by contrast-enhanced magnetic resonance imaging with and without magnetization transfer contrast

The purposes of this study were to compare the conspicuity and lesion volume of contrast-enhancing macroscopic malignant glioma determined by postcontrast magnetic resonance (MR) imaging with and without magnetization transfer (MT) saturation, and to discuss possible implications for radiotherapy planning. Nineteen patients (age 24–60 years) with histologically proven malignant glioma were prospectively examined by MR imaging. After the administration of gadolinium dimeglumine (0.1 mmol/kg body weight), the lesions were imaged with an MT-weighted FLASH (fast, low-angle shot) pulse sequence and with a conventional T₁-weighted spin-echo (SE) sequence without MT saturation. The mean tumor volumes of gliomas measured on MT-weighted FLASH images were significantly (p < .01) larger than those obtained from T₁-weighted SE images (45 ± 15 cm³ vs. 33 ± 10 cm³). The mean contrast-to-noise ratio of enhancing lesions on MT-weighted FLASH was 48 ± 14 compared with 30 ± 14 on SE images, representing a significant (p < .01) improvement. We conclude that the volume of contrast enhancement of malignant glioma identified on MT-weighted FLASH images represents the area of disrupted blood-brain barrier. If this volume of subtle contrast enhancement is caused by tumor infiltration and represents the boost target volume for stereotactic radiosurgery or brachytherapy, MT-weighted FLASH images would be better than T₁-weighted SE images to define these volumes. These improved delineation of areas at highest risk for recurrence following radiation therapy should enhance the efficacy of treatment planning for high-boost therapy.     

MR signal change in venous thrombus relates organizing process and thrombolytic response in rabbit

Venous thrombus is subsequently organized and replaced by fibrous connective tissue. However, the sequential changes in venous thrombi are not reliably detected by current noninvasive diagnostic techniques. The purpose of this study is to reveal whether magnetic resonance (MR) can detect venous thrombus, define thrombus age and predict thrombolytic responses. Thrombus in the rabbit jugular vein was imaged with a 1.5-T MR system at 4 h and at 1, 2 and 4 weeks using three-dimensional (3D) fast asymmetric spin echo T2-weighted (T2W) and 3D-gradient echo T1-weighted (T1W) sequences. The jugular veins were histologically assessed at each time point. Magnetic resonance imaging (MRI) was also performed in vivo before and 30 min after tissue plasminogen activator (t-PA) administration. The thrombi in MRI were comparable in size to histological sections. The signal intensity (SI) of thrombi at 4 h was heterogeneously high or low on T2W or T1W images, respectively. The SI of thrombi on T2W images decreased time-dependently, but increased on T1W images at 1 and 2 weeks. Morphological analysis showed time-dependent decreases in erythrocyte, platelet and fibrin areas and time-dependent increases in smooth muscle cell, macrophage, collagen and iron areas. The t-PA administration significantly decreased thrombus volume at 4 h but not at 1, 2 and 4 weeks. Venous thrombosis can be reliably and noninvasively detected by MRI. Measurement of SI might support assessments of thrombus age and thrombolytic response.     

Gadolinium-DTPA-enhanced and digitally subtracted magnetic resonance imaging of estrogen-induced pituitary lesions in rats: correlation with pituitary anatomy

Pituitary hypertrophy and tumors were induced in male Sprague Dawley rats using estradiol-17 beta. This tumor model generates a variety of pituitary lesions which are relevant to human pituitary disease. In order to characterize these lesions, gadolinium DTPA was injected intravenously into the tail vein of estrogen treated and control rats. High resolution T1-weighted MR images, pre- and postenhancement, were obtained at 8 different time points spanning 300 days following the subcutaneous implantation of the estrogen pellets. Images with 2-mm slice thickness were made with a 2 Telsa small-bore MR imaging system. Both normal and tumorous pituitaries were found to enhance with contrast agent, but contrast uptake was not uniform. Gd-DTPA distribution was sensitive to the different types of lesions generated in the course of this study. Digital subtraction of congruent images, pre- and postcontrast, provided difference images reflecting contrast concentration and allowed identification of subtle enhancement effects. Hypertrophic pituitaries displayed uptake of contrast, but the distribution of contrast agent was nonuniform and appeared mottled. A bright rim enhancement was often seen anterior to the pituitary gland, most likely arising from the oculomotor nerves and arachnoid. Histological slices in the same anatomical plane as the MR images were obtained on the animals allowing identification of individual lesions. Cystic areas within tumors were found to give strong contrast enhancement in less than five min postinjection. Solid and hemorrhagic areas of the pituitary tumor were hypo- to isointense relative to surrounding brain and did not take up contrast agent. Significant perfusion in these areas apparently does not occur.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Prediction of gene therapy-induced tumor size changes by the vascularity changes measured using dynamic contrast-enhanced MRI

We studied the changes of tumor size after gene therapy treatment and its relationship with the changes of vascular volume as measured by dynamic contrast-enhanced magnetic resonance imaging (MRI), to investigate whether the vascular changes is predictive of tumor regression. The study was carried out using a spontaneously regressing rat tumor model (C6 Glioma grown subcutaneously in rats). Three rats were treated with recombinant adenoviruses expressing three genes, mouse interleukin 1-alpha (IL1-alpha), mouse interferon gamma (IFN-gamma), and human transforming growth factor beta (TGF-beta), one from each kind. Two rats were treated with saline as controls. Longitudinal studies were performed to monitor the changes of tumor volume (based on T(2)-weighted images) and the vascular volume (based on dynamic contrast enhanced images). In untreated animals, tumor regression was preceded by several days with a decrease in vascular volume. When the tumor growth was perturbed by expression of mouse IL-1alpha, the increase in vascular volume was correlated with the continuing growth in size, and the decrease in vascular volume was predictive of the onset of tumor regression. As new advances in immunotherapy in cancer treatment emerge, the ability to determine the efficacy of therapy as early as possible will enable optimization of treatment regiments. The vascularity changes measured by dynamic MRI may provide a means to serve for this purpose.     

MRI of normal and abnormal duodenum using Half-Fourier Single-Shot RARE and gadolinium-enhanced spoiled gradient echo sequences.

The objective of this research was two-fold: First, to describe the normal and abnormal MR appearances of the duodenum using combined Half-Fourier Acquisition Single Shot RARE (HASTE) and gadolinium-enhanced standard and fat suppressed spoiled gradient echo (SGE) sequences. The second objective was to assess the ability of these combined sequences to detect and characterize duodenal diseases. MR examinations were performed on fifty consecutive patients with no clinical history of duodenal diseases, who were 1) imaged with HASTE and gadolinium-enhanced standard and fat suppressed SGE sequences and 2) referred to MR examination for reasons other than duodenal diseases, and were reviewed retrospectively to determine the normal MR appearances of the duodenum. A second population of patients with abnormal duodenum who were imaged with the same MR sequences were included in the second part of this study. This population was composed of 20 consecutive patients with subsequently proven duodenal abnormalities, including: malrotation (2), diverticula (4), intussusception (1), sprue (1), polyps (2), neurofibroma (1), lymphoma (1), Zollinger Ellison syndrome (1), metastatic disease (1), Crohn's disease (1), and wall thickening and duodenitis (5). Normal measurements of the duodenum are described. Abnormalities of wall thickness and duodenal masses required combined HASTE and gadolinium-enhanced SGE images to evaluate well. Abnormalities of the bowel lumen (e.g., diverticula and intussusception), and developmental variants (e.g., malrotation), were sufficiently visualized on HASTE images alone. Bowel inflammation was best shown on gadolinium-enhanced fat suppressed SGE images. HASTE and gadolinium-enhanced fat suppressed SGE sequences are complementary techniques for the demonstration of normal and abnormal duodenum. The combined use of both sequences allows evaluation of different aspects of bowel diseases; abnormalities of position, lumen, and contents are well shown on HASTE, while inflammation is best shown on gadolinium enhanced fat suppressed SGE, and wall thickening and masses are best evaluated with the combined use of both techniques.     

Liver metastases from unknown primary site: demonstration on MR images

To demonstrate the MR imaging features of liver metastases in patients with the clinical and histologic diagnosis of tumors of unknown primary tumors, a retrospective 7-year study was performed that included a total of 14 consecutive patients (7 men and 7 women; age range, 39-82 years; mean age, 60.6 years) with liver metastases from unknown primary site who had undergone MR imaging. The following lesion features were evaluated: a) number, b) diameter, c) signal intensity on T1 and T(2)-weighted images, and d) pattern of enhancement on immediate, 45 s and 90 s post gadolinium images. Lesions were classified as hypovascular, hypervascular and nearly isovascular relative to liver parenchyma as shown on immediate post gadolinium images. Patients were separated into four major groups, related to the histologic diagnosis of the lesions: (I) poorly differentiated neoplasms; (II) well-differentiated and moderately differentiated adenocarcinoma; (III) squamous cell carcinoma; (IV) combined poorly differentiated carcinoma and poorly differentiated adenocarcinoma. MRI findings were correlated with histologic information obtained by chart review and confirmed by retrospective histopathology review. All patients had the histologic diagnosis of adenocarcinoma: 8 patients belonged to group II (1 patient with the subtype well-differentiated and 7 patients with the subtype moderately differentiated) and 6 patients to group IV. Eleven patients (79%) presented with multiple lesions distributed throughout both hepatic lobes; 3 patients exhibited solitary lesions. All solitary metastases possessed a diameter equal or larger than 5 cm. Patients with multiple metastases demonstrated a wide range of diameter, ranging from less than 1.5 cm to more than 5 cm. Regarding lesion vascularity, 4 of 13 of the patients had hypovascular metastases and 9 of 13 of the patients had hypervascular lesions. One patient demonstrated both types of lesions. Five of six patients with the histopathologic diagnosis of poorly differentiated adenocarcinoma demonstrated hypervascular metastases. Solitary metastases were most often hypovascular (2 of 3); however no correlation with the histologic subtype was possible. Liver metastases from unknown primary site are often multiple and often hypervascular. Poorly differentiated tumors are the most common histologic type. Metastases are not uncommonly hypovascular, and these are often solitary.     

Evaluation of noncirrhotic hepatic parenchyma with and without significant portal vein stenosis using diffusion-weighted echo-planar MR on the basis of multiple-perfusion-components theory

To determine whether diffusion-weighted echo-planar MR images are sensitive to liver perfusion difference.Noncirrhotic livers of 71 patients (43 males, 28 females; age range, 22-87 years; mean, 61 years) without (n=51) and with (n=20) significant (>70%) portal vein stenosis (accompanying proximal hepatic arterial stenosis and/or biliary tract obstruction in 10) by tumors were examined with diffusion-weighted echo-planar sequences (modified for b factors of 1, 28, 66, 288 and 600 s/mm²). On the basis of multiple-perfusion-components theory, i.e., assuming logarithm of signal intensity for liver perfusion is linearly attenuated versus logarithm of a smaller b factor, we defined the slope of the line as the perfusion-related D′ value. The D′ values of these livers were calculated from images with b factors of 1, 28, and 66 s/mm². The livers' apparent diffusion coefficient values for diffusion (ADC_d values) were calculated from images with b factors of 288 and 600 s/mm².The livers with significant portal vein stenosis had statistically lower mean D′ values than the livers without portal vein stenosis (P<.001 on the Mann-Whitney U test). However, there was no significant difference in ADC_d values between these liver types (P>.05).The D′ value calculated from diffusion-weighted echo-planar sequences with plural smaller b factors may be sensitive to liver perfusion difference.     

Evaluation of abdominal hemodynamics through compressed sensing accelerated functional imaging

PurposeTo compare the imaging characteristics of the volumetric-interpolated breath-hold examination (VIBE) using compressed-sensing (CS) acceleration (CS-VIBE) with the conventional sequence relying on parallel imaging to assess the potential use of CS-VIBE as a functional imaging technique for upper abdominal haemodynamics.Materials and methodsPatients (30 men, 27 women) suspected of having a hepatic disease underwent magnetic resonance imaging (MRI) of the liver, including a dynamic contrast-enhanced study. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid was used as the contrast agent. MRI data of two multi-phase breath-hold exams were used for intra-individual comparisons. The VIBE and CS-VIBE were performed on different days. Image quality in both sequences was qualitatively assessed by three experienced radiologists. Moreover, the contrast ratio (CR) of the aorta, portal vein, liver and pancreas to muscle tissue were measured as a quantitative assessment. For the CS-VIBE, a five-phase time–intensity curve (TIC) was created to evaluate haemodynamics. The measurement area included the pancreas, common hepatic artery, portal vein and superior mesenteric vein. The ratio of that area to the muscle tissue in the same cross section was used to create the TICs.ResultsThe qualitative assessment showed that artefacts were significantly different between the VIBE and CS-VIBE sequences. This finding indicated that the conventional VIBE had fewer artefacts. The CR was significantly higher for the CS-VIBE than for the VIBE images in all phases (p < 0.001). An evaluation of haemodynamics compared with those obtained by CT angiography showed almost the same temporal characteristics in the common hepatic artery, portal vein and superior mesenteric vein signals as those in a previous study.ConclusionCompared with the conventional VIBE, the CS-VIBE had significantly higher temporal resolution and higher image contrast. The temporal resolution of the CS-VIBE was sufficient for viewing abdominal haemodynamics. If the remaining limitation of acquisition speed for dynamic MRI can be adequately addressed, we believe that CS-VIBE functional images with high-contrast haemodynamics will be very useful in clinical practise.     

Imaging findings of solitary fibrous tumor of the prostate: a case report

The imaging findings of a solitary fibrous tumor of the prostate are presented. A 35-year-old male presented with urinary retention and was found on transrectal ultrasonography to have a hypoechoic tumor of the prostate, measuring 5.5 cm in size. Magnetic resonance imaging on, the tumor showed low signal intensity on T1-weighted images and heterogeneous mixed signal intensity on T2-weighted images. Gadolinium-enhanced dynamic study showed gradual enhancement from the periphery to the center, and the enhancement is sustained. On immunohistochemistry, the spindle cells of the tumor showed positive staining for CD34 and bcl-2. Although the tumor was labeled as a low-grade malignancy on account of a low mitotic index (MIB-1 index) of about 5%, the patient developed local recurrence of the tumor with bladder wall invasion 12 months later.