Management of branch-duct intraductal papillary mucinous neoplasms of the pancreas: observation with MR imaging

Purpose

To evaluate the clinical outcomes of conservative management by observation with MRI of patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs).

Materials and Methods

Twenty-three consecutive patients, who were followed up by MRI with magnetic resonance cholangiopancreatography (MRCP) over a period of more than 9 months after initial MRI examinations, were enrolled in this study. On MRI, number of lesions, the maximum diameter of BD-IPMNs, lesion location, the presence of associated dilatation of main pancreatic duct (MPD), the presence of enhancing mural nodules within the lesion and the presence of interval change were retrospectively reviewed on initial and follow-up MR images in consensus by two radiologists. All patients were evaluated to search for evidence of malignant progression of disease.

Results

The follow-up period ranged from 10 to 96 months (mean, 37 months). On initial MRI with MRCP, a total of 39 lesions were found in 23 patients. The maximum diameter of BD-IPMNs ranged between 6 and 32 mm, with a mean of 12 mm. Thirty-four lesions (87%) of 19 patients remained unchanged in the maximum diameter. Five lesions (13%) of four patients showed an increase in the maximum diameter. Enhancing mural nodules were not found in any individual, neither on the initial MRI study nor on the follow-up studies. There was no patient who had evidence of local aggressive growth of tumor or evidence of metastases to distant sites.

Conclusion

Our study suggests that branch-duct IPMNs without enhancing mural nodules are essentially benign and should be managed nonoperatively through observation by MRI.     

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

Purpose

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

Materials and Methods

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

Results

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

Conclusion

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

Uniformly bounded composition operators in the banach space of bounded (p, k)-variation in the sense of Riesz-Popoviciu

We prove that if the composition operator F generated by a function f: [a, b] × ? → ? maps the space of bounded (p, k)-variation in the sense of Riesz-Popoviciu, p ≥ 1, k an integer, denoted by RV_(p,k)[a, b], into itself and is uniformly bounded then RV_(p,k)[a, b] satisfies the Matkowski condition.     

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.     

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.     

Adaptive Chemical Networks under Non‐Equilibrium Conditions: The Evaporating Droplet

Non‐volatile solutes in an evaporating drop experience an out‐of‐equilibrium state due to non‐linear concentration effects and complex flow patterns. Here, we demonstrate a small molecule chemical reaction network that undergoes a rapid adaptation response to the out‐of‐equilibrium conditions inside the droplet leading to control over the molecular constitution and spatial arrangement of the deposition pattern. Adaptation results in a pronounced coffee stain effect and coupling to chemical concentration gradients within the drop is demonstrated. Amplification and suppression of network species are readily identifiable with confocal fluorescence microscopy. We anticipate that these observations will contribute to the design and exploration of out‐of‐equilibrium chemical systems, as well as be useful towards the development of point‐of‐care medical diagnostics and controlled deposition of small molecules through inkjet printing.