RESUMO
Hepatic sinusoids are highly specialized microcirculatory conduits within the hepatic lobules that facilitate liver functions. The sinusoids can be affected by various disorders, including sinusoidal dilatation, sinusoidal obstruction syndrome (SOS), sinusoidal cellular infiltration, perisinusoidal infiltration, and endothelial neoplasms, such as hemangioendothelioma and angiosarcoma. While these disorders, particularly SOS and neoplasms, can be life threatening, their clinical manifestation is often nonspecific. Patients may present with right upper quadrant pain, jaundice, hepatomegaly, ascites, splenomegaly, and unexplained weight gain, although the exact manifestation depends on the cause, severity, and duration of the disease. Ultimately, invasive tests may be necessary to establish the diagnosis. A comprehensive understanding of imaging manifestations of various sinusoidal disorders contributes to early diagnosis and can help radiologists detect subclinical disease. Additionally, specific imaging features may assist in identifying the cause of the disorder, leading to a more focused and quicker workup. For example, a mosaic pattern of enhancement of the liver parenchyma is suggestive of sinusoidal dilatation; peripheral and patchy reticular hypointensity of the liver parenchyma on hepatobiliary MR images is characteristic of SOS; and associated diffuse multiple hyperintensities on diffusion-weighted images may be specific for malignant sinusoidal cellular infiltration. The authors provide an overview of the pathogenesis, clinical features, and imaging appearances of various hepatic sinusoidal disorders, with a special emphasis on SOS. ©RSNA, 2024 Supplemental material is available for this article.
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Hepatopatia Veno-Oclusiva , Humanos , Hepatopatia Veno-Oclusiva/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Diagnóstico DiferencialRESUMO
Pathologic conditions of the biliary system, although common, can be difficult to diagnose clinically. Challenges in biliary imaging include anatomic variants and the dynamic nature of the biliary tract, which can change with age and intervention, blurring the boundaries of normal and abnormal. Choledochal cysts can have numerous appearances and are important to diagnose given the risk of cholangiocarcinoma potentially requiring surgical resection. Choledocholithiasis, the most common cause of biliary dilatation, can be difficult to detect at US and CT, with MRI having the highest sensitivity. However, knowledge of the imaging pitfalls of MRI and MR cholangiopancreatography is crucial to avoid misinterpretation. Newer concepts in biliary tract malignancy include intraductal papillary biliary neoplasms that may develop into cholangiocarcinoma. New paradigms in the classification of cholangiocarcinoma correspond to the wide range of imaging appearances of the disease and have implications for prognosis. Accurately staging cholangiocarcinoma is imperative, given expanding curative options including transplant and more aggressive surgical options. Infections of the biliary tree include acute cholangitis or recurrent pyogenic cholangitis, characterized by obstruction, strictures, and central biliary dilatation. Inflammatory conditions include primary sclerosing cholangitis, which features strictures and fibrosis but can be difficult to differentiate from secondary causes of sclerosing cholangitis, including more recently described entities such as immunoglobulin G4-related sclerosing cholangitis and COVID-19 secondary sclerosing cholangitis. The authors describe a wide variety of benign and malignant biliary tract abnormalities, highlight differentiating features of the cholangitides, provide an approach to interpretation based on the pattern of imaging findings, and discuss pearls and pitfalls of imaging to facilitate accurate diagnosis. ©RSNA, 2024 Supplemental material is available for this article.
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Sistema Biliar , Humanos , Sistema Biliar/diagnóstico por imagem , Sistema Biliar/patologia , Doenças Biliares/diagnóstico por imagem , Diagnóstico DiferencialRESUMO
PURPOSE: Gain-of-function mutations in CTNNB1, gene encoding for ß-catenin, are observed in 25-30% of hepatocellular carcinomas (HCCs). Recent studies have shown ß-catenin activation to have distinct roles in HCC susceptibility to mTOR inhibitors and resistance to immunotherapy. Our goal was to develop and test a computational imaging-based model to non-invasively assess ß-catenin activation in HCC, since liver biopsies are often not done due to risk of complications. METHODS: This IRB-approved retrospective study included 134 subjects with pathologically proven HCC and available ß-catenin activation status, who also had either CT or MR imaging of the liver performed within 1 year of histological assessment. For qualitative descriptors, experienced radiologists assessed the presence of imaging features listed in LI-RADS v2018. For quantitative analysis, a single biopsy proven tumor underwent a 3D segmentation and radiomics features were extracted. We developed prediction models to assess the ß-catenin activation in HCC using both qualitative and quantitative descriptors. RESULTS: There were 41 cases (31%) with ß-catenin mutation and 93 cases (69%) without. The model's AUC was 0.70 (95% CI 0.60, 0.79) using radiomics features and 0.64 (0.52, 0.74; p = 0.468) using qualitative descriptors. However, when combined, the AUC increased to 0.88 (0.80, 0.92; p = 0.009). Among the LI-RADS descriptors, the presence of a nodule-in-nodule showed a significant association with ß-catenin mutations (p = 0.015). Additionally, 88 radiomics features exhibited a significant association (p < 0.05) with ß-catenin mutations. CONCLUSION: Combination of LI-RADS descriptors and CT/MRI-derived radiomics determine ß-catenin activation status in HCC with high confidence, making precision medicine a possibility.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , beta Catenina , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/genética , beta Catenina/genética , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/genética , Estudos Retrospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Mutação , Adulto , Fígado/diagnóstico por imagem , Sistemas de Informação em Radiologia , RadiômicaRESUMO
Photon counting detector CT (PCD-CT) is the newest major development in CT technology and has been commercially available since 2021. It offers major technological advantages over current standard-of-care energy integrating detector CT (EID-CT) including improved spatial resolution, improved iodine contrast to noise ratio, multi-energy imaging, and reduced noise. This article serves as a foundational basis to the technical approaches and concepts of PCD-CT technology with primary emphasis on detector technology in direct comparison to EID-CT. The article also addresses current technological challenges to PCD-CT with particular attention to cross talk and its causes (e.g., Compton scattering, fluorescence, charge sharing, K-escape) as well as pile-up.
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Fótons , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodosRESUMO
Liver congestion is increasingly encountered in clinical practice and presents diagnostic pitfalls of which radiologists must be aware. The complex altered hemodynamics associated with liver congestion leads to diffuse parenchymal changes and the development of benign and malignant nodules. Distinguishing commonly encountered benign hypervascular lesions, such as focal nodular hyperplasia (FNH)-like nodules, from hepatocellular carcinoma (HCC) can be challenging due to overlapping imaging features. FNH-like lesions enhance during the hepatic arterial phase and remain isoenhancing relative to the background liver parenchyma but infrequently appear to wash out at delayed phase imaging, similar to what might be seen with HCC. Heterogeneity, presence of an enhancing capsule, washout during the portal venous phase, intermediate signal intensity at T2-weighted imaging, restricted diffusion, and lack of uptake at hepatobiliary phase imaging point toward the diagnosis of HCC, although these features are not sensitive individually. It is important to emphasize that the Liver Imaging Reporting and Data System (LI-RADS) algorithm cannot be applied in congested livers since major LI-RADS features lack specificity in distinguishing HCC from benign hypervascular lesions in this population. Also, the morphologic changes and increased liver stiffness caused by congestion make the imaging diagnosis of cirrhosis difficult. The authors discuss the complex liver macro- and microhemodynamics underlying liver congestion; propose a more inclusive approach to and conceptualization of liver congestion; describe the pathophysiology of liver congestion, hepatocellular injury, and the development of benign and malignant nodules; review the imaging findings and mimics of liver congestion and hypervascular lesions; and present a diagnostic algorithm for approaching hypervascular liver lesions. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Carcinoma Hepatocelular , Hiperplasia Nodular Focal do Fígado , Neoplasias Hepáticas , Doenças Vasculares , Humanos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Meios de Contraste , Fígado/diagnóstico por imagem , Fígado/patologia , Hiperplasia Nodular Focal do Fígado/diagnóstico , Hiperplasia Nodular Focal do Fígado/patologia , Imageamento por Ressonância Magnética/métodos , Sensibilidade e Especificidade , Estudos RetrospectivosRESUMO
BACKGROUND: Hepatic artery infusion (HAI) is less frequently used in the adjuvant setting for resectable colorectal liver metastasis (CRLM) due to concerns regarding toxicity. Our objective was to evaluate the safety and feasibility of establishing an adjuvant HAI program. METHODS: Patients who underwent HAI pump placement between January 2019 and February 2023 for CRLM were identified. Complications and HAI delivery were compared between patients who received HAI in the unresectable and adjuvant settings. RESULTS: Of 51 patients, 23 received HAI for unresectable CRLM and 28 in the adjuvant setting. Patients with unresectable CRLM more commonly had bilobar disease (n = 23/23 vs n = 18/28, p < 0.01) and more preoperative liver metastases (median 10 [IQR 6-15] vs 4 [IQR 3-7], p < 0.01). Biliary sclerosis was the most common complication (n = 2/23 vs n = 4/28); however, there were no differences in postoperative or HAI-specific complications. In the most recent two years, 0 patients in the unresectable group vs 2 patients in the adjuvant group developed biliary sclerosis. All patients were initiated on HAI with no difference in treatment times or dose reductions. CONCLUSION: Adjuvant HAI is safe and feasible for patients with resectable CRLM. HAI programs can carefully consider including patients with resectable CRLM if managed by an experienced multidisciplinary team with quality assurance controls in place.
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Neoplasias Colorretais , Estudos de Viabilidade , Artéria Hepática , Infusões Intra-Arteriais , Neoplasias Hepáticas , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Colorretais/patologia , Estudos Retrospectivos , Quimioterapia Adjuvante , Resultado do TratamentoRESUMO
PURPOSE: To investigate diagnostic accuracy of virtual non contrast (VNC) images, based on dual-source dual-energy CT (dsDECT), for detection of at least moderate steatosis and to define a threshold value to make this diagnosis on VNC. METHODS: This single-institution retrospective study included patients who had multi-phasic protocol dsDECT. Regions of interests were placed in different segments of the liver and spleen on true non-contrast (TNC), VNC, and portal-venous phase (PVP) images. At least moderate steatosis was defined as liver attenuation (LHU)â¯<â¯40 HU on TNC. Diagnostic performance of VNC to detect steatosis was determined and the new threshold was tested in a validation cohort. RESULTS: 236 patients were included in training cohort. Mean liver attenuation values were 51.3⯱â¯10.8 HU and 58.1⯱â¯11.5 HU for TNC and VNC (pâ¯<â¯0.001), with a mean difference (VNC - TNC) of 6.8⯱â¯6.9 HU. Correlation between TNC and VNC was strong (râ¯=â¯0.81, pâ¯<â¯0.001). The AUCs of LHU on VNC for detection of hepatic steatosis were 0.92 (95â¯% Cl: 0.86-0.98), 0.92 (95â¯% Cl: 0.87-0.97), 0.92 (95â¯% Cl: 0.86-0.99), 0.91 (95â¯% Cl: 0.84-0.97), and 0.87 (95â¯% Cl: 0.80-0.95) for entire liver, left lateral, left medial, right anterior, and right posterior segments, respectively. VNC had sensitivity/specificity of 100â¯% /42â¯% when using a threshold of 40 HU; they were 69â¯% and 95â¯%, respectively, when using optimized threshold of 46 HU. This threshold showed similar performance in validation cohort (nâ¯=â¯80). CONCLUSIONS: Hepatic attenuation on VNC has promising performance for detection of at least moderate steatosis. Proposed threshold of 46 HU provides high specificity and moderate sensitivity to detect steatosis.
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Fígado Gorduroso , Tomografia Computadorizada por Raios X , Humanos , Tomografia Computadorizada por Raios X/métodos , Estudos Retrospectivos , Fígado Gorduroso/diagnóstico por imagem , AbdomeRESUMO
Liver transplant is the definitive treatment of end-stage liver disease and early hepatocellular carcinoma. The number of liver transplant surgeries done is highly affected by the number and availability of deceased donor organs. Living donor liver transplantation has emerged as an alternative source of donors, increasing the availability of organs for transplant. Many factors must be considered when choosing living donor candidates to maintain a high level of donor safety and organ survival. To that end, potential donors undergo a rigorous pre-donation workup.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Transplante de Fígado , Humanos , Doadores Vivos , Transplante de Fígado/métodos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgiaRESUMO
Intestinal transplantation and multivisceral transplantation are technically challenging and complex procedures mainly performed on patients with irreversible and non-medically manageable end-stage intestinal failure. Increasingly, other organs besides small intestines are included in the allograft for which the terms "composite intestinal transplantation" and "multivisceral transplantation" are used. Commonly, complex vascular reconstructions are used for these procedures. Knowledge of surgical anatomy hence is essential for accurate interpretation of postoperative imaging in these patients. This article reviews the indications and most common surgical techniques for intestinal and multivisceral transplantations.
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Intestino Delgado , Intestinos , Humanos , Intestinos/diagnóstico por imagem , Intestinos/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgiaRESUMO
Advancements in immunosuppression protocols, surgical techniques, and postoperative care in the last few decades have improved outcomes of intestinal transplant patients. Normal immediate postoperative imaging appearance can simulate pathology. Intestinal transplant recipients are prone for several postoperative complications due to the complex surgical technique, which involves multiple anastomoses, and immunogenic nature of the allograft intestine. Imaging plays a crucial role in detection of several major complications including infectious, immunologic, vascular, gastrointestinal, pancreaticobiliary, genitourinary, and neoplastic complications. The awareness of the posttransplant anatomy and normal imaging appearances helps radiologists anticipate and accurately detect posttransplant complications.
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Rejeição de Enxerto , Intestinos , Humanos , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/etiologia , Intestinos/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Diagnóstico por Imagem , Cuidados Pós-OperatóriosAssuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Imageamento por Ressonância Magnética , Aprendizado de Máquina , Estudo de Prova de ConceitoRESUMO
PURPOSE: To determine a reliable threshold common duct diameter on CT, in combination with other ancillary CT and clinical parameters, at which the likelihood of pathology requiring further imaging or intervention is increased in post-cholecystectomy patients. METHODS: In this IRB approved retrospective study, two attending radiologists independently reviewed CT imaging for 118 post-cholecystectomy patients, who were subsequently evaluated with MRCP, ERCP, or EUS, prompted by findings on the CT and clinical status. Measurements of the common duct (CD) were obtained at the porta hepatis, distal duct, and point of maximal dilation on axial and coronal CT scans. Patients were grouped by whether they required intervention after follow-up imaging. Pertinent baseline lab values and patient demographics were reviewed. RESULTS: Of the 118 post-cholecystectomy patients, 38 patients (31%) required intervention, and 80 patients (69%) did not require intervention after follow-up imaging. For both readers, axial and coronal CD diameters were significantly higher in the 'intervention required' vs 'no intervention' groups at all locations (p value < 0.05). There was good to excellent inter-reader agreement at all locations (ICC 0.68-0.92). Pertinent baseline lab values including AST (p = 0.043), ALT (p = 0.001), alkaline phosphatase (p = 0.0001), direct bilirubin (p = 0.011), total bilirubin (p = 0.028), and WBC (p = 0.043) were significantly higher in the 'intervention required' group. CD thresholds of 8 mm yielded the highest sensitivities (76-95%), and CD thresholds of 12 mm yielded the highest specificities (65-78%). CD combined with bilirubin levels increased sensitivity and specificity, compared to using either feature alone. CONCLUSION: Dilated CD on CT combined with bilirubin levels increases the sensitivity and specificity for identifying patients needing intervention. We recommend that a post-cholecystectomy patient who presents with a CD diameter > 10 mm on CT and elevated bilirubin levels should undergo further clinical and imaging follow-up.
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Bilirrubina , Colecistectomia , Humanos , Dilatação , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Dilatação PatológicaRESUMO
Focal nodular hyperplasia-like (FNH-like) nodules are hepatocellular lesions with similar radiologic and pathologic features as typical FNH but occur within an abnormal liver. They arise due to alteration of hepatic vasculature at both the microscopic and macroscopic levels. Although these nodules are not thought to have malignant potential, their imaging features overlap with premalignant and malignant lesions including hepatocellular carcinoma (HCC) and arise in patients who may be at risk for HCC, posing a diagnostic and management dilemma. It is important to consider these benign entities when reviewing liver imaging of patients at risk for HCC to reduce unnecessary interventions.
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Carcinoma Hepatocelular , Hiperplasia Nodular Focal do Fígado , Neoplasias Hepáticas , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/patologia , Diagnóstico Diferencial , Hiperplasia Nodular Focal do Fígado/diagnóstico por imagem , Hiperplasia Nodular Focal do Fígado/patologia , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Imageamento por Ressonância MagnéticaRESUMO
PURPOSE: Hemoperitoneum caused by ovarian cyst rupture may necessitate intervention. The literature is lacking in descriptions of CT findings that help guide patient management. The purpose of this study is to consider CT findings associated with a need for intervention (surgical or interventional radiology management) versus conservative treatment (observation, pain management, and blood transfusions). METHODS: Two radiologists retrospectively and independently reviewed 103 CTs of pre-menopausal women who presented with acute hemoperitoneum related to ruptured ovarian cysts between January 2010 and January 2019. The following imaging features were assessed: ovarian cyst characteristics, sentinel clot, contrast extravasation, and hemoperitoneum size. Findings were correlated with patient demographics, clinical parameters, and management with surgery/interventional radiology procedure (intervention group) versus conservative management (conservative group). RESULTS: Of the 103 patients with hemoperitoneum from cyst rupture, 16% (n = 16) required intervention, and 84% underwent conservative treatment (n = 87). Length of stay (p = .008) was higher in the intervention group. Statistically significant CT findings in the intervention versus conservative group included (p-value reader 1/p-value reader 2) greatest AP dimension of hemoperitoneum (p = .001/p = 0.02), posterior cul-de-sac AP dimension (p = 0.03/p = .006), total cul-de-sac AP dimension (p = .002/p = .007), and number of spaces with hemoperitoneum (p = .01/p = .02). There was good to excellent inter-reader agreement for these findings (ICC 0.68-0.91). Active contrast extravasation was significant for one reader (p = .02) with poor inter-reader agreement (ICC 0.36). In utilizing ROC curves, thresholds of 107 mm (greatest axial AP dimension of hemoperitoneum) yielded a sensitivity and specificity of 0.81 and 0.62 for reader 1 and 0.69 and 0.55 for reader 2; 45 mm (posterior cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.63 for reader 1 and 0.94 and 0.49 for reader 2; 70 mm (total cul-de-sac AP dimension) yielded a sensitivity and specificity of 0.75 and 0.64 for reader 1 and 0.75 and 0.50 for reader 2; and greater than 5 spaces yielded a sensitivity and specificity of 0.75 and 0.58 for reader 1 and 0.69 and 0.70 for reader 2. CONCLUSION: CT findings associated with intervention in hemoperitoneum due to ovarian cyst rupture include size of hemoperitoneum, number of abdominopelvic spaces with hemoperitoneum, and contrast extravasation.
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Hemoperitônio , Cistos Ovarianos , Feminino , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Hemoperitônio/terapia , Humanos , Cistos Ovarianos/complicações , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/terapia , Estudos Retrospectivos , Ruptura Espontânea/complicações , Tomografia Computadorizada por Raios X/efeitos adversosRESUMO
PURPOSE: To evaluate performance of 3D magnetic resonance elastography (MRE) using spin-echo echo-planar imaging (seEPI) for assessment of hepatic stiffness compared with 2D gradient-recalled echo (GRE) and 2D seEPI sequences. METHODS: Fifty-seven liver MRE examinations including 2D GRE, 2D seEPI, and 3D seEPI sequences were retrospectively evaluated. Elastograms were analyzed by 2 radiologists and polygonal regions of interests (ROIs) were drawn in 2 different fashions: "curated" ROI (avoiding liver edge, major vessels, and areas of wave interferences) and "non-curated" ROI (including largest cross section of liver, to assess the contribution of artifacts). Liver stiffness measurement (LSM) was calculated as the arithmetic mean of individual stiffness values for each technique. For 3D MRE, LSMs were also calculated based on 4 slices ("abbreviated LSM"). Intra-patient variations in LSMs and different methods of ROI placement were assessed by univariate tests. A p-value of < 0.05 was set as a statistically significant difference. RESULTS: Mean surface areas of the ROIs were 50,723 mm2, 12,669 mm2, 5814 mm2, and 10,642 mm2 for 3D MRE, abbreviated 3D MRE, 2D GRE, and 2D seEPI, respectively. 3D LSMs based on curated and non-curated ROIs showed no clinically significant difference, with a mean difference less than 0.1 kPa. Abbreviated 3D LSMs had excellent correlation with 3D LSMs based on all slices (r = 0.9; p < 0.001) and were not significantly different (p = 0.927). CONCLUSION: 3D MRE allows more reproducible measurements due to its lower susceptibility to artifacts and provides larger areas of parenchyma, enabling a more comprehensive evaluation of the liver.
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Técnicas de Imagem por Elasticidade , Imagem Ecoplanar/métodos , Técnicas de Imagem por Elasticidade/métodos , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/patologia , Imageamento por Ressonância Magnética/métodos , Reprodutibilidade dos Testes , Estudos RetrospectivosRESUMO
The widespread use of high-spatial-resolution cross-sectional imaging has led to an increase in detection of incidental pancreatic cystic lesions. These lesions are a diverse group, ranging from indolent and premalignant lesions to invasive cancers. The diagnosis of several of these lesions can be suggested on the basis of their imaging appearance, while many other lesions require follow-up imaging and/or aspiration. The smaller cystic lesions, often branch-duct intraductal papillary mucinous neoplasms, have overlapping imaging characteristics that make diagnostic assessment of the natural history and malignancy risk confusing. Expert panels have developed societal guidelines, based on a consensus, for surveillance of these lesions. However, these guidelines are often inconsistent and are constantly evolving as additional scientific data are accumulated. Identification of features associated with increased risk of malignancy is important for proper management. The concept of field defect, whereby pancreatic adenocarcinoma develops at a site different from the site of the pancreatic cyst, adds to the complexity of screening guidelines. As a result of the differences in guidelines, key stakeholders (eg, radiologists, gastroenterologists, and surgeons) must review and come to a consensus regarding which guideline, or combination of guidelines, to follow at their individual institutions. Standardized reporting and macros are helpful for ensuring the uniformity of interpretations. Radiologists play a critical role in the detection and characterization of pancreatic cystic lesions, in the follow-up recommendations for these lesions, and in the detection of associated cancer. An invited commentary by Zaheer is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Adenocarcinoma , Cisto Pancreático , Neoplasias Pancreáticas , Adenocarcinoma/patologia , Humanos , Pâncreas , Cisto Pancreático/diagnóstico por imagem , Cisto Pancreático/patologia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/patologiaRESUMO
OBJECTIVE: This study aimed to assess the diagnostic accuracy of magnetic resonance elastography (MRE) in detecting hepatic fibrosis and determining clinically relevant stiffness cutoff values per stage of fibrosis. METHODS: This retrospective study assessed 1488 hepatic MRE evaluations performed at a single institution for 5 years. Mean liver stiffness measurements were collected from 282 patients who had an MRE study within 1 year of histopathologic analysis. Areas under receiver operating characteristic curves were calculated for each stage of fibrosis with nonparametric ordinal measures of accuracy, and Youden Index was determined. RESULTS: Mean liver stiffness measurement values were as follows: F0, 2.5± 0.55 kPa; F1, 3.1± 0.80 kPa; F2, 3.4±0.95 kPa; F3, 4.7±1.44 kPa; and F4, 7.9± 2.64 kPa. Nonparametric ordinal measures of accuracy per fibrosis stage were as follows: F0: 0.934, P < 0.001; F0-F1: 0.917, P < 0.001; F0-F2: 0.944, P < 0.001; and F0-F3: 0.941, P < 0.001. Youden Index values for fibrosis stages F2, F3, and F4 were 3.9, 4.0, and 4.5 kPa, respectively. CONCLUSIONS: Magnetic resonance elastography is an accurate diagnostic tool in assessing liver fibrosis.