Spiral flow-generating tube for saline chaser improves aortic enhancement in Gd-EOB-DTPA-enhanced hepatic MRI.

OBJECTIVES: To evaluate the effect of a spiral tube on contrast enhancement in the hepatic arterial phase (HAP) of gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). METHODS: In this retrospective study, we observed 104 patients who underwent dynamic MRI of the liver between October 2017 and December 2017. Three Gd-EOB-DTPA injection protocols were compared: (A) conventional method (undiluted Gd-EOB-DTPA, injection rate 1 ml/s, n = 36); (B) spiral dilution method (1:1 diluted Gd-EOB-DTPA with saline [off-label], injection rate 2 ml/s via spiral tube, n = 38); (C) spiral-flushed method (undiluted Gd-EOB-DTPA, injection rate 1 ml/s via spiral tube, n = 30). We regarded protocol-A as a control. The signal-to-noise ratio (SNR) of the abdominal aorta was calculated using arterial phase images. Image contrast and artefacts were evaluated by two board-certified radiologists, using a four-point scale. Statistical analyses included Dunnett's test, the Kruskal-Wallis test and the Steel test. RESULTS: The SNR of the aorta was significantly higher with protocol-C (25.4 ± 8.8) than protocol-A (20.8 ± 5.4, p = 0.01). There was no significant difference in SNR between protocols A and B (p = 0.47). The contrast score of protocol-C was significantly higher than that of protocol-A (p = 0.0019). There was no significant difference in contrast score between protocols A and B (p = 0.50). There was no significant difference in artefacts among the three protocols (p = 0.96). CONCLUSIONS: Use of a spiral tube with a slow injection protocol contributed to improved aortic contrast enhancement in the HAP of GD-EOB-DTPA-enhanced hepatic MRI. KEY POINTS: • Gadoxetic acid shows weaker arterial enhancement at recommended doses, compared with nonspecific gadolinium agents; selection of an appropriate injection protocol is important. • A spiral flow-generating tube improves the transport efficiency of the contrast media, and increases the signal-to-noise ratio of the aorta in hepatic arterial phase. • A spiral flow-generating tube does not contribute to artefact reduction in hepatic arterial phase.

Simultaneous acquisition of MR angiography and diagnostic images of abdomen at view-sharing multiarterial phases and comparing the effect of two different contrast agents.

BACKGROUND: Simultaneous acquisition of magnetic resonance angiography (MRA) and diagnostic images is challenging in contrast-enhanced upper abdominal MRI. PURPOSE: To evaluate the image quality of MRA of the abdomen acquired simultaneously with diagnostic MR images, and to compare the contrast effect, conspicuity of aortic branches, and pancreatic lesions in MRA between gadobutrol and gadoterate meglumine. STUDY TYPE: Prospective. POPULATION: Eighty-eight patients with known and suspected upper abdominal disease. FIELD STRENGTH/SEQUENCES: 3T/4D-eTHRIVE (T1 -weighted fat-suppressed 3D fast gradient echo) for multiarterial phase imaging. ASSESSMENT: The artery-to-muscle signal intensity ratio (SIR), conspicuity of aortic branches on the axial, maximum intensity projection (MIP), and volume-rendered (VR) images, and conspicuity of focal pancreatic lesions were compared between gadobutrol and gadoterate meglumine. The diameters of aortic branches were measured on axial MRA and computed tomography angiography (CTA) images and then compared. STATISTICAL TESTS: Quantitative and qualitative data were assessed with the Mann-Whitney U-test. The diameters of aortic branches between MRA and CTA were compared with a Spearman rank correlation test. RESULTS: View-sharing multiarterial phase imaging was successfully performed in all patients. The SIRs of common hepatic artery (P = 0.0051) and left renal artery (RA) (P = 0.045), vascular conspicuities of right and left hepatic arteries (P = 0.010 and 0.030) and right and left RAs on axial (P = 0.0065 and 0.036), and that of gastroduodenal artery on MIP (P = 0.039) with gadobutrol were significantly higher than those with gadoterate meglumine. The conspicuity of focal pancreatic lesions were comparable between the gadobutrol and gadoterate meglumine (P = 0.73). The vascular diameters on MRA and CTA were strongly correlated in all aortic branches (r = 0.842-0.942, P < 0.0001). DATA CONCLUSION: High-quality MRA of the abdomen was obtained simultaneously with the diagnostic MR images using view-sharing multiarterial phase imaging that also demonstrated comparable image quality between gadobutrol and gadoterate meglumine. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2017.

Dual-layer DECT for multiphasic hepatic CT with 50 percent iodine load: a matched-pair comparison with a 120 kVp protocol.

OBJECTIVES: To evaluate the image quality and lesion conspicuity of virtual-monochromatic-imaging (VMI) with dual-layer DECT (DL-DECT) for reduced-iodine-load multiphasic-hepatic CT. METHODS: Forty-five adults with renal dysfunction who had undergone hepatic DL-DECT with 300-mgI/kg were included. VMI (40-70-keV, DL-DECT-VMI) was generated at each enhancement phase. As controls, 45 matched patients undergoing standard 120-kVp protocol (120-kVp, 600-mgI/kg, and iterative reconstruction) were included. We compared the size-specific dose estimate (SSDE), image noise, CT attenuation, and contrast-to-noise ratio (CNR) between protocols. Two radiologists scored the image quality and lesion conspicuity. RESULTS: SSDE was significantly lower in DL-DECT group (p < 0.01). Image noise of DL-DECT-VMI was almost constant at each keV (differences of ≤15%) and equivalent to or lower than of 120-kVp. As the energy decreased, CT attenuation and CNR gradually increased; the values of 55-60 keV images were almost equivalent to those of standard 120-kVp. The highest scores for overall quality and lesion conspicuity were assigned at 40-keV followed by 45 to 55-keV, all of which were similar to or better than of 120-kVp. CONCLUSIONS: For multiphasic-hepatic CT with 50% iodine-load, DL-DECT-VMI at 40- to 55-keV provides equivalent or better image quality and lesion conspicuity without increasing radiation dose compared with standard 120-kVp protocol. KEY POINTS: • 40-55-keV yields optimal image quality for half-iodine-load multiphasic-hepatic CT with DL-DECT. • DL-DECT protocol decreases radiation exposure compared with 120-kVp scans with iterative reconstruction. • 40-keV images maximise conspicuity of hepatocellular carcinoma especially at hepatic-arterial phase.

Breast dose reduction for chest CT by modifying the scanning parameters based on the pre-scan size-specific dose estimate (SSDE).

OBJECTIVE: To investigate the usefulness of modifying scanning parameters based on the size-specific dose estimate (SSDE) for a breast-dose reduction for chest CT. MATERIALS AND METHODS: We scanned 26 women with a fixed volume CT dose index (CTDIvol) (15 mGy) and another 26 with a fixed SSDE (15 mGy) protocol (protocol 1 and 2, respectively). In protocol 2, tube current was calculated based on the patient habitus obtained on scout images. We compared the mean breast dose and the inter-patient breast dose variability and performed linear regression analysis of the breast dose and the body mass index (BMI) of the two protocols. RESULTS: The mean breast dose was about 35 % lower under protocol 2 than protocol 1 (10.9 mGy vs. 16.8 mGy, p < 0.01). The inter-patient breast dose variability was significantly lower under protocol 2 than 1 (1.2 mGy vs. 2.5 mGy, p < 0.01). We observed a moderate negative correlation between the breast dose and the BMI under protocol 1 (r = 0.43, p < 0.01); there was no significant correlation (r = 0.06, p = 0.35) under protocol 2. CONCLUSION: The SSDE-based protocol achieved a reduction in breast dose and in inter-patient breast dose variability. KEY POINTS: • CT scan parameters can be modified based on the pre-scan SSDE. • The pre-scan SSDE is useful for a breast dose reduction. • The fixed SSDE protocol reduced individual variations in the breast dose.

Using 80 kVp on a 320-row scanner for hepatic multiphasic CT reduces the contrast dose by 50 % in patients at risk for contrast-induced nephropathy.

OBJECTIVES: We evaluated the effects of a low contrast material (CM) dose protocol using 80-kVp on the image quality of hepatic multiphasic CT scans acquired on a 320-row CT scanner. METHODS: We scanned 30 patients with renal insufficiency (eGFR < 45 mL/min/1.73 m2) using 80-kVp and a CM dose of 300mgI/kg. Another 30 patients without renal insufficiency (eGFR > 60 mL/min/1.73 m2) were scanned with the conventional 120-kVp protocol and the standard CM dose of 600mgI/kg. Quantitative image quality parameters, i.e. CT attenuation, image noise, and the contrast-to-noise ratio (CNR) were compared and the visual image quality was scored on a four-point scale. The volume CT dose index (CTDIvol) and the size-specific dose estimate (SSDE) recorded with the 80- and the 120-kVp protocols were also compared. RESULTS: Image noise and contrast enhancement were equivalent for the two protocols. There was no significant difference in the CNR of all anatomic sites and in the visual scores for overall image quality. The CTDIvol and SSDE were approximately 25-30 % lower under the 80-kVp protocol. CONCLUSION: Hepatic multiphase CT using 80-kVp on a 320-row CT scanner allowed for a decrease in the CM dose and a reduction in the radiation dose without image quality degradation in patients with renal insufficiency. KEY POINTS: • The 80-kVp CT protocol enabled reduction of contrast dose by 50 % • The 80-kVp CT protocol reduced the radiation dose by 25-33 % • There was no degradation in the image quality of the 80-kVp protocol.

Cardiovascular magnetic resonance myocardial T1 mapping to detect and quantify cardiac involvement in familial amyloid polyneuropathy.

OBJECTIVES: This study sought to explore the potential role of non-contrast T1 mapping for the detection and quantification of cardiac involvement in familial amyloid polyneuropathy (FAP). METHODS: Japanese patients with FAP [n = 41, age 53.2 ± 13.9 years, genotype Val30Met (n = 25), non-Val30Met (n = 16)] underwent cardiac magnetic resonance imaging that included T1 mapping (saturation-recovery method) and late gadolinium-enhanced (LGE) imaging on a 3.0-T MR scanner. Their native T1 was measured on mid-ventricular short-axis images and compared with 30 controls. RESULTS: Of the 41 FAP patients 29 were LGE positive. The native T1 was significantly higher in FAP patients than in the controls (1,634.1 ± 126.3 ms vs. 1,432.4 ± 69.0 ms, p < 0.01), significantly higher in LGE-positive- than LGE-negative FAP patients (1,687.1 ± 104.4 ms vs. 1,505.4 ± 68.5 ms, p < 0.01), and significantly higher in LGE-negative FAP patients than the controls (p < 0.01). A native T1 cutoff value of 1,610 ms yielded 85.4% accuracy for identifying LGE-positive FAP. The native T1 significantly correlated with the interventricular septum wall thickness, the left ventricular mass, the LGE volume, the plasma B-type natriuretic peptide level, and the E/e' ratio (all p < 0.01). CONCLUSION: T1 mapping is of high diagnostic accuracy for the detection of LGE-positive FAP. The native myocardial T1 may be correlated with the severity of cardiac amyloid deposition. KEY POINTS: • The native T1 was higher in FAP patients than the controls. • The native T1 was higher in LGE-positive- than LGE-negative FAP patients. • The native T1 was higher in LGE-negative FAP patients than the controls. • The native T1 correlated with clinical markers of systolic and diastolic dysfunction. • Myocardial T1 mapping is of high diagnostic accuracy for detecting LGE-positive FAP.

Fat Suppressed Contrast-Enhanced T1-Weighted Dynamic Magnetic Resonance Imaging at 3T: Comparison of Image Quality Between Spectrally Adiabatic Iversion Recovery and the Multiecho Dixon Technique in Imaging of the Prostate.

OBJECTIVE: To compare the quality of fat suppression and image quality between multiecho Dixon technique (mDixon) and spectrally adiabatic iversion recovery (SPAIR) in dynamic contrast-enhanced magnetic resonance imaging of the prostate. METHODS: This prospective study assigned thirty consecutive patients to scanning with SPAIR technique (SPAIR protocol) and another consecutive 30 patients to scanning with mDixon technique (mDixon protocol). We calculated the contrast, signal to noise ratio (SNR), contrast to noise ratio (CNR) and the coefficient of variation between the 2 protocols. Two readers compared homogeneity of fat suppression, image noise, image contrast, and image sharpness between the two protocols. RESULTS: The SNR, CNR, and contrast of mDixon protocol were significantly higher than those of the SPAIR protocol (SNR: 14.7 ± 4.1 vs 11.0 ± 2.6; P < 0.05; CNR: 6.3 ± 1.6 vs 0.5 ± 1.5; P < 0.01; contrast: 4.4 ± 1.4 vs 1.3 ± 0.5; P < 0.01), whereas the coefficient of variation of mDixon protocol was significantly lower than that of SPAIR protocol (34.7 ± 15.5 vs 43.7 ± 23.1, P < 0.01). In qualitative image analysis, the image scores for the homogeneity of fat suppression, image noise, and image sharpness were significantly higher with mDixon protocol than those with SPAIR protocol (P < 0.01). There was no significant difference in image contrast between 2 fat suppression protocols (P > 0.05). CONCLUSIONS: In dynamic contrast-enhanced magnetic resonance imaging of the prostate, mDixon technique improved the homogeneity of fat suppression without degrade of image quality compared with SPAIR technique.

Comparison of the Timing of Hepatic Arterial Phase and Image Quality Using Test-Bolus and Bolus-Tracking Techniques in Gadolinium-Ethoxybenzyl-Diethylenetriamine Pentaacetic Acid-Enhanced Hepatic Dynamic Magnetic Resonance Imaging.

OBJECTIVES: The aim of this study was to compare the image quality, the degree of artifacts and the percentage of timing of the optimal hepatic arterial phase (HAP) between test-bolus and bolus-tracking methods on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI). METHODS: In this prospective study, 60 patients who underwent 3-dimensional dynamic Gd-EOB-DTPA-enhanced hepatic 3-T MRI were enrolled in this study. We randomly assigned the 30 patients to the bolus-tracking method, and another 30 patients to the test-bolus method. Signal-to-noise ratios of the liver and spleen in HAP were compared in the 2 groups. Two radiologists independently assessed the ratio of optimal timing of HAP and the degree of ringing and motion artifacts of the 2 protocols. RESULTS: The signal-to-noise ratios of the liver (24.0 [SD, 6.4] vs 20.4 [SD, 4.0]) and spleen (30.0 [SD, 13.3] vs 23.6 [SD, 9.9]) were significantly higher in the test-bolus protocol than in the bolus-tracking protocol. The ratio of optimal timing was also significantly higher with the test-bolus protocol than with the bolus-tracking protocol (76.7% vs 40.0%). The degree of ringing and motion artifacts of test-bolus protocol was significantly lower than that of the bolus-tracking protocol (P < 0.01). CONCLUSIONS: The test-bolus protocol in dynamic 3-T MRI can yield better qualitative image quality and more optimal timing of HAP images, while reducing the degree of artifacts compared with the bolus-tracking protocol.

Paradoxical Effect of Cardiac Output on Arterial Enhancement at Computed Tomography: Does Cardiac Output Reduction Simply Result in an Increase in Aortic Peak Enhancement?

OBJECTIVE: The aim of this study was to evaluate the effect of cardiac output (CO) on aortic peak enhancement using protocols with different contrast material (CM) injection durations. METHODS: We used a flow phantom that simulated the human circulatory system. Contrast material was injected at a rate of 4.0 mL/s for a period of 2.5, 5, 10, 15, or 20 seconds for a CO of 2.8, 4.2, and 5.6 L/min. Single-level serial computed tomography scans of the simulated aorta were acquired after the start of CM delivery, and aortic peak enhancement was recorded under the different injection protocols. RESULTS: Under a long injection duration protocol (20 seconds), a decrease in CO increased aortic peak enhancement proportionally (CO of 2.8 L/min, 420 Hounsfield units [HU]; CO of 4.2 L/min, 365 HU; CO of 5.6 L/min, 291 HU). However, this effect was decreased under shorter injection duration protocols (5, 10, and 15 seconds); under the shortest (2.5-second) injection duration protocol, a decrease in CO resulted in a decrease in aortic peak enhancement (CO of 2.8 L/min, 36 HU; CO of 4.2 L/min, 51 HU; CO of 5.6 L/min, 55 HU). CONCLUSIONS: The magnitude of the effect of CO on aortic peak enhancement depends on the CM injection duration.

Radiation-induced Liver Injury after 3D-conformal Radiotherapy for Hepatocellular Carcinoma: Quantitative Assessment Using Gd-EOB-DTPA-enhanced MRI.

Focal liver reaction (FLR) appears in the hepatobiliary-phase images of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) following radiotherapy (RT). We investigated the threshold dose (TD) for FLR development in 13 patients with hepatocellular carcinoma (HCC) who underwent three-dimensional conformal radiotherapy (3D-CRT) with 45 Gy in 15 fractions. FLR volumes (FLRVs) were calculated based on planning CT images by referring to fused hepatobiliary- phase images. We also calculated the TD and the irradiated volumes (IVs) of the liver parenchyma at a given dose of every 5 Gy (IVdose) based on a dose-volume histogram (DVH). The median TD was 35.2 Gy. The median IV20, IV25, IV30, IV35, IV40, and IV45 values were 371.1, 274.8, 233.4, 188.6, 145.8, and 31.0 ml, respectively. The median FLRV was 144.9 ml. There was a significant difference between the FLRV and IV20, IV25, and IV45 (p<0.05), but no significant differences between the FLRV and IV30, IV35, or IV40. These results suggest that the threshold dose of the FLR is approx. 35 Gy in HCC patients who undergo 3D-CRT in 15 fractions. The percentage of the whole liver volume receiving a dose of more than 30-40 Gy (V30-40) is a potential candidate optimal DVH parameter for this fractionation schedule.

256-Slice coronary computed tomographic angiography in patients with atrial fibrillation: optimal reconstruction phase and image quality.

OBJECTIVES: To assess the optimal reconstruction phase and the image quality of coronary computed tomographic angiography (CCTA) in patients with atrial fibrillation (AF). METHODS: We performed CCTA in 60 patients with AF and 60 controls with sinus rhythm. The images were reconstructed in multiple phases in all parts of the cardiac cycle, and the optimal reconstruction phase with the fewest motion artefacts was identified. The coronary artery segments were visually evaluated to investigate their assessability. RESULTS: In 46 (76.7 %) patients, the optimal reconstruction phase was end-diastole, whereas in 6 (10.0 %) patients it was end-systole or mid-diastole, and in 2 (3.3 %) patients it was another cardiac phase. In 53 (88.3 %) of the controls, the optimal reconstruction phase was mid-diastole, whereas it was end-systole in 4 (6.7 %), and in 3 (5.0 %) it was another cardiac phase. There was a significant difference between patients with AF and the controls in the optimal phase (p < 0.01) but not in the visual image quality score (p = 0.06). CONCLUSIONS: The optimal reconstruction phase in most patients with AF was the end-diastolic phase. The end-systolic phase tended to be optimal in AF patients with higher average heart rates. KEY POINTS: The optimal reconstruction phase in 76.7 % of patients with atrial fibrillation (AF) was end-diastole. The end-systolic phase was optimal in AF patients with higher heart rates. ECG and heart-rate control are necessary to obtain end-diastolic images with fewer motion artefacts.

Usefulness of the Short-Echo Time Cube Sequence at 3-T Magnetic Resonance Cholangiopancreatography: Prospective Comparison With the Conventional 3-Dimensional Fast Spin-Echo Sequence.

OBJECTIVES: We evaluated prospectively the clinical use of the short-echo time (TE) Cube sequence for magnetic resonance cholangiopancreatography (MRCP) at 3 T. METHODS: Using a 3-T unit, we subjected 41 consecutive patients to short-TE Cube MRCP and conventional 3-dimensional fast spin-echo (3D-FSE) MRCP. Two radiologists independently rated the image quality and the visibility of the right and left hepatic, cystic, common bile, and main pancreatic ducts and the gallbladder on a 4-point scale. The averaged visual scores by 2 readers for the image quality were calculated, and the artifacts were evaluated in cases with relatively lower (<3) score. The signal-to-noise ratio, contrast-to-noise ratio, and acquisition time were evaluated by quantitative analysis. RESULTS: The visual scores of the common bile duct (P < 0.05), cystic duct (P < 0.01), and gallbladder (P < 0.01) were significantly higher for Cube than 3D-FSE MRCP. Signal-to-noise ratio was also significantly higher for Cube than 3D-FSE MRCP (P < 0.01). There was no significant difference in the image acquisition time (352.1 ± 93.0 vs 314.1 ± 126.2 seconds, P = 0.059). Four cases on 3D-FSE MRCP and 2 cases on Cube MRCP have relatively lower image quality; however, the difference was not significant (P = 0.18). CONCLUSIONS: The visibility of biliary structures is significantly better on short-TE Cube MRCP than conventional 3D-FSE MRCP images at a clinically acceptable acquisition time.

Clinical impact of model-based type iterative reconstruction with fast reconstruction time on image quality of low-dose screening chest CT.

BACKGROUND: Model-based type iterative reconstruction algorithms with fast reconstruction times are now available. The clinical feasibility of their reconstruction has not been evaluated adequately. PURPOSE: To investigate the effects of model-based type iterative reconstruction, i.e. iterative model reconstruction (IMR), with fast reconstruction time on the qualitative and quantitative image quality at low-dose chest computed tomography (CT). MATERIAL AND METHODS: Thirty-one patients undergoing low-dose screening chest CT were enrolled. Images were reconstructed using filtered back projection (FBP), hybrid iterative reconstruction (HIR), and IMR algorithms. The CT attenuation and image noise for all reconstructions were calculated at the lung apex, middle, and base. Using a 4-point scale, two reviewers visually evaluated the image quality with respect to vessel sharpness, streak artifact, the mediastinum, and the overall image quality of each reconstruction method. RESULTS: The mean estimated effective dose was 1.0 ± 0.3 mSv. There was no significant difference in the CT attenuation among the three reconstructions. The mean image noise of FBP, HIR, and IMR images was 124.3 ± 57.3, 34.8 ± 10.2, and 22.9 ± 5.8 HU, respectively. There were significant differences for all comparison combinations among the three methods (P < 0.01). The best subjective overall image quality for the lung and mediastinum was obtained with IMR (P < 0.01). The reconstruction time for IMR was within 3 min in all cases. CONCLUSION: At low-dose chest CT, IMR can improve the qualitative and quantitative visualization of both lung and mediastinal structures especially in the lung apex at a clinically acceptable reconstruction time. Its application may improve diagnostic performance.

Clinical impact of 3-dimensional balanced turbo-field-echo magnetic resonance cholangiopancreatography at 3 T: prospective intraindividual comparison with 3-dimensional turbo-spin-echo magnetic resonance cholangiopancreatography.

OBJECTIVE: The objective of this study was to evaluate the clinical utility of 3-dimensional (3D) balanced turbo-field-echo (BTFE) magnetic resonance cholangiopancreatography (MRCP) with gate and track acquisition at 3 T. METHODS: Using a 3-T unit, we subjected 52 consecutive patients to 3D BTFE MRCP with the navigator-gated technique and 3D turbo-spin-echo volume isotropic T2-weighted acquisition (VISTA) MRCP with the navigator-triggered technique. Two radiologists independently rated the image quality and visibility of the right and left hepatic duct, cystic duct, common bile duct, gallbladder, and main pancreatic duct using a 4-point scale. The signal-to-noise ratio, contrast-to-noise ratio, and the acquisition time were evaluated by quantitative analysis. RESULTS: The visual scores of the cystic duct, common bile duct, gallbladder, and overall image quality were significantly higher for BTFE than VISTA MRCP (P < 0.01). The score for the main pancreatic duct was significantly higher with VISTA MRCP (P < 0.01). The image acquisition time was significantly shorter with BTFE than VISTA MRCP (139.8 ± 45.4 vs 416.9 ± 108.3 seconds, P < 0.01). There was no significant difference in signal-to-noise ratio and contrast-to-noise ratio. CONCLUSIONS: Three-dimensional BTFE MRCP yields significantly better image quality and visibility of large biliary structures than VISTA MRCP at a significantly shorter acquisition time. Volume isotropic T2-weighted acquisition MRCP provides detailed information on the main pancreatic duct that tends to be obscure on the 3D BTFE sequence.

Characterization of Liver Tumors by Diffusion-Weighted Imaging: Comparison of Diagnostic Performance Using the Mean and Minimum Apparent Diffusion Coefficient.

PURPOSE: To determine the minimum apparent diffusion coefficient (ADC(min)) values of benign and malignant hepatic lesions based on diffusion-weighted imaging and to compare the diagnostic performance of ADC(min) and mean ADC (ADC(mean)) values for differentiating between benign and malignant tumors of the liver. MATERIALS AND METHODS: We retrospectively subjected 240 patients with 195 malignant (hepatocellular carcinoma [HCC], n = 137; metastases, n = 44; cholangiocellular carcinoma [CCC], n = 14) and 45 benign tumors (hemangiomas, n = 37; focal nodular hyperplasia [FNH], n = 8). Both ADC(mean) and ADC(min) were evaluated independently by 2 readers, the sensitivity and specificity for the detection of malignancy were calculated, and receiver operating characteristic (ROC) curves were generated. To determine interobserver agreement, we calculated the Pearson correlation coefficient. RESULTS: Mean ADC (×10 mm/s) was 1.19 for malignant (HCC, 1.15; metastasis, 1.23; CCC, 1.51) and 2.01 for benign tumors (hemangioma, 2.09; FNH, 1.52; P < 0.001). Minimum ADC was 0.81 for malignant (HCC, 0.79; metastasis, 0.81; CCC, 0.91) and 1.62 for benign tumors (hemangioma, 1.66; FNH, 1.28; P < 0.001). The sensitivity, specificity, and the calculated area under the ROC curve for diagnosing malignant lesions were 86.2%, 86.7%, and 0.942 (reader 1) and 88.7%, 88.9%, and 0.939 (reader 2) for ADC(mean); they were of 92.3%, 97.8%, and 0.984 (reader 1) and 94.9%, 97.8%, and 0.983 (reader 2) for ADC(min). CONCLUSIONS: Mean ADC and ADC(min) were valuable for differentiating between malignant and benign hepatic lesions. The area under the ROC curve of ADC(min) was significant higher than that of ADC(mean).

Extracapsular extension of prostate cancer: diagnostic value of combined multiparametric magnetic resonance imaging and isovoxel 3-dimensional T2-weighted imaging at 1.5 T.

OBJECTIVE: The objective of this study was to assess whether adding isovoxel 3-dimensional T2-weighted imaging (volume isotropic T2-weighted acquisition [VISTA]) to multiparametric magnetic resonance imaging (mp-MRI) improves the ability to diagnose the extracapsular extension (ECE) of prostate cancer. METHODS: Two radiologists independently evaluated ECE on images acquired with mp-MRI only (method A) and mp-MRI plus VISTA (method B) in 50 men who had undergone prostatectomy. We also compared the signal-to-noise ratio of the tumor on T2WI and VISTA scans. RESULTS: Sensitivity, specificity, and accuracy were higher with method B. For both readers, specificity, accuracy, and the area under the receiver operating characteristic curve of method B were significantly higher than those of method A (reader 1: P = 0.028, 0.025, and 0.006; reader 2: P = 0.017, 0.0071, and 0.018). The signal-to-noise ratio was significantly higher on T2-weighted imaging than VISTA images (9.21 [SD, 2.46] vs 7.30 [SD, 1.87], P < 0.01). CONCLUSIONS: The addition of VISTA to mp-MRI improves the diagnostic value for ECE significantly.

Improved image quality at 256-slice coronary CT angiography in patients with a high heart rate and coronary artery disease: comparison with 64-slice CT imaging.

BACKGROUND: The 256-slice computed tomography (CT) scanners with wider detector coverage and faster gantry rotation speed are now available. The performance of scanners that feature a rotation speed of 270 ms at coronary CT angiography (CCTA) has not been evaluated in patients with a higher heart rate. PURPOSE: To evaluate the image quality of 256-slice CT with faster gantry rotation speed in patients undergoing CCTA. MATERIAL AND METHODS: We enrolled 886 patients; 357(40.3%) underwent study on a 64-slice CT at a rotation speed of 420 ms, the other 529 (59.7%) were examined using a 256-slice CT scanner at 270 ms. Two observers judged the image quality of 2658 imaged coronary arteries on a 4-point scale. RESULTS: The mean image quality score was significantly higher for the 256 - than the 64-slice CT scans (3.94 ± 0.28 vs. 3.73 ± 0.61; P < 0.01). There was no significant difference in the image quality scores between 64 - and 256-slice scans in patients whose heart rate (HR) was <60 bpm. However, in patients whose HR exceeded 60 bpm these scores were significantly higher for 256-slice CT images (P < 0.01). CONCLUSION: CCTA performed on the 256-slice CT scanner yielded significantly better image quality in patients with an HR exceeding 60 bpm.

Triage of low-risk prostate cancer patients with PSA levels 10 ng/ml or less: comparison of apparent diffusion coefficient value and transrectal ultrasound-guided target biopsy.

OBJECTIVE: The purpose of our study was to identify low-risk prostate cancer on the basis of the D'Amico clinical risk score in patients with prostate-specific antigen (PSA) levels 10 ng/mL or less who had undergone radical prostatectomy by comparing apparent diffusion coefficient (ADC) with transrectal ultrasound (TRUS)-guided target biopsy. MATERIALS AND METHODS: In the preliminary study, we used receiver operating characteristic (ROC) analysis and determined the cutoff ADC to identify prostate cancer with a Gleason score of 6 or less for 117 patients. In the primary study, we assessed the combination of routine MRI (T2-weighted and diffusion-weighted imaging) plus the cutoff ADC value ("method A") to identify low-risk prostate cancer for another 89 patients. Their diagnostic value was compared with that of routine MRI combined with the Gleason score obtained from TRUS-guided target biopsies ("method B"). RESULTS: The preliminary study showed that a mean ADC of 1.04 × 10(-3) mm(2)/s was the best cutoff. In the primary study, accuracy was statistically higher with method A for each reader (p = 0.041). CONCLUSION: In patients with PSA levels 10 ng/mL or less, the combination of MRI findings plus the cutoff ADC is significantly more accurate for the identification of low-risk prostate cancer than is the combination of MRI followed by TRUS-guided target biopsy.

Novel contrast-injection protocol for coronary computed tomographic angiography: contrast-injection protocol customized according to the patient's time-attenuation response.

We developed a new individually customized contrast-injection protocol for coronary computed tomography (CT) angiography based on the time-attenuation response in a test bolus, and investigated its clinical applicability. We scanned 60 patients with suspected coronary diseases using a 64-detector CT scanner, who were randomly assigned to one of two protocols. In protocol 1 (P1), we estimated the contrast dose to yield a peak aortic attenuation of 400 HU based on the time-attenuation response to a small test-bolus injection (0.3 ml/kg body weight) delivered over 9 s. Then we administered a customized contrast dose over 9 s. In protocol 2 (P2), the dose was tailored to the patient's body weight; this group received 0.7 ml/kg body weight with an injection duration of 9 s. We compared the two protocols for dose of contrast medium, peak attenuation, variations in attenuation values of the ascending aorta, and the success rate of adequate attenuation (250-350 HU) of the coronary arteries. The contrast dose was significantly smaller in P1 than in P2 (36.9 ± 9.2 vs 43.1 ± 7.0 ml, P < 0.01). Peak aortic attenuation was significantly less under P1 than under P2 (384.1 ± 25.0 vs 413.5 ± 45.7, P < 0.01). The mean variation (standard deviation) of the attenuation values was smaller in P1 than in P2 (25.0 vs 45.7, P < 0.01). The success rate of adequate attenuation of the coronary arteries was significantly higher with P1 than with P2 (85.0 vs 65.8 %, P < 0.01). P1 facilitated a reduction in the contrast dose, reduced the individual variations in peak aortic attenuation, and achieved optimal coronary CT attenuation (250-350 HU) more frequently than P2.

Contrast material and radiation dose reduction strategy for triple-rule-out cardiac CT angiography: feasibility study of non-ECG-gated low kVp scan of the whole chest following coronary CT angiography.

BACKGROUND: Dedicated coronary computed tomography (CT) scan has been proven to be an accurate diagnostic modality in evaluating coronary artery disease. A second phase scan starting immediately after the coronary CT scan might enable visualization of the different vascular territories of the entire chest. PURPOSE: To investigate the feasibility of a contrast material and radiation dose reduction triple-rule-out (TRO) CT angiography (CTA) protocol with serial non-ECG-gated low kVp scan of the whole chest, which utilizes a recirculated contrast agent. MATERIAL AND METHODS: Thirty patients were scanned with the new TRO-CTA protocol; after the coronary scan with retrospective ECG-gating, non-ECG-gated whole-chest CTA was performed at 80 kVp to evaluate aortic arch (AAr) and pulmonary trunk (PT). Another 30 patients were scanned by our conventional TRO-CTA protocol at 120 kVp with retrospective ECG-gating. We compared the estimated effective dose (ED), contrast material (CM) dose, contrast-to-noise ratio (CNR) of the ascending aorta (AAo), and the rate of patients who could achieve adequate attenuation of the AAr and PT between the two protocols. RESULTS: The total ED of the new TRO-CTA protocol was 29.6% lower than that of the conventional protocol (P < 0.01). The amount of CM used for the new TRO-CTA protocol was significantly lower than in the conventional protocol (60.1 ± 9.6 mL vs. 91.8 ± 22.6 mL, P < 0.01). The CNR of the AAo was 30.2% higher with the new TRO-CTA protocol than with the conventional protocol (P < 0.01). There was no significant difference in the success rate of adequate attenuation of the AAr and PT between the two protocols (P > 0.05). CONCLUSION: The new TRO-CTA protocol can reduce the total dose of radiation and the contrast dose and yield adequate vascular enhancement compared with the conventional protocol.