Assessment of liver fibrosis using a 3-dimensional high-resolution late gadolinium enhancement sequence in children and adolescents with Fontan circulation.

OBJECTIVES: To assess abnormal liver enhancement on 15-20 min delayed 3D high-resolution late gadolinium enhancement (3D HR LGE) sequence in patients with Fontan circulation. METHODS: Retrospective study of pediatric Fontan patients (< 18 years old) with combined cardiac-liver MRI from January 2018 to August 2021. Abnormal hepatic enhancement was graded (0-3) for each lobe, summed for a total liver enhancement score (0-6), and compared to repaired tetralogy of Fallot (rTOF) patients. Correlations with other hepatic imaging biomarkers were performed. Temporal relationships of enhancement compared to traditional early portal venous and 5-7-min delayed phase liver imaging were analyzed. RESULTS: The Fontan group (n = 35, 13 ± 3.4 years old, median time from Fontan 10 (9-12) years) had 23/35 (66%) with delayed 3D HR LGE total liver enhancement score > 0 (range 0-5), with greater involvement of the right lobe (1 (0-1) vs 0 (0-1), p < 0.01). The rTOF group (n = 35, 14 ± 2.6 years old) had no abnormal enhancement. In the Fontan group, total liver enhancement was 3 (2-4) in the early portal venous phase, lower at 1 (1-2) in the 5-7-min delayed phase (p < 0.01), and lowest at 1 (0-2) in the 15-20-min delayed phase (p = 0.03). 3D HR LGE enhancement correlated inversely with portal vein flow (rs = - 0.42, p = 0.01) and positively with left lobe stiffness (rs = 0.51, p < 0.01). The enhancement score decreased in 13/35 (37%) between the 5-7- and 15-20-min delayed phases. CONCLUSIONS: Liver fibrosis can be assessed on 3D HR LGE sequences in patients with Fontan circulation, correlates with other imaging biomarkers of Fontan liver disease, and may add information for hepatic surveillance in this population. KEY POINTS: • Abnormal liver enhancement on 3D HR LGE sequences in Fontan patients likely represents liver fibrosis and is seen in up to 66% of children and adolescents with variable distribution and severity. • The degree of 3D HR LGE liver enhancement correlates with decreased portal vein flow and increased left hepatic lobe stiffness.

MRI Phase-Contrast Blood Flow in Fasting Pediatric Patients with Fontan Circulation Correlates with Exercise Capacity.

Purpose: To assess regional blood flow in fasting pediatric patients with Fontan circulation by using MRI and to explore associations with clinical parameters. Materials and Methods: In this retrospective study, pediatric patients who had undergone the Fontan procedure (<18 years of age) and had undergone clinical cardiac MRI, performed after at least 4 hours of fasting, between 2018 and 2021 were included. Regional blood flow was compared with published healthy volunteer data (n = 19) and assessed in relation to hemodynamic parameters and clinical status. Data are presented as medians, with first to third quartiles in parentheses. Mann-Whitney U, Kruskal-Wallis, χ2, and Spearman rank correlation tests were used. Results: Fifty-five patients (38 boys) with median age at MRI of 14 years (IQR, 11-16 years) and median time from Fontan procedure to MRI of 10 years (IQR, 8-12 years) were included. Patients after Fontan procedure had lower ascending aortic, inferior vena cava, and total systemic blood flow compared with healthy volunteers (3.00 L/min/m2 [IQR, 2.75-3.30 L/min/m2] vs 3.61 L/min/m2 [IQR, 3.29-4.07 L/min/m2]; 1.73 L/min/m2 [IQR, 1.40-1.94 L/min/m2] vs 2.24 L/min/m2 [IQR, 2.06-2.75 L/min/m2]; 2.78 L/min/m2 [IQR, 2.45-3.10 L/min/m2] vs 3.95 L/min/m2 [IQR, 3.20-4.30 L/min/m2], respectively; P < .001). Portal vein flow was greater than hepatic vein flow in 25% of patients. Fontan blood flow was inversely correlated with pre-Fontan mean pulmonary artery pressure (Spearman rank correlation coefficient [rs ]= -0.42, P = .005) and ventricular end diastolic pressure (rs = -0.33, P = .04) and positively correlated with post-Fontan percent predicted oxygen consumption at peak workload (rs = 0.34, P = .02). Conclusion: Reference ranges are provided for regional systemic blood flow derived by using MRI in fasting pediatric patients with Fontan circulation, who had lower systemic blood flow compared with healthy volunteers. Lower fasting Fontan blood flow correlated with lower exercise capacity.Keywords: Pediatrics, Heart, Congenital, MR Imaging, Hemodynamics/Flow Dynamics, Cardiac Supplemental material is available for this article. © RSNA, 2022.

Cáncer de mama: Hallazgos en la resonancia magnética según tipo histológico y modificación de la conducta terapéutica / Role of Magnetic Resonance in Modifying the Therapeutic Approach in Patients with Diagnosis of Breast Cancer and MRI Findings According to the Histological Subtype

Introducción: La resonancia magnética (RM) es importante en el proceso de diagnóstico, estadificación y tratamiento del cáncer de mama, aporta información valiosa del tamaño tumoral y el grado de extensión local. Objetivo: Describir el porcentaje de cambio de conducta terapéutica en relación con los hallazgos de la RM en pacientes con cáncer de mama confirmado. Métodos: Estudio observacional de corte transversal en pacientes con diagnóstico confirmado. Se clasificaron las variables en datos demográficos, clínicos y resultados de pruebas diagnósticas. La principal variable fue la intención terapéutica, medida antes y después de cada estudio. El análisis descriptivo de las variables cuantitativas se realizó con medidas de tendencia central y dispersión; y en las cualitativas, con distribuciones de frecuencias absolutas y relativas. Resultados: Se analizaron 107 pacientes con diagnóstico confirmado de cáncer de mama (edad promedio de 50,6 años [±10,4]). El subtipo histológico más frecuente fue el cáncer ductal infiltrante (69,1 %) seguido por el lobulillar infiltrante (13 %). La estadificación tumoral fue la indicación más común de la RM (74,7 %). Se encontró cambio de actitud terapéutica en el 21,5 % de los casos. Conclusión: Se confirma la importancia de la RM para la toma de decisiones, demuestra cambio en una de cada cuatro pacientes de esta serie. Se debería contemplar como un estudio indispensable en todas las mujeres que requieran estadificación de su patología previo a la toma de una conducta terapéutica

Introduction: MRI is important in diagnosis and staging of breast cancer, providing information on tumor size and degree of local extension, key findings when defining a therapeutic approach. Objective: To describe the percentage of change in the therapeutic conduct in relation to imaging findings in MRI. Methods: Observational cross-sectional study in patients with a confirmed diagnosis of breast cancer who underwent MRI. The variables were classified into demographic and clinical data and diagnostic test results. The main variable was the therapeutic intent, measured before and after each study. The descriptive analysis of quantitative variables was performed with measures of central tendency and dispersion; and qualitative distributions of absolute and relative frequencies. Results: 107 patients with confirmed breast cancer were analyzed, (average age of 50.6 years(± 10.4)). The most common histological subtype was infiltrating ductal cancer (69.1 %) followed by infiltrating lobular cancer (13 %). The most common indication for MRI was tumor staging (74.7 %). Of the total number of patients included, a change in therapeutic approach was found in 21.5 % of cases. Conclusions: The importance of MRI in modifying the therapeutic approach is confirmed, demonstrating this shift in one of every four patients. MRI should be seen as an indispensable study in all women requiring staging of their pathology previous to deciding a therapeutic approach.

Síndrome linfoproliferativo postrasplante con compromiso cerebral: reporte de un caso / Post-transplantation lymphoproliferative disorder with brain involvement: a case report

Abstract. Post-transplantation lymphoproliferative disorder is a low incidence complication of transplant recipient patients. However, mortality is high if the diagnosis and management are not appropriate. For this reason the radiologist should be aware when dealing with images of these patients, particularly in the first year following the transplantation. In this article the case is presented of a woman who was recipient of a kidney, and developed post-transplantation lymphoproliferative disorder, affecting the central nervous system.

Resumen. El síndrome linfoproliferativo postrasplante es una complicación que se presenta con una baja incidencia en los pacientes que han sido trasplantados. Sin embargo, si el diagnóstico y manejo no son oportunos su mortalidad es alta. Por esta razón el radiólogo debe estar atento al diagnóstico al interpretar estudios de este tipo de pacientes, especialmente en el año siguiente al trasplante. Presentamos el caso de una paciente con antecedente de trasplante renal y síndrome linfoproliferativo postrasplante con afección del sistema nervioso central.