The pancreatic exocrine function in patients with pancreatic endocrine insufficiency: the evaluation with cine-dynamic magnetic resonance cholangiopancreatography using a spatially selective inversion-recovery pulse and T1 mapping.

PURPOSE: To evaluate the association of the pancreatic exocrine function estimated by cine-dynamic magnetic resonance cholangiopancreatography (MRCP) using a spatially selective inversion-recovery (IR) pulse with the pancreatic endocrine function estimated by the T1 relaxation time of the pancreatic parenchyma and HbA1c values. MATERIALS AND METHODS: Forty-three patients with suspected hepatobiliary or pancreatic diseases were included. Patients were classified into three groups: HbA1c < 5.7% (normal group), 5.7% ≤ HbA1c < 6.5% (prediabetes group), and HbA1c ≥ 6.5% (diabetes group). The frequency of the secretory flow of the pancreatic juice was observed within the area of the IR pulse, and the moving distance (mean secretion grade) of the pancreatic juice inflow within the area of the IR pulse on cine-dynamic MRCP, and the T1 relaxation time of the pancreatic parenchyma on the T1 map images were assessed. The MR imaging measurements were compared using Spearman's rank correlation coefficient analysis and the Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Both the mean secretion grade and frequency of the pancreatic secretory inflow had a significant negative correlation with the T1 relaxation time of the pancreatic parenchyma (r = - 0.335, p = 0.028 and r = - 0.305, p = 0.047, respectively) and HbA1c values (r = - 0.308, p = 0.044 and r = - 0.313, p = 0.041, respectively). Both the mean secretion grade and frequency of the pancreatic secretory inflow in the elevated HbA1c (prediabetes and diabetes) group were significantly lower than those in the normal group (p = 0.030 and p = 0.029, respectively). CONCLUSION: The pancreatic exocrine function estimated by cine-dynamic MRCP was significantly lower in patients with prediabetes and diabetes than in controls. Cine-dynamic MRCP with a spatially selective IR pulse may be useful for the early diagnosis of pancreatic exocrine insufficiency in patients with pancreatic endocrine insufficiency.

Bile Flow Dynamics in Patients with Cholelithiasis: An Evaluation with Cine-Dynamic Magnetic Resonance Cholangiopancreatography Using a Spatially Selective Inversion-Recovery Pulse.

BACKGROUND: A variety of pathophysiological changes in the biliary system occur in patients with cholelithiasis, but the changes in the bile flow dynamics in those patients remain unclear. The purpose of this study was to elucidate the changes in the bile flow dynamics in patients with cholelithiasis using cine-dynamic magnetic resonance cholangiopancreatography (MRCP) with a spatially selective inversion-recovery (IR) pulse. METHODS: We retrospectively examined 25 patients with gallstones (gallstone group) and 69 patients without gallstones (non-gallstone group) who underwent abdominal MRI, including in- and opposed-phase T1-weighted images and cine-dynamic MRCP with a spatially selective IR pulse. The frequency and secretion grade of the antegrade and reverse flow of the bile on the cine dynamic MRCP images and the signal intensity ratio (SIR) of the gallbladder in the in- and opposed-phase T1-weighted images were evaluated. RESULTS: The frequency and mean secretion grade of the antegrade bile flow were significantly higher in the gallstone group than in the non-gallstone group (p = 0.011 and p = 0.003), while no significant differences in those values of the reverse bile flow were found between the two groups. The SIR of the gallbladder in the T1-weighted gradient-echo in-phase images was significantly lower in the gallstone group than in the non-gallstone group (p = 0.004). CONCLUSIONS: Cine-dynamic MRCP with a spatially selective IR pulse can noninvasively visualize changes in the bile flow dynamics of patients with gallstones.

Three-Dimensional (3D) Breath-Hold Zoomed MR Cholangiopancreatography (MRCP): Evaluation of Additive Value to Conventional 3D Navigator Triggering MRCP in Patients With Branch Duct Intraductal Papillary Mucinous Neoplasms.

BACKGROUND: To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP. PURPOSE: To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas. STUDY TYPE: Retrospective. POPULATION: A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs. FIELD STRENGTH/SEQUENCE: 3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality. STATISTICAL TESTS: Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P < 0.05). RESULTS: Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients. DATA CONCLUSION: 3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 2.

Assessment of the relationship between the hepatic contrast enhancement effect in the hepatobiliary phase and hepatic signal changes in free-breathing continuous multiphasic dynamic EOB-MRI.

PURPOSE: To investigate the relationship between the hepatic contrast enhancement effect in the hepatobiliary phase (HBP) and the contrast enhancement parameters based on the data of continuous signal changes in free-breathing multiphasic dynamic EOB-MR imaging using a compressed sensing (CS) and the self-gating technique, and to clarify which contrast enhancement parameters are useful for estimating the hepatic enhancement effect in the HPB. METHOD: This study included 96 patients. The contrast enhancement ratio (CER) of the liver parenchyma from phase x to phase y was calculated as follows: CERy-x: (SIy -SIx)/SIx. The gradient of the regression line (GRL) was also calculated. Patients can be divided into two groups with sufficient or insufficient liver enhancement in the HBP, then each parameter was compared between these two groups. RESULTS: In the analysis of the arterioportal phases, CER7-pre in the sufficient HBP enhancement group was significantly higher than that in the insufficient HBP enhancement group (0.50 vs 0.44, p < 0.001). Regarding 5 min early hepatocyte phase (phases 1-28) analysis, significant differences were observed in CER28-pre, CER28-7 and Gradient28-7 between the two groups (0.64 vs 0.47, 0.10 vs 0.03, 1.27 vs 0.27, all p < 0.001). For the strength of correlation, CER7-pre, CER28-pre, CER28-7, and GRL28-7 had higher correlation coefficients, compared with the blood sampling data. CONCLUSION: CER in the arterio-portal phase and 5 min early hepatocyte phase had significant correlation with hepatic contrast enhancement effects in the 20 min HBP, suggesting that sufficient 20 min HBP enhancement may be estimated by the CER in the portal phase and 5 min early hepatocyte phase.

Pancreatobiliary Flow Dynamics: Association Between Bile and Pancreatic Juice Evaluated With Cine-Dynamic Magnetic Resonance Cholangiopancreatography Using Spatially Selective Inversion Recovery Pulse.

BACKGROUND: The physiological flow patterns and the reciprocal relationship between pancreatic juice and bile excretion dynamics have not been clearly elucidated by imaging. PURPOSE: To assess the physiological flow patterns of bile and pancreatic juice simultaneously in order to clarify the pancreatobiliary flow dynamics using cine-dynamic magnetic resonance cholangiopancreatography (MRCP) with a spatial selective inversion recovery (IR) pulse. STUDY TYPE: Retrospective. POPULATION: A total of 85 patients with physiologically normal pancreatobiliary flow without ductal dilatation (normal group) and 19 patients with dilated pancreatic duct. FIELD STRENGTH/SEQUENCE: A 3 T, fast spin echo sequence with IR pulse to nullify the signal of static pancreatic juice and bile. ASSESSMENT: The frequency and secretion grade of the antegrade and reverse flow of the pancreatic juice and bile on cine-dynamic MRCP were visually evaluated. Additionally, the reciprocal relationship between pancreatic juice and bile flow was evaluated based on its flow patterns. STATISTICAL TESTS: Spearman's rank correlation coefficient analysis and the Kruskal-Wallis and Mann-Whitney U tests were used. P values of <0.05 were considered to indicate statistical significance. RESULTS: In the normal group, the antegrade pancreatic juice flow and no bile flow pattern was most frequently observed (29%), followed by the no pancreatic juice flow and no bile flow pattern (23%), the antegrade pancreatic juice flow and antegrade bile flow pattern (22%), and the no pancreatic juice flow and reverse bile flow pattern (9%). The flow of the pancreatic juice and bile were synchronized with each other in 47%, while they were not in 53%. In the dilated pancreatic duct group, the mean secretion grade of the antegrade bile and pancreatic juice flow was significantly lower than in the normal group. DATA CONCLUSION: Cine-dynamic MRCP with a spatially selective IR pulse can visualize the variations of the physiological flow patterns of bile and pancreatic juice including 53% of unsynchronized patterns. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 5.

Feasibility of high-resolution magnetic resonance imaging of the liver using deep learning reconstruction based on the deep learning denoising technique.

PURPOSE: To evaluate the feasibility of High-resolution (HR) magnetic resonance imaging (MRI) of the liver using deep learning reconstruction (DLR) based on a deep learning denoising technique compared with standard-resolution (SR) imaging. MATERIALS AND METHODS: This retrospective study included patients who underwent abdominal MRI including both HR imaging using DLR and SR imaging between April 1 and August 31, 2019. DLR was applied to all HR images using 12 different strength levels of noise reduction to determine the optimal denoised level for HR images. The mean signal-to-noise ratio (SNR) was then compared between the original HR images without DLR and the optimal denoised HR images with DLR and SR images. The mean image noise, sharpness and overall image quality were also compared. Statistical analyses were performed with the Friedman and Dunn-Bonferroni post-hoc test. RESULTS: In total, 49 patients were analyzed (median age, 71 years; 25 women). In quantitative analysis, the mean SNRs on the original HR images without DLR were significantly lower than those on the SR images in all sequences (p < 0.01). Conversely, the mean SNRs on optimal denoised HR images were significantly higher than those on the SR images in all sequences (p < 0.01). In the qualitative analysis, the mean scores for the image noise and overall image quality were significantly higher on optimal denoised HR images than on the SR images in all sequences (p < 0.01) except for the mean image noise score in in-phase (IP) images. CONCLUSIONS: The use of a deep learning-based noise reduction technique substantially and successfully improved the SNR and image quality in HR imaging of the liver. Denoised HR imaging using the DLR technique appears feasible for use in liver MR examinations compared with SR imaging.

The extracellular volume fraction of the pancreas measured by dual-energy computed tomography: The association with impaired glucose tolerance.

PURPOSE: To investigate the clinical value of measuring the ECV fraction of the pancreas by DECT in association with an impaired glucose tolerance (IGT) estimated by the hemoglobin A1C (HbA1C) value in patients with or without cirrhosis. MATERIALS AND METHODS: This retrospective study included patients who underwent contrast-enhanced dynamic CT with dual-energy mode between March 2018 and February 2019. The ECV fraction of the pancreas was calculated from iodine map images created from equilibrium-phase contrast-enhanced DECT images. The cross-sectional areas of the pancreas were also measured. RESULTS: In total, 51 patients were analyzed (median age, 69 years old; 22 women). The ECV fraction of the pancreas showed a significant negative correlation with the HbA1c value in the cirrhotic group (ρ=-0.346, p = 0.048), while there was no significant correlation in the non-cirrhotic group (ρ=-0.086, p = 0.734). In the elevated HbA1C group, the ECV fraction of the pancreas in the cirrhotic patients (median, 0.247; interquartile range [IQR], 0.098) was significantly lower than that in the non-cirrhotic patients (0.332, IQR 0.113) (p = 0.024). In the elevated HbA1C group, the cross-sectional area of the pancreas was significantly larger in the cirrhotic patients than that in the non-cirrhotic patients (median [IQR]; 2945 [904] vs. 1885 [909] mm2, p = 0.019). CONCLUSION: A reduction in the ECV fraction of the pancreas measured by DECT as well as the enlargement of the pancreatic parenchyma was observed in cirrhotic patients with IGT. These findings suggest that the measurement of the pancreatic ECV fraction by DECT may help clarify the pathophysiology of IGT in patients with cirrhosis.

Transient respiratory motion artifacts in multiple arterial phases on abdominal dynamic magnetic resonance imaging: a comparison using gadoxetate disodium and gadobutrol.

PURPOSE: To compare the occurrence of transient respiratory motion artifacts (TRMAs) in multiple arterial phases on abdominal magnetic resonance (MR) images between those obtained using gadobutrol and gadoxetate disodium. MATERIALS AND METHODS: Two hundred and fourteen abdominal MR examinations (101 with gadoxetate disodium, 113 with gadobutrol) were evaluated. Dynamic three-dimensional contrast-enhanced T1-weighted imaging (CAIPIRINHA-Dixon-TWIST-VIBE) including single-breath-hold six arterial phase acquisitions was performed on a 3.0-T MRI scanner. The TRMAs frequency and the mean TRMA scores were compared between patients assessed with gadoxetate disodium and those assessed with gadobutrol. In addition, the timing of TRMAs appearing for the first time was also recorded and compared between the two groups. RESULTS: The mean TRMA scores in all arterial phases using gadoxetate disodium were significantly worse than in those using gadobutrol (1.49 ± 0.78 vs. 1.18 ± 0.53, P < .001). Regarding the timing of the occurrence of TRMAs, the severe TRMAs frequency after the third arterial phase was significantly higher in patients using gadoxetate disodium (10/101, 10%) than in those using gadobutrol (0/113, 0%) (P < .001). CONCLUSION: In multiple-arterial-phase dynamic MRI, the TRMAs frequency when using gadoxetate disodium increased compared with gadobutrol, due to intolerable respiratory suspension after the third arterial phase.

Image quality in dual-source multiphasic dynamic computed tomography of the abdomen: evaluating the effects of a low tube voltage (70 kVp) in combination with contrast dose reduction.

PURPOSE: To compare the image quality of multiphasic (arterial, portal, and equilibrium phases) dynamic computed tomography (CT) of the abdomen obtained by a low tube voltage (70kVp) in combination with a half-dose iodine load using low-concentration contrast agent in high tube output dual-source CT with a standard tube voltage (120kVp) and full-dose iodine load using the same group of adult patients. METHODS: Fifty-five patients who underwent both low-tube-voltage (70kVp) abdominal CT with a half-dose iodine load and standard-tube-voltage (120kVp) CT with a full-dose iodine load were analyzed. The mean CT values and signal-to-noise ratio (SNR) of the liver, aorta and portal veins were quantitatively assessed. In addition, the contrast enhancement of the abdominal organs and overall image quality were qualitatively evaluated. RESULTS: The mean CT values and SNR of the liver parenchyma were significantly higher in 70-kVp protocol than in 120-kVp protocol in all 3 phases (p = 0.018 ~ < 0.001). Regarding the qualitative analysis, the overall image quality in the 70-kVp protocol was significantly better than in the 120-kVp protocol in all 3 phases (p < 0.001). In addition, the contrast enhancement scores of the liver parenchyma and hepatic vein in the equilibrium phase were also significantly higher in the 70-kVp protocol than in the 120-kVp protocol (p < 0.001). CONCLUSION: A low tube voltage (70kVp) in combination with a half-dose iodine load using a low-concentration contrast agent and an iterative reconstruction algorithm in high tube output dual-source CT may improve the contrast enhancement and image quality in multiphasic dynamic CT of the abdomen in patients under 71 kg of body weight.

Quantification of pancreas fat on dual-energy computed tomography: comparison with six-point Dixon magnetic resonance imaging.

OBJECTIVES: Although it is important to quantify the degree of fatty degeneration of the pancreas, it is difficult to make such a quantification using conventional computed tomography (CT). The present study evaluated the feasibility of pancreatic fat quantification by dual-energy CT (DECT) compared with T2*-corrected six-point Dixon magnetic resonance imaging (MRI). MATERIALS AND METHODS: Twenty-eight patients who underwent both DECT (100 and 150 kVp) and Dixon MRI without the use of contrast agents were analyzed. The region of interest (ROI) was placed at the head and body/tail of the pancreas on fat volume fraction (FVF) maps generated using the multi-material decomposition (MMD) algorithm on DECT. The FVF (%) of pancreatic parenchyma measured by DECT (CT-FVF) was compared with that measured on FVF maps calculated using Dixon MRI (MR-FVF) using the Spearman rank correlation coefficient. RESULTS: The median CT-FVF (%) values of the head and body/tail of the pancreas on DECT were 14.2% (range 0.1-81.2%) and 9.4% (range 0-40.8%), respectively. The median MR-FVF (%) values of the head and body/tail of the pancreas on Dixon MRI were 12.2% (range 1.2-80.9%) and 8.1% (range 0.3-43.7%), respectively. CT-FVF (%) measured by DECT showed a significant correlation with the MR-FVF (%) measured by Dixon MRI in the head of the pancreas (ρ = 0.631, P < 0.001) as well as the body/tail of the pancreas (ρ = 0.526, P = 0.004). CONCLUSION: DECT may be useful for quantifying the degree of fatty degeneration of the pancreas.

The kinetic analysis of breast cancer: An investigation of the optimal temporal resolution for dynamic contrast-enhanced MR imaging.

INTRODUCTION: There is wide agreement that morphologic features and enhancement kinetics should be evaluated for MRI of the breast, although there has been no clear consensus concerning optimal temporal resolutions. The objective of this study was to investigate the optimal temporal resolution for the kinetic analysis of breast cancers. METHODS: Thirty-four patients with 34 enhancing lesions of breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) on a 3.0-T scanner were included in this retrospective study. DCE-MRI was performed with an original temporal resolution of 10-s, and the values of pharmacokinetic parameters (Ktrans, Ve, Kep, and area under the curve (AUC)) were compared with selected data of 30-s and 60-s time intervals. RESULTS: Among the 34 lesions, 10 showed a wash out pattern, 16 showed a plateau pattern, and 8 showed a persistent enhancement pattern. The Ktrans value in the wash-out pattern was significantly higher than that of other time-intensity curve patterns (p < 0.01). The Kep and AUC also showed significant differences between the wash-out pattern and other types (p < 0.01). On comparing the perfusion parameters among different temporal resolutions, simulations showed that only the AUC differed significantly between the data acquired at a 10-s temporal resolution and that acquired at a 60-s time interval (p < 0.01). Although the comparison of the AUC between the 30-s and 60-s data also showed significant differences (p = 0.01), there was no significant difference between the 10-s and 30-s data (p = 0.17). CONCLUSIONS: DCE-MRI with a temporal resolution of 30-s preserves the kinetic information. Further prospective studies will be needed to investigate the trade-off between temporal and spatial resolution in DCE-MRI.

Influence of fat deposition on T1 mapping of the pancreas: evaluation by dual-flip-angle MR imaging with and without fat suppression.

PURPOSE: To evaluate the influence of fat deposition on T1 relaxation time of pancreatic parenchyma using dual-flip-angle T1 mapping with and without fat suppression. METHODS: Forty-five patients who underwent abdominal MR imaging including T1 mapping with dual-flip-angle method on 3T MRI were included. We measured T1 relaxation time of pancreatic parenchyma on the T1 map images with and without fat suppression. T1 relaxation time of bone marrow was also measured as a reference organ with abundant fat deposition. Fat signal fraction (FSF) was also measured at the same location as T1 map images. Then, the correlation between T1 relaxation time and FSF was assessed. RESULTS: T1 relaxation times of pancreatic parenchyma and bone marrow on the T1 map images without fat suppression showed significantly negative correlation with FSF (pancreas, r = - 0.394, P = 0.007; bone marrow, r = - 0.550, P < 0.001), while there were no significant correlations between them on the T1 map images with fat suppression. On the T1 map images without fat suppression, T1 relaxation times of pancreatic parenchyma as well as bone marrow in patients with FSF ≥ 10% were significantly shorter than those in patients with FSF < 10% (pancreas, P = 0.041; bone marrow, P = 0.005). Conversely, on the T1 map images with fat suppression, no significant differences in T1 relaxation times were found between two groups. CONCLUSION: T1 relaxation time of the pancreas on T1 mapping was influenced by the presence of fat deposition. Therefore, fat suppression technique in T1 mapping will be essential for evaluating T1 relaxation time of pancreatic parenchyma.

Incidentally detected pancreatic adenocarcinomas on computed tomography obtained during the follow-up for other diseases.

PURPOSE: To determine imaging findings of pancreatic adenocarcinomas incidentally detected on contrast-enhanced multiphasic dynamic computed tomography (CT) obtained during the follow-up for other diseases. METHODS: From January 2007 to December 2018, 14 patients with pancreatic adenocarcinomas incidentally detected on CT obtained during the follow-up for other diseases (incidental group) and 105 patients with pancreatic adenocarcinomas symptomatically detected on ultrasound or CT (non-incidental group) were included. Imaging characteristics of the tumor were compared between the two groups. Additionally, imaging findings prior to the detection of a tumor on previous CT images in the incidental group were also assessed. RESULTS: In cancers of the pancreas body/tail, there was a significantly smaller tumor size (median, 17 mm vs. 42 mm, p < 0.001), a significantly lower incidence of loss of fatty marbling (p = 0.025), vascular involvement (p < 0.001), lymph node metastasis (p = 0.046) and distant metastasis (p = 0.017), and a significantly higher incidence of preserved lobulation (p < 0.001) in the incidental group than in the non-incidental group. Regarding the cancers of the pancreas head, there were no significant differences in the radiological findings between the two groups. On previous CT images, small pancreatic nodules, secondary signs, and loss of fatty marbling tended to be the preceding findings of incidental pancreatic adenocarcinomas. CONCLUSION: Incidentally detected pancreatic adenocarcinomas in the pancreas body/tail were characterized by an earlier tumor stage than in cases of symptomatically detected pancreatic adenocarcinoma. Several CT findings prior to the detection of a tumor may be useful for the early detection of pancreatic adenocarcinoma during the follow-up for other diseases.

Liver imaging reporting and data system (LI-RADS) v2018: comparison between computed tomography and gadoxetic acid-enhanced magnetic resonance imaging.

PURPOSE: To determine the consistency of major hepatocellular carcinoma (HCC) features between CT and MRI based on Liver Imaging Reporting and Data System (LI-RADS) v2018 and to investigate the additional value on gadoxetic acid-enhanced MRI. MATERIALS AND METHODS: Patients who underwent dynamic CT and gadoxetic acid-enhanced MRI within 1 month were investigated. Two radiologists evaluated the presence of major HCC features and categorized observations using LI-RADS v2018 algorithm. In addition, each observation was recorded as hyper-, iso-, or hypo-intensity on hepatobiliary-phase (HBP) images. RESULTS: Sixty-one patients with 110 observations were identified. Among 88 observations classified as LR-3, 4 or 5, arterial phase hyper-enhancement and washout appearance showed higher frequencies on CT than on MRI (75.0% vs. 58.0%, P < 0.001, and 60.2% vs. 44.3%, P = 0.014, respectively). Of the 59 LR-3 observations categorized on MRI, 70.0% of observations with hypo-intensity on HBP images were HCCs, whereas 89.5% of observations with iso- or hyper-intensity on HBP images were non-HCCs (P < 0.001) CONCLUSION: The frequencies of arterial phase hyper-enhancement and washout appearances were higher on CT than on gadoxetic acid-enhanced MRI. For LR-3 observations, adding the hepatobiliary-phase hypo-intensity to major features improved the diagnostic performance of MRI in distinguishing HCCs from non-HCC lesions.

Distinct and Shared Endophenotypes of Neural Substrates in Bipolar and Major Depressive Disorders.

Little is known about disorder-specific biomarkers of bipolar disorder (BD) and major depressive disorder (MDD). Our aim was to determine a neural substrate that could be used to distinguish BD from MDD. Our study included a BD group (10 patients with BD, 10 first-degree relatives (FDRs) of individuals with BD), MDD group (17 patients with MDD, 17 FDRs of individuals with MDD), and 27 healthy individuals. Structural and functional brain abnormalities were evaluated by voxel-based morphometry and a trail making test (TMT), respectively. The BD group showed a significant main effect of diagnosis in the gray matter (GM) volume of the anterior cingulate cortex (ACC; p = 0.01) and left insula (p < 0.01). FDRs of individuals with BD showed significantly smaller left ACC GM volume than healthy subjects (p < 0.01), and patients with BD showed significantly smaller ACC (p < 0.01) and left insular GM volume (p < 0.01) than healthy subjects. The MDD group showed a tendency toward a main effect of diagnosis in the right and left insular GM volume. The BD group showed a significantly inverse correlation between the left insular GM volume and TMT-A scores (p < 0.05). Our results suggest that the ACC volume could be a distinct endophenotype of BD, while the insular volume could be a shared BD and MDD endophenotype. Moreover, the insula could be associated with cognitive decline and poor outcome in BD.

MRI of giant cell tumour of larynx: marked T 2 hypointensity due to abundant haemosiderin deposition.

Giant cell tumours (GCTs) are benign tumours commonly found in the long bones. Rarely, they may occur in the larynx, often resulting in hoarseness and anterior neck swelling. Since Wessely reported the first case of laryngeal GCT in 1940, 35 cases have been identified. Herein, we present a case of a 53-year-old male with GCT of the larynx that showed T 1 and T 2 hypointense signal on MRI, presumably owing to abundant haemosiderin deposition. We also discuss the imaging findings of CT and 18F-fludeoxyglucose positron emission tomography scans, as well as the pathological correlation.

Atypical extraventricular neurocytoma in a 3-year-old girl: case report with radiological-pathological correlation.

BACKGROUND: Extraventricular neurocytoma (EVN) is a rare neuronal tumor histologically similar to central neurocytoma but arising in the brain parenchyma outside the ventricles. The minority of EVNs show atypical features including increased proliferative index, microvascular proliferation, or necrosis, and are called atypical EVN. Most of atypical EVNs occur in adults, and the tumors in children are extremely rare. A radiological-pathological correlation and radiological clue to atypical EVNs have not been clarified. CASE REPORT: We report a case of atypical EVN in a 3-year-old girl. Magnetic resonance imaging (MRI) revealed an extraventricular intraparenchymal tumor in the left frontal lobe, which was composed of homogeneous well-demarcated cystic component and peripheral ill-delineated solid component with enhancement. Angiography demonstrated vascular proliferation and arteriovenous shunting in the tumor. Histologically, the resected tumor was diagnosed as atypical EVN. Types of the tumor borders (well-circumscribed or infiltrative) and MRI findings correlated closely. Morphology of the tumor vasculature was remarkable for microvascular proliferation and dilated, thickened veins, which corresponded to the angiographic features. CONCLUSION: Although rare, atypical EVN should be included in the differential diagnosis of a cystic mass in the cerebral hemispheres in children. Radiological evaluation of tumor borders and angiographic characteristics might be useful for predicting atypicality of the tumor.

The prevalence of lymph node metastases in clinically N0 necks with oral cavity squamous cell carcinoma: is CT good enough for nodal staging?

BACKGROUND: Nodal metastases and extracapsular extension (ECE) are important prognostic indicators. However, the diagnostic accuracy of CT is still limited for patients with clinically N0 neck. PURPOSE: To determine the prevalence of lymph node (LN) metastases and ECE for oral cavity squamous cell carcinoma (SCC) patients with clinical and CT negative preoperative neck. MATERIAL AND METHODS: Thirty-two patients with N0 oral cavity SCC who underwent neck dissection were included in this retrospective analysis. The size of LN was measured on transverse CT images, and radiological size criterion was based upon a minimal axial diameter of 10 mm. Pathology was used as the standard reference. Imaging and histopathological correlation was done for 132 LN levels in the 32 patients. RESULTS: Fourteen of 32 patients (44%) had metastatic nodes and six patients had ECE. Among 132 LN levels, 22 levels (17%) had metastatic LNs (level I 5/37, level II 8/39, level III 7/35, level IV 2/18), and eight of 22 levels with metastases had ECE. Poorly differentiated histology was a predictive factor for LN metastases or ECE (poorly versus well and moderately differentiated SCC: P=0.07 for LN metastases and P=0.08 for ECE, respectively). T-classification was also an important predictor for occult nodal metastases (2 of 10 patients in T1, 12 of 22 patients in T2-4), although it did not reach statistical significance (P=0.11). CONCLUSION: Diagnostic accuracy of CT is limited among N0 oral cavity SCC patients. Neck dissection should be performed, particularly for patients with poorly differentiated SCC or higher T-classification.

Evaluation of the facial artery on computed tomographic angiography using 64-slice multidetector computed tomography: implications for facial reconstruction in plastic surgery.

BACKGROUND: Preoperative knowledge of a patient's individual variations in facial artery anatomy would benefit plastic surgeons for reconstructive planning. The authors evaluated the feasibility of multislice computed tomographic angiography in vascular mapping of the facial artery. METHODS: In total, 187 facial arteries in 94 patients without facial tumor or vascular disease were studied. Anatomical variations of the facial artery were classified into four types: type 1, a short course that terminates proximal to the superior labial artery; type 2, an intermediate course that terminates distal to the superior labial artery near the nasolabial fold; type 3, a classic course that extends to the lateral nasal ala beyond the nasolabial fold with an angular branch; and type 4, duplex with dominant lateral angular branch. Facial artery patterns were compared with dominant patterns of the facial-submental artery bifurcation. The extent of the inferior and superior labial artery was evaluated separately. RESULTS: Sixty-four facial artery branches (34 percent) were classified as type 1, 74 (40 percent) as type 2, and 45 (24 percent) as type 3. Type 4 was seen in only four branches (2 percent). The facial artery was dominant in the facial-submental artery bifurcation in 84 percent of type 3 facial arteries. Three-dimensional volume-rendered images allow detailed visualization of the facial artery and its branches and help preoperative mapping. CONCLUSION: Facial computed tomographic angiography allows detailed visualization of the facial artery and its branches and is a potential noninvasive imaging tool for preoperative vascular mapping for facial reconstructive operations.

Dynamic contrast-enhanced MR perfusion imaging of head and neck tumors at 3 Tesla.

BACKGROUND: Dynamic contrast-enhanced (DCE) MR perfusion imaging allows assessment of vascular density and integrity of tumors. The purpose of this study was to determine the diagnostic efficacy of time intensity curve analysis on DCE MRI for characterization of head and neck tumors. METHODS: Twenty patients underwent T1-weighted fast field echo DCE MRI with temporal resolution of 2.6 seconds. In total, 100 dynamic phases covering 20 slices were obtained in 4.5 minutes. Time to peak (TTP), relative maximum enhancement (RME) ratio, and relative washout ratio (RWO) were calculated. RESULTS: Malignant tumors had a significantly lower RME (p = .025) and prolonged TTP with lower RWO than benign lesions. Postradiation changes had a significantly longer TTP (p = .024) and lower RWO (p = .007) than did postradiation recurrent tumors. Receiver operating characteristic (ROC) analysis revealed RWO had highest accuracy (area under the curve [AUC] = 1.0). CONCLUSIONS: DCE MR perfusion imaging provides pivotal information regarding microcirculation, potentially improves differentiation of malignant tumor from postradiation changes.