High Oxide-Ion Conductivity in a Hexagonal Perovskite-Related Oxide Ba7 Ta3.7 Mo1.3 O20.15 with Cation Site Preference and Interstitial Oxide Ions.

Solid oxide-ion conductors are crucial for enabling clean and efficient energy devices such as solid oxide fuel cells. Hexagonal perovskite-related oxides have been placed at the forefront of high-performance oxide-ion conductors, with Ba7 Nb4- x Mo1+ x O20+ x /2 (x = 0-0.1) being an archetypal example. Herein, high oxide-ion conductivity and stability under reducing conditions in Ba7 Ta3.7 Mo1.3 O20.15 are reported by investigating the solid solutions Ba7 Ta4- x Mo1+ x O20+ x /2 (x = 0.2-0.7). Neutron diffraction indicates a large number of interstitial oxide ions in Ba7 Ta3.7 Mo1.3 O20.15 , leading to a high level of oxide-ion conductivity (e.g., 1.08 × 10-3 S cm-1 at 377 °C). The conductivity of Ba7 Ta3.7 Mo1.3 O20.15 is higher than that of Ba7 Nb4 MoO20 and conventional yttria-stabilized zirconia. In contrast to Ba7 Nb4- x Mo1+ x O20+ x /2 (x = 0-0.1), the oxide-ion conduction in Ba7 Ta3.7 Mo1.3 O20.15 is dominant even in highly reducing atmospheres (e.g., oxygen partial pressure of 1.6 × 10-24 atm at 909 °C). From structural analyses of the synchrotron X-ray diffraction data for Ba7 Ta3.7 Mo1.3 O20.15 , contrasting X-ray scattering powers of Ta5+ and Mo6+ allow identification of the preferential occupation of Mo6+ adjacent to the intrinsically oxygen-deficient layers, as supported by DFT calculations. The high conductivity and chemical and electrical stability in Ba7 Ta3.7 Mo1.3 O20.15 provide a strategy for the development of solid electrolytes based on hexagonal perovskite-related oxides.

Portal Vein Embolization: Radiological Findings Predicting Future Liver Remnant Hypertrophy.

OBJECTIVE. The purpose of this article is to evaluate the radiologic findings predicting the future liver remnant hypertrophy ratio after portal vein embolization of the right branch. MATERIALS AND METHODS. The associations between the radiologic findings and the future liver remnant hypertrophy ratio for 79 patients who underwent portal vein embolization of the right branch between July 2007 and April 2017 were retrospectively analyzed. Multiple linear regression was performed to adjust for potential confounders, and the volume ratio of the right lobe anterior segment, number of proximal small branches from the right anterior and posterior portal veins, transient hepatic parenchymal enhancement, portal vein invasion, and variants of main portal vein anatomy were evaluated. The potential confounders were age, ratio of future liver remnant hypertrophy to total liver volume, indocyanine green clearance rate, maximum serum total bilirubin before portal vein embolization, and history of chemotherapy. RESULTS. Statistically significant associations were found between the future liver remnant hypertrophy ratio and the number of proximal small branches from the right anterior and posterior portal veins (p < 0.001), transient hepatic parenchymal enhancement (p < 0.001), portal vein invasion (p = 0.017), and variants of main portal vein anatomy (p = 0.048). The mean future liver remnant hypertrophy rate was 51.0% (n = 16) in patients without the radiologic findings showing statistically significant differences, and 25.8% (n = 63) in patients with at least one significant finding. CONCLUSION. When added to previously reported factors, the radiologic findings identified can help determine the indications for portal vein embolization and novel strategies for major hepatectomy.

Complications in hepatic arterial infusion chemotherapy: retrospective comparison of catheter tip placement in the right/left hepatic artery vs. the gastroduodenal artery.

PURPOSE: To compare the complication rates associated with hepatic arterial infusion chemotherapy (HAIC) for unresectable hepatocellular carcinoma (HCC) using two different catheter tip locations, the right/left hepatic artery (group 1) and the gastroduodenal artery (group 2). METHODS: Between April 2001 and March 2015, 88 patients (group 1, n = 36; group 2, n = 52) with unresectable HCC, underwent HAIC via a transfemorally placed infusion catheter. The incidence of complications related to catheter placement (including hepatic arterial occlusion, catheter dislocation, non-target embolization and port-catheter system infection) as well as catheter patency and patient survival were evaluated. RESULTS: The technical success rate was 100%. The overall complication rate was 17% (15/88 patients). The specific complications were as follows: hepatic artery occlusion, n = 1 (group 2, n = 1), gastroduodenal ulcer, n = 6 (group 1, n = 2; group 2, n = 4); catheter dislocation, n = 1 (group 2, n = 1); port-catheter system infection, n = 3 (group 2, n = 3); and bleeding at the puncture site, n = 4 (group 1, n = 1; group 2, n = 3). CONCLUSIONS: The complication rates in groups 1 and 2 did not differ to a statistically significant extent.

Left lobe graft poses a potential risk of hepatic venous outflow obstruction in adult living donor liver transplantation.

Hepatic venous outflow obstruction (HVOO) is a critical complication after living donor liver transplantation (LDLT). This study aimed to evaluate the incidence of HVOO and the risk factors for HVOO in adults. From 2005 to 2015, 430 adult LDLT patients (right lobe [RL] graft, 270 patients; left lobe [LL] graft, 160 patients) were enrolled and divided into no HVOO (n = 413) and HVOO (n = 17) groups. Patient demographics and surgical data were compared, and risk factors for HVOO were analyzed. Furthermore, the longterm outcomes of percutaneous interventions as treatment for HVOO were assessed. HVOO occurred in 17 (4.0%) patients. The incidence of HVOO in patients receiving a LL graft was significantly higher than in those receiving a RL graft (8.1% versus 1.5%; P = 0.001). The body weight and caliber of hepatic vein anastomosis in the HVOO group were significantly lower compared with the no HVOO group (P = 0.02 and P = 0.008, respectively). Multivariate analysis revealed that only LL graft was an independent risk factor for HVOO (OR, 4.782; 95% CI, 1.387-16.488; P = 0.01). Among 17 patients with HVOO, 7 patients were treated with single balloon angioplasty, and 9 patients who developed recurrence were treated with repeated interventions. Overall, 6 patients underwent stent placement: 1 at the initial procedure, 3 at the second procedure for early recurrence, and 2 following repeated balloon angioplasty (≥3 interventions). These 6 patients experienced no recurrence. Overall graft survival was not significantly different between the HVOO and no HVOO groups (P = 0.99). In conclusion, the use of a LL graft was associated with HVOO, and percutaneous interventions were effective for treating adult HVOO after LDLT. Liver Transplantation 22 785-795 2016 AASLD.

Long-Term Outcome of Percutaneous Biliary Interventions for Biliary Anastomotic Stricture in Pediatric Patients after Living Donor Liver Transplantation with Roux-en-Y Hepaticojejunostomy.

PURPOSE: To retrospectively evaluate long-term outcomes of percutaneous transhepatic biliary drainage (PTBD) followed by balloon dilation and placement of an internal drainage tube for anastomotic stricture in pediatric patients who underwent living donor liver transplantation (LDLT) with Roux-en-Y hepaticojejunostomy (RYHJ). MATERIALS AND METHODS: Fifty-two patients (23 male, 29 female; median age, 5 y) with anastomotic biliary stricture were treated with PTBD followed by balloon catheter dilation and long-term placement of an internal drainage tube, which was removed upon cholangiographic confirmation of free flow of bile into the small bowel. Clinical success, tube independence rate, risk factors of recurrent biliary stricture, and patency rates were evaluated. RESULTS: Thirty-nine patients (75%) had no stricture recurrence. Of 13 patients (25%) with recurrence, six were treated again with the same percutaneous biliary interventions and showed no further recurrence. Clinical success was noted in 43 of 52 patients (83%). Drainage tubes were removed from 49 patients (94%). Multivariate logistic regression analysis indicated that serum alanine aminotransferase level > 53 IU/L at discharge after the initial series of percutaneous biliary interventions was a significant risk factor for recurrent biliary stricture (P = .002). Kaplan-Meier analysis showed 1-, 3-, 5-, and 10-year primary and primary assisted patency rates of 75%, 70%, 70%, and 68%, and 94%, 92%, 88%, and 88%, respectively. CONCLUSIONS: PTBD followed by balloon dilation and internal drainage may be an effective treatment for anastomotic biliary stricture after pediatric LDLT with RYHJ.

Comparison of monopolar and bipolar diffusion weighted imaging sequences for detection of small hepatic metastases.

OBJECTIVE: To compare monopolar (MP) and bipolar (BP) diffusion weighted imaging (DWI) in detecting small liver metastases. MATERIALS AND METHODS: Eighty-eight patients underwent 3-T MRI. The signal-to-noise ratios (SNR) of the liver parenchyma and lesions, the lesion-to-liver contrast-to-noise ratios (CNR), and the detection sensitivities were compared. The lesion distortion was scored (LDS) from 4 (no distortion) to 1 (excessive distortion), dichotomised as no-distortion and distortion, and the association between detected lesions for each reader in the MP or BP DWI group and the dichotomised lesion distortion degree was assessed. RESULT: Forty-six hepatic metastases were confirmed. The CNR with BP images showed significantly higher values than with MP (P=0.017). The detection sensitivities of the three readers were higher in the BP sequence than in MP, and one reader detected significantly more hepatic lesions with BP images (P=0.04). LDS was significantly improved with BP sequence (P=0.002). In the no-distortion group, excluding the MP DWI assessments of one reader, detection sensitivities were significantly higher than in the distortion group (P<0.001 and P=0.002, respectively). CONCLUSION: Reduced lesion distortion improves the detection of small liver metastases, and BP is more sensitive in detecting small liver metastases than MP DWI.

Long-term outcome of percutaneous transhepatic balloon angioplasty for portal vein stenosis after pediatric living donor liver transplantation: a single institute's experience.

PURPOSE: To evaluate retrospectively the long-term outcomes of percutaneous transhepatic balloon angioplasty performed for portal vein stenosis (PVS) after pediatric living donor liver transplantation (LDLT). MATERIALS AND METHODS: Between October 1997 and December 2013, of 527 pediatric patients (age < 18 y) who underwent LDLT in a single institution, 43 patients (19 boys, 24 girls; mean age, 4.1 y ± 4.1) were confirmed to have PVS at direct portography with or without manometry and underwent percutaneous interventions, including balloon angioplasty with or without stent placement. Technical success, clinical success, laboratory findings, manometry findings, patency rates, and major complications were evaluated. Follow-up periods after initial balloon angioplasty ranged from 5-169 months (mean, 119 mo). RESULTS: Technical success was achieved in 65 of 66 sessions (98.5%) and in 42 of 43 patients (97.7%), and clinical success was achieved in 37 of 43 patients (86.0%). Platelet counts improved significantly. Of 32 patients undergoing manometry, 19 showed significant improvement of pressure gradient across the stenosis after percutaneous transhepatic balloon angioplasty. At 1, 3, 5, and 10 years after balloon angioplasty, the rates of primary patency were 83%, 78%, 76%, and 70%, and the rates of primary-assisted patency were 100%, 100%, 100%, and 96%. Two major complications subsequent to balloon angioplasty were noted: severe asthma attack and portal vein thrombosis. CONCLUSIONS: Percutaneous transhepatic balloon angioplasty is a safe and effective treatment with long-term patency for PVS after pediatric LDLT.

Effect of branched-chain amino acids in patients receiving intervention for hepatocellular carcinoma.

AIM: To investigate the usefulness of branched-chain amino acids (BCAA) before transarterial chemoembolization (TACE) or radiofrequency ablation (RFA). METHODS: We investigated the usefulness of pre-intervention with BCAAs by comparing patients treated with BCAAs at 12.45 g/d orally for at least 2 wk before TACE or RFA and those not receiving such pretreatment. A total of 270 patients with hepatocellular carcinoma complicated by cirrhosis were included in the study. Mean changes from baseline (Δ) in serum albumin (Alb), C-reactive protein (CRP), and transaminase levels, as well as peak body temperature were also determined and compared at days 2, 5, and 10 after the start of TACE or RFA. RESULTS: In patients who underwent TACE or RFA, BCAA pre-intervention significantly suppressed the development of post- intervention hypoalbuminemia and reduced inflammatory reactions during the subsequent clinical course. After TACE, the ΔAlb peaked on day 2, remained constantly lower in BCAA-treated patients, compared to the control group, and was -0.13 ± 0.42 g/dL in BCAA-treated patients and -0.33 ± 0.51 g/dL in untreated patients on day 10. The ΔCRP was also significantly lower in BCAA-treated patients on days 2, 5 and 10 after TACE. Like the trends noted after TACE, a similar tendency was noted as to the ΔAlb and ΔCRP after RFA. The changes in serum Alb level were inversely correlated with CRP changes; therefore, a possible involvement of the anti-inflammatory effect of BCAAs was inferred as a factor contributory to the suppression of decrease in serum Alb level. CONCLUSION: Pre-intervention with BCAAs may hasten the recovery of serum Alb level and mitigate post-operative complications in patients undergoing TACE or RFA.

Long-term outcome of percutaneous interventions for hepatic venous outflow obstruction after pediatric living donor liver transplantation: experience from a single institute.

PURPOSE: To evaluate retrospectively the long-term outcome of percutaneous interventions for hepatic venous outflow obstruction (HVOO) occurring after pediatric living donor liver transplantation (LDLT). MATERIALS AND METHODS: Between October 1997 and December 2012, 48 patients (24 boys, 24 girls; median age, 6 y) who had undergone LDLT were confirmed to have HVOO using percutaneous hepatic venography and manometry. All patients underwent percutaneous interventions, including balloon angioplasty with or without stent placement. Technical success, clinical success, patency rates, stent placement, and major complications were evaluated. RESULTS: Technical success was achieved in 92 of 93 sessions (99.0%) and in 47 of 48 patients (97.9%), and clinical success was achieved in 41 of 48 patients (85.4%). During the follow-up period (range, 1-182 mo; median, 51.5 mo), 28 patients were treated with a single session of balloon angioplasty, and 20 patients who developed recurrent stenosis were treated with repeated percutaneous interventions. The rates of primary and primary-assisted patency at 1, 3, 5, and 10 years after balloon angioplasty were 64%, 57%, 57%, and 52% (primary patency) and 98%, 95%, 95%, and 95% (primary-assisted patency). Of six patients with stent placement, four had no recurrent HVOO after the stent placement, but two developed recurrent stenosis. The stent migrated to the right atrium in one patient. CONCLUSIONS: Percutaneous interventions were effective treatments for HVOO after LDLT.

Comparison of acquired diffusion weighted imaging and computed diffusion weighted imaging for detection of hepatic metastases.

OBJECTIVE: To compare the accuracy of acquired diffusion weighted imaging (DWI) (b=1000 s/mm(2)) with that of computed DWI (b=1000 s/mm(2)) for the detection of hepatic metastases. METHODS: Two hundred and sixty patients underwent abdominal magnetic resonance imaging (MRI) at 3.0 T for the evaluation of hepatic metastasis, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), heavily T2WI, DWI with b-values of 0, 500, 1000 s/mm(2), and three-dimensional dynamic contrast-enhanced MRI with gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA), and 190 patients were included in the final study. Computed DWI (=1000 s/mm(2)) was synthesized from lower b-values (b=0 and 500 s/mm(2)). Two groups were assigned and compared: group A (acquired DWI) and group B (computed DWI). Diagnostic performance using each imaging set was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS: A total of 76 hepatic metastases were confirmed. The area under the ROC curve (Az) of group A was larger than that of group B (Observer 1; 0.919-0.915, Observer 2; 0.926-0.901), but there were no significant differences (observer 1, P=0.500; observer 2, P=0.190). There were 5 metastases visualized in group A, but these were difficult to detect in group B. However, there were 2 metastases that were better visualized in group B than in group A. CONCLUSION: There were no significant differences between acquired DWI and computed DWI in the detection of hepatic metastasis.

Standard hepatic vein reconstruction with patch plasty using the native portal vein in adult living donor liver transplantation.

An outflow obstruction of the hepatic vein is a critical complication after living donor liver transplantation (LDLT) and occasionally leads to hepatic failure. Here we introduce a simple method for preventing outflow obstructions by patch plasty in adult LDLT. Between September 2001 and May 2010, 468 adult LDLT procedures were performed at Kyoto University Hospital. We harvested each recipient's portal vein (PV) from the extirpated liver for a patch. We intended to re-form several orifices of the hepatic veins into a single, large orifice. The patch was attached to the anterior wall of the re-formed orifice on the bench. After we put in the liver graft, the procedure for the hepatic vein anastomosis to the inferior vena cava was simple enough that the warm ischemia time was reduced. Three of the 468 cases were diagnosed with an outflow obstruction. All 3 cases underwent hepatic vein reconstruction without patch plasty. In contrast, none of the 159 cases that underwent LDLT with patch plasty suffered from an outflow obstruction, regardless of the liver graft type. The procedure for hepatic vein plasty using a patch from the native PV is simple and elegant and results in excellent outcomes. We propose this as the standard procedure for hepatic vein reconstruction in adult LDLT.

Early evaluation of transcatheter arterial chemoembolization-refractory hepatocellular carcinoma.

BACKGROUND: There is no standard therapy for patients with transcatheter arterial chemoembolization (TACE)-refractory hepatocellular carcinoma (HCC). This study examined whether evaluating the tumor effect (TE) at 1 week after TACE was useful for predicting refractoriness to TACE. METHODS: We performed a historical cohort study involving 54 patients and 119 tumors. TE was evaluated at 1 week and 3 months after TACE, and an overall evaluation was also performed at 3 months based on the response evaluation criteria in cancer of the liver. RESULTS: Among 45 tumors evaluated as TE2 at 1 week, 43 tumors (95.6%) were classified as TE1 or TE2 at 3 months. Of the 24 patients whose tumors were categorized as TE2 at 1 week, none achieved a complete or partial response. CONCLUSIONS: Evaluating the TE at 1 week after TACE is useful for the early diagnosis of TACE-refractory HCC and allows alternative treatment options, such as sorafenib, to be employed before the disease progresses.

Stent angioplasty for a kink in the pulmonary artery anastomosis soon after living-donor lobar lung transplantation.

Herein, we report a case of stent angioplasty for a kink in the pulmonary artery (PA) anastomosis soon after living-donor lobar lung transplantation (LDLLT). A 64-year-old man with idiopathic pulmonary fibrosis underwent bilateral LDLLT with lung donations from his daughters. After reperfusion, the left PA anastomosis showed a kink, which could not be corrected completely during surgery. Due to the kink in the left PA, and the relatively small donor grafts, the patient required extracorporeal membrane oxygenation) after LDLLT. Approximately 24 hours after reperfusion, stent angioplasty was performed, resulting in the patient being successfully weaned from extracorporeal membrane oxygenation on postoperative day 4.

Contrast behavior of high-spatial-resolution T1-weighted MR imaging at 3.0 T vs. 1.5 T.

Twenty-four volunteers were examined at T1-weighted images with thin sections using gradient-based sequences with a possible short and same TR at 3.0 and 1.5 T. Pancreas-to-spleen contrast measurements and scores for visual assessments of image contrast were significantly worse at 3.0 T than at 1.5 T on both sequences. The image contrast of high-spatial-resolution T1-weighted images at 3.0 T is decreased compared to that of images with the same and possible short TR at 1.5 T.

Comparative study of cisplatin and epirubicin in transcatheter arterial chemoembolization for hepatocellular carcinoma.

AIM: Transcatheter arterial chemoembolization (TACE) is an established treatment for unresectable hepatocellular carcinoma (HCC). However, it is unclear which chemotherapeutic agent should be selected for TACE. The aim of this study was to compare the efficacy of cisplatin (CDDP) with that of epirubicin (EPI) in TACE for patients with unresectable or relapsed HCC. METHODS: We performed a historical cohort study involving 131 patients treated with a first TACE, defined as either an initial treatment for previously untreated HCC or a first treatment for relapsed HCC after curative resections or ablations. Efficacy was estimated as the response rate (RR) and it was adjusted for the confounding factors that were defined in this study. RESULTS: The RR were 62.5% (20/32) for the first TACE with CDDP and 51.5% (51/99) for that with EPI. In the adjusted analysis for a history of hepatectomy, percutaneous treatment combined with TACE and tumor factors, the odds ratio was 1.72 (95% confidence interval [CI] = 0.70-4.48). However, a test for interaction between the number of tumors and the chemotherapeutic agent was statistically significant (P = 0.016). In multiple HCC, the RR were 66.7% (10/17) for CDDP and 39.6% (30/46) for EPI. The odds ratio was 4.11 (95% CI = 1.14-17.2). CONCLUSION: CDDP may be more effective than EPI in TACE for multiple HCC. A randomized controlled study is needed to clarify the efficacy of CDDP in TACE in patients with multiple HCC.

Non-contrast-enhanced hepatic MR angiography: do two-dimensional parallel imaging and short tau inversion recovery methods shorten acquisition time without image quality deterioration?

OBJECTIVE: To study whether shortening the acquisition time for selective hepatic artery visualization is feasible without image quality deterioration by adopting two-dimensional (2D) parallel imaging (PI) and short tau inversion recovery (STIR) methods. MATERIALS AND METHODS: Twenty-four healthy volunteers were enrolled. 3D true steady-state free-precession imaging with a time spatial labeling inversion pulse was conducted using 1D or 2D-PI and fat suppression by chemical shift selective (CHESS) or STIR methods. Three groups of different scan conditions were assigned and compared: group A (1D-PI factor 2 and CHESS), group B (2D-PI factor 2×2 and CHESS), and group C (2D-PI factor 2×2 and STIR). The artery-to-liver contrast was quantified, and the quality of artery visualization and overall image quality were scored. RESULTS: The mean scan time was 9.5±1.0 min (mean±standard deviation), 5.9±0.8 min, and 5.8±0.5 min in groups A, B, and C, respectively, and was significantly shorter in groups B and C than in group A (P<0.01). The artery-to-liver contrast was significantly better in group C than in groups A and B (P<0.01). The scores for artery visualization and overall image quality were worse in group B than in groups A and C. The differences were statistically significant (P<0.05) regarding the arterial branches of segments 4 and 8. Between group A and group C, which had similar scores, there were no statistically significant differences. CONCLUSION: Shortening the acquisition time for selective hepatic artery visualization was feasible without deterioration of the image quality by the combination of 2D-PI and STIR methods. It will facilitate using non-contrast-enhanced MRA in clinical practice.

Hepatic venous outflow obstruction in pediatric living donor liver transplantation using left-sided lobe grafts: Kyoto University experience.

The goals of this study were to evaluate the incidence of hepatic venous outflow obstruction (HVOO) in pediatric patients after living donor liver transplantation (LDLT) using left-sided lobe grafts and to assess the therapeutic modalities used for the treatment of this complication at a single center. Four hundred thirteen primary LDLT procedures were performed with left-sided lobe grafts between 1996 and 2006. All transplants identified with HVOO from a cohort of 380 grafts with survival greater than 90 days were evaluated with respect to the patient demographics, therapeutic intervention, recurrence, and outcome. Seventeen cases (4.5%) were identified with HVOO. Eight patients experienced recurrence after the initial balloon venoplasty. Two patients finally required stent placement after they experienced recurrence shortly after the initial balloon venoplasty. A univariate analysis revealed that a smaller recipient-to-donor body weight ratio and the use of reduced grafts were statistically significant risk factors. The cases with grafts with multiple hepatic veins had a higher incidence of HVOO. In conclusion, the necessity of repeated balloon venoplasty and stent placement was related to poor graft survival. Therefore, the prevention of HVOO should be a high priority in LDLT. When grafts with multiple hepatic veins and/or significant donor-recipient size mismatching are encountered, the use of a patch graft is recommended. Stent placement should be carefully considered because of the absence of data on the long-term patency of stents and stent-related complications. New stenting devices, such as drug-eluting and biodegradable stents, may be promising for the management of HVOO.

Comparison of gadolinium-EOB-DTPA-enhanced and diffusion-weighted liver MRI for detection of small hepatic metastases.

OBJECTIVE: To compare the accuracy of gadolinium ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI with that of diffusion-weighted MRI (DWI) in the detection of small hepatic metastases (2 cm or smaller). METHODS: Forty-five patients underwent abdominal MRI at 3 T, including T1-weighted imaging (T1WI), T2-weighted imaging (T2WI), heavily T2WI (HASTE), DWI with a b-value of 500 s/mm(2) and contrast-enhanced MRI with Gd-EOB-DTPA. Two groups were assigned and compared: group A (T1WI, T2WI, HASTE and contrast-enhanced study with Gd-EOB-DTPA), and group B (T1WI, T2WI, HASTE and DWI). Two observers independently interpreted the images obtained in a random order. For all hepatic metastases, the diagnostic performance using each imaging set was evaluated by receiver-operating characteristic (ROC) curve analysis. RESULTS: A total of 51 hepatic metastases were confirmed. The area under the ROC curve (Az) of group A was larger than that of group B, and the difference in the mean Az values between the two image sets was statistically significant, whereas, there were three metastases that lay near thin vessels or among multiple cysts and were better visualised in group B than in group A. CONCLUSION: Gd-EOB-DTPA-enhanced MRI showed higher accuracy in the detection of small metastases than DWI.

Improved detection of hepatic metastases from pancreatic cancer using periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique after SPIO administration.

OBJECTIVES: The purpose of this study was to evaluate the detection of hepatic metastases from the pancreatic cancer using different MR imaging methods, including superparamagnetic iron oxide (SPIO)-enhanced fat-saturated T2-weighted imaging with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) technique. MATERIALS AND METHODS: The institutional review board approved this prospective study. Eighty-two patients (mean age, 55 years) underwent different MR imaging with a 1.5-T scanner. Diagnostic performance with receiver operating characteristics (ROC) curves and sensitivity were evaluated for the following image sets: (A) unenhanced images (T1-weighted in-phase and opposed-phase gradient-echo [GRE] images, and fat-saturated T2-weighted turbo spin-echo [TSE] images) that were included in the subsequent image sets, (B) diffusion-weighted images, (C) SPIO-enhanced fat-saturated T2-weighted TSE images with prospective acquisition correction (PACE), (D) SPIO-enhanced T2*-weighted GRE images, and (E) SPIO-enhanced fat-saturated T2-weighted TSE images acquired with PROPELLER and PACE. RESULTS: The areas under the ROC curves were 0.58 +/- 0.05 (mean +/- standard errors), 0.81 +/- 0.04, 0.70 +/- 0.05, 0.80 +/- 0.04, and 0.90 +/- 0.03, and sensitivity was 0.47, 0.69, 0.56, 0.66, and 0.77 for image sets (A) to (E), respectively, for all lesions. Image set (E) had significantly larger area under the ROC curve for detection of hepatic lesions and higher sensitivity than others. CONCLUSIONS: SPIO-enhanced fat-saturated T2-weighted MR imaging with the PROPELLER technique is more effective for detecting hepatic metastases of pancreatic cancer than diffusion-weighted MR imaging, SPIO-enhanced fat-saturated T2WI without the PROPELLER technique, or SPIO-enhanced T2*-weighted GRE imaging.