Utility of abbreviated MRI in the post-treatment evaluation of rectal cancer.

BACKGROUND: Post-treatment evaluation of patients with rectal cancer (RC) using magnetic resonance imaging (MRI) burdens medical resources, necessitating an exploration of abbreviated protocols. PURPOSE: To evaluate the diagnostic performance of abbreviated MRI (A-MRI) for the post-treatment evaluation of RC patients. MATERIAL AND METHODS: This retrospective study included RC patients who underwent non-contrast rectal MRI and standard liver MRI, as well as abdominal contrast-enhanced computed tomography (CECT) for post-treatment evaluation. A-MRI comprised diffusion-weighted imaging (DWI) and T2-weighted imaging of the upper abdomen and the pelvic cavity. Three radiologists independently reviewed A-MRI, CECT, and standard liver MRI in the detection of viable disease. The diagnostic performances were compared using a reference standard considering all available information, including pathology, FDG-PET, endoscopic results, and clinical follow-up. RESULTS: We included 78 patients (50 men, 28 women; mean age=60.9 ± 10.2 years) and observed viable disease in 34 (43.6%). On a per-patient-basis analysis, A-MRI showed significantly higher sensitivity (95% vs. 81%, P = 0.04) and higher accuracy (93% vs. 82%, P < 0.01), compared to those of CECT, while A-MRI showed comparable sensitivity (91% vs. 91%, P = 0.42) and accuracy (97% vs. 98%, P = 0.06) to that of standard liver MRI. On a per-lesion-based analysis, A-MRI exhibited significantly superior lesion detectability than that of CECT (figure of merit 0.91 vs. 0.77, P < 0.01) and comparable to that of standard liver MRI (figure of merit 0.91 vs. 0.92, P = 0.75). CONCLUSION: A-MRI exhibited higher sensitivity and diagnostic accuracy than those of CECT in the post-treatment evaluation of RC, while it showed comparable performances with standard liver MRI. A-MRI provides diagnostic added value in the follow-up of RC patients.

Intraductal papillary neoplasm of the bile duct: diagnostic value of MRI features in differentiating pathologic subclassifications-type 1 versus type 2.

OBJECTIVES: To identify MRI features for differentiating type 2 from type 1 intraductal papillary neoplasms of bile duct (IPNB) and assessing malignant potential of IPNB. METHODS: This retrospective study included 60 patients with surgically proven IPNB who had undergone preoperative MRI between January 2007 and December 2020. All surgical specimens were reviewed retrospectively to classify types 1 and 2 IPNBs and assess tumor grade. Significant MRI features for differentiating type 2 (n = 40) from type 1 IPNB (n = 20); and for IPNB with an associated invasive carcinoma (n = 43) from intraepithelial neoplasia (n = 17) were determined using logistic regression analysis. RESULTS: An associated invasive carcinoma was more frequently found in type 2 than in type 1 IPNB (85.0% [34/40] vs. 45.0% [9/20], p = 0.003). At univariable analysis, MRI features including extrahepatic location, no dilatation of tumor-bearing segment of bile duct, isolated upstream bile duct dilatation, and single lesion were associated with type 2 IPNB (all p ≤ 0.012). At multivariable analysis, significant MRI findings for differentiating type 2 from type 1 IPNB were extrahepatic location and no dilatation of tumor-bearing segment of bile duct (odds ratio [OR], 7.24 and 46.40, respectively). At univariable and multivariable analysis, tumor size ≥ 2.5 cm (OR, 8.45), bile duct wall thickening (OR, 4.82), and irregular polypoid or nodular tumor shape (OR, 6.44) were significant MRI features for differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia. CONCLUSION: MRI with MR cholangiopancreatography may be helpful in differentiating type 2 IPNB from type 1 IPNB and assessing malignant potential of IPNB. CLINICAL RELEVANCE STATEMENT: Preoperative MRI with MR cholangiopancreatography may be helpful in differentiating type 2 intraductal papillary neoplasms of bile duct (IPNB) from type 1 IPNB and assessing malignant potential of IPNB. KEY POINTS: • In terms of tumor grade, the incidence of invasive carcinoma was significantly higher in type 2 intraductal papillary neoplasm of the bile duct (IPNB) than in type 1 IPNB. • At MRI, extrahepatic location and no dilatation of tumor-bearing segment are significant features for differentiating type 2 IPNBs from type 1 IPNBs. • At MRI, large tumor size, bile duct wall thickening, and irregular polypoid or nodular tumor shape are significant features for differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia.

Relationship between Perceived Stress, Obesity, and Hypertension in Korean Adults and Older Adults.

BACKGROUND: Perceived stress has a significant effect on metabolic diseases, including obesity and hypertension. However, the association between stress levels, obesity, and hypertension according to age and sex is not fully understood. Therefore, this study investigated the relationship between stress levels and obesity and hypertension in Korean adults and older adults. METHODS: We analyzed data from the 2015 survey of the Korea National Physical Fitness Project conducted by the Korea Institute of Sports Science and the Korea Ministry of Culture, Sports, and Tourism. Of the 3457 participants, 2829 were adults (20-64 years old) and 628 were older adults (≥65 years old). The correlation between obesity and hypertension according to the degree of perceived stress (low, medium, and high) was analyzed using the chi-square test. Binary logistic regression analysis was used to investigate the influence of perceived stress levels on obesity and hypertension. Age, body mass index (BMI), blood pressure, exercise frequency, smoking, breakfast, and sleeping hours were included as covariates. RESULTS: In adult males, perceived stress levels, age, and diastolic blood pressure were found to have a significant impact on obesity rates, whereas age and breakfast had a significant effect on hypertension rates. In adult females, age and systolic blood pressure were found to significantly influence obesity rates, whereas age, BMI, and exercise frequency had a significant impact on hypertension rates. In older adult females, perceived stress levels and systolic blood pressure were found to significantly impact obesity rates, and sleep duration influenced the rates of hypertension. The effect of perceived stress level on obesity and hypertension rates was less pronounced in the elderly population than in the adult population. CONCLUSIONS: This study revealed age and sex differences in the relationship between perceived stress, obesity, and hypertension among Koreans. These findings contribute to a better understanding of the complex relationship between perceived stress and metabolic disorders and emphasize the need for a deeper understanding of the specific factors involved in the prevention and management of metabolic diseases.

A Case of Biliary Cast Syndrome with Cholangiocarcinoma-like Lesion in a Patient with No History of Liver Transplantation.

Background and Objectives: Biliary cast syndrome, which was first reported in 1975, is a rare disease that occurs after liver transplantation. The incidence is even lower in patients who have not undergone liver transplantation. This study reports a rare case of biliary cast syndrome with cholangiocarcinoma-like lesions in a patient who did not undergo liver transplantation. Case Report: Herein, we report a case of a 69-year-old man with right upper quadrant pain and elevated levels of alkaline phosphatase and gamma-glutamyl transferase, who had a history of total gastrectomy for gastric cancer and laparoscopic cholecystectomy for acute cholecystitis. Computed tomography (CT) revealed longitudinal bile stones in the extrahepatic and intrahepatic bile ducts and abrupt narrowing of the left main bile duct accompanied by a narrowing of the upstream bile duct in the left lobe of the liver. Based on the CT findings, the removal of the bile stones in the bile duct and additional examinations of the suspected cholangiocarcinoma were performed. The patient's symptoms improved, and examinations for suspected cholangiocarcinoma showed no abnormal findings, and he was discharged one month later. Conclusions: The purpose of this case report is to share a rare case of Biliary Cast Syndrome (BCS) occurring without liver transplantation. Additionally, the report aims to share image findings that mimic cancer in BCS, with the goal of reducing unnecessary repetitive biopsies, minimizing patient discomfort, and decreasing unnecessary costs by aiding in the diagnosis of BCS.

Perfluorobutane-Enhanced Ultrasound for Characterization of Hepatocellular Carcinoma From Non-hepatocellular Malignancies or Benignancy: Comparison of Imaging Acquisition Methods.

OBJECTIVE: The aim of the work described here was to evaluate the diagnostic performance of perfluorobutane (PFB)-enhanced ultrasound in differentiating hepatocellular carcinoma (HCC) from non-HCC malignancies and other benign lesions using different acquisition methods. METHODS: This prospective study included 69 patients with solid liver lesions larger than 1 cm who were scheduled for biopsy or radiofrequency ablation between September 2020 and March 2021. Lesion diagnosis was designated by three blinded radiologists after reviewing three different sets of acquired images selected according to the following presumed acquisition methods: (i) method A, acquisition up to 5 min after contrast injection; (ii) method B, acquisition up to 1 min after contrast injection with additional Kupffer phase; and (iii) method C, acquisition up to 5 min after contrast injection with additional Kupffer phase. RESULTS: After excluding 7 technical failures, 62 patients with liver lesions (mean size: 24.2 ± 14.8 mm), which consisted of 7 benign lesions, 37 non-HCC malignancies and 18 HCCs. For the HCC diagnosis, method C had the highest sensitivity (75.9%), followed by method B (72.2%) and method A (68.5%), but failed to exhibit statistical significance (p = 0.12). There was no significant difference with respect to the pooled specificity between the three methods (p = 0.28). Diagnostic accuracy was the highest with method C (87.1%) but failed to exhibit statistical significance (p = 0.24). CONCLUSION: Image acquisition up to 5 min after contrast injection with additional Kupffer phase could potentially result in high accuracy and sensitivity without loss of specificity in diagnosing HCC with PFB-enhanced ultrasound.

Added Value of Cone-Beam Computed Tomography for Detecting Hepatocellular Carcinomas and Feeding Arteries during Transcatheter Arterial Chemoembolization Focusing on Radiation Exposure.

Background and Objectives: This study aimed to evaluate the added value of cone-beam computed tomography (CBCT) for detecting hepatocellular carcinomas (HCC) and feeding arteries during transcatheter arterial chemoembolization (TACE). Material and methods: Seventy-six patients underwent TACE and CBCT. We subcategorized patients into groups I (61 patients: possible superselection of tumor/feeding arteries) and II (15 patients: limited superselection of tumor/feeding arteries). We evaluated fluoroscopy time and radiation dose during TACE. Two blinded radiologists independently performed an interval reading based on digital subtraction angiography (DSA) imaging only and DSA combined with CBCT in group I. Result: The mean total fluoroscopy time was 1456.3 ± 605.6 s. The mean dose-area product (DAP), mean DAP of CBCT, and mean ratio of DAP of CBCT to total DAP was 137.1 ± 69.2 Gy cm2, 18.3 ± 7.1 Gy cm2, and 13.3%, respectively. The sensitivity for detecting HCC increased after the additional CBCT reading, from 69.6% to 97.3% and 69.6% to 96.4% for readers 1 and 2, respectively. The sensitivity for detecting feeding arteries increased from 60.3% to 96.6% and 63.8% to 97.4% for readers 1 and 2, respectively. Conclusions: CBCT can increase sensitivity for detecting HCCs and feeding arteries without significantly increasing the radiation exposure.

Computed Tomography Indicators for Differentiating Stage 1 Borderline Ovarian Tumors from Stage I Malignant Epithelial Ovarian Tumors.

Preoperative diagnosis of borderline ovarian tumors (BOTs) is of increasing concern. This study aimed to determine computed tomography (CT) features in differentiating stage 1 BOTs from stage I malignant epithelial ovarian tumors (MEOTs). A total of 170 ovarian masses (97 BOTs and 73 MEOTs) from 141 consecutive patients who underwent preoperative CT imaging were retrospectively analyzed. Two readers independently and retrospectively reviewed quantitative and qualitative CT features. Multivariate logistic analysis demonstrated that a larger tumor size (p = 0.0284 for reader 1, p = 0.0391 for reader 2) and a smaller solid component (p = 0.0007 for reader 1, p = 0.0003 for reader 2) were significantly associated with BOTs compared with MEOTs. In the subanalysis of cases with a solid component, smaller (p = 0.0092 for reader 1, p = 0.0014 for reader 2) and ill-defined (p = 0.0016 for reader 1, p = 0.0414 for reader 2) solid component was significantly associated with BOTs compared with MEOTs. Tumor size and the size and margin of the solid component were useful for differentiating stage 1 BOTs from stage 1 MEOTs on CT images.

Development of a deep learning-based auto-segmentation algorithm for hepatocellular carcinoma (HCC) and application to predict microvascular invasion of HCC using CT texture analysis: preliminary results.

BACKGROUND: Automatic segmentation has recently been developed to yield objective data. Prediction of microvascular invasion (MVI) of hepatocellular carcinoma (HCC) using radiomics has been reported. PURPOSE: To develop a deep learning-based auto-segmentation algorithm (DL-AS) for the detection of HCC and to predict MVI using computed tomography (CT) texture analysis. MATERIAL AND METHODS: We retrospectively collected training data from 249 patients with HCC and validation set from 35 patients. Lesions of the training set were manually drawn by radiologist, in the delayed phase. 2D U-Net was selected as the DL architecture. Using the validation set, one radiologist manually drew 2D and 3D regions of interest twice, and the developed DL-AS was performed twice with a one-month time interval. The reproducibility was calculated using intraclass correlation coefficients (ICC). Logistic regression was performed to predict MVI. RESULTS: ICC was in the range of 0.190-0.998/0.341-0.997 in the manual 3D/2D segmentation. In contrast, it was perfect in 3D/2D using DL-AS, with a success rate of 88.6% for the detection of HCC. For predicting MVI, sphericity was a significant parameter (odds ratio <0.001; 95% confidence interval <0.001-0.206; P = 0.020) for predicting MVI using 2D DL-AS. However, 3D DL-AS segmentation did not yield a predictive parameter. CONCLUSION: The auto-segmentation of HCC using DL-AS provides perfect reproducibility, although it failed to detect 11.4% (4/35). However, the extracted parameters yielded different important predictors of MVI in HCC. Sphericity was a significant predictor in 2D DL-AS and 3D manual segmentation, while discrete compactness was a significant predictor in 2D manual segmentation.

Low-contrast-dose liver CT using low monoenergetic images with deep learning-based denoising for assessing hepatocellular carcinoma: a randomized controlled noninferiority trial.

OBJECTIVE: Low monoenergetic images obtained using noise-reduction techniques may reduce CT contrast media requirements. We aimed to investigate the effectiveness of low-contrast-dose CT using dual-energy CT and deep learning-based denoising (DLD) techniques in patients at high risk of hepatocellular carcinoma (HCC). METHODS: We performed a prospective, randomized controlled noninferiority trial at a tertiary hospital between June 2019 and August 2020 (NCT04027556). Patients at high risk of HCC were randomly assigned (1:1) to the standard-contrast-dose group or low-contrast-dose group, which targeted a 40% reduction in contrast medium dose based on lean body weight. HCC conspicuity on arterial phase images was the primary endpoint with a noninferiority margin of 0.2. Images were independently assessed by three radiologists; model-based iterative reconstruction (MBIR) images of the standard-contrast-dose group and low monoenergetic (50-keV) DLD images of the low-contrast-dose group were compared using a generalized estimating equation. RESULTS: Ninety participants (age 59 ± 10 years; 68 men) were analyzed. Compared with the standard-contrast-dose group (n = 47), 40% less contrast media was used in the low-contrast-dose group (n = 43) (107.0 ± 17.1 mL vs. 64.5 ± 11.3 mL, p < 0.001). In the arterial phase, HCC conspicuity on 50-keV DLD images in the low-contrast-dose group was noninferior to that of MBIR images in the standard-contrast-dose group (2.92 vs. 2.56; difference, 0.36; 95% confidence interval, -0.13 to ∞; p = 0.013). CONCLUSIONS: The contrast dose in liver CT can be reduced by 40% without impairing HCC conspicuity when using 50-keV and DLD techniques. KEY POINTS: • In the arterial phase, hepatocellular carcinoma conspicuity on 50-keV deep learning-based denoising images in the low-contrast-dose group was noninferior to that of model-based iterative reconstruction images in the standard-contrast-dose group. • HCC detection was comparable between 50-keV deep learning-based denoising images in the low-contrast-dose group and model-based iterative reconstruction images in the standard-contrast-dose group.

Multiarterial Phase Acquisition in Gadoxetic Acid-Enhanced Liver MRI for the Detection of Hypervascular Hepatocellular Carcinoma in High-Risk Patients: Comparison of Compressed Sensing Versus View Sharing Techniques.

OBJECTIVES: The aim of this study was to compare compressed sensing (CS) and view sharing (VS) techniques for single breath-hold multiarterial phase imaging with respect to image quality and focal liver observation detectability during gadoxetic acid-enhanced magnetic resonance imaging in patients at high risk for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: A total of 385 patients who underwent gadoxetic acid-enhanced magnetic resonance imaging, including triple arterial phases using either CS (n = 224) or VS (n = 161) techniques, were retrospectively included. Among them, 117 patients had 171 focal liver observations (median diameter, 1.3 cm), which were classified according to Liver Imaging Reporting and Data System version 2018. The acquisition rate of optimally timed late arterial phase (LAP) was assessed, and image quality, including respiratory motion artifact and observation conspicuity, was rated on a 4-point scale by 3 radiologists. The Mann-Whitney U test and nonparametric test for repeated measures data were used for image quality and observation conspicuity analysis. The jackknife alternative free-response receiver operating characteristics method was used to compare the observation detectability between the 2 techniques. RESULTS: The CS technique showed significantly higher acquisition rate of optimally timed LAP without transient severe motion (82.1% [184/224] vs 71.4% [115/161]; P = 0.013) than the VS technique. The CS technique also demonstrated significantly improved overall image quality (3.42 ± 0.70 vs 2.97 ± 0.61; P < 0.001) compared with the VS technique. Regarding the detection of hyperenhancing observations, there was no significant difference between the figure of merits of CS and VS techniques (0.660 vs 0.665; P = 0.890). However, the CS technique showed a higher detection rate in Liver Imaging Reporting and Data System M (LR-M, probably or definitely malignant but not HCC specific) observations than the VS technique (100.0% [9/9] vs 44.4% [8/18]; P = 0.009). CONCLUSION: The CS technique tended to provide optimally timed LAP without transient severe motion and demonstrated greater detection rate of LR-M observations than the VS technique in patients at high risk of HCC.

Evaluation of HASTE T2 weighted image with reduced echo time for detecting focal liver lesions in patients at risk of developing hepatocellular carcinoma.

PURPOSE: To compare the image quality and performance of half-Fourier acquisition single-shot turbo spin echo (HASTE) sequences, using compressed sensing (HASTE-CS) and deep-learning based reconstruction (HASTE-DL) in detecting focal liver lesions (FLLs), to those of T2-weighted image using BLADE sequence (T2WI) in patients at risk of developing hepatocellular carcinoma (HCC). MATERIALS AND METHODS: This retrospective study included patients at risk of developing HCC who underwent liver MRI including HASTE-DL, HASTE-CS, T2WI and DWI between January and June 2020. Three radiologists independently reviewed the image quality along with FLL detection in the three T2-based sequences and DWI. Reference lesion characterization was done using the complete set of MRI sequences according to the Liver Imaging Reporting and Data System (LI-RADS) v2018. RESULTS: A total of 227 patients with 88 of whom had FLLs (n = 194, mean size 11.7 ± 10.9 mm) were included. HASTE-DL yielded the highest overall image quality, followed by HASTE-CS and T2WI (3.4 ± 0.5, 3.1 ± 0.6, 2.4 ± 0.5, respectively, P < 0.001 for all). In the detection of FLLs, HASTE-DL showed significantly higher sensitivity than T2WI (51.5 % vs 43.6 %, P = 0.007) whereas HASTE-CS and T2WI bore respectively little difference (P > 0.017) on per-patient basis. For LR-4, -5, -M lesions, HASTE-DL had significantly higher figure of merit than that of T2WI (0.58 vs 0.52, P < 0.001) in per-lesion basis. CONCLUSION: HASTE-DL demonstrated better image quality and higher performance for FLL detection than conventional T2WI in patients at risk of developing HCC.

Increased risk of open-angle glaucoma in non-smoking women with obstructive pattern of spirometric tests.

To investigate differences in the prevalence of open-angle glaucoma (OAG) between different pulmonary function types. A population-based, cross-sectional analysis was conducted using Korean National Health and Nutrition Examination Surveys from 2008 to 2011. A total of 8941 subjects ≥ 40 years of age were analyzed. Chronic obstructive pulmonary disease (COPD) was defined as the ratio between first second of forced expiration (FEV1) and forced vital capacity (FVC) below 70%. The prevalence of glaucoma, as defined by the International Society of Geographical and Epidemiological Ophthalmology, was the main outcome. OAG was more prevalent in women with COPD (8.0% vs. 4.8% normal, P = 0.001) compared to women with normal pulmonary function. Intraocular pressure (IOP) of women with COPD were 13.3 (0.2) mmHg (13.9 (0.1) mmHg for normal function, P = 0.182). Never-smokers were more prevalent in women with COPD and glaucoma (92.9% vs. 52.4% normal function; P < 0.001). COPD was found to increase the risk of glaucoma in women (OR 2.077, P = 0.017) and even further in non-smoking women (OR 2.711, P = 0.003). Women with COPD showed a higher glaucoma prevalence despite similar IOP in comparison to women with normal pulmonary function. Non-smoking COPD is significantly associated with open-angle glaucoma in women.

Subtype Classification of Intrahepatic Cholangiocarcinoma Using Liver MR Imaging Features and Its Prognostic Value.

Introduction: Small-duct (SD) and large-duct (LD) subtypes of cholangiocarcinoma have been investigated for their prognostic factors. This study aimed to evaluate the diagnostic value of liver magnetic resonance imaging (MRI) in differentiating SD and LD types of intrahepatic cholangiocarcinoma (iCCA) and its prognostic value in predicting survival outcomes. Methods: One hundred forty patients with surgically confirmed iCCAs (93 SD type and 47 LD type) who had available preoperative gadoxetic acid-enhanced liver MR images were retrospectively included. MRI features suggestive of the LD type over the SD type were analyzed using multivariate logistic analyses. Postoperative recurrence-free survival (RFS) and overall survival (OS) for 107 patients with available survival data were compared according to MRI features. Results: MRI features suggestive of the LD type included infiltrative contour (odds ratio [OR] 14.2, 95% confidence interval [CI]: 2.5-81.7, p = 0.003), diffuse biliary dilatation (OR 9.7, 95% CI: 1.2-76.9, p = 0.032), no arterial phase hyperenhancement (OR 17.8, 95% CI: 2.7-118.6, p = 0.003), and vascular invasion (OR 4.5, 95% CI: 1.3-15.4, p = 0.018). When two or more features were combined, sensitivity was 59.6% (28/47), and specificity was 95.7% (89/93) in discriminating the LD type. RFS/OS was significantly shorter in patients with two or more MRI features, compared to those with none or one (310 days vs. 529 days, p = 0.011/964 days vs. 2,023 days, p = 0.010). Conclusions: Preoperative liver MRI may help predict the pathological subtype of iCCAs as either the SD type or LD type, allowing preoperative identification of patients with poorer survival outcomes.

Diagnostic Performance of Spin-Echo Echo-Planar Imaging Magnetic Resonance Elastography in 3T System for Noninvasive Assessment of Hepatic Fibrosis.

OBJECTIVE: To validate the performance of 3T spin-echo echo-planar imaging (SE-EPI) magnetic resonance elastography (MRE) for staging hepatic fibrosis in a large population, using surgical specimens as the reference standard. MATERIALS AND METHODS: This retrospective study initially included 310 adults (155 undergoing hepatic resection and 155 undergoing donor hepatectomy) with histopathologic results from surgical liver specimens. They underwent 3T SE-EPI MRE ≤ 3 months prior to surgery. Demographic findings, underlying liver disease, and hepatic fibrosis pathologic stage according to METAVIR were recorded. Liver stiffness (LS) was measured by two radiologists, and inter-reader reproducibility was evaluated using the intraclass correlation coefficient (ICC). The mean LS of each fibrosis stage (F0-F4) was calculated in total and for each etiologic subgroup. Comparisons among subgroups were performed using the Kruskal-Wallis test and Conover post-hoc test. The cutoff values for fibrosis staging were estimated using receiver operating characteristic (ROC) curve analysis. RESULTS: Inter-reader reproducibility was excellent (ICC, 0.98; 95% confidence interval, 0.97-0.99). The mean LS values were 1.91, 2.41, 3.24, and 5.41 kPa in F0-F1 (n = 171), F2 (n = 26), F3 (n = 38), and F4 (n = 72), respectively. The discriminating cutoff values for diagnosing ≥ F2, ≥ F3, and F4 were 2.18, 2.71, and 3.15 kPa, respectively, with the ROC curve areas of 0.97-0.98 (sensitivity 91.2%-95.9%, specificity 90.7%-99.0%). The mean LS was significantly higher in patients with cirrhosis (F4) of nonviral causes, such as primary biliary cirrhosis (9.56 kPa) and alcoholic liver disease (7.17 kPa) than in those with hepatitis B or C cirrhosis (4.28 and 4.92 kPa, respectively). There were no statistically significant differences in LS among the different etiologic subgroups in the F0-F3 stages. CONCLUSION: The 3T SE-EPI MRE demonstrated high interobserver reproducibility, and our criteria for staging hepatic fibrosis showed high diagnostic performance. LS was significantly higher in patients with non-viral cirrhosis than in those with viral cirrhosis.

Image quality in liver CT: low-dose deep learning vs standard-dose model-based iterative reconstructions.

OBJECTIVES: To compare the overall image quality and detectability of significant (malignant and pre-malignant) liver lesions of low-dose liver CT (LDCT, 33.3% dose) using deep learning denoising (DLD) to standard-dose CT (SDCT, 100% dose) using model-based iterative reconstruction (MBIR). METHODS: In this retrospective study, CT images of 80 patients with hepatic focal lesions were included. For noninferiority analysis of overall image quality, a margin of - 0.5 points (scored in a 5-point scale) for the difference between scan protocols was pre-defined. Other quantitative or qualitative image quality assessments were performed. Additionally, detectability of significant liver lesions was compared, with 64 pairs of CT, using the jackknife alternative free-response ROC analysis, with noninferior margin defined by the lower limit of 95% confidence interval (CI) of the difference of figure-of-merit less than - 0.1. RESULTS: The mean overall image quality scores with LDCT and SDCT were 3.77 ± 0.38 and 3.94 ± 0.34, respectively, demonstrating a difference of - 0.17 (95% CI: - 0.21 to - 0.12), which did not cross the predefined noninferiority margin of - 0.5. Furthermore, LDCT showed significantly superior quantitative results of liver lesion contrast to noise ratio (p < 0.05). However, although LDCT scored higher than the average score in qualitative image quality assessments, they were significantly lower than those of SDCT (p < 0.05). Figure-of-merit for lesion detection was 0.859 for LDCT and 0.878 for SDCT, showing noninferiority (difference: - 0.019, 95% CI: - 0.058 to 0.021). CONCLUSION: LDCT using DLD with 67% radiation dose reduction showed non-inferior overall image quality and lesion detectability, compared to SDCT. KEY POINTS: • Low-dose liver CT using deep learning denoising (DLD), at 67% dose reduction, provided non-inferior overall image quality compared to standard-dose CT using model-based iterative reconstruction (MBIR). • Low-dose CT using DLD showed significantly less noise and higher CNR lesion to liver than standard-dose CT using MBIR and demonstrated at least average image quality score among all readers, albeit with lower scores than standard-dose CT using MBIR. • Low-dose liver CT showed noninferior detectability for malignant and pre-malignant liver lesions, compared to standard-dose CT.

Transcatheter Arterial Embolization for Spontaneous Hepatic Rupture Associated with HELLP Syndrome: A Case Report.

Background: Spontaneous hepatic rupture associated with the syndrome characterized by hemolysis, elevated liver enzymes, and a low platelet count (HELLP syndrome) is a rare and life-threatening condition, and only a few cases regarding the management of this condition through transcatheter arterial embolization (TAE) have been previously reported. Case summary: Herein, we report a case involving a 35-year-old pregnant woman who presented at 28 weeks of gestation with right upper quadrant pain, hypotension, and elevated levels of liver enzymes. Transabdominal ultrasound revealed fetal death. She required an emergency cesarean section, and hepatic rupture was identified after the fetus had been delivered. Hepatic packing and TAE were performed. The postprocedural course was uneventful, and the patient was discharged 14 days after she had been admitted to our hospital. Conclusions: Spontaneous hepatic rupture associated with HELLP syndrome is a very serious condition that requires prompt and decisive management. The high maternal and fetal mortality rates associated with this condition can be reduced through early accurate diagnosis and adequate management. The findings in the reported case indicate that TAE may be an attractive alternative to surgery for the management of spontaneous hepatic rupture associated with HELLP syndrome.

Volumetric CT Texture Analysis of Intrahepatic Mass-Forming Cholangiocarcinoma for the Prediction of Postoperative Outcomes: Fully Automatic Tumor Segmentation Versus Semi-Automatic Segmentation.

OBJECTIVE: To determine whether volumetric CT texture analysis (CTTA) using fully automatic tumor segmentation can help predict recurrence-free survival (RFS) in patients with intrahepatic mass-forming cholangiocarcinomas (IMCCs) after surgical resection. MATERIALS AND METHODS: This retrospective study analyzed the preoperative CT scans of 89 patients with IMCCs (64 male; 25 female; mean age, 62.1 years; range, 38-78 years) who underwent surgical resection between January 2005 and December 2016. Volumetric CTTA of IMCCs was performed in late arterial phase images using both fully automatic and semi-automatic liver tumor segmentation techniques. The time spent on segmentation and texture analysis was compared, and the first-order and second-order texture parameters and shape features were extracted. The reliability of CTTA parameters between the techniques was evaluated using intraclass correlation coefficients (ICCs). Intra- and interobserver reproducibility of volumetric CTTAs were also obtained using ICCs. Cox proportional hazard regression were used to predict RFS using CTTA parameters and clinicopathological parameters. RESULTS: The time spent on fully automatic tumor segmentation and CTTA was significantly shorter than that for semi-automatic segmentation: mean ± standard deviation of 1 minutes 37 seconds ± 50 seconds vs. 10 minutes 48 seconds ± 13 minutes 44 seconds (p < 0.001). ICCs of the texture features between the two techniques ranged from 0.215 to 0.980. ICCs for the intraobserver and interobserver reproducibility using fully automatic segmentation were 0.601-0.997 and 0.177-0.984, respectively. Multivariable analysis identified lower first-order mean (hazard ratio [HR], 0.982; p = 0.010), larger pathologic tumor size (HR, 1.171; p < 0.001), and positive lymph node involvement (HR, 2.193; p = 0.014) as significant parameters for shorter RFS using fully automatic segmentation. CONCLUSION: Volumetric CTTA parameters obtained using fully automatic segmentation could be utilized as prognostic markers in patients with IMCC, with comparable reproducibility in significantly less time compared with semi-automatic segmentation.

TUBB3 M323V Syndrome Presents with Infantile Nystagmus.

Variants in the TUBB3 gene, one of the tubulin-encoding genes, are known to cause congenital fibrosis of the extraocular muscles type 3 and/or malformations of cortical development. Herein, we report a case of a 6-month-old infant with c.967A>G:p.(M323V) variant in the TUBB3 gene, who had only infantile nystagmus without other ophthalmological abnormalities. Subsequent brain magnetic resonance imaging (MRI) revealed cortical dysplasia. Neurological examinations did not reveal gross or fine motor delay, which are inconsistent with the clinical characteristics of patients with the M323V syndrome reported so far. A protein modeling showed that the M323V mutation in the TUBB3 gene interferes with αß heterodimer formation with the TUBA1A gene. This report emphasizes the importance of considering TUBB3 and TUBA1A tubulinopathy in infantile nystagmus. A brain MRI should also be considered for these patients, although in the absence of other neurologic signs or symptoms.

Diagnosis of Hippocampal Sclerosis in Children: Comparison of Automated Brain MRI Volumetry and Readers of Varying Experience.

BACKGROUND. Hippocampal sclerosis (HS) is a leading cause of medically refractory temporal lobe epilepsy in children. The diagnosis is clinically important because most patients with HS have good postsurgical outcomes. OBJECTIVE. This study aimed to compare the performance of a fully automated brain MRI volumetric tool and readers of varying experience in the diagnosis of pediatric HS. METHODS. This retrospective study included 22 children with HS diagnosed between January 2009 and January 2020 who underwent surgery and an age- and sex-matched control group of 44 patients with normal MRI findings and extratemporal epilepsy diagnosed between January 2009 and January 2020. Regional brain MRI volumes were calculated from a high-resolution 3D T1-weighted sequence using an automated volumetric tool. Four readers (two pediatric radiologists [experienced] and two radiology residents [inexperienced]) visually assessed each MRI examination to score the likelihood of HS. One inexperienced reader repeated the evaluations using the volumetric tool. The area under the ROC curve (AUROC), sensitivity, and specificity for HS were computed for the volumetric tool and the readers. Diagnostic performances were compared using McNemar tests. RESULTS. In the HS group, the hippocampal volume (affected vs unaffected, 3.54 vs 4.59 cm3) and temporal lobe volume (affected vs unaffected, 5.66 vs 6.89 cm3) on the affected side were significantly lower than on the unaffected side (p < .001) using the volu-metric tool. AUROCs of the volumetric tool were 0.813-0.842 in patients with left HS and 0.857-0.980 in patients with right HS (sensitivity, 81.8-90.9%; specificity, 70.5-95.5%). No significant difference (p = .63 to > .99) was observed between the performance of the volumetric tool and the performance of the two experienced readers as well as one inexperienced reader (AUROCs for these three readers, 0.968-0.999; sensitivity, 86.4-90.9%; specificity, 100.0%). The volumetric tool had better performance (p < .001) than the other inexperienced reader (AUROC, 0.806; sensitivity, 81.8%; specificity, 47.7%). With subsequent use of the tool, this inexperienced reader showed a nonsignificant increase (p = .10) in AUROC (0.912) as well as in sensitivity (86.4%) and specificity (84.1%). CONCLUSION. A fully automated volumetric brain MRI tool outperformed one of two inexperienced readers and performed as well as two experienced readers in identifying and lateralizing HS in pediatric patients. The tool improved the performance of an inexperienced reader. CLINICAL IMPACT. A fully automated volumetric tool facilitates diagnosis of HS in pediatric patients, especially for an inexperienced reader.

Intra-individual comparison of dual portal venous phases for non-invasive diagnosis of hepatocellular carcinoma at gadoxetic acid-enhanced liver MRI.

OBJECTIVES: To compare the diagnostic performances of first and second portal venous phases (PVP1 and PVP2) in revealing washout and capsule appearance for non-invasive HCC diagnoses in gadoxetic acid-enhanced MRI (Gd-EOB-MRI). METHODS: This retrospective study included 123 at-risk patients with 160 hepatic observations (HCCs, n = 116; non-HCC malignancies, n = 18; benign, n = 26) showing arterial phase hyper-enhancement (APHE) ≥ 1 cm at Gd-EOB-MRI. The mean time intervals from gadoxetic acid injection to PVP1 and PVP2 acquisitions were 53 ± 2 s and 73 ± 3 s, respectively. After evaluating image findings independently, imaging findings and diagnoses were finalized by a consensus of two radiologists using either PVP1 or PVP2 image sets according to the LI-RADS v2018 or EASL criteria. Sensitivity, specificity, and accuracy were compared. RESULTS: Among HCCs, more washout and enhancing capsule were observed in PVP2 (83.6% and 27.6%) than in PVP1 (50.9% and 19.8%) (p < 0.001, both). The PVP2 set presented significantly higher sensitivity (83.6% vs. 53.5%, LI-RADS; 82.8% vs. 50.0%, EASL; p < 0.001, both) and accuracy (0.88 vs. 0.73, LI-RADS; 0.88 vs. 0.72, EASL; p < 0.001, both) than the PVP1 set without significant specificity loss (93.2% vs. 93.2%, by LI-RADS or EASL; p = 0.32, both). None of the non-HCC malignancy was non-invasively diagnosed as HCC in both PVP image sets. CONCLUSION: Late acquisition of PVP detected washout and enhancing capsule of HCC more sensitively than early acquisition, enabling accurate diagnoses of HCC, according to LI-RADS or EASL criteria. KEY POINTS: • Among HCCs, more washout and enhancing capsules were observed in PVP2 than PVP1, quantitatively and qualitatively. • The portal venous phase acquired at around 70 s after contrast media administration (PVP2) provided significantly higher sensitivity and AUC value than PVP1 by using LI-RADS v2018 or EASL criteria. • More HCCs were categorized as LR-5 in PVP2 than in PVP1 images, and the specificity of PVP2 (93.5%) was comparable with PVP1 (93.5%).