ABSTRACT
Objective:To compare MRI characteristics between hepatic benign nodules and hepatocellular carcinoma (HCC) associated with Budd-Chiari syndrome(BCS).Methods:A retrospective study was conducted on 130 consecutive patients with BCS who were treated at the Affiliated Hospital of Xuzhou Medical University from January 2011 to June 2018. There were 67 males and 63 females, age ranged from 18 to 78 years, with median age was 46 years. There were 45 patients with HCC and 85 patients with benign liver nodules. This study aimed to compare the clinical characteristics of BCS patients with HCC and benign nodules, and to compare the MRI features (distribution, capsule, plain scan signal, enhancement pattern) between HCC and benign nodules. The receiver operating characteristic (ROC) curve was used to evaluate the efficacy of each of the indicators in the diagnosis of hepatocellular carcinoma.Results:The age and alpha-fetoprotein levels of the BCS patients with benign nodules were significantly lower than the BCS patients with HCC, while the international standardized ratio was significantly higher than the BCS patients with HCC (all P<0.05). Of the 130 BCS patients, there were 337 benign and 78 hepatocellular carcinomas nodules. The diameter of benign nodules was significantly smaller than HCC, and the proportions of benign nodules with encapsulation, fat content, cystic necrosis and hemorrhage were significantly lower than HCC (all P<0.05). The proportions of benign nodules with T 1 weighted imaging high signal, T 2 weighted imaging (T 2WI) low or equal signal and diffusion-weighted imaging (DWI) equal signal were significantly higher than HCC (all P<0.05). The proportions of benign nodules with washout appearance, arterial phase hyperenhancement and washout appearance were significantly lower than HCC (all P<0.05). The areas under the ROC curve for the diagnosis of HCC by DWI high signal and T 2WI high signal were 0.936 and 0.927, respectively, with sensitivities of 96.2% and 92.3%, specificities of 91.0% and 90.1%, respectively. Conclusion:The MRI features of BCS patients with benign regenerative nodules were significantly different from those of BCS patients with HCC. The washout appearance had a low specificity for the diagnosis of HCC.
ABSTRACT
Objective To compare changes in signal intensity (SI) of the dentate nucleus (DN),pons and cerebrospinal fluid (CSF) on unenhanced T1-weighted magnetic resonance imaging (MRI) scans after multiple administrations of the linear gadolinium-based contrast agent.Methods Clinical and imaging data of forty-nine patients who underwent at least 4 consecutive enhanced MRI examinations were analyzed retrospectively (unenhanced T1-weighted MRI scans were performed before and after consecutive enhanced MRI examinations).The mean SI of DN,pons and CSF were measured on unenhanced T1-weighted images.The SI ratio of DN to pons was calculated by dividing the SI in the DN by that in the pans,and so was The DN to CSF SI ratio.The difference of SI ratio of DN-to-pons and DN-to-CSF in the same patient before and after repeated contrast-enhanced T1WI were analyzed by paired-samples t tests.Linear regression analysis was used to analyze whether the SI ratios of DN-to-pons,DN-to-CSF were correlated with any clinical factor.Results The SI ratios of DN-to-pons and DN-to-CSF after multiple contrast administrations were higher than those before enhancement,and the differences were statistically significant.The SI ratios of DN-to-pons and DN-to-CSF before and after repeated contrast enhancement were 0.98±0.62,1.05 ±0.54;3.89±0.94,4.97±1.61 (t=-8.494,-4.526,P＜0.001).The SI ratio differences showed a significant positive correlation with the number of previous gadolinium-based contrast material administrations (pons:b=0.006,P=0.003,CSF:b=0.144,P=0.009).There was no correlation with any other clinical factors(P＞0.05).Conclusions This study indicates that serial injections of linear gadolinium-based contrast agent may lead to an increase in SI in the DN.