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BACKGROUND: Signal intensity on T1 -weighted images (T1 WI) is associated with pancreatic fibrosis and HbA1c levels. PURPOSE: To evaluate the feasibility of the pancreatic T1 value for assessment of subjects with normal and impaired glucose tolerance (IGT). STUDY TYPE: A prospective single-institution study. POPULATION: In all, 95 consecutive patients with a known or suspected pancreatic disease. FIELD STRENGTH/SEQUENCES: 3T/fast pancreatic T1 mapping using a modified Look-Locker sequence. ASSESSMENT: Following the American Diabetes Association criteria, patients were classified into three groups, as follows: no-diabetes subject, HbA1c < 5.7%; prediabetes, 5.7% ≤ HbA1c < 6.5%; and type 2 diabetes mellitus (T2DM), HbA1c ≥ 6.5%. Pancreatic T1 value and signal intensity ratio (SIR = SIpancreas /SImuscle ) using T1 WI were compared with the HbA1c values. STATISTICAL TESTS: Quantitative data were assessed with one-way analysis of variance, Fisher's and Mann-Whitney U tests, and receiver-operating characteristic analysis. RESULTS: The pancreatic T1 value was significantly longer in T2DM than in no-diabetes and prediabetes subjects (P < 0.05) and was significantly longer in prediabetes than in no-diabetes subjects (P < 0.05). The mean pancreatic T1 value was significantly lower in the low-value group (HbA1c < 5.7%) (906.3 msec) compared with the high-value group (HbA1c ≥ 6.5%) (993.8 msec) (P < 0.0001). SIR on T1 WI was significantly higher in the low-value group compared with the high-value group (P = 0.029). The sensitivities, specificities, and area under the receiver-operating characteristic curve (AUCs) for differentiating the low- and high-value groups were 74.1%, 83.8%, and 0.82 in the pancreatic T1 values and 77.8%, 54.4%, and 0.63 in SIR on T1 WI, respectively. The specificity (P < 0.0001) and AUC (P = 0.0020) were significantly higher in the pancreatic T1 values than in SIR on T1 WI. DATA CONCLUSION: Pancreatic T1 value has the potential of being an imaging biomarker for the assessment of IGT. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:711-718.
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Diabetes Mellitus Tipo 2/sangre , Fibrosis/diagnóstico por imagen , Intolerancia a la Glucosa/sangre , Glucosa/metabolismo , Hemoglobina Glucada/análisis , Imagen por Resonancia Magnética , Páncreas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Área Bajo la Curva , Diabetes Mellitus Tipo 2/diagnóstico por imagen , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Análisis de Regresión , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
BACKGROUND: Simultaneous acquisition of magnetic resonance angiography (MRA) and diagnostic images is challenging in contrast-enhanced upper abdominal MRI. PURPOSE: To evaluate the image quality of MRA of the abdomen acquired simultaneously with diagnostic MR images, and to compare the contrast effect, conspicuity of aortic branches, and pancreatic lesions in MRA between gadobutrol and gadoterate meglumine. STUDY TYPE: Prospective. POPULATION: Eighty-eight patients with known and suspected upper abdominal disease. FIELD STRENGTH/SEQUENCES: 3T/4D-eTHRIVE (T1 -weighted fat-suppressed 3D fast gradient echo) for multiarterial phase imaging. ASSESSMENT: The artery-to-muscle signal intensity ratio (SIR), conspicuity of aortic branches on the axial, maximum intensity projection (MIP), and volume-rendered (VR) images, and conspicuity of focal pancreatic lesions were compared between gadobutrol and gadoterate meglumine. The diameters of aortic branches were measured on axial MRA and computed tomography angiography (CTA) images and then compared. STATISTICAL TESTS: Quantitative and qualitative data were assessed with the Mann-Whitney U-test. The diameters of aortic branches between MRA and CTA were compared with a Spearman rank correlation test. RESULTS: View-sharing multiarterial phase imaging was successfully performed in all patients. The SIRs of common hepatic artery (P = 0.0051) and left renal artery (RA) (P = 0.045), vascular conspicuities of right and left hepatic arteries (P = 0.010 and 0.030) and right and left RAs on axial (P = 0.0065 and 0.036), and that of gastroduodenal artery on MIP (P = 0.039) with gadobutrol were significantly higher than those with gadoterate meglumine. The conspicuity of focal pancreatic lesions were comparable between the gadobutrol and gadoterate meglumine (P = 0.73). The vascular diameters on MRA and CTA were strongly correlated in all aortic branches (r = 0.842-0.942, P < 0.0001). DATA CONCLUSION: High-quality MRA of the abdomen was obtained simultaneously with the diagnostic MR images using view-sharing multiarterial phase imaging that also demonstrated comparable image quality between gadobutrol and gadoterate meglumine. LEVEL OF EVIDENCE: 2 Technical Efficacy Stage 1 J. Magn. Reson. Imaging 2017.
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Abdomen/diagnóstico por imagen , Aorta/diagnóstico por imagen , Medios de Contraste/química , Angiografía por Resonancia Magnética , Adulto , Anciano , Anciano de 80 o más Años , Angiografía por Tomografía Computarizada , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Meglumina/química , Persona de Mediana Edad , Compuestos Organometálicos/química , Páncreas/diagnóstico por imagen , Estudios ProspectivosRESUMEN
BACKGROUND: There is limited evidence of parametric MR mapping to characterize carotid plaques associated with cerebral ischemic events. PURPOSE: To explore the apparent diffusion coefficients (ADCs) and longitudinal relaxation rates (R1 ) of carotid plaques, including areas of hemorrhage, lipid-rich/necrotic core (LR/NC) without hemorrhage, and fibrous tissue (Fbr) STUDY TYPE: Prospective. SUBJECTS: Twelve patients who underwent carotid endarterectomy. FIELD STRENGTH/SEQUENCE: R1 was measured using double angle Look-Locker acquisition on 3T systems. Single-shot spin-echo echo-planar imaging with fat suppression and outer-volume suppression (OVS-DWEPI) with b values of 10 and 500 s/mm2 was used for diffusion-weighted imaging. ASSESSMENT: A phantom study using diluted gadolinium solutions and polyvinyl alcohol solutions was used to validate the two protocols. Regions of interest (ROIs) were manually outlined on MR images for areas of LR/NC, hemorrhage, and Fbr based on histological cross-sections. Pixel-based R1 and ADC values in the ROIs were plotted for each component. The probability density function of the plots determined the optimum contours to separate the three components in the ADC-R1 plane. The LR/NC, hemorrhage, and Fbr regions were mapped on MR images based on the above results and compared to histological results. STATISTICAL TESTS: The R1 values of the phantom measurements were tested using Bland-Altman analysis. The accuracies of the MRI classification were calculated. RESULTS: R1 values <8 s-1 calculated using our method agreed with those calculated using an inversion-recovery fast-spin-echo sequence (error, ≤0.1 s-1 ). ADC values obtained using OVS-DWEPI were 4.1% higher than those obtained using standard echo-planar imaging. LR/NC (R1 , 0.4-1.2 s-1 ; ADC, 0-1.5 µm2 /ms), hemorrhage (R1 ≥ 1.5 s-1 ; ADC, 0.5-1.5 µm2 /ms), and Fbr (R1 , 0.2-0.8 s-1 ; ADC, 1.5-2.9 µm2 /ms) were separated on the plots. The accuracies of MRI classification were LR/NC, 0.86; hemorrhage, 0.79; and Fbr, 0.77. CONCLUSION: The combination of ADC and R1 values measured using our method enabled differentiation among LR/NC, hemorrhage, and Fbr. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1657-1667.
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Isquemia Encefálica/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética , Técnicas Histológicas/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Anciano , Anciano de 80 o más Años , Aterosclerosis/diagnóstico por imagen , Isquemia Encefálica/complicaciones , Arterias Carótidas/patología , Estenosis Carotídea/complicaciones , Imagen Eco-Planar , Femenino , Gadolinio/química , Hemorragia/diagnóstico por imagen , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Lípidos/química , Masculino , Persona de Mediana Edad , Necrosis , Fantasmas de Imagen , Placa Aterosclerótica/patología , Alcohol Polivinílico , Probabilidad , Estudios Prospectivos , Relación Señal-RuidoRESUMEN
PURPOSE: To evaluate the diagnostic performance of noncontrast-enhanced magnetic resonance imaging (MRI) to grade pancreatic fibrosis and to assess hemoglobin (Hb) A1c values. MATERIALS AND METHODS: Twenty-nine consecutive patients with pancreatic or biliary malignancy who underwent pancreatectomy were evaluated. Patients were classified into three groups: HbA1c < 5.7 (group 1), 5.7 ≤ HbA1c < 6.5 (group 2), and HbA1c ≥ 6.5 (group 3). MRI of the pancreas was performed using a 1.5T MR system. The pancreas-to-muscle signal intensity ratio (SIR) on in- and opposed-phase T1 -, T2 -, and diffusion-weighted images, as well as the apparent diffusion coefficient were calculated. MRI measurements, degrees of pancreatic fibrosis, and HbA1c values were compared using multiple regression analysis and Kruskal-Wallis test. RESULTS: The pancreatic fibrosis grade was negatively correlated with the SIR on in-phase T1 -weighted images (r = -0.67, P = 0.0002). The pancreatic fibrosis grade and HbA1c value were negatively correlated with the SIR on opposed-phase T1 -weighted images (r = -0.47, P = 0.019 and r = -0.51, P = 0.0089, respectively). SIRs on in- and opposed-phase T1 -weighted images were significantly lower in group 3 than in groups 1 and 2 (P < 0.05). CONCLUSION: The pancreas-to-muscle SIRs on in- and opposed-phase T1 -weighted images could be a potential biomarker for pancreatic fibrosis and elevated HbA1c values.
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Imagen de Difusión por Resonancia Magnética , Hemoglobina Glucada/metabolismo , Páncreas/diagnóstico por imagen , Neoplasias Pancreáticas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Femenino , Fibrosis , Humanos , Masculino , Persona de Mediana Edad , Páncreas/patología , Pancreatectomía , Enfermedades Pancreáticas/patología , Neoplasias Pancreáticas/patología , Radiología , Análisis de Regresión , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To assess prospectively the efficacy of arterial spin labelling (ASL) against conventional and diffusion-weighted (DW) MR imaging for differentiating parotid gland tumours. METHODS: We included 10 pleomorphic adenomas, 12 Warthin's tumours, and nine malignant tumours of the parotid glands. Only tumours larger than 10 mm were included in this study. All parotid gland tumours underwent T1-weighted, T2-weighted, DW, and ASL imaging. Tumour-to-parotid gland signal intensity ratios (SIRs) and apparent diffusion coefficients (ADCs) of solid components were correlated with these pathologies. RESULTS: SIRs on T2-weighted images and ADCs were higher in pleomorphic adenomas than in Warthin's tumours (p < .01) and malignant tumours (p < .01). SIRs on ASL were higher in Warthin's tumours than in pleomorphic adenomas (p < .01) and malignant tumours (p < .05). Az value of SIRs on ASL for differentiating Warthin's tumours from the other pathologies was 0.982. The sensitivity, specificity, and accuracy of SIRs on ASL for the diagnosis of Warthin's tumours at an optimal SIR threshold of over 8.70 were 91.7%, 94.7%, and 93.5%, respectively. CONCLUSIONS: ASL with SIR measurements could non-invasively evaluate tumour blood flow of parotid gland tumours and differentiate Warthin's tumours from pleomorphic adenomas and malignant tumours. KEY POINTS: ⢠ASL non-invasively evaluates tumour blood flow of parotid gland tumours ⢠ASL differentiates Warthin's tumours from pleomorphic adenomas and malignant tumours ⢠ASL cannot differentiate between pleomorphic adenomas and malignant tumours.
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Adenolinfoma/patología , Adenoma Pleomórfico/patología , Neoplasias de la Parótida/patología , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Imagen Multimodal/métodos , Glándula Parótida/patología , Imagen de Perfusión/métodos , Estudios Prospectivos , Sensibilidad y Especificidad , Marcadores de SpinRESUMEN
BACKGROUND: Diffusion-weighted (DW) imaging is commonly used to distinguish between benign and malignant liver lesions. PURPOSE: To prospectively evaluate the true molecular-diffusion coefficient (D), perfusion-related diffusion coefficient (D*), perfusion fraction (f), and ADC of focal hepatic lesions using a free-breathing intravoxel incoherent motion (IVIM) DW sequence, and to determine if these parameters are useful for characterizing focal hepatic lesions. MATERIAL AND METHODS: One hundred and twenty hepatic lesions (34 metastases, 32 hepatocellular carcinoma [HCC], 33 hemangiomas, and 21 liver cysts) in 74 patients were examined. Mean D, D*, f, and ADC values of hepatic lesions were compared among pathologies. ROC curve analyses were performed to assess the performances of D, D*, f, and ADC values for the characterization of liver lesions as benign or malignant. RESULTS: The mean D and ADC values of benign lesions were greater than those of malignant lesions (P < 0.001). Although the mean D and ADC values of liver cysts were greater than those of hemangiomas (P < 0.001), and these values were not significantly different between metastases and HCCs (P = 0.99). Area under the ROC curve for ADC values (0.98) was significantly greater (P = 0.048) than that for D values (0.96) for the differentiation of benign and malignant lesions. Sensitivity and specificity for the detection of malignant lesion were 89% and 98%, respectively, when an ADC cut-off value of 1.40 was applied. CONCLUSION: D and ADC values have more potential for characterizing focal hepatic lesions than D* or f values, and for the differentiation of malignancy and benignity.
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Carcinoma Hepatocelular/diagnóstico , Hemangioma/diagnóstico , Neoplasias Hepáticas/diagnóstico , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Anciano de 80 o más Años , Medios de Contraste , Quistes/diagnóstico , Diagnóstico Diferencial , Femenino , Gadolinio DTPA , Humanos , Aumento de la Imagen/métodos , Procesamiento de Imagen Asistido por Computador/métodos , Imagenología Tridimensional/métodos , Hígado/patología , Hepatopatías/diagnóstico , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Respiración , Sensibilidad y EspecificidadRESUMEN
PURPOSE: This study aimed to evaluate the feasibility of single-shot echo planar diffusion-weighted imaging with compressed SENSE (EPICS-DWI) for pancreas assessment by comparing with single-shot echo planar DWI with parallel imaging (PI-DWI). METHODS: This multicenter prospective study included 27 consecutive participants with untreated pancreatic ductal adenocarcinoma (PDAC) (15 men; mean age, 67 ± 10 years) who underwent pancreatic protocol MRI including both PI-DWI and EPICS-DWI. Two radiologists independently and randomly reviewed the high b-value DWI images and qualitatively assigned confidence scores for overall image quality, image noise, pancreas conspicuity, and PDAC conspicuity using a 5-point scale. One radiologist measured the PDAC-to-pancreas contrast-to-noise-ratio (CNR) on high b-value DWI images and the apparent diffusion coefficient (ADC) value of PDAC. Qualitative and quantitative parameters were compared between PI-DWI and EPICS-DWI using the Wilcoxon signed-rank test. RESULTS: The confidence scores for overall image quality (P < 0.001 in both radiologists) and image noise (P < 0.001 in both radiologists) were higher in EPICS-DWI than in PI-DWI. The pancreas conspicuity was better in EPICS-DWI than in PI-DWI in one of the radiologists (P = 0.02 and 0.06). The PDAC conspicuity was comparable between PI-DWI and EPICS-DWI (P > 0.99 in both radiologists). The PDAC-to-pancreas CNR was higher in EPICS-DWI than in PI-DWI (P = 0.02), while the ADC value of PDAC in PI-DWI was not significantly different compared to that in EPICS-DWI (P = 0.48). CONCLUSION: The image quality and PDAC-to-pancreas CNR was improved in EPICS-DWI compared to PI-DWI. However, the conspicuity and ADC value of PDAC were comparable between PI-DWI and EPICS-DWI.
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PURPOSE: To evaluate the feasibility of a free-breathing sequence (4D FreeBreathing) combined with Compressed SENSE in dynamic contrast-enhanced pancreatic MRI and compare it with a breath-holding sequence (eTHRIVE). METHOD: Patients who underwent pancreatic MRI, either eTHRIVE or 4D FreeBreathing, from April 2022 to November 2023 were included in this retrospective study. Two radiologists, who were unaware of the scan sequence, independently and randomly reviewed the images at the precontrast, pancreatic, portal venous, and equilibrium phases and assigned confidence scores for motion and streaking artifacts, pancreatic sharpness, and overall image quality using a 5-point scale. Furthermore, the radiologists assessed the appropriateness of the scan timing of the pancreatic phase. Mann-Whitney U and Fisher's exact tests were conducted to compare the confidence scores and adequacy of the pancreatic phase scan timing between eTHRIVE and 4D FreeBreathing. RESULTS: Overall, 48 patients (median age, 71 years; interquartile range, 64-77 years; 24 women) were included. Among them, 20 patients (42%) were scanned using 4D FreeBreathing. The 4D FreeBreathing showed moderate streaking artifact but improved motion artifact (P <.001-.17) at all phases. Pancreatic sharpness and overall image quality were almost comparable between two sequences (P = .17-.96). All 20 examinations in 4D FreeBreathing showed appropriate pancreatic phase images, but only 16 (57%; P <.001 for reviewer 1) and 18 (64%; P = .003 for reviewer 2) examinations showed it in eTHRIVE. CONCLUSION: The use of 4D FreeBreathing combined with Compressed SENSE was feasible in pancreatic MRI and provided appropriate pancreatic phase images in all examinations.
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Medios de Contraste , Estudios de Factibilidad , Imagen por Resonancia Magnética , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Imagen por Resonancia Magnética/métodos , Artefactos , Respiración , Aumento de la Imagen/métodos , Contencion de la Respiración , Compresión de Datos/métodos , Neoplasias Pancreáticas/diagnóstico por imagen , Páncreas/diagnóstico por imagen , Enfermedades Pancreáticas/diagnóstico por imagenRESUMEN
PURPOSE: To assess the diagnostic abilities of diffusion-weighted imaging (DWI) with parallel imaging (PI-DWI) and that with Compressed SENSE (EPICS-DWI) for differentiating hepatic hemangiomas (HHs) and liver metastases (LMs). METHOD: This prospective study included 30 participants with HH and/or LM who underwent PI-DWI and EPICS-DWI. Two radiologists assessed the DWI images and assigned confidence scores for hepatic lesions conspicuity using 4-point scale. One of the radiologists additionally calculated the contrast-to-noise ratio (CNR) and measured ADC value of the hepatic lesions. The conspicuity, CNR, and ADC values were compared between the two sequences. A receiver operating characteristic (ROC) analysis was performed to assess the diagnostic abilities of the two sequences for differentiating HHs and LMs. RESULTS: The conspicuity of LMs was better in EPICS-DWI than in PI-DWI (P < .05 in both radiologists). The CNR of LMs was higher in EPICS-DWI than in PI-DWI (P = .008). No difference was found in the CNR of HHs (P = .52), ADC values for HHs (P = .79), and LMs (P = .29) between the two sequences. To differentiate between HHs and LMs, the cutoff ADC values were 1.38 × 10-3 mm2/s in PI-DWI and 1.37 × 10-3 mm2/s in EPICS-DWI. The area under the ROC curve (P = .86), sensitivity (P > .99), and specificity (P > .99) did not vary. CONCLUSIONS: The LMs were more visible in EPICS-DWI than in PI-DWI. However, the cutoff ADC values and diagnostic abilities for differentiating HHs and LMs were almost comparable between the two sequences.
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Hemangioma , Neoplasias Hepáticas , Humanos , Imagen Eco-Planar , Estudios Prospectivos , Neoplasias Hepáticas/diagnóstico por imagen , Imagen de Difusión por Resonancia Magnética , Hemangioma/diagnóstico por imagenRESUMEN
PURPOSE: To evaluate the usefulness of diffusion-weighted MR imaging using a transient gustatory stimulation method in patients with xerostomia. MATERIALS AND METHODS: Ten consecutive patients complaining of xerostomia and 10 healthy volunteers were examined with a 1.5 Tesla (T) MR unit. All study subjects completed a questionnaire, and patients underwent salivary gland scintigraphy and Saxon test. T1-, T2-, and diffusion-weighted MR images were obtained before stimulation. One minute after gustatory stimulation with lemon juice, diffusion-weighted sequence was repeated 9 times. A radiologist evaluated signal intensities and apparent diffusion coefficients (ADCs) in parotid and submandibular glands. ADC increase rate (IR) and times to maximum ADC (Tmax) were assessed. RESULTS: IRs showed a moderate positive correlation with washout rates by scintigraphy for parotid (r = 0.554, P < 0.05) and submandibular (r = 0.617, P < 0.01) glands. Furthermore, Tmax values of parotid and submandibular glands were significantly higher in patients (420 ± 226 and 357 ± 232 s, respectively) than in volunteers (181 ± 68 and 200 ± 75 s, respectively) (P < 0.01). CONCLUSION: Our preliminary results indicate that diffusion-weighted MR imaging using a transient gustatory stimulation method is potentially useful for evaluating patients with xerostomia.
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Imagen de Difusión por Resonancia Magnética/métodos , Saliva/metabolismo , Glándulas Salivales/diagnóstico por imagen , Glándulas Salivales/fisiología , Xerostomía/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Persona de Mediana Edad , Análisis Multivariante , Estimulación Física/métodos , Cintigrafía , Valores de Referencia , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
PURPOSE: To compare the diagnostic value of mono-exponential, bi-exponential, and stretched exponential diffusion-weighted imaging (DWI) for differentiating benign and malignant hepatic lesions. METHODS: This prospective study was approved by our Institutional Review Board and the patients provided written informed consent. Magnetic resonance imaging was acquired for 56 patients with suspected liver disease. This identified 90 focal liver lesions with a maximum diameter >10 mm, of which 47 were benign and 43 were malignant. Using home-built software, two radiologists measured the DWI parameters of hepatic lesions for three models: the apparent diffusion coefficient (ADC) from a mono-exponential model; the true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from a bi-exponential model; and the distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) from a stretched exponential model. The parameters were compared between benign and malignant hepatic lesions. RESULTS: ADC, D, D*, f, and DDC values were significantly lower for malignant hepatic lesions than for benign lesions (P < 0.0001-0.03). Although logistic regression analysis demonstrated that DDC was the only statistically significant parameter for differentiating benign and malignant lesions (P = 0.039), however, the areas under the receiver operating characteristic curve for differentiating benign and malignant lesions were comparable between ADC (0.98) and DDC (0.98) values. CONCLUSION: DDC values obtained from the stretched exponential model could be also used as a quantitative imaging biomarker for differentiating benign and malignant hepatic lesions, however, the diagnostic performance was comparable with ADC values.
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Imagen de Difusión por Resonancia Magnética/métodos , Hepatopatías/diagnóstico por imagen , Humanos , Interpretación de Imagen Asistida por Computador , Hígado/diagnóstico por imagen , Estudios Prospectivos , Curva ROCRESUMEN
OBJECTIVE: To evaluate the feasibility, image quality, and apparent diffusion coefficient (ADC) values of diffusion-weighted imaging (DWI) using echo planar imaging (EPI) with Compressed SENSE (EPICS-DWI) of the abdomen and to compare them with conventional single-shot EPI with parallel imaging (PI) technique (PI-DWI). MATERIALS AND METHODS: This prospective study included 46 participants with known or suspected upper abdominal diseases (19 men and 27 women, mean age, 68 years) who underwent MRI. DWI acquisition was performed using free-breathing two-dimensional fat-suppressed PI-DWI and EPICS-DWI with SENSE or compressed sensing (CS) factor, 3.0. Moreover, image noise and contour of liver and pancreas were qualitatively evaluated using a five-point scale. The mean ADC value and standard deviation (SD) of the liver, pancreas, and spleen were measured, and the coefficient of variation (CV) was calculated. Qualitative and quantitative parameters were compared between PI-DWI and EPICS-DWI using the Wilcoxon test. RESULTS: The mean image quality scores for image noise and contour of liver and pancreas were higher in EPICS-DWI compared with PI-DWI (P < 0.0001). Moreover, the mean ADC values of the liver and pancreas were higher in EPICS-DWI compared with PI-DWI (P < 0.0001), but that of spleen was not significantly different. The mean SD and CV of the liver, pancreas, and spleen were lower in EPICS-DWI compared with PI-DWI (P < 0.0001-0.032). CONCLUSION: EPICS-DWI could be feasible in MRI of the abdomen and significantly improve image quality compared with PI-DWI in aggressive setting. ADC value measurements were higher in EPICS-DWI compared with PI-DWI.
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Imagen de Difusión por Resonancia Magnética , Imagen Eco-Planar , Abdomen/diagnóstico por imagen , Anciano , Estudios de Factibilidad , Femenino , Humanos , Masculino , Estudios Prospectivos , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: This study aims to compare the diagnostic values of mono-exponential, bi-exponential, and stretched exponential diffusion-weighted imaging (DWI) in differentiating hepatic hemangiomas and liver metastases. METHOD: This prospective study was approved by our institutional review board, and written informed consent was obtained from all patients. In this study, 244 patients with known or suspected liver disease underwent magnetic resonance imaging. Among them, 37 patients who had focal hepatic lesions with a maximum diameter of ≥10â¯mm were evaluated. Using home-built software, two radiologists measured the DWI parameters of hepatic lesions for the three models: the apparent diffusion coefficient (ADC) from a mono-exponential model; the true diffusion coefficient (D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) from a bi-exponential model; and the distributed diffusion coefficient (DDC) and water molecular diffusion heterogeneity index (α) from a stretched exponential model. The parameters were compared between hepatic hemangiomas and liver metastases. RESULTS: In total, 64 focal hepatic lesions were evaluated, of which 22 were identified to be hepatic hemangiomas and 42 were liver metastases. ADC, D, f, and DDC values were significantly lower in liver metastases than in hepatic hemangiomas (Pâ¯<⯠0.0001,â¯<⯠0.0001, 0.015, andâ¯<⯠0.0001, respectively); whereas, the α value was significantly higher in liver metastases than in hepatic hemangiomas (Pâ¯=⯠0.028). The areas under the ROC curve (AUCs) for differentiating hepatic hemangiomas and liver metastases in ADC, D, D*, f, DDC, and α were 0.940, 0.908, 0.608, 0.686, 0.952, and 0.667, respectively. The AUC values of ADC and DDC were significantly greater than those of D* (Pâ¯<⯠0.0001), f (Pâ¯=⯠0.0001), and α values (Pâ¯=⯠0.0001). CONCLUSION: ADC and DDC values from the mono-exponential and stretched exponential models could be considered as quantitative imaging biomarkers for differentiating hepatic hemangiomas and liver metastases.
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Hemangioma , Neoplasias Hepáticas , Imagen de Difusión por Resonancia Magnética , Hemangioma/diagnóstico por imagen , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Estudios Prospectivos , Curva ROCRESUMEN
OBJECTIVE: To assess the noncontrast two-dimensional single-shot balanced turbo-field-echo magnetic resonance angiography (b-TFE MRA) features of the abdominal aortic aneurysm (AAA) status following endovascular aneurysm repair (EVAR) and evaluate to detect endoleaks (ELs). MATERIALS AND METHODS: We examined four aortic stent-grafts in a phantom study to assess the degree of metallic artifacts. We enrolled 46 EVAR-treated patients with AAA and/or common iliac artery aneurysm who underwent both computed tomography angiography (CTA) and b-TFE MRA after EVAR. Vascular measurements on CTA and b-TFE MRA were compared, and signal intensity ratios (SIRs) of the aneurysmal sac were correlated with the size changes in the AAA after EVAR (AAA prognoses). Furthermore, we examined six feasible b-TFE MRA features for the assessment of ELs. RESULTS: There were robust intermodality (r = 0.92-0.99) correlations and interobserver (intraclass correlation coefficient = 0.97-0.99) agreement. No significant differences were noted between SIRs and aneurysm prognoses. Moreover, "mottled high-intensity" and "creeping high-intensity with the low-band rim" were recognized as significant imaging findings suspicious for the presence of ELs (p < 0.001), whereas "no signal black spot" and "layered high-intensity area" were determined as significant for the absence of ELs (p < 0.03). Based on the two positive features, sensitivity, specificity, and accuracy for the detection of ELs were 77.3%, 91.7%, and 84.8%, respectively. Furthermore, the k values (0.40-0.88) displayed moderate-to-almost perfect agreement. CONCLUSION: Noncontrast MRA could be a promising imaging modality for ascertaining patient follow-up after EVAR.
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Aneurisma de la Aorta Abdominal/cirugía , Endofuga/diagnóstico por imagen , Angiografía por Resonancia Magnética , Anciano , Anciano de 80 o más Años , Implantación de Prótesis Vascular , Medios de Contraste/química , Endofuga/diagnóstico , Endofuga/etiología , Procedimientos Endovasculares , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Stents , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: To preliminarily evaluate the feasibility and usefulness of MR elastography of the liver at 3 T with cine-tagging and bending energy (BE) analysis for the evaluation of hepatic fibrosis. MATERIALS AND METHODS: Twenty-two patients underwent MR elastography with four different cine-tagging grids on the liver (16- or 20-mm sagittal or coronal). Nine images serially obtained during 1-s of exhalation were analyzed to define coordinates of grid intersections. BE values were calculated using the thin-plate spline method. BE values were compared among patient groups with different fibrosis stage thresholds. RESULTS: In the 22 patients, six had a fibrosis score of F0, one had F1, seven had F2, three had F3, and five had F4. Mean BE value with 16-mm sagittal grid was greater with fibrosis score F0 (1.54 ± 0.63) than with ≥F1 (0.97 ± 0.12, P = 0.013) as well as with ≤F1 (1.48 ± 0.60) than with ≥F2 (0.96 ± 0.36, P = 0.019). CONCLUSION: Our results showed that MR elastography with 16-mm sagittal grid and BE analysis had a potential in discrimination for the patients with moderate or advanced hepatic fibrosis from those with healthy liver or slight fibrosis.
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Diagnóstico por Imagen de Elasticidad/métodos , Imagen por Resonancia Cinemagnética/métodos , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Área Bajo la Curva , Fibrosis , Hepatitis Crónica/patología , Humanos , Procesamiento de Imagen Asistido por Computador , Hígado/patología , Cirrosis Hepática/patología , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To evaluate pancreatic T1 mapping and extracellular volume (ECV) fraction's feasibility to assess impaired glucose tolerance (IGT) patients. METHODS: A total of 45 consecutive patients with known or suspected pancreatic disease underwent contrast-enhanced magnetic resonance (MR) imaging, including T1 mapping, using saturation recovery sequence. Patients were classified into three groups based on the American Diabetes Association criteria: no-diabetes subjects, HbA1c < 5.7%; pre-diabetes, 5.7% ≤ HbA1c < 6.5%; and type 2 diabetes mellitus (T2DM), HbA1c ≥ 6.5%. Pre-contrast pancreatic T1 value and ECV of the pancreas were computed, and then pre-contrast pancreatic T1 value, ECV and HbA1c values were compared. The present prospective study was approved by our institutional review board. Written informed consent was obtained from all patients. RESULTS: A positive correlation between HbA1c values and both pre-contrast pancreatic T1 value and ECV (r = 0.79, P < 0.001 and r = 0.60, P < 0.001, respectively) were observed. The pre-contrast pancreatic T1 value and ECV were significantly higher in T2DM vs. no-diabetes subjects and pre-diabetes (P < 0.001). No significant difference between two qualitative values (P = 0.14) was found, however, the sensitivity, specificity, and area under the receiver-operating-characteristic curve differentiating no-diabetes subjects and pre-diabetes from T2DM were superior in ECV (100%, 93.5%, and 0.990) vs. pre-contrast pancreatic T1 values (84.6%, 96.8%, and 0.906). CONCLUSIONS: The ECV of the pancreas could serve as a potential imaging biomarker for the assessment of pancreatic fibrosis leading to IGT.
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Intolerancia a la Glucosa , Imagen por Resonancia Magnética/métodos , Enfermedades Pancreáticas/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Medios de Contraste , Femenino , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Sensibilidad y Especificidad , Relación Señal-RuidoRESUMEN
PURPOSE: To evaluate the correlation between HeF obtained from gadoxetic acid-enhanced MR imaging and clinical biomarkers for the assessment of liver function. METHODS: This prospective study was approved by our Institutional Review Board, and written informed consent was obtained from the patients. We recruited 48 patients carrying a known or suspected liver disease to undergo gadoxetic acid-enhanced MR imaging. The new model of the HeF was calculated from ΔR1 values of the liver and spleen. The HeF, quantitative liver-to-spleen contrast ratio (Q-LSC), and ΔT1 value (the reduction rate of the T1 value between the pre- and post-contrast images) were compared with the Child-Pugh and end-stage liver disease (MELD) scores. RESULTS: Among 48 patients, 40 were in Child-Pugh class A and 8 were in class B. The median HeF (P = 0.0001), Q-LSC (P = 0.015), and ΔT1 value (P = 0.0023) in patients in Child-Pugh class A were significantly higher than those in class B. The sensitivities, specificities, and area under the receiver-operating-characteristic curves for differentiating Child-Pugh class A and B were 95.0%, 87.5%, and 0.93 in the HeF; 77.5%, 75.0%, and 0.78 in the Q-LSC; and 57.5%, 100.0%, and 0.84 in the ΔT1 value, respectively. The HeF was significantly correlated with Child-Pugh (r = - 0.58, P < 0.0001) and MELD score (r = - 0.57, P < 0.0001). CONCLUSIONS: The HeF was well correlated with Child-Pugh and MELD score and could be a new biomarker to assess liver function.
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Gadolinio DTPA , Hepatocitos/fisiología , Aumento de la Imagen/métodos , Hepatopatías/diagnóstico por imagen , Hepatopatías/fisiopatología , Imagen por Resonancia Magnética/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Medios de Contraste , Femenino , Humanos , Hígado/diagnóstico por imagen , Hígado/fisiopatología , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
To assess if intravoxel incoherent motion (IVIM) imaging can be used to predict early response to chemoradiotherapy (CRT) in cervical cancer. IVIM imaging before and during CRT (at doses of 20 and 40 Gy) was performed in 17 patients with cervical squamous cell carcinoma. The percentage changes of IVIM parameters were significantly higher for complete remission (CR) than non-CR groups. IVIM may play a supplementary role for predicting early response to CRT in cervical cancer.
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Quimioradioterapia , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Neoplasias del Cuello Uterino , Femenino , Humanos , Pronóstico , Resultado del Tratamiento , Neoplasias del Cuello Uterino/diagnóstico por imagen , Neoplasias del Cuello Uterino/terapiaRESUMEN
PURPOSE: To assess the combined parallel imaging (PI) and optimized integrated compressed sensing technique (prototype Compressed SENSE) for magnetic resonance cholangiopancreatography (MRCP) compared with conventional MRCP. METHODS: This prospective study was approved by our Institutional Review Board, and all patients provided written informed consent. A total of 56 consecutive patients (27 men and 29 women; mean age 67.2 years) underwent breath-hold three-dimensional (3D) MRCP with PI alone (BH-MRCP; acquisition time, 23 s), respiratory-triggered 3D MRCP with PI alone (RT-MRCP; 201 s) and respiratory-triggered 3D MRCP with Compressed SENSE (RT-MRCPcs; 45 s). Relative duct-to-periductal contrast ratios (RCs) of the pancreaticobiliary ducts were calculated for quantitative image analyses. Two radiologists graded the visibility of the pancreaticobiliary ducts, pancreatic cystic lesion, motion artifact, and overall image quality using a five-point rating scale for qualitative image analyses. Theses qualitative and quantitative measurements were then compared among the three sequences. RESULTS: RCs of the common bile duct, right hepatic duct (RHD), left hepatic duct (LHD), and main pancreatic duct at the pancreatic head, body, and tail segments, were significantly higher RT-MRCP, followed by RT-MRCPcs and BH-MRCP (P < 0.001). The visibility of the peripheral RHD and LHD was slightly better in RT-MRCP than in RT-MRCPcs and BH-MRCP (P < 0.001). The visibility of other pancreaticobiliary ducts, pancreatic cystic lesion, motion artifact, and overall image quality were almost comparable among three sequences. CONCLUSION: The acquisition time was markedly reduced in RT-MRCPcs compared with conventional RT-MRCP while there were significant differences in both quantitative and qualitative analyses, the differences were small enough that the reduced acquisition time makes up for it.
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Enfermedades de las Vías Biliares/diagnóstico por imagen , Pancreatocolangiografía por Resonancia Magnética/métodos , Enfermedades Pancreáticas/diagnóstico por imagen , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artefactos , Contencion de la Respiración , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Técnicas de Imagen Sincronizada RespiratoriasRESUMEN
PURPOSE: To compare four free-breathing scan techniques for gadoxetic acid-enhanced hepatobiliary phase imaging with conventional breath-hold scans. MATERIALS AND METHODS: Gadoxetic acid-enhanced hepatobiliary phase imaging with six image acquisition sets performed in 50 patients. Image acquisition sets included fat-suppressed 3D T1-weighted turbo field echo with free-breathing pseudo-golden-angle radial stack-of-stars (FBRS) acquisition, FBRS with track (FBRST), FBRS with gate and track (FBRSG&T), thin-slice FBRS with gate and track (thin-slice FBRSG&T), free-breathing Cartesian acquisition (CartesianFB), and breath-hold Cartesian acquisition (CartesianBH). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and image quality compared to the six-image acquisition sets. RESULTS: Signal-to-noise ratio and CNR were significantly higher in FBRS, FBRST, FBRSG&T, and thin-slice FBRSG&T than in CartesianFB and CartesianBH (P < 0.001). Based on sharpness, motion artifacts, visibility of intrahepatic vessels, and overall image quality, thin-slice FBRSG&T had the highest image quality followed by CartesianBH and FBRSG&T (P < 0.001). Severe motion artifacts were observed in 25 patients in CartesianFB and three patients in CartesianBH, whereas image quality remained above the acceptable range in FBRSG&T, FBRST, FBRS, and thin-slice FBRSG&T in all cases. CONCLUSION: Thin-slice FBRSG&T demonstrated excellent image quality compared with conventional CartesianBH in gadoxetic acid-enhanced hepatobiliary phase imaging. It can be apply to supplemental sequences of patients with unstable breath holding.