Comparison of Optimized 3D-SPACE and 3D-TSE Sequences at 1.5T MRCP in the Diagnosis of Choledocholithiasis.

PURPOSE: The aim of the study was to evaluate whether or not MRCP using a 3D-SPACE sequence allows for better image quality and a higher level of diagnostic confidence than a conventional 3D-TSE sequence at 1.5 T regarding the diagnosis of choledocholithiasis in a routine clinical setting. MATERIALS AND METHODS: 3D-SPACE and 3D-TSE sequences were performed in 42 consecutive patients with suspected choledocholithiasis undergoing MRCP. Evaluation of image quality and diagnostic confidence was done on the pancreaticobiliary tree which was subdivided into 10 segments. They were scored and statistically evaluated separately for visibility and diagnostic certainty by three radiologists with differing levels of experience on a five-point scale of 1 to 5 and -2 to 2, respectively. Student t-test was performed, and the interobserver agreement was also calculated. RESULTS: Image quality for each segment was significantly better for the 3D-SPACE sequence compared to the 3D-TSE sequence (4.48 ±â€Š0.94 vs. 3.98 ±â€Š1.20; 5-point scale p < 0.01). Diagnostic confidence for the reporting radiologist was also significantly better for 3D-SPACE than for 3D-TSE (1.68 ±â€Š0.56 vs. 1.46 ±â€Š0.70; 3-point scale; p < 0.01). The interobserver agreement was high in both sequences, 0.62 - 0.83 and 0.64 - 0.82, respectively. CONCLUSION: The optimized 3D-SPACE sequence allows for better image quality in 1.5 T MRCP examinations and leads to a higher diagnostic confidence for choledocholithiasis compared to the conventional 3D-TSE sequence. KEY POINTS: • 3D-SPACE allows for better image quality in 1.5 T MRCP.• This leads to a higher diagnostic confidence particularly in the periampullary region.• 3D-SPACE should be considered to substitute conventional 3D-TSE sequences in clinical routine MRCP.

Radioembolisation using yttrium 90 (Y-90) in patients affected by unresectable hepatic metastases.

PURPOSE: This study was done to evaluate the effectiveness of radioembolisation of liver metastases with yttrium 90 (Y-90) in patients with no response to chemotherapy. MATERIALS AND METHODS: From February 2005 to January 2008, we treated 110 patients affected by liver metastatic disease from colorectal, breast, gastric, pancreatic, pulmonary, oesophageal and pharyngeal cancers and from cholangiocarcinoma and melanoma. We excluded patients with bilirubin level >1.8 mg/dl and pulmonary shunt >20% but not patients with minor extrahepatic metastases. RESULTS: We obtained a complete /partial response in 45 patients, stable disease in 42 patients and progressive disease in 23 patients. In 90 cases, we obtained a decrease in specific tumour marker level. The technical success rate was 96%, and technical effectiveness estimated at 3 months after treatment was 83.6%. Side effects were grade 4 hepatic failure in one case, grade 2 gastritis in six cases and grade 2 cholecystitis in two cases. The median survival and progression-free survival calculated by Kaplan-Meier analysis were 323 days and 245 days, respectively. CONCLUSIONS: According to our 3-year experience, Y-90 radioembolisation (SIR-spheres) is a feasible and safe method to treat liver metastases with an acceptable level of complications and a good response rate.

Transient focal lesion in the splenium of the corpus callosum: MR imaging with an attempt to clinical-physiopathological explanation and review of the literature.

PURPOSE: This article discusses the possible pathophysiological conditions responsible for magnetic resonance imaging (MRI) finding of transient focal lesions in the splenium of the corpus callosum on the basis of our experience and a review of the literature. MATERIALS AND METHODS: In six patients undergoing computed tomography (CT) and MRI examinations, focal nonhemorrhagic lesions of the splenium of the corpus callosum were incidentally discovered. Patients had been referred for suspected encephalitis (n=2), dural sinus thrombosis (n=1) and multiple sclerosis (n=3). MRI examinations were repeated after 4, 8 and 12 weeks and in two cases also after 6 and 9 months. MRI and medical records were retrospectively reviewed with respect to patients' clinical history, medication and laboratory findings to define lesion aetiology. RESULTS: In all patients, the lesions were isolated, reversible and with no contrast enhancement. In four patients, the lesion disappeared after complete remission of the underlying disease, whereas in two patients, they persisted for 6 and 9 months, respectively. CONCLUSIONS: To our knowledge and according to previous reports, the fact that these lesions are detected in a relatively large number of conditions with heterogeneous etiopathogenetic factors leads to the hypothesis that a common underlying pathophysiological mechanism that, considering signal characteristic, reversibility and white matter location, could be represented by vasogenic oedema.