T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: An observational study.

INTRODUCTION AND AIMS: Contradictory results have been reported about hyperintensity of the globus pallidus and/or dentate nucleus on unenhanced T1-weighted magnetic resonance (MR) images after exposure to various gadolinium-based contrast agents. This change in signal intensity varies with different gadolinium-based contrast agents. We aimed to determine whether signal intensity in the dentate nucleus is increased in unenhanced T1-weighted images in patients who have undergone multiple studies with the macrocyclic gadolinium-based contrast agent gadoterate meglumine. We thoroughly reviewed the literature to corroborate our results. MATERIALS AND METHODS: We included patients who had undergone more than 10 MR studies with gadoterate meglumine. We quantitatively analyzed the signal intensity in unenhanced T1-weighted MR images measured in regions of interest placed in the dentate nucleus and the pons, and we calculated the dentate nucleus-to-pons signal intensity ratios and the differences between the ratio in the first MR study and the last MR study. We used t-tests to evaluate whether the differences between the signal intensity ratios were different from 0. We also analyzed the subgroups of patients who had been administered <15 and ≥15 doses of gadoterate meglumine. We used Pearson correlation to determine the relationships between the differences in the signal intensity ratios and the number of doses of gadoterate meglumine administered. RESULTS: The 54 patients (26 men) had received a mean of 13.8±3.47 doses (range, 10-23 doses). The difference in the dentate nucleus-pons signal intensity ratio between the first and last MR study was -0.0275±0.1917 (not significantly different from 0; p=0.2968) in the entire group, -0.0357±0.2204 (not significantly different from 0; p = 0.351 in the patients who had received <15 doses (n=34), and -0.0135±0.1332 (not significantly different from 0; p = 0.655) in those who had received ≥15 doses (n=20). Differences in signal intensity ratios did not correlate significantly with the accumulated dose of gadoterate meglumine (P = 0.9064; ρ = -0.0164 [95%]). CONCLUSIONS: Receiving more than 10 doses of gadoterate meglumine was not associated with increased signal intensity in the dentate nucleus.

Intensidad de la señal en T1 en el núcleo dentado tras la administración del agente de contraste con gadolinio macrocíclico gadoterato de meglumina: un estudio observacional / T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: an observational study

Introducción y objetivo: Se han notificado resultados contradictorios sobre un aumento en la intensidad de la señal (IS) en las imágenes de resonancia magnética (RM) ponderadas en T1 no realzadas en el globo pálido y/o el núcleo dentado (ND) después de la exposición a varios agentes de contraste con gadolinio (ACG). Este cambio en la señal varía en función del ACG específico. Nuestro objetivo fue investigar si existe un aumento en la IS del ND en imágenes ponderadas en T1 no realzadas en pacientes sometidos a múltiples administraciones del ACG macrocíclico gadoterato de meglumina. Se realizó una revisión exhaustiva de la bibliografía para corroborar nuestros resultados. Materiales y métodos: Se incluyeron pacientes que se habían sometido a más de 10 estudios de RM con contraste y administración exclusiva de gadoterato de meglumina. Se llevó a cabo un análisis cuantitativo mediante el uso de mediciones de regiones de interés en el ND y el puente en imágenes no realzadas ponderadas en T1. Se calcularon las proporciones ND-puente y las diferencias en las proporciones entre el inicio y la última RM realizada. Se utilizó una prueba de la t de una muestra para evaluar si las diferencias en la proporción de la IS difieren de 0. Se realizó un análisis de subgrupos de pacientes con<15 y ≥15 dosis. Se utilizó el análisis de correlación de Pearson para determinar las correlaciones entre las diferencias de las proporciones de la IS y el número de administraciones del ACG.(AU)

Introduction and aims: Contradictory results have been reported about hyperintensity of the globus pallidus and/or dentate nucleus on unenhanced T1-weighted magnetic resonance (MR) images after exposure to various gadolinium-based contrast agents. This change in signal intensity varies with different gadolinium-based contrast agents. We aimed to determine whether signal intensity in the dentate nucleus is increased in unenhanced T1-weighted images in patients who have undergone multiple studies with the macrocyclic gadolinium-based contrast agent gadoterate meglumine. We thoroughly reviewed the literature to corroborate our results. Materials and methods: We included patients who had undergone more than 10 MR studies with gadoterate meglumine. We quantitatively analyzed the signal intensity in unenhanced T1-weighted MR images measured in regions of interest placed in the dentate nucleus and the pons, and we calculated the dentate nucleus-to-pons signal intensity ratios and the differences between the ratio in the first MR study and the last MR study. We used t-tests to evaluate whether the differences between the signal intensity ratios were different from 0. We also analyzed the subgroups of patients who had been administered<15 and ≥15 doses of gadoterate meglumine. We used Pearson correlation to determine the relationships between the differences in the signal intensity ratios and the number of doses of gadoterate meglumine administered.(AU)

T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: an observational study. / Intensidad de la señal en T1 en el núcleo dentado tras la administración del agente de contraste con gadolinio macrocíclico gadoterato de meglumina: un estudio observacional.

INTRODUCTION AND AIMS: Contradictory results have been reported about hyperintensity of the globus pallidus and/or dentate nucleus on unenhanced T1-weighted magnetic resonance (MR) images after exposure to various gadolinium-based contrast agents. This change in signal intensity varies with different gadolinium-based contrast agents. We aimed to determine whether signal intensity in the dentate nucleus is increased in unenhanced T1-weighted images in patients who have undergone multiple studies with the macrocyclic gadolinium-based contrast agent gadoterate meglumine. We thoroughly reviewed the literature to corroborate our results. MATERIALS AND METHODS: We included patients who had undergone more than 10 MR studies with gadoterate meglumine. We quantitatively analyzed the signal intensity in unenhanced T1-weighted MR images measured in regions of interest placed in the dentate nucleus and the pons, and we calculated the dentate nucleus-to-pons signal intensity ratios and the differences between the ratio in the first MR study and the last MR study. We used t-tests to evaluate whether the differences between the signal intensity ratios were different from 0. We also analyzed the subgroups of patients who had been administered<15 and ≥15 doses of gadoterate meglumine. We used Pearson correlation to determine the relationships between the differences in the signal intensity ratios and the number of doses of gadoterate meglumine administered. RESULTS: The 54 patients (26 men) had received a mean of 13.8±3.47 doses (range, 10-23 doses). The difference in the dentate nucleus-pons signal intensity ratio between the first and last MR study was -0.0275±0.1917 (not significantly different from 0; p=0.2968) in the entire group, -0.0357±0.2204 (not significantly different from 0; p=0.351 in the patients who had received <15 doses (n=34), and -0.0135±0.1332 (not significantly different from 0; p=0.655) in those who had received ≥15 doses (n=20). Differences in signal intensity ratios did not correlate significantly with the accumulated dose of gadoterate meglumine (P=0.9064; ρ=-0.0164 [95%]). CONCLUSIONS: Receiving more than 10 doses of gadoterate meglumine was not associated with increased signal intensity in the dentate nucleus.

T1 Signal-Intensity Increase in the Dentate Nucleus after Multiple Exposures to Gadodiamide: Intraindividual Comparison between 2 Commonly Used Sequences.

BACKGROUND AND PURPOSE: Different T1-weighted sequences have been used for qualitative and quantitative evaluation of T1 signal intensity related to gadolinium deposition in the dentate nucleus in patients who underwent several enhanced MR imaging studies. Our purpose was to perform an intraindividual qualitative and quantitative comparison between T1-weighted spin-echo and 3D magnetization-prepared rapid acquisition of gradient echo sequences in patients who had multiple exposures to gadodiamide. MATERIALS AND METHODS: Our retrospectively selected population included 18 patients who underwent at least 3 administrations of gadodiamide and had a baseline and a final MR imaging performed with both T1-weighted sequences. Qualitative and quantitative analyses were independently performed. Dentate nucleus/middle cerebellar peduncle signal-intensity ratios and signal changes between the baseline and final examinations were compared by using the Wilcoxon signed rank test. Correlation between quantitative and qualitative evaluations was assessed by using a polyserial correlation test. RESULTS: The differences between the 2 sequences for both baseline and last examination dentate nucleus/middle cerebellar peduncle ratios were statistically significant (P = .008 and P = .006, respectively); however, the signal-intensity changes of the ratios with time were not (P = .64). The correlation between the qualitative and quantitative analysis was very strong (near-perfect) (r = 0.9) for MPRAGE and strong (r = 0.63) for spin-echo sequences. CONCLUSIONS: T1-weighted spin-echo and MPRAGE sequences cannot be used interchangeably for qualitative or quantitative analysis of signal intensity in the dentate nucleus in patients who received gadodiamide. Baseline and final examination ratios should be evaluated across time by using the same sequence. Qualitative analysis performed with MPRAGE correlated better with quantitative analysis and may offer advantages over spin-echo sequences for research purposes.

Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update.

In current practice, gadolinium-based contrast agents have been considered safe when used at clinically recommended doses in patients without severe renal insufficiency. The causal relationship between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with renal insufficiency resulted in new policies regarding the administration of these agents. After an effective screening of patients with renal disease by performing either unenhanced or reduced-dose-enhanced studies in these patients and by using the most stable contrast agents, nephrogenic systemic fibrosis has been largely eliminated since 2009. Evidence of in vivo gadolinium deposition in bone tissue in patients with normal renal function is well-established, but recent literature showing that gadolinium might also deposit in the brain in patients with intact blood-brain barriers caught many individuals in the imaging community by surprise. The purpose of this review was to summarize the literature on gadolinium-based contrast agents, tying together information on agent stability and animal and human studies, and to emphasize that low-stability agents are the ones most often associated with brain deposition.

Comparación de una secuencia en 3D con eco de gradiente potenciada en T1 con 3 factores de reducción de imagen en paralelo diferentes, en apnea y respiración libre, utilizando una bobina de 32 canales a 1,5T. Estudio preliminar / A comparison of a T1 weighted 3D gradient-echo sequence with three different parallel imaging reduction factors, breath hold and free breathing, using a 32 channel coil at 1.5T. A preliminary study

Objetivo. Analizar si el aumento de la resolución temporal utilizando mayores factores de reducción (FR) de imagen en paralelo (IP), tanto en apnea como con respiración libre, utilizando una secuencia 3D con eco de gradiente (EG) potenciada en T1, sin contraste y una bobina de múltiples elementos (phased array) de 32 canales, proporciona una calidad de imagen diagnóstica, con posibilidad de ser aplicada en pacientes que no puedan cooperar para mantener la apnea. Material y métodos. Se incluyeron en el estudio 9 sujetos sanos (5 mujeres y 4 varones; rango de edad: 20-49; media: 36 años). Se les realizó un estudio de RM abdominal con secuencias 3D EG en un equipo de 1,5T con bobina de múltiples elementos (phased-array) de 32 canales con FR de imagen en paralelo de 2, 4 y 6, en apnea y con respiración libre. Dos revisores evaluaron retrospectiva y cualitativamente la calidad de imagen de las secuencias, la magnitud de los artefactos, incluyendo los artefactos de movimiento por reducción de señales, de solapamiento (aliasing), de granulado de los píxeles y la heterogeneidad de la señal. Los resultados se compararon mediante la prueba de Wilcoxon de los rangos con signo y la corrección de Bonferroni para comparaciones múltiples. Resultados. La adquisición en apnea proporcionó mejor calidad de imagen y menos artefactos que la adquisición con respiración libre. La tasa de artefactos fue mayor para FR más altos. La mejor calidad se obtuvo con secuencias en apnea con un FR = 2. Un FR = 4 presentó tasas menores pero diagnósticas (p = 0,004). La severidad de los artefactos, en especial el granulado de los píxeles (p = 0,004), hizo que las secuencias con un FR = 6 no fueran diagnósticas. Ninguna de las secuencias obtenidas con respiración libre fue diagnóstica. Conclusión. Las secuencias obtenidas en apnea con un FR = 2 presentaron una calidad de imagen excelente, y aquellas con un FR = 4 presentaron una calidad buena y potencialmente se pueden aplicar en pacientes poco colaboradores. Ninguna de las secuencias obtenidas con respiración libre se consideró diagnóstica (AU)

Purpose. To investigate whether increasing temporal resolution with higher parallel imaging (PI) reduction factors (RF) in both breath-hold and free breathing approaches, using a non-contrast T1-weighted 3D gradient echo (GRE) sequence and a 32-channel phased array coil, permits diagnostic image quality, with potential application in patients unable to cooperate with breath-hold requirements. Materials and methods. The 9 healthy subjects (5 females and 4 males; age range was 20-49, mean 36 yrs) were recruited. A 3D GRE MR imaging of the abdomen was performed on 1.5T MR system using a 32-element phased-array torso coil with PI RFs of 2, 4 and 6, breath hold and free breathing. Two reviewers retrospectively qualitatively evaluated all sequences for image quality, extent of artifacts, including motion, truncation, aliasing, pixel graininess and signal heterogeneity. The results were compared using Wilcoxon signed rank and a Bonferroni adjustment was applied for multiple comparisons. Results. Image quality and extent of artifacts were better with breath hold than with free breathing acquisitions. The rate of artifacts increased with higher RF. The best quality was acquired with breath hold sequence using RF=2. RF=4 had lower but diagnostic rates (P=.004). The severity of artifacts, mainly pixel graininess (P=.004), rendered sequences with RF=6 non-diagnostic. All sequences were non-diagnostic in free breathing acquisitions. Conclusion. Breath hold sequences with RF=2 had excellent quality and RF=4 had good quality and may be potentially used in partially cooperative patients. None of the sequences was considered diagnostic in free breathing acquisitions (AU)

Secuencia de disparo único eco de gradiente en fase y fase opuesta con preparación de la magnetización: descripción y optimización de la técnica con equipo de 1, 5 T / In-phase and out-of-phase single-shot magnetization-prepared gradient recalled echo: description and optimization of technique at 1.5T

Objetivo: Implementar técnicas en fase y en fase opuesta (EF/FO) con eco de gradiente con preparación de la magnetización (Magnetization-Prepared Gradient Recalled Echo [MP-GRE]) y evaluar la viabilidad y la calidad de imagen diagnóstica entre las secuencias MP-GRE antes y después de la optimización, incluyendo aquellos pacientes que no pueden colaborar manteniendo la apnea. Material y métodos: Para la realización del presente estudio retrospectivo, llevado a cabo de conformidad con la ley HIPPA de protección de datos médicos de EE.UU., se obtuvo la aprobación del Comité de Ética Institucional con exención de obtención del consentimiento informado. Se incluyeron 2 grupos de pacientes en el estudio, antes y después de la optimización de los parámetros MP-GRE, con 73 (24 no colaboradores/49 colaboradores) y 64 (22 no colaboradores/42 colaboradores) pacientes consecutivos, respectivamente. La secuencia no sensible al movimiento usada en este estudio fue 2D MP-GRE con técnica de disparo único. Dos radiólogos evaluaron cualitativamente las secuencias para identificar la presencia de artefactos de cancelación de fase en las imágenes en FO y para determinar la calidad de imagen, la extensión de los artefactos (artefacto de fantasma, artefacto de cancelación de señal, error de registro espacial y granulado de los píxeles) y la visibilidad de las lesiones en las diferentes secuencias. También se evaluó la capacidad para detectar visualmente esteatosis hepática y adenomas suprarrenales de contenido graso. Los análisis cualitativos se compararon mediante las pruebas de Wilcoxon y Mann-Whitney. Resultados: Hubo diferencias estadísticamente significativas entre todas las secuencias MP-GRE en lo relativo al artefacto de cancelación de fase (p < 0,0001), presente en las secuencias MP-GRE FO y despreciable o ausente en las secuencias MP-GRE EF, tanto antes (EF1) como después (EF2) de la optimización, en todos los pacientes. Los artefactos de cancelación de señal fueron significativamente más marcados en las secuencias in MP-GRE EF1 (p < 0,0001). El error de registro espacial fue ligeramente más marcado en las secuencias MP-GRE EF2 (p = 0,0027) en los pacientes no colaboradores. Las secuencias MP-GRE en FO y las secuencias MP-GRE EF2 mostraron una calidad de imagen significativamente mayor (p < 0,0001).En las secuencias MP-GRE se identificaron subjetivamente la esteatosis hepática (n = 20) y los adenomas suprarrenales (n = 5) basándose en la pérdida de señal desde la secuencia EF a la secuencia en FO. Conclusión: La técnica de disparo único MP-GRE EF/FO es una técnica viable que permite la obtención de imágenes resistentes al movimiento, ofreciendo una calidad de imagen diagnóstica adecuada. Esta técnica puede proporcionar información EF y en FO de pacientes que no son capaces de mantener la apnea (AU)

Purpose: To implement in-phase and out-of-phase (IP/OP) techniques with Magnetization-Prepared Gradient Recalled Echo (MP-GRE) and to evaluate the feasibility and diagnostic image quality among pre and post-optimized MP-GRE sequences, including patients unable to cooperate with breath-hold requirements. Materials and methods: Institutional review board approval with waiver of informed consent was obtained for this HIPAA-compliant retrospective study. Two groups of patients were included in the study, before and after optimization of MP-GRE parameters, with seventy-three (24 noncooperative/49 cooperative) and sixty-four (22 noncooperative/42 cooperative) consecutive patients, respectively. The motion-insensitive sequence used in this study was a single-shot 2D MP-GRE. Two radiologists qualitatively evaluated the sequences to identify the presence of phase cancellation artifact in OP images and to determine image quality, extent of artifacts (respiratory ghosting, bounce-point artifact, spatial misregistration and pixel graininess) and lesion conspicuity on the various sequences. The ability to visually detect liver steatosis and fatty adrenal adenomas was evaluated. Qualitative analyses were compared using the Wilcoxon and Mann-Whitney tests. Results: There were statistically significant differences between all MP-GRE sequences concerning phase cancellation artifact (P<.0001) which was present in MP-GRE OP sequences and negligible to absent in the pre (IP1) and post-optimized (IP2) MP-GRE IP sequences, respectively, in all patients. Bounce point artifacts were significantly more pronounced in MP-GRE IP1 (P<0.0001). Spatial misregistration was slightly more prominent in noncooperative patients with MP-GRE IP2 (P=0.0027). MP-GRE OP and MP-GRE IP2 showed significantly higher overall image quality (P<0.0001).MP-GRE sequences subjectively identified hepatic steatosis (n=20) and adrenal adenomas (n=5) based on signal loss from IP to OP sequence. Conclusion: Single shot IP/OP MP-GRE is feasible and allows motion resistant imaging with adequate diagnostic image quality. This technique is able to provide IP and OP information in patients unable to suspend respiration (AU)

A comparison of a T1 weighted 3D gradient-echo sequence with three different parallel imaging reduction factors, breath hold and free breathing, using a 32 channel coil at 1.5 T. A preliminary study.

PURPOSE: To investigate whether increasing temporal resolution with higher parallel imaging (PI) reduction factors (RF) in both breath-hold and free breathing approaches, using a non-contrast T1-weighted 3D gradient echo (GRE) sequence and a 32-channel phased array coil, permits diagnostic image quality, with potential application in patients unable to cooperate with breath-hold requirements. MATERIALS AND METHODS: The 9 healthy subjects (5 females and 4 males; age range was 20-49, mean 36 yrs) were recruited. A 3D GRE MR imaging of the abdomen was performed on 1.5 T MR system using a 32-element phased-array torso coil with PI RFs of 2, 4 and 6, breath hold and free breathing. Two reviewers retrospectively qualitatively evaluated all sequences for image quality, extent of artifacts, including motion, truncation, aliasing, pixel graininess and signal heterogeneity. The results were compared using Wilcoxon signed rank and a Bonferroni adjustment was applied for multiple comparisons. RESULTS: Image quality and extent of artifacts were better with breath hold than with free breathing acquisitions. The rate of artifacts increased with higher RF. The best quality was acquired with breath hold sequence using RF=2. RF=4 had lower but diagnostic rates (P=.004). The severity of artifacts, mainly pixel graininess (P=.004), rendered sequences with RF=6 non-diagnostic. All sequences were non-diagnostic in free breathing acquisitions. CONCLUSION: Breath hold sequences with RF=2 had excellent quality and RF=4 had good quality and may be potentially used in partially cooperative patients. None of the sequences was considered diagnostic in free breathing acquisitions.

[In-phase and out-of-phase single-shot magnetization-prepared gradient recalled echo: description and optimization of technique at 1.5 T]. / Secuencia de disparo único eco de gradiente en fase y fase opuesta con preparación de la magnetización: descripción y optimización de la técnica con equipo de 1,5 T.

PURPOSE: To implement in-phase and out-of-phase (IP/OP) techniques with Magnetization-Prepared Gradient Recalled Echo (MP-GRE) and to evaluate the feasibility and diagnostic image quality among pre and post-optimized MP-GRE sequences, including patients unable to cooperate with breath-hold requirements. MATERIALS AND METHODS: Institutional review board approval with waiver of informed consent was obtained for this HIPAA-compliant retrospective study. Two groups of patients were included in the study, before and after optimization of MP-GRE parameters, with seventy-three (24 noncooperative/49 cooperative) and sixty-four (22 noncooperative/42 cooperative) consecutive patients, respectively. The motion-insensitive sequence used in this study was a single-shot 2D MP-GRE. Two radiologists qualitatively evaluated the sequences to identify the presence of phase cancellation artifact in OP images and to determine image quality, extent of artifacts (respiratory ghosting, bounce-point artifact, spatial misregistration and pixel graininess) and lesion conspicuity on the various sequences. The ability to visually detect liver steatosis and fatty adrenal adenomas was evaluated. Qualitative analyses were compared using the Wilcoxon and Mann-Whitney tests. RESULTS: There were statistically significant differences between all MP-GRE sequences concerning phase cancellation artifact (P<.0001) which was present in MP-GRE OP sequences and negligible to absent in the pre (IP1) and post-optimized (IP2) MP-GRE IP sequences, respectively, in all patients. Bounce point artifacts were significantly more pronounced in MP-GRE IP1 (P<.0001). Spatial misregistration was slightly more prominent in noncooperative patients with MP-GRE IP2 (P=.0027). MP-GRE OP and MP-GRE IP2 showed significantly higher overall image quality (P<.0001). MP-GRE sequences subjectively identified hepatic steatosis (n=20) and adrenal adenomas (n=5) based on signal loss from IP to OP sequence. CONCLUSION: Single shot IP/OP MP-GRE is feasible and allows motion resistant imaging with adequate diagnostic image quality. This technique is able to provide IP and OP information in patients unable to suspend respiration.

Breast MRI: intraindividual comparative study at 1.5 and 3.0T; initial experience.

PURPOSE: To prospectively and intraindividually compare breast magnetic resonance imaging (MRI) at 1.5 Tesla (T) and 3.0T. METHODS: A prospective intraindividual Ethics Committee- approved study was performed in 31 women (average age 58.6±12.3 years), with 114 lesions (9 benign, 105 breast cancers; 24 patients with unilateral and 7 with bilateral cancers). Axial bilateral breast high-spatial resolution contrast-enhanced dynamic MRI was performed at 1.5T using 3 dimensional (3D) dynamic gradient-echo sequences in all patients (spatial resolution 1.1×0.7×2 mm; temporal resolution 41 sec per dynamic acquisition), and after 24-48 h at 3.0T (0.6×0.6×1.7 mm; temporal resolution 65 and 72 sec per dynamic acquisition). Contrast enhancement ratio, number and features of enhancing lesions, image quality and reliability were compared by two radiologists independently. RESULTS: 102 cancer lesions were detected at 1.5T and 105 cancer lesions were detected in 31 patients at 3.0T. One cancer lesion was observed at 1.5T which was missed at 3.0T, and 3 cancer lesions and one high-risk lesion (LCIS) were detected at 3.0T while missed at 1.5T. Enhancement rates were significantly higher at 1.5T (224.5±100.2) compared to 3.0T (133.7±38.3). Better image quality was observed at 3.0T. Interobserver reliability was higher at 3.0T (p= 0.684) compared to 1.5T (p= 0.351). CONCLUSION: Detection of breast cancer shows a trend of better performance at 3.0T than at 1.5T.

Aneurysm of the inferior vena cava: case report.

Venous aneurysms are uncommon. Despite their infrequency, venous aneurysms can present with significant clinical complications such as thrombosis, pulmonary embolism, and death. In this report, we present the case of a thrombosed inferior vena cava aneurysm discovered in a 16-year-old male who had deep vein thrombosis of the right lower extremity. Thrombosis of the inferior vena cava is uncommon in the pediatric population. Therefore, congenital abnormalities such as an inferior vena cava aneurysm should be considered when evaluating pediatric patients who present with deep vein thrombosis.

Early-enhancing non-neoplastic lesions on gadolinium-enhanced MRI of the liver.

AIM: To assess the frequency, cause, and significance of early-enhancing, non-neoplastic (EN) lesions on gadolinium-enhanced magnetic resonance imaging (MRI) of the liver performed for the detection of malignant hepatic tumours. MATERIALS AND METHODS: From September 1997 to September 2000, we reviewed the images of 125 patients, suspected of having hepatic tumours, in whom (1) gadolinium-enhanced triphasic dynamic gradient-recalled-echo (GRE) imaging in addition to unenhanced T1- and T2-weighted MRI was performed, (2) conventional angiography and combination computed tomography (CT) hepatic arteriography and CT during arterial portography were performed within 2 weeks of the MRI, and (3) definitive surgery within 2 weeks of the MRI or follow-up study by means of intravenously contrast-enhanced CT or MRI in 10 months or more was performed. Angiographic studies were correlated to determine the underlying causes of the EN lesions. RESULTS: We found 78 EN lesions in 36 patients (29%), ranging in size from 4 and 50 mm (mean, 12.2 mm). From the MR reports, our radiologists had prospectively diagnosed EN lesions as probable malignant tumours in eight (10%), possible malignant tumours in 36 (46%), and probable non-neoplastic lesion in 34 (44%). EN lesions were found in 27 of 81 (33%) cirrhotic patients and in nine of 44 (20%) non-cirrhotic patients. Fifty-one EN lesions (65%) were located along the liver edge. The shape was circular in 42 (54%), oval in 14 (18%), irregular in 12 (15%), wedge-shaped in seven (9%), and fan-shaped in three (4%). Twenty EN lesions (26%) appeared slightly hyperintense on T2-weighted images. The causes were non-neoplastic arterio-portal shunting in 48 (62%), cystic venous drainage in four (5%), rib compression in four (5%), aberrant right gastric venous drainage in two (3%), and unknown in 20 (26%). CONCLUSION: Over half the number of EN lesions were caused by non-neoplastic arterio-portal shunting, occasionally showing slight hyperintensity on T2-weighted images. On MR images the non-neoplastic nature of the EN lesion was often ascertained. Radiologists should not overcall EN lesions as malignant as the patients involved would be inappropriately considered inoperable. In problematic cases, further investigation with angiographic CT or follow-up imaging studies should be performed.

New contrast agents for imaging the liver.

The contrast agents suited for hepatic imaging can be divided into nonspecific, extracellular space- (ECS) directed, reticuloendothelial system- (RES) selective, and hepatocyte-selective compounds. There is a wide variation in regard to biodistribution, pharmacokinetics, contrast behavior, and tissue specificity. The ECS contrast agents provide information on vascularization and perfusion similar to that of X-ray contrast agents. The RES- and hepatocyte-specific contrast agents offer more "functional" information that may enhance tissue characterization; however, the biology of the different hepatocellular and nonhepatocellular tumors is limiting the diagnostic efficacy of the tissue-specific compounds in many respects.

Imaging of benign and malignant focal liver lesions.

Over the past 15 years, MR imaging of the abdomen and pelvis has progressed significantly. Although initially found to be useful as an adjunct to CT imaging for selective applications, MR imaging now is establishing a role as a primary diagnostic technique. Increasing evidence shows that MR imaging has advantages over CT regarding diagnostic sensitivity and specificity for many abnormalities of solid organs, bile and pancreatic ducts, bowel, peritoneum, and retroperitoneum. This article discusses and contrasts current MR and CT techniques for imaging the liver and discusses the relative ability to identify and diagnose focal liver disease.

Exophytic benign tumors of the liver: appearance on MRI.

The purpose of our study was to determine the MR imaging appearance of exophytic benign liver tumors on precontrast and postgadolinium images. We reviewed our 9.5 year experience with MRI of the liver with dynamic gadolinium enhanced imaging to identify four patients with five histologically proven exophytic benign liver tumors. The histological diagnoses were cavernous hemangioma (2), focal nodular hyperplasia (FNH) (1), and hepatocellular adenoma (HCA) (2 exophytic adenomas in a patient with adenomatosis of the liver). All MRI studies were performed at 1.5 T and included: in-phase and out-of-phase T1-weighted spoiled gradient echo (SGE), T2-weighted fat-suppressed echo train spin echo, single shot T2-weighted sequences, and serial postgadolinium T1-weighted SGE sequences without and with fat-suppression. Prospective interpretations were reviewed and retrospective consensus readings of all MR images were performed assessing location, size, origin, morphology, visibility of the connection to the liver, signal characteristics on precontrast T1-weighted and T2-weighted images, and enhancement patterns on serial postgadolinium images. Three of the five tumors were pedunculated and connected to the liver by a thin stalk, which was prospectively identified in one patient. On precontrast and serial postgadolinium images, all exophytic tumors showed signal characteristics comparable to imaging features of standard intraparenchymal benign liver tumors. Our findings illustrate that the characteristic T1, T2, and postgadolinium imaging findings of these tumors permit correct identification of their liver origin despite their exophytic location, even if their connection with liver is not visualized.

MR imaging findings of infectious cholangitis.

The purpose of this study was to evaluate the appearance of infectious cholangitis on MRI. The MR images of 13 patients (9 women, 4 men; age range, 14-79 years) with clinically confirmed infectious cholangitis, who represent our complete 9.5 year experience with this entity, were retrospectively evaluated. All MR studies were performed at 1.5 T and included: in-phase and out-of-phase T(1)-weighted spoiled gradient echo (SGE), T(2)-weighted fat-suppressed echo train spin echo, single shot T(2)-weighted sequences, and serial postgadolinium T(1)-weighted SGE sequences without and with fat-suppression. The biliary ductal system was evaluated regarding presence of dilatation, stenosis, wall irregularities, wall thickening, and gadolinium enhancement of duct walls. The liver parenchyma was evaluated regarding focal signal abnormalities on precontrast and serial postgadolinium images. Biliary ductal dilatation was observed in 100% of patients. Mild to moderate thickening of bile duct walls combined with increased enhancement on postgadolinium images was observed in 92% of patients. The liver parenchyma showed periportal or wedge-shaped areas of hyperintense signal on T(2)-weighted images in 69% of patients. On T(1)-weighted images, 54% of patients showed areas of hypointense signal and 15% of patients showed wedge-shaped hyperintense areas. Areas with increased enhancement on immediate postgadolinium SGE were observed in 58% of patients, and in 42% of patients increased enhancement persisted on 2 min postgadolinium fat-suppressed images. Distinctive MRI findings on pre- and postgadolinium images are appreciated for infectious cholangitis.

Acute renal failure: common occurrence of preservation of corticomedullary differentiation on MR images.

The purpose of this study was to evaluate the relationship between renal corticomedullary differentiation (CMD) on MR imaging and serum creatinine (sCr) level in patients with acute renal failure (ARF). Twenty-one patients with ARF were retrospectively investigated. In all 21 patients, sCr levels were obtained on the same date as the MR study, and within 8 days before and after the MR study. CMD was assessed on non-contrast T(1)-weighted images and immediate post-gadolinium spoiled gradient echo (Gd-SGE) images. Presence of CMD was graded into 3 groups as 'preserved', 'intermediate', or 'loss'. On non-contrast T(1)-weighted images, 12/21 (57%) showed loss of CMD and 9/21 (43%) showed preserved CMD. On immediate Gd-SGE images, 5/21 (24%) showed loss of CMD, 12/21 (57%) preserved CMD, and 4/21 (19%) intermediate CMD. The sCr levels of 9 patients with preserved CMD on non-contrast T(1)-weighted images ranged from 1.4 to 10.5 mg/dl (mean 4.6 mg/dl), while those of 12 patients with loss of CMD ranged from 1.6 to 7.6 mg/dl (mean 4.8 mg/dl), which was not statistically significant (p > 0.2). Renal CMD can remain preserved on non-contrast T(1)-weighted or immediate Gd-SGE images in patients with acute presentation of ARF, independent of sCr level.

MRI of carcinoid tumors: spectrum of appearances in the gastrointestinal tract and liver.

The purpose of this study was to evaluate the spectrum of appearances of gastrointestinal carcinoid tumors at magnetic resonance imaging (MRI) and to elucidate patterns of appearances of carcinoid liver metastases on precontrast and postgadolinium images. The MR examinations of 29 patients (11 men, 18 women; age range, 33-87 years) with histologically confirmed gastrointestinal carcinoid tumors, representing our complete 9.5 years of experience with this entity, were retrospectively reviewed. Twelve patients had MR examinations prior to resection or biopsy of the primary tumor (preoperative group); 17 patients were imaged postsurgically (postoperative group). All MR studies were performed at 1.5 T and comprised T1-weighted spoiled gradient echo (SGE), T2-weighted fat-suppressed turbo spin echo, HASTE, and serial postgadolinium T1-weighted SGE sequences without and with fat suppression. Morphology, signal intensity, and contrast enhancement of primary tumors and of metastases to the mesentery, peritoneum, and liver were evaluated. Primary tumors were visualized in 8 of 12 patients and best demonstrated on postgadolinium T1-weighted fat-suppressed images. The appearance of primary tumors was a nodular mass originating from the bowel wall (4 of 12 patients) or regional uniform bowel wall thickening (4 of 12 patients) with moderate intense enhancement on postgadolinium images. In 4 of 12 patients the primary tumor was prospectively not seen. Mesenteric metastases, seen in eight patients, presented as nodular masses and were associated with mesenteric stranding in seven patients. A total of 156 liver metastases were evaluated in 16 patients. On precontrast T1- and T2-weighted images, 117 metastases (75%) were hypointense and hyperintense, respectively. A total of 146 metastases (94%) were hypervascular, showing moderate intense enhancement during the hepatic arterial phase, and 9 metastases (6%) were hypovascular. Twenty-three metastases (15%) were visible only on immediate postgadolinium images. MRI is able to demonstrate findings in carcinoid tumors, including the primary tumor, mesenteric metastases, and liver metastases. Liver metastases are commonly hypervascular and may be demonstrable only on immediate postgadolinium images.