Role of augmenter of liver regeneration on testicular ischemia and ischemia/reperfusion injury: An experimental study.

Background: Testicular torsion causes ischemic injury, and torsion causes reperfusion injury. Aim: Evaluating the role of augmenter of liver regeneration (ALR) in testicular ischemia and ischemia/reperfusion injury. Materials and Method(s): Seventy-eight (78) healthy Wistar albino male rats were randomly divided into four groups; control (C) (n = 6), sham (S) (n = 24), torsion (T) (n = 24), and torsion/detorsion (T/D) (n = 24). S, T, and T/D groups were divided into four subgroups (n = 6) as 1st, 2nd, 3rd, and 4th hours. Blood, tissue ALR, and histology analyses were performed between groups and subgroups. Results: The increase in plasma ALR values at the 3rd and 4th hours compared to the 1st hour in the T group were significant (P < 0.01, P < 0.001, respectively). In the T/D group, a significant increase was observed in plasma ALR values at the 3rd and 4th hours compared to the 1st hour (P < 0.05, P < 0.001, respectively). Plasma ALR values at the 1st, 2nd, 3rd, and 4th hours were higher in the T and T/D groups than in the C group (P < 0.001, P < 0.05, respectively). Plasma ALR values were higher in the T group at the 1st, 2nd, 3rd, and 4th hours than in the S group (P < 0.05). A significant increase was observed in tissue ALR at the 3rd and 4th hours than at the 1st hour in the T group (P < 0.05, P < 0.001, respectively). A significant increase was observed in tissue ALR at the 3rd and 4th hours than in the 1st hour in the T/D group (P < 0.05, P < 0.001, respectively). Discussion: ALR in plasma and testicular tissue has a potential role in the early diagnosis of testicular torsion and in predicting the prognosis of T and T/D.

Gingival crevicular fluid tissue/blood vessel-type plasminogen activator and plasminogen activator inhibitor-2 levels in patients with rheumatoid arthritis: effects of nonsurgical periodontal therapy.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the effect of nonsurgical periodontal therapy on clinical parameters and gingival crevicular fluid levels of tissue/blood vessel-type plasminogen activator (t-PA) and plasminogen activator inhibitor-2 (PAI-2) in patients with periodontitis, with or without rheumatoid arthritis (RA). MATERIAL AND METHODS: Fifteen patients with RA and chronic periodontitis (RA-P), 15 systemically healthy patients with chronic periodontitis (H-P) and 15 periodontally and systemically healthy volunteers (C) were included in the study. Plaque index, gingival index, probing pocket depth, clinical attachment level, bleeding on probing, gingival crevicular fluid t-PA and PAI-2 levels, erythrocyte sedimentation rate, serum C-reactive protein and disease activity score were evaluated at baseline and 3 mo after mechanical nonsurgical periodontal therapy. RESULTS: All periodontal clinical parameters were significantly higher in the RA-P and H-P groups compared with the C group (p < 0.001) and decreased significantly after treatment (p < 0.001). Pretreatment t-PA levels were highest in the RA-P group and significantly decreased post-treatment (p = 0.047). Pre- and post-treatment PAI-2 levels were significantly lower in controls compared with both periodontitis groups (p < 0.05). Gingival crevicular fluid volume and the levels of t-PA and PAI-2 were significantly correlated. CONCLUSION: In patients with periodontitis and RA, nonsurgical periodontal therapy reduced the pretreatment gingival crevicular fluid t-PA levels, which were significantly correlated with gingival crevicular fluid PAI-2 levels. The significantly higher t-PA and PAI-2 gingival crevicular fluid levels in periodontal patients, regardless of systemic status, suggest that the plasminogen activating system plays a role in the disease process of periodontitis.

Psychometric properties of a Turkish version of the oral health impact profile-14.

OBJECTIVES: The purpose of this study was to analyze and evaluate a Turkish translation of the oral health impact profile-14 (OHIP-14) in a Turkish population to provide an objective standard for future studies. METHODS: This cross-sectional research study consisted of three independent studies. Data were collected utilizing a personal interview and a review of periodontal records. This study was performed on 1205 subjects who were visiting for routine medical check-ups. The OHIP-14 was administered to measure oral health related to the quality of life, along with a questionnaire addressing demographic information, such as age, gender, and education. RESULTS: The reliability coefficient (Cronbach's alpha) of the Turkish version OHIP-14-TR (OHIP-14-TR) was reported to be nearly perfect in all 3 parts of our study (alpha 1: 0.82; alpha 2: 0.76; alpha 3: 0.91); additionally, values were greater than the recommended 0.70 threshold. Spearman's correlation coefficients showed that both OHIP scores significantly correlated with periodontal parameters, serving as proof of convergent validity (P < 0.01, P< 0.001). The principal component analysis with varimax rotation revealed seven factors. The OHIP-14-TR was more than 95% comprehensible. CONCLUSION: The OHIP-14-TR is a reliable, valid, and comprehensible scale for measuring oral health-related quality of life in the Turkish population.

A new technique for the reconstruction of complex portal vein anomalies in right lobe living liver donors.

Living donor liver right lobe transplantation using donors with variation of the right sectorial portal vein is considered a challenging procedure in terms of the donor's safety and the complexity of reconstruction in the recipient. We describe an innovative technique to reconstruct double portal vein orifices via a deceased donor iliac vein graft. The postoperative course of the recipient was uneventful. Doppler ultrasound on the fourth postoperative month revealed equivalent flow in both portal vein branches. Reconstruction of double right portal vein branches using a cryopreserved iliac vein is a valuable technique for utilizing right lobe grafts with challenging portal vein anatomy.

Bilateral renal artery dissection following extreme exertion.

Dissection of a renal artery is rare and is usually associated with underlying arterial disease. Bilateral renal artery dissection following extreme exertion is exceptionally uncommon, and thus presents a diagnostic challenge. We report a case of a middle-aged, otherwise healthy man who presented to the hospital with left flank pain after a long bicycling trip. Initial laboratory tests and urinalysis were normal. Careful review of a contrast-enhanced computed tomography angiogram (CTA) with 3D reconstruction revealed bilateral segmental renal artery dissection and thrombosis with corresponding renal infarcts. He was treated medically and rapidly recovered.

MRI and S-MRCP findings in patients with suspected chronic pancreatitis: correlation with endoscopic pancreatic function testing (ePFT).

PURPOSE: To review magnetic resonance imaging (MRI) and secretin stimulated magnetic resonance cholangiopancreatography (S-MRCP) findings of patients with suspected chronic pancreatitis and compare them with endoscopic pancreatic function testing (ePFT). MATERIALS AND METHODS: MRI and S-MRCP findings of 36 patients with clinically suspected chronic pancreatitis were reviewed. Baseline ductal changes, duodenal filling grades, and pancreatic duct caliber change (PDC) on S-MRCP, mean values of pancreatic anteroposterior (AP) diameter, signal intensity ratio (SIR) between pancreas and the spleen on T1-weighted fat saturated images, and arterial to venous (A/V) enhancement ratios were compared between groups of normal and abnormal pancreatic exocrine function determined by ePFT. RESULTS: All patients (n = 24) with normal ePFT (HCO(3) >80 mEq/L) had grade 3 normal duodenal filling. Patients with abnormal ePFT (HCO(3) <80 mEq/L) (n = 12) had grade 1 (n = 1) and grade 2 (n = 11) diminished duodenal filling (P < 0.0001). PDC was 1.51 in the normal ePFT group versus 1.27 in the abnormal ePFT group (P = 0.01). No significant differences were found in terms of mean pancreatic AP diameter (21.8 vs. 19.8 cm), SIR (1.59 vs. 1.44), and A/V (1.08 vs. 1.01) between groups of normal/abnormal pancreatic exocrine function. CONCLUSION: Despite discrepancies between pancreatic exocrine function and the findings on standard MRI/MRCP, the S-MRCP findings are comparable to ePFT in the evaluation of chronic pancreatitis.

Hepatobiliary and pancreatic MRI and MRCP findings in patients with HIV infection.

OBJECTIVE: The purpose of this article is to describe the spectrum of MRI and MR cholangiopancreatography (MRCP) findings of hepatic, pancreatic, and biliary manifestations in patients with HIV infection. CONCLUSION: The spectrum of MRI and MRCP findings in HIV-infected patients includes acute or chronic hepatitis (or both), pancreatitis, cholangitis, acalculous cholecystitis, and biliary strictures that may resemble primary sclerosing cholangitis. The presence of segmental extrahepatic biliary strictures is characteristic of AIDS cholangiopathy.

Imaging of liver disease: comparison between quadruple-phase multidetector computed tomography and magnetic resonance imaging.

BACKGROUND AND AIM: To compare quadruple-phase multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the assessment of focal and diffuse liver disease. METHODS: Quadruple-phase contrast-enhanced MDCT and MRI of 37 consecutive patients were retrospectively reviewed by two readers (R1 and R2). In patients with focal liver lesions, the gold standard was histopathology (n = 17) and/or long-term (>6 months) follow-up imaging (n = 27) or transarterial chemoembolization (n = 1). Diffuse liver disease was confirmed by histopathology in all patients, when present. RESULTS: Both readers identified 60 focal liver lesions on MDCT and 56 focal liver lesions on MRI. Gold standard diagnoses revealed 48 focal liver lesions in 25 patients. Diagnosis of malignant liver lesions revealed a sensitivity of 88% (R1) and 91% (R2) for MRI; 63% (R1) and 66% (R2) for MDCT; and a specificity of 75% (R1) and 79% (R2) for MRI; 50% (R1) and 64% (R2) for MDCT. MRI was superior to MDCT for the diagnosis of malignant focal liver lesions, when the mean areas under the alternative free-response receiver operating characteristic curves (A(Z)) were compared (MRI = 0.93 vs CT = 0.69), (P < 0.00001). Thirty-three patients had histopathologically confirmed diffuse liver disease. Overall diagnosis of diffuse liver disease revealed a sensitivity of 88% (R1) and 92% (R2) for MRI; 75% (R1) and 74% (R2) for MDCT; and a specificity of 100% for both modalities by both readers. CONCLUSIONS: MRI is superior for the assessment of malignant focal liver lesions and diffuse liver disease compared to quadruple-phase MDCT, and can be considered as primary diagnostic imaging modality for liver imaging.

Comparison between malignant and benign abdominal lymph nodes on diffusion-weighted imaging.

RATIONALE AND OBJECTIVES: The purpose of this study is to review the apparent diffusion coefficient (ADC) values of benign and metastatic abdominal lymph nodes on diffusion-weighted imaging (DWI). MATERIALS AND METHODS: Twenty-eight patients with a total of 40 benign (20 patients) and 16 malignant (8 patients) lymph nodes who underwent DWI MRI of the abdomen (b = 0.600) were enrolled in the study. ADC values of the lymph nodes were measured and comparison was made between benign and malignant groups. RESULTS: Mean ADC value of lymph nodes was 2.38 +/- 0.29 and 1.84 +/- 0.37 x 10(-3) mm(2)/sec in the benign and malignant groups, respectively. There was a significant statistical difference between the ADC values of benign and malignant lymph nodes (P < .0005). CONCLUSION: A wide range of ADC values exist in patients with metastatic abdominal lymph nodes, with a tendency of higher ADC values in benign lymph nodes.

Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses.

OBJECTIVE: To evaluate the value of dynamic MR imaging in the differential diagnosis of adrenal adenomas and malignant tumors, especially in cases with atypical adenomas. MATERIALS AND METHODS: Sixty-four masses (48 adenomas, 16 malignant tumors) were included in this prospective study. Signal loss of masses was evaluated using chemical shift MR imaging. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, with the acquisition starting simultaneously with i.v. contrast administration (0-100 s) followed by a T1-weighted FFE sequence in the late phase (5th minute). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained according to the SIs on the 0th, 25th, 50th 75th and 100th second. Also, the wash-in rate, maximum relative enhancement, time-to-peak, and wash-out of contrast at 100 s of masses in both groups were calculated. The statistical significance was determined by Mann-Whitney U test. To evaluate the diagnostic performance of the quantitative tests, receiver operating characteristic (ROC) analysis was performed. RESULTS: Chemical shift MR imaging was able to differentiate 44 out of 48 adenomas (91.7%) from non-adenomas. The 4 adenomas (8.3%) which could not be differentiated from non-adenomas by this technique did not exhibit signal loss on out-of-phase images. With a cut-off value of 30, SI indices of adenomas had a sensitivity of 93.8%, specificity of 100% and a positive predictive value of 100%. On visual evaluation of dynamic MR imaging, early phase contrast enhancement patterns were homogeneous in 75% and punctate in 20,83% of the adenomas; while patchy in 56.25% and peripheral in 25% of the malignant tumors. On the late phase images 58.33% of the adenomas showed peripheral ring-shaped enhancement and 10.41% showed heterogeneous enhancement. All of the malignant masses showed heterogeneous enhancement. At the 25th second, the SIs and wash-in rates of the adenomas were significantly higher than those of the malignant masses (p=0.010). Time-to-peak enhancement of the malignant masses was significantly longer than that of the adenomas. With a cut-off value of 52.85 s, the time-to-peak enhancement had 87.5% sensitivity and 80% specificity. CONCLUSION: Chemical shift MR has a high sensitivity and specificity in the differential diagnosis of adenomas and malignant adrenal masses. However, taking into consideration only the atypical adenomas, chemical shift MRI is of no diagnostic value. Although the diagnostic value of dynamic MRI is lower than chemical shift MRI, in the atypical cases contrast enhancement patterns and time-to-peak and wash-in rates derived from SI-time curve of dynamic MRI give are contributory to the results of chemical shift MRI.

Primary peritoneal carcinoma: computed tomography and magnetic resonance findings.

OBJECTIVE: To present computed tomography (CT) and magnetic resonance imaging (MRI) findings of primary peritoneal carcinoma (PPC) at initial presentation (IP) and recurrent disease (RD). METHODS: We studied 15 consecutive female patients (age range, 47-83 years; mean, 66.2 years) with pathologically proven PPC who underwent CT and/or MRI between July 2000 and December 2005. Preoperative radiological evaluation and postoperative follow-up was done with CT and/or magnetic resonance studies. All CT and MRI studies were evaluated retrospectively, independently, and blindly by 2 radiologists for the imaging findings of PPC. RESULTS: The imaging findings were as follows: ascites, 2 of 2 at IP, 9 of 10 at RD; peritoneal thickening and enhancement, 1 of 2 at IP, 9 of 10 at RD; peritoneal nodules or bulky mass lesions, 1 of 2 at IP, 8 of 10 at RD; lymph node involvement, 1 of 2 at IP, 3 of 10 at RD; and distant metastases, 1 of 10 at RD. CONCLUSION: Ascites, peritoneal thickening and enhancement, and peritoneal nodules or bulky mass lesions were the most frequent findings of PPC. Recurrent disease revealed similar findings compared with the IP.

Focal pancreatitis mimicking pancreatic mass: magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) findings including diffusion-weighted MRI.

BACKGROUND: Focal pancreatitis (FP) is a confined inflammation that mimics a pancreatic mass. Its imaging diagnosis is important to avoid unnecessary procedures. PURPOSE: To describe the spectrum of magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) and diffusion-weighted MRI (DWI) findings of focal pancreatitis mimicking pancreatic masses. MATERIAL AND METHODS: Findings of MRI/MRCP including DWI with a b value of 0 and 600 s/mm(2) in 14 patients with pancreatic masses on MRI were retrospectively reviewed and compared to normal pancreas in 14 patients as a control group. RESULTS: FP revealed hypointense signal intensity (SI) (3/14), hypo- to isointense SI (7/14), or isointense SI (4/14) on T1-weighted images, and hypointense SI (1/14), isointense SI (5/14), iso- to hyperintense SI (7/14), or hyperintense SI (1/14) on T2-weighted images compared to remaining pancreas (RP). MRCP images revealed dilatation of the common bile duct (CBD) and main pancreatic duct (MPD) (5/14), dilatation of the MPD only (3/14), dilatation of the CBD only (3/14), and normal MPD and CBD (3/14). Both FP and RP revealed three types of time-signal intensity curves: 1) rapid rise to a peak, with a rapid decline (FP=2, RP=4), 2) slow rise to a peak, followed by a slow decline (FP=5, RP=4), and 3) slower rise to a peak, with a slow decline or plateau (FP=7, RP=6). Mean apparent diffusion coefficient (ADC) values for FP and RP were 2.09+/-0.18 and 2.03+/-0.2 x 10(-3) mm(2)/s, respectively. ADC values of FP and RP revealed no significant difference. CONCLUSION: The spectrum of imaging findings of focal pancreatitis on MRI/MRCP including DWI was described. Findings of FP were not distinctive as compared to the remaining pancreas.

Magnetic resonance imaging measurement of left ventricular blood flow and coronary flow reserve in patients with chronic heart failure due to coronary artery disease.

BACKGROUND: Coronary sinus flow reflects global cardiac perfusion and has been used for the assessment of myocardial flow reserve, which is reduced in chronic heart failure(CHF). Coronary flow reserve (CFR) can be measured by using phase-contrast (PC)velocity-encoded cine (VEC) magnetic resonance imaging (MRI). PURPOSE: To quantify and compare global left ventricular (LV) perfusion and CFR inpatients with CHF and in a healthy control group by measuring coronary sinus flow with PC VEC MRI, and to correlate this with global LV perfusion, segmental first-pass perfusion, and viability in the same patients. MATERIAL AND METHODS: Cardiac MRI was performed in 20 patients with CHF of ischemic origin and in a control group of healthy subjects (n=11) at rest and after pharmacological stress induced by i.v. dipyridamole. The MRI protocol included cine MRI, VEC MRI, first-pass perfusion, and delayed contrast-enhanced MRI for viability.Global LV perfusion was quantified by measuring coronary sinus flow on VEC MRI at rest in all subjects. CFR was determined as the ratio of global LV perfusion before and after pharmacologic stress. RESULTS: At rest, global LV perfusion was not significantly different in patients with CHF and the control group. After administration of dipyridamole, global LV perfusion and CFR were significantly lower in patients with CHF compared to the control group(P<0.001). An inverse correlation was observed between CFR and the number of infarcted and/or ischemic segments (P=0.083, P=0.037). CONCLUSION: A combined cardiac MRI protocol including function and perfusion techniques together with VEC MRI can be used to evaluate global LV perfusion and CFR in patients with CHF. Global LV perfusion and CFR measurements may have potential in the monitoring of CHF. Impaired CFR may contribute to progressive decline in LV function in patients with CHF.

Quantitative assessment of the impacts of stoppa repair and total extraperitoneal repair on the lower extremity muscular functions in cases of unilateral inguinal hernia: a randomized controlled study.

PURPOSE: Choosing the best operative technique for unilateral inguinal hernia is a challenge for surgeons. Therefore, anticipating loss of strength in the lower extremity muscles could be the initial step to make the right decision. To this end, this prospective randomized controlled study compared the physical activity parameters of the lower extremity muscles in patients who underwent total extraperitoneal repair (TEP) and Stoppa repair. METHODS: Fifty patients with unilateral inguinal hernia who were 18-65 years of age were admitted to a single institution in a metropolitan city in Turkey. Patients were randomized in a 1:1 ratio to parallel study arms of TEP and STOPPA repair. They were evaluated in the preoperative period and on the postoperative day 3 for an objective isometric and isokinetic assessment of the pain-related functional changes in the lower extremity muscles. RESULTS: The measurement results obtained with the Cybex device on the postoperative day 3 were presented as numeric parameters in the digital setting, where the Stoppa repair resulted in a higher loss of strength in the lower extremities compared to the TEP repair. With respect to the total workforce loss in isokinetic muscular measurements at 90 °C/s extension, 90 °C/s flexion, 180 °C/s extension and 180 °C/s flexion, the difference between the TEP repair and Stoppa repair was statistically significant in favor of TEP repair (p < 0.05). CONCLUSION: This study is the first comparative study in the literature to demonstrate the favorable impact of the laparoscopic hernia repair on the physical activity on the same anatomic site compared to the open surgical procedure by using quantitative values. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02813057.

Serial contrast-enhanced MRI of the pancreas: correlation with secretin-stimulated endoscopic pancreatic function test.

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the relationship between the pancreatic enhancement on serial contrast-enhanced MRI (CEMRI) and pancreatic exocrine function using the secretin-stimulated endoscopic pancreatic function test (ePFT). MATERIALS AND METHODS: A total of 30 patients with clinical symptoms consistent with chronic pancreatitis underwent CEMRI of the abdomen and ePFT within a 1- to 4-week interval. CEMRI was performed in arterial, early venous, and late venous phases. Secretin ePFT was performed with the measurement of HCO(3) concentration from the duodenal aspirates after secretin stimulation. Contrast enhancement ratio of the arterial phase to early venous phase was measured on CEMRI (SIRa/SIRv). A three-point evaluation system was used for grading the HCO(3) concentration and the enhancement ratio on MRI. For the significance of correlation, kappa statistics was used. Sensitivity and specificity of CEMRI was determined for the diagnosis of early chronic pancreatitis accepting ePFT as a reference. RESULTS: Twenty patients had identical scores on both secretin ePFT and CEMRI. Ten patients revealed discrepancy in scores. Kappa statistics revealed moderate agreement between MRI and ePFT (kappa = 0.44). Sensitivity and specificity values for the diagnosis of pancreatitis were 82% and 57%, respectively. Positive predictive value was 56%, and negative predictive value was 86%. CONCLUSION: The results of our data indicate that serial CEMRI is an appropriate imaging technique to rule out early chronic pancreatitis. However, secretin-stimulated imaging or ePFT may still be needed for the definite diagnosis of pancreatic exocrine dysfunction.

Contrast agents for MR imaging of the liver.

Imaging of the liver is performed most often to detect and characterize focal liver lesions. MR imaging has been the method of choice to assess focal liver lesions accurately. Nonspecific intravenous contrast agents have been used for routine abdominal MR imaging protocols including liver imaging. Over the last 10 to 15 years new contrast agents have been developed that combine the excellent contrast resolution of MR imaging with improved tissue specificity. This article reviews various contrast agents that are in clinical use for liver MR imaging and discusses their potential clinical role.

Renal-related perinephric fluid collections: MRI findings.

We retrospectively reviewed MR studies on 10 patients with renal-related perinephric fluid collections who underwent MRI in three institutions between January 2001 and August 2004. All patients underwent MRI of the abdomen and T1-weighted, T2-weighted and serial contrast-enhanced images, including delayed-phase contrast-enhanced images 10-12 min after contrast injection, were obtained. Perinephric fluid collections in 5 patients revealed MRI findings of simple fluid content (i.e., hypointense on T1-weighted images and hyperintense on T2-weighted images). In another 5 patients, a complex perinephric fluid content (i.e., mixed hyper/hypointense on T1-weighted images and mixed hypo/hyperintense on T2-weighted images compatible with blood breakdown products and pus) was observed. In 5 patients, contrast extravasation on late-phase images that was compatible with urine leak was demonstrated. Our results suggest that MRI may determine the content of perinephric fluid collections on noncontrast T1-weighted and T2-weighted images and that contrast extravasation on late-phase images is associated with urine extravasation from renal collecting systems.

Anomalous pancreaticobiliary junction (APBJ) with the drainage of the uncinate process into the minor papilla: demonstration by MRI.

We report a case of a 30-year-old patient with anomalous pancreaticobiliary junction (APBJ) that has not been described before. The patient had a clinical history of recurrent attacks of pancreatitis, cholangitis and cholecystitis that were confirmed by abnormal laboratory values. Endoscopic retrograde cholangiopancreatography revealed a 20 mm long junction of choledoc and pancreatic duct, and uncinate process draining into the minor papilla. On MR cholangiopancreatography, strictures at the junction of hepatic duct, increased gallbladder wall thickness and intraductal stone in the pancreatic duct were demonstrated as complementary findings. Other MRI findings included decreased signal intensity of the pancreas consistent with fibrosis from past pancreatitis attacks and atrophy of the left liver lobe.

Future horizons in MR imaging.

In this article, we defined the major areas of active research in clinical MR imaging. Further increases in the number of parallel coils within an imaging array and in advances in parallel imaging pulse sequences and postprocessing will lead to further reductions in imaging time analogous to the impact of multidetector CT on helical CT. The synergism between parallel and high-field imaging will aid the development of high-field imaging. The combined dynamic and hepatic parenchymal enhancement of new contrast agents that have or may soon receive FDA approval will enable improved detection and characterization of liver lesions. The lymphotropic SPIO agents will remain an active area of clinical research to further assess their role in oncologic staging. Molecular imaging contrast research using magnetic particles and MR microscopy will continue to flourish. Screening examinations by MR imaging will re-main an area of research for the short- and intermediate term, with the final outcome dependent more on socioeconomic costs than the underlying capability of achieving high-quality screening studies.