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Objective:To compare the predictive value of contrast-enhanced ultrasound(CEUS) Liver Imaging Reporting and Date System(LI-RADS) version 2017 with magnetic resonance imaging(MRI) LI-RADS version 2018 applied alone or in combination for focal liver lesions in high-risk patients.Methods:From January 2018 to October 2021, the clinical and imaging datas of 212 patients with 300 nodules underwent CEUS and contrast-enhanced MRI(CEMRI) within 4 weeks in Ruijin Hospital and its Wuxi branch were retrospectively analyzed. Each nodule was categorized according to the CEUS LI-RADS v2017 and CT/MRI LI-RADS v2018. Inter-modalities agreement was assessed with Cohen′s Kappa. The diagnostic performances of the two classification criteria applied alone and in combination for the predictive value of malignant risk of focal liver lesions were compared using histopathology or follow-up as gold standard.Results:The inter-modalities agreement of CEUS LI-RADS v2017 and MRI LI-RADS v2018 was moderate (Kappa=0.441). The specificity of CEUS LR-5, MRI LR-5 and CEUS LR-5+ MRI LR-5 in the diagnosis of HCC was 93.66%, 95.07% and 88.73% ( P>0.05), respectively, positive predictive values of them were 93.13%, 93.81% and 89.81%( P>0.05), respectively. The sensitivity of CEUS LR-M, MRI LR-M and CEUS LR-M+ MRI LR-M in the diagnosis of non-HCC malignancy was 85.71%, 82.86% and 100%, respectively. CEUS LR-M+ MRI LR-M had higher sensitivity than MRI LR-M( P=0.033), whereas no difference was found between CEUS LR-M+ MRI LR-M and CEUS LR-M( P=0.063). Conclusions:The inter-modalities agreement of the LI-RADS category between CEUS and MRI is moderate. The specificity and positive predictive values of HCC in LR-5 of the CEUS and MRI LI-RADS are comparable. In addition, the sensitivity of non-HCC malignancy in LR-M of the CEUS and MRI LI-RADS are comparable. The combined application of CEUS and MRI LR-M can improve the diagnostic sensitivity of non-HCC malignancy.
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Primary female urethral adenocarcinoma is rare. This paper reports a case of primary urethral mucinous adenocarcinoma complicated with signet ring cell carcinoma. The patient underwent urethral tumor resection in another hospital. Postoperative examination indicated that the tumor remained, and the tumor was completely removed after urethral tumor resection. After 11 months of follow-up, there was no tumor residue or recurrence.
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Objective:To investigate the clinical value of iodine density map and low keV virtual monoenergetic images (VMI) derived from dual-layer spectral detector CT (DLCT) for the pancreatic neuroendocrine tumors (pNETs) detection.Methods:From January to June 2019, data of 23 pathologically confirmed patients of pNETs were retrospectively analyzed. All of the patients underwent pancreas enhanced DLCT scanning within 1 week before surgery. The conventional polyenergetic images (PI), iodine density map and 40, 50, 60, 70 keV VMI were generated. One resident radiologist with 3 years’ experience and one senior radiologist with over 10 years’ experience interpreted the images for the lesion detection independently using the following image series: PI, VMI (40-70 keV), PI combined with iodine density map. Lesion detection rates were recorded and compared among different image series. The CT value and noise of lesion, normal pancreatic parenchyma, and abdominal subcutaneous fat were measured in PI and VMI in both arterial and portal vein phases. The contrast-to-noise ratio (CNR) of lesion was calculated. The CT value of lesion and normal pancreatic parenchyma, CNR of lesion, and image noise were compared using repeated one-way ANOVA test. Subjective image quality was assessed with a 5-point scale and compared with Friedman test.Results:A total of 26 lesions were confirmed from 23 patients. For resident radiologist and senior radiologist, the detection rates of pNETs lesion using PI were 76.9% (20/26) and 84.6% (22/26) respectively, and both improved to 92.3% (24/26) using image series of 40 and 50 keV VMI. For senior radiologist, the pNETs lesion detection rate was further improved to 96.2% (25/26) using image series of PI with iodine map. The CT value of lesion and normal pancreatic parenchyma, CNR, and image noise had statistical differences among PI and VMI (40-70 keV) in both arterial and portal vein phase ( P<0.001). The mean CT attenuation and CNR of lesion in VMI increased significantly as the energy level decreased.The CNR of lesion in all VMI (40-70 keV) was significantly higher than that in PI. The median of subjective scores of image quality in PI and VMI (40-70 keV) were 3, 3, 4, 4, and 5 respectively, and the difference was statistically significant (χ2=66.393, P<0.001). Conclusions:The low keV VMI derived from DLCT can increase the CT value and CNR of pNETs, and the lesion detection rate can be improved combined with iodine density map. The CNR of pNETs is the highest in 40 keV VMI, and image noise is still lower than that of PI, so 40 keV VMI is recommended for clinical application.
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Objective To compare the appearances between chronic mastitis and breast cancer on MRI and investigate the differ-ential diagnostic value.Methods MRI data of 20 patients with chronic mastitis pathologically proved by biopsy or operation were ret-rospectively analyzed.30 cases of breast cancer were contemporaneously chosen as the control group.Morphological feature and dy-namic contrast-enhanced(DCE)manifestation of the lesions were evaluated and statistical difference was compared between mastitis and breast cancer.Morphological feature included configuration,spiculated sign,ring-like enhancement,peri-focal edema,skin thick-ening,nipple involvement and axillary lymph nodes enlargement.DCE manifestation contained calculating early enhancement ratio and drawing time-intensity curve (TIC).Results There were significant statistical differences among configuration,ring-like en-hancement and peri-focal edema between mastitis and breast cancer,respectively.No statistical differences could be found among spiculated sign,skin thickening,nipple involvement and axillary lymph nodes enlargement.Early enhancement ratio in the group of mastitis was 1.1 56±0.635 while 1.253±0.499 in the group of breast cancer and there was no statistical difference between them. There were 1 1 cases with type Ⅰ TIC,6 with type Ⅱ,3 with type Ⅲ in the lesions of mastitis,while 4 with type Ⅰ,1 1 with typeⅡ,1 5 with type Ⅲ in the lesions of breast cancer and significant statistical differences could be found between two groups.Conclu-sion Mastitis usually manifests as non-mass-like lesions on MRI.Ring-like enhancement,peri-focal edema and benign type TIC can be applied to discriminate mastitis from breast cancer.
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Objective To evaluate the changes of endometrial microcirculation between pre-and postmenopause with magnetic resonance dynamic contrast-enhanced perfusion weighted imaging (MR DCE-PWI)and intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI).Methods Thirty-three patients with normal endometrium (premenopause in 21 and postmenopause in 12)confirmed by pathology underwent DCE-PWI,IVIM-DWI and conventional MRI.Quantitative parameters of DCE-PWI and IVIM-DWI in the endometrium were analyzed and compared between pre-and postmenopause groups.Results The DCE-PWI parameters were significantly higher in premenopause group than those in postmenopause one with significant differences in Ktrans (0.161±0.081)min-1 vs (0.097±0.054)min-1 , Kep (0.285±0.145)min-1 vs (0.184±0.119)min-1 and IAUC60 (20.854±10.695)mmol·kg-1 ·s vs (10.481±6.253)mmol·kg-1 ·s. No significant differences were found between the two groups in IVIM-DWI parameters including D,D* and f values.Conclusion DCE-PWI,rather than IVIM-DWI,can be used to quantitatively evaluate the changes of endometrial microcirculation between pre-and postmenopause.
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Objective To investigate the value of susceptibility?weighted imaging (SWI) for characterization of small hepatocellular carcinoma (sHCC) in cirrhotic livers. Methods Two hundred seventy?two patients suspiciousof HCC underwent conventional MR imaging and susceptibility?weighted imaging (SWI). Two hundred and five patients were excluded due to either size larger than 3.0 cm, no cirrhosis or HCC. Finally, a total of 84 hepatocellular nodules in 67 patients were included in this prospective study. There were 22 DNs in 12 cases, 8 DNs with HCC foci in 7 cases, and 54 overt HCCs in 48 cases. Two abdominal radiologists independently evaluated signal intensity and enhancing pattern using conventional MRI set and conventional MRI combining with SWI set. A five?point scale was performed to evaluate diagnostic confidence of HCC. Kappa analysis was performed to assess interobserver agreement of the two sets by two readers.The diagnostic performance and confidence level were compared for each image set,ROC was used to evaluate the diagnostic efficiency.Results Good interobserver agreement was identified with a Kappa value of 0.923 for conventional MRI set and 0.865 for conventional MRI combining with SWI set, respectively. The diagnostic sensitivity, specificity, accuracy, and area under the alternative?free response ROC (Az) were 80.6% and 80.6%, 81.8% and 77.3%, 81.0% and 79.8%, 0.804 and 0.782 using conventional MRI set, and 93.5%and 85.5%, 90.9%and 86.4%, 92.9%and 85.7%, 0.898 and 0.859 using conventional MRI combining with SWI set for reader 1 and reader 2, respectively.The diagnostic confidence level of conventional MRI combining with SWI set for diagnosis of HCC with less than 2 cm in size(n=36) was significantly higher than that of conventional MRI (reader 1, 3.86±0.47 vs 3.40±0.91;reader 2, 3.85±0.57 vs 3.41±0.92;t values were 3.733 and 2.468, P were 0.001 and 0.018).Conclusion SWI can provide additional valuable information and improve diagnostic performance for characterization of sHCC in cirrhotic livers.
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Objective To investigate imaging characteristics of multistep hepatocarcinogenesis in cirrhotic livers on susceptibility-weighted imaging (SWI).Methods Seventy-three patients with 83 nodules in cirrhotic livers underwent hepatic MR imaging with SWI.Two radiologists reviewed MR images by consensus.Imaging characteristics of dysplastic nodules (DN),DN with malignant foci and hepatocellular carcinoma (HCC) were evaluated.Prussian blue staining was performed for semiquantification of hepatic iron content and above cirrhosis-associated nodules.Results Positive iron staining of background liver parenchyma was found in 69 of 73 patients and 4 HCC patients showed iron-negative staining of background liver parenchyma.Nine DNs appeared as hypointensity or isointensity with pathologically confirmed similar (n =7) or slightly decreased (n =2) iron deposition compared with background liver parenchyma.SWI detected 14 of 15 DNs with malignant foci.Seven patients appeared as homogeneous hyperintensity and 1 patient appeared as heterogeneous hyperintensity due to intratumoral hemorrhages.The remaining 6 patients demonstrated as nodule-in-nodule appearance with iron deposition in all background nodules,iron deposition with grade 1 in one internal HCC foci,and iron-free in 5 internal HCC foci.The remaining 50 patients with hepatic iron deposition had 55 HCC lesions.Three HCC lesions had iron deposition with grade 1 to 2 and the remaining 52 HCC lesions were pathologically iron-resistant.HCC appeared as hyperintensity compared with siderotic surrounding liver parenchyma.However,HCCs with diameter larger than 3 cm usually demonstrated heterogeneous hyperintensity due to intratumoral hemorrhage.Conclusions SWI could accurately demonstrate dynamic iron depletion on multistep hepatocarcinogenesis in cirrhotic livers.On SWI images,DNs appear as hypointensity due to siderosis and malignant nodules appear as hyperintensity due to iron depletion.
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Objective To evaluate mesenteric muhidetector row CT angiography (MDCTA) in the diagnosis of acute mesenteric ischemia (AMI).Methods In this study,43 cases of AMI proven by clinical criteria,or operation and pathology underwent whole abdomen MDCT precontrast,arterial phase and venous phase scan with 0.6 mm collimation.The mesenteric arteries and veins were reconstructed by using volume rendering (VR),maximum intensity projection (MIP),thin slab maximum intensity projection (TSMIP) techniques,and abnormal CT angiography findings as well as abnormal bowel and mesentery were analyzed.Results It was found that AMI was caused by superior mesenteric artery (SMA) embolism (n =4),SMA thrombosis (n = 6),mesenteric and portal venous thrombosis (n = 13),SMA dissection (n =5),strangulated bowel obstruction (n = 10) and vasculitis (n = 5).MDCTA showed clearly the position,shape,severity and extent of the vascular occlusion,narrow and dissection.It could also demonstrate the abnormal course and direction of the vessels including vascular gathering,shift,tortuosity,retortion,and twist.Furthermore,the pathogenesis of various conditions including atherosclerotic plaque,emboli,thrombosis,dissection,tumorous invasion,strangulated bowel obstruction and vasculitis could be identified by MDCTA.Conclusion MDCTA can clearly demonstrate direct signs leading to AMI,and identify AMI and its etiology at early stage,with the combination with its indirect findings.