Usefulness of Arterial Subtraction in Applying Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Algorithm to Gadoxetic Acid-Enhanced MRI

Objective@#We aimed to evaluate the usefulness of arterial subtraction images for predicting the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) using gadoxetic acid-enhanced MRI and the Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm. @*Materials and Methods@#This study included 90 patients (mean age ± standard deviation, 57 ± 9 years) who underwent liver transplantation or resection after LRT and had 73 viable and 32 nonviable HCCs. All patients underwent gadoxetic acid-enhanced MRI before surgery. Two radiologists assessed the presence of LR-TR features, including arterial phase hyperenhancement (APHE) and LR-TR categories (viable, nonviable, or equivocal), using ordinary arterial-phase and arterial subtraction images. The reference standard for tumor viability was surgical pathology. The sensitivity of APHE for diagnosing viable HCC was compared between ordinary arterial-phase and arterial subtraction images. The sensitivity and specificity of the LR-TR algorithm for diagnosing viable HCC was compared between the use of ordinary arterial-phase and the use of arterial subtraction images.Subgroup analysis was performed on lesions treated with transarterial chemoembolization (TACE) only. @*Results@#The sensitivity of APHE for viable HCCs was higher for arterial subtraction images than ordinary arterial-phase images (71.2% vs. 47.9%; p 0.999). In a subgroup of 63 lesions treated with TACE only, the use of arterial subtraction images showed a significant increase in sensitivity (81.4% [35/43] vs. 67.4% [29/43]; p = 0.031) without significant decrease in specificity (85.0% [17/20] vs. 90.0% [18/20]; p > 0.999). @*Conclusion@#Use of arterial subtraction images compared with ordinary arterial-phase images improved the sensitivity while maintaining specificity for diagnosing viable HCC after LRT using gadoxetic acid-enhanced MRI and the LR-TR algorithm.

Usefulness of Arterial Subtraction in Applying Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Algorithm to Gadoxetic Acid-Enhanced MRI

Objective@#We aimed to evaluate the usefulness of arterial subtraction images for predicting the viability of hepatocellular carcinoma (HCC) after locoregional therapy (LRT) using gadoxetic acid-enhanced MRI and the Liver Imaging Reporting and Data System treatment response (LR-TR) algorithm. @*Materials and Methods@#This study included 90 patients (mean age ± standard deviation, 57 ± 9 years) who underwent liver transplantation or resection after LRT and had 73 viable and 32 nonviable HCCs. All patients underwent gadoxetic acid-enhanced MRI before surgery. Two radiologists assessed the presence of LR-TR features, including arterial phase hyperenhancement (APHE) and LR-TR categories (viable, nonviable, or equivocal), using ordinary arterial-phase and arterial subtraction images. The reference standard for tumor viability was surgical pathology. The sensitivity of APHE for diagnosing viable HCC was compared between ordinary arterial-phase and arterial subtraction images. The sensitivity and specificity of the LR-TR algorithm for diagnosing viable HCC was compared between the use of ordinary arterial-phase and the use of arterial subtraction images.Subgroup analysis was performed on lesions treated with transarterial chemoembolization (TACE) only. @*Results@#The sensitivity of APHE for viable HCCs was higher for arterial subtraction images than ordinary arterial-phase images (71.2% vs. 47.9%; p 0.999). In a subgroup of 63 lesions treated with TACE only, the use of arterial subtraction images showed a significant increase in sensitivity (81.4% [35/43] vs. 67.4% [29/43]; p = 0.031) without significant decrease in specificity (85.0% [17/20] vs. 90.0% [18/20]; p > 0.999). @*Conclusion@#Use of arterial subtraction images compared with ordinary arterial-phase images improved the sensitivity while maintaining specificity for diagnosing viable HCC after LRT using gadoxetic acid-enhanced MRI and the LR-TR algorithm.

Correlation of the Strain Elastography-Derived Elasticity Scores with Prognostic Histologic Features, Immunohistochemical Markers, and Molecular Subtypes of Invasive Ductal Carcinoma

PURPOSE@#To investigate the correlation of the strain elasticity of breast cancer with histologic features, immunohistochemical markers and molecular subtypes that are known to be factors related to prognosis.@*MATERIALS AND METHODS@#B-mode ultrasound and strain elastography were performed in 123 patients (mean age, 53.4; range, 28–82) with invasive ductal carcinoma (IDC) (mean size, 1.54 cm; range, 0.4–7.0 cm). Histologic grade, lymph node (LN) status, lymphovascular invasion, immunohistochemical biomarkers [estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 (HER2), CK5/6, epidermal growth factor receptor, and Ki-67] and molecular subtypes were determined from surgical pathology reports. The relationships between these factors and elasticity scores were evaluated.@*RESULTS@#LN involvement was associated with a higher elasticity score which was statistically significant (p = 0.042). The tumor size, lymphovascular invasion, histologic grades, immunohistochemical markers and molecular subtypes had no significant correlation with the elasticity score (p > 0.05 for all). However, the IDCs with larger size and a positive lymphovascular invasion tended to have higher elasticity scores. Furthermore, higher histologic grade cancers and the HER2 overexpression-type tended to have lower elasticity scores.@*CONCLUSION@#The elasticity score of IDC had a significant correlation with LN involvement but no statistically significant correlation with the histologic features, immunohistochemical markers or molecular subtypes.

Abdominal Aortic Calcification is Associated with Diastolic Dysfunction, Mortality, and Nonfatal Cardiovascular Events in Maintenance Hemodialysis Patients

This study evaluated the significance of aortic calcification index (ACI), an estimate of abdominal aortic calcification by plain abdominal computed tomography (CT), in terms of left ventricular (LV) diastolic dysfunction, mortality, and nonfatal cardiovascular (CV) events in chronic hemodialysis patients. Hemodialysis patients who took both an abdominal CT and echocardiography were divided into a low-ACI group (n = 64) and a high-ACI group (n = 64). The high-ACI group was significantly older, had a longer dialysis vintage and higher comorbidity indices, and more patients had a previous history of CV disease than the low-ACI group. The ACI was negatively correlated with LV end-diastolic volume or LV stroke volume, and was positively correlated with the ratio of peak early transmitral flow velocity to peak early diastolic mitral annular velocity (E/E' ratio), a marker of LV diastolic function. The E/E' ratio was independently associated with the ACI. The event-free survival rates for mortality and nonfatal CV events were significantly lower in the high-ACI group compared with those in the low-ACI group, and the ACI was an independent predictor for all-cause deaths and nonfatal CV events. In conclusion, ACI is significantly associated with diastolic dysfunction and predicts all-cause mortality and nonfatal CV events in hemodialysis patients.

Image Quality Improvement after Implementation of a CT Accreditation Program

OBJECTIVE: The purpose of this study was to evaluate any improvement in the quality of abdominal CTs after the utilization of the nationally based accreditation program. MATERIALS AND METHODS: Approval was obtained from the Institutional Review Board, and informed consent was waived. We retrospectively analyzed 1,011 outside abdominal CTs, from 2003 to 2007. We evaluated images using a fill-up sheet form of the national accreditation program, and subjectively by grading for the overall CT image quality. CT scans were divided into two categories according to time periods; before and after the implementation of the accreditation program. We compared CT scans between two periods according to parameters pertaining to the evaluation of images. We determined whether there was a correlation between the results of a subjective assessment of the image quality and the evaluation scores of the clinical image. RESULTS: The following parameters were significantly different after the implementation of the accreditation program: identifying data, display parameters, scan length, spatial and contrast resolution, window width and level, optimal contrast enhancement, slice thickness, and total score. The remaining parameters were not significantly different between scans obtained from the two different periods: scan parameters, film quality, and artifacts. CONCLUSION: After performing the CT accreditation program, the quality of the outside abdominal CTs show marked improvement, especially for the parameters related to the scanning protocol.

Imaging Findings of Intrahepatic Bile Duct Adenoma (Peribiliary Gland Hamartoma): a Case Report and Literature Review

Intrahepatic bile duct adenoma is a rare benign epithelial hepatic tumor derived from bile duct cells. We report the imaging findings of a patient with bile duct adenoma, which appeared as a small heterogeneously enhancing mass with focal small cystic change on CT and MRI. Follow-up images at seven months showed a slight increase in tumor size, which could be partly explained by intratumoral hemorrhage on pathologic examination. Although rare, bile duct adenoma should be considered as a differential diagnosis of a small hypervascular tumor located in the periphery of liver. Focal cystic change and intratumoral hemorrhage may occur.

Primary Hepatic Lymphoma: MR Imaging and Pathologic Correlation

Primary hepatic lymphoma is extremely rare, representing less than 1% of all extranodal lymphomas. We report MR imaging features and pathologic correlation of a case of primary hepatic lymphoma. MR images showed a large lobulated mass with gradual contrast enhancement, resembling intrahepatic cholangiocarcinoma. However, both hepatobiliary phase image obtained 20 minutes after injection of hepatocyte specific contrast agent and diffusion-weighted image demonstrated characteristic three layered pattern representing viable lymphoma in the outer layer, tumor necrosis in the middle layer and necrotic hepatic parenchyma in the center.

MRI Protocol of Female Pelvis

Although ultrasonography is the most commonly used first-line imaging modality of the female pelvis because of diagnostic accuracy, low cost and safety, MRI is the best imaging modality of choice for the evaluation of the female pelvis. The indication of female pelvis MRI is diverse and includes the evaluation of Mullerian duct anomaly, differential diagnosis and characterization of uterine and ovarian tumors, and staging of malignant uterine and ovarian tumors. Understanding of MR protocols according to the specific gynecologic pathology allows accurate diagnosis and proper patient management.

MRI Protocol of Female Pelvis

Although ultrasonography is the most commonly used first-line imaging modality of the female pelvis because of diagnostic accuracy, low cost and safety, MRI is the best imaging modality of choice for the evaluation of the female pelvis. The indication of female pelvis MRI is diverse and includes the evaluation of Mullerian duct anomaly, differential diagnosis and characterization of uterine and ovarian tumors, and staging of malignant uterine and ovarian tumors. Understanding of MR protocols according to the specific gynecologic pathology allows accurate diagnosis and proper patient management.

A case of metronidazole induced encephalopathy in a cirrhotic patient / 대한내과학회지

Metronidazole induced encephalopathy is a rare disease caused by the antibiotic drug, metronidazole. Metronidazole is a nitroimidazole antibiotic used for anaerobic infections, Helicobacter pylori infection and spontaneous bacterial peritonitis. Metronidazole has good cellular penetration and is believed to penetrate the CSF and central nervous system. The incidence of metronidazole induced encephalopathy is unknown, though several previous studies have addressed brain changes caused by metronidazole neurotoxicity. Neurologic side effects include peripheral neuropathy, seizures, encephalopathy, dysarthria, and ataxia. We experienced a case of metronidazole induced encephalopathy, diagnosed by brain MRI in a patient with spontaneous bacterial peritonitis and performed follow-up imaging after discontinuation of metronidazole.

Benign Lymphoproliferative Disorder of the Perirenal Space and Renal Sinus in Sjogren's Syndrome: A Case Report

We report a case of benign lymphoproliferative disease involving the perirenal space and renal sinus in patients with Sjogren's syndrome, which simulated malignant lymphoma. CT scans revealed homogeneous soft tissue masses in both renal sinuses and perirenal thin band-like lesions. An ultrasonogrphy revealed thin hypoechoic rims along the capsule of both kidneys as well as hypoechoic masses filled in renal sinuses. The lesions completely regressed following steroid treatment. Although rare, since these benign lymphoproliferative disorders with a similar appearance to lymphoma can occur in patients with Sjogren's syndrome, pathological biopsies should be performed.

Intracortical Bone Metastasis Mimicking Intracortical Osteoid Osteoma: A Case Report

Cortical metastasis usually occurs in the diaphysis of the long bones with the appearance of a cookie-bite pattern; this is associated with cortical destruction extending into the soft tissue as well as into the medullary cavity, or there can be a periosteal reaction. We report here on a 66-year-old woman who was diagnosed with intracortical metastasis in the proximal metaphysis of the right femur as an initial metastatic focus from primary lung cancer. CT detected an intracortical osteolytic lesion without cortical destruction or thickening. The MR images showed extensive peritumoral edema in the surrounding soft tissue and adjacent bone marrow edema, and this all mimicked osteoid osteoma.

Intrasellar Schwannoma: A Case Report

Schwannomas usually arise from sensory nerves, and most often from the vestibular component of the acoustic nerve. Intrasellar and parasellar schwannomas are exceedingly rare. It is difficult to distinguish them from typical pituitary macroadenomas because of their clinical and radiological resemblance. In this report, we present an unusual case of an intrasellar schwannoma with a suprasellar extension that radiographically simulated a pituitary macroadenoma.