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The main purpose of the article is to review the normal vertebral marrow and its appearance on MRI, including age-related changes and pathologic appearance based on routine MR sequences like T1, T2 & STIR. The signal intensity of the bone marrow depends mainly on the fat and water content. Each component has its appearance on MRI sequence that allows their differentiation. The red marrow is highly cellular, so it leads to a low signal intensity on T1-weighted sequences and high signal intensity on short tau inversion recovery (STIR) or fat-saturated T2-weighted sequences. Whereas, the yellow marrow presents an increased signal on T1- weighted sequences and low signal intensity on STIR or fat-saturated T2-weighted sequences. The differential diagnosis of pathological bone marrow includes degenerative changes, neoplasm, infection, and infiltrative marrow disorders. In this study, 30 cases were included, who presented with a chief complaint of neck pain, backache and radiculopathy who underwent MRI for evaluating the underlying pathology. The main objective of this study is to evaluate different MRI findings in these patients.METHODSPatients having neck pain, backache, and radiculopathy who presented in the Department of Radiodiagnosis at NRI Medical College and Hospital, Chinakakani, were included in the present study. On a random basis, 30 cases were included in the study, and all of them underwent routine MRI spine to a particular region according to the symptom.RESULTSThirty patients were studied with an age range of 22 years to 80 years. In our study, out of 30 patients, 4 had fatty replacement of marrow, 3 had hemangioma, 6 had Modic endplate changes, 3 had metastases, 4 had osteoporosis, 5 had Koch's spine, 5 had myeloproliferative disease. Of the 4 patients who had osteoporosis, two patients had wedge compression fractures.CONCLUSIONMRI is the sensitive tool in the imaging of vertebral marrow and imaging modality of choice in studying the bone marrow diseases. Routine sequences like T1, T2 & STIR sequences are the key for proper diagnosis and management of spinal pathology.
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Aims: The main objectives of our study were to evaluate the role of Multiparametric MRI (mp-MRI) in diagnosis of carcinoma prostate and to compare the various MRI sequences used in MRI in evaluating carcinoma prostate with histopathological diagnosis kept as reference standard. Materials and Methods: This prospective cross-sectional study of 40 patients was performed by using various sequences used in mp-MRI i.e. T2 weighted imaging (T2WI), Diffusion Weighted Imaging (DWI), Magnetic Resonance Spectroscopy (MRS) and Dynamic Contrast Enhanced study (DCE). Findings of mp-MRI sequences were compared with histopathological diagnosis. Statistical analysiswasperformed using SPSS computer statistical program for window release 16. Results: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of DCE in diagnosing carcinoma prostate were 88.89%, 50.00%, 94.12% and 33.33% respectively where assensitivities, specificities, PPVs, NPVs of DWI and MRS were same in our study i.e. 94.44%, 75.00%, 97.14% and 60.00%respectively. Overall sensitivity, specificity, PPV, NPV of mp-MRI by combining these sequences were found to be 97.22%, 75%, 97.22% and 75% respectively. Diagnostic accuracies of DWI, DCE and MRS were 92.5%, 85% and 92.5% respectively and overall diagnostic accuracy after combining these sequences in mp-MRI was 95%. Conclusions: mp-MRI including all the sequences has very good role in evaluation of carcinoma prostate. Diagnostic accuracy of mp-MRI increases when all sequences used together to assess prostatic lesions, so all the sequences should be used together in prostate cancer evaluation rather than using individual sequences.
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OBJECTIVE: To directly compare the diagnostic performance of true and oblique axial T2-weighted imaging (T2WI) for assessing parametrial invasion (PMI) in cervical cancer. MATERIALS AND METHODS: This retrospective study included 71 women with treatment-naive cervical cancer who underwent MRI that included both oblique and true axial T2WI, followed by radical hysterectomy. Two blinded radiologists (Radiologist 1 and Radiologist 2) independently assessed the presence of PMI on both sequences using a 5-point Likert scale. Receiver operating characteristic (ROC) curve analysis was performed, with a subgroup analysis for tumors sized > 2.5 cm and ≤ 2.5 cm in diameter. Inter-reader agreement was assessed with kappa (k) statistics. RESULTS: At hysterectomy, 15 patients (21.1%) had PMI. For Radiologist 1, the area under the ROC curve (AUC) was greater for oblique axial than for true axial T2WI {0.941 (95% confidence interval [CI] = 0.858–0.983) vs. 0.917 (95% CI = 0.827–0.969), p = 0.027}. The difference was not significant for Radiologist 2 (0.879 [95% CI = 0.779–0.944] vs. 0.827 [95% CI = 0.719–0.906], p = 0.153). For tumors > 2.5 cm, AUC was greater with oblique than with true axial T2WI (0.906 vs. 0.860, p = 0.046 for Radiologist 1 and 0.839 vs. 0.765, p = 0.086 for Radiologist 2). Agreement between the radiologists was almost perfect for oblique axial T2WI (k = 0.810) and was substantial for true axial T2WI (k = 0.704). CONCLUSION: Oblique axial T2WI potentially provides greater diagnostic performance than true axial T2WI for determining PMI, particularly for tumors > 2.5 cm. The inter-reader agreement was greater with oblique axial T2WI.
Subject(s)
Female , Humans , Area Under Curve , Hysterectomy , Magnetic Resonance Imaging , Retrospective Studies , ROC Curve , Uterine Cervical NeoplasmsABSTRACT
Objective To evaluate the clinical value of high-resolution T2-weighted magnetic resonance imaging (HR-T2WI), readout-segmented echo-planar imaging (RS-EPI) and HR-T2WI plus RS-EPI in differentiating non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). Methods A prospective study was conducted on 95 patients with bladder cancer identified by cystoscope biopsy, who underwent surgery treatment in our hospital from Jun. 2016 to Dec. 2017. All 95 patients had clear pathological staging, and received HR-T2WI and RS-EPI examination. NMIBC and MIBC were differentiated using HR-T2WI, RS-EPI and HR-T2WI plus RS-EPI, and the diagnosis results were compared with the pathological results using Kappa test. The receiver operating characteristic (ROC) curve was drawn and the area under curve (AUC) of ROC was calculated to evaluate the sensitivity, specificity, accuracy of HR-T2WI, RS-EPI and HR-T2WI plus RSEPI. DeLong test was used to compare the AUC of three methods. Results The diagnostic results of HR-T2WI, RS-EPI and HRT2WI plus RS-EPI had good agreement with the pathological results (Kappa=0.770, 0.787 and 0.936; all P<0.01). The AUC, sensitivity, specificity and accuracy of HR-T2WI, RS-EPI and HR-T2WI plus RS-EPI were 0.899, 95.5% (42/44), 82.4% (42/51) and 88.4% (84/95), 0.891, 84.1% (37/44), 94.1% (48/51) and 89.5% (85/95), and 0.966, 93.2% (41/44), 100.0% (51/51) and 96.8% (92/95), respectively. The AUC of HR-T2WI+RS-EPI was higher than that of HR-T2WI and RS-EPI (Z=-2.627 8 and -2.720 5, P=0.008 6 and 0.006 5). Conclusion HR-T2WI plus RS-EPI can be used as a preoperative non-invasive examination method to differentiate NMIBC and MIBC.
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OBJECTIVE: To assess the value of applying MultiVane to liver T2-weighted imaging (T2WI) compared with conventional T2WIs with emphasis on detection of focal liver lesions. MATERIALS AND METHODS: Seventy-eight patients (43 men and 35 women) with 86 hepatic lesions and 20 pancreatico-biliary diseases underwent MRI including T2WIs acquired using breath-hold (BH), respiratory-triggered (RT), and MultiVane technique at 3T. Two reviewers evaluated each T2WI with respect to artefacts, organ sharpness, and conspicuity of intrahepatic vessels, hilar duct, and main lesion using five-point scales, and made pairwise comparisons between T2WI sequences for these categories. Diagnostic accuracy (Az) and sensitivity for hepatic lesion detection were evaluated using alternative free-response receiver operating characteristic analysis. RESULTS: MultiVane T2WI was significantly better than BH-T2WI or RT-T2WI for organ sharpness and conspicuity of intrahepatic vessels and main lesion in both separate reviews and pairwise comparisons (p < 0.001). With regard to motion artefacts, MultiVane T2WI or BH-T2WI was better than RT-T2WI (p < 0.001). Conspicuity of hilar duct was better with BH-T2WI than with MultiVane T2WI (p = 0.030) or RT-T2WI (p < 0.001). For detection of 86 hepatic lesions, sensitivity (mean, 97.7%) of MultiVane T2WI was significantly higher than that of BH-T2WI (mean, 89.5%) (p = 0.008) or RT-T2WI (mean, 84.9%) (p = 0.001). CONCLUSION: Applying the MultiVane technique to T2WI of the liver is a promising approach to improving image quality that results in increased detection of focal liver lesions compared with conventional T2WI.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Artifacts , Biliary Tract Diseases/diagnosis , Liver Diseases/diagnosis , Liver Neoplasms/diagnosis , Magnetic Resonance Imaging , Pancreatic Diseases/diagnosis , Retrospective StudiesABSTRACT
PURPOSE: To compare the frequency of posterior globe flattening between two-dimensional T2-weighted imaging (2D T2WI) and three-dimensional (3D T2WI). MATERIALS AND METHODS: Sixty-nine patients (31 female; mean age, 44.4 years) who had undergone both 5-mm axial T2WI and sagittal 3D 1-mm isovoxel T2WI of the whole brain for evaluation of various diseases (headache [n = 30], large hemorrhage [n = 19], large tumor or leptomeningeal tumor spread [n = 15], large infarct [n = 3], and bacterial meningitis [n = 2]) were used in this study. Two radiologists independently reviewed both sets of images at separate sessions. Axial T2WI and multi-planar imaging of 3D T2WI were visually assessed for the presence of globe flattening. The optic nerve sheath diameter (ONSD) was measured at a location 4 mm posterior to each globe on oblique coronal imaging reformatted from 3D T2WI. RESULTS: There were significantly more globes showing posterior flattening on 3D T2WI (105/138 [76.1%]) than on 2D T2WI (27/138 [19.6%], P = 0.001). Inter-observer agreement was excellent for both 2D T2WI and 3D T2WI (Cohen's kappa = 0.928 and 0.962, respectively). Intra-class correlation coefficient for the ONSD was almost perfect (Cohen's kappa = 0.839). The globes with posterior flattening had significantly larger ONSD than those without on both 2D and 3D T2WI (P < 0.001; 6.14 mm +/- 0.44 vs. 5.74 mm +/- 0.44 on 2D T2WI; 5.90 mm +/- 0.47 vs. 5.56 mm +/- 0.34 on 3D T2WI). Optic nerve protrusion was significantly more frequent on reformatted 1-mm 3D T2WI than on 5-mm 2D T2WI (8 out of 138 globes on 3D T2WI versus one on 2D T2WI; P = 0.018). CONCLUSION: Posterior globe flattening is more frequently observed on 3D T2WI than on 2D T2WI in patients suspected of having increased intracranial pressure. The globes with posterior flattening have significantly larger ONSD than those without.
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Female , Humans , Brain , Hemorrhage , Intracranial Pressure , Meningitis, Bacterial , Optic NerveABSTRACT
Prostatic stromal sarcoma (PSS) is quite rare. Herein, we describe magnetic resonance imaging (MRI) features of a PSS identified in a 26-year-old man with dysuria and hematuria. MRI clearly depicted the extent and multinodular appearance of the tumor, which was mainly located in the central zone of the prostate. The tumor appeared as a heterogeneously signal-hyperintense mass with a pseudocapsule on T2-weighted imaging. Contrast-enhanced T1-weighted MRI showed necrotic portions in the gradually enhanced solid mass, and diffusion-weighted imaging permitted the accurate assessment of the local extent of the tumor. Thus, the appearance on MRI was quite different from that of adenocarcinoma of the prostate.