Magnetic Resonance Elastography and Other Magnetic Resonance Imaging Techniques in Chronic Liver Disease: Current Status and Future Directions

Recent advances in the noninvasive imaging of chronic liver disease have led to improvements in diagnosis, particularly with magnetic resonance imaging (MRI). A comprehensive evaluation of the liver may be performed with the quantification of the degree of hepatic steatosis, liver iron concentration, and liver fibrosis. In addition, MRI of the liver may be used to identify complications of cirrhosis, including portal hypertension, ascites, and the development of hepatocellular carcinoma. In this review article, we discuss the state of the art techniques in liver MRI, namely, magnetic resonance elastography, hepatobiliary phase MRI, and liver fat and iron quantification MRI. The use of these advanced techniques in the management of chronic liver diseases, including non-alcoholic fatty liver disease, will be elaborated.

Spontaneous cerebrospinal fluid rhinorrhoea: computed tomography and magnetic resonance imaging findings

Spontaneous cerebrospinal fluid rhinorrhoea is a rare clinical entity. The accurate localisation of the leakage site is essential for surgical planning. Imaging techniques such as high-resolution computed tomography (CT), CT cisternography and magnetic resonance cisternography in variable combinations are performed for this purpose. This pictorial essay aims to present the spectrum of imaging findings in cases of spontaneous cerebrospinal fluid rhinorrhoea, which may be useful for radiologists in the determination of the site of cerebrospinal fluid leakage.

Central clot score at computed tomography as a predictor of 30-day mortality after acute pulmonary embolism

<p><b>INTRODUCTION</b>The severity of acute pulmonary embolism can be assessed with computed tomography (CT) using clot burden estimation. We compared the existing CT obstruction scores with an in-house developed central clot score for the prediction of 30-day pulmonary embolism (PE)-related mortality.</p><p><b>MATERIALS AND METHODS</b>In 125 consecutive patients [47 men, 78 women; mean age +/- standard deviation (SD, 60.4 years +/- 16.6] with acute PE, 2 readers in consensus assessed the severity of PE with 2 existing clot scoring systems (Mastora and Qanadli) and central clot score. The right ventricular dysfunction was assessed by right ventricular diameter (RVD), left ventricular diameter (LVD), ventricular ratio (VR) and septal deviation. Univariate and multivariate regression analysis were performed to correlate these parameters and 30-day PE-related mortality.</p><p><b>RESULTS</b>Ten patients (8%) died of PE within 30 days following CT and 115 patients did not have PE-related death outcome. There was a significant difference in all 3 clot scores, LVD and VR between patients with 30-day PE-related death and those without (P < or =0.001-0.02). Univariate regression analysis showed that all three clot scores and LVD were predictors of PE death, however with multivariate analysis, only central clot score showed significant correlation with 30-day PE death [Odds ratio (OR), 1.1; 96% CI, 1-1.16; P <0.003]. A central clot index of 53% had 100% sensitivity, 76.5% specificity, 23.5% positive predictive value and 98% negative predictive value for 30-day PE death.</p><p><b>CONCLUSION</b>Central clot score is a strong predictor of 30-day PE death and may therefore allow therapy and risk stratification in patients with acute PE.</p>