ABSTRACT
OBJECTIVE: To compare 2D spoiled dual gradient-echo (SPGR-DE) and 3D SPGR-DE with fat and water separation for the assessment of focal and diffuse fatty infiltration of the liver. METHODS: A total of 227 consecutive patients (141 men; 56 ± 14 years) underwent clinically indicated liver MRI at 1.5 T including multiple-breath-hold 2D SPGR-DE and single-breath-hold 3D SPGR-DE with automatic reconstruction of fat-only images. Two readers assessed the image quality and number of fat-containing liver lesions on 2D and 3D in- and opposed-phase (IP/OP) images. Liver fat content (LFC) was quantified in 138 patients without chronic liver disease from 2D, 3D IP/OP, and 3D fat-only images. RESULTS: Mean durations of 3D and 2D SPGR-DE acquisitions were 23.7 ± 2.9 and 97.2 ± 9.1 s respectively. The quality of all 2D and 3D images was rated diagnostically. Three-dimensional SPGR-DE revealed significantly more breathing artefacts resulting in lower image quality (P < 0.001); 2D and 3D IP/OP showed a similar detection rate of fat-containing lesions (P = 0.334) and similar LFC estimations (mean: +0.4 %; P = 0.048). LFC estimations based on 3D fat-only images showed significantly higher values (mean: 2.7 % + 3.5 %) than those from 2D and 3D IP/OP images (P < 0.001). CONCLUSION: Three dimensional SPGR-DE performs as well as 2D SPGR-DE for the assessment of focal and diffuse fatty infiltration of liver parenchyma. The 3D SPGR-DE sequence used was quicker but more susceptible to breathing artefacts. Significantly higher LFC values are derived from 3D fat-only images than from 2D or 3D IP/OP images.
Subject(s)
Echo-Planar Imaging/methods , Fatty Liver/diagnosis , Image Interpretation, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Adolescent , Adult , Aged , Aged, 80 and over , Artifacts , Cohort Studies , Fatty Liver/pathology , Female , Humans , Male , Middle Aged , Quality Control , Young AdultABSTRACT
BACKGROUND & AIMS: Hepatocellular carcinoma (HCC) recurs in approximately 70% of cases after resection. Vascular invasion by tumor cells can be classified as gross or microscopic (microvascular invasion [mVI]) and is a risk factor for recurrence. We examined a large cohort of patients with HCC who were treated by resection to identify features of mVI that correlated with recurrence and survival. METHODS: We reviewed the records of all HCC resections performed at the Mount Sinai School of Medicine between January 1990 and March 2006 to identify those with mVI, established by histologic analysis. The numbers and sizes of vessels invaded, invasion of a vessel with a muscular wall, distance from the tumor, and satellite nodules were recorded. RESULTS: Of the 384 patients who underwent resection for HCC, 131 (34.1%) met the entry criteria. The median follow-up period was 28.9 months. There were 68 recurrences and 54 deaths. In multivariate analysis, invasion of a vessel with a muscular wall predicted recurrence (hazard ratio, 1.8; P = .02), and invasion of a vessel with a muscular wall (hazard ratio, 2.2; P = .018) and invasion of a vessel that was more than 1 cm from the tumor (hazard ratio, 2.1; P = .015) predicted survival. A risk score that assigned points for the presence of each variable correlated with recurrence (P = .028) and survival (P < .0001). CONCLUSIONS: A novel classification system that includes invasion of a vessel with a muscular wall and invasion of a vessel that is more than 1 cm from the tumor can accurately predict risk of recurrence and survival of patients with mVI after resection of HCC.
