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1.
Clin Radiol ; 65(3): 185-92, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20152273

ABSTRACT

AIM: To evaluate the diagnostic performance of magnetic resonance urography (MRU) versus retrograde pyelography and/or ureteroscopy (RPU) in the detection of upper urinary tract neoplasms. MATERIALS AND METHODS: This retrospective study included 35 patients with suspected upper urinary tract malignancy who underwent MRU and RPU within 6-months in our institution during the study period (February 2002 to January 2007). MRU and RPU reports were reviewed and results recorded. For each patient, the urinary tract was sub-divided into four regions for analysis: left kidney/renal pelvis, left ureter, right kidney/renal pelvis, and right ureter. MRU and RPU results for each patient were compared to a reference standard and the diagnostic performance of both techniques was compared. RESULTS: A total of 113 regions were analysed on MRU and 90 regions on RPU. Nineteen neoplasms were identified. Sensitivity, specificity, positive predictive value, and negative predictive value for the detection of urinary tract neoplasms were 63, 91, 60, and 92% for MRU, respectively, and 53, 97, 83, and 88% for RPU, respectively. These differences were not statistically significant (p>0.05). CONCLUSION: The high negative predictive value of MRU in the present series supports its use as a non-invasive screening examination for excluding the presence of upper urinary tract malignancy.


Subject(s)
Magnetic Resonance Imaging/methods , Urography/methods , Urologic Neoplasms/diagnosis , Adult , Aged , Contrast Media , Cystoscopy , Diagnosis, Differential , False Negative Reactions , Female , Hematuria/etiology , Humans , Kidney Pelvis , Male , Middle Aged , Predictive Value of Tests , Reference Standards , Retrospective Studies , Ureter/pathology , Ureteroscopy
3.
J Magn Reson Imaging ; 16(6): 668-75, 2002 Dec.
Article in English | MEDLINE | ID: mdl-12451580

ABSTRACT

PURPOSE: To evaluate the T1 efficacy of EVP-ABD, a new manganese (Mn)-based contrast agent, for vascular and liver tissue enhancement in comparison with currently approved agents. MATERIALS AND METHODS: Ten Yorkshire pigs (body weight, 26 -46 kg) were used for the efficacy evaluation, nine for kinetic T1 evaluation (three each agent) and one for post EVP-ABD imaging. With a fast imaging scheme to monitor T1 values of blood and liver, 10 micromol/kg EVP-ABD was injected intravenously and compared with gadopentetate dimeglumine (Magnevist, GdDTPA) and mangafodipir trisodium (Teslascan, mangafodipir trisodium) at routine clinical dosages. All were imaged with 3D T1 Gradient Recalled Echo (GRE) sequence (TR/TE/alpha = 3.8/1.6/25 degrees ) prior to and 10 minutes post injection using a 1.5-T whole-body scanner. Additional high-resolution 2D liver images (TR/TE/alpha = 50/4.6/40 degrees ) and arterial phase images of the upper aorta were acquired from the pig for post EVP-ABD imaging. RESULTS: At 10 micromol/kg, EVP-ABD provided a dramatic decline in blood T1, comparable to 0.1 mmol/kg GdDTPA, followed by a rapid return to blood baseline T1 values. In addition to the blood enhancement phase, EVP-ABD achieved a 70% reduction in liver T1 within 2 minutes postadministration, with an imaging window of at least 2 hours. A substantially improved signal-to-noise ratio (SNR) was observed in both the 2D and 3D liver images postcontrast. CONCLUSION: EVP-ABD demonstrated peak vascular enhancement similar to GdDTPA and prolonged specific liver enhancement exceeding mangafodipir trisodium. EVP-ABD has favorable T1 enhancing characteristics with the potential to allow for a comprehensive liver evaluation.


Subject(s)
Contrast Media , Liver/blood supply , Magnetic Resonance Imaging , Animals , Aorta , Contrast Media/pharmacokinetics , Edetic Acid/analogs & derivatives , Edetic Acid/pharmacokinetics , Gadolinium DTPA/pharmacokinetics , Manganese , Pyridoxal Phosphate/analogs & derivatives , Pyridoxal Phosphate/pharmacokinetics , Swine
4.
Radiology ; 221(2): 371-9, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11687678

ABSTRACT

PURPOSE: To develop a low-dose magnetic resonance (MR) renographic method performed with and without an angiotensin converting enzyme (ACE) inhibitor and in conjunction with gadolinium-enhanced MR angiography in patients with suspected renovascular disease. MATERIALS AND METHODS: Thirty-two patients underwent MR renography (turbo fast low-angle shot sequence: repetition time, 5 msec; echo time, 2.3 msec; flip angle, 15 degrees; one coronal image acquired every 2 seconds for 4 minutes) following intravenous injection of 2 mL of gadopentetate dimeglumine, which was repeated following intravenous injection of an ACE inhibitor. Contrast material-enhanced MR angiography was also performed. On the basis of renographic findings, renal cortex and renal medulla enhancement curves and normalized enhancement ratios were analyzed. RESULTS: The cortex and medulla showed an early transient period of enhancement within 20 seconds (vascular phase). During 1-2 minutes, a second, gradual increase in medullary enhancement, reflecting transit of filtered contrast material, was observed that was significantly greater in patients with a serum creatinine level less than 2 mg/dL (177 micromol/L) than in those with a level of 2 mg/dL or greater (P < .01). After injection of the ACE inhibitor, patients with elevated creatinine levels showed low renal medullary enhancement regardless of the presence of renal artery stenosis (RAS). However, in patients with creatinine less than 2 mg/dL, medullary enhancement ratios after injection of the ACE inhibitor were consistently lower in patients with RAS of 50% or greater than in those without stenosis (P = .02 to .08). CONCLUSION: Low-dose MR renography can be performed in the clinical setting before and after injection of an ACE inhibitor, and its potential use for evaluating decreased renal function as a consequence of RAS is promising.


Subject(s)
Contrast Media/administration & dosage , Gadolinium DTPA/administration & dosage , Radioisotope Renography/methods , Renal Artery Obstruction/diagnostic imaging , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Feasibility Studies , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged
5.
Magn Reson Imaging Clin N Am ; 9(4): 675-96, v, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11694433

ABSTRACT

MR imaging provides exquisite, versatile, and unique soft tissue contrast, which allows for an effective evaluation of a wide range of liver disorders. A careful selection of imaging strategies can yield a comprehensive assessment of the liver in a reasonable examination time. Recent advances in MR hardware and software allow for rapid acquisition times that can bypass many of the motion artifacts that previously posed limitations to abdominal MR imaging. The ability to obtain artifact-free images with sufficient contrast-to-noise ratios across a broad range of techniques is now feasible with rapid scanning. This capability has emerged as the result of the implementation of high-performance gradient systems and localized phased-array body coils. In this article, the authors review the current status of MR imaging strategies for the evaluation of the liver, with an emphasis on the use of fast scanning techniques.


Subject(s)
Liver/pathology , Magnetic Resonance Imaging/methods , Artifacts , Contrast Media , Echo-Planar Imaging/methods , Humans , Liver/anatomy & histology
6.
Magn Reson Imaging Clin N Am ; 9(4): 697-716, v-vi, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11694434

ABSTRACT

Recent improvements in MR technology have enabled the development of volumetric three-dimensional (3D) imaging methods for fat-suppressed T1-weighted images of the entire upper abdomen with pixel sizes of approximately 2 mm in all dimensions and with acquisition times of less than 25 seconds for breath-hold imaging. When performed with a timing scheme, dynamic contrast-enhanced volumetric imaging of the liver can be performed with selective imaging during the arterial phase and portal venous phase of enhancement. The volumetric data sets can be reconstructed in any oblique plane, enabling improved detection, localization, and characterization of small liver lesions. The combination of high-resolution isotropic pixels and accurate timing also permits angiographic reconstructions of the 3D images, producing MR angiography and venography that can be useful in therapeutic planning, such as for catheter-based interventions or surgical resections or transplantation. Additionally, with use of a hepatobiliary contrast agent such as mangafodipir, T1-weighted volumetric MR cholangiography can be performed in patients with nonobstructed systems for depiction of intrahepatic biliary anatomy.


Subject(s)
Liver/pathology , Magnetic Resonance Imaging/methods , Bile Ducts/anatomy & histology , Bile Ducts/pathology , Contrast Media , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Liver/anatomy & histology , Liver/blood supply , Magnetic Resonance Angiography , Magnetic Resonance Imaging/instrumentation , Portal Vein/anatomy & histology , Portal Vein/pathology
7.
AJR Am J Roentgenol ; 177(5): 1101-7, 2001 Nov.
Article in English | MEDLINE | ID: mdl-11641180

ABSTRACT

OBJECTIVE: Our purpose was to evaluate a comprehensive MR imaging strategy for recipients of liver transplants that relies on dynamic interpolated three-dimensional (3D) MR imaging for simultaneous vascular, parenchymal, and extrahepatic imaging. MATERIALS AND METHODS: Twenty-three consecutive adult patients underwent 30 MR imaging examinations between 2 days and 99 months (mean, 15 months) after transplantation using a breath-hold 3D gradient-echo sequence (TR range/TE range, 3.7-4.7/1.8-1.9; flip angle, 12-30 degrees ) with an intermittent fat-saturation pulse and interpolation in the section-select direction to enable pixel size 3 mm or less in all dimensions. Unenhanced and triphasic contrast-enhanced 3D imaging (average dose, 0.13 mmol/kg of gadopentetate dimeglumine) was performed. A subset of patients (n = 13) also underwent MR cholangiopancreatography using half-Fourier single-shot turbo spin-echo imaging. MR imaging examinations were correlated with digital subtraction angiography (n = 8), contrast-enhanced cholangiography (n = 9), sonography (n = 13), and histopathology (n = 14). RESULTS: MR imaging revealed abnormal findings in 27 (90%) of 30 examinations, including vascular disease in nine, biliary complications in four, and evidence of intra- or extra-hepatic hepatocellular carcinoma recurrence in six. Digital subtraction angiography confirmed seven MR angiography examinations but suggested disease overestimation in one. Contrast-enhanced cholangiography confirmed findings of MR cholangiopancreatography in seven cases but suggested disease underestimation in two. CONCLUSION: Dynamic interpolated 3D MR imaging combined with dedicated MR cholangiopancreatography can provide a comprehensive assessment of vascular, biliary, parenchymal, and extrahepatic complications in most recipients of liver transplants.


Subject(s)
Cholangiography , Cholestasis, Extrahepatic/diagnosis , Common Bile Duct Diseases/diagnosis , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Liver Transplantation , Liver/blood supply , Magnetic Resonance Imaging , Postoperative Complications/diagnosis , Vascular Diseases/diagnosis , Adult , Aged , Anastomosis, Surgical , Angiography, Digital Subtraction , Female , Humans , Magnetic Resonance Angiography , Male , Middle Aged , Sensitivity and Specificity
8.
AJR Am J Roentgenol ; 177(3): 703-7, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11517079

ABSTRACT

OBJECTIVE: Real-time interactive duplex MR imaging is a new phase-contrast MR imaging technique that enables the quantification and display of flow velocities in real time without the need for cardiac gating. We investigated the feasibility and reliability of the technique to assess hemodynamic information both in vitro and in vivo in the carotid arteries and in the venous sinuses. SUBJECTS AND METHODS: Real-time interactive duplex MR measurements (TR/TE, 53/27; flip angle, 90 degrees; encoding velocity, 100 or 150 cm/sec) were performed in vitro with a steady-flow phantom and in 10 healthy volunteers in whom common and internal carotid artery velocities were measured. In eight volunteers, velocity measurements were also performed in the superior sagittal sinus during both normal breathing and hyperventilation. Time-velocity plots were analyzed qualitatively and quantitatively and compared with findings from conventional segmented k-space phase-contrast MR imaging and Doppler sonography. RESULTS: Velocity determinations for real-time duplex MR and conventional phase-contrast MR imaging showed an in vitro correlation of 0.99 and an in vivo correlation of 0.83 (carotid arteries) and 0.76 (venous sinus). Velocity measurements in the carotid arteries with real-time MR imaging were significantly lower than those obtained with conventional phase-contrast MR (averaged, 7.8%; p = 0.003) or sonography (23.7%, p < 0.001), likely because of volume averaging. Small but significant velocity changes occurring in the venous sinus during hyperventilation were reliably identified with both MR techniques. CONCLUSION: Real-time interactive duplex MR imaging can be effectively applied in neurovascular imaging to obtain hemodynamic information.


Subject(s)
Carotid Arteries/anatomy & histology , Cranial Sinuses/anatomy & histology , Hemodynamics/physiology , Image Processing, Computer-Assisted , Magnetic Resonance Imaging/methods , Adult , Aged , Aged, 80 and over , Blood Flow Velocity/physiology , Female , Humans , Male , Middle Aged , Phantoms, Imaging , Reference Values , Sensitivity and Specificity
9.
Clin Imaging ; 25(2): 130-2, 2001.
Article in English | MEDLINE | ID: mdl-11483425

ABSTRACT

Bannayan-Zonana syndrome (BZS) is a genetic disorder with autosomal dominant inheritance characterized by macrocephaly and multiple hamartomas of mesodermal origin. Here we present a patient with BZS manifested by many of the classic features, as well as a high-flow upper extremity arteriovenous malformation (AVM). Although this rare syndrome was initially described in 1971, to our knowledge, this is the first report showing an association of AVM with BZS and the first report of this syndrome in the radiologic literature.


Subject(s)
Abnormalities, Multiple/diagnosis , Arm/blood supply , Arteriovenous Malformations/diagnostic imaging , Arteriovenous Malformations/surgery , Magnetic Resonance Angiography/methods , Arteriovenous Malformations/complications , Hamartoma/complications , Hamartoma/diagnosis , Head/abnormalities , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Sensitivity and Specificity , Soft Tissue Neoplasms/complications , Soft Tissue Neoplasms/diagnosis , Syndrome , Tomography, X-Ray Computed/methods , Treatment Outcome , Vascular Surgical Procedures/methods
10.
Surg Clin North Am ; 81(3): 489-95, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11459266

ABSTRACT

In this article, the author reviews the effect of contemporary imaging techniques on the diagnosis of various pancreatic neoplasms. Histologic detail and the relationship to other means of diagnosis are included.


Subject(s)
Cholangiopancreatography, Endoscopic Retrograde , Pancreatic Cyst/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Tomography, X-Ray Computed , Adenocarcinoma, Mucinous/diagnostic imaging , Adenoma/diagnostic imaging , Cystadenoma, Papillary/diagnostic imaging , Humans
11.
Surg Clin North Am ; 81(2): 307-20, ix-x, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11392418

ABSTRACT

Current MR imaging technology offers the surgeon diagnostic information about pancreatic diseases. This article reviews the basics of MR imaging formation and the rationale for the different types of imaging sequences that comprise a comprehensive pancreaticobiliary examination. Clinical examples include evaluation of pancreatic neoplasms, acute and chronic pancreatitis, and congenital abnormalities.


Subject(s)
Magnetic Resonance Imaging , Pancreas/anatomy & histology , Pancreatic Neoplasms/pathology , Pancreatitis/pathology , Acute Disease , Chronic Disease , Humans
12.
AJR Am J Roentgenol ; 176(6): 1475-82, 2001 Jun.
Article in English | MEDLINE | ID: mdl-11373217

ABSTRACT

OBJECTIVE: Our aim was to investigate the feasibility of MR imaging as a comprehensive preoperative imaging test for examination of liver donor candidates for adult-to-adult right lobe transplantation. SUBJECTS AND METHODS: Twenty-five consecutive donor candidates were examined at 1.5 T using a torso phased array coil with breath-hold T1- and T2-weighted imaging of the abdomen, MR cholangiography using T2-weighted turbo spin-echo imaging, and MR angiography and venography of the liver using two interpolated three-dimensional spoiled gradient-echo sequences (average dose of gadolinium contrast material, 0.17 mmol/kg). Images were interpreted for liver parenchymal and extrahepatic abnormalities; measurements of right and left lobe liver volumes; definition of hepatic arterial, portal venous, and hepatic venous anatomy; and definition of the biliary branching pattern. Findings were compared with those of conventional angiography in 13 patients, 11 of whom also had surgical findings for comparison. RESULTS: Nine patients were excluded as candidates for donation on the basis of MR imaging findings that included parenchymal or extrahepatic abnormalities in five patients, vascular anomalies in two, and biliary anomalies in three. Two patients who did not undergo surgery underwent conventional angiography that confirmed MR angiographic findings except for a small (<2 mm) accessory left hepatic artery missed on MR imaging. Of the nine patients who underwent successful right hepatectomy, all MR imaging findings were corroborated intraoperatively. In two patients, right hepatectomy was aborted at laparotomy because of intraoperative cholangiography findings; in one of them, the biliary finding was unsuspected on MR imaging. CONCLUSION: A comprehensive MR imaging examination has the potential to serve as the sole preoperative imaging modality for living adult-to-adult liver donor candidates provided improvements in definition of intrahepatic biliary anatomy can be achieved.


Subject(s)
Hepatectomy , Liver Transplantation , Living Donors , Magnetic Resonance Imaging , Adult , Angiography , Bile Ducts/anatomy & histology , Contrast Media , Feasibility Studies , Female , Hepatic Artery/anatomy & histology , Hepatic Veins/anatomy & histology , Humans , Liver/blood supply , Magnetic Resonance Angiography , Male , Portal Vein/anatomy & histology , Prospective Studies
13.
Radiology ; 219(2): 445-54, 2001 May.
Article in English | MEDLINE | ID: mdl-11323471

ABSTRACT

PURPOSE: To determine the sensitivity and specificity of magnetic resonance (MR) imaging for detection of hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) by using explantation correlation in patients with cirrhosis and no known HCC. MATERIALS AND METHODS: Seventy-one patients without a known history of HCC who underwent MR imaging and subsequent transplantation within 90 days were examined. Breath-hold turbo short inversion time inversion-recovery and/or T2-weighted turbo spin-echo MR images were obtained. Dynamic two- or three-dimensional gadolinium-enhanced gradient-echo MR images were obtained in the hepatic arterial, portal venous, and equilibrium phases. Prospective MR image interpretations were compared directly with explanted liver pathologic results. RESULTS: Eleven (15%) of 71 patients had hepatic malignancies; MR imaging enabled diagnosis of tumor in six (54%) of 11 patients. On a lesion-by-lesion basis, MR imaging depicted 11 of 20 hepatic neoplasms, for an overall sensitivity of 55%. MR imaging depicted four (80%) of five lesions larger than 2 cm, six (50%) of 12 lesions 1-2 cm, and one (33%) of three lesions smaller than 1 cm. MR imaging depicted only nine (15%) of 59 DNS: The specificities of MR imaging for detection of HCC and DNs on a per patient basis were 60 (86%) of 70 patients and 53 (85%) of 62 patients, respectively. CONCLUSION: MR imaging is insensitive for the diagnosis of small (<2-cm) HCCs and DNS:


Subject(s)
Carcinoma, Hepatocellular/diagnosis , Liver Cirrhosis/complications , Liver Neoplasms/diagnosis , Liver/pathology , Magnetic Resonance Imaging , Adult , Aged , Carcinoma, Hepatocellular/complications , False Positive Reactions , Female , Humans , Liver Neoplasms/complications , Male , Middle Aged , Sensitivity and Specificity
15.
J Comput Assist Tomogr ; 25(2): 236-8, 2001.
Article in English | MEDLINE | ID: mdl-11242220

ABSTRACT

Retroperitoneal fat necrosis is a well-known complication of acute pancreatitis. We describe an unusual case of fat necrosis presenting as multiple, bilateral renal pseudotumors in a patient with acute pancreatitis. The imaging findings on CT and MR are discussed.


Subject(s)
Fat Necrosis/etiology , Kidney Diseases/etiology , Pancreatitis/complications , Acute Disease , Diagnosis, Differential , Fat Necrosis/diagnostic imaging , Humans , Kidney Diseases/diagnosis , Kidney Diseases/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Pancreatitis/diagnostic imaging , Retroperitoneal Space , Tomography, X-Ray Computed
17.
Radiology ; 218(1): 47-53, 2001 Jan.
Article in English | MEDLINE | ID: mdl-11152778

ABSTRACT

PURPOSE: To determine the sensitivity of magnetic resonance (MR) imaging for detection of siderotic nodules in patients with cirrhosis and whether the frequency of hepatocellular carcinoma (HCC) and dysplastic nodules is greater if siderotic nodules are present. MATERIALS AND METHODS: MR imaging (1.5 T) was performed within 0-117 days (mean, 30 days) before liver transplantation in 77 patients. Two readers retrospectively evaluated gradient-echo (GRE) (echo time [TE], > or = 9 and 4-5 msec) and turbo short inversion time inversion-recovery or T2-weighted images for low-signal-intensity nodules. Whole-explant pathologic correlation was available in every case. RESULTS: At explantation, 28 (36%) of 77 patients had HCC, 25 (32%) had dysplastic nodules, and nine (12%) had both; 35 (45%) patients had siderotic nodules. The sensitivity of GRE imaging with 9-msec or longer TE for the detection of siderotic nodules was 80% (28 of 35) but decreased to 31% (11 of 35) with 4-5-msec TE. Frequency of HCC was not significantly higher (P =.27) in patients with (43% [15 of 35]) than in patients without (31% [13 of 42]) siderotic nodules. Frequency of dysplastic nodules also was not significantly higher (P =.42) in patients with (37% [13 of 35]) than in patients without (29% [12 of 42]) siderotic nodules. CONCLUSION: Sensitivity of MR imaging for the detection of siderotic nodules was improved with use of GRE pulse sequences with longer TEs of 9 msec or greater (80%) versus 4-5 msec (31%); however, there was no significant increased frequency of HCC or dysplastic nodules in patients with pathologically proved siderotic nodules.


Subject(s)
Carcinoma, Hepatocellular/pathology , Liver Cirrhosis/pathology , Liver Neoplasms/pathology , Magnetic Resonance Imaging , Adult , Aged , Carcinoma, Hepatocellular/epidemiology , Female , Humans , Liver Neoplasms/epidemiology , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Siderosis/pathology
18.
Abdom Imaging ; 26(6): 640-7, 2001.
Article in English | MEDLINE | ID: mdl-11907731

ABSTRACT

BACKGROUND: We retrospectively reviewed the imaging features of a series of patients with cystic pancreatic masses, the majority of whom underwent imaging surveillance. METHODS: Imaging data from 30 patients with known cystic pancreatic masses were reviewed. Nine patients had surgical and/or cytologic classification. Of the 21 who were not operated on, all underwent serial imaging surveillance. Of these, five had corroborative endoscopic retrograde cholangiopancreatography and 16 were followed by only computed tomography and/or magnetic resonance imaging. RESULTS: In the nonoperated group, mean follow-up time was 30 months (3-144 months). Two patients demonstrated growth, and the remainder remain stable. In the patients who underwent surgery, invasive carcinoma was found in those with lesions larger than 4 cm, involvement of the main pancreatic duct, or visible solid components on the imaging study. Smaller lesions were benign. CONCLUSION: In patients with suspected cystic pancreatic neoplasms, surveillance might be possible if lesions are smaller than 2.5 cm, spare the main pancreatic duct, and demonstrate no solid components.


Subject(s)
Pancreatic Cyst/diagnostic imaging , Pancreatic Neoplasms/diagnostic imaging , Adenocarcinoma/diagnostic imaging , Aged , Cholangiopancreatography, Endoscopic Retrograde , Cystadenocarcinoma/diagnostic imaging , Cystadenoma/diagnostic imaging , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Male , Retrospective Studies , Time Factors , Tomography, X-Ray Computed
19.
J Comput Assist Tomogr ; 24(5): 773-6, 2000.
Article in English | MEDLINE | ID: mdl-11045701

ABSTRACT

OBJECTIVE: To determine if iron containing "siderotic" nodules detected at magnetic resonance (MR) imaging are regenerative (RN) or dysplastic (DN) and to attempt to identify features that may distinguish them. MATERIAL AND METHODS: MR imaging (1.5 T) was performed on 77 cirrhotic patients who underwent orthotopic liver transplantation within 0-117 days (mean 30 days) of MR imaging. Two readers retrospectively evaluated breath-hold gradient-echo pulse sequences (echo time > or =9.0 ms, flip angle < or =45 degrees) for the presence of hypointense nodules, which were classified as micronodular (< or =3 mm), macronodular (>3 mm), or mixed. Nodule distribution was classified as focal (<5), scattered (5-20), or diffuse (>20) per slice. Thin section pathologic correlation was available in all cases, and Prussian blue iron stains were performed. RESULTS: Of 35 patients with pathologically proven siderotic nodules, 10 (29%) had at least 2 siderotic DN. MR detected siderotic nodules in 10 of 10 (100%) patients with siderotic DN and RN, and in 18 of 25 patients (72%) with siderotic RN only. CONCLUSION: Siderotic RN cannot be reliably distinguished from siderotic DN with MR imaging, and therefore the widely used term "siderotic regenerative nodule" should be avoided and replaced by "siderotic nodule."


Subject(s)
Liver Cirrhosis/pathology , Liver Regeneration , Liver/pathology , Magnetic Resonance Imaging , Siderosis/pathology , Female , Humans , Liver/physiology , Liver Cirrhosis/physiopathology , Liver Cirrhosis/surgery , Liver Transplantation , Male , Middle Aged , Retrospective Studies
20.
J Comput Assist Tomogr ; 24(4): 628-34, 2000.
Article in English | MEDLINE | ID: mdl-10966200

ABSTRACT

PURPOSE: The purpose of this work was to determine the sensitivity of hepatic digital subtraction arteriography (DSA) for the detection of hepatocellular carcinoma (HCC) and dysplastic nodules (DNs) when compared with pathological findings from whole liver explants. METHOD: Twenty-one patients 30-72 years old (mean 54 years) with cirrhosis and known or clinically suspected HCC (20 prior to chemoembolization) underwent hepatic DSA with subsequent transplantation within 80 days (mean 32 days). The prospective DSA report was compared with pathologic findings from explanted livers. RESULTS: Overall, DSA detected 31 of 95 HCC lesions for a sensitivity of 33%. Of these 31 lesions, 28 were hypervascular and 3 were hypovascular. DSA detected all six HCCs measuring >5 cm, all six HCCs measuring 3-5 cm, and all five HCCs 2-3 cm, resulting in a sensitivity of 100% (17/17) for HCC >2 cm. DSA detected 7 of 18 HCCs measuring 1-2 cm (sensitivity 39%) and 7 of 60 HCCs < or =1 cm (sensitivity 12%). Overall sensitivity for DSA in detection of HCC < or =2 cm was 18% (14/78 lesions). None of 17 DNs (0.2-1.5 cm in size) was identified on DSA. CONCLUSION: DSA is insensitive to small HCC (< or =2 cm), carcinomatosis arising within nodules, and DN.


Subject(s)
Angiography, Digital Subtraction/methods , Carcinoma, Hepatocellular/diagnosis , Liver Neoplasms/diagnosis , Adult , Aged , Female , Humans , Liver Diseases/diagnosis , Liver Transplantation , Male , Middle Aged , Sensitivity and Specificity
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