Radial MRI during free breathing in contrast-enhanced hepatobiliary phase imaging.

BACKGROUND: Use of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) for diagnosis of hepatic tumors has been previously reported. Fat-saturated 3D T1-weighted gradient echo sequence (TIGRE) imaging using a breath-hold technique is usually used for dynamic studies and hepatobiliary phase Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI). In cases where the patient has difficulty holding their breath, this scanning method can be difficult. PURPOSE: To investigate the usefulness of a fat-saturated T1-weighted spin-echo (SE) sequence using a radial read-out (radial acquisition regime-SE, RADAR-SE) during free breathing for hepatobiliary phase Gd-EOB-DTPA-enhanced MRI. MATERIAL AND METHODS: Images were acquired at 1.5 T. First, a phantom with diluted Gd-EOB-DTPA was scanned using the TIGRE sequence and the RADAR-SE sequence. Contrast ratios of the sequences were compared. Next, the hepatobiliary phase was imaged in 62 patients using the TIGRE sequence with breath-hold and the RADAR-SE during free breathing. Qualitative and quantitative evaluations were compared. RESULTS: In the phantom study, RADAR-SE had a higher contrast ratio than TIGRE. In the clinical study, artifacts were more conspicuous in RADAR-SE compared to TIGRE images in the qualitative evaluation. However, RADAR-SE images were equal to or better than TIGRE images in patients who had difficulty holding their breath. The signal intensity ratio of the liver was statistically higher using RADAR-SE than TIGRE. CONCLUSION: RADAR-SE can be useful for hepatobiliary phase Gd-EOB-DTPA-enhanced MRI in patients who have difficulty holding their breath.

Wandering spleen with gastric volvulus and intestinal non-rotation in an adult male patient.

We report an extremely rare case of wandering spleen (WS) complicated with gastric volvulus and intestinal non-rotation in a male adult. A 22-year-old man who had been previously treated for Wilson disease was admitted with severe abdominal pain. Radiological findings showed WS in the midline of the pelvic area. The stomach was mesenteroaxially twisted and intestinal non-rotation was observed. Radiology results did not show any evidence of splenic or gastrointestinal (GI) infarction. Elective emergency laparoscopy confirmed WS and intestinal non-rotation; however, gastric volvulus was not observed. It was suspected that the stomach had untwisted when gastric and laparoscopic tubes were inserted. Surgery is strongly recommended for WS because of the high risk of serious complications; however, some asymptomatic adult patients are still treated conservatively, such as the patient in this study. The present case is reported with reference to the literature.