查看更多>>摘要：Background Fistulas are serious complications of splenic and perisplenic fluid accumulations, which are often difficult to detect by routine imaging methods. Purpose To evaluate the occurrence of spontaneous fistulas detectable during computed tomography-guided percutaneous drainage placement (CTGDP) with contrast filling of splenic or perisplenic fluid collections and to assess characteristics in comparison with perihepatic or peripancreatic fluid accumulations, also being treated with CTGDP. Material and Methods In 127 CTGDP-procedures, pre-interventional CTs conducted with intravenous contrast agent were compared to post-interventional CTs including contrast filling of the drain to identify spontaneous fistulas. Patient and case characteristics were evaluated, and therapeutic consequences of fistula identification were analyzed. Results A total of 43 perisplenic, 40 peripancreatic, and 44 perihepatic drains were evaluated; 13 (30.2%) perisplenic, 7 (17.5%) peripancreatic, and 10 (22.7%) perihepatic fistulas were observed. Concerning the frequency of fistulas, no significant difference was found between the patient groups (P = 0.39). All fistulas were solely proven in CT scans including contrast filling of the drain. Seven fistulas (23.3%) required additional interventions. Perihepatic drains were significantly more often associated with recent surgery (P < 0.001). The mean size of peripancreatic drains was significantly greater (11.8 +/- 3.9 F; P < 0.001) than in perihepatic or perisplenic fluid collections. Conclusion Spontaneous fistulas detected during CTGDP of splenic or perisplenic fluid collections are common. Post-interventional contrast filling of the drain drastically improves the detection rate of perisplenic, peripancreatic and perihepatic fistulas simultaneously initiating appropriate follow-up interventions.
Van den Bosch, VincentPedersoli, FedericoKeil, SebastianNeumann, Ulf P....
7页
查看更多>>摘要：Background In patients with bilobar metastatic liver disease, surgical clearance of both liver lobes may be achieved through multiple-stage liver resections. For patients with extensive disease, a major two-staged hepatectomy consisting of resection of liver segments II and III before right-sided portal vein embolization (PVE) and resection of segments V-VIII may be performed, leaving only segments IV +/- I as the liver remnant. Purpose To describe the outcome following right-sided PVE after prior complete resection of liver segments II and III. Material and Methods In this retrospective study, 15 patients (mean age = 60.4 +/- 9.3 years) with liver metastases from colorectal cancer (n = 14) and uveal melanoma (n = 1) who were scheduled to undergo a major two-stage hepatectomy, were included. Total liver volume (TLV) and volume of the future liver remnant (FLR) were measured on pre- and postinterventional computed tomography (CT) scans, and standardized FLR volumes (ratio FLR/TLV) were calculated. Patient data were retrospectively analyzed regarding peri- and postinterventional complications, with special emphasis on liver function tests. Results The mean standardized post-PVE FLR volume was 26.9% +/- 6.4% and no patient developed hepatic insufficiency after the PVE. Based on FLR hypertrophy and liver function tests, all but one patient were considered eligible for the subsequent right-sided hepatectomy. However, due to local tumor progression, only 9/15 patients eventually proceeded to the second stage of surgery. Conclusion Right-sided PVE was safe and efficacious in this cohort of patients who had previously undergone a complete resection of liver segments II and III as part of a major staged hepatectomy pathway leaving only segments IV(+/- I) as the FLR.
查看更多>>摘要：Background Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has been widely used in clinical practice. However, scientific evidence is lacking for recommending a particular sequence for measuring tumor size. Purpose To retrospectively compare the size of hepatocellular carcinoma (HCC) measured on different gadoxetic acid-enhanced MRI sequences using pathology as a reference. Material and Methods A total of 217 patients with single HCC who underwent gadoxetic acid-enhanced MRI before surgery were included. The size of the HCC was measured by two abdominal radiologists independently on the following sequences: T1-weighted; T2-weighted; b-500 diffusion-weighted imaging (DWI); and arterial, portal venous, transitional, and hepatobiliary phases. Tumor size measured on MRI was compared with pathological size by using Pearson correlation coefficient, independent-sample t test, and Bland-Altman plot. Agreement between two readers was evaluated with intraclass correlation coefficient (ICC). Results Correlation between the MR images and pathology was high for both readers (0.899-0.955). Absolute error between MRI and pathologic assessment was lowest on hepatobiliary phase images for both readers (reader 1, 2.8 +/- 4.2 mm; reader 2, 3.2 +/- 3.4 mm) and highest on arterial phase images for reader 1 (4.9 +/- 4.4 mm) and DWI phase images for reader 2 (5.1 +/- 4.9 mm). Absolute errors were significantly different for hepatobiliary phase compared with other sequences for both readers (reader 1, P <= 0.012; reader 2, P <= 0.037). Inter-reader agreements for all sequence measurements were strong (0.971-0.997). Conclusion The performance of gadoxetic acid-enhanced MRI sequences varied with HCC size, and the hepatobiliary phase may be optimal among these sequences.
查看更多>>摘要：Background After computed tomography (CT)-guided interventions, routine in-hospital observation is recommended by the Cardiovascular and Interventional Radiological Society of Europe. Purpose To evaluate the frequency of delayed major complications or hospitalizations after CT-guided biopsies in patients with initially no or minor complications and to assess whether routine in-hospital observation is justified. Material and Methods This retrospective study included 433 outpatients after CT-guided biopsy of the thoracic (n = 176), abdominal (n = 129), or musculoskeletal (n = 128) region with subsequent in-hospital observation. Complications were graded according to the current Society of Interventional Radiology recommendations and grouped into minor or major. A complication that occurred during in-hospital observation was defined as delayed complication. A delayed major complication was a newly developed major complication or a progression from an initially minor to a major complication. Hospitalization frequencies were evaluated similarly. Occurrence, 95% confidence intervals (CI), and P values for significant differences between the three organ groups were calculated. If delayed major complications were more frequent than 1%, routine in-hospital observation was considered justified. Results Delayed, major complication frequencies were: thoracic, 8.2% (95% CI 4.6-13.4); abdominal, 0.0% (95% CI 0.0-2.9); and musculoskeletal, 0.0% (95% CI 0.0-2.9) (P < 0.001). Delayed hospitalization frequencies were: thoracic, 8.8% (95% CI 5.0-14.2); abdominal, 1.6% (95% CI 0.2-5.6); and musculoskeletal, 0.0% (95% CI 0.0-2.9) (P < 0.001). Conclusion After thoracic interventions, routine observation is considered justified for patient safety whereas routine observation may be omitted after musculoskeletal interventions. In the abdominal group, no delayed complications were observed, but delayed hospitalization occurred. Thus, in-hospital observation could be justified in a safe patient environment, but remains an individual decision.
查看更多>>摘要：Background Little is known about the associations between cardiovascular risk factors (CRF) and disc degeneration (DD). Purpose To evaluate the potential association between CRFs and intervertebral DD in a population-based sample. Methods A total of 400 participants from the community-based KORA-study were assessed in terms of CRFs, specifically obesity, hypertension, diabetes, elevated LDL-c, low HDL-c, elevated triglycerides, smoking status, and alcohol consumption. The patients additionally underwent whole-body magnetic resonance imaging (MRI) using T2-weighted single-shot fast-spin-echo and T1 dual-echo gradient-echo Dixon pulse sequences. Thoracic and lumbar DD were assessed using the Pfirrmann score and for the presence of disc bulging/protrusion. Cross-sectional associations between CRFs and MR-based Pfirrmann score were then analyzed. Results A total of 385 individuals (58.2% men; mean age 56.3 +/- 9.2 years) were included. Prevalence of DD was 76.4%. Older age (beta = 0.18; 95% CI 0.12-0.25; P < 0.001) and higher body mass index (BMI) (beta = 0.19; 95% CI 0.06-0.30; P = 0.003) were significantly associated with DD of the thoracolumbar spine. Diabetes was significantly associated with DD at T7/8 (P = 0.029) and L3/4 (P = 0.017). Hypertension correlated significantly with DD in univariate analysis, but the association did not persist using multivariate analysis (beta = 0.53; 95% CI -0.74 to 1.81; P = 0.41). None of the other CRFs (P >= 0.11) were associated with advanced DD. Disc bulging was independently associated with hypertension (beta = 0.47; 95% CI 0.27-0.81; P = 0.01). Conclusion A significant independent association exists between age, BMI, and intervertebral DD. In contrast, there is no significant association between cardiovascular risk factors and DD. Providing strong evidence that the pathologic process undergirding DD is mechanical, rather than microvascular, in nature.
Wong, Tony T.Quarterman, PatrickLynch, Thomas S.Rasiej, Michael J....
7页
查看更多>>摘要：Background Ultrashort echo time (UTE) T2* is sensitive to molecular changes within the deep calcified layer of cartilage. Feasibility of its use in the hip needs to be established to determine suitability for clinical use. Purpose To establish feasibility of UTE T2* cartilage mapping in the hip and determine if differences in regional values exist. Material and Methods MRI scans with UTE T2* cartilage maps were prospectively acquired on eight hips. Hip cartilage was segmented into whole and deep layers in anterosuperior, superior, and posterosuperior regions. Quantitative UTE T2* maps were analyzed (independent one-way ANOVA) and reliability was calculated (ICC). Results UTE T2* mean values (anterosuperior, superior, posterosuperior): full femoral layer (19.55, 18.43, 16.84 ms) (P=0.004), full acetabular layer (19.37, 17.50, 16.73 ms) (P=0.013), deep femoral layer (18.68, 17.90, 15.74 ms) (P=0.010), and deep acetabular layer (17.81, 16.18, 15.31 ms) (P=0.007). Values were higher in anterosuperior compared to posterosuperior regions (mean difference; 95% confidence interval [CI]): full femur layer (2.71 ms; 95% CI 0.91-4.51: P=0.003), deep femur layer (2.94 ms; 95% CI 0.69-5.19; P=0.009), full acetabular layer (2.63 ms 95% CI 0.55-4.72; P=0.012), and deep acetabular layer (2.50 ms; 95% CI 0.69-4.30; P=0.006). Intra-reader (ICC 0.89-0.99) and inter-reader reliability (ICC 0.63-0.96) were good to excellent for the majority of cartilage layers. Conclusion UTE T2* cartilage mapping was feasible in the hip with mean values in the range of 16.84-19.55 ms in the femur and 16.73-19.37 ms in the acetabulum. Significantly higher values were present in the anterosuperior region compared to the posterosuperior region.
查看更多>>摘要：The calf muscle group is a common area for injury within the professional athlete population. Anatomical and biomechanical differences between the different component muscles vary their individual predispositions to and patterns of injury. However, there is a common unifying factor: injuries involving tendinous components have greater clinical implications with regards to rehabilitation, potential intervention, length of time to return to play, and re-injury rates. As such, accurate understanding of the underlying anatomy and subsequent interpretation of the injury patterns carry significant clinical ramifications. Ultrasound is a useful tool but has limitations, particularly when assessing soleus. As such, magnetic resonance imaging remains the workhorse in calf injury investigation.
Kiil, Rosa MarieArnbak, Bodil Al-MashhadiZejden, AnnaSchiottz-Christensen, Berit...
10页
查看更多>>摘要：Background Pregnancy-related pain may be associated with sacroiliac joint (SIJ) changes, detectable by magnetic resonance imaging (MRI). Purpose To analyze the prevalence and course of SIJ MRI and clinical findings in women referred with low back pain and relate these to pregnancy. Material and Methods A retrospective follow-up study from a longitudinally collected cohort comprising 328 women. Results Women reporting debut of pain in relation to a pregnancy (PP group) tended to have a higher baseline prevalence of all investigated MRI findings, cumulated positive SIJ tests, and a potential fulfilment of the spondyloarthritis diagnosis compared to remainders. The prevalence of subchondral bone marrow edema (BME), any SIJ MRI finding, and potential fulfilment of the spondyloarthritis diagnosis were significantly higher in the PP group compared to women who had not been pregnant. In the total study group, the prevalence of >= 1 MRI finding increased over the four-year study period from 34% to 47% (P<0.001), driven by increasing prevalence of BME (25% to 32%; P=0.008) and fatty marrow deposition (FMD) (20% to 25%; P=0.020). In addition, the BME volume score increased. Over time, the PP group had persisting high prevalence of buttock pain and total MRI findings and their FMD volume score increased, but there were no between-group differences in MRI variables at follow-up. Conclusion Overall, the prevalence of MRI findings increased over time. Although the PP group had different clinical and SIJ MRI characteristics cross-sectional at baseline compared to remainders, longitudinal analyses revealed that these diminished over time.
查看更多>>摘要：Background It is difficult for conventional magnetic resonance imaging (MRI) to distinguish benign soft-tissue masses (STMs) from malignant masses. Purpose To quantitatively compare the diagnostic value of intravoxel incoherent motion (IVIM) and diffusion kurtosis imaging (DKI) in STMs. Material and Methods The data from 58 patients with STMs were retrospectively analyzed. The GE Discovery 3.0-T MRI scanner was used to acquire conventional MRI sequences, IVIM, and DKI images. The chi-square test, independent sample t-test, and Mann-Whitney U tests were used to compare the differences between conventional MRI features, IVIM, and DKI parameters (D-slow, D-fast, f, mean kurtosis [MK], and mean diffusivity [MD]) between the benign and malignant groups. Receiver-operating characteristic (ROC) curve analysis was also performed. Results Tumor size and depth are statistically different in STTs. Ds(low), MK, and MD values in the malignant groups are significantly lower than the benign groups (P < 0.05). However, D-fast and f values are not statistically different between the two groups. The area under the curve (AUC) of D-slow value (0.859) is higher than MD (0.765) and MK (0.676) values for identifying benign and malignant STMs. The D-slow value showed the best specificity (82.93%). The sensitivity and specificity of IVIM and DKI parameters are higher than that of conventional MRI sequences. Conclusion IVIM and DKI can be used to distinguish between benign and malignant STMs, with D-slow as the most meaningful parameter.
查看更多>>摘要：Background Dual-energy computed tomography, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can be used to distinguish microinvasion areas of malignant bone tumors. However, reports of diffusion kurtosis imaging (DKI) to determine the extent of intramedullary infiltration are relatively rare. Purpose To assess the application value of MR-DKI in differentiating areas of microinfiltration and simple edema in rabbit bone VX2 tumor models. Material and Methods Conventional MRI and DKI were performed on 25 successfully constructed rabbit VX2 bone tumor models. We acquired a midline sagittal section of the tumor for hematoxylin and eosin staining. Using pathological findings as the gold standard and combining them with MRI data, strict point-to-point control was performed to delineate regions of interest (ROIs) in the microinfiltration and simple-edema areas of bone tumors for quantitative measurement of mean diffusivity (MD) and mean kurtosis (MK). MD and MK values between microinfiltration and simple-edema areas were compared using an independent sample t-test, and the diagnostic values were evaluated by receiver operating characteristic (ROC) curve analysis. Results In comparison with the simple-edema area, the micro-infiltration area demonstrated significantly smaller MD values and larger MK values (P < 0.05), and MD showed a better area under the curve (AUC) than MK (AUC = 0.884 vs. AUC = 0.690) for distinguishing the microinfiltration area from the simple-edema area. The optimal cutoff MD value was 1108.5 mm(2)/s with a sensitivity of 84% and specificity of 84%. Conclusion DKI can distinguish the microinfiltration and simple-edema areas of malignant bone tumors in animal experiments.
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