Investigation of histological heterogeneity based on the discrepancy between the hyperintense area on T2-weighted images and the accumulation area on 11C-methionine PET in minimally enhancing glioma

Pulmonary sclerosing pneumocytoma is a rare benign pulmonary tumor of primitive epithelial origin. Because of the unspecific radiological features mimicking malignancies and its histological heterogeneity, the differential diagnosis with adenocarcinoma and carcinoid tumors is still challenging. We report our experience of two cases of sclerosing pneumocytoma, as well as a review of the literature. Immunohistochemical findings showed intense staining of the cuboidal epithelial cells for cytokeratin-pool and TTF-1, with focal positivity for progesterone receptors. Round and spindle cells expressed positivity for vimentin, TTF-1 and focally for the progesterone receptor. Cytologic diagnosis of pulmonary pneumocytoma requires the identification of its dual cell population, made up of abundant stromal cells and fewer surface cells. Since the pre- and intraoperative diagnosis should guide surgical decision making, obtaining a sufficient specimen size to find representative material in the cell block is of paramount importance.

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Assessment of intramyocardial hemorrhage with dark-blood T2*-weighted cardiovascular magnetic resonance

Journal of Cardiovascular Magnetic Resonance ◽

10.1186/s12968-021-00787-4 ◽

2021 ◽

Vol 23 (1) ◽

Author(s):

Xingmin Guan ◽

Yinyin Chen ◽

Hsin-Jung Yang ◽

Xinheng Zhang ◽

Daoyuan Ren ◽

...

Keyword(s):

Cardiovascular Magnetic Resonance ◽

Magnetic Resonance ◽

Major Adverse Cardiovascular Events ◽

Observer Variability ◽

Dark Blood ◽

Imaging Characteristics ◽

Inter Observer Variability ◽

Sensitivity Specificity ◽

Bright Blood ◽

T2 Weighted Images

Abstract Background Intramyocardial hemorrhage (IMH) within myocardial infarction (MI) is associated with major adverse cardiovascular events. Bright-blood T2*-based cardiovascular magnetic resonance (CMR) has emerged as the reference standard for non-invasive IMH detection. Despite this, the dark-blood T2*-based CMR is becoming interchangeably used with bright-blood T2*-weighted CMR in both clinical and preclinical settings for IMH detection. To date however, the relative merits of dark-blood T2*-weighted with respect to bright-blood T2*-weighted CMR for IMH characterization has not been studied. We investigated the diagnostic capacity of dark-blood T2*-weighted CMR against bright-blood T2*-weighted CMR for IMH characterization in clinical and preclinical settings. Materials and methods Hemorrhagic MI patients (n = 20) and canines (n = 11) were imaged in the acute and chronic phases at 1.5 and 3 T with dark- and bright-blood T2*-weighted CMR. Imaging characteristics (Relative signal-to-noise (SNR), Relative contrast-to-noise (CNR), IMH Extent) and diagnostic performance (sensitivity, specificity, accuracy, area-under-the-curve, and inter-observer variability) of dark-blood T2*-weighted CMR for IMH characterization were assessed relative to bright-blood T2*-weighted CMR. Results At both clinical and preclinical settings, compared to bright-blood T2*-weighted CMR, dark-blood T2*-weighted images had significantly lower SNR, CNR and reduced IMH extent (all p < 0.05). Dark-blood T2*-weighted CMR also demonstrated weaker sensitivity, specificity, accuracy, and inter-observer variability compared to bright-blood T2*-weighted CMR (all p < 0.05). These observations were consistent across infarct age and imaging field strengths. Conclusion While IMH can be visible on dark-blood T2*-weighted CMR, the overall conspicuity of IMH is significantly reduced compared to that observed in bright-blood T2*-weighted images, across infarct age in clinical and preclinical settings at 1.5 and 3 T. Hence, bright-blood T2*-weighted CMR would be preferable for clinical use since dark-blood T2*-weighted CMR carries the potential to misclassify hemorrhagic MIs as non-hemorrhagic MIs.

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Follow-up magnetic resonance imaging of Löffler endocarditis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa381 ◽

2020 ◽

Author(s):

Shinya Ito ◽

Akihiro Isotani ◽

Kyohei Yamaji ◽

Kenji Ando

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Corticosteroid Therapy ◽

Cardiac Mri ◽

High Intensity ◽

Left Ventricular ◽

Eosinophil Infiltration ◽

Resonance Imaging ◽

T2 Weighted Images

Abstract Background Löffler endocarditis is a condition characterized by cardiac infiltration of eosinophils. Cardiac magnetic resonance imaging (MRI) is a modality for the diagnosis of myocardial damage. Case summary This is the case of a 77-year-old man with acute decompensated heart failure who was admitted. Transthoracic echocardiography showed preserved left ventricular (LV) systolic function along with LV thrombi attached to the septo-apical wall and the posterior wall, consistent with Löffler endocarditis. Cardiac MRI revealed obliteration of the LV apex and partial filling of the LV cavity, as well as near circumferential subendocardial late gadolinium enhancement (LGE) in the mid- and apical segments. T2-weighted images showed a near circumferential high-intensity area of the LV subendocardial muscle in the mid- and apical segments. High-dose corticosteroids and intravenous heparin were initiated, followed by maintenance warfarin therapy. At 18 months, follow-up cardiac MRI revealed the disappearance of the LV thrombi, and a reduction of LGE, as well as high-intensity areas in the T2-weighted images. Discussion The high-intensity area of T2-weighted images indicate the presence of subendocardial oedema. Eosinophil-mediated heart damage evolves through three stages: (i) acute necrotic, (ii) thrombotic, and (iii) fibrotic stages. Since the deposition of toxic eosinophil granule proteins and eosinophil infiltration injured the endocardium, the first-line treatment for Löffler endocarditis is corticosteroid therapy. In this case, LGE in the subendocardium and the high-intensity area in the T2-weighted images were reduced at 18 months. High-intensity areas of T2-weighted images in the acute phase might indicate the possibility of therapeutic response to corticosteroid therapy.

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Effects of Interobserver Variability on 2D and 3D CT- and MRI-Based Texture Feature Reproducibility of Cartilaginous Bone Tumors

Journal of Digital Imaging ◽

10.1007/s10278-021-00498-3 ◽

2021 ◽

Author(s):

Salvatore Gitto ◽

Renato Cuocolo ◽

Ilaria Emili ◽

Laura Tofanelli ◽

Vito Chianca ◽

...

Keyword(s):

Bone Tumors ◽

Intraclass Correlation ◽

Texture Feature ◽

Region Of Interest ◽

Unenhanced Ct ◽

Unenhanced Computed Tomography ◽

2D And 3D ◽

Feature Stability ◽

Ct And Mri ◽

T2 Weighted Images

AbstractThis study aims to investigate the influence of interobserver manual segmentation variability on the reproducibility of 2D and 3D unenhanced computed tomography (CT)- and magnetic resonance imaging (MRI)-based texture analysis. Thirty patients with cartilaginous bone tumors (10 enchondromas, 10 atypical cartilaginous tumors, 10 chondrosarcomas) were retrospectively included. Three radiologists independently performed manual contour-focused segmentation on unenhanced CT and T1-weighted and T2-weighted MRI by drawing both a 2D region of interest (ROI) on the slice showing the largest tumor area and a 3D ROI including the whole tumor volume. Additionally, a marginal erosion was applied to both 2D and 3D segmentations to evaluate the influence of segmentation margins. A total of 783 and 1132 features were extracted from original and filtered 2D and 3D images, respectively. Intraclass correlation coefficient ≥ 0.75 defined feature stability. In 2D vs. 3D contour-focused segmentation, the rates of stable features were 74.71% vs. 86.57% (p < 0.001), 77.14% vs. 80.04% (p = 0.142), and 95.66% vs. 94.97% (p = 0.554) for CT and T1-weighted and T2-weighted images, respectively. Margin shrinkage did not improve 2D (p = 0.343) and performed worse than 3D (p < 0.001) contour-focused segmentation in terms of feature stability. In 2D vs. 3D contour-focused segmentation, matching stable features derived from CT and MRI were 65.8% vs. 68.7% (p = 0.191), and those derived from T1-weighted and T2-weighted images were 76.0% vs. 78.2% (p = 0.285). 2D and 3D radiomic features of cartilaginous bone tumors extracted from unenhanced CT and MRI are reproducible, although some degree of interobserver segmentation variability highlights the need for reliability analysis in future studies.

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Hypointense Synovial Lesions on T2-Weighted Images: Differential Diagnosis with Pathologic Correlation

American Journal of Roentgenology ◽

10.2214/ajr.181.3.1810761 ◽

2003 ◽

Vol 181 (3) ◽

pp. 761-769 ◽

Cited By ~ 48

Author(s):

José A. Narváez ◽

Javier Narváez ◽

Raúl Ortega ◽

Eugenia De Lama ◽

Yolanda Roca ◽

...

Keyword(s):

Differential Diagnosis ◽

Pathologic Correlation ◽

Synovial Lesions ◽

T2 Weighted Images

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Imaging Features of Aggressive Giant Cell Tumors of the Mobile Spine: Retrospective Analysis of 101 Patients From Single Center

Global Spine Journal ◽

10.1177/2192568220982280 ◽

2021 ◽

pp. 219256822098228

Author(s):

Bei Yuan ◽

Lihua Zhang ◽

Shaomin Yang ◽

Hanqiang Ouyang ◽

Songbo Han ◽

...

Keyword(s):

Giant Cell ◽

Vertebral Body ◽

Signal Intensity ◽

Imaging Features ◽

Single Center ◽

Giant Cell Tumors ◽

Ct Guided ◽

Cortical Destruction ◽

Mobile Spine ◽

T2 Weighted Images

Study Design: Retrospective study. Objectives: Giant cell tumors (GCTs) of the mobile spine can be locally aggressive. This study described and classified the typical and atypical appearance of aggressive spinal GCTs according to imaging findings to help the imaging diagnosis, especially for patients with rapid neurological deficit that may require emergent surgery without biopsy. Methods: Computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients diagnosed with aggressive spinal GCTs at single center were reviewed. Results: Overall, 101 patients with 100 CT images and 94 MR images were examined. All lesions were osteolytic with cortical destruction; 95 lesions showed epidural extension; 90 were centered in the vertebral body; 82 showed pathological fracture and/or collapse of the vertebral body; 78 had pseudotrabeculation on CT; 80 showed low-to-iso signal intensity or heterogeneous high-signal intensity with cystic areas on the T2-weighted images; 9 showed fluid–fluid level on T2-weighted images; and 61 patients showed marked enhancement on contrast-enhanced CT and/or MRI. Forty-one lesions (40.6%) had at least 1 atypical radiographic feature: 19 involved ≥2 segments; 11 were centered in the posterior neural arch; 10 had a paravertebral mass over 2 segments; 16 showed partial margin sclerosis with partial cortical destruction on CT scans; and 3 showed mineralization within the tumor on CT. Eighty-eight patients underwent CT-guided biopsy with a diagnostic accuracy rate of 94.3%. Conclusions: Spinal GCTs might appear more radiologically atypical, and about 40% of the lesions may have at least 1 atypical feature. CT-guided biopsies are recommended for definitive diagnosis.

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Clinical Stage I Carcinoma of the Uterine Cervix Value of Preoperative Magnetic Resonance Imaging in Assessing Parametrial Invasion

Tumori Journal ◽

10.1177/030089160208800410 ◽

2002 ◽

Vol 88 (4) ◽

pp. 291-295 ◽

Cited By ~ 9

Author(s):

Sandro Sironi ◽

Massimo Bellomi ◽

Gaetano Villa ◽

Silvia Rossi ◽

Alessandro Del Maschio

Keyword(s):

Cervical Cancer ◽

Mr Imaging ◽

Tumor Invasion ◽

Early Stage ◽

Imaging Techniques ◽

Clinical Stage ◽

Fast Spin Echo ◽

Parametrial Invasion ◽

Early Stage Cervical Cancer ◽

T2 Weighted Images

Aims and Background The purpose of this prospective study was to assess the efficacy of different MR imaging techniques in the evaluation of parametrial tumor invasion in patients with early stage cervical cancer. Methods A total of 73 consecutive patients, clinically considered to have invasive tumor (<3 cm in diameter) confined to the cervix, underwent MR imaging studies at 1 T, according to the following protocol: fast spin-echo (FSE) T2-weighted, gadolinium-enhanced SE T1-weighted, and fat-suppressed gadolinium-enhanced SE T1-weighted sequences. Images obtained with each sequence were evaluated for parametrial invasion with the use of histopathologic findings as the standard of reference. Results In the assessment of tumor infiltration of the parametrium, with FSE T2-weighted images accuracy was 83%, with SE T1-weighted gadolinium-enhanced images was 65%, and with SE T1-weighted gadolinium-enhanced fat-suppressed images was 72%. The difference between the accuracy rate achieved with FSE T2-weighted images and those obtained with the other two MR sequences was statistically significant (P <0.05). The high negative predictive value (95%) for the exclusion of parametrial tumor invasion was the principal contributor to the staging accuracy obtained with FSE T2-weighted imaging. Conclusions Unenhanced FSE T2-weighted imaging is a reliable method for determining the degree of tumor invasion in patients with early stage cervical cancer. Our data suggest that contrast-enhanced sequences, even with the use of the fat suppression technique, have limited value in assessing tumor extension.

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