Clinical and Pathological Attributes of Hepatocellular Carcinoma Showing Lack of Restricted Diffusion on Magnetic Resonance Imaging

Objective: To correlate non-restricted diffusion magnetic resonance imaging (MRI) patterns of hepatocellular carcinoma (HCC), with histopathology and clinical outcome.Material and Methods: We retrospectively evaluated pre-treatment MRIs showing non-restricted diffusion HCC lesions (≥1-centimeter), excluding lesions with poor quality/non-available diffusion weighted imaging (DWI). Three radiologists evaluated 37 lesions in 27 patients, for: T1-weighted (T1W)/T2-weighted (T2W) characteristics, arterial enhancement, washout on portal venous/delayed phase, capsular enhancement, intralesional fat component and presence of cirrhosis. Histopathological reports were categorized as: well/moderate/poorly differentiated. Kaplan-Meier survival analysis was calculated for clinical outcome.Results: From a total of 37 lesions, 24 lesions had available pathological grading, which revealed well and moderately differentiated equally (12 lesions each). None of the non-restricted diffusion HCCs were poorly differentiated. Thirty-five of the 37 lesions (94.6%) showed arterial enhancement with washout; 34 lesions (91.9%) were T2W hypo-/isointense, 33 esions (89.2%) were T1W iso-/hyperintense, 19 lesions (51.4%) showed capsular enhancement and 8 lesions (21.6%) had intralesional fat. These findings in the well and moderately differentiated groups were not significantly different (p-value 0.178-1.000). Overall mean-survival was 6.972 years (95% confidence interval (CI); 5.3-8.6). The 1-year, overall survival rate was 83.6% and for 3-years was 67.9%. Mean survival of well and moderately differentiated groups were 6.88 and 7.23 years (95% CI 5.7-8.0 and 4.4-10.1), respectively (p-value=0.319).Conclusion: DWI may help to predict histological grading of HCC and clinical outcome. We found that non-restricted diffusion HCCs were histologically well or moderately differentiated, with no significant difference of imaging findings and survival rates between the two groups. No poorly differentiated lesions were seen in our non-restricted HCC cohort.

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Comparison of LI-RADS 2018 and KLCA-NCC 2018 for noninvasive diagnosis of hepatocellular carcinoma using magnetic resonance imaging

Clinical and Molecular Hepatology ◽

10.3350/cmh.2020.0004 ◽

2020 ◽

Vol 26 (3) ◽

pp. 340-351 ◽

Cited By ~ 2

Author(s):

Sunyoung Lee ◽

Seung-seob Kim ◽

Dong ryul Chang ◽

Hyerim Kim ◽

Myeong-Jin Kim

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

High Risk ◽

Magnetic Resonance ◽

Statistical Significance ◽

Liver Imaging ◽

Noninvasive Diagnosis ◽

Resonance Imaging ◽

Extracellular Contrast Agent ◽

Significant Difference

Background/Aims: This study aimed to compare the diagnostic performances of Liver Imaging Reporting and Data System (LI-RADS) 2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 criteria on magnetic resonance imaging (MRI) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients.Methods: This retrospective study included 273 treatment-naïve patients (71 patients with extracellular contrast agent [ECA]-MRI and 202 patients with hepatobiliary agent [HBA]-MRI; 352 lesions including 263 HCCs) with high risk of HCC who underwent contrast-enhanced MRI between 2016 and 2017. Two readers evaluated all lesions according to the criteria of LI-RADS 2018 and KLCA-NCC 2018. The per-lesion diagnostic performances were compared using the generalized estimating equation method.Results: On ECA-MRI, the sensitivity and specificity of LI-RADS 2018 and KLCA-NCC 2018 were not significantly different (LR-5 vs. definite HCC: 75.8% vs. 69.4%, P=0.095 and 95.8% vs. 95.8%, P>0.999; LR-5/4 vs. definite/probable HCC: 87.1% vs.83.9%, P=0.313 and 87.5% vs. 91.7%, P=0.307). On HBA-MRI, definite HCC of KLCA-NCC 2018 showed significantly higher sensitivity (79.1% vs. 68.2%, P<0.001) than LR-5 of LI-RADS 2018 without a significant difference in specificity (93.9% vs. 95.4%, P=0.314). Definite/probable HCC of KLCA-NCC 2018 had higher specificity (92.3% vs. 80.0%, P=0.003) than LR-5/4 of LI-RADS 2018. The sensitivity was lower for definite/probable HCC than for LR-5/4 without statistical significance (85.6% vs. 88.1%, P=0.057).Conclusions: On ECA-MRI, LI-RADS 2018 and KLCA-NCC 2018 showed comparable diagnostic performances. On HBA-MRI, definite HCC of KLCA-NCC 2018 provided better sensitivity than LR-5 category of LI-RADS 2018 without compromising the specificity, while definite/probable HCC of KLCA-NCC 2018 revealed higher specificity than LR-5/4 of LI-RADS 2018 for diagnosing HCC.

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Magnetic Resonance Imaging Grading of Pituitary Macroadenoma- SIPAP Classification Revisited.

10.21203/rs.3.rs-955034/v1 ◽

2021 ◽

Author(s):

Shayan Sirat Maheen Anwar ◽

Kiran Hilal ◽

Anam Khan ◽

Asra Ahmad

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Pituitary Adenomas ◽

Tumour Size ◽

P Value ◽

Kappa Statistics ◽

Pituitary Macroadenoma ◽

Resonance Imaging ◽

Tumour Delineation ◽

Significant Difference

Abstract BACKGROUNDMagnetic resonance imaging (MRI) is regarded as the modality of choice in diagnosis of pituitary adenomas. Since surgery is the first line therapy for all pituitary adenomas with exception of prolactinoma, simple and reproducible MRI classification based on major directions of tumour growth is an essential tool providing the exact road map for right surgical approach and maximum safe resection.SIPAP MRI classification for pituitary adenomas is derived from KNOSP-STEINER classification of parasellar growth, to which has been added grading for superior, inferior, anterior and posterior tumour extension.We, therefore, propose to incorporate SIPAP classification in routine reporting template of pituitary adenomas, for ideal radiological description of tumour delineation, relationship to juxtasellar structures, and tumour size, hence facilitating greater success rate in surgical and subsequent clinical management.METHODSTwo radiologists retrospectively reviewed imaging of 49 patients with biopsy-proven pituitary macroadenoma and graded according to SIPAP classification. Study was conducted at Aga Khan University Hospital from 1st July 2019 to 30th June 2020. Data was analyzed using Stata version 15. Interobserver variability was calculated using Cohen’s Kappa. Comparison between grading before and after treatment was performed by Chi-square test. P values <0.05 were considered statistically significant.RESULTSSixty three percent patients were male and 37% female. Overall, maximum preoperative and postoperative volume was 71.82 cm3 and 49.50 cm3 respectively, with significant difference in pre and post-operative volumes (14.1±17.7 vs. 4.5±10.4, p-value <0.001). Length showed most significant difference pre and post-operatively (2.4±1.1 vs. 1.3±1.1, p-value <0.001). Individual tumour extensions according to SIPAP for pre- and post-operative grading showed significant difference (p-value <0.001), except for anterior extension. For suprasellar extension, 67.3% patients had pre-operative grade 3 and 63.3% had post-operative grade 0. For infrasellar extension, 51.0% had pre-operative grade 2 and 71.4% had post-operative grade 0. Anterior, posterior and parasellar extensions showed increased frequency in grade 0 in post-operative stage compared to pre-operative. Substantial inter-observer agreement was achieved for Superior, Inferior, Anterior and Posterior extent with all Kappa statistics values above 0.7 (p-value <0.001).CONCLUSIONWe propose incorporating simple and objective SIPAP classification in routine MR reporting for ideal pituitary tumour delineation, relationship to juxtasellar structures and tumour size.

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Estimation of ventricles size of human brain by Magnetic Resonance Imaging in Nepalese Population: A retrospective study

Journal of Gandaki Medical College-Nepal ◽

10.3126/jgmcn.v13i1.28542 ◽

2020 ◽

Vol 13 (1) ◽

pp. 45-50

Author(s):

Sushma Singh ◽

Bhoj Raj Sharma ◽

Urusha Prajapati ◽

Pujan Sharma ◽

Manoj Bhatta ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Retrospective Study ◽

Magnetic Resonance ◽

Fourth Ventricle ◽

Third Ventricle ◽

P Value ◽

Resonance Imaging ◽

Mean Width ◽

Significant Difference ◽

The Mean

Background and Objective: Magnetic resonance imaging (MRI) provides image acquisition of three-dimensional data and measurement in any chosen imaging plane. Objective of this study is to assess the size of ventricles of the brain of normal Nepalese people and establish the range of size of the ventricular system and compute the ventricular dimensions among different age and gender. Materials and methods: This is a cross-sectional retrospective study done at Gandaki Medical College, Pokhara. A total of 106 MRI scan data of healthy individuals were collected over a period of seven months between March to September 2019. Patients ranged between eight and eighty years of age with 58 males and 48 females. Measurements of the mean of bifrontal diameter (BFD), bihemispheric diameter (BHD), third ventricle transverse dimension (TVTD), fourth ventricle antero-posterior dimension (FVAP), fourth ventricle width (FVW), and frontal horn ratio (FHR) were done. Result: The mean of BFD, BHD, TVTD, FVAP, FVW, and FHR were found to be 3.05 ± 0.10 cm, 10.11 ± 0.40 cm, 0.43 ± 0.11 cm, 0.90 ± 0.11 cm, 1.22 ± 0.12 cm, and 0.30 ± 0.01 cm, respectively. The mean width of fourth ventricle in males and females was observed to be 1.23 ± 0.12 cm and 1.19 ± 0.11 cm respectively. There was a significant correlation of TVTD, FVAP, FHR and BFD with age with Pearson correlation coefficient 0.393 (P value <0.01), 0.259 (P value <0.01), 0.34 (P value <0.01), and 0.219 (P value <0.05) respectively. However, BHD and FVW have no correlation with age. Conclusion: Third Ventricle Traverse Dimension, FVP, FVW and FHR show almost similar or slight difference in measurement according to gender. However, BFD shows larger difference in measurement according to gender. Similarly there is no such significant difference according to age in measurement of BFD, BHD, FVAP, FVW and FHR, while TVTD measurement shows slight increased measurement according to age.

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Faculty Opinions recommendation of Cholangiocarcinoma in cirrhosis: absence of contrast washout in delayed phases by magnetic resonance imaging avoids misdiagnosis of hepatocellular carcinoma.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1165197.630626 ◽

2009 ◽

Author(s):

Tamar Taddei

Keyword(s):

Magnetic Resonance Imaging ◽

Hepatocellular Carcinoma ◽

Magnetic Resonance ◽

Resonance Imaging

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Can diffusion and T2 star-weighted magnetic resonance imaging aid in the diagnosis of ectopic endometrium?

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00513-1 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Mariam Raafat ◽

Soha H. Talaat ◽

Salma M. Abdelghaffar ◽

Engy A. Ali

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Statistical Significance ◽

P Value ◽

Large Sample Size ◽

Resonance Imaging ◽

Conventional Mri ◽

Patient Will ◽

Magnetic Resonance Imaging Mri ◽

Ectopic Endometrium

Abstract Background Endometriosis is a common gynecologic disorder characterized by the implantation of the endometrial tissue ectopically outside the endometrial cavity. It affects about 10% of females at the childbearing period and is estimated to be present up to 20–50% in women complaining of infertility. While laparoscopy is considered the mainstay for diagnosis, magnetic resonance imaging (MRI) is recognized as a useful tool for definitive diagnosis, pre-surgical planning, and determining whether the patient will require multi-specialty involvement. The aim of this study is to evaluate the performance of MRI with the addition of diffusion-weighted imaging (DWI) and T2 star (T2*) to conventional MRI, for the accurate assessment of ectopic endometrium. Results Endometriotic lesions that showed diffusion restriction on DWI were 80.7%, and 96.1% of the endometriotic lesions had signal voids on the T2*W sequence, whereas only 65.4% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the T2* sequence, compared to the conventional MR protocol sensitivity (SE) = 96.12% and specificity (SP) = 85.7% in T2*-weighted images, SE = 80.7% and SP = 71.4% in DWI, and SE = 65.4% and SP = 71.4% in conventional MRI. P value for conventional MRI was 0.1, which is of no statistical significance (p < 0.05). P value for DWI was 0.016, which is statistically significant (p < 0.05). P value for T2*WI was 0.001, which is more statistically significant (p < 0.05) and could be adequately correlated with laparoscopy. Conclusion DWI and T2* significantly increase MRI diagnostic accuracy by allowing the detection of the hemorrhagic character of the endometriotic lesions. Studies with a large sample size are needed to confirm that they can replace invasive laparoscopy for the diagnosis of endometriosis.

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