Diagnostic and prognostic value of a diffusion-weighted image of the liver with magnetic resonance imaging in patients with alcoholic liver disease

The aim of the study was to assess the diagnostic and prognostic value of a diffusion-weighted image of the liver with magnetic resonance imaging in patients with alcoholic liver disease.Material and methods. A total of 113 patients with alcoholic liver disease (ALD) were examined. Among them, 65 (57.5%) are men and 48 (42.5%) are women. The mean age of patients is 46.3 ± 5.2 years. The structure of the instrumental algorithm for examining patients was presented: ultrasound of the abdominal cavity organs with clinical elastography – 98 (86.7%) patients, MRI of the liver with the mandatory inclusion of the DWI liver sequence in the protocol (n = 113). The b-factor values of 100/600/1000 were used for the liver DWI sequence. Liver biopsy was chosen as the reference method in 65 (57.5%) patients.Results. The patients were monitored for 12 months. At the first stage, the qualitative characteristics of the liver DWI sequence were assessed: no or there is a diffusion limitation. At the second stage, the quantitative indicators of the DWI sequence were assessed in the form of calculating the measured diffusion index and coefficient. In order to standardize the technique of liver DWI on MRI in patients with ALD, the results were compared with the data of clinical elastography (p < 0.01) and liver biopsy (p < 0.05). Upon admission and monitoring of patients (after 1, 3, 6, 9 months), a high correlation was found in the assessment of comparing the quantitative indicators of DWI with clinical elastography (r = 0.873) and an average correlation with biopsy data (r = 0.715).Conclusions. There was a high correlation between the limitation of liver diffusion on MRI and negative clinical and laboratory dynamics (r = 0.889) and in the absence of limitation of diffusion in the liver and positive clinical and laboratory dynamics (r = 0.885). DWI of the liver on MRI in patients with ALD has a high diagnostic and prognostic value in assessing abnormal abstinence regimen (AUROC = 0.903 (95% CI 0.871–0.911)). Diagnostic and prognostic significance of the developed criteria for DWI of the liver at MRI in patients with ABD at admission: for a qualitative assessment AUROC = 0.844 (95% CI 0.801–0.869), quantitative – AUROC = 0.908 (95% CI 0.875–0.911); with dynamic observation: for a qualitative assessment AUROC = 0.939 (95% CI 0.901–0.955), quantitative – AUROC = 0.919 (95% CI 0.871–0.931).

Clinical and imaging features of carcinosarcoma of the uterus and cervix

Aim The purpose of our study was to analyze the clinical and imaging features of uterine carcinosarcoma (UCS) and cervical carcinosarcoma (CCS), and to explore the diagnostic and staging accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) examinations. Methods 41 patients including 37 with UCS and 4 with CCS from July 2011 to September 2020 were enrolled in the study. Of the 37 UCS cases, 7 had CT images, 27 had MRI images, and 3 had both CT and MRI images. The Clinical data, CT or MRI imaging findings were analyzed. Diagnosis and staging accuracy of CT and MRI images were also analyzed. Results Carcinosarcoma usually occurs in postmenopausal women (40/41), with the typical clinical symptom being vaginal bleeding (33/41). The CA125 degree was significantly different between the two invasion depth groups (p = 0.011). Most uterine carcinosarcomas showed unclear boundaries, uneven density, low or equal signal on T1WI, high or mixed signal on T2WI, uneven high signal on diffusion-weighted image (DWI), and mild enhancement. The diagnostic accuracies of CT and MRI for carcinosarcoma were 0% and 3.33%, respectively. The diagnostic accuracy for malignant tumors on CT and MRI was 50% and 83.33%, respectively. Conclusions Carcinosarcoma lesions presented with huge mass filling in the cavity, and some presented with small polypoid lesions or endometrial thickening. Evaluation of lymph node metastasis is a significant challenge for imaging staging.

Clinical-Diffusion Mismatch Is Associated with Early Neurological Improvement after Late-Window Endovascular Treatment

<b><i>Background:</i></b> Clinical-diffusion mismatch (CDM) and perfusion-diffusion mismatch (PDM) are used to select patients for endovascular thrombectomy (EVT) in the late-window period. As CDM well reflects true penumbra, we hypothesized that patients with CDM and PDM would respond better to EVT than those with PDM only at the late-window period. <b><i>Methods:</i></b> Acute ischemic stroke patients who received EVT 6–24 h after stroke onset were included. PDM (perfusion-/diffusion-weighted image (DWI) lesion volume &#x3e;1.8) was used to select candidates for EVT in this time-period in our center. CDM was defined according to the DAWN trial criteria. Response to EVT was compared between patients with and without CDM. Early neurological improvement (ENI) was defined as improvement &#x3e;4 points on National Institutes of Health Stroke Scale (NIHSS) score 1 day after EVT. Multivariable analysis was performed to investigate independent factors associated with ENI. The correlation between DWI lesion volume and NIHSS score was investigated in those with and without CDM. <b><i>Results:</i></b> Among 94 patients enrolled, all patients had PDM and 44 (46.3%) had CDM. Forty-eight patients (51.1%) showed ENI. The prevalence of hypertension, initial NIHSS score, improvement in NIHSS score after EVT, and prevalence of ENI were greater in patients with CDM than those without. ENI was independently associated with onset-to-door time (odds ratio [95% confidence interval]: 0.998 [0.997–1.000]; <i>p</i> = 0.042), complete recanalization (23.912 [2.238–255.489]; <i>p</i> = 0.009), initial NIHSS score (1.180 [1.012–1.377]; <i>p</i> = 0.034), and the presence of CDM (5.160 [1.448–18.386]; <i>p</i> = 0.011). The correlation between DWI lesion volume and initial NIHSS score was strong in patients without CDM (<i>r</i> = 0.731) but only moderate in patients with CDM (<i>r</i> = 0.355). <b><i>Conclusion:</i></b> Patients with both CDM and PDM had a better response to late-window EVT than those with PDM only.

The Image Information Of Mri Brain In Axial Diffusion Weighted Image (Dwi) With Variation B Value In Ischemic Stroke

The purpose of the research is to identify the differences between image information of MRI Brain in axial plane Diffusion Weighted Image (DWI) sequence and variation b value in case ischemic stroke, and to determine optimal b value in examination MRI Brain in case Ischemic Stroke. This research was a quantitative research with experimental approach. This research was done in Panti Rapih Hospital, Yogyakarta and used 8 ischemic stroke patients with 3 variasion b value (500s/mm2, 1000 s/mm2, 1500 s/mm2) and 3 radiologists as respondents. The data were analyzed using Friedman test. Result showed that there was difference between image information of MRI Brain in axial plane Diffusion Weighted Image (DWI) sequence and variation b value in case ischemic stroke with p0.05 which means there is a difference between Basal Ganglia, Cerebellum, and the border of the infarction. Meanwhile, Cortex Cerebri, Thalamus and Pons obtained no difference in image information and the optimal b value for MRI Brain examination of ischemic stroke 1500 s/mm2. Based on the result there was a difference between image information of MRI Brain in axial plane Diffusion Weighted Image (DWI) sequence and variation b value in case ischemic stroke. Optimal value of variation b value for MRI Brain examination of ischemic stroke was 1500 s/mm2.