Comparative Study of Multiple High-Signal-Intensity Spots on 3D and 2D Magnetic Resonance Sialography for Patients with Sjögren’s Syndrome

We investigated the sensitivities of 2-dimensional (2D) magnetic resonance sialography (MR-S) and unilateral sagittal and axial 3-dimensional (3D) MR-S using a surface coil and their combination in diagnosing patients with Sjögren’s syndrome (SS). We retrospectively analyzed the 3D and 2D MR-S results of 78 patients with SS. We evaluated the sensitivities of multiple high-signal-intensity spots and staging on MR sialograms and analyzed the efficient imaging methods and cross section for diagnosing patients with SS. The sensitivities of MR-S for detecting abnormal findings (i.e., MR-S stage 1 or higher) were as follows: 65 cases (83.3% [95% confidence interval (CI): 73.2–90.8]) for unilateral sagittal 3D MR-S; 62 cases (79.4% [95% CI: 68.8–87.8]) for axial 3D MR-S; 66 cases (84.6% [95% CI: 74.7–91.8]) for combined unilateral sagittal and axial 3D MR-S; and 32 cases (41.0% [95% CI: 30.0–52.7]) for bilateral sagittal 2D MR-S. The ratio of the abnormal finding of MR-S was tested using the two-tailed Fisher’s exact test. Unilateral sagittal, axial, and combined unilateral sagittal and axial 3D MR-S showed significantly higher sensitivity than bilateral sagittal 2D MR-S, respectively ( P < 0.001). Most cases upstaged by 3D MR-S were those positive (stage 1 or higher) among the stage 0 cases detected by 2D MR-S. Axial 3D MR-S, compared with 2D MR-S, understaged four cases, which was due to the imaging range of the axial 3D MR-S. We concluded that a single unilateral sagittal 3D MR-S was sufficient and axial 3D MR-S was unnecessary for SS staging. T1- and T2-weighted images are essential for investigating the salivary glands in patients with SS. Therefore, we also concluded that bilateral sagittal 3D MR-S of the parotid glands in addition to T1- and T2-weighted imaging is necessary, sufficient, and most efficient for precise MR imaging examination of the salivary glands, including diagnosing SS.

Imaging findings of uterine adenosarcoma with sarcomatous overgrowth: two case reports, emphasizing restricted diffusion on diffusion weighted imaging

Background Adenosarcoma is classified as a mixed epithelial and mesenchymal tumor composed of a benign epithelial component and a malignant stromal component. The stromal component in adenosarcoma is usually low grade, and consequently the prognosis is relatively favorable. While, adenosarcoma with sarcomatous overgrowth (SO) is defined as an adenosarcoma in which the sarcomatous component constitutes more than 25% of the tumor. The stromal component is also high-grade sarcoma showing greater nuclear pleomorphism and mitotic activity, thus, it is associated with worse prognosis. MRI findings of adenosarcoma without SO have been described in previous literatures but the imaging findings in adenosarcoma with SO may be poorly defined. Therefore we present two cases of uterine adenosarcoma with SO. Case presentation Patient 1 was a 76-year-old woman referred to our hospital with complaint of abdominal distension and postmenopausal bleeding. Patient 2 was a 57-year-old woman with complaint of lower abdominal pain and abnormal uterine bleeding. On magnetic resonance imaging (MRI), T2 weighted imaging showed a large, heterogeneous high-intensity mass with hyperintense tiny cysts that expanded the uterine cavity and extended into the cervical canal for both patients. On diffusion-weighted imaging (DWI), both masses appeared as high signal intensity. Patient 2 also had a right ovarian adult granulosa cell tumor that may have contributed to development of the adenosarcoma. Patient 1 recurred with peritoneal sarcomatosis 6 months after surgery and died of the disease. Patient 2 also recurred with a left upper lung metastasis 3 months after surgery. Conclusions DWI may depict pathological changes produced by SO of adenosarcoma as high signal intensity, even though SO does not seem to change MRI findings of adenosarcoma on other sequences. Therefore, DWI could potentially predict SO in presumptive adenosarcoma on MRI and the patient’s prognosis. It is also important for pathologists to know if SO can arise in adenosarcoma because they need to examine the tumor thoroughly to determine the percentage of SO component in the tumor volume when SO is present.

Comparison between subtraction and dynamic MRI in assessing treatment response following radiofrequency ablation in patients with hepatocellular carcinoma

Background Hepatocellular carcinoma (HCC) is one of the most prevalent cancers worldwide, and if left untreated, one of the most lethal. Ablative therapies including radiofrequency ablation (RFA) play increasingly important role for patients with liver tumors who are not surgical candidates. Monitoring treatment response following ablation is crucial in oncologic imaging. Dynamic contrast-enhanced MRI can assess changes in tumor vascularity and perfusion while subtraction imaging is useful in differentiating residual tumor from post-ablation parenchymal changes. The aim of this study is to compare the role of subtraction MRI and conventional dynamic MRI in assessing treatment response following RFA in patients with HCC. Results The study included 48 patients with 62 HCC lesions who underwent RFA from May to October 2020, followed by MRI evaluation with 1-month interval. Two readers with experience in hepatic imaging interpreted the dynamic and subtraction dynamic MRI. The hepatic focal lesions were classified into “well-ablated” and “residual” groups according to MRI findings, and the agreement between the two readers was evaluated. Using dynamic MRI, the first reader reported 38 well-ablated lesions, and the second reader agreed in 34 of them (89.5%). Residual disease was reported by the first reader in 22 lesions and the second reader disagreed in 10 of them (45.5%) where complete ablation was reported. Thirty-eight out 44 well-ablated lesions (86.4%) showed high signal intensity on non-enhanced T1 images, and 28 lesion (63.6%) showed intermediate T2 signal. All the mis-matched readings occurred in lesions with a high signal intensity in pre-contrast T1 images. Moderate agreement between the two readers was found with Kappa value of 0.467. Significant additive value of subtraction technique to dynamic MRI was detected with a P value of 0.009. No major complications recorded except for a single case of major portal vein branch occlusion. Conclusion MRI is a powerful imaging tool in assessing tumor viability and complications after RFA in patients with HCC. Dynamic MRI study is the gold standard in detecting recurrent lesions while subtraction technique is crucial in differentiating between arterial enhancement due to residual disease and normal hyperintense T1 signal of the ablation zone.

The potential role of diffusion weighted imaging in the diagnosis of early carotid and vertebral artery dissection

Purpose To investigate the role of the diffusion weighted imaging (DWI) in the acute dissection of internal carotid artery (ICA) and vertebral artery (VA) and assessing the length of intramural hematoma (IMH), caused by dissection. Methods We analyzed 28 patients presenting with a dissection of the ICA and/or VA with respect to the presence of high signal intensity areas on DWI suggestive of dissection and 20 control subjects without arterial dissection, some with and some without atherosclerotic lesions. ICA or VA dissection was defined by clinical and imaging, computed tomography angiography (CTA), MR angiography (MRA), and digital subtraction angiography (DSA) findings. The length of DWI hyperintensity was compared to length of the occlusion or stenosis on the angiographic examination. Results In 28 patients, 30 dissected arteries were analyzed. Time intervals from the onset of the first clinical symptoms to the radiological evaluation ranged from 1.5 h to 42 days. In 28 (93%) of the dissections, a high signal intensity of the affected artery was present on DWI. The measurement of the dissection length on DWI compared to DSA showed a mean deviation of 2.7 mm and a standard deviation of 3.7 mm. Conclusion DWI is a highly sensitive and valuable pulse sequence for the detection of dissected cervical arteries even in the first hours after symptom onset. In contrast to CTA and MRA, DWI can be a potential tool for a reliable measurement of the dissection length.

The Need for Surgery of Isolated Sphenoid Sinus Disease Care Based on Imaging Findings

Background: In general, ISSD may be detected due to clinical symptoms, but some ISSDs are found incidentally during radiological examinations for the assessment of unrelated diseases. This study aims to evaluate the clinical aspects of all ISSDs detected by image inspection. Methods: A total of 94 patients with ISSD were enrolled in this study. The study patients were classified into two groups: a group who improved with conservative treatment (n=25), and a group who did not improve with conservative treatment (n=69). Their clinical symptoms, medical histories, pathologies, and imaging findings were assessed.Results: The incidence of high signal intensity on T2-weighted images in the improvement group was significantly higher compared with the non-improvement group. Conversely, the incidences of bone erosion and expansion were significantly higher in the non-improvement group. Of the 42 cases receiving surgery, 10 cases (23.8%) had asymptomatic ISSD.Conclusion: This study suggests that ISSD with high signal intensity on T2-weighted images and/or without bone erosion and expansion in imaging findings could improve by conservative treatment or watchful waiting. Because some asymptomatic ISSD cases required surgery, proper diagnosis of ISSD regardless of clinical symptoms is important to prevent severe illness.

MOG-antibody Related Unilateral Cerebral Cortical Encephalitis With Refractory Cephalalgia: a Case Report

Background: Myelin oligodendrocyte glycoprotein (MOG) antibody positive utilateral cerebral cortical encephalitis (UCCE) comprises a new entity with heterogeneity which usually present as epilepsy. Cases with cephalalgia as the only clinical feature were rare reported. Here, We report a case with MOG antibody positive UCCE who only presented with refractory cephalalgia and had a good response to glucocorticoid. MOG antibody-related UCCE should be identified when patients present with refractory headache and it may represent benign cortical encephalitis.Case Presentation: The case of a 41-year-old woman with MOG antibody positive UCCE presented with refractory cephalalgia. Neurological examination is normal, and fundus examination suggested bilateral optic nerve head edema. Brain MRI discovered Flair hyperintense lesions in the sulci of right temporoparietal occipital cortex. MOG antibody was positive both in the serum and cerebrospinal fluid. When the patient was treated with intravenous methylprednisolone, her headache completely disappeared and brain MRI showed partly recovery. At the follow-up of 6 months after discharge, she had no relapse, serum MOG antibody was negative and the high signal intensity on Flair had completely disappeared.Conclusions: MOG antibody-positive UCCE with headache as the single clinical symptom may represent benign cortical encephalitis.

High signal intensity on diffusion-weighted magnetic resonance images is a useful finding for detecting early-stage pancreatic cancer

Purpose Early detection of pancreatic ductal adenocarcinoma (PDAC) may improve the prognosis. We evaluated novel imaging findings that may contribute to early detection. Methods This single-center, retrospective study enrolled 37 patients with a localized main pancreatic duct (MPD) stricture and no obvious pancreatic mass. All patients underwent endoscopic retrograde cholangiopancreatography and brush sampling with cytology and serial pancreatic juice aspiration cytologic examination via endoscopic naso-pancreatic drainage. Patients with cytology-confirmed malignancy underwent surgical resection. The remaining patients were followed by contrast-enhanced computed tomography (CECT), magnetic resonance imaging (MRI), and endoscopic retrograde cholangiopancreatography. Results Twenty patients had confirmed malignancy (cancer group) and 17 did not (non-cancer group). Age, MPD stricture location, and PDAC risk factors were similar, but the sex predominance and symptom rate differed between the two groups. In the cancer group, 17 patients were diagnosed by cytology and three by clinical symptoms. CECT, MRI, and endoscopic ultrasonography (EUS) revealed no solid tumors in either group. CECT revealed no significant differences between groups. Diffusion-weighted MRI revealed significant differences in the signal intensity between groups. EUS detected indistinct and small hypoechoic areas in 70% and 41.2% of patients in the cancer and non-cancer groups, respectively. In the cancer group, 11 were diagnosed with cancer at the first indication, and nine were diagnosed at follow-up; the prognosis did not differ between these two subgroups.ss Conclusions High signal intensity in diffusion-weighted MRI may be useful for detecting early-stage PDAC and may be an indication for surgical resection even without pathologic confirmation. Clinical trial registration The study was a registered at the University Hospital Medical Information Network (UMIN000039623). Graphic abstract

P–326 Presence of adenomyosis at MRI in endometriosis women negatively affect live birth chances in IVF cycles

Study question What is the impact of adenomyosis and its magnetic resonance imaging (MRI) characteristics on live birth rate (LBR) in endometriosis-affected women undergoing in-vitro fertilization (IVF) treatment? Summary answer Among women undergoing IVF, the presence of adenomyosis at MRI, and especially T2 high signal-intensity spots within the myometrium have a negative impact on LBR. What is known already: Adenomyosis is a frequent gynecologic disease. With the development of imaging technics for the diagnosis (notably MRI), several adenomyosis phenotypes have been described and fertility issues seem variable according to the lesions characteristics. Moreover, on IVF outcomes, controversial results have been found in studies assessing the impact of adenomyosis. What make the impact-assessment of adenomyosis on fertility issues even more difficult is the frequent association with endometriosis, another known risk factor of infertility. Some data suggested that adenomyosis could worsen IVF prognostics, however there is no clear consensus about the impact of the adenomyosis on IVF outcomes in endometriosis affected-women. Study design, size, duration This was an observational study including phenotyped endometriosis patients, aged between 18 to 42 years, who underwent IVF/intra-cytoplasmic sperm injection (ICSI) treatment in a tertiary care center, from June 2015 through July 2018.Only women who had performed a pelvic MRI during the pre-therapeutic ART work-up, were retained for this study. The MRI data were interpreted by radiologists who had expertise in gynaecological MRI. Participants/materials, setting, methods A continuous series of 202 endometriosis affected women was included. The women were followed until four ART cycles had been completed, until delivery or until discontinuation of treatment before the completion of four cycles. The primary outcome was the delivery of one or more live infant(s) after up to four IVF/ICSI cycles. Patients and MRI characteristics were compared between women who gave a live birth and those without live birth. Main results and the role of chance The mean age of the included population was 32.5 ±3.7 years. 90.1% (182/202) had deep infiltrating endometriosis whereas only 5.4% (11/202) and 4.5% (9/202) had respectively isolated ovarian endometriosis (OMA) and superficial peritoneal endometriosis (SUP). The presence of adenomyosis (internal and/or external lesions) was found in 71.8% (145/202) of included women. The cumulative live birth rate was 57.4% (116/202). Women that gave birth (‘live birth +’) were significantly younger, (33.3±4.1 vs 32.0±3.3 p = 0.026) and had significant better ovarian reserve parameters (AMH, AFC). The presence of adenomyosis (internal and/or external lesions) (76/116 (65.5%) versus 69/86 (80.2%), p = 0.022) and the presence of T2 high-signal intensity myometrial spots (27/116 (23.3%) and 37/86 (43.0%), p = 0.003) were significantly less frequently found in the group of women ‘Live birth +’. After multivariate analysis, the presence of adenomyosis (OR: 0.48 95% CI (0.29–0.99) p = 0.048) and the presence of T2 high-signal intensity myometrial spots (OR: 0.43 95% CI (0.22–0.86) p = 0.018) were independently found to be associated with a decrease in cumulative chances of live birth. Limitations, reasons for caution The inclusion of patients from our referral center could constitute a possible selection bias, as those women may have suffered from particularly severe forms of adenomyosis ± endometriosis. Wider implications of the findings: In women presenting endometriosis, the practitioner should perform an appropriate imaging work-up searching for adenomyosis, to identify prognostic factors and to plan the strategy of patient management in the setting of ART. Trial registration number NA