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To determine whether a modified caudate-right lobe ratio (C/RL) with use of the right portal vein to set the lateral boundary (C/RL-r) is more accurate for diagnosing cirrhosis and evaluating its clinical severity than is the previously described C/RL with use of the main portal vein to set the lateral boundary (C/RL-m).Two hundred thirty-six patients (121 with pathologically proved cirrhosis and 115 without history of chronic hepatic diseases) underwent magnetic resonance (MR) imaging. Two independent observers measured C/RL-r and compared it with C/RL-m. Results were compared by using receiver operating characteristic (ROC) curves and accuracy measures at various thresholds.The area below the ROC curve was greater for C/RL-r (0.797) than for C/RL-m (0.731; P =.040). By using a C/RL-r greater than 0.90, the sensitivity, specificity, and accuracy for the MR imaging diagnosis of cirrhosis were 71.7%, 77.4%, and 74.2%, respectively. The highest accuracy of the C/RL-m was 65.7%, when the C/RL-m was greater than 0.55. Interobserver agreement was statistically confirmed for both measurements by using kappa analysis. Significant differences were found among the three Child-Pugh classes by using C/RL-r (P =.0105) but not by using C/RL-m.C/RL-r is more accurate for diagnosing cirrhosis and evaluating its clinical severity than is C/RL-m.

To evaluate impaired respiratory mechanics in pulmonary emphysema, dynamic breathing magnetic resonance imaging (BMRI) was acquired with fast-gradient echo pulse sequences at fixed thoracic planes over two to three slow, deep respiratory cycles in 6 controls and 28 patients with pulmonary emphysema including 9 patients undergoing lung volume reduction surgery (LVRS). Respiratory motions of the diaphragm and chest wall (D/CW) were assessed by a cine-loop view, a fusion display of maximal inspiratory and expiratory images, and the time-distance curves. By contrast with normal subjects with regular synchronous D/CW motions, the patients frequently showed reduced, irregular, or asynchronous motions, with significant decreases in the maximal amplitude of D/CW motions (MAD and MACW), and the length of apposition of the diaphragm (LAD) (P < 0.0001, P < 0.001, P < 0. 01, respectively). After LVRS, nine patients showed improvements in D/CW configuration and mobility, with significantly increased MAD, MACW, and LAD (P < 0.01, P < 0.0001, and P < 0.05, respectively). In 40 studies of 28 patients including the post-LVRS examinations, the normalized MAD and MACW significantly correlated with %FEV(1) (r = 0. 881 and r = 0.906; P < 0.0001, respectively). BMRI seems useful for noninvasively and directly assessing the impaired respiratory mechanics associated with abnormal ventilation in pulmonary emphysema, and also for monitoring the effects of LVRS. J. Magn. Reson. Imaging 1999;10:510-520.

To determine whether the frequency of hepatocellular carcinoma (HCC) in patients with cirrhosis is affected by hepatic iron deposition as detected with magnetic resonance (MR) imaging.In a retrospective search of MR imaging and histopathology records, 196 patients with histopathologically proved cirrhosis and with (n = 80) or without (n = 116) HCC who underwent T2-weighted conventional or fast spin-echo and gradient-echo (GRE) (echo timeor = 6.0 msec) imaging were identified. MR images were qualitatively and quantitatively evaluated for diffuse hepatic iron deposition and siderotic regenerative nodules to assess their correlation with the presence of HCC.Hepatic parenchymal iron deposition was seen in 79 (40%) patients, and iron deposition in regenerative nodules was seen in 71 (36%) at MR imaging. The mean signal intensity ratio of GRE images in patients with hepatic iron deposition was significantly lower than that in patients without it (P.001). The frequency of HCC in patients with iron deposition in regenerative nodules (52% [37 of 71 patients]) was significantly higher (P = .015) than that in patients without iron in regenerative nodules (34% [43 of 125 patients]).The occurrence of HCC may be associated causally with iron deposition in regenerative nodules in patients with cirrhosis. MR imaging can enable detection of iron deposition in regenerative nodules as a possible risk factor for the development of HCC.

High-resolution contrast-enhanced dynamic MRI of the uterus can be performed with the combination of a phased-array multicoil and fast GE techniques. This technique can improve the ability to visualize normal anatomy of the uterus and periuterine tissues, including vascular structures and pelvic ligaments, and to detect pathologic processes of the uterus and determine their extent.

Hepatic lesions with delayed enhancement are sometimes encountered on gadolinium-enhanced MRI of the liver. This study illustrates the varied appearances of several pathologic entities with delayed enhancement, including hepatic hemangioma, hepatic metastases, intrahepatic cholangiocarcinoma, focal nodular hyperplasia, hepatic abscess, hepatocellular carcinoma, and hepatocellular carcinoma after transcatheter arterial chemoembolization, and presents the utility of arterial-phase dynamic MRI in the differential diagnosis of these lesions. Possible causes of these delayed enhancements are also discussed.

Computed tomography (CT), including biphasic contrast material-enhanced helical dynamic scanning and three-dimensional CT angiography, is useful in evaluating acquired abnormalities of the portal venous system. At contrast-enhanced CT, portal venous thrombus usually manifests as low-attenuation intraluminal lesions combined with enlargement of the affected portal vein. Cavernous transformation, a masslike network of intertwined veins that provides an alternative pathway for a stenosed or occluded portal vein, is depicted as multiple, periportal vascular structures. At helical dynamic CT, arterioportal shunts manifest as early enhancement of the affected portal vein, transient hyperperfusion abnormalities with lobar or segmental distribution, or transient wedge-shaped enhancement peripheral to the tumor. In patients with portosplenic venous invasion by malignant neoplasms, peripancreatic or perigastric veins may dilate if they function as hepatopetal collateral veins. In patients with portal hypertension, a variety of hepatofugal collateral pathways can develop, including esophageal, paraesophageal, coronary gastric, inferior phrenic, paraumbilical, abdominal wall, splenorenal, gastrorenal, retrocaval, and mesocaval collateral pathways. An understanding of the varied CT appearances of acquired abnormalities of the portal venous system will allow more definitive diagnosis and help avoid false diagnosis of disease.

Biphasic contrast material-enhanced dynamic magnetic resonance (MR) imaging is an important technique for evaluating liver disease. However, several potential diagnostic pitfalls may be encountered, including lobar, segmental, subsegmental, and subcapsular hyperperfusion abnormalities; early-enhancing pseudolesions, particularly in the medial segment of the left hepatic lobe; heterogeneous hyperperfusion abnormalities throughout the liver; and hypointense pseudolesions due to vascular artifacts, unenhanced hepatic vessels, partial volume artifacts, magnetic susceptibility artifacts, and regenerative nodules in cirrhosis. These abnormalities sometimes have appearances similar to those of true lesions or tumor spread to the surrounding liver parenchyma on arterial-dominant phase dynamic MR images. In most cases, however, no corresponding abnormalities are seen with other pulse sequences or on delayed-phase MR images. In addition, hyperperfusion abnormalities due to readily recognizable causes are often found in characteristic locations and thus can be differentiated from true tumors. An understanding of the causes of these potential pitfalls and how to avoid them will help radiologists understand and correctly interpret images.

Although congenital abnormalities of the portal venous system are uncommon, they are sometimes encountered incidentally because of the widespread use of cross-sectional imaging techniques. These abnormalities include the preduodenal portal vein. duplication of the portal vein, portal vein aneurysm, rotation of the superior mesenteric vein. variations in portal venous tributaries, intrahepatic portosystemic venous shunts, and mesenteric vascular malformations. This pictorial essay illustrates the normal anatomy and the congenital abnormalities of the portal venous system as shown by radiologic imaging. focusing on the value of CT and MR imaging in diagnosing these abnormalities. Familiarity with the varied features of congenital abnormalities of the portal venous system will permit more accurate diagnoses and will help prevent false pathologic diagnoses.

The appearances of most common liver neoplasms at computed tomography (CT) and magnetic resonance (MR) imaging have been established. However, there are considerable overlaps in the appearances of various pathologic entities. Certain hepatic lesions, such as hepatic hemangioma, adenoma, focal nodular hyperplasia, intrahepatic cholangiocarcinoma, metastases, hepatocellular carcinoma, regenerative nodules, adenomatous hyperplastic nodules, abscess, and hepatocellular carcinoma treated with transcatheter arterial chemoembolization, can have unusual characteristics at CT and MR imaging that may lead to misinterpretation. Dynamic helical CT and double-phase multisection dynamic MR imaging techniques may be helpful in differentiating between these entities because hemodynamics of the lesion can be evaluated by obtaining both arterial-phase and delayed-phase images. It is important for radiologists to be aware of these uncommon appearances of liver neoplasms. Familiarity with these varied CT and MR imaging features will permit a more accurate diagnosis and aid in avoidance of a false diagnosis.

In the arterial phase of dynamic contrast-enhanced MR images, we observed areas of increased contrast enhancement adjacent to hepatocellular carcinomas treated by percutaneous ethanol injection. The purpose of this study was to assess the frequency, appearance, and location of this hyperperfusion abnormality. It is important not to mistake this finding for other pathologic conditions.Multisection dynamic MR images obtained in 33 consecutive patients with hepatocellular carcinoma treated with percutaneous ethanol injection were reviewed. Hepatic parenchymal hyperperfusion abnormalities were diagnosed when areas of early enhancement were seen in the hepatic parenchyma adjacent to the treated tumor. The location, appearance, and frequency of the findings were recorded.Hepatic parenchymal hyperperfusion abnormalities were observed in 15 (45%) of the 33 patients on arterial-dominant-phase images. Of these 15 patients, 10 (67%) had MR imaging within 1 month after percutaneous ethanol injection. Hyperperfusion abnormalities were located in liver parenchyma adjacent to the lesion with wedge-shaped appearances. In two patients, early opacification of the peripheral portal branch was seen within the area of hyperperfusion abnormalities.Hepatic hyperperfusion abnormalities are commonly seen adjacent to a treated hepatocellular carcinoma on contrast-enhanced MR images. Awareness of this hyperperfusion abnormality, which is caused by increased blood flow after percutaneous ethanol injection, is important because such a finding may be misinterpreted as another pathologic condition such as tumor progression or tumor thrombosis of the portal vein branches.

Objective Our goal was to evaluate the usefulness of multisection dynamic MRI with gadopentetate dimeglumine in the assessment of the therapeutic efficacy of transcatheter arterial chemoembolization (TAE) with iodized oil for hepatocellular carcinomas (HCCs). Materials and Methods Findings on multisection dynatnic MR images were compared with gross appearance and histologic findings in 13 patients with HCCs after TAE with iodized oil. Arterial dominant phase images of the entire liver were obtained 20 s after the start of administration of gadopentetate dimeglumine. Results In 3 of the 13 patients, no enhancing areas within the tumors were detected. In the retnaining 10 patients, enhancing portions were detected within the tumor on arterial dominant phase images. Histologically, viable tumor cells were present in the rapidly enhancing portions, while necrotic tissues were present in nonenhancing areas, irrespective of the accumulation of iodized oil on CT scans. However, in one patient in whotn no enhancing portion was seen in the tumor, a small number of viable tumor cells within the capsule were identified on pathologic examination. Conclusion Multisection dynamic MRI is helpful for evaluating the therapeutic efficacy of TAE with iodized oil for HCCs by revealing the hemodynamics of the tumor irrespective of accumulation of iodized oil. Index Terms Liver neoplasms—Contrast media—Magnetic resonance imaging.

Knowledge of the normal MRI appearances of the ankle ligaments and tendons is particularly important in the diagnosis of ankle sprains. In most clinical practices, the ankle is imaged in a neutral position with standard imaging planes and sequences. The purpose of our study was to investigate whether passive positioning influences the MRI appearances of the ligaments of the ankle.The axial and coronal T1-weighted MR images obtained from 10 subjects were reviewed by two musculoskeletal radiologists. The following imaging planes were used: dorsiflexion with inversion, dorsiflexion with neutral, dorsiflexion with eversion, neutral with inversion, neutral, neutral with eversion, plantarflexion with inversion, plantarflexion with neutral, and plantarflexion with eversion. A subjective rating system was used to determine the optimal imaging plane and position for individual ligaments in each volunteer. Each ligament was rated on a scale (of 1 to 6).There were significant differences in the appearances of the anterior talofibular (p = 0.0002), calcaneofibular (p0.0001), and posterior talofibular (p0.0001) ligaments between the optimal and least optimal ankle positions in the axial plane, and in those of the (plantar calcaneonavicular) spring (p0.0001), tibiocalcaneal (p0.0001), posterior tibiotalar (p = 0.0087) and posterior talofibular (p = 0.0213) ligaments in the coronal plane.Kinematic MRI of the ankle is feasible and appears to improve visualization of ankle ligaments compared to MRI.

Purpose To determine the frequency of occurrence of the right posterior hepatic notch sign at MR imaging in patients with cirrhosis, and to assess its diagnostic capability of this sign as a simple diagnostic MR finding of cirrhosis. Materials and Methods This study population included 330 patients with pathologically proved cirrhosis (N = 202) or without clinical evidence of chronic liver diseases (N = 128, control group). MR images were qualitatively evaluated for the presence of the right posterior hepatic notch sign. This sign was considered present if there was a sharp notch in the right posterior surface of the liver. The presence of the expanded gallbladder fossa sign was also evaluated during the same reading session. Results The right posterior hepatic notch sign was observed in 145 of the 202 patients in the cirrhosis group, while this sign was seen in only two of the 128 patients in the control group (P < 0.0001). The sensitivity, specificity, and accuracy of this sign for the MR diagnosis of cirrhosis were 72%, 98%, and 82%, respectively. When the presence of either the expanded gallbladder fossa sign or the right posterior hepatic notch sign was considered for the MR diagnosis of cirrhosis, the sensitivity and accuracy increased to 86% and 89%, respectively. Conclusion The right posterior hepatic notch sign can be used as a simple and highly specific sign of cirrhosis, if present. The diagnostic performance can be improved when the presence of either the expanded gallbladder fossa sign or the right posterior hepatic notch sign was considered. J. Magn. Reson. Imaging 2003;18:561–566. © 2003 Wiley-Liss, Inc.

Because full vials of commercially available MR arthrographic contrast are expensive, we hypothesized that the small residual contrast in a "used" vial would be adequate for MR arthrography. After sterility testing and quantity analysis of the residual contrast in 28 vials, this method was successfully used in 10 patients. J. Magn. Reson. Imaging 2000;12:953-955.

To evaluate the frequency, location, and appearance of transient increased attenuation in the liver during arterial-phase helical or incremental computed tomography (CT) in patients with gallbladder disease without hepatic extension.Findings in dynamic CT examinations in 31 patients with surgically proved gallbladder disease not extending into the liver and in 31 control patients without gallbladder disease were retrospectively reviewed and correlated with findings in other imaging examinations.Areas of transient increased hepatic attenuation (n = 27) were identified in 22 of 31 patients with gallbladder disease and in only one of 31 control patients. The difference in these findings was statistically significant (P.001). In the 27 areas of transient increased hepatic attenuation, these findings were categorized as curvilinear or nodular attenuation adjacent to the gallbladder fossa in 13 (48%), segmental or subsegmental attenuation in segment IV and/or V in seven (26%), lobar attenuation in the left lobe (segments II-IV) in four (15%), and nodular attenuation seen as an early enhancing "pseudolesion" in segment IV in three (11%). Hepatic angiography performed in 10 of the 22 patients showed early depiction of the dilated cystic vein (n = 8) and direct communication with the portal branches (n = 2).Transient increased attenuation in the liver had a variable appearance at dynamic arterial-phase CT in most patients with gallbladder disease. This attenuation was most likely due to increased blood flow from the hepatobiliary system.

C adolinium-enhanced MR imaging using a multiphase. multisection dynamic technique has potential value in revealing splenic disease because the technique can potentially provide differential contrast enhancement between splenic lesions and normal splenic tissues I I 1. However, this technique sometimes leads to difficulties in image interpretation that result from heterogeneous early enhancement or from artifacts that are intrinsic to MR imaging. This essay illustrates several common artifacts and potential pitfalls in the interpretation of gadoliniumenhanced MR imaging ofthe spleen.

On arterial-dominant-phase images in multisection dynamic MR imaging, early-enhancing areas that are perfusion abnormalities rather than tumor deposit are sometimes encountered. The purpose of this article was to determine the frequency, location, and appearance of these hepatic parenchymal hyperperfusion abnormalities and to discuss possible causes of these abnormalities. Multisection dynamic MR images obtained in 415 patients with suspected hepatobiliary diseases were reviewed for the presence of hyperperfusion abnormalities. A total of 96 hyperperfusion abnormalities were identified in 88 (21%) of 415 patients. They were characterised from their shape, distribution, or location as lobar or segmental (n = 36 [38%]), subsegmental (n = 32 [33%]), or subcapsular (n = 28 [29%]) hyperperfusion abnormalities. Presumable etiologies were considered as follows: (a) compression, obstruction, or ligation of the portal vein; (b) siphoning effect by tumor; (c) aberrant cystic venous drainage; (d) percutaneous ethanol injection; (e) percutaneous needle biopsy; (f) rapid drainage by the subcapsular vein; or (g) cirrhosis or unknown. A significant percentage of patients had hepatic hyperperfusion abnormalities. Familiarity with these hyperperfusion abnormalities on multisection dynamic MR images is important to prevent false-positive diagnoses.