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Background & Aims: Ultrasound (US) is recommended for HCC surveillance in high-risk patients but has limited performance in detecting early-stage HCC. We aimed to compare the diagnostic performance of biannual US and annual non-contrast abbreviated magnetic resonance imaging (NC-AMRI) as HCC surveillance modalities in high-risk patients., Methods: This prospective, multicenter cohort study enrolled participants with an estimated annual risk of HCC greater than 5% between October 2015 and April 2017. Participants underwent six rounds of HCC surveillance at 6-month intervals, with both US and NC-AMRI at rounds 1, 3, and 5, and only US at rounds 2, 4, and 6. The sensitivity, diagnostic yield (DY), and false referral rate (FRR) for HCC detection by US and NC-AMRI were compared., Results: In total, 208 participants underwent 980 US and 516 NC-AMRI examinations during 30 months of follow-up. Among them, 34 HCCs were diagnosed in 31 participants, with 20 (64.5%) classified as very early-stage and 11 (35.5%) as early-stage HCC. The sensitivity of annual NC-AMRI (71.0%, 22/31) was marginally higher than that of biannual US (45.2%, 14/31; p = 0.077). NC-AMRI showed a significantly higher DY than US (4.26% vs. 1.43%, p <0.001), with a similar FRR (2.91% vs. 3.06%, p = 0.885). A simulation of alternating US and NC-AMRI at 6-month intervals yielded a sensitivity of 83.9% (26/31), significantly exceeding that of biannual US (p = 0.006)., Conclusions: Annual NC-AMRI showed a marginally higher sensitivity than biannual US for HCC detection in high-risk patients. The DY of annual NC-AMRI was significantly higher than that of biannual US, without increasing the FRR. Thus, alternating US and NC-AMRI at 6-month intervals could be an optimal surveillance strategy for high-risk patients., Impact and Implications: Current guidelines permit the use of magnetic resonance imaging (MRI) as a surveillance tool for hepatocellular carcinoma in patients in whom ultrasonography (US) is inadequate. However, the specific indications, imaging sequences, and intervals for MRI surveillance remain unclear. In our study, we found that annual non-contrast abbreviated MRI exhibited marginally higher sensitivity and significantly better diagnostic yield than biannual US in patients at high risk of hepatocellular carcinoma. Alternating US and non-contrast abbreviated MRI at 6-month intervals led to significantly improved sensitivity compared to biannual US, making it a potentially optimal surveillance strategy for high-risk patients., Gov Identifier: NCT02551250., (Copyright © 2024 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Objectives: This study aimed to evaluate the efficiency of imaging features and texture analysis (TA) based on baseline rectal MRI for the early prediction of therapeutic response to neoadjuvant chemoradiotherapy (nCRT) and tumor recurrence in patients with locally advanced rectal cancer (LARC)., Methods: Consecutive patients with LARC who underwent rectal MRI between January 2014 and December 2015 and surgical resection after completing nCRT were retrospectively enrolled. Imaging features were analyzed, and TA parameters were extracted from the tumor volume of interest (VOI) from baseline rectal MRI. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the optimal TA parameter cutoff values to stratify the patients. Logistic and Cox regression analyses were performed to assess the efficacy of each imaging feature and texture parameter in predicting tumor response and disease-free survival., Results: In total, 78 consecutive patients were enrolled. In the logistic regression, good treatment response was associated with lower tumor location (OR = 13.284, p = 0.012), low Conv&#95;Min (OR = 0.300, p = 0.013) and high Conv&#95;Std (OR = 3.174, p = 0.016), Shape&#95;Sphericity (OR = 3.170, p = 0.015), and Shape&#95;Compacity (OR = 2.779, p = 0.032). In the Cox regression, a greater risk of tumor recurrence was related to higher cT stage (HR = 5.374, p = 0.044), pelvic side wall lymph node positivity (HR = 2.721, p = 0.013), and gray-level run length matrix&#95;long-run low gray-level emphasis (HR = 2.268, p = 0.046)., Conclusions: Imaging features and TA based on baseline rectal MRI could be valuable for predicting the treatment response to nCRT for rectal cancer and tumor recurrence., Key Points: • Imaging features and texture parameters of T2-weighted MR images of rectal cancer can help to predict treatment response and the risk for tumor recurrence. • Tumor location as well as conventional and shape indices of texture features can help to predict treatment response for rectal cancer. • Clinical T stage, positive pelvic side wall lymph nodes, and the high-order texture parameter, GLRLM&#95;LRLGE, can help to predict tumor recurrence for rectal cancer.

Background: Ultrasonography (US) is recommended as a standard surveillance tool for patients with a high risk of developing hepatocellular carcinoma (HCC). However, the low sensitivity of US for small HCC can lead to surveillance failure, resulting in advanced stage tumor presentations. For the early detection of HCC in high-risk patients and to improve survival and prognosis, a new efficient imaging tool with a high sensitivity for HCC detection is needed. The purpose of this study is to evaluate and compare the feasibility and efficacy of non-contrast magnetic resonance imaging (MRI) with US as a surveillance tool for HCC in patients with liver cirrhosis., Methods: MAGNUS-HCC is a prospective, multicenter clinical trial with a crossover design for a single arm of patients. This study was approved by six Institutional Review Boards, and informed consent was obtained from all participants. All patients will undergo liver US every 6 months and non-contrast liver MRI every 12 months during a follow-up period of 3 years. If a focal liver lesion suspected of harboring HCC is detected, dynamic liver computed tomography (CT) will be performed to confirm the diagnosis. After the last surveillance round, patients without suspicion of HCC or who are not diagnosed with HCC will be evaluated with a dynamic liver CT to exclude false-negative findings. The primary endpoint is to compare the rate of detection of HCC by US examinations performed at 6-month intervals with that of yearly non-contrast liver MRI studies during a 3-year follow-up. The secondary endpoint is the survival of the patients who developed HCC within the 3-year follow-up period., Discussion: MAGNUS-HCC is the first study to compare the feasibility of non-contrast MRI with US as a surveillance tool for the detection of HCC in high-risk patients. We anticipate that the evidence presented in this study will establish the efficacy of non-contrast MRI as a surveillance tool for HCC in high-risk patients., Trial Registration: The date of trial registration ( NCT02551250 ) in this study was September 15, 2015, and follow-up is still ongoing.

Magnetic resonance (MR) imaging is a useful imaging tool with superior soft tissue contrast for diagnostic evaluation. The MR environments poses unique risks to patients and employees differently from ionizing radiation exposure originated from computed tomography and plain x-ray films. The technology associated with MR system has evolved continuously since its introduction in the late 1970s. MR systems have advanced with static magnetic fields, faster and stronger gradient magnetic fields and more powerful radiofrequency transmission coils. Higher field strengths of MR offers greater signal to noise capability and better spatial resolution, resulting in better visualization of anatomic detail, with a reduction in scan time. With the rapid evolution of technology associated with MR, we encounter new MR-related circumstances and unexpected dangerous conditions. A comprehensive update of our knowledge about MR safety is necessary to prevent MR-related accidents and to ensure safety for patients and staff associated with MR. This review presents an overview about MR-related safety issues and updates., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Aim: The purpose of the study was to investigate imaging predictors of Kirsten-ras (KRAS) mutations using magnetic resonance imaging (MRI) in patients with rectal cancer., Patients and Methods: A total of 275 patients with rectal cancer were enrolled. They underwent pretreatment rectal MRI, and then KRAS mutation evaluation following surgery. Two reviewers assessed diverse MRI findings associated with rectal cancer., Results: KRAS mutations were detected in 107 (38.9%). KRAS mutations were associated with N stage, gross tumor pattern, axial length of the tumor, and the ratio of the axial to the longitudinal dimensions of the tumor (p=0.0064, p<0.0001, p=0.0003 and p=0.0090). The frequency of KRAS mutations was higher in N2 stage (53.70%), and polypoid tumors (59.09%). Tumors with KRAS mutations exhibited a longer axial length, as well as a larger ratio of the axial to the longitudinal dimensions., Conclusion: KRAS mutations were associated with N stage, a polypoid pattern, axial tumor length, and the ratio of the axial to the longitudinal dimensions of the tumor., (Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background & Aims: Computed tomography (CT) and magnetic resonance imaging (MRI) play important roles in diagnosis and staging of hepatocellular carcinoma (HCC). However, prognostic roles of radiological characteristics are not yet determined., Methods: Eighty-eight patients treated with chemoembolization were analysed. Radiological parameters at baseline were assessed in all patients using both dynamic CT and MRI. Treatment responses were assessed using modified RECIST 4 weeks after the first chemoembolization., Results: Gross vascular invasion (GVI), bile duct invasion, irregular tumour margin (ITM), peripheral ragged enhancement (PRE) and satellite nodules on CT or MRI were associated with non-response (stable disease or progression) after chemoembolization respectively (all P ≤ 0.05). GVI, ITM and PRE on CT or MRI were also independently associated with poor overall survival (OS) respectively (all P ≤ 0.05). Using these results, a prognostic scoring system for CT and MRI were developed; 0, absence of all three features (GVI, ITM and PRE); 1, presence of one feature; 2, presence of two features; and 3, presence of three features. After adjusting tumour size, tumour number and alpha-foetoprotein level, both CT and MRI scores were independently associated with OS (both P < 0.001). Patients with CT or MRI score ≥2 had a worse OS than those with score <2 (adjusted hazard ratios, 3.837 and 2.938 respectively). MRI-specific parameters such as signal intensity on T2- or T1-weighted images, fat signal or hyperintensity on diffusion-weighted images did not have prognostic value (all P > 0.05)., Conclusions: Radiological parameters by CT and MRI may be useful in biological characterization of tumours and prognostification for HCC treated with chemoembolization., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose: The aim of this study was to compare the magnetic resonance imaging (MRI) evaluation of transplanted meniscal allograft with second-look arthroscopy and evaluate the sensitivity, specificity, and accuracy of MRI for assessing graft status., Methods: From 1996 to 2012, among 290 knees that underwent meniscal allograft transplantation and received follow-up examination for more than 1 year, those knees that underwent second-look arthroscopy were reviewed. Patients with no postoperative MRI and patients with a time gap between postoperative MRI and second-look arthroscopy of more than 3 months were excluded. Anatomically, the meniscus was divided into 3 segments: anterior one-third, mid body, and posterior one-third. Each part of the meniscus was evaluated using both methods. Grade 3 MRI signal intensity was diagnosed as a meniscal tear radiologically. By use of second-look arthroscopy as the standard, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of postoperative MRI were assessed in each segment of the grafts., Results: Twenty knees were retrospectively enrolled. The specificity, PPV, and accuracy for the anterior one-third were lower than those for the mid body and posterior one-third (specificity of 35.3% v 91.7% and 90%, respectively; PPV of 21.4% v 87.5% and 90.9%, respectively; and accuracy of 45% v 90% and 95%, respectively). However, the sensitivity and NPV were similar among the anterior one-third, mid body, and posterior one-third (sensitivity of 100%, 87.5%, and 100%, respectively; and NPV of 100%, 91.7%, and 100%, respectively). There were no significant differences in the comparison between the diagnostic MRI values of lateral grafts and medial grafts. Of 5 cases that showed grade 3 signal at only the anterior one-third section, 60% had no clinical signs. There were no graft tears in any cases., Conclusions: The anterior one-third of grafts showed low specificity, PPV, and accuracy of postoperative MRI compared with the mid body and posterior one-third. MRI tended to grade the anterior one-third more poorly than second-look arthroscopy. These features should be considered when evaluating transplanted meniscal allografts on postoperative MRI., Level of Evidence: Level III, study of non-consecutive patients evaluating a diagnostic test with a gold standard., (Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: We aimed to compare polyvinyl alcohol (PVA) particles with calibrated superparamagnetic iron oxide (SPIO) nanoparticle-loaded chitosan microspheres in a rabbit model, specifically regarding the relative distribution of embolic agents within the uterus based on magnetic resonance imaging (MRI) and pathological evaluation., Methods: Twelve New Zealand white rabbits underwent uterine artery embolization using either standard PVA particles (45-150 µm or 350-500 µm) or calibrated SPIO-embedded chitosan microspheres (45-150 µm or 300-500 µm). MRI and histopathological findings were compared one week after embolization., Results: Calibrated SPIO-loaded chitosan microspheres 45-150 µm in size were detected on T2-weighted images. On histological analysis, calibrated SPIO-embedded chitosan microspheres were found in both myometrium and endometrium, whereas PVA particles were found only in the perimyometrium or extrauterine fat pads. A proportional relationship was noted between the calibrated SPIO-embedded chitosan microsphere size and the size of the occluded artery., Conclusion: Calibrated SPIO-embedded chitosan microspheres induced greater segmental arterial occlusion than PVA particles and showed great potential as a new embolic material. SPIO-embedded chitosan microspheres can be used to follow distribution of embolic particles through MRI studies.

Background: Graft extrusion after meniscus allograft transplantation (MAT) may be affected by horn fixation, which differs between medial and lateral MAT. Few studies have compared graft extrusion, especially sagittal extrusion, after medial and lateral MAT., Hypothesis: In patients undergoing medial and lateral MAT, graft extrusion is likely similar and not correlated with postoperative Lysholm scores., Study Design: Cohort study; Level of evidence, 2., Methods: Meniscus graft extrusion in the coronal and sagittal planes was compared in 51 knees undergoing medial MAT and 84 undergoing lateral MAT. Distances from the anterior and posterior articular cartilage margins to the anterior (anterior cartilage meniscus distance [ACMD]) and posterior (posterior cartilage meniscus distance [PCMD]) horns, respectively, were assessed on immediate postoperative magnetic resonance imaging and compared in patients undergoing medial and lateral MAT. Correlations between coronal and sagittal graft extrusion and between extrusion and the Lysholm score were compared in the 2 groups., Results: In the coronal plane, mean absolute (4.3 vs 2.7 mm, respectively; P<.001) and relative (39% vs 21%, respectively; P<.001) graft extrusions were significantly greater for medial than lateral MAT. In the sagittal plane, mean absolute and relative ACMD and PCMD values were significantly greater for medial than lateral MAT (P<.001 each). For both medial and lateral MAT, mean absolute and relative ACMDs were significantly larger than PCMDs (P<.001 each). Graft extrusion>3 mm in the coronal plane was significantly more frequent in the medial (78%) than in the lateral (35%) MAT group. In the sagittal plane, the frequencies of ACMDs (72% vs 39%, respectively) and PCMDs (23% vs 4%, respectively) >3 mm were also significantly greater in the medial than in the lateral MAT group. Coronal and sagittal extrusions were not correlated with postoperative Lysholm scores for both medial and lateral MAT., Conclusion: The amount and incidence of graft extrusion were greater after medial than lateral MAT in both the coronal and sagittal planes. In the sagittal plane, graft extrusion was greater and more frequent on the anterior than the posterior horn in both medial and lateral MAT. However, graft extrusion was not correlated with early clinical outcomes after both medial and lateral MAT., (© 2014 The Author(s).)

Objective: To compare the accuracy of multidetector computed tomography (MDCT) and gadoxetic acid-enhanced magnetic resonance imaging (MRI) for the detection of intrahepatic tumor recurrence after curative resection of hepatocellular carcinoma (HCC)., Materials and Methods: Fifty-six patients who underwent MDCT and gadoxetic acid-enhanced MRI for postoperative surveillance after resection of HCC were retrospectively analyzed; 26 patients had a recurrence (36 lesions) and 30 patients did not. Recurrent HCCs were confirmed by histological examinations in two, typical dynamic imaging findings on CT and/or MRI in 28, and by demonstration of growth or tumor staining on angiography on six. Two reviewers graded the confidence for the presence of recurrence on CT and MRI, using a five-point scale. The jackknife free-response receiver operating characteristic method was used to compare diagnostic performance. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated., Results: For 36 recurrent lesions, the figure of merit was significantly higher for MRI than MDCT for detecting recurrence for both reviewers (p < 0.005 for both reviewers). In lesion-by-lesion analysis, the sensitivity was significantly higher on MRI (100% for reviewer 1 and 97% for reviewer 2) than on MDCT (44.4% and 66.6%) for both reviewers (p < 0.005 for both reviewers). Also in patient-by-patient analysis, sensitivity was significantly higher on MRI (100% and 96.1%) than on MDCT (57.6% and 76.9%) for both reviewers (p < 0.05 for both reviewers)., Conclusion: Gadoxetic acid-enhanced MRI is superior to MDCT for detecting intrahepatic recurrence after curative resection of HCC.

Purpose: To retrospectively determine whether the hyperintense hepatocellular carcinomas (HCCs) seen on the hepatobiliary phase of gadoxetic acid-enhanced MR imaging (EOB-MRI) might have different histologic characteristics from usual hypointense HCCs., Materials and Methods: Two hundred three surgically proven HCCs from 192 patients who underwent preoperative EOB-MRI were analyzed. The demographic and histologic characteristics of hyperintense HCCs were compared with usual hypointense HCCs by using the t-test or Fisher's exact test., Results: By visual assessment, 18 (8.8%) tumors were classified as hyperintense HCCs. Patients with hyperintense HCC were significantly (p<0.05) older (60.1 vs. 55.2 years) than those with hypointense HCCs. Hyperintense HCCs showed significantly lower rate of microvascular invasion (27.8% vs. 53.5%) and significantly higher rate of peliosis (61.1% vs. 30.8%). Hyperintense HCCs were more frequently expanding type, and none showed infiltrative type or scirrhous histologic pattern., Conclusions: Hyperintense HCCs seem to have clinical and histologic features that might be related with more favorable outcomes., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Purpose: To quantify liver T1 relaxation times before and after oxygen inhalation in patients with and without liver cirrhosis using a 3 Tesla (T) MRI., Materials and Methods: Institutional Review Board approval and written informed consent were obtained. Ninety-two noncirrhotic patients and 87 patients with hepatitis B viral liver cirrhosis (72 Child-Pugh class A and 15 Child-Pugh class B or C) underwent MRI with a 3.0T system before and after the supply of 100% oxygen at a rate of 15 L/min by means of a nonrebreather ventilation mask for 3 min. T1 maps were acquired using three-dimensional spoiled gradient echo sequences with two different flip angles (2° and 14°) and a fixed TR/TE (2.54 ms/0.95 ms). Liver T1 values were obtained using a T1 processing tool (MapIT software). The mean baseline T1 values of three groups (control, Child-Pugh class A, and Child-Pugh class B/C) were compared using an analysis of variance test. Liver T1 value before and after oxygenation was compared using a paired t-test for each group., Results: The baseline liver T1 value was significantly higher in the control group (941 ± 136 ms) than in Child-Pugh A (858 ± 143 ms) and Child-Pugh B/C (783 ± 164 ms) group (P < 0.001 and P < 0.0001). The reduction in the liver T1 value after oxygen inhalation was significant in the control group (P = 0.012) but not significant in Child-Pugh class A (P = 0.079) and Child-Pugh class B/C (P = 0.752)., Conclusion: The baseline liver T1 relaxation time was significantly different between the patients with and without liver cirrhosis. The shortening effect of oxygen on the liver T1 value was significant in the control group but not in the cirrhotic patients., (Copyright © 2012 Wiley Periodicals, Inc.)

Background: Little is known about morphologic changes in the remodeling period after human meniscal allograft transplantation (MAT)., Hypothesis: The gross structure of meniscal transplants may be altered significantly in width and thickness during early remodeling periods., Study Design: Cohort study; Level of evidence, 3., Methods: Thirty-one patients who underwent MAT (9 medial and 22 lateral menisci) between 2008 and 2009 were prospectively evaluated by serial magnetic resonance imaging scans 2 days, 6 weeks, and 3, 6, and 12 months after surgery. At each time point, the width and thickness of the menisci were measured. The relative degree of shrinkage after 1 year was categorized as minimal (<10%), mild (10%-25%), moderate (25%-50%), or severe (>50%). The Lysholm score and Tegner activity level were used for clinical outcome scales., Results: More apparent changes were observed at mid-body rather than at the posterior horn. Meniscal width at the mid-body decreased to 89% (P < .01), whereas thickness increased to 115% (P < .01) at 12 months. Shrinkage was observed for 3 months after MAT, but there were no significant changes thereafter. The thickness of the meniscal peripheral rim did not change before 3 months but increased afterward, for up to 1 year. Of the 31 patients, 20 (64.5%) had minimal shrinkage, 6 (19.4%) had mild shrinkage, 5 (16.1%) had moderate shrinkage, and none had severe shrinkage over 1 year. In the 5 cases of moderate shrinkage, the reduction occurred progressively for 1 year. However, the relative morphologic changes did not correlate with clinical outcome scales at postoperative 1 and 2 years (P > .05). The preoperative alignment deviation, cartilage status (Outerbridge grade), age, gender, amount of extrusion, and time from previous meniscectomy did not affect the degree of shrinkage., Conclusion: Gross morphologic alterations, as determined by width and thickness, were observed during the first postoperative year. Substantial shrinkage at the mid-body occurred progressively for 1 year in 16.1% of the cases. No association was found between morphologic changes and short-term clinical outcomes.

Background: Although numerous studies have reported outcomes of meniscus allograft transplantation, only a few dealt with isolated procedures or employed objective evaluation methods., Hypothesis: Isolated lateral meniscus allograft transplantation (LMAT) provides clinical improvements and favorable objective results in symptomatic lateral meniscus-deficient knees., Study Design: Case series; Level of evidence, 4., Methods: The authors collected and analyzed the results of 29 consecutive isolated LMATs with a minimum of 24 months' follow-up. The mean age of the patients was 29.6 years (range, 18-48 years). The modified Lysholm scoring system and the Hospital for Special Surgery score were used to evaluate subjective improvements. Every patient underwent postoperative magnetic resonance imaging (MRI) or second-look arthroscopy or both as objective evaluation. The allograft extrusion and relative percentage of extrusion (RPE) was measured on final MRI. Status of the allograft was classified according to the above 3 categories into 3 grades; satisfactory, fair, or poor., Results: The average length of follow-up was 53.6 months. Symptoms and functions of the involved knee improved in 28 knees (96.6%) at the last follow-up. The average preoperative modified Lysholm score was 69.5, which increased to 89.9 postoperatively (P < .001). The average preoperative Hospital for Special Surgery pain score was 15.3, which increased to 26.7 postoperatively (P < .001). Postoperative MRI alone was performed in 22 knees (75.9%), second-look arthroscopy alone in 1 knee (3.4%), and both examinations in 6 knees (20.7%). The MRI scans revealed 4 gross and 5 small tears in the allograft and also provided valuable information despite magnetic susceptibility artifacts. Mean allograft extrusion was 4.0 mm and mean RPE was 45.4%. At second-look arthroscopy, 3 gross tears and a small flap tear were identified in 4 cases. According to the clinical and the objective criteria, the allografts were graded as satisfactory in 20 cases (69.0%), fair in 5 cases (17.2%), and poor in 4 cases (13.8%)., Conclusion: The results of the present study showed remarkable symptomatic improvements and acceptable objective findings in short- to intermediate-term follow-up. Even in cases with favorable clinical results, MRI or second-look arthroscopy was necessary to identify the actual status of the allograft. Isolated LMAT could be an effective treatment for symptomatic, lateral meniscus-deficient knees.

Objective: To investigate the usefulness of the external rotation (ER) position on magnetic resonance (MR) arthrography for the diagnosis of superior labral anterior to posterior (SLAP) lesion., Materials and Methods: Approval of institutional review board was obtained, and informed consent was waived. The MR arthrograms of 210 shoulders that were arthroscopically confirmed as SLAP lesion in 163 shoulders and intact superior labrum in 47 shoulders were retrospectively reviewed in each neutral and ER position for the diagnosis of SLAP lesion, the extent of distraction of the torn labrum, and the external rotation angle. The sensitivity, specificity, and diagnostic accuracy of MR arthrograms for determining SLAP lesion were assessed in each position. For the arthroscopically confirmed group, the diagnosis of SLAP lesion and the extent of distraction about the tear were compared between neutral and ER positions by Fisher's exact test and the paired t-test. The correlation between the external rotation angle and the diagnosis of SLAP lesion, and between the external rotation angle and the differences in the extent of distraction were evaluated in the ER position using the ANOVA test., Results: Sensitivity and diagnostic accuracy of MR arthrography for SLAP lesion increased from 64.4% and 71.0% in the neutral position to 78.5% and 81.9% in the ER position, respectively, without change of specificity, which was 93.6% in both positions. The diagnosis of SLAP lesion was changed from negative to SLAP lesion in 16.0% of the arthroscopically confirmed group. Mean difference in the extent of distraction about the tear was 0.69 mm (range -1.40 ∼ 6.67 mm), which was statistically significant. There was no relationship between the external rotation angle and the diagnosis of SLAP lesion, and between the external rotation angle and the differences in the extent of distraction., Conclusion: Shoulder MR arthrography with additional ER positioning helps in the diagnosis of SLAP lesion and provides information about the displaceability of the torn labrum.

Purpose: To compare the image quality of two variants of a three-dimensional (3D) gradient echo sequence (GRE) for hepatic MRI., Materials and Methods: Thirty-nine patients underwent hepatic MRI on a 3.0 Tesla (T) magnet (Intera Achieva; Philips Medical Systems). The clinical protocol included two variants of a 3D GRE with fat suppression: (i) a "centric" approach, with elliptical centric k-space ordering and (ii) an "enhanced" approach using linear sampling and partial Fourier in both the slice and phase encoding direction. "Centric" and "Enhanced" 3D GRE images were obtained both precontrast (n = 32) and after gadoxetic acid injection (n = 39). Two reviewers jointly reviewed MR images for anatomic sharpness, overall contrast, homogeneity, and absence of artifacts. The liver-to-lesion signal difference ratio (SDR) was measured. Paired sample Wilcoxon test and paired t-tests were used., Results: Enhanced 3D GRE images performed better than centric 3D GRE images with respect to anatomic sharpness (P = 0.0156), overall contrast (P = 0.0195), homogeneity (P < 0.0001), and absence of artifacts (P = 0.0003) on precontrast images. For postcontrast MRI, enhanced 3D GRE images showed better quality in terms of overall contrast (P = 0.0195), homogeneity (P < 0.0001), and absence of artifacts (P = 0.009). Liver-to-lesion SDR on enhanced 3D GRE images (0.48 ± 0.13) was significantly higher than that of conventional 3D GRE images (0.40 ± 0.19, P = 0.0004) on postcontrast images, but not on precontrast images., Conclusion: The enhanced 3D GRE sequence available on our scanner provided better hepatic image quality than the centric variant, without compromising lesion contrast., (Copyright © 2010 Wiley-Liss, Inc.)

Objectives: Using gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI), the purpose of this study was to evaluate findings of focal hepatic eosinophilic infiltration., Methods: This retrospective study included 8 patients with 7 histologically confirmed focal eosinophilic infiltration (FEI) of the liver. One case was considered as FEI by using clinical findings and follow-up imaging. Gadoxetic acid-enhanced MRI and DWI were reviewed by 2 radiologists. We evaluated the signal intensity of focal lesions on T1-weighted, T2-weighted, and DW images and the pattern of enhancement in arterial, portal, equilibrium, and hepatobiliary phases of the gadoxetic acid-enhanced MRI. Apparent diffusion coefficient (ADC) value for focal eosinophilic infiltration was also calculated., Results: On T2-weighted images, 7 (88%) of 8 cases (7/8 lesions) showed mixed hyperintensity with irregular margins. Six (75%) of the 8 cases showed rim enhancement in the arterial phase. Most cases (5/8 lesions [63%]) showed isointensity or hypointensity in the portal and equilibrium phases. In the hepatobiliary phase, all cases (8/8) showed mixed hypointensity with irregular margins and nonspherical shapes. All cases showed hyperintensity in both low and high b-value ranges on DWI. The ADCs for 6 cases showed less than 1.05 × 10(-3) mm2/s (0.74 × 10(-3) to 1.03 × 10(-3) mm2/s)., Conclusions: Focal eosinophilic infiltration showed mixed hypointensity, irregular margins, and nonspherical shapes with excellent lesion-to-liver contrast in the hepatobiliary phase of the gadoxetic acid-enhanced MRI. Diffusion-weighted imaging and ADCs may not be helpful for characterizing these benign hepatic lesions.

Background: Osteophytes can be observed on the tibial plateau during meniscus allograft transplantation (MAT). However, no studies to date have evaluated the effect of these osteophytes on meniscus allograft extrusion. Hypothesis: Osteophyte excision in the tibial plateau could reduce extrusion of the transplanted meniscus and improve short-term clinical outcomes with meniscus allograft transplantation. Study Design: Cohort study; Level of evidence, 3. Methods: Between October 2004 and July 2012, a total of 323 patients underwent MAT at a single institution. Of these, 88 patients had a peripheral osteophyte in their tibial plateau, and they were enrolled in the study retrospectively. The mean age of the patients was 35.3 years (range, 15-56 years); there were 57 male and 31 female patients. Forty-four patients underwent osteophyte excision concomitantly with MAT and 44 patients underwent MAT only. The 2 groups showed no difference in terms of age, body mass index, time after meniscectomy, and preoperative knee scores. A medial meniscus allograft was transplanted in 13 cases (15%) and a lateral meniscus in 75 (85%). The absolute extrusion and relative percentage of extrusion were measured to evaluate allograft extrusion 12 months after MAT. The modified Lysholm scoring system and the Hospital for Special Surgery score at 2 years after MAT were used to evaluate clinical outcomes. Results: The mean absolute extrusions at 1 year postoperatively in the excision and nonexcision groups were 3.5 ± 1.5 and 5.5 ± 1.6 mm, respectively. The mean relative percentages of extrusion were 34.1% 6 15.9% and 54.7% 6 20.7%, respectively. The rates of allograft extrusion (.3 mm) were 28 of 44 (63.6%) and 41 of 44 (93.2%) in the excision and nonexcision groups, respectively. The intergroup differences in absolute extrusion, relative percentage of extrusion, and rate of allograft extrusion were statistically significant (P \ .001 for all 3 parameters). There were no significant differences in the clinical outcomes (modified Lysholm or Hospital of Special Surgery scores) at 2-year follow-up (P \ .762 and \ .298, respectively). Conclusion: The excision of a peripheral osteophyte larger than 2 mm in the proximal tibial plateau was associated with less allograft extrusion after MAT. [ABSTRACT FROM AUTHOR]

Objectives: Glucose metabolism, perfusion, and water diffusion may have a relationship or affect each other in the same tumor. The understanding of their relationship could expand the knowledge of tumor characteristics and contribute to the field of oncologic imaging. The purpose of this study was to evaluate the relationships between metabolism, vasculature and cellularity of advanced hepatocellular carcinoma (HCC), using multimodality imaging such as 18F-FDG positron emission tomography (PET), dynamic contrast enhanced (DCE)-MRI, and diffusion weighted imaging(DWI). Materials and Methods: Twenty-one patients with advanced HCC underwent 18F-FDG PET, DCE-MRI, and DWI before treatment. Maximum standard uptake values (SUVmax) from 18F-FDG-PET, variables of the volume transfer constant (Ktrans) from DCE-MRI and apparent diffusion coefficient (ADC) from DWI were obtained for the tumor and their relationships were examined by Spearman’s correlation analysis. The influence of portal vein thrombosis on SUVmax and variables of Ktrans and ADC was evaluated by Mann-Whitney test. Results: SUVmax showed significant negative correlation with Ktransmax (ρ = −0.622, p = 0.002). However, variables of ADC showed no relationship with variables of Ktrans or SUVmax (p>0.05). Whether portal vein thrombosis was present or not did not influence the SUV max and variables of ADC and Ktrans (p>0.05). Conclusion: In this study, SUV was shown to be correlated with Ktrans in advanced HCCs; the higher the glucose metabolism a tumor had, the lower the perfusion it had, which might help in guiding target therapy. [ABSTRACT FROM AUTHOR]

Abstract: Backgrounds: European Association for the Study of the Liver (EASL) and modified Response Evaluation Criteria in Solid Tumours (mRECIST) guidelines, which measure changes in arterialised hepatocellular carcinoma (HCC), differ in terms of number of target lesions (all versus ⩽2) and calculation method (bidimensional versus unidimensional). We compared prognostic values of mRECIST for predicting overall survival (OS) with reference to EASL criteria in treatment-naïve HCC undergoing trans-arterial chemoembolisation (TACE). Methods: The ability to predict OS during longitudinal follow-up was expressed as C-index, and a sample size of 292 patients was required to validate its equivalence between each criteria. Treatment responses were assessed using both guidelines 4weeks after the first TACE, using dynamic computed tomography or magnetic resonance imaging. Kaplan–Meier and Cox regression analyses were used to explore differences in OS between responders (complete or partial) and non-responders (stable or progressive disease), defined by each method. Results: C-index for EASL and mRECIST guidelines was 0.753 and 0.759, respectively, demonstrating equivalence between two methods. Differences in median OS between responders and non-responders were statistically significant for both EASL (30.1 versus 18.7months, p <0.001) and mRECIST (33.8 versus 17.1months, p <0.001) guidelines. In addition to radiological response, α-fetoprotein (p <0.001), tumour number (p <0.001) and tumour size (p =0.048) were significant predictors of OS. In multivariate analysis, radiological criteria, tumour number and α-fetoprotein were identified as independent predictors (all p <0.05). Conclusion: mRECIST, a simpler method, provided prognostic values for predicting OS equivalent to EASL criteria in patients with HCC undergoing TACE as an initial treatment modality. [Copyright &y& Elsevier]

Background: In lateral meniscus allograft transplantation (MAT) using the keyhole method, precise trough drilling is critical for ensuring the graft is placed at the correct anatomic position to minimize the risk of extrusion. However, no study has focused on the effect of bony trough axial obliquity on graft extrusion. Our purpose was to investigate whether bony trough axial obliquity and bony trough position correlate with graft extrusion in lateral MAT using the keyhole method. Hypothesis: We hypothesized that drilling the tibial bony trough at a greater axial angle would increase the risk of graft extrusion. Study Design: Case series; Level of evidence, 4. Methods: The study involved 49 patients who underwent lateral MAT between 2009 and 2010 following total or subtotal meniscectomy. The mean patient age at the time of surgery was 34 years (range, 19-52 years). Graft extrusion and bony trough parameters (absolute and relative distance at the anterior, center, and posterior cuttings of the bony trough, and axial trough angle [ATA]) were assessed using conventional magnetic resonance imaging (MRI) performed on postoperative day 2. The correlation between graft extrusion and MRI trough parameters was analyzed, and multiple linear regression analysis was performed to identify predictors of graft extrusion. Results: Of the 7 MRI measurement parameters, the ATA (r = .355, P = .012), absolute anterior distance (r = .301, P = .031), and relative anterior distance (r = .307, P = .032) were found to positively correlate with absolute extrusion. The ATA (r = .296, P = .037) and relative anterior distance (r = .296, P = .039) were also found to correlate with relative extrusion. The ATA was found to be a predictor of absolute extrusion (β = .36, P = .012) and relative extrusion (β = .33, P = .019). Conclusion: The risk of graft extrusion increases as the axial plane trough angle increases. The angle can be reduced by ensuring that the bony trough starting point is not created in too lateral a position. [ABSTRACT FROM AUTHOR]

Background: Meniscus allograft transplantation (MAT) has shown efficacy in relieving pain and improving knee joint function, but objective evaluation in a large number of patients is necessary to verify this effect.Hypothesis: Meniscus allograft transplantation relieves pain and improves function of the involved knee joint. Objective evaluation provides evidence of allograft integrity.Study Design: Case series; Level of evidence, 4.Methods: Of the 115 knees that underwent MAT from December 1996 to February 2009, 110 (95.7%) were followed up for more than 2 years and were enrolled in this study. Of these, 83 underwent lateral MAT, and 27 underwent medial MAT. Clinical outcomes were evaluated using the modified Lysholm score and Knee Society pain score. All knees underwent postoperative magnetic resonance imaging (MRI) and/or second-look arthroscopy to evaluate the integrity and position of the allografts, with allograft status classified as satisfactory, fair, or poor.Results: At a mean follow-up of 49.4 months, clinical improvement was achieved in 104 of the 110 knees (94.5%). Mean modified Lysholm score increased from 72.7 preoperatively to 92.3 at final follow-up (P < .001), and mean preoperative Knee Society pain score increased from 32.5 to 47.7 (P < .001). Of the 110 knees, 90 were evaluated by postoperative MRI alone, 2 by second-look arthroscopy alone, and 18 by both. Magnetic resonance imaging showed 12 gross tears and 6 small tears in the allograft. Mean extrusion of the allograft was 3.7 mm, and mean relative percentage of extrusion was 42.6%. Second-look arthroscopy showed 6 gross tears and 1 small flap tear. Classification by clinical outcome, MRI, and second-look arthroscopy graded 90 allografts (81.8%) as satisfactory, 8 (7.3%) as fair, and 12 (10.9%) as poor.Conclusion: Meniscus allograft transplantation using bone fixation resulted in significant symptomatic and functional improvements. Magnetic resonance imaging or second-look arthroscopy was necessary to assess allograft status even after favorable clinical outcome. Meniscus allograft transplantation with bone fixation is considered effective for symptomatic, totally meniscectomized knees. [ABSTRACT FROM PUBLISHER]

We investigated the cone beam computed tomography (CBCT)-based-liver-perfusion-mapping usefulness during transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) to access treatment response and predict outcomes. From October 2016 to September 2018, 42 patients with HCCs scheduled for conventional TACE were prospectively enrolled. Three reviewers evaluated the unenhanced and contrast-enhanced CBCT and CBCT-based-liver-perfusion-mapping of each tumor. Parenchymal blood volume (PBV) was measured. The operator's judgment on the technical results was recorded. Response outcome was determined on follow-up CT or magnetic resonance imaging, according to the modified Response Evaluation Criteria in Solid Tumors. Diagnostic performance for detection of a viable tumor was evaluated using multiple logistic regression with C-statistics. CBCT-based-liver-perfusion-mapping and the maximum PBV of the tumor were significant in multiple logistic regression analysis of response (p < 0.0001, p = 0.0448, respectively), with C-statistics of 0.9540 and 0.7484, respectively. Diagnostic accuracy of operator's judgment was 79.66% (95%CI 69.39%–89.93%). Diagnostic performance of CBCT-based-liver-perfusion-mapping showed a high concordance in three reviewers. The mean PBV of tumor, maximum PBV of tumor, and mean PBV of liver significantly decreased after TACE (each p < 0.001). In ROC curve analysis, the AUC for prediction of residual tumor by the maximum PBV of tumor after TACE was 0.7523, with 80.8% sensitivity and 60.6% specificity. [ABSTRACT FROM AUTHOR]