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Objectives: This study aimed to assess the feasibility of pancreatic steatosis quantification by automated whole-volume measurement of the fat fraction of the pancreas on CT in comparison to MRI using proton-density fat fraction (PDFF) techniques. Methods: Fifty-nine patients who underwent both CT and MRI were analyzed. Automated whole-volume measurement of pancreatic fat on unenhanced CT was performed by a histogram analysis with local thresholding. Three sets of CT fat volume fraction (FVF) (%) values with thresholds of −30 Hounsfield unit (HU), −20 HU and −10 HU were compared to MR-FVF (%) values measured on a PDFF map. Results: The median −30 HU CT-FVF, −20 HU CT-FVF, −10 HU CT-FVF and MR-FVF values of the pancreas were 8.6% (interquartile range (IQR), 11.3), 10.5% (IQR, 13.2), 13.4% (IQR, 16.1) and 10.9% (IQR, 9.7), respectively. The −30 HU CT-FVF (%), −20 HU CT-FVF (%) and −10 HU CT-FVF (%) of the pancreas showed a significant positive correlation with the MR-FVF (%) of the pancreas (ρ = 0.898, p < 0.001, ρ = 0.905, p < 0.001, ρ = 0.909, p < 0.001, respectively). The −20 HU CT-FVF (%) displayed reasonable agreement with the MR-FVF (%) with a low absolute fixed bias (mean difference, 0.32%; limit of agreement from −10.1 to 10.7%). Conclusion: The automated whole-volume measurement of the CT fat fraction of the pancreas using the threshold CT attenuation value of −20 HU may be a feasible, non-invasive, and convenient technique for quantifying pancreatic steatosis. Advances in knowledge: CT-FVF value of the pancreas had a positive correlation with the MR-FVF value. The −20 HU CT-FVF may be a convenient technique for quantifying pancreatic steatosis.

Purpose To evaluate the high-resolution CT (HRCT) findings of pulmonary infections in patients with hematologic malignancy and compare them between patients with or without hematopoietic stem cell transplantation (HSCT). Materials and methods A total of 128 patients with hematologic malignancy and pulmonary infection were included in this study. The diagnoses of the patients consisted of bacterial pneumonia (37 non-HSCT cases and 14 HSCT cases), pneumocystis pneumonia (PCP) (29 non-HSCT cases and 11 HSCT cases), and fungal infection other than PCP (20 non-HSCT cases and 17 HSCT cases). Two chest radiologists retrospectively evaluated the HRCT criteria and compared them using chi-squared tests and a multiple logistic regression analysis. Results According to the multiple logistic regression analysis, nodules were an indicator in HSCT patients with PCP (p = 0.025; odds ratio, 5.8; 95% confidence interval, 1.2–26.6). The centrilobular distribution of nodules was the most frequent (n = 4, 36%) in HSCT patients with PCP. A mosaic pattern was an indicator of PCP in both HSCT and non-HSCT patients. There were no significant differences in other infections. Conclusion The mosaic pattern could be an indicator of PCP in both HSCT and non-HSCT patients. Nodules with centrilobular distribution might be relatively frequent HRCT findings of PCP in HSCT patients.

Objective CT enterography/enteroclysis (CTE) is listed in the clinical practice guidelines as a method for diagnosing small bowel bleeding, as is capsule endoscopy (CE), but there are no real-world data yet available on CTE in Japan. This study aimed to investigate the diagnostic ability of CTE and long-term prognosis after CTE in Japan. Patients We conducted a retrospective cohort study of patients suspected of having small bowel bleeding who underwent both CTE and CE within 30 days between April 2008 and March 2019. The number of patients free from rebleeding for up to 24 months was thus determined. Results Seventy-one patients were extracted from the database. The 43 patients (60.6%) with a definite and suspicious source of bleeding in the small bowel were detected by CTE. When the 31 patients with a definite source of bleeding in the small bowel were analyzed, the sensitivity of CTE was 19/31 (61.3%) and that of CE was 24/31 (77.4%), thus indicating no significant difference (p=0.332). However, the sensitivity when CTE and CE were used in combination was 30/31 (96.8%), which was significantly higher than that of CE alone (p=0.0412). No rebleeding was observed in the CTE and CE negative group (p=0.0965). Conclusion The combined use of CTE and CE increased the detection rate of small bowel bleeding. Therefore, in patients with suspected tumor/polyp lesions, not only CE, but also CTE should be performed. This study provides the first real-world data on the diagnostic accuracy of CTE for small bowel bleeding in Japan.

Objective Transmural healing (TH) has been attracting attention as a new therapeutic target for Crohn's disease, but there are few clinical data on TH in Japan. We introduced low-dose computed tomography enterography (CTE) as a monitoring method for Crohn's disease and retrospectively investigated the accuracy of evaluating TH by CTE. Methods Among Crohn's disease patients who underwent low-dose CTE at our hospital from January 2009 to March 2021, 122 patients who underwent colonoscopy or balloon endoscopy within 2 weeks were included. Results of radiological and endoscopic examinations were reviewed independently by radiologists and gastrointestinal endoscopists, respectively. The concordance rate of the diagnosis between CTE and endoscopy was evaluated. Results Twenty-six patients (21.3%) achieved TH, and the kappa index was 0.743. On comparing the TH and non-TH groups, the Crohn's disease activity index (p=0.02), endoscopic healing rate (p0.001), serum albumin (p=0.043), and serum C-reactive protein level (p=0.018) showed significant differences. Among the 122 patients, 69 (56.5%) showed concordance between the diagnosis of CTE and endoscopy, and 22 (18.0%) achieved both TH and endoscopic healing. Conclusion This study provides real-world data on Crohn's disease evaluated with low-dose CTE in Japan. The TH criterion used in this study has a high kappa coefficient and can be used reproducibly in many institutions.

Background To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP. Purpose To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas. Study type Retrospective. Population A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs. Field strength/sequence 3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality. Statistical tests Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P Results Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients. Data conclusion 3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern. Level of evidence 4 TECHNICAL EFFICACY: Stage 2.

To evaluate the feasibility of High-resolution (HR) magnetic resonance imaging (MRI) of the liver using deep learning reconstruction (DLR) based on a deep learning denoising technique compared with standard-resolution (SR) imaging.This retrospective study included patients who underwent abdominal MRI including both HR imaging using DLR and SR imaging between April 1 and August 31, 2019. DLR was applied to all HR images using 12 different strength levels of noise reduction to determine the optimal denoised level for HR images. The mean signal-to-noise ratio (SNR) was then compared between the original HR images without DLR and the optimal denoised HR images with DLR and SR images. The mean image noise, sharpness and overall image quality were also compared. Statistical analyses were performed with the Friedman and Dunn-Bonferroni post-hoc test.In total, 49 patients were analyzed (median age, 71 years; 25 women). In quantitative analysis, the mean SNRs on the original HR images without DLR were significantly lower than those on the SR images in all sequences (p 0.01). Conversely, the mean SNRs on optimal denoised HR images were significantly higher than those on the SR images in all sequences (p 0.01). In the qualitative analysis, the mean scores for the image noise and overall image quality were significantly higher on optimal denoised HR images than on the SR images in all sequences (p 0.01) except for the mean image noise score in in-phase (IP) images.The use of a deep learning-based noise reduction technique substantially and successfully improved the SNR and image quality in HR imaging of the liver. Denoised HR imaging using the DLR technique appears feasible for use in liver MR examinations compared with SR imaging.

Background Quantitative analyses of computed tomography (CT) images using computer-aided detection (CAD) are correlated with visual assessments and pulmonary function test findings and might be useful for predicting the prognosis of patients with idiopathic pulmonary fibrosis (IPF). Purpose To evaluate the association between the quantitative analysis of long-term follow-up CT of IPF and the progression and prognosis. Material and Methods A total of 48 patients with IPF who received over one year of follow-up CT were included in this study. The results of quantitative analyses (emphysema, ground-glass attenuation [GGA], consolidation, reticulation, and honeycombing) using a CAD software program of initial and follow-up CT findings were evaluated, and the association with the progression of the total lesion of IPF and prognosis using Spearman's rank correlation and Cox regression analyses was considered. Results Results of quantitative analyses of consolidation, reticulation, honeycombing, and the total lesion on initial CT were correlated with progressive changes in the total lesion of IPF per year (r = 0.4375, 0.4128, 0.4649, and 0.4095, respectively). The results of quantitative analyses of honeycombing (hazard ratio [HR] = 1.40, 95% confidence interval [CI] = 1.03−1.89, P = 0.0314) and GGA (HR = 0.85, 95% CI = 0.72−0.99, P = 0.0384) at initial CT were prognostic factors according to a multivariate Cox regression analysis. Conclusion The quantitative analysis of honeycombing using a CAD software program of CT findings may be useful for predicting the progression and prognosis of patients with IPF.

Aim The impact of sustained virologic response (SVR) on surgical outcomes for patients with hepatitis C virus (HCV)‐related hepatocellular carcinoma (HCC) remains controversial. This study aimed to evaluate the influence of SVR on long‐term surgical outcomes after hepatectomy. Methods This multicenter study included 504 patients who underwent curative resection for HCV‐related HCC. Patients with a history of HCC treatment, HBV infection, poor liver function, and tumor with major vascular invasion were excluded. Long‐term surgical outcomes (overall survival [OS] and recurrence‐free survival [RFS]) among patients who achieved SVR before hepatectomy (Pre‐SVR group: 58 patients), after hepatectomy (Post‐SVR group: 54 patients), and without SVR (Non‐SVR group: 186 patients) were compared after adjusting for 13 confounding factors. Using the surgically resected specimens, comparison of the pathological changes in liver fibrosis between the first and second hepatectomy were analyzed. Results Patients with SVR were younger, had better liver function, and less liver fibrosis compared to patients without SVR. Propensity score‐matched OS and RFS were significantly better in Pre‐SVR group than Non‐SVR group (P = .029 and P = .009, respectively). Inverse probability‐weighted OS and RFS were also significantly better in the Post‐SVR group (P = .001 and P = .021, respectively) than in the Non‐SVR group. Histopathological evaluation revealed that only the patients with SVR had regression of liver fibrosis (P, Although the achievement of sustained virologic response (SVR) is essential for improving survival in patients with hepatitis C virus (HCV) infection, its importance on surgical outcomes for HCV‐related hepatocellular carcinoma (HCC) is still controversial. In this multicenter study, we demonstrated the importance of achieving SVR before or after hepatectomy for improving long‐term surgical outcomes. These results can encourage patients with HCV‐related HCC to undergo antiviral therapy regardless of the timing.

Objectives To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival. Results FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3-151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively. Materials and methods Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirty-two tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3). Conclusions Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.

To compare the occurrence of transient respiratory motion artifacts (TRMAs) in multiple arterial phases on abdominal magnetic resonance (MR) images between those obtained using gadobutrol and gadoxetate disodium. Two hundred and fourteen abdominal MR examinations (101 with gadoxetate disodium, 113 with gadobutrol) were evaluated. Dynamic three-dimensional contrast-enhanced T1-weighted imaging (CAIPIRINHA-Dixon-TWIST-VIBE) including single-breath-hold six arterial phase acquisitions was performed on a 3.0-T MRI scanner. The TRMAs frequency and the mean TRMA scores were compared between patients assessed with gadoxetate disodium and those assessed with gadobutrol. In addition, the timing of TRMAs appearing for the first time was also recorded and compared between the two groups. The mean TRMA scores in all arterial phases using gadoxetate disodium were significantly worse than in those using gadobutrol (1.49 ± 0.78 vs. 1.18 ± 0.53, P

There is wide agreement that morphologic features and enhancement kinetics should be evaluated for MRI of the breast, although there has been no clear consensus concerning optimal temporal resolutions. The objective of this study was to investigate the optimal temporal resolution for the kinetic analysis of breast cancers.Thirty-four patients with 34 enhancing lesions of breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) on a 3.0-T scanner were included in this retrospective study. DCE-MRI was performed with an original temporal resolution of 10-s, and the values of pharmacokinetic parameters (Ktrans, Ve, Kep, and area under the curve (AUC)) were compared with selected data of 30-s and 60-s time intervals.Among the 34 lesions, 10 showed a wash out pattern, 16 showed a plateau pattern, and 8 showed a persistent enhancement pattern. The Ktrans value in the wash-out pattern was significantly higher than that of other time-intensity curve patterns (p 0.01). The Kep and AUC also showed significant differences between the wash-out pattern and other types (p 0.01). On comparing the perfusion parameters among different temporal resolutions, simulations showed that only the AUC differed significantly between the data acquired at a 10-s temporal resolution and that acquired at a 60-s time interval (p 0.01). Although the comparison of the AUC between the 30-s and 60-s data also showed significant differences (p = 0.01), there was no significant difference between the 10-s and 30-s data (p = 0.17).DCE-MRI with a temporal resolution of 30-s preserves the kinetic information. Further prospective studies will be needed to investigate the trade-off between temporal and spatial resolution in DCE-MRI.

Objective: Major liver resection is an effective treatment option for patients with liver malignancy. The future liver remnant (FLR) volume and complications after portal vein embolization (PVE) were compared between the ipsilateral right portal vein (PTPE) and transileocolic (TIPE) approaches. Methods: A total of 42 patients (TIPE, n = 22; PTPE, n = 20) underwent right lobectomy after PVE. CT and hepatobiliary scintigraphy were repeated before and after PVE. The blood examination findings and the FLR values (FLRCT: calculated from CT, %FLRCT: FLRCT ratio, %FLRSPECT: FLR ratio using single photon emission CT, FLRCT/BS: FLRCT to body surface ratio) were compared between two approach sites. The complications and mortality were also analyzed after PVE and major right hepatectomy. Results: There were no significant differences in the patient characteristics, blood examination findings or FLR values between two groups. Adequate liver regeneration was observed without significant differences between PTPE and TIPE (increased ratio of FLRCT: 8.7% vs 19.2%, p = 0.15 [25–75 percentile: 17.1–60.4], %FLRCT: 11.2% vs 8.3%, p = 0.25 [6.3–13.3], %FLRSPECT: 15.4% vs 19.2%, p = 0.09 [16.0–22.4], FLRCT/BS: 33.6% vs 47.1%, p = 0.19 [17.2–60.4], respectively), but TIPE required a significantly longer procedure time than PTPE [181.4 min vs 108.7 min, p < 0.01 (103.3–193.5)]. However, one patient was converted to TIPE due to bleeding during PTPE. After right lobectomy, portal vein stenosis or thrombosis was noted in three patients [two with TIPE (9.1%) and one with PTPE (5%)] and three TIPE patients died within 90 days (13.6%) after right hepatectomy. Conclusion: FLR volume significantly increased after PVE, regardless of the approach sites; however, PTPE is a useful technique with a shorter procedure time.

An 81-year-old woman who had undergone total thyroidectomy for papillary thyroid cancer 12 years earlier was found to have a tumor in the tail of the pancreas. Four years earlier, skin, lung, and mediastinal lymph node metastases had appeared. Computed tomography (CT) showed a mass 26 mm in diameter in the tail of the pancreas. Thereafter, the pancreatic tumor increased in size, while the lung metastases remained stable. Unenhanced CT at the time of first detection showed that the tumor was heterogeneous, with low-attenuation areas indicating fat components. As the tumor grew, the fat components became unclear. Laparoscopic distal pancreatectomy and splenectomy were performed. The tumor was diagnosed as dedifferentiated liposarcoma with a well-differentiated liposarcoma component at the tumor margin. The pancreas is an extremely rare site of primary liposarcoma. In the present case, a pancreatic liposarcoma appeared during follow-up of thyroid cancer, and the changes over time were able to be observed with CT.

Purpose To evaluate the association of the pancreatic exocrine function estimated by cine-dynamic magnetic resonance cholangiopancreatography (MRCP) using a spatially selective inversion-recovery (IR) pulse with the pancreatic endocrine function estimated by the T1 relaxation time of the pancreatic parenchyma and HbA1c values. Materials and methods Forty-three patients with suspected hepatobiliary or pancreatic diseases were included. Patients were classified into three groups: HbA1c U tests. Results Both the mean secretion grade and frequency of the pancreatic secretory inflow had a significant negative correlation with the T1 relaxation time of the pancreatic parenchyma (r = − 0.335, p = 0.028 and r = − 0.305, p = 0.047, respectively) and HbA1c values (r = − 0.308, p = 0.044 and r = − 0.313, p = 0.041, respectively). Both the mean secretion grade and frequency of the pancreatic secretory inflow in the elevated HbA1c (prediabetes and diabetes) group were significantly lower than those in the normal group (p = 0.030 and p = 0.029, respectively). Conclusion The pancreatic exocrine function estimated by cine-dynamic MRCP was significantly lower in patients with prediabetes and diabetes than in controls. Cine-dynamic MRCP with a spatially selective IR pulse may be useful for the early diagnosis of pancreatic exocrine insufficiency in patients with pancreatic endocrine insufficiency.

PURPOSE To evaluate the image quality of ultra-high-resolution CT (U-HRCT) in the comparison among four different reconstruction methods, focusing on the gastric wall structure, and to compare the conspicuity of a three-layered structure of the gastric wall between conventional HRCT (C-HRCT) and U-HRCT. METHOD Our retrospective study included 48 patients who underwent contrast-enhanced U-HRCT. Quantitative analyses were performed to compare image noise of U-HRCT between deep-learning reconstruction (DLR) and other three methods (filtered back projection: FBP, hybrid iterative reconstruction: Hybrid-IR, and Model-based iterative reconstruction: MBIR). The mean overall image quality scores were also compared between the DLR and other three methods. In addition, the mean conspicuity scores for the three-layered structure of the gastric wall at five regions were compared between C-HRCT and U-HRCT. RESULTS The mean noise of U-HRCT with DLR was significantly lower than that with the other three methods (P

To determine imaging findings of pancreatic adenocarcinomas incidentally detected on contrast-enhanced multiphasic dynamic computed tomography (CT) obtained during the follow-up for other diseases. From January 2007 to December 2018, 14 patients with pancreatic adenocarcinomas incidentally detected on CT obtained during the follow-up for other diseases (incidental group) and 105 patients with pancreatic adenocarcinomas symptomatically detected on ultrasound or CT (non-incidental group) were included. Imaging characteristics of the tumor were compared between the two groups. Additionally, imaging findings prior to the detection of a tumor on previous CT images in the incidental group were also assessed. In cancers of the pancreas body/tail, there was a significantly smaller tumor size (median, 17 mm vs. 42 mm, p

To determine the consistency of major hepatocellular carcinoma (HCC) features between CT and MRI based on Liver Imaging Reporting and Data System (LI-RADS) v2018 and to investigate the additional value on gadoxetic acid-enhanced MRI.Patients who underwent dynamic CT and gadoxetic acid-enhanced MRI within 1 month were investigated. Two radiologists evaluated the presence of major HCC features and categorized observations using LI-RADS v2018 algorithm. In addition, each observation was recorded as hyper-, iso-, or hypo-intensity on hepatobiliary-phase (HBP) images.Sixty-one patients with 110 observations were identified. Among 88 observations classified as LR-3, 4 or 5, arterial phase hyper-enhancement and washout appearance showed higher frequencies on CT than on MRI (75.0% vs. 58.0%, P 0.001, and 60.2% vs. 44.3%, P = 0.014, respectively). Of the 59 LR-3 observations categorized on MRI, 70.0% of observations with hypo-intensity on HBP images were HCCs, whereas 89.5% of observations with iso- or hyper-intensity on HBP images were non-HCCs (P 0.001) CONCLUSION: The frequencies of arterial phase hyper-enhancement and washout appearances were higher on CT than on gadoxetic acid-enhanced MRI. For LR-3 observations, adding the hepatobiliary-phase hypo-intensity to major features improved the diagnostic performance of MRI in distinguishing HCCs from non-HCC lesions.

To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP.To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas.Retrospective.A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs.3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality.Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P 0.05).Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients.3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern.4 TECHNICAL EFFICACY: Stage 2.

BACKGROUND Reduced field-of-view diffusion-weighted imaging (rDWI) with tilted two-dimensional radiofrequency (RF) excitation planes has not yet been applied to the imaging of the pancreas although the utility of this technique which allows the acquisition of high-quality images without aliasing artifacts in the phase-encoding direction has been evaluated for brain and spinal cord imaging. PURPOSE To evaluate the visual image quality of the pancreas by tilting the excitation plane (tilted rDWI) in comparison to conventional DWI (cDWI) and rDWI without using the tilted excitation plane. STUDY TYPE Retrospective. POPULATION Thirty-two patients evaluated for suspected pancreatobiliary diseases. FIELD STRENGTH/SEQUENCE Echo-planar imaging DWI (cDWI, rDWI, and tilted rDWI) acquired at 3 T. ASSESSMENT Images from each DWI sequence were analyzed by five radiologists to compare image quality (conspicuity of pancreatic edges, interslice signal homogeneity, overall image quality, and conspicuity of focal pancreatic lesions) and artifacts (presence of blurring or ghosting artifacts, susceptibility artifacts, and aliasing artifact). STATISTICAL TESTS Shapiro-Wilk test was performed to assess whether data were normally distributed. Friedman test followed by Bonferroni-adjusted Wilcoxon signed-rank test for post hoc analysis was performed to compare image quality and artifact scores. RESULTS The mean scores for conspicuity of pancreatic edges (3.36 vs. 2.37), interslice signal homogeneity (3.14 vs. 2.81), presence of ghosting artifacts (3.32 vs. 2.66), susceptibility artifacts (3.06 vs. 2.30), and aliasing artifacts (3.90 vs. 2.34), and overall image quality (3.49 vs. 2.36) were significantly higher in the tilted rDWI than in the rDWI (P

Purpose The purpose of this study was to compare the high-resolution CT (HRCT) findings of pulmonary infectious and noninfectious complications with extensive ground-glass attenuation (GGA) in immunocompromised patients. Materials and methods One hundred fifty-two immunocompromised patients with pulmonary complications that showed extensive GGA (> 50% of the whole lung on HRCT) were included in this study. The diagnoses of the 152 patients were as follows: pneumocystis pneumonia (PCP), n = 82; drug-induced pneumonia, n = 38; bacterial pneumonia, n = 9; cytomegalovirus pneumonia, n = 6; idiopathic pneumonia syndrome, n = 6; diffuse alveolar hemorrhage (DAH), n = 4; fungal infection, n = 3; tuberculosis, n = 2 and pulmonary edema, n = 2. Two chest radiologists retrospectively evaluated the CT criteria, which consisted of 12 findings. Results The nodule (p = 0.015), the bronchovascular bundle (BVB) thickening (p = 0.001), and the interlobular septum (ILS) thickening (p = 0.002) were significantly infrequent in PCP. The ILS thickening was significantly frequent in drug-induced pneumonia (p p = 0.005). The nodule was significantly frequent in DAH (p = 0.049). Conclusion Nodules, BVB thickening, and ILS thickening could be useful HRCT findings for the differential diagnosis of pulmonary complications in immunocompromised patients with extensive GGA.

Supplemental Digital Content is available in the text., Background: Given the characteristic differences between intravascular ultrasound (IVUS) and optical frequency domain imaging (OFDI), their approach to therapeutic guidance during percutaneous coronary interventions (PCIs) and arterial healing response after stenting may also vary. Methods: MISTIC-1 (The Multimodality Imaging Study in Cardiology cohort 1) is a multicenter, randomized-controlled, noninferiority trial that compared imaging end points between OFDI- and IVUS-guided PCI. Patients with stable coronary artery disease were randomly assigned to either OFDI- or IVUS-guided PCI using a Biolimus A9-eluting stent according to a prespecified protocol for imaging guidance. Stent sizing was based on external elastic lamina in IVUS-guided PCI while lumen up-size in OFDI-guided PCI. Postprocedural OFDI was investigated regardless of randomization, while operators in IVUS-guided PCI arm were blinded to the images. The primary end point was in-segment minimum lumen area assessed using OFDI at 8 months, while the secondary end point was a composite of cardiovascular mortality, target-vessel myocardial infarction, or target-lesion revascularization (device-oriented composite end point). Patients were followed up to 3 years after the index procedure. Results: A total of 109 patients (mean age 70 years, male 78%) with 126 lesions were enrolled. Postprocedural minimum stent area was 6.31±1.89 and 6.72±2.08 mm2 in OFDI and IVUS group, respectively (P=0.26). At the 8-month follow-up, in-segment minimum lumen area was 4.56±1.94 and 4.13±1.86 mm2 in OFDI and IVUS group, respectively (Pnon-inferiority

The morphologic changes in the compensated stage of liver cirrhosis (cLC) are not diffuse atrophic changes. With cLC lobar or segmental changes combined with atrophy of the right lobe and medial segment together with hypertrophy of the caudate lobe and lateral segment are commonly seen. The purpose of this study was to evaluate the morphologic changes in hepatitis virus-related liver cirrhosis in relationship to haemodynamics of the portal vein on dynamic contrast-enhanced computed tomography (DCE-CT) METHODS: This study included 72 patients, 46 with hepatitis virus-related cirrhosis and 26 with a normally functioning liver, who underwent DCE-CT. In cirrhosis patients, the morphologic change index (MCI) of the liver was calculated and categorised into two groups, high-MCI (MCI ≥ 0.4) (n = 21) and low-MCI (MCI 0.4) (n = 25). Cross-sectional areas of the main, right and left portal veins and the intra-portal distribution from splenic venous flow were evaluated for their relationships with the MCI and compared among three groups (normal-control, low MCI and high MCI).There was a significant difference in the cross-sectional area of the left portal vein between the high-MCI group and the low-MCI group (p = 0.013) and the control group (p = 0.008). A significant correlation was identified between the cross-sectional area of the left portal vein and the MCI (r = 0.508, p 0.001).Cross-sectional area of the left portal vein may be a factor related to morphologic changes in hepatitis virus-related liver cirrhosis and could be a possible index of the left portal venous flow volume.This study may be useful for predicting the degree of hepatic morphologic changes and the condition of cirrhosis in association with regional hepatic morphologic changes.

Purpose To examine the frequency and patterns of renal parenchymal retention of iodinated contrast agent during follow-up computed tomography (CT) performed one day after undergoing contrast-enhanced CT and to evaluate the association with the renal function before and after contrast-enhanced CT. Materials and Methods This retrospective study included 55 patients who underwent follow-up CT the day after contrast-enhanced CT had been performed. Two radiologists categorized the retention patterns on a scale of 0–6 (0: no retention, 1: diffuse parenchymal, 2: diffuse cortical, 3: subcapsular tiny nodular, 4: cortical wedge-shaped, 5: medullary focal, 6: renal pelvic). In addition, we collected the patients’ clinical data, including the development of contrast-induced nephropathy (CIN). Results A total of 37 patients (67 %) showed retention of contrast agent in the kidney (retention group), while 18 did not (non-retention group). A diffuse parenchymal pattern and renal pelvis pattern were the most common. High levels of creatinine (Cre) and blood urea nitrogen (BUN) before contrast-enhanced CT were significantly associated with the retention in the kidney (p = 0.018, 0.006, respectively). The frequency of the development of CIN was significantly higher (p = 0.021) in the retention group (10/37) than in the non-retention group (0/18). A diffuse parenchymal pattern and diffuse cortical pattern were significantly more common in patients with CIN than in those without CIN (p = 0.003, p = 0.045, respectively). Conclusion Renal parenchymal retention of iodinated contrast agent the day after contrast-enhanced CT was a frequently recognized finding and was associated with renal dysfunction. This finding, especially diffuse parenchymal and cortical patterns, may be a potential biomarker of CIN development.

Although it is important to quantify the degree of fatty degeneration of the pancreas, it is difficult to make such a quantification using conventional computed tomography (CT). The present study evaluated the feasibility of pancreatic fat quantification by dual-energy CT (DECT) compared with T2*-corrected six-point Dixon magnetic resonance imaging (MRI). Twenty-eight patients who underwent both DECT (100 and 150 kVp) and Dixon MRI without the use of contrast agents were analyzed. The region of interest (ROI) was placed at the head and body/tail of the pancreas on fat volume fraction (FVF) maps generated using the multi-material decomposition (MMD) algorithm on DECT. The FVF (%) of pancreatic parenchyma measured by DECT (CT-FVF) was compared with that measured on FVF maps calculated using Dixon MRI (MR-FVF) using the Spearman rank correlation coefficient. The median CT-FVF (%) values of the head and body/tail of the pancreas on DECT were 14.2% (range 0.1–81.2%) and 9.4% (range 0–40.8%), respectively. The median MR-FVF (%) values of the head and body/tail of the pancreas on Dixon MRI were 12.2% (range 1.2–80.9%) and 8.1% (range 0.3–43.7%), respectively. CT-FVF (%) measured by DECT showed a significant correlation with the MR-FVF (%) measured by Dixon MRI in the head of the pancreas (ρ = 0.631, P

To compare the image quality of multiphasic (arterial, portal, and equilibrium phases) dynamic computed tomography (CT) of the abdomen obtained by a low tube voltage (70kVp) in combination with a half-dose iodine load using low-concentration contrast agent in high tube output dual-source CT with a standard tube voltage (120kVp) and full-dose iodine load using the same group of adult patients. Fifty-five patients who underwent both low-tube-voltage (70kVp) abdominal CT with a half-dose iodine load and standard-tube-voltage (120kVp) CT with a full-dose iodine load were analyzed. The mean CT values and signal-to-noise ratio (SNR) of the liver, aorta and portal veins were quantitatively assessed. In addition, the contrast enhancement of the abdominal organs and overall image quality were qualitatively evaluated. The mean CT values and SNR of the liver parenchyma were significantly higher in 70-kVp protocol than in 120-kVp protocol in all 3 phases (p = 0.018 ~

BACKGROUND Pancreatic exocrine insufficiency is one of the causes of malabsorption syndrome. In many cases of malabsorption syndrome, pancreatic exocrine insufficiency can be treated with pancreatic enzyme replacement therapy. Therefore, it is important to detect pancreatic endocrine insufficiency as early and accurately as possible. Recent studies have shown that cine-dynamic MR cholangiopancreatography (MRCP) may be useful to evaluate pancreatic exocrine function PURPOSE: To identify abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion for which cine-dynamic MRCP should be performed to diagnose pancreatic exocrine insufficiency. STUDY TYPE Prospective. POPULATION In all, 111 patients with various types of abdominal symptoms. FIELD STRENGTH/SEQUENCE 5 T or 3 T, MRCP with spatially selective inversion recovery pulse (cine-dynamic MRCP). ASSESSMENT Cine-dynamic MRCP was performed and an 18-question clinical questionnaire on abdominal symptoms was administered. The secretion grade derived from cine-dynamic MRCP was compared between those answering "yes" and "no" for all 18 items STATISTICAL TESTS: Univariate analysis and further analyzed using multiple regression analysis. The associations between the secretion grade and the items in the clinical questionnaire were analyzed by univariate analysis and further analyzed using multiple regression analysis. RESULTS The following three items showed significantly negative correlations with secretion grade: Q9, Does your rectal gas smell foul? (β = -0.44, P = 0.001); Q13, Is stool quantity large? (β = -0.41, P = 0.001); and Q18, Are your stools soft? (β = -0.53, P < 0.001). No significant correlations with exocrine pancreatic function measured by cine-dynamic MRCP were seen for the remaining 15 abdominal symptom items. DATA CONCLUSION Abdominal symptoms that suggest decreased flow of pancreatic enzyme secretion were foul rectal gas, large stool, and soft stool. Pancreatic exocrine insufficiency due to decreased pancreatic enzyme flow may be suspected in patients with these abdominal symptoms. LEVEL OF EVIDENCE 1 Technical Efficacy Stage: 3 J. Magn. Reson. Imaging 2019;50:417-423.

A questionnaire survey was conducted regarding the prognosis for pancreatic cancer at 8 major hospitals in Yamaguchi Prefecture. A total of 552 patients with pancreatic cancer who underwent radical surgery between 1997 and 2016 were identified. Five of them survived for more than 10 years. Among the 5 patients, none was treated with neoadjuvant chemotherapy: 4 underwent PD and 1 underwent DP-CAR. Two of them were treated with adjuvant chemotherapy. No complications occurred during their postoperative courses. All of them had no recurrence and survived. Here, we reported the longterm postoperative survival of patients with pancreatic cancer with literature review.

To evaluate the correlation between the pancreatic exocrine insufficiency estimated by cine-dynamic MRCP using spatially selective IR pulse and the severity stages (modified Cambridge classification) based on morphological changes of the pancreatic duct in patients with suspected chronic pancreatitis.Thirty-nine patients with suspected chronic pancreatitis underwent cine-dynamic MRCP with a spatially selective IR pulse. The secretion grading score (5-point scale) based on the moving distance of pancreatic juice inflow on cine-dynamic MRCP was assessed, and compared with the stage of the severity of chronic pancreatitis based on morphological changes of pancreatic duct.The stage of the severity of chronic pancreatitis based on morphological changes had significant negative correlations with the secretion grade (r=-0.698, P0.001). The secretion grading score of stage 4 was significantly lower than stage 1-3 (P0.001, P=0.002, P=0.025, respectively). In all 19 patients in stage 4, the secretion grading score was0.70. The secretion grading score of stage 1 was significantly higher than stage 2 and 4 (P=0.019, P0.001, respectively). In stage 2, the secretion grading score was0.70 in 8 (89%) of 9 patients showing pancreatic exocrine insufficiency. Conversely, in stage 3, the secretion grading score was0.70 in 2 (33%) of 6 patients showing normal pancreatic exocrine function.It should be noted that the degree of morphological changes of pancreatic duct does not necessarily reflect the severity of pancreatic exocrine insufficiency at cine-dynamic MRCP in stage 2-3 chronic pancreatitis.

Purpose To investigate the clinical value of measuring the ECV fraction of the pancreas by DECT in association with an impaired glucose tolerance (IGT) estimated by the hemoglobin A1C (HbA1C) value in patients with or without cirrhosis. Materials and Methods This retrospective study included patients who underwent contrast-enhanced dynamic CT with dual-energy mode between March 2018 and February 2019. The ECV fraction of the pancreas was calculated from iodine map images created from equilibrium-phase contrast-enhanced DECT images. The cross-sectional areas of the pancreas were also measured. Results In total, 51 patients were analyzed (median age, 69 years old; 22 women). The ECV fraction of the pancreas showed a significant negative correlation with the HbA1c value in the cirrhotic group (ρ=-0.346, p = 0.048), while there was no significant correlation in the non-cirrhotic group (ρ=-0.086, p = 0.734). In the elevated HbA1C group, the ECV fraction of the pancreas in the cirrhotic patients (median, 0.247; interquartile range [IQR], 0.098) was significantly lower than that in the non-cirrhotic patients (0.332, IQR 0.113) (p = 0.024). In the elevated HbA1C group, the cross-sectional area of the pancreas was significantly larger in the cirrhotic patients than that in the non-cirrhotic patients (median [IQR]; 2945 [904] vs. 1885 [909] mm2, p = 0.019). Conclusion A reduction in the ECV fraction of the pancreas measured by DECT as well as the enlargement of the pancreatic parenchyma was observed in cirrhotic patients with IGT. These findings suggest that the measurement of the pancreatic ECV fraction by DECT may help clarify the pathophysiology of IGT in patients with cirrhosis.

Purpose To evaluate the influence of cholecystectomy on the flow dynamic pattern of bile in the extrahepatic bile duct by using cine-dynamic MRCP with spatially-selective inversion-recovery (IR) pulse non-invasively. Materials and methods 56 patients with cholecystectomy and 48 control subjects without cholecystectomy who underwent cine-dynamic MRCP with spatially-selective IR pulse at 1.5 T or 3 T (TR/TE, 4000 msec/500 msec; echo train spacing, 6.5 msec; echo train length, 172; section thickness, 50 mm; matrix, 320 × 320; field of view, 320 × 320 mm; bandwidth, 488 Hz; and inversion time, 2200 msec). In cine-dynamic MRCP, IR pulse with 20 mm width was placed on the common bile duct (CBD) to evaluate the movement of bile (antegrade and reversed bile flow). Cine-dynamic MRCP imaging was scanned every 15 s (imaging, 4 s; rest, 11 s) during 5 min to acquire a series of single-shot images (a total of 20 images). The frequency that antegrade or reversed bile flow was observed in the extrahepatic bile duct, and 5-point grading score based on the moving distance of antegrade or reversed bile flow were compared between the groups. Both groups were compared using the χ2 and Mann-Whitney U tests (P Results Antegrade bile flow was observed more frequently in the cholecystectomy group than in the non-cholecystectomy group (5.1 times vs. 2.8 times, P = 0.008). Mean grading score of antegrade bile flow was significantly greater in the cholecystectomy group than in the non-cholecystectomy group (mean grade, 0.33 vs 0.21; P = 0.014). Regarding reversed bile flow, there were no significant differences in the frequency and grading score between cholecystectomy group and non-cholecystectomy group. Conclusion Antegrade bile flow was observed more frequently and predominantly in patients after cholecystectomy in cine-dynamic MRCP with spatially-selective IR pulse while reversed bile flow was observed equivalently.