Joseph A. Borrello

MR appearance of umbilical endometriosis.

Objective We describe the MR appearance of endometriosis involving the umbilicus in two patients. One patient had a history of laparoscopy performed through the umbilicus; the other had an umbilical hernia. Materials and Methods MR imaging was performed using both a body coil and a spine coil (with the patient lying prone on the spine coil). The lesions were surgically removed and their MR appearance was correlated with the results of histologic analysis. Results The lesions were well delineated on MRI and showed evidence of prior hemorrhage consistent with endometriosis. Both lesions were shown to be endometriosis at surgical pathology. Conclusion MR imaging was useful for delineating the size and location of the lesions and excluding intraabdominal extension.

Characterization of focal hepatic masses by dynamic contrast-enhanced MR imaging: Findings in 311 lesions

This study aimed to determine the overall accuracy of known enhancement patterns for the characterization of a large series of focal hepatic masses on dynamic contrast-enhanced magnetic resonance (MR) images. Breath-hold T1-weighted images of the liver acquired before intravenous gadolinium administration and serially over 6-10 min after contrast injection were acquired in < 25 a using FLASH or rapid spin-echo pulse sequences. A total of 311 proven focal hepatic masses in 128 patients were analyzed, including 192 malignant lesions (166 metastases and 26 hepatomas) and 119 benign lesions (48 cavernous hemangiomas, 45 hepatic cysts, and 26 other abnormalities). The lesions were evaluated for a variety of characteristics independently by two reviewers who were blinded to results. Cavernous hemangiomas showed early peripheral nodular enhancement (80% sensitivity and 99% specificity) and hepatic cysts showed no enhancement (100% sensitivity and 95% specificity). Hepatic metastases showed variable, moderate enhancement (47% by one reviewer and 74% by the other). Metastatic lesions from hypervascular primary neoplasms displayed peak enhancement during the hepatic artery dominant (bolus) phase, while other malignant neoplasms showed later peak enhancement (72% sensitivity and 77% specificity). Five metastatic foci with early homogeneous enhancement showed a delayed peripheral washout of contrast (rim sign), while no nonmetastatic foci displayed this finding (3% sensitivity and 100% specificity). Characteristic enhancement patterns of focal hepatic lesions were described in a large series of patients. This study confirms results of previous investigators who have shown that early nodular peripheral enhancement was highly specific for hemangiomas and lack of enhancement was highly specific for hepatic cysts. Hypervascular metastatic foci show earlier peak enhancement than other malignant lesions. Some (2-3%) metastatic lesions display a peripheral washout of contrast on serial images, with 100% specificity.

Safety and efficacy of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. multicenter phase III clinical trials (safety).

The short‐term1 safety of mangafodipir trisodium (MnDPDP) injection was studied in 546 adults with known or suspected focal liver lesions. An initial contrast‐enhanced computed tomography examination was followed by unenhanced magnetic resonance imaging (MRI), injection of MnDPDP (5 μmol/kg), and enhanced MRI. Adverse events were reported for 23% of the patients; most were mild to moderate in intensity, did not require treatment, and were not drug related. The most commonly reported adverse events were nausea (7%) and headache (4%). The incidence of serious adverse events was low (nine events in six patients) and not drug related. Injection‐associated discomfort was reported for 69% of the patients, and the most commonly reported discomforts included heat (49%) and flushing (33%). Changes in laboratory values and vital signs were generally transient, were not clinically significant, and did not require treatment. There were no clinically significant short‐term risks from exposure to MnDPDP. J. Magn. Reson. Imaging 2000;12:186–197.

A retrospective analysis of the accuracy of T2-weighted images and dynamic gadolinium-enhanced sequences in the detection and characterization of focal hepatic lesions.

The aim of this study was to determine the relative ability of T2‐weighted and dynamic gadolinium‐enhanced T1‐weighted gradient‐echo sequences to detect and characterize focal hepatic lesions. We retrospectively studied 37 patients with proven focal hepatic lesions using the following sequences: a T1‐weighted spin‐echo sequence (T1), a T2‐weighted sequence (T2), and a series of breath‐hold dynamic gadolinium‐enhanced T1‐weighted gradient‐echo sequences (Gd). Two observers were asked to determine retrospectively the number and type of focal hepatic lesions present using images from three combinations of sequences (T1+T2, T1+Gd, T1+T2+Gd). Proof of the number and diagnosis of focal lesions in each patient was established using a consensus read. Both readers detected more focal lesions when both the T2‐weighted sequences and the gadolinium‐enhanced sequences were available than on either sequence alone, although this improvement reached statistical significance (P < 0.05) only for one of the readers. There was no significant difference (P < 0.05) in the ability to characterize lesions between any of the sets of sequences. The combination of dynamic gadolinium‐enhanced images and T2‐weighted images was shown to assess focal hepatic lesions better than either of these sequences alone.J. Magn. Reson. Imaging 1999;9:266–273.

Dynamic contrast-enhanced MR imaging of the liver: Parenchymal enhancement patterns

A retrospective study of 164 patients undergoing dynamic contrast-enhanced magnetic resonance (MR) imaging was performed to assess hepatic parenchymal enhancement patterns and to correlate these patterns with hepatic function and disease. Rapid T1-weighted images were acquired before and after gadolinium administration. Hepatic enhancement patterns were analyzed blindly by two observers. Medical records were reviewed to document known liver pathology and liver function test results. A total of 72% of patients had homogeneous enhancement of the liver parenchyma; 28% had heterogeneous enhancement. Of the latter group, 61% of patients had enhancement conforming to segmental or lobar boundaries. Patients with heterogeneous enhancement patterns were more likely to have abnormal liver function test results and hepatic morphological abnormalities on their MR examinations than patients with homogeneous enhancement patterns. Heterogeneous hepatic enhancement on dynamic MR images is associated with a higher likelihood of liver disease and biochemical evidence of hepatic dysfunction than homogeneous enhancement.

Large angle spin-echo imaging

A study was undertaken to assess the use of excitation flip angles greater than 90 degrees for T1 weighted spin-echo (SE) imaging with a single 180 degrees refocusing pulse and short TR values. Theoretical predictions of signal intensity for SE images with excitation pulse angles of 90-180 degrees were calculated based on the Bloch equations and then measured experimentally from MR images of MnCl2 phantoms of various concentrations. Liver signal-to-noise ratios (SNR) and liver-spleen contrast-to-noise ratios (CNR) were measured from breathhold MR images of the upper abdomen in 16 patients using 90 and 110 degrees excitation flip angles. The theoretical predictions showed significant improvements in SNR with excitation flip angles > 90 degrees, which were more pronounced at small TR values. The phantom studies showed reasonably good agreement with the theoretical predictions in correlating the excitation pulse angle with signal intensity. In the human imaging studies, the 110 degrees excitation pulse angle resulted in a 7.4% (p < .01) increase in liver SNR and an 8.2% (p = .2) increase in liver-spleen CNR compared to the 90 degrees pulse angle at TR = 275 ms. Increased signal intensity resulting from the use of large flip angle excitation pulses with a single echo SE pulse sequence was predicted and confirmed experimentally in phantoms and humans.

A prospective assessment of breath-hold fast spin echo and inversion recovery fast spin echo techniques for detection and characterization of focal hepatic lesions.

The purpose of this study was to prospectively assess two breath-hold T(2)-weighted fast spin-echo sequences and two breath-hold inversion recovery fast spin-echo sequences to determine their relative ability to detect and characterize focal hepatic lesions. Fourteen patients with a total of nineteen proven focal hepatic lesions were imaged with two breath-hold T(2)-weighted (T2W) fast spin echo sequences (HASTE TE = 66 and HASTE TE = 120), two breath-hold inversion recovery fast spin echo sequences (IRFSE TE = 64 and IRFSE TE = 95), and a nonbreath-hold T(2)-weighted fast-spin echo sequence (FSE TE = 96-120). Contrast-to-noise ratios (CNRs) were measured for all proven lesions on all sequences. Both IRFSE sequences and the HASTE sequence with TE = 66 showed an improvement in lesion-liver and liver-spleen CNRs compared to the nonbreath-hold T2W sequence. The mean difference in CNR between benign and malignant lesions was largest for the HASTE TE = 120 sequence. These preliminary results suggest that a breath-hold IRFSE sequence (TE = 64 or 95) has an equal ability to detect focal hepatic lesions as a nonbreath-hold T2W FSE sequence (TE = 96-120). The HASTE TE = 120 showed the greatest ability to discriminate between benign and malignant lesions.

Chemical shift misregistration artifact: Increased conspicuity following intravenous administration of gadopentetate dimeglumine

We have observed increased conspicuity of chemical shift misregistration artifact (CSMA) associated with enhancing structures on MR images after the intravenous administration of gadopentetate dimeglumine compared with corresponding unenhanced images. In this study, we investigate the influence of gadopentetate dimeglumine administration on the conspicuity of CSMA in MR imaging of the kidneys. Nine gadopentetate-enhanced and unenhanced T1-weighted images of the kidneys were evaluated in a side-by-side fashion for the conspicuity of both the high and low signal intensity (SI) components of CSMA. A phantom study of saline in a bath of oil and increasing concentrations of gadopentetate dimeglumine in a bath of oil was performed. There was increased conspicuity of both the high and low SI components of CSMA in gadopentetate-enhanced images compared with unenhanced images in all study cases and in the phantom samples containing gadopentetate compared with the saline control. In conclusion, the administration of gadopentetate dimeglumine results in increased conspicuity of CSMA on MR images of the kidneys.