Ruofan Sheng

MRI of small intrahepatic mass-forming cholangiocarcinoma and atypical small hepatocellular carcinoma (≤3 cm) with cirrhosis and chronic viral hepatitis: a comparative study.

OBJECTIVE The objective was to identify the decision-making magnetic resonance (MR) features in differentiating small intrahepatic mass-forming cholangiocarcinoma (sIMCC) from atypical small hepatocellular carcinoma (sHCC) (≤3 cm) in patients with cirrhosis and chronic viral hepatitis. METHODS Signal features and relative contrast of sHCCs and sIMCCs in T2-weighted and dynamic enhanced imaging were analyzed. A subgroup comparison between the cirrhosis and noncirrhosis chronic viral hepatitis group was also made. RESULTS Univariate analysis revealed that tumor contours (P<.001), signals in T2-weighted (P<.001) and each phase of contrast-enhanced scanning (P<.001), enhancement patterns (P<.001), as well as accompanying findings of tumor capsule (P<.001), hepatic capsule retraction (P<.001), bile duct dilation (P=.031), and transient hepatic intensity difference (P=.002) were different between sIMCC and atypical sHCC. Multivariate analysis indicated that dynamic enhancement patterns (P<.001) and signals in T2-weighted images (P=.024) were independent predictors for differentiation. Confusing MR features were more often observed in the cirrhosis group compared with those in the noncirrhosis chronic viral hepatitis group. CONCLUSION Dynamic enhancement patterns and signals in T2-weighted images were the most important MR features to differentiate sIMCC from atypical sHCC with cirrhosis and chronic viral hepatitis.

Microvascular invasion in hepatocellular carcinoma: is it predictable with a new, preoperative application of diffusion-weighted imaging?

PURPOSE The study aimed to explore the use of MRI in predicting the microvascular invasion (MVI) of hepatocellular carcinoma (HCC). MATERIALS AND METHODS The preoperative MRI and tissues of resected HCC patients were collected. The imaging characteristics that have previously been suggested and the mismatch between diffusion-weighted imaging (DWI) and T2-weighted imaging of regions, which the authors called DWI/T2 mismatch, were analyzed and compared with histopathological references. RESULTS A multivariate logistic regression analysis showed that DWI/T2 mismatch was an independent predictor of MVI. CONCLUSION The DWI/T2 mismatch can be a preoperative predictor of MVI for HCC.

Staging liver fibrosis in chronic hepatitis B with T1 relaxation time index on gadoxetic acid-enhanced MRI: Comparison with aspartate aminotransferase-to-platelet ratio index and FIB-4.

To assess the accuracy of the T1 relaxation time index on gadoxetic acid‐enhanced magnetic resonance imaging (MRI) for staging liver fibrosis in chronic hepatitis B (CHB), in comparison and combination with the aspartate aminotransferase‐to‐platelet ratio index (APRI) and fibrosis‐4 (FIB‐4).

Intrahepatic distant recurrence following complete radiofrequency ablation of small hepatocellular carcinoma: risk factors and early MRI evaluation

BACKGROUND Radiofrequency ablation (RFA) is related to a high intrahepatic distant recurrence (IDR) rate, and the associations between IDR and relevant imaging features have not yet been fully investigated. This study aimed to determine both clinical and imaging risk factors of IDR after complete RFA for HBV-related small hepatocellular carcinoma (HCC) (≤ 3 cm). METHODS Thirty-five patients (29 men and 6 women; mean age 60.7 years) with 40 HBV-related small HCCs who underwent complete RFA were included in our study. The incidence and potential clinical and MR imaging risk factors for IDR after RFA were assessed using the Kaplan-Meier method, the log-rank test and a stepwise Cox hazard model. RESULTS The median follow-up period was 25 (4-45) months, and IDR was observed in 20 (57.1%) patients. The 12- and 24-month cumulative IDR-free survival rates were 76.7% and 61.3%, respectively. Univariate analysis revealed that pretreatment albumin < 3.5 g/dL (P = 0.026), multinodular tumor (P = 0.032), ablative margin < 3 mm (P = 0.007), no or disrupted periablational enhancement within 24 hours (P = 0.001) and at 1 month (P = 0.043) after RFA, and hyperintensity of the central ablative zone on T1-weighted images (T1WI) at 1 month after RFA (P = 0.004) were related to IDR. Multivariate analysis showed that pretreatment albumin < 3.5 g/dL (P = 0.032), multinodular tumor (P = 0.012), no or disrupted periablational enhancement within 24 hours after RFA (P = 0.001), and hyperintensity of the central ablative zone on T1WI at 1 month after RFA (P = 0.003) were independent risk factors for IDR. During the 1-month follow-up, the apparent diffusion coefficient exhibited an up-and-down evolution without significant value in the prediction of IDR following RFA. CONCLUSIONS Patients with HBV-related small HCC had a high IDR rate after RFA. The risk factors included low serum albumin, multiple nodules, lesions with no or disrupted periablational enhancement and persistent hyperintensity in the central ablative zone on T1WI within 1 month after RFA.

Histogram Analysis of Diffusion Kurtosis Magnetic Resonance Imaging for Diagnosis of Hepatic Fibrosis

Objective To investigate the diagnostic value of diffusion kurtosis imaging (DKI) histogram analysis in hepatic fibrosis staging. Materials and Methods Thirty-six rats were divided into carbon tetrachloride-induced fibrosis groups (6 rats per group for 2, 4, 6, and 8 weeks) and a control group (n = 12). MRI was performed using a 3T scanner. Histograms of DKI were obtained for corrected apparent diffusion (D), kurtosis (K) and apparent diffusion coefficient (ADC). Mean, median, skewness, kurtosis and 25th and 75th percentiles were generated and compared according to the fibrosis stage and inflammatory activity. Results A total of 35 rats were included, and 12, 5, 5, 6, and 7 rats were diagnosed as F0–F4. The mean, median, 25th and 75th percentiles, kurtosis of D map, median, 25th percentile, skewness of K map, and 75th percentile of ADC map demonstrated significant correlation with fibrosis stage (r = −0.767 to 0.339, p < 0.001 to p = 0.039). The fibrosis score was the independent variable associated with histogram parameters compared with inflammatory activity grade (p < 0.001 to p = 0.041), except the median of K map (p = 0.185). Areas under the receiver operating characteristic curve of D were larger than K and ADC maps in fibrosis staging, although no significant differences existed in pairwise comparisons (p = 0.0512 to p = 0.847). Conclusion Corrected apparent diffusion of DKI histogram analysis provides added value and better diagnostic performance to detect various liver fibrosis stages compared with ADC.

The diagnosis of coronary plaque stability by multi-slice computed tomography coronary angiography

Background Coronary computed tomographic angiography is a robust non-invasive method to assess coronary artery disease (CAD) and analyze coronary plaque stability, especially for the non-calcified plaques. The aim of this study was to investigate the differential characteristics between the unstable coronary plaques and the stable coronary plaques using multi-slice computed tomography (MSCT). Methods Sixty patients with coronary heart disease (37 unstable plaques and 31 stable plaques) were included. The napkin ring thickness, napkin-ring sign, plaque CT attenuation and degree of lumen stenosis were retrospectively analyzed. The diagnostic performances of MSCT were determined to predict the unstable plaques. The difference was statistically significant if P<0.05. Results The napkin ring thickness of the unstable plaques was thinner than that of the stable plaques (P<0.05). The napkin-ring sign was more frequently observed in the unstable group (89.2%) than the stable group (22.6%, P<0.05). The average CT value of the unstable plaques (26.8±17.8 HU) was lower than that of the stable plaques (68.5±25.5 HU, P<0.05). The unstable plaques had more severe lumen stenosis or occlusion (70.3%) than the stable plaques (41.9%, P<0.05). The measurable napkin ring thickness of the plaques with a cutoff value of 0.8 mm and an accuracy of 89.5% was one independent factor to predict unstable plaques. The optimal combined threshold of the napkin-ring sign and/or the plaque CT value of 53 HU with an accuracy of 80.9% was to predict unstable plaques. Conclusions The optimal combined threshold of the napkin-ring sign and/or the plaque CT value ≤53 HU may be a good indicator to predict the unstable plaques in patients with CAD. The subgroup of measurable napkin ring thickness of the non-calcified plaques may also be an independent factor to predict the unstable plaques in patients with CAD.

Value of MRI morphologic features with pT1-2 rectal cancer in determining lymph node metastasis: TANG et al.

To investigate the different features between metastatic lymph node and nonmetastatic lymph node on magnetic resonance imaging (MRI) and the relationship between the rectal lesion and lymph node metastasis (LNM).

Histogram analyses of diffusion kurtosis indices and apparent diffusion coefficient in assessing liver regeneration after ALPPS and a comparative study with portal vein ligation

To investigate the value of diffusion kurtosis imaging (DKI) histogram analysis in assessing liver regeneration and the microstructure basis after associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), in comparison with portal vein ligation (PVL).

MR imaging of hepatocellular adenomas on genotype-phenotype classification: A report from China

PURPOSE To investigate and compare the MR features between hepatocellular adenoma (HCA) subtypes in China, including preliminary observations on diffusion-weighted imaging (DWI). METHODS Thirty-six patients with 39 pathologically proven HCAs underwent gadopentetate dimeglumine enhanced MRI. The morphological and imaging features on T1, T2-weighted, dynamic-enhanced imaging and DWI were retrospectively evaluated and compared between four HCA subtypes, using Kruskal-Wallis test, Fishers exact test and Dunn-Bonferroni post hoc test. RESULTS HCA frequently occurred in male (n = 19, 52.8%), lacked an association with oral contraceptives (n = 0), and had a relatively high incidence of coexistent Hepatitis B infection (n = 6, 16.7%). Signals on T1 and T2-weighted imaging, enhancement pattern and intensity, lesion heterogeneity, as well as accompanying findings including lesion steatosis, necrosis or cystic component, central scar, and pseudocapsule were different between HCA subtypes (P < .0001 to P = .019). Apparent diffusion coefficient (ADC) values among HCA subtypes were different as a whole (P = .029), within which β-catenin-mutated HCA had the lowest ADCs; but post hoc comparisons demonstrated no significant differences between groups (P = .066-1.000). CONCLUSION Both clinical and MR imaging presentation of HCA in China had some specific characteristics, and a good relationship existed between MR data and genotype-phenotype classification. Furthermore, ADC value may provide a potential indicator of malignant transformation.

Magnetic resonance imaging findings of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion in adults: a pilot study

PurposeThe purpose of the study was to retrospectively analyze MRI findings of renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusion (Xp11.2/TFE RCC) in adults.MethodsSixteen patients with Xp11.2/TFE RCC were reviewed retrospectively. The clinical characteristics and imaging features were assessed and then compared between metastatic and non-metastatic subgroups.ResultsThe mean age at diagnosis was 47.4 (20–76) years. Seven (44 %) patients were men, and nine (56 %) patients were women. The lesions predominantly exhibited an endophytic distribution (n = 14, 88 %) with a capsule (n = 16, 100 %), accompanied by solid and cystic patterns (n = 12, 75%) and hemorrhage (n = 11, 69 %). The tumors prevalently appeared hyper- to isointense on T1WI (n = 14, 88 %), hypointense on T2WI (n = 13, 81 %), and hyperintense on DWI (n = 16, 100 %) with a lower ADC (P < 0.001) than that of the surrounding tissue. The tumors were less enhanced than the normal renal cortex in all phases with a prolonged enhancement pattern (P ≤ 0.001). In addition, six patients (38 %) developed recurrence or metastases. The RCCs with metastases showed an irregular shape (P = 0.013), an incomplete capsule (P = 0.018), heterogeneous solid-cystic patterns (P = 0.034), and hemorrhage (P = 0.037) than non-metastatic subgroups.ConclusionsMRI provides valuable information for the diagnosis of adult Xp11.2/TFE RCCs. Features including irregular shape, incomplete capsule, mixed solid-cystic pattern, and hemorrhage may indicate the occurrence of recurrence or metastases.