Sheng-Xiang Rao

Improving detection of siderotic nodules in cirrhotic liver with a multi-breath-hold susceptibility-weighted imaging technique.

To evaluate the role of abdominal susceptibility‐weighted imaging (SWI) in the detection of siderotic nodules in cirrhotic liver.

Solid pseudopapillary tumor of the pancreas: cross-sectional imaging and pathologic correlation.

Objective: This study aimed to evaluate the cross-sectional imaging features of solid pseudopapillary tumor of the pancreas (SPTP) with pathologic correlation. Methods: Imaging features of 29 cases with SPTP proven by histopathologic examinations, including 26 women and 3 men with a mean age of 27 years, were retrospectively investigated and correlated to their pathologic findings. According to the largest diameter, all cases were divided into 23 large tumors (>3.0 cm) and 6 small ones (≤3.0 cm). Results: Large tumors commonly displayed the typical imaging features: a large well-encapsulated mass with varying solid-cystic and hemorrhagic areas and early peripheral heterogeneous enhancement with progressive fill-in on dynamic contrast-enhanced examination, which agreed with their pathologic findings: a large fibrous pseudocapsule-surrounded mass with variegated and variable combinations of solid, hemorrhagic, or cystic-necrotic areas in cut surface. The computed tomographic and magnetic resonance imaging features of small tumors were atypical: a small rarely encapsulated mass without observed hemorrhagic areas and cystic changes with gradual enhancement less than normal pancreatic parenchyma on dynamic contrast-enhanced images. Conclusions: Imaging appearances were different between large and small SPTPs. Compared with computed tomography, magnetic resonance imaging was more powerful to identify the capsule, solid-cystic portions, and hemorrhagic areas of SPTP and to avoid misdiagnosis.

Efficacy of Berberine in Patients with Non-Alcoholic Fatty Liver Disease

Objectives A randomized, parallel controlled, open-label clinical trial was conducted to evaluate the effect of a botanic compound berberine (BBR) on NAFLD. Methods A randomized, parallel controlled, open-label clinical trial was conducted in three medical centers (NIH Registration number: NCT00633282). A total of 184 eligible patients with NAFLD were enrolled and randomly received (i) lifestyle intervention (LSI), (ii) LSI plus pioglitazone (PGZ) 15mg qd, and (iii) LSI plus BBR 0.5g tid, respectively, for 16 weeks. Hepatic fat content (HFC), serum glucose and lipid profiles, liver enzymes and serum and urine BBR concentrations were assessed before and after treatment. We also analyzed hepatic BBR content and expression of genes related to glucose and lipid metabolism in an animal model of NAFLD treated with BBR. Results As compared with LSI, BBR treatment plus LSI resulted in a significant reduction of HFC (52.7% vs 36.4%, p = 0.008), paralleled with better improvement in body weight, HOMA-IR, and serum lipid profiles (all p<0.05). BBR was more effective than PGZ 15mg qd in reducing body weight and improving lipid profile. BBR-related adverse events were mild and mainly occurred in digestive system. Serum and urine BBR concentrations were 6.99ng/ml and 79.2ng/ml, respectively, in the BBR-treated subjects. Animal experiments showed that BBR located favorably in the liver and altered hepatic metabolism-related gene expression. Conclusion BBR ameliorates NAFLD and related metabolic disorders. The therapeutic effect of BBR on NAFLD may involve a direct regulation of hepatic lipid metabolism. Trial Registration ClinicalTrials.gov NCT00633282

Potential of MR histogram analyses for prediction of response to chemotherapy in patients with colorectal hepatic metastases.

AbstractPurposeTo determine if magnetic resonance imaging (MRI) histogram analyses can help predict response to chemotherapy in patients with colorectal hepatic metastases by using response evaluation criteria in solid tumours (RECIST1.1) as the reference standard.Materials and methodsStandard MRI including diffusion-weighted imaging (b=0, 500 s/mm2) was performed before chemotherapy in 53 patients with colorectal hepatic metastases. Histograms were performed for apparent diffusion coefficient (ADC) maps, arterial, and portal venous phase images; thereafter, mean, percentiles (1st, 10th, 50th, 90th, 99th), skewness, kurtosis, and variance were generated. Quantitative histogram parameters were compared between responders (partial and complete response, n=15) and non-responders (progressive and stable disease, n=38). Receiver operator characteristics (ROC) analyses were further analyzed for the significant parameters.ResultsThe mean, 1st percentile, 10th percentile, 50th percentile, 90th percentile, 99th percentile of the ADC maps were significantly lower in responding group than that in non-responding group (p=0.000–0.002) with area under the ROC curve (AUCs) of 0.76–0.82. The histogram parameters of arterial and portal venous phase showed no significant difference (p>0.05) between the two groups.ConclusionHistogram-derived parameters for ADC maps seem to be a promising tool for predicting response to chemotherapy in patients with colorectal hepatic metastases.Key Points• ADC histogram analyses can potentially predict chemotherapy response in colorectal liver metastases. • Lower histogram-derived parameters (mean, percentiles) for ADC tend to have good response. • MR enhancement histogram analyses are not reliable to predict response.

Liver fibrosis staging using T1 mapping on gadoxetic acid-enhanced MRI compared with DW imaging.

AIM To evaluate the utility of T1 mapping on gadoxetic acid-enhanced magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) for staging liver fibrosis. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and included 145 patients (mean age: 54 years old; 115 men and 30 women). Necro-inflammatory activity grade (G) and liver fibrosis stage (S) were histopathologically determined. T1 relaxation time and apparent diffusion coefficient (ADC) of the liver were measured and the reduction rate of the T1 relaxation time (Δ%) was calculated. T1 relaxation time measurements were compared with ADC values according to S/G scores. RESULTS Unenhanced hepatobiliary phase (HBP) and Δ% of T1 relaxation times showed significant correlations with S/G scores (rho: 0.28, 0.51, -0.35 for the S score, 0.26, 0.39, -0.26 for the G score, respectively, p<0.05). ADC values showed significant correlation with the S score (rho: -0.17, p = 0.04) and did not correlate significantly with the G score (rho: -0.07, p = 0.39). The areas under receiver operator characteristics (AUC) curve of unenhanced HBP, Δ% T1 relaxation time, and the ADC value were 0.68, 0.82, 0.71, 0.61 for the identification of S ≥ 3, and 0.63, 0.68, 0.62, 0.52 for the identification of G ≥ 3, respectively. The HBP T1 relaxation time was better than that of ADC for identification of S ≥ 3 (p = 0.0005) and G ≥ 3 (p = 0.014). CONCLUSIONS The HBP T1 relaxation time measurement on gadoxetic acid-enhanced MRI images might be a potential biomarker in the staging of hepatic fibrosis, and was more accurate than the ADC measurement.

Metabolite detection of pancreatic carcinoma by in vivo proton MR spectroscopy at 3T: initial results

PurposeThe authors sought to identify metabolic features of pancreatic carcinoma by in vivo proton magnetic resonance (MR) spectroscopy at 3 Tesla.Materials and methodsForty healthy volunteers and 40 patients with pancreatic carcinoma confirmed by histopathology underwent T2-weighted imaging for localisation of the single voxel. Respiration-triggered 1H MR spectroscopy was used to detect metabolites in normal pancreas and cancerous tissue. All spectral data were processed with SAGE software. Unsuppressed water at 4.7 ppm was used as an internal reference to determine metabolite concentrations. Each ratio among the different peak areas was statistically evaluated between normal pancreas and pancreatic carcinoma.ResultsThe following five groups of spectra were detected: unsaturated fatty acids (-CH = CH-) at 5.4 ppm; residual water at 4.7 ppm; choline metabolites at 3.2 ppm; unsaturated fatty acids (-CH2-CH = CH-) or a combination of N-acetylaspartate (NAA), N-acetylaspartylglutamate (NAAG), glutamine, glutamate, macromolecules and unsaturated fatty acids (-CH2-CH = CH-) at 2.0 ppm and lipids at 1.3 ppm. Ratio of lipids to unsuppressed water in normal pancreas was statistically greater than that in pancreatic cancer (p=0.004). Ratio of choline to unsuppressed water in normal pancreas was statistically greater than that in pancreatic cancer (p=0.0001). Ratio of fatty acids (-CH = CH-) to lipids in normal pancreas was statistically lower than that in pancreatic cancer (p=0.006).ConclusionsCompared with normal pancreas, pancreatic carcinoma has a higher ratio of fatty acids (-CH = CH-) to lipids and lower ratios of lipids to unsuppressed water and choline to unsuppressed water at 3T.AbstractObiettivoScopo dello studio è identificare le caratteristiche metaboliche del carcinoma pancreatico tramite l’esecuzione della spettroscopia protonica a risonanza magnetica (RM).Materiali e metodiL’esame RM è stato eseguito su 40 volontari sani e 40 Pazienti con diagnosi di carcinoma pancreatico mediante sequenze T2-pesate per la localizzazione del voxel. Per la rilevazione dei metaboliti nel pancreas normale e nel tessuto neoplastico è stata utilizzata la spettroscopia RM con gating respiratorio; i dati spettroscopici sono stati elaborati con il software SAGE. La determinazione della concentrazione dei metaboliti è stata ottenuta in riferimento al segnale dell’acqua non soppressa a 4,7 parti per milione (ppm). Ogni rapporto tra i diversi picchi è stato valutato statisticamente confrontando il pancreas normale ed il carcinoma pancreatico.RisultatiSono stati individuati i seguenti 5 gruppi di spettri: acidi grassi insaturi (-CH=CH-) a 5,4 ppm; acqua residua a 4,7 ppm; metaboliti della colina a 3,2 ppm; acidi grassi insaturi (-CH2-CH=CH-) o una combinazione di N-acetilaspartato (NAA), N-acetilaspartil-glutammato (NAAG), glutammina, glutammato e acidi grassi insaturi (-CH2-CH=CH-) a 2,0 ppm e lipidi a 1,3 ppm. Il rapporto lipidi / acqua non soppressa nel pancreas normale è risultato significativamente maggiore del medesimo rapporto nel carcinoma pancreatico (p=0,004). Il rapporto colina / acqua non soppressa nel pancreas normale è risultato significativamente maggiore del medesimo rapporto nel carcinoma pancreatico (p=0,0001). Il rapporto acidi grassi (-CH=CH-) / lipidi nel pancreas normale è risultato significativamente minore del medesimo rapporto nel cancro pancreatico (p=0,006).ConclusioniA confronto con il pancreas normale, il carcinoma pancreatico presenta maggior rapporto acidi grassi (-CH=CH-) / lipidi ed un minor rapporto lipidi / acqua non soppressa e colina / acqua non soppressa a 3T.

Evaluation of ADC measurements among solid pancreatic masses by respiratory-triggered diffusion-weighted MR imaging with inversion-recovery fat-suppression technique at 3.0 T☆

PURPOSE The objective of this paper was to investigate the value of apparent diffusion coefficients (ADCs) for differential diagnosis among solid pancreatic masses using respiratory triggered diffusion-weighted MR imaging with inversion-recovery fat-suppression technique (RT-IR-DWI) at 3.0 T. MATERIALS AND METHODS 20 normal volunteers and 72 patients (Pancreatic ductal adenocarcinoma [PDCA, n=30], mass-forming pancreatitis [MFP, n=15], solid pseudopapillary neoplasm [SPN, n=12], and pancreatic neuroendocrine tumor[PNET, n=15]) underwent RT-IR-DWI (b values: 0 and 600 s/mm(2)) at 3.0 T. Results were correlated with histopathologic data and follow-up imaging. ADC values among different types of pancreatic tissue were statistically analyzed and compared. RESULTS Statistical difference was noticed in ADC values among normal pancreas, MFP, PDCA, SPN and PNET by ANOVA (p<.001). Normal pancreas had the highest ADC value, then followed by PNET, PDCA, MFP and SPN. There was noticeable statistical difference in ADC values among PDCA, MFP and normal pancreas by Least Significant Difference (LSD) (p<.001). ADC of SPN was statistically lower than that of PNET (p=0.1800×10(-4)), PDCA (p=0.0300×10(-4)) and normal pancreas (p=0.0007×10(-4)). ADC of PNET was statistically lower than that of normal pancreas (p=0.0360) and higher than that of MFP (p=9.3000×10(-4)). CONCLUSIONS ADC measurements using RT-IR-DWI at 3.0T may aid to disclose the histopathological pattern of normal pancreas and solid pancreatic masses, which may be helpful in characterizing solid pancreatic lesions.

Using a 2D multibreath‐hold susceptibility‐weighted imaging to visualize intratumoral hemorrhage of hepatocellular carcinoma at 3T MRI: Correlation with pathology

To assess the value of 2D multibreath‐hold susceptibility‐weighted imaging (SWI) for visualizing intratumoral hemorrhage of hepatocellular carcinoma (HCC) and correlate with pathological results.

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.

Evaluation of pancreatic cancer by multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging at 3.0T.

OBJECTIVE To investigate the microcirculation in pancreatic cancer by pharmacokinetic analysis of multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging at 3.0T. MATERIALS AND METHODS Multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging was performed in 40 healthy volunteers and 40 patients with pancreatic cancer proven by histopathology using an axial three-dimensions fat-saturated T1-weighted spoiled-gradient echo sequence at 3.0T. A two compartment model with T1 correction was used to quantify the transfer constant, the rate constant of backflux from the extravascular extracellular space to the plasma and the extravascular extracellular space fractional volume in pancreatic cancer, obstructive pancreatitis distal to the malignant tumor, adjacent pancreatic tissue proximal to the tumor and normal pancreas. All parameters were statistically analyzed. RESULTS Statistical differences were noticed in both the transfer constant (p=0.000075) and the rate constant of backflux (p=0.006) among different tissues. Both the transfer constant and the rate constant of backflux in pancreatic cancer were statistically lower than those in normal pancreas and adjacent pancreatic tissue (p<0.05). Both the transfer constant and the rate constant of backflux in obstructive pancreatitis were statistically lower than those in normal pancreas and adjacent pancreatic tissue (p<0.05). The extravascular extracellular space fractional volume in pancreatic cancer was statistically lager than that in normal pancreas (p=0.002). CONCLUSION Multiple breath-hold dynamic contrast-enhanced magnetic resonance imaging offers a useful technique to evaluate the microenvironment in pancreatic cancer at 3.0T. Compared to normal pancreas, pancreatic cancer has lower transfer constant, rate constant of backflux and larger extravascular extracellular space fractional volume.