https://www.gastrojournal.org/article/S0016-5085(15)00099-2/pdf

American Gastroenterological Association Technical Review on the Diagnosis and Management of Asymptomatic Neoplastic Pancreatic Cysts

Magnetic resonance imaging (MRI) is the mainstay of diagnosis, staging and follow-up of much musculoskeletal pathology. Diffusion-weighted magnetic resonance imaging (DWI) is a recent addition to the MR sequences conventionally employed. DWI provides qualitative and quantitative functional information concerning the microscopic movements of water at the cellular level. A number of musculoskeletal disorders have been evaluated by DWI, including vertebral fractures, bone marrow infection, bone marrow malignancy, primary bone and soft tissue tumours; post-treatment follow-up has also been assessed. Differentiation between benign and malignant vertebral fractures by DWI and monitoring of therapy response have shown excellent results. However, in other pathologies, such as primary soft tissue tumours, DWI data have been inconclusive in some cases, contributing little additional information beyond that gained from conventional MR sequences. The aim of this article is to critically review the current literature on the contribution of DWI to musculoskeletal MRI.

Diffusion-weighted imaging (DWI) in musculoskeletal MRI: a critical review

Cyst Features and Risk of Malignancy in Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Meta-Analysis

Although the function of magnetic resonance (MR) imaging in the evaluation of musculoskeletal tumors has traditionally been to help identify the extent of disease prior to treatment, its role continues to evolve as new techniques emerge. Conventional pulse sequences remain heavily used and useful, but with the advent of chemical shift imaging, diffusion-weighted imaging, perfusion imaging and MR spectroscopy, additional quantitative metrics have become available that may help expand the role of MR imaging to include detection, characterization, and reliable assessment of treatment response. This review discusses a multiparametric approach to the evaluation of musculoskeletal tumors, with a focus on the utility and potential added value of various pulse sequences in helping establish a diagnosis, assess pretreatment extent, and evaluate a tumor in the posttreatment setting for recurrence and treatment response.

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12111740/-/DC1

© RSNA, 2012

https://pubs.rsna.org/doi/pdf/10.1148/radiol.12111740

Musculoskeletal tumors: How to use anatomic, functional, and metabolic MR techniques

OBJECTIVE To systematically determine the imaging findings for distinguishing malignant and benign branch-duct type intraductal papillary mucinous neoplasms (BD-IPMNs), including mixed type, and their diagnostic value through meta-analysis of published studies. BACKGROUND Management of BD-IPMNs, including mixed type, largely relies on imaging findings. The current knowledge on imaging findings to distinguish malignant and benign BD-IPMNs has weak evidence and is mostly from scattered individual retrospective studies. METHODS Thorough literature search in Ovid-MEDLINE and EMBASE databases was conducted to identify studies where findings of computed tomography, magnetic resonance imaging, and endoscopic ultrasonography of BD-IPMNs with or without main pancreatic duct (MPD) dilatation were correlated with surgical/pathological findings. Review of 1128 article candidates, including full-text review of 102 articles, identified 23 eligible articles with a total of 1373 patients for meta-analysis. Dichotomous data regarding distinction between malignant and benign BD-IPMNs were pooled using random effects model to obtain the diagnostic odds ratios (DORs) and their 95% confidence intervals (CIs) of various individual imaging findings for diagnosing malignant BD-IPMN. RESULTS Presence of mural nodules revealed the highest pooled DOR (95% CI) of 6.0 (4.1-8.8) followed by MPD dilatation [3.4 (2.3-5.2)], thick septum/wall [unadjusted, 3.3 (1.5-6.9); publication bias-adjusted, 2.3 (0.9-5.5)], and cyst size greater than 3 cm [2.3 (1.5-3.5)]. Multilocularity and multiplicity of the cystic lesions did not reveal statistically significant association with malignancy. CONCLUSIONS Presence of mural nodules should be regarded highly suspicious for malignancy warranting a surgical excision whereas cyst size greater than 3 cm, MPD dilatation (5-9 mm), or thick septum/wall may better be managed by careful observation and/or further evaluation.

Imaging features to distinguish malignant and benign branch-duct type intraductal papillary mucinous neoplasms of the pancreas: a meta-analysis.

Purpose
We evaluated the efficacy of using the apparent diffusion coefficient (ADC) to differentiate soft tissue tumors.

Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis.

OBJECTIVE. The purpose of this article is to show how CT image fusion with 3D reconstruction is used to depict in detail the anatomic structures of the hepatic hilum in the presence of hepatobiliary abnormalities.CONCLUSION. CT image fusion is a comprehensive imaging technique for preoperative evaluation of the blood vessels and bile ducts of the hepatic hilum.

https://www.ajronline.org/doi/pdfplus/10.2214/AJR.07.2280

CT image fusion for 3D depiction of anatomic abnormalities of the hepatic hilum.

This study aimed to compare the usefulness of multidetector row CT (MDCT), MR cholangiopancreatography (MRCP), and endoscopic ultrasonography (EUS) in diagnosing branch duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas. Imaging and pathological findings were retrospectively evaluated for 25 patients with branch duct IPMNs of the pancreas who underwent surgical resection (13 adenomas, 4 borderline lesions, and 8 carcinomas). MDCT and MRCP were performed on all 25 patients, whereas EUS was performed on 22 patients. MDCT and MRCP were used to identify features predictive of malignancy, including carcinoma, borderline lesions, and the presence of thickened irregular walls/septa or a solid mass. EUS was used to identify the presence of intramural nodules or a solid mass. Correlations between histopathology and maximum diameter of the main pancreatic duct (MPD) or cyst size detected by MDCT and MRCP were also examined. Presence of a solid mass was highly correlated with malignancy with all imaging methods (MDCT; P=0.001, MRCP; P=0.008, EUS; P 0.05), though values tended to be larger in malignant tumors. Our results suggest that the presence of thickened irregular walls/septa or a solid mass on MDCT are highly correlated with malignancy, and that MDCT is useful for diagnosis of branch duct IPMNs of the pancreas.

/pdf/utility-of-multidetector-row-ct-in-diagnosing-branch-duct-ildi6jvd6m.pdf

Utility of multidetector row CT in diagnosing branch duct IPMNs of the pancreas compared with MR cholangiopancreatography and endoscopic ultrasonography.

Purpose

To compare contrast material-enhanced three-dimensional (3D) magnetic resonance imaging (MRI) at 3.0T and multidetector row computed tomography (MDCT) in the same patient with regard to image quality of pancreatobiliary disease and hepatic vascular conspicuity.



Materials and Methods

This study enrolled 32 patients with pancreatobiliary disease who underwent both gadolinium-enhanced 3D dynamic MRI and multiphasic CT using 16-MDCT. Data analysis of image quality was performed by two radiologists based on source images, multiplanar reconstruction (MPR), curved planar reconstruction (CPR), and maximum intensity projection (MIP) reconstruction. Determination of image quality was based on a 4-point image quality rating scale.



Results

The overall image quality of the MRI axial images was superior to that of the axial MDCT images. The MRI protocol yielded an average score of 3.8 points versus 3.5 for the CT imaging. No significant difference was found between 3.0T MRI and MDCT images in MPR or CPR image quality. Image quality for visualization of the distal intrahepatic segmental arteries was significantly improved using MDCT imaging. No significant difference was found between the MDCT and 3.0T MR in portal vein branch image quality.



Conclusion

High-resolution dynamic contrast-enhanced MR imaging at 3.0T is a comprehensive technique which provides high image quality in pancreatobiliary disease. J. Magn. Reson. Imaging 2009;29:846–852. © 2009 Wiley-Liss, Inc.

Comparison of dynamic MRI at 3.0T and MDCT of pancreatobiliary disease: Evaluation with source, MPR, CPR, and MIP images for image quality and hepatic arterial and portal venous vessel conspicuity

1.5T Magnetic resonance (MR) imaging has become an accepted method for assessing prostate cancer. However, the role of 1.5T MRI in local staging of prostate cancer is limited. It is hoped that 3.0T MRI will be more useful in local staging of prostate cancer. The purpose of this study was to evaluate the tissue contrast, artifact presence, and image quality of T2-weighted images (T2WI) of prostate cancer using 3T MRI with a phased-array coil at different slice thicknesses and fields of view (FOV). We examined 15 patients with prostate cancer. We obtained MR images at slice thicknesses of 2 mm and 5 mm in both small and large FOV. The image obtained at a slice thickness of 2 mm with a small FOV had inferior tissue contrast compared to the other images (P<0.05), but there was no statistically significant difference in contrast between images obtained at a slice thickness of 2 mm with a large FOV and those obtained at a slice thickness of 5 mm. Artifacts were rated equally among the parameter combinations. The overall image quality obtained at a slice thickness of 2 mm with a large FOV was significantly superior to the other three imaging parameters (p<0.05). The image obtained at a slice thickness of 2 mm with a large FOV was superior to the other three images in evaluating T2WI of prostate cancer with 3T MRI.

Jun Sakoda

Papers

Diffusion-weighted imaging of soft tissue tumors: usefulness of the apparent diffusion coefficient for differential diagnosis.

CT image fusion for 3D depiction of anatomic abnormalities of the hepatic hilum.

Utility of multidetector row CT in diagnosing branch duct IPMNs of the pancreas compared with MR cholangiopancreatography and endoscopic ultrasonography.

Comparison of dynamic MRI at 3.0T and MDCT of pancreatobiliary disease: Evaluation with source, MPR, CPR, and MIP images for image quality and hepatic arterial and portal venous vessel conspicuity

MR imaging of prostate cancer at 3T with an external phased-array coil: evaluation of T2-weighted images.