Showing papers in "European Radiology in 2010"
TL;DR: AWBU resulted in significant cancer detection improvement compared with mammography alone, and may justify this technology’s expense for women with dense breasts and/or at high risk for breast cancer.
Abstract: Purpose
Mammography, the standard method of breast cancer screening, misses many cancers, especially in dense-breasted women. We compared the performance and diagnostic yield of mammography alone versus an automated whole breast ultrasound (AWBU) plus mammography in women with dense breasts and/or at elevated risk of breast cancer.
431 citations
TL;DR: The aim of this review is to give a comprehensive overview of current methods and applications as well as future perspectives in the field of neuromuscular imaging in inherited muscle diseases and provide diagnostic algorithms that might guide us through the differential diagnosis in hereditary myopathies.
Abstract: Driven by increasing numbers of newly identified genetic defects and new insights into the field of inherited muscle diseases, neuromuscular imaging in general and magnetic resonance imaging (MRI) in particular are increasingly being used to characterise the severity and pattern of muscle involvement. Although muscle biopsy is still the gold standard for the establishment of the definitive diagnosis, muscular imaging is an important diagnostic tool for the detection and quantification of dystrophic changes during the clinical workup of patients with hereditary muscle diseases. MRI is frequently used to describe muscle involvement patterns, which aids in narrowing of the differential diagnosis and distinguishing between dystrophic and non-dystrophic diseases. Recent work has demonstrated the usefulness of muscle imaging for the detection of specific congenital myopathies, mainly for the identification of the underlying genetic defect in core and centronuclear myopathies. Muscle imaging demonstrates characteristic patterns, which can be helpful for the differentiation of individual limb girdle muscular dystrophies. The aim of this review is to give a comprehensive overview of current methods and applications as well as future perspectives in the field of neuromuscular imaging in inherited muscle diseases. We also provide diagnostic algorithms that might guide us through the differential diagnosis in hereditary myopathies.
280 citations
TL;DR: A brief review of the current X-ray methods used for quantitative assessment of the skeleton, data on the levels of radiation exposure associated with these methods and information about radiation safety issues are provided.
Abstract: Recent advances in medical X-ray imaging have enabled the development of new techniques capable of assessing not only bone quantity but also structure. This article provides (a) a brief review of the current X-ray methods used for quantitative assessment of the skeleton, (b) data on the levels of radiation exposure associated with these methods and (c) information about radiation safety issues. Radiation doses associated with dual-energy X-ray absorptiometry are very low. However, as with any X-ray imaging technique, each particular examination must always be clinically justified. When an examination is justified, the emphasis must be on dose optimisation of imaging protocols. Dose optimisation is more important for paediatric examinations because children are more vulnerable to radiation than adults. Methods based on multi-detector CT (MDCT) are associated with higher radiation doses. New 3D volumetric hip and spine quantitative computed tomography (QCT) techniques and high-resolution MDCT for evaluation of bone structure deliver doses to patients from 1 to 3 mSv. Low-dose protocols are needed to reduce radiation exposure from these methods and minimise associated health risks.
278 citations
TL;DR: Clinical performance of tomosynthesis in one view at the same total dose as standard screen-film mammography is not inferior to digital mammography in two views.
Abstract: To compare the clinical performance of digital breast tomosynthesis (DBT) with that of full-field digital mammography (FFDM) in a diagnostic population. The study enrolled 200 consenting women who had at least one breast lesion discovered by mammography and/or ultrasound classified as doubtful or suspicious or probably malignant. They underwent tomosynthesis in one view [mediolateral oblique (MLO)] of both breasts at a dose comparable to that of standard screen-film mammography in two views [craniocaudal (CC) and MLO]. Images were rated by six breast radiologists using the BIRADS score. Ratings were compared with the truth established according to the standard of care and a multiple-reader multiple-case (MRMC) receiver-operating characteristic (ROC) analysis was performed. Clinical performance of DBT compared with that of FFDM was evaluated in terms of the difference between areas under ROC curves (AUCs) for BIRADS scores. Overall clinical performance with DBT and FFDM for malignant versus all other cases was not significantly different (AUCs 0.851 vs 0.836, p = 0.645). The lower limit of the 95% CI or the difference between DBT and FFDM AUCs was −4.9%. Clinical performance of tomosynthesis in one view at the same total dose as standard screen-film mammography is not inferior to digital mammography in two views.
273 citations
TL;DR: Reduced Gd-EOB-DTPA uptake might be an early event of hepatocarcinogenesis, preceding portal blood flow reduction, although difficulties exist in differentiating HCCs from DNs.
Abstract: Objective:
To retrospectively investigate enhancement patterns of hepatocellular carcinoma (HCC) and dysplastic nodule (DN) in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine (Gd-EOB-DTPA)-enhanced MRI in relation to histological grading and portal blood flow.
235 citations
TL;DR: A review of modern imaging techniques commonly used in dental practice and their clinical applications is presented and applications, limitations and current trends of these dental “in-office” radiographic techniques are discussed.
Abstract: A review of modern imaging techniques commonly used in dental practice and their clinical applications is presented. The current dental examinations consist of intraoral imaging with digital indirect and direct receptors, while extraoral imaging is divided into traditional tomographic/panoramic imaging and the more recently introduced cone beam computed tomography. Applications, limitations and current trends of these dental “in-office” radiographic techniques are discussed.
181 citations
TL;DR: DWI during CRT for HNC allows more accurate response prediction than anatomical imaging, correlating significantly with 2-year LRC.
Abstract: To evaluate diffusion-weighted (DWI) magnetic resonance imaging (MRI) for treatment prediction during chemoradiotherapy (CRT) of head and neck squamous cell carcinoma (HNC). Thirty patients with HNC underwent echo-planar DWI and anatomical MRI before and 2 and 4 weeks into CRT. Patient follow-up lasted 2 years post-CRT. Tumour ADC (ΔADC) and volume changes (ΔV) between baseline, and 2 and 4 weeks’ follow-up were compared for lesions with recurrence versus complete remission (CR) using a Mann-Whitney U test. The predictive value of the ΔADC and ΔV for locoregional control (LRC) was examined with the Kaplan-Meier method. The study was approved by the local ethics committee. All patients gave written informed consent. The ΔADC in primary tumours and nodal metastases, 2 and 4 weeks after the start of CRT, was significantly lower in lesions with post-CRT recurrence than in lesions with CR (ΔADC2 weeks and ΔADC4 weeks for primary tumours, relative to nodal metastases: p 0.05). DWI during CRT for HNC allows more accurate response prediction than anatomical imaging, correlating significantly with 2-year LRC.
180 citations
TL;DR: Preliminary results suggest that tinnitus patients learn to voluntarily reduce spatially specific auditory activations by rtfMRI neurofeedback and that this may reduce tinnitis symptoms.
Abstract: Tinnitus consists of a more or less constant aversive tone or noise and is associated with excess auditory activation. Transient distortion of this activation (repetitive transcranial magnetic stimulation, rTMS) may improve tinnitus. Recently proposed operant training in real-time functional magnetic resonance imaging (rtfMRI) neurofeedback allows voluntary modification of specific circumscribed neuronal activations. Combining these observations, we investigated whether patients suffering from tinnitus can (1) learn to voluntarily reduce activation of the auditory system by rtfMRI neurofeedback and whether (2) successful learning improves tinnitus symptoms. Six participants with chronic tinnitus were included. First, location of the individual auditory cortex was determined in a standard fMRI auditory block-design localizer. Then, participants were trained to voluntarily reduce the auditory activation (rtfMRI) with visual biofeedback of the current auditory activation. Auditory activation significantly decreased after rtfMRI neurofeedback. This reduced the subjective tinnitus in two of six participants. These preliminary results suggest that tinnitus patients learn to voluntarily reduce spatially specific auditory activations by rtfMRI neurofeedback and that this may reduce tinnitus symptoms. Optimized training protocols (frequency, duration, etc.) may further improve the results.
180 citations
TL;DR: The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate.
Abstract: The purpose of this review article is to familiarize radiologists with the recently revised Response Evaluation Criteria in Solid Tumours (RECIST), used in many anticancer drug trials to assess response and progression rate. The most important modifications are: a reduction in the maximum number of target lesions from ten to five, with a maximum of two per organ, with a longest diameter of at least 10 mm; in lymph nodes (LNs) the short axis rather than the long axis should be measured, with normal LN measuring <10 mm, non-target LN ≥10 mm but <15 mm and target LN ≥15 mm; osteolytic lesions with a soft tissue component and cystic tumours may serve as target lesions; an additional requirement for progressive disease (PD) of target lesions is not only a ≥20% increase in the sum of the longest diameter (SLD) from the nadir but also a ≥5 mm absolute increase in the SLD (the other response categories of target lesion are unchanged); PD of non-target lesions can only be applied if the increase in non-target lesions is representative of change in overall tumour burden; detailed imaging guidelines. Alternative response criteria in patients with hepatocellular carcinoma and gastrointestinal stromal tumours are discussed.
175 citations
TL;DR: Tomosynthesis can be used as an additional technique to mammography in patients referred with an abnormal screening mammogram or with clinical symptoms, however, additional lesions detected by tomosynthesis are also likely to be detected by other techniques used in the clinical work-up of these patients.
Abstract: The purpose of this study was to assess the potential value of tomosynthesis in women with an abnormal screening mammogram or with clinical symptoms. Mammography and tomosynthesis investigations of 513 woman with an abnormal screening mammogram or with clinical symptoms were prospectively classified according to the ACR BI-RADS criteria. Sensitivity and specificity of both techniques for the detection of cancer were calculated. In 112 newly detected cancers, tomosynthesis and mammography were each false-negative in 8 cases (7%). In the false-negative mammography cases, the tumor was detected with ultrasound (n = 4), MRI (n = 2), by recall after breast tomosynthesis interpretation (n = 1), and after prophylactic mastectomy (n = 1). Combining the results of mammography and tomosynthesis detected 109 cancers. Therefore in three patients, both mammography and tomosynthesis missed the carcinoma. The sensitivity of both techniques for the detection of breast cancer was 92.9%, and the specificity of mammography and tomosynthesis was 86.1 and 84.4%, respectively. Tomosynthesis can be used as an additional technique to mammography in patients referred with an abnormal screening mammogram or with clinical symptoms. Additional lesions detected by tomosynthesis, however, are also likely to be detected by other techniques used in the clinical work-up of these patients.
169 citations
TL;DR: Single ADC measurements pre- or intra-treatment did not predict response, but ADC post-treatment was a marker for LF, and Serial change in ADC was an even stronger marker, when using an early or late treatment fall in ADC to identify LF.
Abstract: Objective
To investigate the role of diffusion-weighted imaging (DWI) in predicting and monitoring chemoradiotherapy response in head and neck squamous cell carcinoma (HNSCC).
TL;DR: The results suggest that the imaging findings of triple-negative breast cancer might be useful in diagnosing triple- negative breast cancer.
Abstract: This study was designed to investigate the mammography and ultrasound findings of triple-negative breast cancer and to compare the results with characteristics of ER-positive/PR-negative/HER2-negative breast cancer and ER-negative/PR-negative/HER2-positive breast cancer. From January 2007 to October 2008, mammography and ultrasound findings of 245 patients with pathologically confirmed triple-negative (n = 87), ER-positive/PR-negative/HER2-negative (n = 93) or ER-negative/PR-negative/HER2-positive breast cancers (n = 65) were retrospectively reviewed. We also reviewed pathological reports for information on the histological type, histological grade and the status of the biological markers. Triple-negative breast cancers showed a high histological grade. On mammography, triple-negative breast cancers usually presented with a mass (43/87, 49%) or with focal asymmetry (19/87, 22%), and were less associated with calcifications. On ultrasound, the cancers were less frequently seen as non-mass lesions (12/87, 14%), more likely to have circumscribed margins (43/75, 57%), were markedly hypoechoic (36/75, 57%) and less likely to show posterior shadowing (4/75, 5%). Among the three types of breast cancers, ER-negative/PR-negative/HER2-positive breast cancers most commonly had associated calcifications (52/65, 79%) on mammography and were depicted as non-mass lesions (21/65, 32%) on ultrasound. Our results suggest that the imaging findings might be useful in diagnosing triple-negative breast cancer.
TL;DR: Skeletal muscle metastases (SMM) were located in the iliopsoas muscle, paravertebral muscles, gluteal muscles, lower extremity muscles, abdominal wall muscles, thoracic wall muscles and upper extremities muscles.
Abstract: Background
Although skeletal muscles comprise nearly 50% of the total human body mass and are well vascularised, metastases in the musculature are rare. The reported prevalence of skeletal muscle metastases from post-mortem studies of patients with cancer is inconstant and ranges from 0.03 to 17.5%.
TL;DR: DIR brain MR imaging at 3 T substantially improves the sensitivity of the detection of cortical lesions compared with the standard magnetic field strength of 1.5 T, and significantly more lesions could be detected in the infratentorial, periventricular and juxtacortical white matter.
Abstract: Objective
To investigate the impact of a higher magnetic field strength of 3 Tesla (T) on the detection rate of cortical lesions in multiple sclerosis (MS) patients, in particular using a dedicated double inversion recovery (DIR) pulse sequence.
TL;DR: 3D spectroscopic images of mice that distinguished calcium, iodine and barium were produced that distinguished contrast agents with K-edges only 4 keV apart and multi-contrast imaging and molecular CT are potential future applications.
Abstract: Spectral CT differs from dual-energy CT by using a conventional X-ray tube and a photon-counting detector. We wished to produce 3D spectroscopic images of mice that distinguished calcium, iodine and barium. We developed a desktop spectral CT, dubbed MARS, based around the Medipix2 photon-counting energy-discriminating detector. The single conventional X-ray tube operated at constant voltage (75 kVp) and constant current (150 µA). We anaesthetised with ketamine six black mice (C57BL/6). We introduced iodinated contrast material and barium sulphate into the vascular system, alimentary tract and respiratory tract as we euthanised them. The mice were preserved in resin and imaged at four detector energy levels from 12 keV to 42 keV to include the K-edges of iodine (33.0 keV) and barium (37.4 keV). Principal component analysis was applied to reconstructed images to identify components with independent energy response, then displayed in 2D and 3D. Iodinated and barium contrast material was spectrally distinct from soft tissue and bone in all six mice. Calcium, iodine and barium were displayed as separate channels on 3D colour images at <55 µm isotropic voxels. Spectral CT distinguishes contrast agents with K-edges only 4 keV apart. Multi-contrast imaging and molecular CT are potential future applications.
TL;DR: Initial testing suggests that the multispectral MR image analysis approach for segmenting normal and abnormal brain tissue, including white matter lesions, is highly reproducible and accurate with the potential to be applied to routinely collected clinical MRI data.
Abstract: Objective
Brain tissue segmentation by conventional threshold-based techniques may have limited accuracy and repeatability in older subjects. We present a new multispectral magnetic resonance (MR) image analysis approach for segmenting normal and abnormal brain tissue, including white matter lesions (WMLs).
TL;DR: CEUS improves the diagnostic performance significantly in the differentiation of intrahepatic cholangiocarcinoma and hepatocellular carcinoma and is compared with prior studies on this topic.
Abstract: Objective
We assessed the usefulness of contrast-enhanced ultrasound (CEUS) in the differentiation of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC).
TL;DR: Whole-body DWI with ADC analysis can potentially be used for lesion detection and staging in patients with diffuse large B-cell lymphoma, and all involved organ lesions showed restricted diffusion.
Abstract: Objective
To design a whole-body MR protocol using exclusively diffusion-weighted imaging (DWI) with respiratory gating and to assess its value for lesion detection and staging in patients with diffuse large B-cell lymphoma (DLBCL), with integrated FDG PET/CT as the reference standard.
TL;DR: The results suggest that the quantitative diagnostic features can be used for developing automated breast CAD for mass lesions to achieve a high diagnostic performance, but more advanced algorithms are needed for diagnosis of lesions presenting as non-mass-like enhancement.
Abstract: Purpose
To investigate methods developed for the characterisation of the morphology and enhancement kinetic features of both mass and non-mass lesions, and to determine their diagnostic performance to differentiate between malignant and benign lesions that present as mass versus non-mass types.
TL;DR: Assessment of inflammatory parameters in patients with TTC provides further insights into the pathophysiological mechanisms in TTC, supporting the contribution of an inflammatory process in the acute setting.
Abstract: Objective
Takotsubo cardiomyopathy (TTC) is an increasingly recognised acute cardiac syndrome, whose underlying pathophysiological mechanisms remain unknown. Inflammation might play a role as this has been shown in endomyocardial biopsies. The aim of this study was to assess inflammatory parameters in patients with TTC using a comprehensive cardiovascular magnetic resonance imaging (CMR) approach.
TL;DR: CT is the imaging modality of choice for preoperative staging and detection of recurrence in patients with ovarian cancer, with positron emission tomography (PET)/CT emerging as the optimal imaging technique for suspected recurrence, particularly in Patients with negative CT or magnetic resonance imaging (MRI).
Abstract: Objective
To design clear guidelines for the staging and follow-up of patients with ovarian cancer, and to provide the radiologist with a framework for use in multidisciplinary conferences.
TL;DR: Recent advances in imaging may improve the outcome of salvage therapies (by improving patient selection and treatment targeting) and should open the way to focal salvage treatments in the near future.
Abstract: Because prostate cancer local recurrences can be efficiently treated by salvage therapies, it becomes critical to detect them early. The first alert is the rise of the prostate specific antigen (PSA) level after the post-treatment nadir, which can correspond to a distant recurrence, a local recurrence or both. This so-called biochemical failure (BF) is defined as PSA level > 0.2 ng/ml after radical prostatectomy (RP) and PSA level > nadir + 2 ng/ml after radiotherapy. There is no consensual definition of BF after cryotherapy, high-intensity focused ultrasound (HIFU) ablation or brachytherapy. Local recurrences after RP are treated by radiotherapy, those after radiotherapy by RP, cryotherapy, brachytherapy or HIFU ablation. Recurrences after cryotherapy or HIFU ablation can be treated by a second session or radiotherapy. Recurrences after brachytherapy are difficult to treat. In patients with BF, MRI can detect local recurrences, whatever the initial treatment was. Dynamic contrast-enhanced MRI seems particularly accurate. The role of spectroscopy remains controversial. Ultrasound-based techniques are less accurate, but this may change with the advent of ultrasonic contrast media. These recent advances in imaging may improve the outcome of salvage therapies (by improving patient selection and treatment targeting) and should open the way to focal salvage treatments in the near future.
TL;DR: Sensitivity and specificity of ueMRM in mass lesions equal that of ceMRM, however, a reduced lesion visibility in ue MRM may lead to more false-negative findings.
Abstract: Objective
This study was performed to assess the sensitivity and specificity for malignant and benign mass lesions of a diagnostic approach combining DWI with T2-weighted images (unenhanced MR mammography, ueMRM) and compare the results with contrast-enhanced MR mammography (ceMRM).
TL;DR: VNCTA may potentially replace TNCT as part of a multi-phase liver imaging protocol with consequent saving in radiation dose.
Abstract: To compare virtual non-enhanced liver CT (VNCT) from dual-energy CT (DECT) with true non-enhanced liver CT (TNCT) in patients. A total of 102 patients underwent multi-phase abdominal CT. Liver arterial VNCT (VNCTA) and portovenous VNCT (VNCTV) images were derived from the arterial and portovenous DECT data. The mean CT number, signal to noise ratio (SNR), image quality, contrast to noise (CNR) of liver lesions, lesion detectability and radiation dose were compared. There was no difference in mean CT numbers of all organs (all P > 0.05). SNR on VNCT images was higher than that of TNCT (all P 0.05), but SNR of the lesions on VNCT was higher than that on TNCT (P < 0.001). Radiation dose of biphase DECT was lower than that of routine triphase CT (P < 0.001). VNCTA may potentially replace TNCT as part of a multi-phase liver imaging protocol with consequent saving in radiation dose.
TL;DR: DW-MRI allows reliable determination of diffusion and micro-circulation contributions in renal allografts shortly after transplantation; deviations in AR indicate potential clinical utility of this method to non-invasively monitor derangements in renal both cortex and medulla.
Abstract: To determine the inter-patient variability of apparent diffusion coefficients (ADC) and concurrent micro-circulation contributions from diffusion-weighted MR imaging (DW-MRI) in renal allografts early after transplantation, and to obtain initial information on whether these measures are altered in histologically proven acute allograft rejection (AR). DW-MRI was performed in 15 renal allograft recipients 5–19 days after transplantation. Four patients presented with AR and one with acute tubular necrosis (ATN). Total ADC (ADCT) was determined, which includes diffusion and micro-circulation contributions. Furthermore, diffusion and micro-circulation contributions were separated, yielding the “perfusion fraction” (FP), and “perfusion-free” diffusion (ADCD). Diffusion parameters in the ten allografts with stable function early after transplantation demonstrated low variabilities. Values for ADCT and ADCD were (×10−5 mm2/s) 228 ± 14 and 203 ± 9, respectively, in cortex and 226 ± 16 and 199 ± 9, respectively, in medulla. FP values were 18 ± 5% in cortex and 19 ± 5% in medulla. FP values were strongly reduced to less than 12% in cortex and medulla of renal transplants with AR and ATN. FP values correlated with creatinine clearance. DW-MRI allows reliable determination of diffusion and micro-circulation contributions in renal allografts shortly after transplantation; deviations in AR indicate potential clinical utility of this method to non-invasively monitor derangements in renal allografts.
TL;DR: Bronchial artery embolisation (BAE) is an effective and safe procedure for haemoptysis control in most cases, however, high recurrence and mortality rates are associated with aspergilloma.
Abstract: To evaluate the immediate and long-term results of arterial embolisation in the management of haemoptysis and to identify factors influencing outcome. A retrospective analysis was carried out of the medical records and angiograms of 50 patients who underwent transarterial embolisation for haemoptysis. The most frequent causes of haemoptysis included bronchiectasis (16%), active tuberculosis (12%) and aspergilloma (12%). A total of 126 bronchial and non-bronchial systemic arteries were embolised in 62 procedures. Immediate cessation of haemoptysis was achieved in 43 patients (86%). Haemoptysis was controlled in 36 patients (72%), recurred in 14 (28%) and 11 (22%) required repeat embolisation. The worst outcomes were observed in patients with aspergilloma: all six suffered recurrent bleeding and three (50%) died from massive haemoptysis. Aspergilloma was also associated with an increased risk of haemoptysis recurrence (p < 0.05). A good clinical outcome was achieved in those with active tuberculosis and malignancy. Complication rates were low and included transient chest pain, false aneurysm and one case of lower limb weakness. Bronchial artery embolisation (BAE) is an effective and safe procedure for haemoptysis control in most cases. However, high recurrence and mortality rates are associated with aspergilloma. Early intervention with repeat embolisation is recommended in these patients and elective surgery should be considered.
TL;DR: CD lesions seem to be associated with motility changes and this leads to an increased lesion detection rate compared with standard-MRE imaging alone.
Abstract: Objective
To evaluate retrospectively in patients with Crohn’s disease (CD) if magnetic resonance (MR) motility alterations correlate with CD typical lesions leading to an increased detection rate.
TL;DR: MRI combining T2-weighted and DCE images is a promising method for guiding post-HIFU biopsy towards areas containing recurrent cancer and viable prostate tissue.
Abstract: The objective was to evaluate T2-weighted (T2w) and dynamic contrast-enhanced (DCE) MRI in detecting local cancer recurrences after prostate high-intensity focused ultrasound (HIFU) ablation. Fifty-nine patients with biochemical recurrence after prostate HIFU ablation underwent T2-weighted and DCE MRI before transrectal biopsy. For each patient, biopsies were performed by two operators: operator 1 (blinded to MR results) performed random and colour Doppler-guided biopsies ("routine biopsies"); operator 2 obtained up to three cores per suspicious lesion on MRI ("targeted biopsies"). Seventy-seven suspicious lesions were detected on DCE images (n = 52), T2w images (n = 2) or both (n = 23). Forty patients and 41 MR lesions were positive at biopsy. Of the 36 remaining MR lesions, 20 contained viable benign glands. Targeted biopsy detected more cancers than routine biopsy (36 versus 27 patients, p = 0.0523). The mean percentages of positive cores per patient and of tumour invasion of the cores were significantly higher for targeted biopsies (p < 0.0001). The odds ratios of the probability of finding viable cancer and viable prostate tissue (benign or malignant) at targeted versus routine biopsy were respectively 3.35 (95% CI 3.05-3.64) and 1.38 (95% CI 1.13-1.63). MRI combining T2-weighted and DCE images is a promising method for guiding post-HIFU biopsy towards areas containing recurrent cancer and viable prostate tissue.
TL;DR: The results suggest that free-breathing navigator-gated 3D SSFP MRA with non-selective radiofrequency excitation is a promising technique that provides high image quality and diagnostic accuracy for the assessment of thoracic aortic disease without the need for intravenous contrast material.
Abstract: Objectives
The purpose of this study was to determine the image quality and diagnostic accuracy of three-dimensional (3D) unenhanced steady state free precession (SSFP) magnetic resonance angiography (MRA) for the evaluation of thoracic aortic diseases.
TL;DR: DW imaging proved to be accurate in assessing myometrial invasion, and it could replace dynamic imaging as an adjunct to routine T2-weighted imaging for preoperative evaluation of endometrial cancer.
Abstract: Objective: To determine the diagnostic accuracy of diffusion- weighted (DW) magnetic resonance (MR) imaging in the preoperative assessment of myometrial invasion by endometrial cancer. Materials and methods: In this prospective study, 47 patients with histologically con- firmed endometrial cancer underwent preoperative MR imaging and total hysterectomy. The MR protocol in- cluded spin-echo multishot T2- weighted, dynamic T1-weighted and DW images acquired with b-values of 0 and 500 s/mm 2 . Myometrial tumour spread was classified as superficial (<50%) or deep (≥50% myometrial thickness). Postoperative histopatho- logical findings served as a reference standard. Indices of diagnostic per- formance were assessed for each sequence. Results: At histopatho- logical examination, superficial myo- metrial invasion was found in 34 patients and deep myometrial inva- sion in 13. In the assessment of tumour invasion, sensitivity, specific- ity, positive and negative predictive values of T2-weighted images were 92.3%, 76.5%, 60.0% and 96.3%, respectively. The corresponding va- lues for dynamic images were 69.2%, 61.8%, 40.9% and 84.0%, and for DW images 84.6%, 70.6%, 52.4% and 92.3%. T2-weighted and DW imaging proved to be the most accurate techniques for tumour spread determination. Conclusion: DW im- aging proved to be accurate in asses- sing myometrial invasion, and it could replace dynamic imaging as an adjunct to routine T2-weighted imag- ing for preoperative evaluation of endometrial cancer.