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Background and Clinical Significance: Low-grade endometrial stromal sarcoma (LGESS) is a rare uterine malignancy that causes non-specific symptoms which presents more typically in younger women compared to other uterine sarcomas. Preoperative diagnosis of myometrial LGESS is challenging, as it is frequently mistaken for a benign uterine mass, such as a degenerating leiomyoma. Despite its rarity, the imaging findings of LGESS are highly variable, complicating the diagnostic process. Characteristic findings on magnetic resonance imaging T2-weighted imaging (T2WI)—including intra-tumoral low signal intensity (SI) bands (correlating with preserved myometrial bundles separated by tumor cells on histopathology), cystic/necrotic changes, and absence of a speckled appearance—have been significantly associated with LGESS. Additionally, apparent diffusion coefficient mapping can aid in the characterization of uterine masses. Case Presentation: We present a case of LGESS initially misdiagnosed as red degeneration of a uterine leiomyoma (RDL) due to a peripheral rim showing high SI on T1-weighted imaging and low SI on T2WI, which was interpreted as a thrombosed vessel. Histopathology demonstrated necrotic tissue outlined by normal uterine tissue, corresponding to the peripheral rim. We suggest that susceptibility-weighted imaging could have aided in distinguishing between the two conditions due to its high sensitivity to blood products. Moreover, diffusion-weighted imaging revealed restriction along T2 low SI bands, with no restrictions within the bands themselves, potentially indicating a viable tumor along preserved myometrium. Conclusions: These imaging features may provide valuable insights for diagnosing LGESS and differentiating it from RDL, supporting further research on LGESS imaging characteristics.

Hepatic steatosis without specific causes (e.g., viral infection, alcohol abuse, etc.) is called non-alcoholic fatty liver disease (NAFLD), which ranges from non-alcoholic fatty liver (NAFL) to non-alcoholic steatohepatitis (NASH), fibrosis, and NASH-related cirrhosis. Despite the usefulness of the standard grading system, liver biopsy has several limitations. In addition, patient acceptability and intra- and inter-observer reproducibility are also concerns. Due to the prevalence of NAFLD and limitations of liver biopsies, non-invasive imaging methods such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) that can reliably diagnose hepatic steatosis have developed rapidly. US is widely available and radiation-free but cannot examine the entire liver. CT is readily available and helpful for detection and risk classification, significantly when analyzed using artificial intelligence; however, it exposes users to radiation. Although expensive and time-consuming, MRI can measure liver fat percentage with magnetic resonance imaging proton density fat fraction (MRI-PDFF). Specifically, chemical shift-encoded (CSE)-MRI is the best imaging indicator for early liver fat detection. The purpose of this review is to provide an overview of each imaging modality with an emphasis on the recent progress and current status of liver fat quantification.

The purpose of this study was to evaluate the image quality of compressed-sensing accelerated single-shot fast spin-echo (SSFSECS) sequences acquired within a single breath-hold in comparison with conventional SSFSE (SSFSECONV) and multishot TSE (mTSE). A total of 101 patients who underwent liver MRI at 3 T, including SSFSECONV (acquisition time (TA) = 58–62 s), mTSE (TA = 108 s), and SSFSECS (TA = 18 s), were included in this retrospective study. Two radiologists assessed the three sequences with respect to artifacts, organ sharpness, small structure visibility, overall image quality, and conspicuity of main lesions of liver and pancreas using a five-point evaluation scale system. Descriptive statistics and the Wilcoxon signed-rank test were used for statistical analysis. SSFSECS was significantly better than SSFSECONV and mTSE for artifacts, small structure visibility, overall image quality, and conspicuity of main lesions (p < 0.005). Regarding organ sharpness, mTSE and SSFSECS did not significantly differ (p = 0.554). Conspicuity of liver lesion did not significantly differ between SSFSECONV and mTSE (p = 0.404). SSFSECS showed superior image quality compared with SSFSECONV and mTSE despite a more than three-fold reduction in TA, suggesting a remarkable potential for saving time in liver imaging.

While magnetic resonance cholangiopancreatography (MRCP) is routinely used, compressed sensing MRCP (CS-MRCP) and gradient and spin-echo MRCP (GRASE-MRCP) with breath-holding (BH) may allow sufficient image quality with shorter acquisition times. This study qualitatively and quantitatively compared BH-CS-MRCP and BH-GRASE-MRCP and evaluated their clinical effectiveness. Data from 59 consecutive patients who underwent both BH-CS-MRCP and BH-GRASE-MRCP were qualitatively analyzed using a five-point Likert-type scale. The signal-to-noise ratio (SNR) of the common bile duct (CBD), contrast-to-noise ratio (CNR) of the CBD and liver, and contrast ratio between periductal tissue and the CBD were measured. Paired t-test, Wilcoxon signed-rank test, and McNemar’s test were used for statistical analysis. No significant differences were found in overall image quality or duct visualization of the CBD, right and left 1st level intrahepatic duct (IHD), cystic duct, and proximal pancreatic duct (PD). BH-CS-MRCP demonstrated higher background suppression and better visualization of right (p = 0.004) and left 2nd level IHD (p < 0.001), mid PD (p = 0.003), and distal PD (p = 0.041). Image quality degradation was less with BH-GRASE-MRCP than BH-CS-MRCP (p = 0.025). Of 24 patients with communication between a cyst and the PD, 21 (87.5%) and 15 patients (62.5%) demonstrated such communication on BH-CS-MRCP and BH-GRASE-MRCP, respectively. SNR, contrast ratio, and CNR of BH-CS-MRCP were higher than BH-GRASE-MRCP (p < 0.001). Both BH-CS-MRCP and BH-GRASE-MRCP are useful imaging methods with sufficient image quality. Each method has advantages, such as better visualization of small ducts with BH-CS-MRCP and greater time saving with BH-GRASE-MRCP. These differences allow diverse choices for visualization of the pancreaticobiliary tree in clinical practice.

Magnetic resonance cholangiopancreatography (MRCP) has been widely used in clinical practice, and recently developed compressed-sensing accelerated MRCP (CS-MRCP) has shown great potential in shortening the acquisition time. The purpose of this prospective study was to evaluate the clinical feasibility and image quality of optimized breath-hold CS-MRCP (BH-CS-MRCP) and conventional navigator-triggered MRCP. Data from 124 consecutive patients with suspected pancreaticobiliary diseases were analyzed by two radiologists using a five-point Likert-type scale. Communication between a cyst and the pancreatic duct (PD) was analyzed. Signal-to-noise ratio (SNR) of the common bile duct (CBD), contrast ratio between the CBD and periductal tissue, and contrast-to-noise ratio (CNR) of the CBD and liver were measured. Optimized BH-CS-MRCP showed significantly fewer artifacts with better background suppression and overall image quality. Optimized BH-CS-MRCP demonstrated communication between a cyst and the PD better than conventional MRCP (96.7% vs. 76.7%, p = 0.048). SNR, contrast ratio, and CNR were significantly higher with optimized BH-CS-MRCP (p < 0.001). Optimized BH-CS-MRCP showed comparable or even better image quality than conventional MRCP, with improved visualization of communication between a cyst and the PD.

Liver fibrosis staging is of great clinical importance because it is used to assess the severity of the underlying chronic liver disease. Among various imaging-based methods, apparent diffusion coefficient (ADC) measurement using diffusion-weighted imaging (DWI) has the potential to be used as an imaging biomarker for liver fibrosis assessment. In this study, we investigated the usefulness of liver ADC normalization using the spleen as a reference organ in liver fibrosis staging with 66 patients who underwent liver magnetic resonance imaging (MRI), transient elastography (TE), and surgical resection of a hepatic mass. ADC values of the liver (ADCliver) and spleen were analyzed, and the spleen was used for ADCliver normalization (nADCliver). ADCliver showed a weak negative correlation with TE (r = −0.246; p = 0.047) and fibrosis stage (r = −0.269; p = 0.029), while n ADCliver showed a moderate negative correlation with TE (r = −0.504; p < 0.001) and fibrosis stage (r = −0.579; p < 0.001). AUC values for nADCliver (0.777−0.875) were higher than those for ADCliver for each stage of fibrosis (0.596−0.713, p = 0.037−0.157). AUC values for TE (0.726−0.884) and nADCliver were not statistically different. In conclusion, normalized liver ADC can be useful in diagnosing liver fibrosis stage in patients with variable DWI acquisitions.