Search

Objectives: Our aim was twofold. First, to validate Anali scores with and without gadolinium (ANALI Gd and ANALI NoGd ) in primary sclerosing cholangitis (PSC) patients. Second, to compare the ANALIs prognostic ability with the recently-proposed potential functional stricture (PFS)., Materials and Methods: This retrospective study included 123 patients with a mean age of 41.5 years, who underwent gadoxetic acid-enahnced MRI (GA-MRI). Five readers independently evaluated all images for calculation of ANALI Gd and ANALI NoGd scores based upon following criteria: intrahepatic bile duct change severity, hepatic dysmorphia, liver parenchymal heterogeneity, and portal hypertension. In addition, hepatobiliary contrast excretion into first-order bile ducts was evaluated on 20-minute hepatobiliary-phase (HBP) images to assess PFS. Inter- and intrareader agreement were calculated (Fleiss´and Cohen kappas). Kaplan-Meier curves were generated for survival analysis. ANALI NoGd , ANALI Gd , and PFS were correlated with clinical scores, labs and outcomes (Cox regression analysis)., Results: Inter-reader agreement was almost perfect (ϰ = 0.81) for PFS, but only moderate-(ϰ = 0.55) for binary ANALI NoGd . For binary ANALI Gd , the agreement was slightly better on HBP (ϰ = 0.64) than on arterial-phase (AP) (ϰ = 0.53). Univariate Cox regression showed that outcomes for decompensated cirrhosis, orthotopic liver transplantation or death significantly correlated with PFS (HR (hazard ratio) = 3.15, p < 0.001), ANALI NoGd (HR = 6.42, p < 0.001), ANALI Gd HBP (HR = 3.66, p < 0.001) and ANALI Gd AP (HR = 3.79, p < 0.001). Multivariate analysis identified the PFS, all three ANALI scores, and Revised Mayo Risk Score as independent risk factors for outcomes (HR 3.12, p < 0.001; 6.12, p < 0.001; 3.56, p < 0.001;3.59, p < 0.001; and 4.13, p < 0.001, respectively)., Conclusion: ANALI NoGd and GA-MRI-derived ANALI scores and PFS could noninvasively predict outcomes in PSC patients., Clinical Relevance Statement: The combined use of Anali scores and the potential functional stricture (PFS), both derived from unenhanced-, and gadoxetic acid enhanced-MRI, could be applied as a diagnostic and prognostic imaging surrogate for counselling and monitoring primary sclerosing cholangitis patients., Key Points: Primary sclerosing cholangitis patients require radiological monitoring to assess disease stability and for the presence and type of complications. A contrast-enhanced MRI algorithm based on potential functional stricture and ANALI scores risk-stratified these patients. Unenhanced ANALI score had a high negative predictive value, indicating some primary sclerosing cholangitis patients can undergo non-contrast MRI surveillance., Competing Interests: Compliance with ethical standards Guarantor The scientific guarantor of this publication is Dr. Ahmed Ba-Ssalamah. Conflict of interest Michael Trauner received grant support from Albireo, Cymabay, Falk, Gilead, Intercept, MSD, and Takeda, honoraria for consulting from BiomX, Boehringer Ingelheim, Falk, Genfit, Gilead, Intercept, Janssen, MSD, Novartis, Phenex, and Regulus, speaker fees from BMS, Falk, Gilead, Intercept and MSD, as well as travel support from Abbvie, Falk, Gilead, and Intercept. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Nikolaos Kartalis is a member of the European Radiology Editorial Board. He has not taken part in the review or selection process of this article. Statistics and biometry Dr. Michael Weber kindly provided statistical advice for this manuscript. Informed consent Informed Consent was waived by the Institutional Review Board. Ethical approval Institutional Review Board approval was obtained. Ethics commission (EC), Nr: 2249/2016 Radiologic Diagnosis of Cholestatic Liver Disease; A Retrospective Data Analysis. Study subjects or cohorts overlap Some study subjects or cohorts have been previously reported in Poetter-Lang S, Messner A, Bastati N et al (2023) Diagnosis of functional strictures in patients with primary sclerosing cholangitis using hepatobiliary contrast-enhanced MRI: a proof-of-concept study. Eur Radiol 33(12):9022-9037. https://doi.org/10.1007/s00330-023-09915-3. In the above-mentioned previous study, this cohort was used to prove the efficacy of potential functional stricture (PFS) to diagnose dominant or functional stricture in patients with PSC using ERCP as the gold standard. In this current study, this cohort is used to compare between the Anali scores and PFS to predict the short-, and mid to long term outcome of PSC patients. Methodology RetrospectiveDiagnostic or prognostic studyPerformed at one institution, (© 2024. The Author(s).)

Abstract: Manganese-based contrast agents (MBCAs) show promise to complement gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI) of the liver. Management of patients with focal liver lesions and severely impaired renal function uses unenhanced liver MRI or GBCA-enhanced MRI. However, unenhanced MRI risks reducing patient's survival.Gadolinium-based contrast agents, which help to detect and visualize liver lesions, are associated with increased risk of nephrogenic systemic fibrosis in renally impaired patients, a severe adverse event (AE) with potentially fatal outcome. Therefore, use of GBCA in patients with impaired renal function requires careful consideration. Other concerns are related to tissue deposition in the brain and other organs due to lack of gadolinium clearance, which could lead to concerns also for other patient populations, for example, those exposed to multiple procedures with GBCA. Of particular concern are the linear chelates that remain available for liver MRI, where there is no replacement technology. This has highlighted the urgency for safer alternatives.An alternative may be the drug candidate Ascelia-MBCA (ACE-MBCA, Orviglance), oral manganese chloride tetrahydrate. This candidate effectively visualizes and detects focal liver lesions, as demonstrated in 8 clinical studies on 201 adults (healthy or with known or suspected focal liver lesions). ACE-MBCA has a low and transient systemic exposure, which is likely the reason for its beneficial safety profile. The AEs were primarily mild and transient, and related to the gastrointestinal tract. This new, orally administered product may offer a simple imaging approach, allowing appropriate patient management in renally impaired patients when use of GBCA requires careful consideration.In this review, we highlight the clinical development of ACE-MBCA-a novel, liver-specific contrast agent. We begin with a brief overview of manganese properties, addressing the need for MBCAs and describing their optimal properties. We then review key findings on the novel agent and how this allows high-quality MRIs that are comparable to GBCA and superior to unenhanced MRI. Lastly, we provide our view of future perspectives that could advance the field of liver imaging, addressing the medical needs of patients with focal liver lesions and severe renal impairment.Our review suggests that ACE-MBCA is a promising, effective, and well-tolerated new tool in the radiologist's toolbox., Competing Interests: Conflicts of interest and sources of funding: T.B.B. and N.K. accepted paid consultancy from Bayer. H.P.H. and A.N. are employed at Ascelia Pharma. H.P.H. and A.N. also have shares in Ascelia Pharma. Ascelia Pharma funded editorial and writing services from Aixial Group. There were no other sources of funding or conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: To investigate the detectability of renal stones in corticomedullary and nephrographic phases on contrast-enhanced computed tomography (CT)., Methods: All consecutive patients between January 2012 and February 2016 undergoing CT of the kidneys according to our department's standard four-phase protocol and having at least one stone in the NC-phase (NCP) were included. Fifty patients with altogether 136 stones were eligible. Two radiologists in consensus evaluated the NCP from each examination and documented the number, location, and size of stones. Three abdominal radiologists blinded to the findings of the NCP reviewed independently the corticomedullary and nephrographic phases on two different occasions. They reported the number and location of stones in each kidney. For the inter-observer agreement the intra-class correlation coefficient (ICC) was estimated. The detection rate of renal stones was calculated for the three radiologists and compared between the two contrast-enhanced phases and the results were analyzed with concern to the size of the stones., Results: The ICC was 0.86. There was no statistically significant difference between corticomedullary and nephrographic phases (p = 0.94). The detection rate for stones measuring 3-5 mm was 82-88% and 98% for stones ≥ 6 mm., Conclusion: The detectability of renal stones ≥ 6 mm on contrast-enhanced CT is extremely high. This means that stones with a higher risk of not passing spontaneously can be safely diagnosed.

Objectives: To compare the sensitivity of MRI to detect colorectal cancer liver metastases (CRLM) after ingestion of manganese-based contrast agent (CMC-001) with that of a comprehensive intravenous gadobenate dimeglumine protocol, and to assess the safety and acceptability of oral manganese., Methods: 20 patients suspected of having 1-6 CRLM were included prospectively in this randomised cross-over study. Liver MRI was performed with a one-week interval at 1.5 T and included T1-w VIBE and T2-HASTE, before and after administration of 1.6 g CMC-001 or 0.1 mmol/kg gadobenate dimeglumine. The metastasis-to-liver signal intensity (SI) ratio was calculated. Standard of reference was histopathology after surgery, or combination of other imaging studies and/or follow up. Adverse events (AE) and clinicolaboratory tests were monitored., Results: Of 44 metastases, 41 were detected after CMC-001 (93%) and 42 after gadobenate dimeglumine (95%). Fifteen false-positive lesions were found after CMC-001 and 2 after gadobenate dimeglumine. The metastasis-to-liver SI ratio was significantly higher after CMC-001 than after gadobenate dimeglumine (0.51 and 0.21 respectively, P < 0.0001). More AE occurred after manganese compared to gadobenate dimeglumine., Conclusions: CMC-001 is as sensitive as an extensive intravenous gadobenate dimeglumine protocol in detecting CRLM. It was relatively well tolerated but had higher rates of gastrointestinal AE., Key Points: • Liver MRI after ingestion of manganese is highly sensitive for detecting metastases • High false-positive rate necessitates further evaluation, in some cases • The MR examination time is short • Oral ingestion of manganese seems safe and relatively well tolerated by patients • Manganese compounds may be useful for liver metastasis surveillance after colorectal cancer.

Objectives: To evaluate the added value of pre- and intraoperative contrast-enhanced ultrasound (transabdominal, or TCEUS and intraoperative, or ICEUS, respectively) in patients with known or highly suspected colorectal cancer liver metastases (CRLM) who have previously undergone extensive gadobenate dimeglumine (Gd-BOPTA) liver MRI., Methods: Fifteen patients with a total of 31 lesions were included in the comparison of TCEUS vs. MRI and nine patients with a total of 19 lesions were included in the comparison of ICEUS vs. MRI. MRI examinations were performed before TCEUS and ICEUS. The analysis was performed lesion by lesion. Sensitivity, positive predictive value (PPV) and accuracy were calculated and compared., Results: On comparing TCEUS with MRI, sensitivity differed significantly, with values of 87% and 100%, respectively (p value < 0.05), but there was no significant difference in PPV and accuracy. The comparison of ICEUS with MRI, however, showed no significant difference in sensitivity, PPV or accuracy., Conclusions: Transabdominal and intraoperative contrast-enhanced ultrasound have no added value in the preoperative evaluation of patients with CRLM undergoing extensive gadobenate dimeglumine liver MRI.

Multi-detector computed tomography is today the workhorse in the evaluation of the vast majority of patients with known or suspected liver disease. Reasons for that include widespread availability, robustness and repeatability of the technique, time-efficient image acquisitions of large body volumes, high temporal and spatial resolution as well as multiple post-processing capabilities. However, as the technique employs ionizing radiation and intravenous iodine-based contrast media, the associated potential risks have to be taken into account. In this review article, liver protocols in clinical practice are discussed with emphasis on optimisation strategies. Furthermore, recent developments such as perfusion CT and dual-energy CT and their applications are presented. [ABSTRACT FROM AUTHOR]