Search

Purpose: To evaluate Gd-EOB-DTPA-enhanced magnetic resonance (MR) performance during dynamic (DYN) phases, hepatobiliary (HB) phase and diffusion-weighted imaging (DWI) compared with pathological findings in patients undergoing orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) associated with different conditions, such as stage of chronic liver disease, histological grading, nodule size, and occurrence of previous treatments., Methods: Retrospective analysis of 64 nodules reported as HCC at pathological analysis on 28 explanted livers, examined about 3 months before OLT using a 1.5 T device and 16 channels array after intravenous GD-EOB-DTPA injection. Lesions features and hepatic functional values were recorded for each patient. Two radiologists performed in consensus the analysis of nodules on DYN, HB, and DWI. MR findings were compared with those of pathological anatomy. Diagnostic indicators were calculated for each technique., Results: DYN and HB showed no statistically significant difference in sensitivity (88% and 98%, respectively), diagnostic accuracy (90.6% and 99.9%), and specificity (both 100%), for all Child-Pugh scores, gradings, sizes, and presence or absence of previous treatments. DWI had a statistically significant lower sensitivity compared to DYN (p = 0.001) and HB (p < 0.0001); its sensitivity was significantly inferior for Child-Pugh Class B nodules than for Child-Pugh Class A ones (p = 0.00005). DWI sensitivity presented a significant increase (p = 0.03) with grading and presence of previous treatments (p = 0.0006). ADC values showed no statistically significant changes with Child-Pugh score, grading and nodules size; statistically significant increase was instead found for treated vs. untreated nodules (p = 0.016)., Conclusions: In a multiparametric HCC MRI assessment, DYN and HB play the leading role, with DWI faring acceptably well for Child-Pugh Class A nodules and treated ones.

Purpose: This study was conducted to evaluate the role and clinical impact of dynamic magnetic resonance imaging (MRI) in the diagnosis and follow-up of acute pyelonephritis (APN)., Materials and Methods: We retrospectively reviewed 442 consecutive renal MRI examinations (279 diagnostic and 163 follow-up) performed in 285 patients (mean age 42.17 years), 35 of whom were kidney transplant recipients with a clinical suspicion of APN., Results: MRI showed signal abnormalities suggestive of APN in 125/244 (51.2%) patients with native kidneys. Except for two examinations performed without paramagnetic contrast material, the inflammatory foci appeared as areas of nonenhancement: single in 39/123 cases, multiple in 84/123, unilateral in 60/84 and bilateral in 24/84. Abscesses were present in 40/123 (32.5%) positive cases. During follow-up, we observed complete normalisation of MRI signs in 86/103 patients; 17/103 (16.5%) cases evolved into fibrosis and scarring. In 15/35 (42.8%) patients with transplanted kidney, MRI was positive for APN., Conclusions: Renal MRI is an effective tool for the diagnosis and follow-up of APN both in patients not at risk and those at higher risk, such as those with a transplanted kidney. The high costs of the examination are offset by better treatment planning and early complication detection.

Both traditional exams (rectal exploration, rectoscopy, barium enema, CEA) and advanced imaging (31 US, 40 CT and 11 MR) were performed for preoperative evaluation of rectal carcinoma in order to assess the accuracy of radiological imaging in the T and N staging. The results obtained have not been considered satisfactory and it is felt that US, CT and MR should not be employed routinely for rectal staging. Indeed accuracy of US, CT and MR is respectively 64%, 75% and 81% in the T evaluation and 64%, 70% and 64% in the N staging. In order to evaluate the effective usefulness of these three latter imaging techniques a double therapeutical choice was proposed. The first treatment option was suggested on the basis of traditional staging while a second choice was given considering US, TC and MR data also. Operatory findings subsequently allowed a definitive judgement on the influence of the different techniques on treatment selection. US has furnished useful data that could have allowed us to modify treatment in one case while in 5 other cases diagnostic error would have influenced treatment negatively. CT was useful in 5 cases while in 7 cases it would have influenced treatment choice negatively. MR would have been useful in one case and harmful in another. It is concluded that only patients with large neoplasms (stages T3 and T4) benefit from CT and MR staging with the exception of those cases that have tumors above the peritoneal fold or in strict relation with the sphincter structures. US was useful only in evaluating relations of neoplasms of the anterior rectal wall with nearby pelvic structures.