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To distinguish MR features according to different proportions of the histopathological hepatocellular carcinoma (HCC) component and to investigate whether the proportion of the HCC component can predict the prognosis of patients with cHCC-CCA.The study enrolled 106 cHCC-CCA patients confirmed by histopathology. The MR imaging features and clinicopathological findings were retrospectively evaluated and compared between two subgroups with different proportions of the HCC component. The recurrence-free survival (RFS) and overall survival (OS) were evaluated using Kaplan-Meier survival curves and compared using the log-rank test. Moreover, whether the proportion of the HCC component was a predictor of RFS and OS was investigated using Cox regression analyses.The Liver Imaging Reporting and Data System (LI-RADS) category 4/5 was more prevalent in cHCC-CCAs with an HCC component50% (odds ratio (OR) = 5.559, p = 0.018), 70% (OR = 4.031, p = 0.008), and 90% (OR = 6.282, p = 0.012) than in those with an HCC component ≤ 50%, 70%, and 90%, respectively. In addition, cHCC-CCAs with an HCC component70% (HR: 0.241, p = 0.023) had a better OS prognosis than those with an HCC component ≤ 70%.cHCC-CCAs categorized as LR-4/5 are mainly composed of HCC component, and cHCC-CCAs with an HCC component70% are associated with better OS than those with an HCC component ≤ 70%. These findings suggest that the proportion of HCC or CCA component can predict the prognosis of cHCC-CCA patients.• cHCC-CCAs categorized as LR-4/5 are mainly composed of HCC component. • cHCC-CCAs with an HCC component70% are associated with better OS than those with an HCC component ≤ 70%.

The clinical utility of Dixon water-fat separation coronary MR angiography (CMRA) with compressed sensing (CS) reconstruction has not been determined in a patient population. This study was designed to evaluate the performance of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA sequence in vitro and in vivo.In vitro phantom MRI, we compared key parameters of the SENSE and CS images. And in this prospective in vivo study, from November 2019 to October 2020, 94 participants were recruited for 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA. The accuracy of CMRA for detecting a ≥ 50% reduction in diameter was determined using X-ray coronary angiography (CA) as the reference method.Compared with SENSE, CS with an appropriate acceleration factor offers both higher SNR/CNR (p0.05) and a shortened acquisition. Fifty-eight patients successfully completed the CMRA and CA. The sensitivity, specificity, positive predictive values, negative predictive values, and accuracy of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA according to a patient-based analysis were 96.4%, 66.7%, 73.0%, 95.2% and 81.0%, respectively. The area under the receiver-operator characteristic (ROC) curve (AUC) of 3.0 T non-contrast-enhanced Dixon water-fat separation CS whole-heart CMRA for detecting significant coronary artery stenosis is 0.908, 0.895, and 0.904 in patient-, vessel-, and segment-based analyses respectively.3.0 T non-contrast-enhanced Dixon water-fat separation whole-heart CMRA using appropriate CS is a promising noninvasive and radiation-free technique to detect clinically significant coronary stenosis on patients with suspected CAD.

To investigate whether pre-treatment contrast-enhanced MRI could predict the therapeutic response of systemic treatment in advanced intrahepatic cholangiocarcinoma (ICC).This retrospective study enrolled 61 ICC participants with contrast-enhanced MRI before combined systemic therapy. Clinical characteristics and MRI features were compared between patients with and without therapeutic response by univariate and multivariate logistic regression analyses. Then, a combined MRI-based model and the nomogram were established based on the results of the multivariate analysis. The diagnostic performances of significant findings and the combined model were evaluated and compared. The progression-free survival (PFS) rates between patients with high and low combined index values were compared.Thirty (49.18%) patients showed overall response after therapy. In multivariate analysis, tumor margin (odds ratio (OR) = 5.004, p = 0.014), T2 homogeneity (OR = 14.93, p = 0.019), and arterial peritumoral enhancement (OR = 5.076, p = 0.042) were independent predictive factors associated with therapeutic response. The C-index with the formulated nomogram incorporating the three independent imaging features was 0.828 (95% CI 0.710-0.913). Diagnostic characteristics of the combined index were superior to any single feature alone (p = 0.0007-0.0141). ICCs with high combined index values showed higher PFS rates than those with low values (χPre-treatment contrast-enhanced MRI can be used to predict therapeutic response in advanced ICC with systemic therapy. The combination model incorporating significant MRI features achieved an improved predictive value, which may play an important role in identifying appropriate therapeutic candidates.• Contrast-enhanced MRI can predict response of systemic therapy in advanced ICC. • MRI features of tumor margin, T2 homogeneity, and arterial peritumoral enhancement are related to therapeutic response. • The combined MRI-based model may help to identify appropriate therapeutic candidates.

OBJECTIVES This study valued MR delayed enhancement pattern in predicting postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma (IMCC). METHODS From 2011 to 2015, 231 patients of IMCC underwent DCE-MRI preoperatively. Enhancement patterns and MRI characteristics were evaluated. Recurrence and mortality data were compared among IMCCs with different enhancement patterns. Prognostic factor analysis was performed using preoperative and postoperative clinical-pathologic factors, as well as imaging findings. RESULTS Fifty-six (24.2%), 142 (61.5%) and 33 (14.3%) tumors showed hypo, peripheral rim and diffuse hyper enhancement in AP. Fifty-six (24.2%), 81 (35.1%) and 94 (40.7%) tumors showed hypo, heterogeneous and uniform enhancement in DP. Patients with arterial diffuse hyper enhancement or delayed uniform enhancement IMCCs had lower preoperative CA19-9 levels, smaller tumor sizes and minor operations than the rest patients (p

To investigate the clinical feasibility of single-breath-hold (SBH) T2-weighted (T2WI) liver MRI with deep learning-based reconstruction in the evaluation of image quality and lesion delineation, compared with conventional multi-breath-hold (MBH) T2WI.One hundred and fifty-two adult patients with suspected liver disease were prospectively enrolled. Two independent readers reviewed images acquired with conventional MBH-T2WI and SBH-T2WI at 3.0 T MR scanner. For image quality analyses, motion artifacts scores and boundary sharpness scores were compared using nonparametric Wilcoxon matched pairs tests between MBH-T2WI and SBH-T2WI. With the reference standard, 89 patients with 376 index lesions were included for lesion analyses. The lesion detection rates were compared by chi-square test, the lesion conspicuity scores and lesion-liver contrast ratio (CR) were compared using nonparametric Wilcoxon matched pairs tests between the two sequences.For both readers, motion artifacts scores of SBH-T2WI were significantly lower than MBH-T2WI (P 0.001). Boundary sharpness scores of SBH-T2WI were significantly higher than MBH-T2WI (P 0.001). The lesion detection rates for SBH-T2WI were significantly higher than MBH-T2WI (P 0.001); the differences of lesion detection rates between the two sequences were statistically significant for small (≤ 10 mm) liver lesions (P 0.001), while not significant for larger (10 mm) lesions (P 0.05). Lesion conspicuity scores were significantly higher on SBH-T2WI than MBH-T2WI in the entire cohort as well as in both stratified subgroups of lesions ≤10 mm and 10 mm (P 0.001 for all). CRs for focal liver lesions were also significantly higher with SBH-T2WI (P 0.001).The SBH-T2WI sequence with deep-learning based reconstruction showed promising performance as it provided significantly better image quality, lesion detectability, lesion conspicuity and contrast within a single breath-hold, compared with the conventional MBH-T2WI.

Purpose: To investigate the potential of diffusion kurtosis imaging (DKI) for the assessment of renal fibrosis in chronic kidney disease (CKD), using histopathology as the reference standard. Methods: Eighty-nine CKD patients and twenty healthy volunteers were recruited in this study. DKI was performed in all participants and all CKD patients received renal biopsy. The values of mean diffusivity (MD) and mean kurtosis (MK) in the renal cortex and medulla were compared between CKD patients and healthy volunteers. The Spearman correlation coefficient was calculated to assess the relationship between MD, MK values and the estimated glomerular filtration rate (eGFR), serum creatinine (SCr), 24 h urinary protein (24 h-UPRO), histopathological fibrosis score. Results: The medullary MD values were significantly lower than cortex, while the cortical MK values were significantly lower than medulla for all participants. Renal parenchymal MD values were significantly lower in the CKD patients than healthy controls, whereas MK values were significantly higher in the CKD patients than healthy controls. In the CKD patients, the significantly negative correlation was observed between the renal parenchymal MD values and the 24 h-UPRO, SCr, histopathological fibrosis score, as well as between the renal parenchymal MK values and the eGFR, while the significantly positive correlation was found between the renal parenchymal MD values and the eGFR, as well as between the renal parenchymal MK values and the 24 h-UPRO, SCr, histopathological fibrosis score. Conclusion: DKI shows great potential in the noninvasive assessment of renal fibrosis in CKD.

Background Intramyocardial hemorrhage (IMH) within myocardial infarction (MI) is associated with major adverse cardiovascular events. Bright-blood T2*-based cardiovascular magnetic resonance (CMR) has emerged as the reference standard for non-invasive IMH detection. Despite this, the dark-blood T2*-based CMR is becoming interchangeably used with bright-blood T2*-weighted CMR in both clinical and preclinical settings for IMH detection. To date however, the relative merits of dark-blood T2*-weighted with respect to bright-blood T2*-weighted CMR for IMH characterization has not been studied. We investigated the diagnostic capacity of dark-blood T2*-weighted CMR against bright-blood T2*-weighted CMR for IMH characterization in clinical and preclinical settings. Materials and methods Hemorrhagic MI patients (n = 20) and canines (n = 11) were imaged in the acute and chronic phases at 1.5 and 3 T with dark- and bright-blood T2*-weighted CMR. Imaging characteristics (Relative signal-to-noise (SNR), Relative contrast-to-noise (CNR), IMH Extent) and diagnostic performance (sensitivity, specificity, accuracy, area-under-the-curve, and inter-observer variability) of dark-blood T2*-weighted CMR for IMH characterization were assessed relative to bright-blood T2*-weighted CMR. Results At both clinical and preclinical settings, compared to bright-blood T2*-weighted CMR, dark-blood T2*-weighted images had significantly lower SNR, CNR and reduced IMH extent (all p p Conclusion While IMH can be visible on dark-blood T2*-weighted CMR, the overall conspicuity of IMH is significantly reduced compared to that observed in bright-blood T2*-weighted images, across infarct age in clinical and preclinical settings at 1.5 and 3 T. Hence, bright-blood T2*-weighted CMR would be preferable for clinical use since dark-blood T2*-weighted CMR carries the potential to misclassify hemorrhagic MIs as non-hemorrhagic MIs.

BACKGROUND Vesical Imaging-Reporting and Data System (VI-RADS) has been shown to be effective in diagnosing muscle invasion of bladder cancer (BC) in primary patients. PURPOSE To evaluate the diagnostic efficacy of VI-RADS in a BC target population which included post-treatment patients, and to determine the repeatability. STUDY TYPE Prospective. POPULATION Seventy-three patients (42 with primary BC, 31 with post-treatment BC). FIELD STRENGTH/SEQUENCE 3.0 T MRI with propeller fast spin-echo T2 WI, echo planer imaging diffusion-weighted imaging (DWI), and dynamic contrast-enhanced imaging (DCEI). ASSESSMENT VI-RADS scores were independently assessed by five radiologists with different levels of experience. The diagnostic efficiency in each group (primary and post-treatment) and of each radiologist was assessed. STATISTICAL TESTS Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), and area under the curve (AUC) in receiver operating characteristic curve analysis were calculated to evaluate VI-RADS diagnostic performance. Interobserver agreement was assessed using weighted Kappa statistics. A P value

Objectives The 9th International Forum for Liver Magnetic Resonance Imaging (MRI) was held in Singapore in September 2019, bringing together radiologists and allied specialists to discuss the latest developments in and formulate consensus statements for liver MRI, including the applications of gadoxetic acid–enhanced imaging. Methods As at previous Liver Forums, the meeting was held over 2 days. Presentations by the faculty on days 1 and 2 and breakout group discussions on day 1 were followed by delegate voting on consensus statements presented on day 2. Presentations and discussions centered on two main meeting themes relating to the use of gadoxetic acid–enhanced MRI in primary liver cancer and metastatic liver disease. Results and conclusions Gadoxetic acid–enhanced MRI offers the ability to monitor response to systemic therapy and to assist in pre-surgical/pre-interventional planning in liver metastases. In hepatocellular carcinoma, gadoxetic acid–enhanced MRI provides precise staging information for accurate treatment decision-making and follow-up post therapy. Gadoxetic acid–enhanced MRI also has potential, currently investigational, indications for the functional assessment of the liver and the biliary system. Additional voting sessions at the Liver Forum debated the role of multidisciplinary care in the management of patients with liver disease, evidence to support the use of abbreviated imaging protocols, and the importance of standardizing nomenclature in international guidelines in order to increase the sharing of scientific data and improve the communication between centers. Key Points • Gadoxetic acid–enhanced MRI is the preferred imaging method for pre-surgical or pre-interventional planning for liver metastases after systemic therapy. • Gadoxetic acid–enhanced MRI provides accurate staging of HCC before and after treatment with locoregional/biologic therapies. • Abbreviated protocols for gadoxetic acid–enhanced MRI offer potential time and cost savings, but more evidence is necessary. The use of gadoxetic acid–enhanced MRI for the assessment of liver and biliary function is under active investigation.

To compare the difference of evaluating the microcirculatory function status of primary small HCC between DCE-MRI with two-compartmental pharmacokinetic model and IVIM-DWI. 27 patients (22 men, 5 women; mean age, 49 years; range 36–65 years) with primary single sHCC who underwent IVIM-DWI and DCE–MRI before the operation were included in this retrospective study. The MR perfusion parameters are Ktrans, Ve, Kep, D, D* and f. Pathological results include pathological grade (low grade ≤ II, high grade > II) and MVD. The perfusion parameters and pathological results of sHCC were analyzed and compared in their relevance, sensitivity and specificity. Statistical methods included Spearman and ROC curve analysis. The perfusion parameters (Ktrans, Kep, D*, f) were significantly positive correlated (r = 0.892, 0.808, 0.589 and 0.543, P = 0.000, 0.000, 0.001 and 0.003 with MVD of sHCC. The parameter Ve and D values were negatively correlated (r = − 0.454 and − 0.399, P = 0.017 and 0.039, respectively) with the pathological grade. Regarding the evaluation MVD of sHCC, the evaluation of the sensitivity and specificity performance was present in descending order: Ktrans > Kep > PF > D*. In the evaluation pathological grade of sHCC, the sensitivity and specificity were better by parameters D than Ve. DCE-MRI is better than IVIM-DWI for evaluation microcirculation functional status of sHCC. But for evaluating the pathological grade, IVIM-DWI is better than DCE-MRI. Combination of the two imaging techniques may provide more comprehensive evaluation in microcirculation functional status of the sHCC.

Response evaluation criteria in solid tumors (RECIST) often fail to identify clinically meaningful response to bevacizumab-containing therapy in colorectal liver metastasis (CRLM). This study aimed to develop RECIST by combining contrast-enhanced and diffusion-weighted magnetic resonance imaging (MRI). A total of 126 patients with CRLM who underwent hepatic resection after bevacizumab-containing chemotherapy were split into initial analyses cohort (N = 42, with 76 indexed liver metastases) and validation cohort (N = 84). In lesion-based analyses, percentage decrease of arterial enhancement area and percentage increase of apparent diffusion coefficient (ADC) value from baseline to post-chemotherapy were measured. Their optimal cutoff values for distinguishing pathology-confirmed major and minor response were determined. Then, the developed RECIST (D-RECIST) was established by combining functional and size-based items. Survival relevance of D-RECIST and RECIST was examined in the validation cohort. Percentage decrease of arterial enhancement area and increase of ADC value significantly differed between lesions of pathologic major or minor response, with optimal cutoffs of approximately 33% and 19%, respectively. Patients defined as responders by D-RECIST had a significantly longer median disease-free survival (DFS) than non-responders (p = 0.021; 12.9 versus 8.6 months). No significant difference was observed with RECIST (p = 0.524). In a Cox regression model, D-RECIST- but not RECIST-defined responses independently predicted the DFS (p = 0.034 and 0.811). D-RECIST-defined responses provided significant prognostic information, and thus may serve as a better response evaluation approach than RECIST in CRLM treated with bevacizumab-containing therapy. • Changes in arterial enhancement area and apparent diffusion coefficient value are associated with pathological response in colorectal liver metastases treated with bevacizumab. • The MRI-based response criteria developed by combining size-based and functional features can provide significant prognostic information.

Objectives To develop radiomics-based nomograms for preoperative microvascular invasion (MVI) and recurrence-free survival (RFS) prediction in patients with solitary hepatocellular carcinoma (HCC) ≤ 5 cm. Methods Between March 2012 and September 2019, 356 patients with pathologically confirmed solitary HCC ≤ 5 cm who underwent preoperative gadoxetate disodium–enhanced MRI were retrospectively enrolled. MVI was graded as M0, M1, or M2 according to the number and distribution of invaded vessels. Radiomics features were extracted from DWI, arterial, portal venous, and hepatobiliary phase images in regions of the entire tumor, peritumoral area ≤ 10 mm, and randomly selected liver tissue. Multivariate analysis identified the independent predictors for MVI and RFS, with nomogram visualized the ultimately predictive models. Results Elevated alpha-fetoprotein, total bilirubin and radiomics values, peritumoral enhancement, and incomplete or absent capsule enhancement were independent risk factors for MVI. The AUCs of MVI nomogram reached 0.920 (95% CI: 0.861–0.979) using random forest and 0.879 (95% CI: 0.820–0.938) using logistic regression analysis in validation cohort (n = 106). With the 5-year RFS rate of 68.4%, the median RFS of MVI-positive (M2 and M1) and MVI-negative (M0) patients were 30.5 (11.9 and 40.9) and > 96.9 months (p < 0.001), respectively. Age, histologic MVI, alkaline phosphatase, and alanine aminotransferase independently predicted recurrence, yielding AUC of 0.654 (95% CI: 0.538–0.769, n = 99) in RFS validation cohort. Instead of histologic MVI, the preoperatively predicted MVI by MVI nomogram using random forest achieved comparable accuracy in MVI stratification and RFS prediction. Conclusions Preoperative radiomics-based nomogram using random forest is a potential biomarker of MVI and RFS prediction for solitary HCC ≤ 5 cm. Key Points • The radiomics score was the predominant independent predictor of MVI which was the primary independent risk factor for postoperative recurrence. • The radiomics-based nomogram using either random forest or logistic regression analysis has obtained the best preoperative prediction of MVI in HCC patients so far. • As an excellent substitute for the invasive histologic MVI, the preoperatively predicted MVI by MVI nomogram using random forest (MVI-RF) achieved comparable accuracy in MVI stratification and outcome, reinforcing the radiologic understanding of HCC angioinvasion and progression.

Assessment of microvascular invasion (MVI) in intrahepatic cholangiocarcinoma (ICC) by using a noninvasive method is an unresolved issue. Deep learning (DL) methods based on multiparametric fusion of MR images have the potential of preoperative assessment of MVI.To investigate whether a multiparametric fusion DL model based on MR images can be used for preoperative assessment of MVI in ICC.Retrospective.A total of 519 patients (200 females and 319 males) with a single ICC were categorized as a training (n = 361), validation (n = 90), and an external test cohort (n = 68).A 1.5 T and 3.0 T; axial T2-weighted turbo spin-echo sequence, diffusion-weighted imaging with a single-shot spin-echo planar sequence, and dynamic contrast-enhanced (DCE) imaging with T1-weighted three-dimensional quick spoiled gradient echo sequence.DL models of multiparametric fusion convolutional neural network (CNN) and late fusion CNN were both constructed for evaluating MVI in ICC. Gradient-weighted class activation mapping was used for visual interpretation of MVI status in ICC.The DL model performance was assessed through the receiver operating characteristic curve (ROC) analysis, and the area under the ROC curve (AUC) with the accuracy, sensitivity, and specificity were measured. P value lt; 0.05 was considered as statistical significance.In the external test cohort, the proposed multiparametric fusion DL model achieved an AUC of 0.888 with an accuracy of 86.8%, sensitivity of 85.7%, and specificity of 87.0% for evaluating MVI in ICC, and the positive predictive value and negative predictive value were 63.2% and 95.9%, respectively. The late fusion DL model achieved a lower AUC of 0.866, with an accuracy of 83.8%, sensitivity of 78.6%, specificity of 85.2% for evaluating MVI in ICC.Our DL model based on multiparametric fusion of MRI achieved a good diagnostic performance in the evaluation of MVI in ICC.3 TECHNICAL EFFICACY: Stage 2.

Objectives: To evaluate the performance of a deep learning-based method to automatically quantify left ventricular (LV) function from MR images in different cardiomyopathy. Methods: This retrospective study included MRI data sets from 2013 to 2020. Data on left ventricular function from patients with hypertrophic cardiomyopathy (HCM), patients with dilated cardiomyopathy (DCM), and healthy participants were analyzed. MRI data from a total of 388 patients were measured manually and automatically.The performance of Convolutional Neural Networks (CNNs) was evaluated based on the manual notes of two experienced observers: (a) LV segmentation accuracy, and (b) LV functional parameter accuracy. Bland-Altman analysis, Receiver operating Characteristic (ROC) curve analysis and Pearson correlation analysis were used to evaluate the consistency between fully automatic and manual diagnosis of HCM and DCM. Results: The deep-learning CNN performed best in HCM in evaluating LV function and worst in DCM. Compared with manual analysis, four parameters of LV function in the HCM group showed high correlation (r at least >0.901), and the correlation of DCM in all parameters was weaker than that of HCM, especially EF (r2 = 0.776) and SV (r2 = 0.645). ROC curve analysis indicated that at the optimal cut-off value, EF from automatic segmentation identified DCM and HCM patients with sensitivity of 92.31 and 78.05%, specificity of 82.96 and 54.07%, respectively. Conclusion: Among different heart diseases, the analysis of cardiac function based on deep-learning CNN may have different performances, with DCM performing the worst and HCM the best and thus, special attention should be paid to DCM patients when assessing LV function through artificial intelligence method. LV function parameter obtained by artificial intelligence method may play an important role in the future AI diagnosis of HCM and DCM. Advances in knowledge: These data for the first time objectively evaluate the performance of a commercially available deep learning-based method in cardiac function evaluation of different cardiomyopathy and point out its advantages and disadvantages in different cardiomyopathy. This work did not attempt to design the algorithm itself, but rather applied an already existing method to a test dataset of clinical data and evaluated the results for a limited number of cardiomyopathy.

Recently, a prototype 5.0 T whole-body MRI scanner was developed. A 5.0 T diffusion-weighted imaging (DWI) may help overcome the issues that limit 3.0 T DWI.To evaluate the feasibility of 5.0 T high-field DWI in the upper abdomen and assess the agreement of the apparent diffusion coefficient (ADC) with that from 3.0 T abdominal DWI.Prospective proof of concept.Nine volunteers (mean ± SD age: 37.3 ± 7.0 years, 8 M), eight healthy and one with liver and kidney cysts.3.0 T and 5.0 T; respiratory-triggered spin-echo echo-planar-imaging (SE-EPI)-based DWI sequence.Subjective image quality scores. The ADC values in abdominal organs (liver, pancreas, spleen, and kidney) were measured by two observers for evaluating the interobserver and interfield agreement.Wilcoxon-rank sum test, Bland-Altman analysis, intraclass correlation coefficients (ICCs), and coefficients of variation (CVs).The 5.0 T DWI displayed an increase in subjective image quality score compared to 3.0 T DWI without the significant difference (3.0 T DWI: 3.50 ± 0.47, 5.0 T DWI: 3.72 ± 0.42, P = 0.157). Both the interfield and interobserver agreements of ADC values were substantial to excellent (ICCs = 0.640-0.902). For all four upper abdominal organs, there were no significant differences between the ADC values measured by two observers and between the ADC values of 3.0 T and 5.0 T DWI (P = 0.134-1.000). The CVs of ADC measurements from 3.0 T and 5.0 T DWI were all less than 15.0% (6.7%-14.2%).The substantial to excellent agreements between the ADC values measured with 3.0 T and 5.0 T DWI for liver, pancreas, spleen, and kidney suggested that 5.0 T DWI can be applied for abdominal imaging. The ADC values from 5.0 T abdominal DWI hold the potential to serve as the quantitative markers for clinical investigations.2 TECHNICAL EFFICACY: Stage 1.

To investigate the impact of preoperative gadoxetate disodium (EOB) MRI-based radiomics on predicting glypican 3 (GPC3)-positive expression and the relevant recurrence-free survival (RFS) of HCC ≤ 5 cm.Between January 2014 and October 2018, 259 patients with solitary HCC ≤ 5 cm who underwent hepatectomy and preoperative EOB-MRI were retrieved. Multivariate logistic regression was implemented to identify independent predictors for GPC3. By combining five feature selection strategies and three classifiers, 15 GPC3-oriented radiomics models could be constructed, the best of which with independent clinicoradiologic predictors was integrated into the comprehensive nomogram.GPC3 was an independent risk factor of postoperative recrudescence for HCC. Alpha-fetoprotein20 ng/mL, homogenous T2 signal and hypointensity on hepatobiliary phase were independently related to GPC3-positive expression in the clinicoradiologic model. With 10 features selected by support vector machines-recursive feature elimination, logistic regression-based classifier achieved the best performance among 15 radiomics models. After five-fold cross-validation, our comprehensive nomogram acquired better average area under receiver operating characteristic curves (training and validation cohorts: 0.931 vs. 0.943) than the clinicoradiologic algorithm (0.738 vs. 0.739) and the optimal radiomics model (0.943 vs. 0.931). Net reclassification indexes further demonstrated the superiority of GPC3 nomogram over clinicoradiologic and radiomics algorithms (46.54%, p0.001; 7.84%, p = 0.207). Meanwhile, higher radiomics score significantly shortened the median RFS (from77.9 to 48.2 months, p = 0.044), which was analogue to that of the histological GPC3-positive phenotype (from73.9 to 43.2 months, p0.001).Preoperative EOB-MRI radiomics-based nomogram satisfactorily distinguished GPC3 status and outcomes of solitary HCC ≤ 5 cm.

BACKGROUND Oxaliplatin-induced liver injury (OILI) not only impairs hepatic regeneration but also increases postoperative morbidity and mortality. Therefore, noninvasive, accurate, and early diagnosis of OILI is mandatory. PURPOSE To evaluate the potential of T1 mapping on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI for assessing OILI in a mouse model. STUDY TYPE Case control, animal model. ANIMAL MODEL Thirty oxaliplatin-treated mice and 10 control mice were included. FIELD STRENGTH Volumetric interpolated breath-hold examination sequence: 3T scanner with a phased-array animal 8-channel coil. T1 mapping before and at hepatobiliary phase (HBP) after injection of Gd-EOB-DTPA were undertaken. ASSESSMENT T1 relaxation times of the liver parenchyma were measured and the reduction rate (ΔT1 %) was calculated. Histological findings were used as a standard reference. STATISTICAL TESTS The Kruskal-Wallis test with pairwise comparisons using the Mann-Whitney U-test were applied to compare the parameters across groups. Spearman's rank correlation test and receiver operating characteristics (ROC) analyses were performed. Areas under the curves (AUCs) were compared using the DeLong method. RESULTS Histologically, mice were classified as normal (n = 10), hepatocellular degeneration without fibrosis (n = 16), and hepatocellular degeneration with fibrosis (n = 14). HBP T1 relaxation time increased with the severity of OILI (rho = 0.60, P

PURPOSE: We aimed to evaluate which morphologic features on magnetic resonance imaging (MRI) could predict the progression of pancreatic cystic lesions (PCLs) that are suitable for follow-up. METHODS: A total of 2176 MRI findings of PCLs were retrospectively reviewed between January 2009 and December 2016. The study population was composed of 223 patients. Clinical data and morphologic features of PCLs were recorded. We divided the individuals into two sub-groups according to the final features on MRI. Univariable and multivariable regression analyses were performed to identify independent risk factors for progression of PCLs. RESULTS: A total of 84 PCLs (37.7%) progressed during follow-up, while 139 PCLs (62.3%) were stable. Age (odds ratio [OR], 1.042; P = 0.017), number of lesions (OR, 0.491; P = 0.048), communication to pancreatic duct (PD) (OR, 2.425; P = 0.007) and presence of septa (OR, 6.105; P < 0.001) were significant independent factors for progression of PCLs. Among 84 lesions that progressed, 23 lesions (27.4%) increased to ≥ 30 mm in diameter or showed worrisome imaging features at the end of follow-up that needed clinical intervention. The initial size and communication to PD were independent factors for progression of PCLs necessitating clinical intervention (P < 0.001 and P = 0.011, respectively). CONCLUSION: Age, number of the lesions, communication to PD and presence of septa were independent risk factors for the progression of PCLs, and the initial size and communication to PD could potentially predict PCLs needing clinical interventions.

Background Myocardial strain for assessment of hypertrophic cardiomyopathy (HCM) is of importance and may play a role in identifying obstruction in HCM patients. Purpose To evaluate the utility of myocardial strain for detecting left ventricular (LV) outflow tract (LVOT) obstruction in HCM patients based on magnetic resonance tissue tracking. Study type Retrospective. Population In all, 44 adult HCM patients with LVOT obstruction and 108 adult HCM patients without LVOT obstruction. Field strength/sequence 1.5 T; Steady-state free-precession cine sequence; phase-sensitive inversion-prepared segmented gradient echo sequence for late gadolinium enhancement (LGE) imaging. Assessment Strain parameters including the local and global levels of LV myocardium and the subtraction (Sub) of myocardial strain variables between interventricular septal segments (IVSS) and noninterventricular septal segments (NIVSS) were measured for differentiating HCM with obstruction from nonobstruction. Average and maximum LV wall thickness (Average and Maximum LVWT) were also analyzed. Statistical tests Univariate and multivariate logistic regression analysis, area under the receiver operating characteristic (ROC) curve (AUC), intraclass correlation coefficient. Results In multivariate analysis, Average LVWT, Maximum LVWT, and the subtraction of radial peak strain (Sub Radial PS) between NIVSS and IVSS were independently associated with LVOT obstruction. The AUCs were 0.731, 0.840, and 0.890 for Average LVWT, Maximum LVWT, and Sub Radial PS, respectively. Sub Radial PS (cutoff value: 8.1%) demonstrated the highest sensitivity of 75.0% and a high specificity of 87.9% for identifying LVOT; Maximum LVWT (cutoff value: 22.9 mm) showed good sensitivity (72.7%) and specificity (83.3%). Combining Maximum LVWT >22.9 mm and Sub Radial PS > 8.1% achieved a better diagnostic performance (specificity 95.4%, sensitivity 70.5%). Data conclusion Combining Maximum LVWT >22.9 mm and Sub Radial PS >8.1% holds promise for objectively evaluating LVOT obstruction in HCM patients with very high specificity and acceptable sensitivity. Level of evidence 3 TECHNICAL EFFICACY STAGE: 2.

To investigate the relationship between imaging findings and S100A4 overexpression in pancreatic ductal adenocarcinoma (PDAC) and to determine imaging biomarkers of S100A4 overexpression from whole-tumor evaluation with MRI and texture analysis. A total of 60 patients with pathologically confirmed PDAC were included in the study. All patients underwent preoperative abdominal contrast-enhanced MRI examination with Magnetom Aera (Siemens Healthcare, Germany, 1.5 T) at our institute. Whole-tumor evaluation including texture analysis was performed. Sections of specimens were reviewed, and the S100A4 expression status was quantitatively evaluated. Univariate and multivariate logistic regression analyses were conducted to find imaging biomarkers that could predict S100A4 overexpression. Twenty-four tumors (40.0%) had negative results for S100A4 overexpression, and 36 tumors (60.0%) exhibited overexpression. After univariate and multivariate analysis, distal pancreatic duct dilatation, T1WI_10th percentile and the enhancement rate difference between delayed phase (DP) and portal venous phase (PVP) were identified to predict S100A4 overexpression in PDAC independently (p = 0.009, 0.012 and 0.044), with odds ratios (ORs) of 0.102, 0.139 and 4.645, respectively. The area under the ROC curve (AUC) values were 0.715, 0.707 and 0.691. The AUC value of the proposed model was 0.877 with a sensitivity of 80.6% and specificity of 75.0%. A model including distal pancreatic duct dilatation, T1WI_10th percentile and the enhancement rate difference between the DP and PVP could predict S100A4 overexpression in PDAC as imaging biomarkers.

Background The presence of microvascular invasion (MVI) in intrahepatic cholangiocarcinoma (ICC) is a significant adverse prognostic factor. This study sought to investigate the correlation between preoperative imaging parameters and MVI in ICC. Methods A total of 108 patients with surgically resected single ICC tumors (34 MVI-positive and 74 MVI-negative lesions) who underwent MRI examination, including T1WI, T2WI, DWI, and dynamic enhancement imaging, were enrolled in this retrospective study. The following qualitative and quantitative characteristics were evaluated: tumor morphology, signal features on T1WI and T2WI, intrahepatic duct dilatation, hepatic capsule retraction, target sign on DWI, dynamic enhancement pattern, arterial phase enhancement pattern, dot−/band-like enhancement inside the tumor, visible vessel penetration inside the tumor (hepatic artery, portal vein, or hepatic vein), integrity of the enhancement edge of the arterial phase, peripheral hepatic enhancement, tumor size, maximum enhancement edge thickness, arterial edge enhancement ratio, and delayed phase enhancement ratio. Other clinicopathological features were also used to predict and evaluate MVI in ICC. Chi-square test, Fisher’s exact test, and independent t-test were used for univariate analysis to determine the relationships among the presence of MVI and these MR parameters. Logistic regression analysis was used to identify predictors of MVI among these MR parameters. Results Among MRI characteristics, tumor morphology, intrahepatic duct dilatation, arterial phase enhancement pattern, visible hepatic artery penetration sign, maximum diameter of the tumor and the arterial phase edge enhancement ratio were correlated with MVI (P = 0.007, 0.003, 0.008, 0.000, 0.003, and 0.002, respectively). Furthermore, higher CA19–9 levels (≥37 U/ml) and pathological tumor grade III were also related to MVI (P = 0.014 and 0.004, respectively). However, multivariate logistic regression analysis demonstrated that none of the parameters were independent risk factors for the diagnosis of MVI in ICCs. Conclusion For the preoperative prediction of MVI in ICC, six qualitative and quantitative data obtained on preoperative MRI, as well as one tumorigenic marker and the pathological tumor grade, were statistically significant. More research is needed to identify MR characteristics that can be used as independent risk factors.

Background Cardiac magnetic resonance (MR) has become an essential diagnostic imaging modality in cardiovascular disease. However, the insufficient image quality of traditional breath-hold (BH) T2-weighted (T2W) imaging may compromise its diagnostic accuracy. Purpose To assess the efficacy of the BLADE technique to reduce motion artifacts and improve the image quality. Material and Methods Free-breathing TSE-T2W imaging sequence with cartesian and BLADE k-space trajectory were acquired in 20 patients. Thirty patients underwent conventional BH turbo spin-echo (TSE) T2W imaging and free-breathing BLADE T2W (FB BLADE-T2W) imaging. Twenty-one patients who had a signal loss of myocardium in BH short-axis T2W turbo inversion recovery (TSE-T2W-TIR) were scanned using free-breathing BLADE T2W turbo inversion recovery (BLADE TSE-T2W-TIR). The overall image quality, blood nulling, and visualization of the heart were scored on a 5-point Likert scale. The signal loss of myocardium, incomplete fat suppression near the myocardium, and the streaking or ghosting artifacts were noted in T2W-TIR sequences additionally. Results The overall imaging quality, blood nulling, and the visualization of heart structure of FB BLADE-T2W imaging sequence were significantly better than those of FB T2W imaging with Cartesian k-space trajectory and BH TSE-T2W imaging sequence ( PConclusions FB BLADE T2W imaging provides improved myocardial visibility, less motion sensitivity, and better image quality. It may be applied in patients who have poor breath-holding capability.

We aimed to develop a radiomics-based model derived from gadoxetic acid–enhanced MR images to preoperatively identify cytokeratin (CK) 19 status of hepatocellular carcinoma (HCC). A cohort of 227 patients with single HCC was classified into a training set (n = 159) and a time-independent validated set (n = 68). A total of 647 radiomic features were extracted from multi-sequence MR images. The least absolute shrinkage and selection operator regression and decision tree methods were utilized for feature selection and radiomics signature construction. A multivariable logistic regression model incorporating clinico-radiological features and the fusion radiomics signature was built for prediction of CK19 status by evaluating area under curve (AUC). In the whole cohort, 57 patients were CK19 positive and 170 patients were CK19 negative. By combining 11 and 6 radiomic features extracted in arterial phase and hepatobiliary phase images, respectively, a fusion radiomics signature achieved AUCs of 0.951 and 0.822 in training and validation datasets. The final combined model integrated a-fetoprotein levels, arterial rim enhancement pattern, irregular tumor margin, and the fusion radiomics signature, with a sensitivity of 0.818 and specificity of 0.974 in the training cohort and that of 0.769 and 0.818 in the validated cohort. The nomogram based on the combined model showed satisfactory prediction performance in training (C-index 0.959) and validation (C-index 0.846) dataset. The combined model based on a fusion radiomics signature derived from arterial and hepatobiliary phase images of gadoxetic acid–enhanced MRI can be a reliable biomarker for CK19 status of HCC. • Arterial rim enhancement pattern and irregular tumor margin on hepatobiliary phase on gadoxetic acid–enhanced MRI can be useful for evaluating CK19 status of HCC. • A radiomics-based model performed better than the clinico-radiological model both in training and validation datasets for predicting CK19 status of HCC. • The nomogram based on the fusion radiomics signature can be easily used for CK19 stratification of HCC.

To evaluate the role of perfusion parameters with MR imaging of the liver in diagnosing MVI in hepatocellular carcinoma (HCC) (between 1 and 5 cm).This retrospective study was approved by the institutional review board. In 80 patients with 43 MVI( +) and 42 MVI( -) HCC, whole-liver perfusion MR imaging with Cartesian k-space undersampling and compressed sensing reconstruction was performed after injection of 0.1 mmol/kg gadopentetate dimeglumine. Parameters derived from a dual-input single-compartment model of arterial flow (Fa), portal venous flow (Fp), total blood flow (Ft = Fa + Fp), arterial fraction (ART), distribution volume (DV), and mean transit time (MTT) were measured. The significant parameters between the two groups were included to correlate with the presence of MVI at simple and multiple regression analysis.In MVI-positive HCC, Fp was significantly higher than in MVI-negative HCC, whereas the reverse was seen for ART (p 0.001). Tumor size (β = 1.2, p = 0.004; odds ratio, 3.20; 95% CI 1.45, 7.06), Fp (β = 1.1, p = 0.004; odds ratio, 3.09; 95% CI 1.42, 6.72), and ART (β = - 3.1, p = 0.001; odds ratio, 12.13; 95% CI 2.85, 51.49) were independent risk factors for MVI. The AUC value of the combination of all three metrics was 0.931 (95% CI 0.855, 0.975), with sensitivity of 97.6% and specificity of 76.2%.The combination of Fp, ART, and tumor size demonstrated a higher diagnostic accuracy compared with each parameter used individually when evaluating MVI in HCC (between 1 and 5 cm).

Hepatocellular carcinoma (HCC) is the most common liver cancer worldwide, and early recurrence of HCC after curative hepatic resection is indicative of poor prognoses. We aim to develop a predictive model for postoperative early recurrence of HCC based on deep and radiomics features from multi-phasic magnetic resonance imaging (MRI).A total of 472 HCC patients were included and divided into the training (n = 378) and validation (n = 94) cohorts in the retrospective study. We separately extracted radiomics features and deep features from eight phases of gadoxetic acid-enhanced MRI and utilized the least absolute shrinkage and selection operator logistic regression algorithm for feature selection and model construction. We integrated the selected two types of features into a combined model and established a radiomics model as well as a deep learning (DL) model for comparison.In the training and validation cohorts, the combined model demonstrated better performance for stratifying patients at high risk of early recurrence (AUC of 0.911 and 0.840, accuracy of 0.779 and 0.777, sensitivity of 0.927 and 0.769, specificity 0.720 and 0.779) than the radiomics model (AUC of 0.740 and 0.780) and the DL model (AUC of 0.887 and 0.813).The combined model integrating deep and radiomics features from multi-phasic MRI is efficient for noninvasively stratifying patients at high risk of early HCC recurrence after resection.

Changwu Zhou,1,2,&ast; Xiaoyan Ni,2,&ast; Xin Lu,2 Yi Wang,2 Xianling Qian,2 Chun Yang,2 Mengsu Zeng1,2 1Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China; 2Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Chun YangDepartment of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of ChinaTel +86 18702135336Email dryangchun@hotmail.comMengsu ZengShanghai Institute of Medical Imaging, Shanghai, People’s Republic of ChinaTel +86 13501922963Email zeng.mengsu@zs-hospital.sh.cnPurpose: To investigate the significance of MR features based on the Liver Imaging Reporting and Data System (LI-RADS ver. 2018) for identifying the expression of cytokeratin 19 (CK-19) in patients with combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA) before surgery.Patients and Methods: The study enrolled 174 patients pathologically confirmed to have cHCC-CCA according to the 2019 WHO classification. The preoperative MR imaging features and clinicopathological findings were retrospectively evaluated and compared between the CK-19-positive and CK-19-negative cHCC-CCA groups.Results: One hundred seventy-four patients (mean age, males vs females: 56.6 ± 10.0 years vs 54.7 ± 14.2 years) were evaluated. The presence of mosaic architecture, targetoid appearance, cholangiectasis, hepatic capsule retraction, and corona enhancement was significantly higher in the CK-19-positive group (all p < 0.05), while nonrim arterial phase hyperenhancement (APHE) was more common in the CK-19-negative group (p = 0.04). The univariate analysis showed that hepatitis B virus infection, CEA > 5 ng/mL, tumor size, nonrim APHE, mosaic architecture, targetoid appearance, cholangiectasis, hepatic capsule retraction, and corona enhancement were significant risk factors for CK-19-positive cHCC-CCA (all p < 0.05). Unfortunately, the multivariate analysis revealed that only corona enhancement (OR = 2.359, p = 0.03) was an independent risk factor associated with CK-19-positive cHCC-CCA.Conclusion: Corona enhancement is significantly correlated with CK-19 positivity in patients with cHCC-CCA.Keywords: liver neoplasms, magnetic resonance imaging, cytokeratin 19

Rationale and Objectives Combined immune and anti-angiogenic treatment has shown promising results for unresectable hepatocellular carcinoma (HCC), but with a high risk of early progression. In this study, we aimed to investigate whether pre-treatment magnetic resonance imaging (MRI) features and MRI-based nomogram could predict the risk of disease progression of unresectable HCC after first-line lenvatinib/anti-PD-1 antibody therapy. Materials and Methods Thirty-seven HCC participants with qualified pre-treatment contrast-enhanced MRI were enrolled. All patients received combined lenvatinib and anti-PD-1 antibody treatment. Progression free survival rate was analyzed using the Kaplan-Meier method. Potential clinical-radiological risk factors for progression were analyzed using the log-rank tests and Cox regression model. The performance of MRI-based nomogram was evaluated based on C-index, calibration, and decision curve analyses. Results The 6-month and 12-month cumulative progression free survival rates were 59.5% (95% confidence interval (CI), 43.6%-75.4%) and 48.0% (95% CI, 31.7%-64.3%). On multivariate analysis, no or incomplete tumor capsule (hazard ratio (HR) = 15.215 [95% CI 2.707-85.529], p = 0.002), heterogeneous signal on T2-weighted imaging (HR = 28.179 [95% CI 2.437-325.838]; p = 0.008) and arterial contrast-to-noise ratio ≤95.45 (HR = 5.113 [95% CI 1.538-17.00]; p = 0.008) were independent risk factors for disease progression. Satisfactory predictive performance of the nomogram incorporating the three independent imaging features was obtained with a C-index value of 0.880 (95% CI 0.824-0.937), and the combined nomogram had more favorable clinical prediction performance than any single feature. Conclusion MRI features can be considered effective predictors of disease progression for unresectable HCC with first-line lenvatinib plus anti-PD-1 antibody therapy, and the combined MRI-based nomogram achieved a superior prognostic model, which may help to identify appropriate candidates for the therapy.

Ruofan Sheng,1,2,&ast; Jing Huang,3,&ast; Weiguo Zhang,4 Kaipu Jin,1,2 Li Yang,1,2 Huanhuan Chong,1,2 Jia Fan,5,6 Jian Zhou,5,6 Dijia Wu,3 Mengsu Zeng1,2,6 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 2Shanghai Institute of Medical Imaging, Shanghai, People’s Republic of China; 3Shanghai United Imaging Intelligence Co., Ltd., Shanghai, People’s Republic of China; 4Dushuhu District, No. 1 Affiliated Hospital, Suzhou University, Suzhou, Jiangsu, People’s Republic of China; 5Department of Liver Surgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China; 6Cancer Center, Shanghai Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Mengsu ZengDepartment of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, People’s Republic of ChinaTel +86-021-64041990-2130Fax +86-021-64439906Email mengsuzeng@163.comDijia WuShanghai United Imaging Intelligence Co., Ltd., No. 2879, Longteng Boulevard, Xuhui District, Shanghai, 200232, People’s Republic of ChinaTel +86-021-67076888Fax +86-021-64439906Email dijia.wu@united-imaging.comPurpose: Liver imaging reporting and data system (LI-RADS) classification, especially the identification of LR-3 to 5 lesions with hepatocellular carcinoma (HCC) probability, is of great significance to treatment strategy determination. We aimed to develop a semi-automatic LI-RADS grading system on multiphase gadoxetic acid-enhanced MRI using deep convolutional neural networks (CNN).Patients and Methods: An internal data set of 439 patients and external data set of 71 patients with suspected HCC were included and underwent gadoxetic acid-enhanced MRI. The expert-guided LI-RADS grading system consisted of four deep 3D CNN models including a tumor segmentation model for automatic diameter estimation and three classification models of LI-RADS major features including arterial phase hyper-enhancement (APHE), washout and enhancing capsule. An end-to-end learning system comprising single deep CNN model that directly classified the LI-RADS grade was developed for comparison.Results: On internal testing set, the segmentation model reached a mean dice of 0.84, with the accuracy of mapped diameter intervals as 82.7% (95% CI: 74.4%, 91.7%). The area under the curves (AUCs) were 0.941 (95% CI: 0.914, 0.961), 0.859 (95% CI: 0.823, 0.890) and 0.712 (95% CI: 0.668, 0.754) for APHE, washout and capsule, respectively. The expert-guided system significantly outperformed the end-to-end system with a LI-RADS grading accuracy of 68.3% (95% CI: 60.8%, 76.5%) vs 55.6% (95% CI: 48.8%, 63.0%) (P< 0.0001). On external testing set, the accuracy of mapped diameter intervals was 91.5% (95% CI: 81.9%, 100.0%). The AUCs were 0.792 (95% CI: 0.745, 0.833), 0.654 (95% CI: 0.602, 0.703) and 0.658 (95% CI: 0.606, 0.707) for APHE, washout and capsule, respectively. The expert-guided system achieved an overall grading accuracy of 66.2% (95% CI: 58.0%, 75.2%), significantly higher than the end-to-end system of 50.1% (95% CI: 43.1%, 58.1%) (P< 0.0001).Conclusion: We developed a semi-automatic step-by-step expert-guided LI-RADS grading system (LR-3 to 5), superior to the conventional end-to-end learning system. This deep learning-based system may improve workflow efficiency for HCC diagnosis in clinical practice.Keywords: liver imaging reporting and data system, LI-RADS, hepatocellular carcinoma, HCC, magnetic resonance imaging, MRI, deep learning

Huanhuan Chong,1,2 Yuda Gong,3 Xianpan Pan,4 Aie Liu,4 Lei Chen,4 Chun Yang,1 Mengsu Zeng1,2,5 1Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 2Shanghai Institute of Medical Imaging, Shanghai, 200032, People’s Republic of China; 3Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, People’s Republic of China; 4Shanghai United Imaging Intelligence Co., Ltd, Shanghai, 200232, People’s Republic of China; 5Department of Medical Imaging, Shanghai Medical College, Fudan University, Shanghai, 200032, People’s Republic of ChinaCorrespondence: Mengsu Zeng; Chun YangDepartment of Radiology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai, 200032, People’s Republic of ChinaTel +86-21-13501922963; +86-21-18702135336Email mengsu_zeng@163.com; dryangchun@hotmail.comBackground: Whether peritumoral dilation radiomics can excellently predict early recrudescence (≤ 2 years) in hepatocellular carcinoma (HCC) remains unclear.Methods: Between March 2012 and June 2018, 323 pathologically confirmed HCC patients without macrovascular invasion, who underwent liver resection and preoperative gadoxetate disodium (Gd-EOB-DTPA) MRI, were consecutively recruited into this study. Multivariate logistic regression identified independent clinicoradiologic predictors of 2-year recrudescence. Peritumoral dilation (tumor and peritumoral zones within 1cm) radiomics extracted features from 7-sequence images for modeling and achieved average but robust predictive performance through 5-fold cross validation. Independent clinicoradiologic predictors were then incorporated with the radiomics model for constructing a comprehensive nomogram. The predictive discrimination was quantified with the area under the receiver operating characteristic curve (AUC) and net reclassification improvement (NRI).Results: With the median recurrence-free survival (RFS) reaching 60.43 months, 28.2% (91/323) and 16.4% (53/323) patients suffered from early and delay relapse, respectively. Microvascular invasion, tumor size > 5 cm, alanine aminotransferase > 50 U/L, γ-glutamyltransferase > 60 U/L, prealbumin ≤ 250 mg/L, and peritumoral enhancement independently impaired 2-year RFS in the clinicoradiologic model with AUC of 0.694 (95% CI 0.628– 0.760). Nevertheless, these indexes were paucity of robustness (P > 0.05) when integrating with 38 most recurrence-related radiomics signatures for developing the comprehensive nomogram. The peritumoral dilation radiomics—the ultimate prediction model yielded satisfactory mean AUCs (training cohort: 0.939, 95% CI 0.908– 0.973; validation cohort: 0.842, 95% CI 0.736– 0.951) after 5-fold cross validation and fitted well with the actual relapse status in the calibration curve. Besides, our radiomics model obtained the best clinical net benefits, with significant improvements of NRI (35.9%-66.1%, P < 0.001) versus five clinical algorithms: the clinicoradiologic model, the tumor-node-metastasis classification, the Barcelona Clinic Liver Cancer stage, the preoperative and postoperative risks of Early Recurrence After Surgery for Liver tumor.Conclusion: Gd-EOB-DTPA MRI-based peritumoral dilation radiomics is a potential preoperative biomarker for early recurrence of HCC patients without macrovascular invasion.Keywords: gadoxetate disodium, hepatocellular carcinoma, radiomics, magnetic resonance imaging, neoplasm recurrence

Accurately staging liver fibrosis is of great clinical significance. We aimed to evaluate the clinical potential of the non-Gaussian fractional order calculus (FROC) diffusion model in staging liver fibrosis.A total of 82 patients with chronic hepatitis B (CHB) were included in this prospective study. Diffusion weighted imaging (DWI)-derived parameters including the diffusion coefficient (D), fractional order parameter (β) and microstructural quantity (μ) sourced from FROC-DWI, and apparent diffusion coefficient (ADC) derived from mono-exponential DWI, as well as the aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) were calculated. Their correlations with fibrosis stages and the diagnostic efficacy in predicting liver fibrosis were assessed and compared.D (r = -0.667), β (r = -0.671), μ (r = -0.481), and ADC (r = -0.665) displayed significant correlations with fibrosis stages (p0.001). D, β and ADC (p0.01) were independently associated with fibrosis; and compared to inflammatory activity, fibrosis was the independent factor significantly correlated with D, β and ADC (p0.001). There were no significant differences between the area under curves of D, β, μ or their combinations and ADC for predicting different fibrosis stages (p0.05). The diagnostic performance of the combined index with four diffusion metrics was better than D, β, μ or ADC used alone (p0.05) as well as APRI or FIB-4 (p0.01) in fibrosis staging.FROC-DWI was valuable in staging liver fibrosis in patients with CHB, but there were no significant differences between the FROC-DWI parameters and the classical ADC. However, the combined DWI-derived index including D, β, μ and ADC offered the best diagnostic efficacy and may serve as a reliable tool for fibrosis evaluation, superior to APRI and FIB-4.

Background Gadoxetic acid-enhanced magnetic resonance imaging (MRI) has been widely used in clinical practice. However, scientific evidence is lacking for recommending a particular sequence for measuring tumor size. Purpose To retrospectively compare the size of hepatocellular carcinoma (HCC) measured on different gadoxetic acid-enhanced MRI sequences using pathology as a reference. Material and Methods A total of 217 patients with single HCC who underwent gadoxetic acid-enhanced MRI before surgery were included. The size of the HCC was measured by two abdominal radiologists independently on the following sequences: T1-weighted; T2-weighted; b-500 diffusion-weighted imaging (DWI); and arterial, portal venous, transitional, and hepatobiliary phases. Tumor size measured on MRI was compared with pathological size by using Pearson correlation coefficient, independent-sample t test, and Bland–Altman plot. Agreement between two readers was evaluated with intraclass correlation coefficient (ICC). Results Correlation between the MR images and pathology was high for both readers (0.899–0.955). Absolute error between MRI and pathologic assessment was lowest on hepatobiliary phase images for both readers (reader 1, 2.8±4.2 mm; reader 2, 3.2±3.4 mm) and highest on arterial phase images for reader 1 (4.9±4.4 mm) and DWI phase images for reader 2 (5.1±4.9 mm). Absolute errors were significantly different for hepatobiliary phase compared with other sequences for both readers (reader 1, P≤0.012; reader 2, P≤0.037). Inter-reader agreements for all sequence measurements were strong (0.971–0.997). Conclusion The performance of gadoxetic acid-enhanced MRI sequences varied with HCC size, and the hepatobiliary phase may be optimal among these sequences.

Microvascular invasion (MVI) is a critical risk factor for postoperative recurrence of hepatocellular carcinoma (HCC). Preknowledge of MVI would assist tailored surgery planning in HCC management. In this multicenter study, we aimed to explore the validity of deep learning (DL) in MVI prediction using two imaging modalities—contrast-enhanced computed tomography (CE-CT) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI). A total of 750 HCCs were enrolled from five Chinese tertiary hospitals. Retrospective CE-CT (n = 306, collected between March, 2013 and July, 2019) and EOB-MRI (n = 329, collected between March, 2012 and March, 2019) data were used to train two DL models, respectively. Prospective external validation (n = 115, collected between July, 2015 and February, 2018) was performed to assess the developed models. Furthermore, DL-based attention maps were utilized to visualize high-risk MVI regions. Our findings revealed that the EOB-MRI-based DL model achieved superior prediction outcome to the CE-CT-based DL model (area under receiver operating characteristics curve (AUC): 0.812 vs. 0.736, p = 0.038, sensitivity: 70.4% vs. 57.4%, p = 0.015, specificity: 80.3% vs. 86.9%, p = 0.052). DL attention maps could visualize peritumoral high-risk areas with genuine histopathologic confirmation. Both DL models could stratify high and low-risk groups regarding progression free survival and overall survival (p &lt, 0.05). Thus, DL can be an efficient tool for MVI prediction, and EOB-MRI was proven to be the modality with advantage for MVI assessment than CE-CT.

Objectives To evaluate the diagnostic value of liver extracellular volume (ECVliver) measurement by equilibrium MR in staging liver fibrosis in chronic hepatitis B (CHB) patients, and to compare its performance with serum fibrosis indices. Materials and methods 91 CHB patients were included and underwent gadopentetate dimeglumine-enhanced MRI with T1 mapping sequence before and 15-min after contrast. ECVliver, aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (FIB-4) were calculated and compared between fibrosis subgroups, and the correlations between the three indices and fibrosis stage or inflammatory activity were measured by Spearman correlation analysis and stepwise multiple regression analysis. Diagnostic performance in evaluating liver fibrosis stage was assessed and compared using receiver operating characteristic analysis. Results Interobserver agreement showed an excellent interclass correlation coefficient of 0.895 for ECVliver. ECVliver, APRI and FIB-4 were different between fibrosis stages as a whole (F/H = 18.44–24.36, P ≤ 0.001). ECVliver had the strongest correlation with fibrosis stage (r = 0.727, P Conclusion MR ECVliver provides a promising noninvasive tool in staging liver fibrosis for CHB patients, superior to the fibrosis indices of APRI and FIB-4.

Background The purpose was to investigate the difference of detection rate of incidental pancreatic cystic lesions (PCLs) with computed tomography (CT) and magnetic resonance imaging (MRI) and to compare the difference between CT and MRI and to explore the effect of this difference on surgical resection. Methods We reviewed the diagnostic reports for incidental PCLs between 2013 and 2016. Images of PCLs would be re-evaluated. Clinical and imaging data were recorded. The chi-square and independent t-test were conducted for categorical and continuous variables. Results The prevalence of PCLs was 1.91% (1038/54210) and 3.36% (1282/38099) on CT and MRI respectively, and increased with increasing age (P

Background We aimed to investigate neuromelanin-sensitive magnetic resonance imaging (NM-MRI) features in the locus coeruleus of de novo Parkinson's disease patients with different cognitive states and to determine whether these features are associated with cognitive impairment. Methods Three groups of subjects were recruited in this study, including patients with de novo PD with mild cognitive impairment (n = 23), patients with de novo PD without cognitive impairment (n = 48), and control subjects (n = 32). All subjects underwent clinical evaluations, as well as MRI scanning. The contrast-to-noise ratio of the locus coeruleus in the neuromelanin-sensitive MRI images and cortical thickness were measured. Results The contrast-to-noise ratio of the locus coeruleus in PD patients with mild cognitive impairment was significantly lower than that of controls (P = 0.016). The contrast-to-noise ratio of the locus coeruleus for PD patients without cognitive impairment was intermediate between that of controls and PD patients with mild cognitive impairment. Furthermore, multiple linear regression analysis showed that the contrast-to-noise ratio of the locus coeruleus was negatively associated with performance on the Trail Making Test B in all PD patients, controlling for age, sex, years of education, the Unified Parkinson's Disease Rating Scale motor scores from right upper limb, Geriatric Depression Rating Scales scores, Rapid Eye Movement Sleep Behavior Disorder Screening Questionnaire scores, and cortical thickness. Conclusions Dysfunction of the locus coeruleus neurons may partly contribute to the decline in executive function in early de novo PD. In the future, the locus coeruleus-norepinephrine system might be targeted for early-intervention strategies in PD patients. © 2019 International Parkinson and Movement Disorder Society.

To retrospectively evaluate the value of MR features based on Liver Imaging Reporting and Data System (LI-RADS ver.2017) for identifying the status of cytokeratin (CK) 19 expression of HCC before surgery.A total of 201 patients with 207 HCCs who underwent MR imaging were reviewed retrospectively. MR features based on LI-RADS ver.2017 as well as clinical data were compared between CK19-positive (n = 51) and CK19-negative (n = 156) HCCs groups. Potential predictive parameters were identified by univariate and multivariate logistic regression analysis and diagnostic odds ratios (ORs) were recorded.MR features including targetoid appearance (p = 0.001) was more frequently observed while non-peripheral "washout" (p 0.0001) and non-rim arterial phase hyper-enhancement (p 0.0001) were found less frequently in CK19-positive HCCs compared to CK19-negative HCCs. At multivariate analysis, serum alphafetoprotein (AFP)20 ng/ml (OR = 5.9) and targetoid appearance (OR = 4.2) and non-peripheral "washout" (OR = 0.2) were significant independent predictors of CK19-positive HCCs.Targetoid appearance and absence non-peripheral "washout" combined with elevated AFP were useful for differentiating CK19-positive HCCs from CK19-negative HCC.

OBJECTIVES The objective of this study was to compare gadobutrol-enhanced gradient-echo sequence (GRE) acquisition with T2-prepared non-contrast-enhanced steady-state free precession (SSFP) in coronary magnetic resonance angiography at 1.5 T. METHODS Twenty-one subjects successfully completed GRE and SSFP acquisition. Signal-to-noise ratio (SNR), contrast-to-noise ratio, image quality, sharpness, visibility, length, and lumen diameter of vessels were analyzed by 2 experienced radiologists. RESULTS The SNR at whole left circumflex artery, left main artery, and proximal left descending artery (LAD) was significantly higher in SSFP acquisition (P < 0.05). The SNR of distal LAD was slightly higher in GRE acquisition (P < 0.05). The contrast-to-noise ratio at distal LAD, proximal and distal RCA were significantly higher with GRE acquisition (P < 0.05). CONCLUSIONS Double-dose gadobutrol-enhanced GRE and unenhanced SSFP coronary magnetic resonance angiography at 1.5 T have their own characteristics, and the combined use of the 2 methods may be taken into consideration.