[Show abstract][Hide abstract] ABSTRACT: This pictorial review aims to illustrate the magnetic resonance imaging (MRI) findings and presentation patterns of anatomical variations and various benign and malignant pathologies of the duodenum, including sphincter contraction, major papilla variation, prominent papilla, diverticulum, annular pancreas, duplication cysts, choledochocele, duodenal wall thickening secondary to acute pancreatitis, postbulbar stenosis, celiac disease, fistula, choledochoduodenostomy, external compression, polyps, Peutz-Jeghers syndrome, ampullary carcinoma and adenocarcinoma. MRI is a useful imaging tool for demonstrating duodenal pathology and its anatomic relationships with adjacent organs, which is critical for establishing correct diagnosis and planning appropriate treatment, especially for surgery.
Full-text · Article · Nov 2015 · Korean Journal of Radiology
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the additional diagnostic value of "inversion recovery" single-shot fast-spin echo (IR-SSFSE) sequence using the inversion time at the null point for hepatic hemangiomas as a supplement to standard T2-weighted (T2W) magnetic resonance imaging for the distinction of hemangiomas and cysts.
A total of 228 lesions in 56 patients were evaluated in this retrospective study. In addition to routine hepatic magnetic resonance imaging, IR-SSFSE imaging using inversion time value of 600 milliseconds (null point for hepatic hemangiomas) was obtained. Two radiologists independently reviewed T2W images at first and T2W images plus IR-SSFSE sequence 4 weeks afterward and used a 5-point scale to indicate the possibility of detected hyperintense lesion is a cyst or a hemangioma. A receiver operating characteristic analysis and κ statistics were used to evaluate the diagnostic additive value of IR-SSFSE sequence for differentiation of hepatic hemangiomas and cysts, and to determine interobserver agreement, respectively.
Among 228 lesions, diameters of which ranges from 2 to 125 mm (mean, 13.84 ± 16.24 mm), 56.14% of them (n = 128) were hemangiomas, and 43.86% of them were cysts (n = 100). In the receiver operating characteristic analysis for the differentiation of hepatic hemangiomas from cysts, the calculated area under the curve (AUC) for standard T2W images alone was 0.889 (95% confidence interval [CI], 0.825-0.953) for the first observer and 0.913 (95% CI, 0.861-0.965) for the second observer. When IR-SSFSE sequence was combined to T2W images, AUC was calculated as 0.958 (95% CI, 0.920-0.996) for the first observer and 0.980 (95% CI, 0.956-1.0) for the second observer. The AUC values obtained from standard T2W images and standard T2W plus IR-SSFSE images were significantly different for both observers (P < 0.01). Both observers demonstrate better performance in differentiating hemangiomas and cysts with a combination of IR-SSFSE sequence and T2W imaging than with T2W imaging alone. Adding IR-SSFSE sequence as a supplement to standard T2W images improved the sensitivity and the κ values.
Inversion recovery single-shot fast-spin echo sequence using the inversion time to null signal from the hepatic hemangiomas as a supplement to standard T2W images is useful for distinguishing hemangiomas from hepatic cysts without the need for intravenous gadolinium chelate administration.
No preview · Article · May 2015 · Journal of computer assisted tomography
[Show abstract][Hide abstract] ABSTRACT: Congenital anomalies of pancreas and its ductal drainage are uncommon but in general surgically correctable causes of recurrent pancreatitis. A gastric duplication cyst communicated with an accessory pancreatic lobe is an extremely rare cause of recurrent pancreatitis, but an early and accurate diagnosis of this anomaly is important because suitable surgical treatment may lead to a satisfactory outcome. Herein, we presented multidetector computed tomography and magnetic resonance imaging findings of a gastric duplication cyst communicating with an accessory pancreatic lobe via an aberrant duct in a 29-year-old woman with recurrent acute pancreatitis and also reviewed other similar cases reported in the literature.
No preview · Article · Dec 2014 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: La terminologie et la structure de classification relatives à la pancréatite aiguë formulées dans le cadre du premier symposium d'Atlanta ont été passées en revue et un nouvel énoncé de consensus a récemment été proposé. Les principaux changements comprennent la subdivision en deux catégories des collections liquidiennes aiguës qui surviennent au cours des quatre premières semaines d'une pancréatite aiguë, soit les « collections liquidiennes péripancréatiques aiguës » et les « collections nécrotiques aiguës », selon la présence ou non de débris nécrotiques. Les collections liquidiennes tardives ont également été subdivisées en deux catégories, soit les « pseudokystes » et les « nécroses kystiques collectées ». Il est important de recourir à la nouvelle terminologie pour décrire ces collections, puisque celles-ci mènent à des décisions distinctes en matière de traitement. Cet article vise à fournir un aperçu des collections liquidiennes associées à la pancréatite aiguë, en portant une attention particulière à leur signification pronostique et à leur incidence sur la prise en charge clinique, ainsi qu'à illustrer la nouvelle terminologie.
No preview · Article · Aug 2014 · Canadian Association of Radiologists Journal
[Show abstract][Hide abstract] ABSTRACT: Acute pancreatitis is an acute inflammatory disease of the pancreas that may also involve surrounding tissues or remote organs. The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Generally, imaging is recommended to confirm the clinical diagnosis, investigate the etiology, and grade the extend and severity of the acute pancreatitis. Ultrasound is the first-line imaging modality in most centers for the confirmation of the diagnosis of acute pancreatitis and the ruling out of other causes of acute abdomen, but it has limitations in the acute clinical settting. Computed tomography not only establishes the diagnosis of acute pancreatitis, but also enables to stage severity of the disease. Magnetic resonance imaging has earned an ever more important role in the diagnosis of acute pancreatitis. It is especially useful for imaging of patients with iodine allergies, characterizing collections and assessment of an abnormal or disconnected pancreatic duct. The purpose of this review article is to present an overview of the acute pancreatitis, clarify confusing terminology, underline the role of ultrasound, computed tomography and magnetic resonance imaging according to the proper clinical context and compare the advantages and limitations of each modality.
No preview · Article · Apr 2014 · Diagnostic and interventional imaging
[Show abstract][Hide abstract] ABSTRACT: La pancréatite aiguë est une maladie inflammatoire aiguë du pancréas qui peut également affecter les tissus environnants ou les organes distants. La Classification d’Atlanta de la pancréatite aiguë, présentée en 1992, répartit les patients en groupes affectés de forme légère ou sévère sur la base de critères cliniques et biochimiques. Récemment, la terminologie et le schéma de classification établis lors du Symposium initial d’Atlanta ont été révisés et un nouveau texte de consensus a été proposée par le Groupe de travail sur la classification de la pancréatite aiguë (Acute Pancreatitis Classification Working Group). D’une manière générale, une imagerie est recommandée pour confirmer le diagnostic clinique, explorer l’étiologie et effectuer une gradation de l’étendue de la sévérité de la pancréatite aiguë. L’échographie constitue la modalité d’imagerie de première ligne dans la plupart des centres pour la confirmation du diagnostic de pancréatite aiguë et l’élimination d’autres causes d’abdomen aigu, mais elle présente des limites dans un cadre clinique aigu. La tomodensitométrie permet non seulement d’établir le diagnostic de la pancréatite aiguë, mais également de déterminer le stade de sévérité de la maladie. L’imagerie par résonance magnétique a conquis un rôle encore plus important dans le diagnostic de la pancréatite aiguë. Elle est particulièrement utile chez les patients présentant des allergies à l’iode, pour caractériser des épanchements et évaluer des anomalies ou des déconnexions des canaux pancréatiques. L’objectif de cet article de synthèse est de présenter un aperçu de la pancréatite aiguë, de clarifier les confusions terminologiques, de souligner le rôle de l’échographie, de la tomodensitométrie et de l’imagerie par résonance magnétique en fonction du contexte clinique correct et de comparer les avantages et les limites de chacune de ces modalités.
[Show abstract][Hide abstract] ABSTRACT: Objective:
The purpose of this article is to determine the added diagnostic value of T1-weighted gradient-echo in-phase images obtained during MRCP in the detection and differentiation of hepatolithiasis and intrahepatic pneumobilia.
Materials and methods:
Intrahepatic bile ducts in 47 patients were scored in terms of their possibility of containing biliary stone and air. MRI was performed with a 1-T system for 32 patients and with a 3-T system for 15 patients. Two radiologists independently reviewed two sets of MRI scans: set 1 included T2-weighted MRCP images, and set 2 included T2-weighted MRCP images plus T1-weighted gradient-echo in-phase images. The diagnostic performances of set 1 and set 2 in the evaluation of the bile ducts containing air or stone and bile ducts containing neither of them were analyzed using the area under the receiver operating characteristic curve (AUC) for clustered data. The sensitivities and specificities of both image sets to detect intrahepatic stone or air were also calculated and compared.
For the diagnosis of hepatolithiasis, the AUC obtained from set 2 (0.983) was significantly higher than that obtained from set 1 (0.879; p = 0.037). For the diagnosis of pneumobilia, the AUC obtained from set 2 (0.965) was also significantly higher than that of set 1 (0.765; p = 0.002). With use of percutaneous transhepatic cholangiography, ERCP, and CT as the reference standards, the sensitivity of set 2 (97.1%; 95% CI, 91.1-100%) was significantly higher than that of set 1 (74.3%; 95% CI, 56.7-91.9%) in detecting intrahepatic stones (p = 0.011). For the detection of pneumobilia, the sensitivity of set 2 (98.5%; 95% CI, 95.4-100%) was also significantly higher than that of set 1 (70.8%; 95% CI, 57.7-83.3%; p = 0.000).
The addition of T1-weighted gradient-echo in-phase images to standard MRCP sequences improves the detection and differentiation of hepatolithiasis and intrahepatic pneumobilia.
No preview · Article · Jan 2014 · American Journal of Roentgenology
[Show abstract][Hide abstract] ABSTRACT: The Atlanta classification of acute pancreatitis was introduced in 1992 and divides patients into mild and severe groups based on clinical and biochemical criteria. Recently, the terminology and classification scheme proposed at the initial Atlanta Symposium have been reviewed and a new consensus statement has been proposed by the Acute Pancreatitis Classification Working Group. Major changes include subdividing acute fluid collections into "acute peripancreatic fluid collection" and "acute post-necrotic pancreatic/peripancreatic fluid collection (acute necrotic collection)" based on the presence of necrotic debris. Delayed fluid collections have been similarly subdivided into "pseudocyst" and "walled of pancreatic necrosis". Appropriate use of the new terms describing the fluid collections is important for management decision-making in patients with acute pancreatitis. The purpose of this review article is to present an overview of complications of the acute pancreatitis with emphasis on their prognostic significance and impact on clinical management and to clarify confusing terminology for pancreatic fluid collections.
[Show abstract][Hide abstract] ABSTRACT: Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.
Preview · Article · Nov 2013 · Korean journal of radiology: official journal of the Korean Radiological Society
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to retrospectively assess the correlation between minimum apparent diffusion coefficient (ADCmin) values obtained from diffusion-weighted magnetic resonance imaging (MRI) and maximum standardized uptake values (SUVmax) obtained from positron emission tomography-computed tomography (PET-CT) in rectal cancer.
Forty-one patients with pathologically confirmed rectal adenocarcinoma were included in this study. For preoperative staging, PET-CT and pelvic MRI with diffusion-weighted imaging were performed within one week (mean time interval, 3±1 day). For ADC measurements, the region of interest (ROI) was manually drawn along the border of each hyperintense tumor on b=1000 s/mm2 images. After repeating this procedure on each consecutive tumor-containing slice to cover the entire tumoral area, ROIs were copied to ADC maps. ADCmin was determined as the lowest ADC value among all ROIs in each tumor. For SUVmax measurements, whole-body images were assessed visually on transaxial, sagittal, and coronal images. ROIs were determined from the lesions observed on each slice, and SUVmax values were calculated automatically. The mean values of ADCmin and SUVmax were compared using Spearman's test.
The mean ADCmin was 0.62±0.19×10-3 mm2/s (range, 0.368-1.227×10-3 mm2/s), the mean SUVmax was 20.07±9.3 (range, 4.3-49.5). A significant negative correlation was found between ADCmin and SUVmax (r=-0.347; P = 0.026).
There was a significant negative correlation between the ADCmin and SUVmax values in rectal adenocarcinomas.
Full-text · Article · Oct 2013 · Diagnostic and interventional radiology (Ankara, Turkey)
[Show abstract][Hide abstract] ABSTRACT: Distinguishing the benign and malignant cardiac masses is usually a diagnostic challenge, and safe, non-invasive, and reliable techniques are necessary to avoid any delay in treatment. The previously described "sun ray" appearance is an important sign in the diagnosis of cardiac angiosarcoma, and in this report we present 3-T magnetic resonance imaging findings to distinguish the rare but fatal cardiac angiosarcoma.
No preview · Article · Sep 2013 · Cardiology in the Young
[Show abstract][Hide abstract] ABSTRACT: We present three patients with Behçet's disease associated with intracardiac thrombus and pulmonary vascular involvement. One of these patients had also Budd-Chiari syndrome. All patients were treated with corticosteroid plus monthly intravenous cyclophosphamide as first line treatment and with no recurrences. Immunosuppressive therapy was successful in the treatment of intracardiac thrombus and also in the regression of pulmonary vascular thromboses in these patients. Intracardiac thrombus in Behçet's disease is rarely seen. Behçet's disease should be remembered in the differential diagnosis of the patients with intracardiac mass, especially in patients from the Mediterranean and Middle East populations.
[Show abstract][Hide abstract] ABSTRACT: Diffusion-weighted magnetic resonance imaging (DW- MRI) is a method where the signal required to produce a MRI image is determined by the "mobility of water". Diffusivity measurements have multiple components related to tissue cellularity and organization, integrity of the cell membranes, extracellular space tortuosity and perfusion (1). Until recent years, main limitation for the use of DWI in the body area wa the artefacts originating from the physiologic movements which decrease the diagnostic yield of the method. With advanced technology, elimination of disturbing artifacts can be possible to a degree… Diffusion-weighted imaging signal intensity and the values of apparent diffusion coefficient (ADC) are of particular interest, because these parameters can sometimes show changes in bowel wall, when no abnormalities are typically seen on conventional MR images. Therefore, this method is rapidly becoming an adjunct to a conventional body MRI study, especially in the early detection of cancer. The ADC map provides quantitative information on diffusion. It is a measure of the freedom of water diffusion and is useful in tissue characterization. Malign lesions are characterized by a high signal on DWI and a low signal on ADC. Measured values from ADC map are believed to be low because of a shift (diffusion) of water within malign tissue, from the extracellular to the intracellular compartment, is relatively restricted. Thus, one of the important advantages of the DWI is that it can manifest the nature of the lesion without the need for intravenous contrast material injection. This is particularly beneficial in patients with reduced renal function (1). In the current issue of Turkish Journal of Gastroenterology, Solak and colleagues (2) have investigated the value of DW-MRI in the differentiation of benign and malignant diffuse bowel wall thickening. They discussed the diagnostic importance and potential use of ADC measurements. For quantitative analysis in DW-MRI, a radiologist has measured the thickened colonic wall ADC values in the three regions of interest (ROI) by using dedicated software at the workstation. A circular ROI with a diameter of at least 4 mm2 has been placed to three different portions of the thickened wall to obtain average ADC values of the lesion. The authors concluded that benign bowel pathologies leading to wall thickening had significantly higher ADC values than those of malignant ones. In ROC curve analysis, the cut-off value of ADC to differentiate benign from malignant wall thickening was found as 1.21mm 2 /s with a sensitivity of 100%, a specificity of 87,3%, and an accuracy of 89,3%. With visual assessment of the DWIs and the measurements of ADC values, malignant lesions were differentiated from benign ones with sensitivity of 100%, specificity of 89,2%, and an accuracy of 90,4%. Before considering whether this bald conclusion does justice to the possible contribution of DWI to the noninvasive differentiation of benign and malign bowel lesions, it is worth considering that, even in the absence of DWI, experienced eyes can easily pick out the nature of the lesions on conventional T2-weighted MR images. Indeed, the authors of this study could also accurately perceive the differences of malignancy or benignity of the suspicious lesion with visual assessment. However, it is not clear from the study that how they have evaluated the images and if they have blinded to T2- weighted sequences for this assessment. In this study, small ROIs have been used for ADC measurements. ROI size might affect the accuracy of measurements, since the tissue changes can be heterogeneous in terms of its internal structure and signal intensity. In a study conducted by Lambregts et al, mean tumour ADCs in rectal cancer were measured according to three distinct ROI protocols: [a] 'Whole-volume', [b] 'Singleslice' and [c] 'Solid tumour samples'. It is reported that ADC measurements of the whole tumour volume provide the most reproducible results (3). Previously it was demonstrated that qualitative assessment of DW- MRI is useful for detecting colorectal cancers (4). Evaluation of inflammatory bowel disease (IBD) using DW- MRI have also found place in the literature (5-8). Oussalah et al. (8) recently reported clinical-radiological results obtained with DW-MRI in 96 patients with IBD, 35 with ulcerative colitis (UC), and 61 with CD. They stated that in patients with UC it is possible to replace completely the use of the intravenous contrast material with MR-DWI in the identification of active inflammatory bowel segments. Kılıçkesmez et al. (5) also evaluated the value of quantitative DW- MRI in the assessment of the inflammatory activity in UC. They found that DW-MRI is useful in identifying disease activity in UC patients, especially when the disease involved rectum. In another study from the same authors (6) was concerning the rectosigmoid colon. In that study, the authors showed that quantitative DWI might be able to differentiate inflammatory and neoplastic involvements. When we look at this perspective, the study conducted by Solak et al. (2) obviously, is not the first study aiming to differentiate benign and malignant diffuse bowel wall thickening with DW- MRI. A difference from previous study comes from the inclusion of longer intestinal segments to be assessed. However, the results of the study are similar to those of the earlier study (6) in that they call for further research and requirement of increasing patient population size. Actually, this conclusion is justified because of the overlapping ADC values. It has been known previously that a number of benign lesions can exhibit hyperintensity on DW- MRI with high b-values, (9) and that ADC values in benign and malignant lesions may overlap, which makes it difficult to distinguish lesions using DW- MRI alone. In both studies (2,6), it was emphasized that, radiologists should be aware of possible overlaps of ADC values that may lead to misdiagnoses when only DWI is interpreted. In abstract section, the authors have noted that the patients in malignancy group have had scirrhous type of colorectal cancer. This inclusion criterion seems very strict. Because, scirrhous carcinoma is extraordinarily uncommon in the colon. In a series of 12,000 cases of colonic carcinoma studied by Fahl, et al. (10), 11 instances of this type were found. If this was the case, the study under consideration has utmost importance. Also, to my knowledge, scirrhous type carcinoma does not take part in current histologic typing and grading WHO classification of colorectal cancer. In previous studies without predominancy of scirrhous type, the low ADC values were found in cancer (4, 6). Actually, the two subtypes of colorectal adenocarcinoma (signet ring cell adenocarcinoma and mucinous adenocarcinoma) produce different signal intensities on conventional MRI than ordinary form and can influence the ADC values of the tumor. It is established that mucinous adenocarcinoma of the rectum showed higher ADC values compared to well-differentiated adenocarcinoma as a result of low cellularity, due to extracellular mucin (11). From this aspect of view, ADC values of mucinous adenocarcinoma may mimick those of benign lesions. Again, if we ask the same question as in the title, the answer will be: no, if ever DWI is used as a supplemental sequence of conventional MRI. With the use of a qualitative assessment of high b-value images and ADC maps, the technique is very helpful to facilitate this differentiation when bowel wall thickening is found on conventional MRI incidentally. Because the factors that influence the diffusivity are complex, meticulous technique and knowledge of potential interpretive pitfalls will help to avoid mistakes.
No preview · Article · Apr 2013 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: Aim:
To determine the relationship between caudate-right lobe ratio (C/R) and model for end-stage liver disease (MELD) score.
The study included 50 patients with cirrhosis and a control group of 20 patients. C/R was measured as described by Harbin et al. The size of the spleen was measured on coronal images. The Organ Procurement and Transplantation Network Web site was used for MELD score calculation. Aspartate to alanine aminotranferase (AST/ALT) ratio was calculated.
There was statistically significant difference between the two groups. C/R, the size of the spleen, and AST/ALT values were significantly correlated with MELD score.
There is a significant relationship between the C/R and MELD score.
No preview · Article · Oct 2012 · Clinical imaging
[Show abstract][Hide abstract] ABSTRACT: To determine the frequency of perirenal hyperintensity on heavily T2-weighted images and to evaluate its relationship with serum creatinine levels.
Axial and coronal single-shot fast spin-echo images which have been originally obtained for MR cholangiopancreatography in 150 subjects were examined by two observers individually for the presence of perirenal hyperintensity. The morphologic properties of perirenal hyperintensity (peripheral rim-like, discontinuous, polar) were recorded. Chi square test was used to test whether the frequencies of bilateral perirenal hyperintensity differ significantly in subjects with high serum creatinine levels and those with normal creatinine levels. This test was also used to compare the frequencies of perirenal hyperintensity in patients with and without renal cysts and in patients with and without corticomedullary differentiation. A p value of less than 0.05 was considered to be statistically significant.
The perirenal hyperintensity was identified in 40 of 150 cases (26.6%) on heavily T2-weighted image. Serum creatinine levels were high in 18 of 150 cases (12%). The perirenal hyperintensity was present in 11 of 18 subjects (61%) with high serum creatinine levels and 26 of 132 subjects (19.7%) with normal creatinine levels. The difference of rates in two groups was statistically significant. Odds ratio was 6407 (95% confidence interval 2264 -18,129) . The frequency of perirenal hyperintensity was also significantly higher in subjects with renal cyst or cysts in whom serum creatinine levels were normal (p<0.05) (37.5% vs. 11.8%).
Perirenal hyperintensities are more frequent in patients with high serum creatinine levels. They are also more common in patients with simple renal cysts.
Full-text · Article · Nov 2011 · European journal of radiology
[Show abstract][Hide abstract] ABSTRACT: The aims of this study were to determine the frequencies of the perianal fistula subtypes according to the Parks and St. James's University Hospital (SJUH) classification systems and to evaluate the adequacy of these two systems for classifying and reporting perianal fistulas.
Magnetic resonance imaging examinations of 52 patients (44 men, 8 women) with perianal fistula were reviewed retrospectively. The fistulas were classified according to the Parks and SJUH classification systems.
According to the Parks system, 13 patients had intersphincteric (25%), 36 had transsphincteric (69.23%), and 2 had (3.84%) extrasphincteric fistulas. Only one fistula (a subsphincteric fistula) (1.92%) could not be classified. According to the SJUH system, 10 patients had grade 1 (19.23%), 2 patients had grade 2 (3.84%), 13 patients had grade 3 (25%), 21 patients had grade 4 (40.38%), and 5 patients had grade 5 (9.61%) perianal fistulas. The one (and only) subsphincteric fistula was left unclassified.
The most common types are transsphincteric and intersphincteric fistulas. Although the two most commonly used classification systems are adequate for describing most perianal fistulas, there is a small percentage that is left unclassified.
No preview · Article · Jun 2011 · Japanese journal of radiology
[Show abstract][Hide abstract] ABSTRACT: Diffuse or continuous multifocal tumors with accompanying portal vein thrombosis yield considerable changes in the magnetic resonance imaging findings of hepatocellular carcinoma. The overlapped imaging findings of these two co-existing pathologies may be confusing. We aimed to evaluate the magnetic resonance imaging findings of widespread hepatocellular carcinoma lesions complicated with portal vein thrombosis.
Twenty-two patients (20 male, 2 female; mean age: 57 years) with portal vein thrombosis and diffuse-type hepatocellular carcinoma who underwent contrast-enhanced hepatic magnetic resonance imaging in our department between August 2001 and November 2008 were evaluated retrospectively. The unenhanced axial T1-weighted, T2-weighted, and post-contrast early- and late-phase images were reviewed in each patient.
On T2-weighted magnetic resonance images, tumors were seen mildly hyperintense in 11 patients and heterogeneously hyperintense in 11 patients. Unenhanced T1-weighted images demonstrated homogeneous hypointensity in 15 patients and heterogeneous hypointensity in 7 patients. Post-contrast early-phase magnetic resonance images showed patchy enhancement in 12 patients, moth-eaten enhancement in 6 patients, strong enhancement in 1 patient, and minimal enhancement in 3 patients. Post-contrast late-phase magnetic resonance images demonstrated heterogeneous washout in all patients. Portal vein thrombosis was present in all patients. The mean diameter of main portal vein thrombi was 27 mm (range: 25-30 mm). Serum alpha-fetoprotein levels were elevated in all patients.
In patients with chronic parenchymal liver disease, when portal vein thrombosis and high serum alpha-fetoprotein values co-exist, careful attention must be paid to the hepatic parenchymal changes, especially on contrast-enhanced images, in order to not overlook diffuse-type hepatocellular carcinoma.
No preview · Article · Apr 2011 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology
[Show abstract][Hide abstract] ABSTRACT: The esophageal mural veins are important for providing blood to the esophageal submucosal varices. The purpose of this study was to investigate any correlation between the diameters of esophageal mural veins as observed on routine contrast-enhanced magnetic resonance angiography and the endoscopic grades of esophageal varices in patients with portal hypertension.
The images of 57 patients with portal hypertension in whom magnetic resonance portography was performed were evaluated retrospectively. The correlation between the diameter of the esophageal mural veins and the endoscopic grade of the esophageal varices was investigated with Spearman's correlation test. This test was also used to assess the correlation between the grade of esophageal varices and the diameters of the paraesophageal veins. A p value less than 0.05 was considered to be statistically significant.
A positive correlation was determined between the diameter of mural veins and the endoscopic grade of the esophageal varices (p=0.022; r=0.363). There was no correlation, however, between the endoscopic grade of the esophageal varices and the diameter of the paraesophageal veins.
A correlation exists between the diameters of the esophageal mural veins and the endoscopic grades of the esophageal varices. Magnetic resonance angiography may give information about the status of the esophageal varices in portal hypertensive patients.
No preview · Article · Sep 2010 · The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology