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European Radiology (Online Firstâ„¢)
10/05/2012, Unenhanced CT findings can predict the development of urinary calculi in stone-free patients »»

Abstract
Objectives  
To determine if calcium deposits in the papillae can be identified by unenhanced computed tomography (uCT) even before renal stones develop.
Methods  
A retrospective review of 413 patients with calculi identified 31 patients (stone-forming group) with a history of urinary tract calculi with a calculus demonstrated by uCT and a stone-free uCT before calculi had developed. The control group (n=31) was composed of live kidney donors with no history of calculi and a stone-free uCT. CT attenuation was measured in all CTs using two regions of interest of 0.05 cm2 and 0.1 cm2 over the tip and the neighbouring area of the papillae. Student's and Wilcoxon t-tests were used for comparing results in the two groups.
Results  
The attenuation of the tip of the papilla was higher in the stone-forming group when compared to the controls after (45.2 HU versus 32.1 HU, P=0.001) and even before frank calculi had developed (44.2 HU versus 32.1 HU, P=0.003). There was no significant difference in papillary attenuation in the stone group before and after calculi had developed (45.2 HU versus 44.2 HU, P=0.82).
Conclusion  
Stone-forming patients exhibit higher papillary density even before calculi develop. This could define a population at risk of developing calculi.
Key Points   
Unenhanced CT shows high density papillae in patients who subsequently develop calculi.
These probably correlate with Randalls plaques.
Subjects at high risk of developing stone disease could be identified.
Targeted prophylaxis might be helpful.

  • Content Type Journal Article
  • Category Urogenital
  • Pages 1-7
  • DOI 10.1007/s00330-012-2463-9
  • Authors
    • Alexandru Ciudin, Urology Department, Hospital Clínic Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain
    • Maria Pilar Luque Galvez, Urology Department, Hospital Clínic Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain
    • Rafael Salvador Izquierdo, Radiology Department, Hospital Clínic Barcelona, Barcelona, Spain
    • Agustin Franco de Castro, Urology Department, Hospital Clínic Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain
    • Eduardo Garcia-Cruz, Urology Department, Hospital Clínic Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain
    • Juan Alcover García, Urology Department, Hospital Clínic Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain
    • Jose Ricardo Alvarez-Vijande García, Urology Department, Hospital Clínic Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain
    • Carlos Nicolau, Radiology Department, Hospital Clínic Barcelona, Barcelona, Spain
    • Antonio Alcaraz Asensio, Urology Department, Hospital Clínic Barcelona, Calle Villarroel 170, 08036 Barcelona, Spain

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10/05/2012, Association between carotid plaque enhancement shown by multidetector CT angiography and histologically validated microvessel density »»

Abstract
Purpose  
Carotid plaques analysed by MDCTA can show contrast enhancement. The purpose of this study was to explore the association between carotid plaque enhancement (CPE) and microvessel density.
Materials and methods  
We obtained IRB approval. Twenty-nine consecutive (male, 20; median age, 63) symptomatic patients studied with 16-detector CT were prospectively analysed. Examinations were performed before and after intravenous contrast medium administration, and analysis of plaque enhancement was performed. Patients underwent en bloc carotid endarterectomy; histological sections were prepared and the presence of microvessels quantified. Logistic regression analysis as well as ROC curve and area under the curve was calculated.
Results  
A statistically significant association between the degree of CPE and microvessel density (P=0.009; rho=0.553) was observed. The ROC curve analysis confirmed this association with an area under the curve of 0.906, 0.735, 0.644 and 0.546 for CPE of 10 HU, 15 HU, 20 HU and 25 HU respectively. There was a statistically significant difference between the CPE and the degree of neovascularisation (P=0.0003).
Conclusion  
Results of this preliminary study suggest that CPE might be associated with the microvessel density. Histological analysis seems to demonstrate that the degree of intra-plaque neo-vascularisation is statistically associated with CPE.
Key Points  
 
Carotid artery plaque enhancement at CT is associated with microvessel density.
 
The degree of intra-plaque neo-vascularisation is statistically associated with carotid plaque enhancement.
 
Plaque enhancement at CT should be considered when assessing vulnerable plaques.

  • Content Type Journal Article
  • Category Head and Neck
  • Pages 1-9
  • DOI 10.1007/s00330-012-2467-5
  • Authors
    • Luca Saba, Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di CagliariPolo di Monserrato, s.s. 554, Monserrato, Cagliari 09045, Italy
    • Maria Letizia Lai, Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di CagliariPolo di Monserrato, s.s. 554, Monserrato, Cagliari 09045, Italy
    • Roberto Montisci, Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di CagliariPolo di Monserrato, s.s. 554, Monserrato, Cagliari 09045, Italy
    • Elisabetta Tamponi, Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di CagliariPolo di Monserrato, s.s. 554, Monserrato, Cagliari 09045, Italy
    • Roberto Sanfilippo, Department of Vascular Surgery, Azienda Ospedaliero Universitaria (A.O.U.), di CagliariPolo di Monserrato, s.s. 554, Monserrato, Cagliari 09045, Italy
    • Gavino Faa, Department of Pathology, Azienda Ospedaliero Universitaria (A.O.U.), di CagliariPolo di Monserrato, s.s. 554, Monserrato, Cagliari 09045, Italy
    • Mario Piga, Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di CagliariPolo di Monserrato, s.s. 554, Monserrato, Cagliari 09045, Italy

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10/05/2012, MR elastography of liver tumours: value of viscoelastic properties for tumour characterisation »»

Abstract
Objectives  
To assess the value of the viscoelastic parameters in the characterisation of liver tumours at MR elastography.
Patients and methods  
Ninety-four patients with liver tumours >1 cm prospectively underwent MR elastography using 50-Hz mechanical waves and a full three-directional motion-sensitive sequence. The model-free viscoelastic parameters (the complex shear modulus and its real and imaginary parts, i.e. the storage and loss moduli) were calculated in 72 lesions after exclusion of cystic, treated or histopathologically undetermined tumours.
Results  
We observed higher absolute shear modulus and loss modulus in malignant versus benign tumours (3.38±0.26 versus 2.41±0.15 kPa, P<0.01 and 2.25±0.26 versus 1.05±0.13 kPa, P<0.001, respectively). Moreover, the loss modulus of hepatocellular carcinomas was significantly higher than in benign hepatocellular tumours. The storage modulus did not differ significantly between malignant and benign tumours. The area under the receiver-operating characteristic curve of loss modulus was significantly larger than that of the absolute shear modulus and storage modulus when comparing malignant and benign lesions.
Conclusions  
The increased loss modulus is a better discriminator between benign and malignant tumours than the increased storage modulus or absolute value of the shear modulus.
Key Points   
Magnetic Resonance elastography is a new method of assessing the liver.
Increased loss modulus is an indicator of malignancy in hepatic tumours.
Loss modulus is a better discriminator than absolute shear modulus values.
The viscoelastic properties of lesions offer promise for characterising liver tumours.

  • Content Type Journal Article
  • Category Hepatobiliary-Pancreas
  • Pages 1-9
  • DOI 10.1007/s00330-012-2474-6
  • Authors
    • Philippe Garteiser, Department of Radiology, University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France
    • Sabrina Doblas, Department of Radiology, University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France
    • Jean-Luc Daire, Department of Radiology, University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France
    • Mathilde Wagner, Department of Radiology, University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France
    • Helena Leitao, Department of Radiology, Hospital of the University of Coimbra, Coimbra, Portugal
    • Valérie Vilgrain, Department of Radiology, University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France
    • Ralph Sinkus, Department of Radiology, University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France
    • Bernard E. Van Beers, Department of Radiology, University Paris Diderot, Sorbonne Paris Cité, INSERM UMR 773, University Hospitals Paris Nord Val de Seine, Beaujon, 100 boulevard du Général Leclerc, 92118 Clichy Cedex, France

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09/05/2012, Management of peripheral arterial interventions with mono or dual antiplatelet therapythe MIRROR study: a randomised and double-blinded clinical trial »»

Abstract
Objectives  
To investigate the influence of dual antiplatelet therapy vs. aspirin alone on local platelet activation and clinical endpoints in patients with PAD treated with endovascular therapy.
Methods  
Patients received either 500 mg aspirin and 300 mg clopidogrel before intervention followed by a daily dose of 100 mg aspirin and 75 mg clopidogrel for 6 months, or the same doses of aspirin plus placebo instead of clopidogrel. Primary endpoints were local concentrations of platelet activation markers -thromboglobulin and CD40L, and the rate of patients resistant to clopidogrel. Secondary endpoints included the clinical development 6 months after the intervention.
Results  
Eighty patients, 40 in each group, were enrolled. The median peri-interventional concentration of -TG was 224.5 vs. 365.5 (P=0.03) in the clopidogrel and placebo group. The concentration of CD40L was 127 and 206.5 (P=0.05). Thirty per cent of patients who had received clopidogrel were resistant. Two clopidogrel and eight placebo patients required TLR (P=0.04). The clopidogrel patients who needed revascularisation were both resistant to clopidogrel. Minor bleeding complications occurred in one clopidogrel and two placebo patients.
Conclusion  
Dual antiplatetet therapy reduces peri-interventional platelet activation and improves functional outcome without higher bleeding complications. An individual tailored dual antiplatelet therapy seems desirable for endovascularly treated patients with PAD.
Key Points   
The role of clopidogrel and aspirin following endovascular therapy was investigated.
Dual antiplatelet therapy reduces peri-interventional platelet activation more than aspirin alone.
Dual antiplatelet therapy improves the outcome of endovascularly treated patients.
Clopidogrel resistance is important when treating peripheral arterial disease endovascularly.

  • Content Type Journal Article
  • Category Vascular-Interventional
  • Pages 1-9
  • DOI 10.1007/s00330-012-2441-2
  • Authors
    • Gunnar Tepe, Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität, Tübingen, Germany
    • Rüdiger Bantleon, Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität, Tübingen, Germany
    • Klaus Brechtel, Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität, Tübingen, Germany
    • Jörg Schmehl, Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität, Tübingen, Germany
    • Thomas Zeller, Kardiologie & Angiologie, Herzzentrum Bad Krozingen, Bad Krozingen, Germany
    • Claus D. Claussen, Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität, Tübingen, Germany
    • Frederik F. Strobl, Radiologische Klinik, Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität, Tübingen, Germany

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09/05/2012, Magnetic resonance 4D flow analysis of cerebrospinal fluid dynamics in Chiari I malformation with and without syringomyelia »»

Abstract
Objective  
To analyse cerebrospinal fluid (CSF) hydrodynamics in patients with Chiari type I malformation (CM) with and without syringomyelia using 4D magnetic resonance (MR) phase contrast (PC) flow imaging.
Methods  
4D-PC CSF flow data were acquired in 20 patients with CM (12 patients with presyrinx/syrinx). Characteristic 4D-CSF flow patterns were identified. Quantitative CSF flow parameters were assessed at the craniocervical junction and the cervical spinal canal and compared with healthy volunteers and between patients with and without syringomyelia.
Results  
Compared with healthy volunteers, 17 CM patients showed flow abnormalities at the craniocervical junction in the form of heterogeneous flow (n=3), anterolateral flow jets (n=14) and flow vortex formation (n=5), most prevalent in patients with syringomyelia. Peak flow velocities at the craniocervical junction were significantly increased in patients (15.5±11.3 vs. 4.7±0.7  cm/s in healthy volunteers, P<0.001). At the level of C1, maximum systolic flow was found to be significantly later in the cardiac cycle in patients (30.8±10.3 vs. 22.7±4.1%, P<0.05).
Conclusions  
4D-PC flow imaging allowed comprehensive analysis of CSF flow in patients with Chiari I malformation. Alterations of CSF hydrodynamics were most pronounced in patients with syringomyelia.
Key Points  
Analysis of CSF flow is important in patients with Chiari I malformation
4D-PC MRI allows analysis of CSF in patients with Chiari I.
Chiari I patients show characteristic qualitative and quantitative alterations of CSF flow.
Alterations of CSF hydrodynamics are most pronounced in patients with associated syringomyelia.

  • Content Type Journal Article
  • Category Neuro
  • Pages 1-11
  • DOI 10.1007/s00330-012-2457-7
  • Authors
    • Alexander C. Bunck, Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
    • Jan Robert Kroeger, Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
    • Alena Juettner, Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
    • Angela Brentrup, Department of Neurosurgery, University Hospital of Muenster, Muenster, Germany
    • Barbara Fiedler, Department of General Pediatrics, University Hospital of Muenster, Muenster, Germany
    • Gerard R. Crelier, Institute for Biomedical Engineering, ETH and University of Zurich, Zurich, Switzerland
    • Bryn A. Martin, Laboratory of Hemodynamics and Cardiovascular Technology, School of Engineering, Interfaculty Institute of Bioengineering, Ecole Polytechnique Federale de Lausanne, Lausanne, Switzerland
    • Walter Heindel, Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
    • David Maintz, Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
    • Wolfram Schwindt, Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany
    • Thomas Niederstadt, Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, building A1, 48149 Muenster, Germany

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09/05/2012, Craniofacial gunshot injuries: an unrecognised risk factor for blunt cervical vascular injuries? »»

Abstract
Objectives  
To review our institutional experience with cervical arterial injuries remote from the penetrating tract seen in the setting of craniofacial gunshot injuries.
Methods  
Institutional Review Board approval was obtained. Our institutional trauma registry was queried over a 5-year period for patients with cervical arterial injuries due to penetrating craniofacial gunshot wounds who underwent CT angiography. Imaging results and clinical notes were reviewed.
Results  
A total of 427 patients sustained gunshot wounds to the head, face and/or neck, of whom 222 underwent CT angiography yielding 56 patients with 78 vascular injuries. There were five internal carotid artery injuries remote from the wound tract. The incidence of these indirect cervical arterial injuries in our patient population was 1.2%, or 2.8% of patients who underwent CT angiography.
Conclusions  
The incidence of indirect cervical arterial injuries with craniofacial gunshot wounds is comparable to or slightly higher than those seen in pure blunt trauma. Screening patients with craniofacial gunshot injuries with CT angiography may yield unexpected cervical vascular injuries remote from the penetrating tract. The significance and optimal therapy of these injuries are unknown. Additional experience will be needed to determine the significance of indirect cervical arterial injuries in the setting of craniofacial gunshot wounds.
Key Points  
There are several known risk factors for blunt cervical arterial injuries.
Cervical arterial injuries may occur remote from the wound following craniofacial gunshot wounds.
Craniofacial gunshot wounds pose a risk for blunt cervical vascular injuries.

  • Content Type Journal Article
  • Category Emergency Radiology
  • Pages 1-7
  • DOI 10.1007/s00330-012-2439-9
  • Authors
    • Scott D. Steenburg, Diagnostic Imaging Department, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201, USA
    • Clint W. Sliker, Diagnostic Imaging Department, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201, USA

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09/05/2012, Follow-up of coiled intracranial aneurysms: comparison of 3D time-of-flight and contrast-enhanced magnetic resonance angiography at 3T in a large, prospective series »»

Abstract
Objectives  
To compare 3D-TOF magnetic resonance angiography (MRA) and contrast-enhanced MRA (CE-MRA) sequences at 3T in the follow-up of coiled aneurysms with digital subtracted angiography (DSA) as the gold standard.
Methods  
DSA, 3D-TOF and CE-MRA were performed in a prospective series of 126 aneurysms in 96 patients (57 female, 39 male; age: 2575 years, mean: 51.3±11.3 years). The quality of aneurysm occlusion was assessed independently and anonymously by a core laboratory.
Results  
Using DSA (gold standard technique), total occlusion was depicted in 57 aneurysms (45.2%), neck remnant in 34 aneurysms (27.0%) and aneurysm remnant in 35 aneurysms (27.8%). Sensitivity, specificity, positive predictive value and negative predictive value were very similar with 3D-TOF and CE-MRA. Visibility of coils was much better with 3D-TOF (95.2%) than with CE-MRA (23.0%) (P<0.001). Also, substantial artefacts were less frequent with 3D-TOF (4.0%) than with CE-MRA (11.9%; P=0.012).
Conclusions  
In this large prospective series of patients with coiled aneurysms, at 3T 3D-TOF MRA was equivalent to CE-MRA for the evaluation of aneurysm occlusion, but coil visibility was superior at 3D-TOF. Thus the use of 3D-TOF at 3T is recommended for the follow-up of coiled intracranial aneurysms.
Key Points  
Different Magnetic Resonance (MR) imaging techniques are used to evaluate intracranial aneurysms.
At 3T MR, 3D-TOF and CE-MRA appear equivalent for evaluating coiled aneurysms..
Coils are better visualised on 3D-TOF than on CE-MRA.
Combined analysis of 3D-TOF and CE-MRA does not seem helpful.
At 3T, 3D-TOF techniques are recommended for monitoring patients with coiled aneurysms.

  • Content Type Journal Article
  • Category Neuro
  • Pages 1-9
  • DOI 10.1007/s00330-012-2466-6
  • Authors
    • Laurent Pierot, Department of Radiology, Maison Blanche Hospital, University of Reims, Reims, France
    • Christophe Portefaix, Department of Radiology, Maison Blanche Hospital, University of Reims, Reims, France
    • Anne Boulin, Department of Neuroradiology, Foch Hospital, Suresnes, France
    • Jean-Yves Gauvrit, Department of Radiology, CHU Rennes, University of Rennes, Rennes, France

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07/05/2012, Imaging vascular function for early stage clinical trials using dynamic contrast-enhanced magnetic resonance imaging »»

Abstract  
Many therapeutic approaches to cancer affect the tumour vasculature, either indirectly or as a direct target. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has become an important means of investigating this action, both pre-clinically and in early stage clinical trials. For such trials, it is essential that the measurement process (i.e. image acquisition and analysis) can be performed effectively and with consistency among contributing centres. As the technique continues to develop in order to provide potential improvements in sensitivity and physiological relevance, there is considerable scope for between-centre variation in techniques. A workshop was convened by the Imaging Committee of the Experimental Cancer Medicine Centres (ECMC) to review the current status of DCE-MRI and to provide recommendations on how the technique can best be used for early stage trials. This review and the consequent recommendations are summarised here.
Key Points
Tumour vascular function is key to tumour development and treatment
Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can assess tumour vascular function
Thus DCE-MRI with pharmacokinetic models can assess novel treatments
Many recent developments are advancing the accuracy of and information from DCE-MRI
Establishing common methodology across multiple centres is challenging and requires accepted guidelines

  • Content Type Journal Article
  • Category Magnetic Resonance
  • Pages 1-14
  • DOI 10.1007/s00330-012-2446-x
  • Authors
    • M. O. Leach, Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research & Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2, 5PT, UK
    • B. Morgan, College of Medicine, Biological Sciences & Psychology, University of Leicester, Maurice Shock Building, University Road, PO Box 138, Leicester, LE1 9HN UK
    • P. S. Tofts, Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Sussex, BN1 3PS UK
    • D. L. Buckley, Division of Medical Physics, University of Leeds, Level 8, Worsley Building, Clarendon Way, Leeds, LS2 9JT UK
    • W. Huang, Advanced Imaging Research Centre, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
    • M. A. Horsfield, Department of Cardiovascular Sciences, Medical Physics Section, Leicester Royal Infirmary, Leicester, LE1 5WW UK
    • T. L. Chenevert, University of Michigan Health System, 1500 E. Medical Centre Drive, Ann Arbor, MI 48109, USA
    • D. J. Collins, Cancer Research UK and EPSRC Cancer Imaging Centre, Royal Marsden Hospital NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
    • A. Jackson, University of Manchester, Wolfson Molecular Imaging Centre, 27 Palatine Road, Withington, Manchester, M20 3LJ, UK
    • D. Lomas, Department of Radiology, University of Cambridge, Level 5, Box 218, Hills Road, Cambridge, CB2 0QQ UK
    • B. Whitcher, Mango Solutions, Unit 2 Greenways Business Park, Bellinger Close, Chippenham, SN15 1BN UK
    • L. Clarke, Imaging Technology Development Branch, Cancer Imaging Program, EPN, Room 6066, 613 Executive Boulevard, Rockville, MD 20852-7412, USA
    • R. Plummer, Medical Oncology, Northern Institute for Cancer Research, University of Newcastle Upon Tyne, The Medical School, Framlington Place, Newcastle Upon Tyne, NE2 4HH UK
    • I. Judson, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, UK
    • R. Jones, Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow, G12 0YN UK
    • R. Alonzi, Mount Vernon Cancer Centre, Northwood, HA6 2RN UK
    • T. Brunner, Gray Institute for Radiation, Oncology & Biology, Old Road Campus Research Building, Off Roosevelt Drive, Oxford, OX3 7DQ UK
    • D. M. Koh, Diagnostic Radiology, Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK
    • P. Murphy, Clinical Imaging, GlaxoSmithKline, London, UK
    • J. C. Waterton, AstraZeneca, Personalised Healthcare & Biomarkers, Mereside Alderley Park, Macclesfield, Cheshire SK10 4TG, UK
    • G. Parker, Biomedical Imaging Institute, University of Manchester, Stopford Building, Manchester, M13 9BT UK
    • M. J. Graves, Cambridge University Hospitals NHS Foundation Trust, MRIS Unit, Box 162, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
    • T. W. J. Scheenen, Department of Radiology, Radbound University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA, Nijmegen, The Netherlands
    • T. W. Redpath, Aberdeen Biomedical Imaging Centre, University of Aberdeen, Lilian Sutton Building, Foresterhill, Aberdeen AB25 2ZD, UK
    • M. Orton, Cancer Research UK and EPSRC Cancer Imaging Centre, Institute of Cancer Research & Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2, 5PT, UK
    • G. Karczmar, Department of Radiology, Lynn S Florsheim MRIS Lab, University of Chicago, MC 2026m, 5841S. Maryland Avenue, Chicago, IL 60637, USA
    • H. Huisman, Radbound University Medical Center, Nijmegen, The Netherlands
    • J. Barentsz, Department of Radiology, Radbound University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
    • A. Padhani, Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
    • on behalf of the Experimental Cancer Medicine Centres Imaging Network Steering Committee

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05/05/2012, Detection of neck recurrence in patients with differentiated thyroid cancer: comparison of ultrasound, contrast-enhanced CT and 18F-FDG PET/CT using surgical pathology as a reference standard: (ultrasound vs. CT vs. 18F-FDG PET/CT in recurrent thyroid cancer) »»

Abstract
Objectives  
To compare the diagnostic performance of ultrasound, contrast-enhanced computed tomography (CT) and 18F-FDG positron emission tomography (PET)/CT for detecting recurrent differentiated thyroid cancer in the neck.
Methods  
Twenty patients who had undergone previous surgery for differentiated thyroid cancer (19 papillary carcinomas; 1 medullary carcinoma) and presented with pathologically proven recurrence in the neck were included. All patients had undergone ultrasound, CT and PET/CT in the 2 months before further surgery. In each patient, ultrasound, CT and PET/CT images were retrospectively reviewed to determine the presence of loco-regional recurrence by level-by-level analysis. Imaging results were correlated with the histological evaluation of the neck dissection as a standard of reference.
Results  
Recurrences were found at 52 out of 110 cervical nodal levels surgically explored. The sensitivity, specificity and accuracy were 69.2 %, 89.7 % and 80.0 % for ultrasound; 63.5 %, 94.8 % and 80.0 % for CT; and 53.8 %, 79.3 % and 67.3 % for PET/CT, respectively. ROC analysis revealed higher diagnostic performance with ultrasound than with PET/CT for detecting recurrent tumour.
Conclusions  
Although no significant difference was found among the three techniques, the sensitivity and specificity of ultrasound and CT were higher than those of PET/CT for the evaluation of cervical recurrence in patients with differentiated thyroid cancer.
Key Points   
Ultrasound, CT and 18 F-FDG PET/CT can all detect recurrent thyroid cancer.
Ultrasound and CT have higher sensitivity and specificity.
Ultrasound, CT and 18 F-FDG PET/CT frequently demonstrated discordant findings

  • Content Type Journal Article
  • Category Head and Neck
  • Pages 1-9
  • DOI 10.1007/s00330-012-2470-x
  • Authors
    • Young Lan Seo, Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong, Kangdong-gu, Seoul, 134-701 Korea
    • Dae Young Yoon, Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong, Kangdong-gu, Seoul, 134-701 Korea
    • Sora Baek, Department of Nuclear Medicine, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong, Kangdong-gu, Seoul, 134-701 Korea
    • You Jin Ku, Department of Radiology, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong, Kangdong-gu, Seoul, 134-701 Korea
    • Young-Soo Rho, Department of Otorhinolaryngology, Ilsong Memorial Institute of Head and Neck Cancer, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong, Kangdong-gu, Seoul, 134-701 Korea
    • Eun-Jae Chung, Department of Otorhinolaryngology, Ilsong Memorial Institute of Head and Neck Cancer, Kangdong Seong-Sim Hospital, Hallym University College of Medicine, 445 Gil-dong, Kangdong-gu, Seoul, 134-701 Korea
    • Sung Hye Koh, Department of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 896, Pyungchon-dong, Dongan-gu, Anyang, Gyonggi-do 431-070, Korea

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05/05/2012, Metabolic response at repeat PET/CT predicts pathological response to neoadjuvant chemotherapy in oesophageal cancer »»

Abstract
Objectives  
Reports have suggested that a reduction in tumour 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) examination during or after neoadjuvant chemotherapy may predict pathological response in oesophageal cancer. Our aim was to determine whether metabolic response predicts pathological response to a standardised neoadjuvant chemotherapy regimen within a prospective clinical trial.
Methods  
Consecutive patients staged with potentially curable oesophageal cancer who underwent treatment within a non-randomised clinical trial were included. A standardised chemotherapy regimen (two cycles of oxaliplatin and 5-fluorouracil) was used. PET/CT was performed before chemotherapy and repeated 2428 days after the start of cycle 2.
Results  
Forty-eight subjects were included: mean age 65 years; 37 male. Using the median percentage reduction in SUVmax (42%) to define metabolic response, pathological response was seen in 71% of metabolic responders (17/24) compared with 33% of non-responders (8/24; P=0.009, sensitivity 68%, specificity 70%). Pathological response was seen in 81% of subjects with a complete metabolic response (13/16) compared with 38% of those with a less than complete response (12/32; P=0.0042, sensitivity 52%, specificity 87%). There was no significant histology-based effect.
Conclusions  
There was a significant association between metabolic response and pathological response; however, accuracy in predicting pathological response was relatively low.
Key Points   
PET/CT may predict tumour response to chemotherapy in oesophageal cancer.
This was a prospective study using a standardised chemotherapy regimen.
A significant association between PET/CT findings and disease response was found.
However accuracy in predicting pathological response was relatively low.

  • Content Type Journal Article
  • Category Oncology
  • Pages 1-9
  • DOI 10.1007/s00330-012-2459-5
  • Authors
    • R. S. Gillies, Department of Oncology, Oxford Cancer & Haematology Centre, Oxford, UK
    • M. R. Middleton, Department of Oncology, Oxford Cancer & Haematology Centre, Oxford, UK
    • C. Blesing, Department of Oncology, Oxford Cancer & Haematology Centre, Oxford, UK
    • K. Patel, Department of Oncology, Oxford Cancer & Haematology Centre, Oxford, UK
    • N. Warner, Department of Oncology, Oxford Cancer & Haematology Centre, Oxford, UK
    • R. E. K. Marshall, Department of Oesophagogastric Surgery, Oxford Cancer & Haematology Centre, Oxford, UK
    • N. D. Maynard, Department of Oesophagogastric Surgery, Oxford Cancer & Haematology Centre, Oxford, UK
    • K. M. Bradley, Department of Radiology, Oxford Cancer & Haematology Centre, Oxford, UK
    • F. V. Gleeson, Department of Radiology, Oxford Cancer & Haematology Centre, Oxford, UK

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05/05/2012, Macroscopic heterogeneity of liver fat: an MR-based study in type-2 diabetic patients »»

Abstract
Objective  
To assess the heterogeneity of liver fat deposition with MR of the liver in type-2 diabetic (T2D) patients.
Methods  
We enrolled 121 consecutive T2D patients. The reference standard was 3.0-T 1H-MR spectroscopy. Hepatic steatosis was defined as liver fat content (LFC) 5.56 %. A triple-echo gradient-echo sequence corrected for T1 recovery and T2* decay was used to calculate LFC in left and right livers and hepatic segments. Analyses were performed using a linear mixed model.
Results  
Fifty-nine (48.8 %) patients had liver steatosis, whereas 62 (51.2 %) did not. Steatosis was greater in the right than in the left liver (P<0.0001) [mean difference: 1.32 % (range: 0.018.75 %)]. In seven patients (5.8 %), LFC was <5.56 % in one side of the liver, whereas it was 5.56 % in the other.
Steatosis of the left and right liver was heterogeneous at the segmental level in both non-steatotic (P<0.001 and P<0.0001 respectively) and steatotic (P<0.0001 and P=0.0002 respectively) patients [mean maximum difference: 3.98 % (range: 0.7419.32 %)]. In 23 patients (19 %), LFC was <5.56 % in one segment, whereas it was 5.56 % in at least one other.
Conclusion  
Overall, the mean segmental/lobar variability of steatosis is low. However, segmental variability can sometimes lead to a misdiagnosis.
Key Points  
 
There is a need for methods quantifying steatosis over a large region.
 
Steatosis is usually greater in the right than left lobe of the liver.
 
Steatosis within both left and right hepatic lobes is segmentally heterogeneous.
 
Segmental variability of steatosis can result in misdiagnosis.

  • Content Type Journal Article
  • Category Hepatobiliary-Pancreas
  • Pages 1-8
  • DOI 10.1007/s00330-012-2468-4
  • Authors
    • Violaine Capitan, Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079 Dijon, France
    • Jean-Michel Petit, Department of Endocrinology, Diabetology, and Metabolic Diseases, CHU (University Hospital), BP 77908, 21079 Dijon, France
    • Serge Aho, Department of Biostatistics and Medical Informatics, CHU (University Hospital), BP 77908, 21079 Dijon, France
    • Pierre-Henri Lefevre, Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079 Dijon, France
    • Sylvain Favelier, Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079 Dijon, France
    • Romaric Loffroy, Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079 Dijon, France
    • Patrick Hillon, University of Burgundy, INSERM U866, BP 87900, 21079 Dijon, France
    • Denis Krausé, Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079 Dijon, France
    • Jean-Pierre Cercueil, Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079 Dijon, France
    • Boris Guiu, Department of Radiology, CHU (University Hospital), 14 rue Paul Gaffarel, BP 77908, 21079 Dijon, France

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02/05/2012, Optimising diffusion-weighted MR imaging for demonstrating pancreatic cancer: a comparison of respiratory-triggered, free-breathing and breath-hold techniques »»

Abstract
Objectives  
To compare respiratory-triggered, free-breathing, and breath-hold DWI techniques regarding (1) image quality, and (2) signal intensity (SI) and ADC measurements in pancreatic ductal adenocarcinoma (PDAC).
Methods  
Fifteen patients with histopathologically proven PDAC underwent DWI prospectively at 1.5 T (b=0, 50, 300, 600 and 1,000 s/mm2) with the three techniques. Two radiologists, independently and blindly, assigned total image quality scores [sum of rating diffusion images (lesion detection, anatomy, presence of artefacts) and ADC maps (lesion characterisation, overall image quality)] per technique and ranked them. The lesion SI, signal-to-noise ratio, mean ADC and coefficient of variation (CV) were compared.
Results  
Total image quality scores for respiratory-triggered, free-breathing and breath-hold techniques were 17.9, 16.5 and 17.1 respectively (respiratory-triggered was significantly higher than free-breathing but not breath-hold). The respiratory-triggered technique had a significantly higher ranking. Lesion SI on all b-values and signal-to-noise ratio on b300 and b600 were significantly higher for the respiratory-triggered technique. For respiratory-triggered, free-breathing and breath-hold techniques the mean ADCs were 1.201, 1.132 and 1.253×10-3 mm2/s, and mean CVs were 8.9, 10.8 and 14.1 % respectively (respiratory-triggered and free-breathing techniques had a significantly lower mean CV than the breath-hold technique).
Conclusion  
In both analyses, respiratory-triggered DWI showed superiority and seems the optimal DWI technique for demonstrating PDAC.
Key Points   
Diffusion-weighted magnetic resonance imaging is increasingly used to detect pancreatic cancer
Images are acquired using various breathing techniques and multiple b-values
Breathing techniques used: respiratory-triggering, free-breathing and breath-hold
Respiratory-triggering seems the optimal breathing technique for demonstrating pancreatic cancer

  • Content Type Journal Article
  • Category Hepatobiliary-Pancreas
  • Pages 1-7
  • DOI 10.1007/s00330-012-2469-3
  • Authors
    • Nikolaos Kartalis, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, 141 86 Stockholm, Sweden
    • Louiza Loizou, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, 141 86 Stockholm, Sweden
    • Nick Edsborg, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, 141 86 Stockholm, Sweden
    • Ralf Segersvärd, Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
    • Nils Albiin, Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, 141 86 Stockholm, Sweden

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02/05/2012, Contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT »»

Abstract
Objectives  
To evaluate the safety of contrast-enhanced MDCT in patients with renal impairment.
Methods  
We conducted a retrospective review of 938 patients with stable renal insufficiency (eGFR between 15 and 60 ml/min) who underwent contrast-enhanced MDCT. SCr levels were measured at baseline and 4872 h after contrast medium administration. The incidence of contrast-induced nephropathy (CIN) in the total study population was assessed. As a control group, 1,164 separate patients with renal insufficiency who did not receive contrast medium for CT were also reviewed.
Results  
The overall incidence of CIN in the patient population with renal insufficiency was 6.1 %; the incidence was 4.4 %, 10.5 % and 10.0 % for patients whose eGFR was 4560, 3045 and 30 ml/min, respectively (P<0.01). In the control group, 5.8 % of patients showed an increase in the SCr level from the baseline. The increase in the SCr level showed no significant difference between the patients who received CM and those who did not (P=0.82)
Conclusions  
The risk of CIN from contrast-enhanced MDCT in patients with renal insufficiency appeared to be low, and there was no significant difference in the incidence of CIN in comparison with patients who did not receive CM.
Key Points   
The contrast medium used for multidetector CT can induce nephropathy.
Contrast-induced nephropathy (CIN) developed in 6.1 % of patients with renal insufficiency.
However, nephropathy developed in 5.8 % of similar patients not receiving contrast medium.
Thus, the risk of CIN associated with MDCT appears to be low.
Special care should still be taken in patients with renal insufficiency.

  • Content Type Journal Article
  • Category Contrast Media
  • Pages 1-6
  • DOI 10.1007/s00330-012-2473-7
  • Authors
    • Ryusuke Murakami, Department of Radiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo, Tokyo, 1138602 Japan
    • Hiromitsu Hayashi, Department of Radiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo, Tokyo, 1138602 Japan
    • Ken-ichi Sugizaki, Department of Radiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo, Tokyo, 1138602 Japan
    • Tamiko Yoshida, Department of Radiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo, Tokyo, 1138602 Japan
    • Emi Okazaki, Department of Radiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo, Tokyo, 1138602 Japan
    • Shin-ichiro Kumita, Department of Radiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo, Tokyo, 1138602 Japan
    • Chojin Owan, Department of Radiology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi Bunkyo, Tokyo, 1138602 Japan

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02/05/2012, Does CT colonography have a role for population-based colorectal cancer screening? »»

Abstract  
Colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related deaths in Europe. CRC screening has been proven to reduce disease-specific mortality and several European countries employ national screening programmes. These almost exclusively rely on stool tests, with endoscopy used as an adjunct in some countries. Computed tomographic colonography (CTC) is a potential screening test, with an estimated sensitivity of 88 % for advanced neoplasia 10 mm. Recent randomised studies have shown that CTC and colonoscopy have similar yields of advanced neoplasia per screened invitee, indicating that CTC is potentially viable as a primary screening test. However, the evidence is not fully elaborated. It is unclear whether CTC screening is cost-effective and the impact of extracolonic findings, both medical and economic, remains unknown. Furthermore, the effect of CTC screening on CRC-related mortality is unknown, as it is also unknown for colonoscopy. It is plausible that both techniques could lead to decreased mortality, as for sigmoidoscopy and gFOBT. Although radiation exposure is a drawback, this disadvantage may be over-emphasised. In conclusion, the detection characteristics and acceptability of CTC suggest it is a viable screening investigation. Implementation will depend on detection of extracolonic disease and health-economic impact.
Key Points
Meta-analysis of CT colonographic screening showed high sensitivity for advanced neoplasia 10mm.
CTC, colonoscopy and sigmoidoscopy screening all have similar yields for advanced neoplasia.
Good quality information regarding the cost-effectiveness of CTC screening is lacking.
There is little good quality data regarding the impact of extracolonic findings.
CTC triage is not clinically effective in first round gFOBT/FIT positives.

  • Content Type Journal Article
  • Category Gastrointestinal
  • Pages 1-9
  • DOI 10.1007/s00330-012-2449-7
  • Authors
    • Margriet C. de Haan, Department of Radiology, G1-228, Academic Medical Centre Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
    • Steve Halligan, Centre for Medical Imaging, University College London, London, UK
    • Jaap Stoker, Department of Radiology, G1-228, Academic Medical Centre Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands

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02/05/2012, Magnetic resonance imaging of the active second stage of labour: Proof of principle »»

Abstract
Objective  
To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible.
Materials and methods  
Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour.
Results  
Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts.
Conclusion  
CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications.
Key Points  
The active second stage of obstetric delivery can be followed by MRI.
Wireless cardiotocography allows monitoring of the foetus during MRI.
It has potential applications in evaluation of late obstetric problems.

  • Content Type Journal Article
  • Category Magnetic Resonance
  • Pages 1-7
  • DOI 10.1007/s00330-012-2455-9
  • Authors
    • F. V. Güttler, Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany
    • A. Heinrich, Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany
    • J. Rump, Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany
    • M. de Bucourt, Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany
    • B. Schnackenburg, Philips GmbH Unternehmensbereich Healthcare, Lübeckertordamm 5, 20099 Hamburg, Germany
    • C. Bamberg, Department of Obstetrics, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany
    • B. Hamm, Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany
    • U. K. Teichgräber, Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany

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02/05/2012, 18F-FDG uptake by spleen helps rapidly predict the dose level after total body irradiation in a Tibetan minipig model »»

Abstract
Objectives  
To investigate whether 18F- FDG uptake can be applied in dosimetry to facilitate the rapid and accurate evaluation of individual radiation doses after a nuclear accident.
Methods  
Forty-eight Tibetan minipigs were randomised into a control group (n=3) and treatment groups (n=45). 18F-FDG combined positron-emission tomography and computed tomography (PET/CT) were carried out before total body irradiation (TBI) and at 6, 24 and 72 h after receiving TBI doses ranging from 1 to 11 Gy. Spleen tissues and blood samples were also collected for histological examination, apoptosis and blood analysis.
Results  
Mean standardised uptake values (SUVs) of the spleen showed significant differences between the experimental and the control groups. Spleen SUV at 6 h post-irradiation showed significant correlation with radiation dose; Spearmans correlation coefficient was 0.97 (P<0.01). Histological observations showed that damage to the splenic lymphocyte became more severe with an increase in the radiation dose. Moreover, apoptosis was one of the major routes of splenic lymphocyte death, which was also confirmed by flow cytometry analysis.
Conclusions  
In the Tibetan minipig model, radiation doses have a close relationship with the 18F-FDG uptake of the spleen. This finding suggests that 18F-FDG PET/CT may be useful for the rapid detection of individual radiation doses.
Key Points  
The spleen responds rapidly and is very sensitive to total body irradiation.
In Tibetan minipigs, the radiation dose is closely related to the 18F-FDG uptake of the spleen.
18F-FDG PET/CT may be useful for the prediction of individual radiation doses.

  • Content Type Journal Article
  • Category Emergency Radiology
  • Pages 1-8
  • DOI 10.1007/s00330-012-2451-0
  • Authors
    • Yu Jue Wang, Department of Laboratory Animal Center, Southern Medical University, 1838 Guangzhou North Road, 510515 Guangzhou, Guangdong, China
    • Shao Jie Wu, Department of Hematology, Zhujiang Hospital, Southern Medical University, 253 Industry Road, 510282 Guangzhou, Guangdong, China
    • Kun Yuan Guo, Department of Hematology, Zhujiang Hospital, Southern Medical University, 253 Industry Road, 510282 Guangzhou, Guangdong, China
    • Chi Chen, Department of Hematology, Zhujiang Hospital, Southern Medical University, 253 Industry Road, 510282 Guangzhou, Guangdong, China
    • Qiang Xie, Department of Oncology and PET/CT, Guangdong Provincial Corp Hospital, Chinese Peoples Armed Police Forces, 268 Yanling Road, 510507 Guangzhou, Guangdong, China
    • Wei Wang Gu, Department of Laboratory Animal Center, Southern Medical University, 1838 Guangzhou North Road, 510515 Guangzhou, Guangdong, China
    • Liang Cai, Department of Oncology and PET/CT, Guangdong Provincial Corp Hospital, Chinese Peoples Armed Police Forces, 268 Yanling Road, 510507 Guangzhou, Guangdong, China
    • Fei Zou, School of Public Health and Tropical Medicine, Southern Medical University, 1838 Guangzhou North Road, 510515 Guangzhou, Guangdong, China

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02/05/2012, Automated tube potential selection for standard chest and abdominal CT in follow-up patients with testicular cancer: comparison with fixed tube potential »»

Abstract
Objective  
To evaluate prospectively, in patients with testicular cancer, the radiation dose-saving potential and image quality of contrast-enhanced chest and abdominal CT with automated tube potential selection.
Methods  
Forty consecutive patients with testicular cancer underwent contrast-enhanced arterio-venous chest and portal-venous abdominal CT with automated tube potential selection (protocol B; tube potential 80140 kVp), which is based on the attenuation of the CT topogram. All had a first CT at 120 kVp (protocol A) using the same 64-section CT machine and similar settings. Image quality was assessed; dose information (CTDIvol) was noted.
Results  
Image noise and attenuation in the liver and spleen were significantly higher for protocol B (P<0.05 each), whereas attenuation in the deltoid and erector spinae muscles was similar. In protocol B, tube potential was reduced to 100 kVp in 18 chest and 33 abdominal examinations, and to 80 kVp in 5 abdominal CT examinations; it increased to 140 kVp in one patient. Image quality of examinations using both CT protocols was rated as diagnostic. CTDIvol was significantly lower for protocol B compared to protocol A (reduction by 12%, P<0.01).
Conclusion  
In patients with testicular cancer, radiation dose of chest and abdominal CT can be reduced with automated tube potential selection, while image quality is preserved.

  • Content Type Journal Article
  • Category Computed Tomography
  • Pages 1-9
  • DOI 10.1007/s00330-012-2453-y
  • Authors
    • Ralph Gnannt, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
    • Anna Winklehner, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
    • Daniel Eberli, Clinic for Urology, University Hospital Zurich, Zurich, Switzerland
    • Alexander Knuth, Clinic for Oncology, University Hospital Zurich, Zurich, Switzerland
    • Thomas Frauenfelder, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
    • Hatem Alkadhi, Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland

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29/04/2012, Standardising measurement of tumour vascularity by imaging: recommendations for ultrasound, computed tomography, magnetic resonance imaging and positron emission tomography »»

Abstract  
This review analyses the need for, and likely impact of, four subsequent papers which discuss the importance of standardisation of ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) when assessing tumour vascularity. This is particularly important when measuring the vascular effects of therapeutic agents in oncological research and practice. As imaging inexorably moves from the subjective interpretative art-form of the past into its modern role as a fully fledged objective scientific discipline, it is incumbent on all radiologists to understand the need for strict adherence to perceived best practice when evaluating lesions as part of trials. Indeed trials may only be funded by pharmaceutical companies and other grant-giving bodies if rigorous adherence to imaging protocols and quality assurance is in place.
Key Points
Various imaging methods can now robustly assess tumour vascular support.
US, CT, MRI and PET are increasingly used to assess tumour vascularity.
These techniques have reached technical maturity for use in therapeutic oncological trials.
Consensus guidelines about using these techniques in assessing tumour vascularity are introduced.
Image acquisition protocols and quality assurance must be established for large trials.

  • Content Type Journal Article
  • Category Editorial
  • Pages 1-3
  • DOI 10.1007/s00330-012-2444-z
  • Authors
    • Adrian K. Dixon, Department of Radiology, Addenbrookes Hospital and the University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Level 5, Box 218, Hills Road, Cambridge, CB2 0QQ UK
    • Fiona J. Gilbert, Department of Radiology, Addenbrookes Hospital and the University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Level 5, Box 218, Hills Road, Cambridge, CB2 0QQ UK

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29/04/2012, Percutaneous embolization of persistent low-output enterocutaneous fistulas »»

Abstract
Objectives  
To present and retrospectively evaluate the technique of percutaneous embolization of chronic enterocutaneous fistulas (ECFs) using n-butyl-2-cyanoacrylate and Lipiodol under fluoroscopic guidance.
Methods  
Six patients with a total of seven post-operative low-output ECFs of the large intestine were treated. After fistulography a hydrophilic guide wire and a catheter were advanced through the ECF into the intestine. After dilation of the bowel with saline and contrast medium, the catheter was withdrawn into the enteric orifice and glue together with Lipiodol was injected while simultaneously pulling the catheter.
Results  
Complete closure of all seven fistulas was achieved. There were no peri-procedural complications. In one patient 1 month following embolization a low-output enteric discharge was observed, but the ECF spontaneously healed 5 days later. In one patient 18 months after the embolization a new perforation due to diverticulitis close to the embolization site occurred and resection of the sigmoid colon was performed. One patient needed reoperation due to a recurrence of rectal carcinoma.
Conclusions  
In our series of patients, the presented technique of percutaneous embolization proved to be efficacious and easy to perform. It may have potential as a first-line treatment of low-output ECFs but a prospective study with a larger series of patients and a longer follow-up is required.
Key Points   
Patients with low-output fistulas have recurrent infections and reduced quality of life.
Surgical treatment is complex with a relatively high morbidity and occasional mortality.
Several percutaneous and endoscopy treatments have previously been proposed with mixed results.
Hydrophilic guide wires and hydrophilic catheters offer new potential treatment options.
Sealing the fistula with cyanoacrylate glue and Lipiodol seems potentially efficacious.

  • Content Type Journal Article
  • Category Interventional
  • Pages 1-7
  • DOI 10.1007/s00330-012-2461-y
  • Authors
    • Liana Cambj Sapunar, Department of Diagnostic and Interventional Radiology, University Hospital Split, Spinciceva 1, 21 000 Split, Croatia
    • Budimir Sekovski, Department of Diagnostic and Interventional Radiology, University Hospital Split, Spinciceva 1, 21 000 Split, Croatia
    • Dario Mati, Department of Surgery, University Hospital Split, Spinciceva 1, 21 000 Split, Croatia
    • Andro Tripkovi, Department of Surgery, University Hospital Split, Spinciceva 1, 21 000 Split, Croatia
    • Leo Grandi, Department of Surgery, University Hospital Split, Spinciceva 1, 21 000 Split, Croatia
    • Nikica Druijani, Department of Surgery, University Hospital Split, Spinciceva 1, 21 000 Split, Croatia

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29/04/2012, High accuracy of mesoscopic epi-fluorescence tomography for non-invasive quantitative volume determination of fluorescent protein-expressing tumours in mice »»

Abstract
Objectives  
To compare mesoscopic epi-fluorescence tomography (MEFT) and EPRI-illumination reflectance imaging (EPRI) for quantitative tumour size assessment in mice.
Methods  
Tumour xenografts of green/red fluorescent protein (GFP/RFP)-expressing colon cancer cells were measured using MEFT, EPRI, ultrasound (US) and micro computed tomography (CT) at day 14 post-injection (n=6). Results from MEFT and EPRI were correlated with each other and with US and CT (reference methods). Tumour volumes were measured ex vivo by GFP and RFP fluorescence imaging on cryoslices and compared with the in vivo measurements.
Results  
High correlation and congruency were observed between MEFT, US and CT (MEFT/US: GFP: r 2=0.96; RFP: r 2=0.97, both P<0.05; MEFT/CT: GFP: r 2=0.93; RFP: r 2=0.90; both P<0.05). Additionally, in vivo MEFT data were highly correlated and congruent with ex vivo cryoslice imaging results (GFP: r 2=0.96; RFP: r 2=0.99; both P<0.05). In comparison, EPRI significantly overestimated tumour volumes (P<0.05), although there was a significant correlation with US and CT (EPRI/US: GFP: r 2=0.95; RFP: r 2=0.94; both P<0.05; EPRI/CT GFP: r 2=0.86; RFP: r 2=0.86; both P<0.05).
Conclusions  
Fluorescence distribution reconstruction using MEFT affords highly accurate three-dimensional (3D) tumour volume data showing superior accuracy compared to EPRI. Thus, MEFT is a very suitable technique for quantitatively assessing fluorescence distribution in superficial tumours at high spatial resolution.
Key Points   
Mesoscopic epi-fluorescence tomography (MEFT) is an important new molecular imaging technique.
MEFT allows accurate size determination of superficial tumours with high resolution.
MEFT is a suitable technique for longitudinal assessment of tumour growth.
MEFT allows 3D reconstruction and quantification of fluorescence distributions.

  • Content Type Journal Article
  • Category Experimental
  • Pages 1-8
  • DOI 10.1007/s00330-012-2462-x
  • Authors
    • Lotfi Abou-Elkacem, Department of Experimental Molecular Imaging, Medical Faculty, RWTH Aachen University, Pauwelstraße 30, 52074 Aachen, Germany
    • Saskia Björn, Institute for Biological and Medical Imaging, Technische Universität München and Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
    • Dennis Doleschel, Department of Experimental Molecular Imaging, Medical Faculty, RWTH Aachen University, Pauwelstraße 30, 52074 Aachen, Germany
    • Vasilis Ntziachristos, Institute for Biological and Medical Imaging, Technische Universität München and Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
    • Ralf Schulz, Institute for Biological and Medical Imaging, Technische Universität München and Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
    • Robert M. Hoffman, Department of Surgery, University of California and AntiCancer Inc., Ostrow St, 7917, San Diego, CA 92111, USA
    • Fabian Kiessling, Department of Experimental Molecular Imaging, Medical Faculty, RWTH Aachen University, Pauwelstraße 30, 52074 Aachen, Germany
    • Wiltrud Lederle, Department of Experimental Molecular Imaging, Medical Faculty, RWTH Aachen University, Pauwelstraße 30, 52074 Aachen, Germany

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29/04/2012, Axial T2* mapping in intervertebral discs: a new technique for assessment of intervertebral disc degeneration »»

Abstract
Objectives  
To demonstrate the potential benefits of biochemical axial T2* mapping of intervertebral discs (IVDs) regarding the detection and grading of early stages of degenerative disc disease using 1.5-Tesla magnetic resonance imaging (MRI) in a clinical setting.
Methods  
Ninety-three patients suffering from lumbar spine problems were examined using standard MRI protocols including an axial T2* mapping protocol. All discs were classified morphologically and grouped as healthy or abnormal. Differences between groups were analysed regarding to the specific T2* pattern at different regions of interest (ROIs).
Results  
Healthy intervertebral discs revealed a distinct cross-sectional T2* value profile: T2* values were significantly lower in the annulus fibrosus compared with the nucleus pulposus (P=0.01). In abnormal IVDs, T2* values were significantly lower, especially towards the centre of the disc representing the expected decreased water content of the nucleus (P=0.01). In herniated discs, ROIs within the nucleus pulposus and ROIs covering the annulus fibrosus showed decreased T2* values.
Conclusions  
Axial T2* mapping is effective to detect early stages of degenerative disc disease. There is a potential benefit of axial T2* mapping as a diagnostic tool, allowing the quantitative assessment of intervertebral disc degeneration.
Key Points   
Axial T2* mapping effective in detecting early degenerative disc disease.
Healthy and abnormal intervertebral discs revealed distinct cross-sectional T2* value profiles.
T2* can be performed at 1.5 T in a clinical setting.

  • Content Type Journal Article
  • Category Magnetic Resonance
  • Pages 1-7
  • DOI 10.1007/s00330-012-2448-8
  • Authors
    • Sven Hoppe, Department of Orthopaedic Surgery, Inselspital, Berne University Hospital, 3010 Berne, Switzerland
    • Sebastian Quirbach, Department of Orthopaedic Surgery, Inselspital, Berne University Hospital, 3010 Berne, Switzerland
    • Tallal C. Mamisch, Department of Radiology, Inselspital, Berne University Hospital, Berne, Switzerland
    • Fabian G. Krause, Department of Orthopaedic Surgery, Inselspital, Berne University Hospital, 3010 Berne, Switzerland
    • Stefan Werlen, Department of Radiology, Clinic Sonnenhof, Berne, Switzerland
    • Lorin M. Benneker, Department of Orthopaedic Surgery, Inselspital, Berne University Hospital, 3010 Berne, Switzerland

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29/04/2012, Diagnostic performance of whole-body MRI for the detection of persistent or relapsing disease in multiple myeloma after stem cell transplantation »»

Abstract
Objectives  
To compare the diagnostic performance of whole-body MRI (WBMRI) with haematological parameters for detecting persistent or relapsing disease in patients with multiple myeloma after stem cell transplantation.
Methods  
Sixty-six WBMRI acquisitions were performed in 33 patients with multiple myeloma at two time points after stem cell transplantation. Extent of disease and inter-test dynamics of intra- and extramedullary myeloma manifestations were compared (kappa statistics) with Uniform Response Criteria, comprising haematological parameters.
Results  
Using data from 66 sequential WBMRI acquisitions in 33 patients, 10 patients (30.3 %) were classified as having progressive disease and 23 (69.7 %) as being in remission. Eight (80 %) of the ten patients with progressive disease revealed intramedullary lesions, and two patients (20 %) had intra- and extramedullary lesions. WBMRI and laboratory tests were concordant in 26/33 (78.8 %) patients. We found an agreement of 51.2 %, 95 % confidence interval 19.8 %-82.6 %, between results from WBMRI and haematological parameters. WBMRI had a sensitivity of 63.6 %, specificity of 86.4 %, PPV of 70.0 %, NPV of 82.6 % and accuracy of 78.8 % for detection of remission.
Conclusions  
WBMRI allows the detection and exact localisation of intra- and extramedullary myeloma manifestations after stem cell transplantation, but shows only moderate agreement with routinely performed laboratory tests for determination of remission.
Key Points  
Whole body magnetic resonance imaging (WBMRI) is increasingly used for oncological purposes
WBMRI allows localisation of intra- and extramedullary myeloma manifestations after SCT
However, WBMRI and serum analyses do not fully concur when assessing response
Thus, WBMRI offers limited incremental value over laboratory tests to determine remission

  • Content Type Journal Article
  • Category Magnetic Resonance
  • Pages 1-6
  • DOI 10.1007/s00330-012-2445-y
  • Authors
    • Peter Bannas, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Hannah B. Hentschel, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Thorsten A. Bley, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • András Treszl, Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Christine Eulenburg, Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Thorsten Derlin, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Jin Yamamura, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Gerhard Adam, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Thomas Stübig, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Nicolaus Kröger, Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
    • Christoph Weber, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany

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28/04/2012, Efficacy of microwave versus radiofrequency ablation for treatment of small hepatocellular carcinoma: experimental and clinical studies »»

Abstract
Objective  
To prospectively compare microwave (MW) ablation using a modified internal cooled-shaft antenna with radiofrequency (RF) ablation in in vivo porcine liver and in patients with small hepatocellular carcinoma (sHCC).
Methods  
In an animal study, MW and RF ablations using a cooled-shaft antenna or internally cooled electrode were performed in in vivo porcine liver. Coagulation diameters of both ablations were compared. For clinical study, 42 patients with sHCC were treated with MW or RF ablation. Complete ablation (CA) and local tumour progression (LTP) were compared.
Results  
MW ablation produced significantly larger ablation zones than RF ablation in both porcine liver and sHCC with an ablated volume of 33.3±15.6 cm3 vs. 18.9±9.1 cm3 and 109.3±58.3 cm3 vs. 48.7±30.5 cm3, respectively. The CA rate was 95.5 % (21/22) for MW ablation and 95.0 % (19/20) for RF ablation. In a 5.1-month follow-up, the LTP rate was 18.2 % (4/22) in the MW ablation group and 15.0 % (3/20) in the RF ablation group.
Conclusion  
MW ablation using a modified cooled-shaft antenna produces a larger ablation zone than RF ablation, with an efficacy similar to RF ablation in local tumour control. MW ablation is a safe and promising treatment of sHCC.
Key Points  
Microwave ablation with a cooled-shaft antenna produces a larger ablation zone than radiofrequency ablation.
Microwave and radiofrequency ablation showed similar local tumour control in small HCC.
Microwave ablation seems safe and efficient for small liver cancers (<3 cm).

  • Content Type Journal Article
  • Category Interventional
  • Pages 1-8
  • DOI 10.1007/s00330-012-2442-1
  • Authors
    • Guo-Jun Qian, Department of Ultrasonic Intervention, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
    • Neng Wang, Department of Ultrasonic Intervention, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
    • Qiang Shen, Department of Ultrasonic Intervention, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
    • Yue Hong Sheng, Department of Ultrasonic Intervention, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
    • Jie-Qiong Zhao, Department of Ultrasonic Intervention, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China
    • Ming Kuang, Department of Hepatobiliary Surgery, Division of Interventional Ultrasound, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, 510080 China
    • Guang-Jian Liu, Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
    • Meng-Chao Wu, First Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200438 China

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27/04/2012, Magnetic resonance imaging of the knee at 3 and 7 Tesla: a comparison using dedicated multi-channel coils and optimised 2D and 3D protocols »»

Abstract
Objectives  
To show the feasibility and possible superiority of two 7 Tesla knee protocols (7 T high resolution and 7 T quick) using a new 28-channel knee coil compared to an optimised 3 T knee protocol using an 8-channel knee coil.
Methods  
The study was approved by the ethics committee. Both 3 T and 7 T MRI of the knee were performed in 10 healthy volunteers (29.6±7.9 years), with two 2D sequences (PD-TSE and T1-SE) and three isotropic 3D sequences (TRUFI, FLASH and PD-TSE SPACE). Quantitative contrast-to-noise ratio (CNR) and qualitative evaluations were performed by different readers, and intra- and inter-rater agreement was assessed.
Results  
The signal-to-noise ratio (SNR) as well as the CNR values for cartilagebone, cartilagefluid, cartilagemenisci and meniscifluid were, in most cases, higher at 7 T compared to 3 T, and the 7 T quick measurement was slightly superior compared to the 7 T high-resolution measurement. The results of the subjective qualitative analysis were higher for the 7 T measurements compared to the 3 T measurements. Inter- and intra-observer reliability was high (0.8840.999).
Conclusions  
Through higher field strength and an optimal coil, resolution at 7 T can be increased and acquisition time can be reduced, with superior quantitative and comparable qualitative results compared to 3 T.
Key Points   
7-Tesla MRI using a dedicated 28-channel knee coil provides high quality.
Isotropic 3D-MR sequences benefit more from ultra-high-field than basic 2D sequences.
At 7 T high resolution and short MR acquisition are possible.
Dedicated coils ensure the clinical applicability of musculoskeletal MRI at ultra-high-field.

  • Content Type Journal Article
  • Category Musculoskeletal
  • Pages 1-8
  • DOI 10.1007/s00330-012-2450-1
  • Authors
    • Goetz H. Welsch, MR Center, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, 1090 Vienna, Austria
    • Vladimir Juras, MR Center, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, 1090 Vienna, Austria
    • Pavol Szomolanyi, MR Center, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, 1090 Vienna, Austria
    • Tallal C. Mamisch, MR Center, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, 1090 Vienna, Austria
    • Peter Baer, Siemens Healthcare, Erlangen, Germany
    • Claudia Kronnerwetter, MR Center, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, 1090 Vienna, Austria
    • Matthias Blanke, Department of Trauma Surgery, University of Erlangen, Erlangen, Germany
    • Hiroyuki Fujita, Quality Electrodynamics (QED), Mayfield Village, OH, USA
    • Siegfried Trattnig, MR Center, Department of Radiology, Medical University of Vienna, Lazarettgasse 14, 1090 Vienna, Austria

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27/04/2012, Magnetic resonance colonography in severe attacks of ulcerative colitis »»

Abstract
Objectives  
To evaluate the ability of MR colonography (MRC) to detect lesions in severe attacks of ulcerative colitis (UC) and to assess its concordance with rectosigmoidoscopy.
Methods  
Eighteen patients underwent MRC and rectosigmoidoscopy. MRC consisted of a water-filled colonic procedure followed by T1/T2w images. Image quality was recorded. Inflammatory lesions and the existence of signs of severity were analysed. We calculated MR accuracy in the diagnosis of inflammatory lesions, as well as per segment and per patient concordance depending on the presence or absence of severe lesions.
Results  
The MR image quality of the 108 segments was satisfactory. Endoscopy was used to study 36 segments (rectum and sigmoid). MRC had a positive predictive value of 100% and a sensitivity of 64% in the diagnosis of inflammatory lesions. Concordance for the diagnosis of severe lesions was excellent for the rectum (k=0.85) and good for the sigmoid (k=0.64). MRC diagnosed signs of severity in all patients affected at endoscopy. MRC also disclosed signs of severity located higher in the colon in four patients with nonsevere lesions at rectosigmoidoscopy.
Conclusions  
MRC can accurately diagnose inflammatory lesions in severe attacks of UC and significantly correlates with rectosigmoidoscopy in the diagnosis of severe lesions.
Key Points  
Magnetic Resonance Colonography (MRC) is increasingly used to investigate the large bowel.
MRC seems accurate in diagnosing inflammatory lesions in severe attacks of UC.
MRC findings significantly correlate with rectosigmoidoscopy findings for severe lesions.
Unlike rectosigmoidoscopy, MRC can identify severe lesions throughout the colon.

  • Content Type Journal Article
  • Category Gastrointestinal
  • Pages 1-9
  • DOI 10.1007/s00330-012-2456-8
  • Authors
    • C. Savoye-Collet, Radiology Department QUANTIF - LITIS EA 4108, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
    • J. B. Roset, Radiology Department QUANTIF - LITIS EA 4108, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
    • E. Koning, Radiology Department QUANTIF - LITIS EA 4108, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
    • C. Charpentier, Gastroenterology Department - ADEN U 1073, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
    • S. Hommel, Gastroenterology Department - ADEN U 1073, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
    • E. Lerebours, Gastroenterology Department - ADEN U 1073, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
    • J. N. Dacher, Radiology Department QUANTIF - LITIS EA 4108, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
    • G. Savoye, Gastroenterology Department - ADEN U 1073, Rouen University Hospital Charles Nicolle, 1 rue de Germont, 76031 Rouen, France

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27/04/2012, Model-based iterative reconstruction technique for radiation dose reduction in chest CT: comparison with the adaptive statistical iterative reconstruction technique »»

Abstract
Objectives  
To prospectively evaluate dose reduction and image quality characteristics of chest CT reconstructed with model-based iterative reconstruction (MBIR) compared with adaptive statistical iterative reconstruction (ASIR).
Methods  
One hundred patients underwent reference-dose and low-dose unenhanced chest CT with 64-row multidetector CT. Images were reconstructed with 50 % ASIR-filtered back projection blending (ASIR50) for reference-dose CT, and with ASIR50 and MBIR for low-dose CT. Two radiologists assessed the images in a blinded manner for subjective image noise, artefacts and diagnostic acceptability. Objective image noise was measured in the lung parenchyma. Data were analysed using the sign test and pair-wise Students t-test.
Results  
Compared with reference-dose CT, there was a 79.0 % decrease in doselength product with low-dose CT. Low-dose MBIR images had significantly lower objective image noise (16.93±3.00) than low-dose ASIR (49.24±9.11, P<0.01) and reference-dose ASIR images (24.93±4.65, P<0.01). Low-dose MBIR images were all diagnostically acceptable. Unique features of low-dose MBIR images included motion artefacts and pixellated blotchy appearances, which did not adversely affect diagnostic acceptability.
Conclusion  
Diagnostically acceptable chest CT images acquired with nearly 80 % less radiation can be obtained using MBIR. MBIR shows greater potential than ASIR for providing diagnostically acceptable low-dose CT images without severely compromising image quality.
Key Points  
Model-based iterative reconstruction (MBIR) creates high-quality low-dose CT images.
MBIR significantly improves image noise and artefacts over adaptive statistical iterative techniques.
MBIR shows greater potential than ASIR for diagnostically acceptable low-dose CT.
The prolonged processing time of MBIR may currently limit its routine use in clinical practice.

  • Content Type Journal Article
  • Category Computed Tomography
  • Pages 1-11
  • DOI 10.1007/s00330-012-2452-z
  • Authors
    • Masaki Katsura, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
    • Izuru Matsuda, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
    • Masaaki Akahane, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
    • Jiro Sato, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
    • Hiroyuki Akai, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
    • Koichiro Yasaka, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
    • Akira Kunimatsu, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
    • Kuni Ohtomo, Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan

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27/04/2012, Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma »»

Abstract
Objective  
To quantify radiation exposure and mortality risk from computed tomography (CT) and positron emission tomography (PET) imaging with 18F-fluorodeoxyglucose (18F-FDG) in patients with malignant lymphoma (Hodgkins disease [HD] or non-Hodgkins lymphoma [NHL]).
Methods  
First, organ doses were assessed for a typical diagnostic work-up in children with HD and adults with NHL. Subsequently, life tables were constructed for assessment of radiation risks, also taking into account the disease-related mortality.
Results  
In children with HD, cumulative effective dose from medical imaging ranged from 66 mSv (newborn) to 113 mSv (15 years old). In adults with NHL the cumulative effective dose from medical imaging was 97 mSv. Average fractions of radiation-induced deaths for children with HD [without correction for disease-related mortality in brackets] were 0.4% [0.6%] for boys and 0.7% [1.1%] for girls, and for adults with NHL 0.07% [0.28%] for men and 0.09% [0.37%] for women.
Conclusion  
Taking into account the disease-related reduction in life expectancy of patients with malignant lymphoma results in a higher overall mortality but substantial lower incidence of radiation induced deaths. The modest radiation risk that results from imaging with CT and 18F-FDG PET can be considered as justified, but imaging should be performed with care, especially in children.
Key Points  
 
Survival of malignant lymphoma has improved dramatically over the past decades.
 
PET and CT currently play important roles for malignant lymphoma patients.
 
The potential hazard of ionising radiation has become an increasingly important issue.
 
When assessing radiation risks, disease-related reduction in life expectancy should be considered.
 
CT and 18 F-FDG PET create a modest radiation-induced mortality risk.

  • Content Type Journal Article
  • Category Physics
  • Pages 1-9
  • DOI 10.1007/s00330-012-2447-9
  • Authors
    • R. A. J. Nievelstein, Department of Radiology (E 01.132), University Medical Center, P.O. Box 85500, 3508 CX Utrecht, The Netherlands
    • H. M. E. Quarles van Ufford, Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands
    • T. C. Kwee, Department of Radiology (E 01.132), University Medical Center, P.O. Box 85500, 3508 CX Utrecht, The Netherlands
    • M. B. Bierings, Department of Pediatric Hematology, University Medical Center, Utrecht, The Netherlands
    • I. Ludwig, Department of Hematology, University Medical Center, Utrecht, The Netherlands
    • F. J. A. Beek, Department of Radiology (E 01.132), University Medical Center, P.O. Box 85500, 3508 CX Utrecht, The Netherlands
    • J. M. H. de Klerk, Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands
    • W. P. Th. M. Mali, Department of Radiology (E 01.132), University Medical Center, P.O. Box 85500, 3508 CX Utrecht, The Netherlands
    • P. W. de Bruin, Department of Radiology, University Medical Center, Leiden, The Netherlands
    • J. Geleijns, Department of Radiology, University Medical Center, Leiden, The Netherlands

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27/04/2012, Prevalence and prognosis of coronary stent gap detected by multi-detector CT: a follow-up study »»

Abstract
Objectives  
To evaluate the features of stent gap (SG) and the long-term impact of SG on in-stent restenosis (ISR) in patent stents.
Methods  
A total of 347 consecutive patients with 781 stents who underwent MDCT were assessed for SG and ISR. Clinical and stent features were compared between the SG and non-SG groups. In the follow-up study, among 82 patients with 175 patent stents [26 assessed by conventional coronary angiography (CCA) including 6 contacted in a telephone survey, 46 assessed by computed tomography angiography (CTA) and 10 by both], the incidence of ISR was compared between stents with and without SG.
Results  
Three patients and 13 stents were excluded. SG was observed in 12.5% of patients and 8.6% of stents. ISR detected by CTA was noted in 21.2% of SG, and SG accounted for 23.7% of ISR. Stent number, length, location, overlapping pattern, tortuosity and in-out angle were predisposing factors for SG. During a mean follow-up period of 15 months after detection of SG, the incidence of ISR was significantly higher in the SG group than in the non-SG group (43.8/14.9% by CCA, 33.3/10.1% by CTA and CCA).
Conclusion  
Patent stents with SG detected by CTA had a higher incidence of late restenosis, indicating that long-term follow-up or further intervention is necessary.
Key Points  
Coronary artery computed tomographic angiography (CTA) is increasingly used following coronary intervention.
Gaps within coronary stents detected by CTA correlate with in-stent restenosis.
Patients with stent gaps have more late restenosis at follow-up.
More attention should be given to patients with stent gaps.

  • Content Type Journal Article
  • Category Cardiac
  • Pages 1-8
  • DOI 10.1007/s00330-012-2458-6
  • Authors
    • Xinghua Zhang, Department of Radiology, PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
    • Li Yang, Department of Radiology, PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
    • Haiyue Ju, Department of Radiology, PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
    • Fan Zhang, Department of Radiology, PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
    • Jian Wu, Department of Radiology, PLA General Hospital, 28 Fuxing RD, Haidian District, Beijing 100853, China
    • Bin He, Department of Cardiology, PLA General Hospital, Beijing, China
    • Yundai Chen, Department of Cardiology, PLA General Hospital, Beijing, China

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27/04/2012, Evaluation of different magnetic resonance imaging techniques for the assessment of active left atrial emptying »»

Abstract
Objectives  
There is currently no agreement on the best method of assessing active left atrial (LA) emptying. This study evaluated the relative merits of cine- and velocity encoded (VENC) magnetic resonance imaging (MRI) for the assessment of active LA emptying.
Methods  
Total LA emptying volume (TLAEV) and active LA stroke volume (ALASV) were assessed in 107 consecutive patients using cine-MRI and transmitral flow measurements by VENC-MRI. The fraction of active LA emptying (ALAEF) was calculated as the ratio of ALASV to TLAEV. LA and left ventricular (LV) output were calculated by multiplying TLAEV and LV stroke volume by heart rate, respectively.
Results  
Intra- and inter-observer variances were significantly larger for cine-MRI than for VENC-MRI measurements of ALASV (24.7 mL2 vs. 3.7 mL2 and 57.7 mL2 vs. 4.2 mL2; P<0.0001). Biplane cine-MRI underestimated TLAEV (mean difference 57±32 %; P<0.0001) and ALASV (mean difference 24±51 %; P<0.0001) but overestimated ALAEF (mean difference 31±54 %, P<0.0001) compared with VENC-MRI. There was significantly better agreement between LV output and LA output measured by VENC-MRI compared with LA output measured by cine-MRI (mean difference 0.30±1.12 L/min vs. 2.05±1.44 L/min; P<0.0001).
Conclusion  
VENC-MRI is the more appropriate method of assessing active LA emptying and its use should be favoured.
Key Points   
Cardiac magnetic resonance imaging (MRI) offers new possibilities in assessing atrial emptying.
Cine-MRI measurements of active LA emptying have lower reproducibility than velocity encoded MRI.
Cine-MRI overestimates the fraction of active LA emptying compared with VENC-MRI.
VENC-MRI is the more appropriate method of assessing active LA emptying.

  • Content Type Journal Article
  • Category Cardiac
  • Pages 1-8
  • DOI 10.1007/s00330-012-2460-z
  • Authors
    • Kai Muellerleile, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
    • Michael Groth, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
    • Dennis Saring, Department of Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
    • Daniel Steven, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
    • Arian Sultan, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
    • Imke Drewitz, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
    • Boris Hoffmann, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
    • Jakob Lueker, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
    • Gerhard Adam, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
    • Gunnar K. Lund, Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
    • Stephan Willems, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
    • Thomas Rostock, Department of Cardiology, Electrophysiology, Center for Cardiology and Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany

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27/04/2012, Long-term follow-up of non-calcified pulmonary nodules (<10 mm) identified during low-dose CT screening for lung cancer »»

Abstract
Objectives  
To assess the long-term stability of small (<10 mm) non-calcified pulmonary nodules (NCNs) in high-risk subjects initially screened for lung cancer using low-dose chest computed tomography (LDCCT).
Methods  
A total of 449 subjects initially underwent screening with serial LDCCT over a 2-year period. Participants identified as having NCNs 10 mm were referred for formal lung cancer workup. NCNs <10 mm diameter were followed in accordance with the study protocol. Seven years after baseline screening, subjects with previously documented NCNs <10 mm, which were unchanged in size after the 2-year follow-up period, were re-imaged using LDCCT to assess for interval nodule growth.
Results  
Eighty-three subjects with previously documented stable NCNs <10 mm underwent LDCCT at 7 years. NCNs were unchanged in 78 subjects and had decreased in size in 4 subjects. There was interval growth of an NCN (from 6 mm to 9 mm) in one subject re-imaged at 7 years, but this nodule has remained stable in size over a further 2-year follow-up period.
Conclusions  
Non-calcified pulmonary nodules <10 mm in size that are unchanged in size or smaller after 2 years of follow-up with LDCCT are most likely benign.
Key Points  
Computed tomography is increasingly used for screening for lung cancer.
However CT frequently reveals unsuspected lung nodules.
Seven-year follow-up of small (<10 mm) non-calcified pulmonary nodules is reassuring.
Even in high-risk patients most nodules will likely be benign.

  • Content Type Journal Article
  • Category Chest
  • Pages 1-6
  • DOI 10.1007/s00330-012-2443-0
  • Authors
    • Michael M. Slattery, Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland
    • Claire Foley, Clinical Research Centre, RCSI, Beaumont Hospital, Beaumont Road, Dublin, Ireland
    • Dermot Kenny, Clinical Research Centre, RCSI, Beaumont Hospital, Beaumont Road, Dublin, Ireland
    • Richard W. Costello, Respiratory Division, Beaumont Hospital, Beaumont Road, Dublin, Ireland
    • P. Mark Logan, Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland
    • Michael J. Lee, Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin, Ireland

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27/04/2012, In vivo MRI discrimination between live and lysed iron-labelled cells using balanced steady state free precession »»

Abstract
Objectives  
The goal of this study was to evaluate the ability of balanced steady state free precession (b-SSFP) magnetic resonance imaging sequence to distinguish between live and lysed iron-labelled cells.
Methods  
Human breast cancer cells were labelled with iron oxide nanoparticles. Cells were lysed using sonication. Imaging was performed at 3 T. The timing parameters for b-SSFP and the number of iron-labelled cells in samples were varied to optimise the b-SSFP signal difference between live and lysed iron-labelled cell samples. For in vivo experiments, cells were mixed with Matrigel and implanted into nude mice. Three mice implanted with live labelled cancer cells were irradiated to validate this method.
Results  
Lysed iron-labelled cells have a significantly higher signal compared with live, intact iron-labelled cells in bSSFP images. The contrast between live and dead cells can be maximised by careful optimisation of timing parameters. A change in the b-SSFP signal was measured 6 days after irradiation, reflecting cell death in vivo. Histology confirmed the presence of dead cells in the implant.
Conclusions  
Our results show that the b-SSFP sequence can be optimised to allow for the discrimination of live iron-labelled cells and lysed iron-labelled cells in vitro and in vivo.
Key Points  
Balanced steady state free precession (b-SSFP) MRI can assess iron-labelled cells.
bSSFP can discriminate between live and lysed iron-labelled cells.
The compartmentalisation of iron in cells influences the bSSFP signal.
The bSSFP signal increases after cell death by irradiation in vivo.

  • Content Type Journal Article
  • Category Molecular Imaging
  • Pages 1-8
  • DOI 10.1007/s00330-012-2435-0
  • Authors
    • E. J. Ribot, Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, 100 Perth Drive, Rm1200B, London, ON, Canada N6A 5K8
    • P. J. Foster, Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, 100 Perth Drive, Rm1200B, London, ON, Canada N6A 5K8

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27/04/2012, Analysis of the impact of digital tomosynthesis on the radiological investigation of patients with suspected pulmonary lesions on chest radiography »»

Abstract
Objective  
To assess the impact of digital tomosynthesis (DTS) on the radiological investigation of patients with suspected pulmonary lesions on chest radiography (CXR).
Methods  
Three hundred thirty-nine patients (200 male; age, 71.19±11.9 years) with suspected pulmonary lesion(s) on CXR underwent DTS. Two readers prospectively analysed CXR and DTS images, and recorded their diagnostic confidence: 1 or 2=definite or probable benign lesion or pseudolesion deserving no further diagnostic workup; 3=indeterminate; 4 or 5=probable or definite pulmonary lesion deserving further diagnostic workup by computed tomography (CT). Imaging follow-up by CT (n=76 patients), CXR (n=256) or histology (n=7) was the reference standard.
Results  
DTS resolved doubtful CXR findings in 256/339 (76 %) patients, while 83/339 (24 %) patients proceeded to CT. The mean interpretation time for DTS (mean±SD, 220±40 s) was higher (P<0.05; Wilcoxon test) than for CXR (110±30 s), but lower than CT (600±150 s). Mean effective dose was 0.06 mSv (range 0.030.1 mSv) for CXR, 0.107 mSv (range 0.0940.12 mSv) for DTS, and 3 mSv (range 24 mSv) for CT.
Conclusions  
DTS avoided the need for CT in about three-quarters of patients with a slight increase in the interpretation time and effective dose compared to CXR.
Key Points  
Digital tomosynthesis (DTS) improves the diagnostic confidence of chest radiography (CXR)
DTS reduces the need for CT for a suspected pulmonary lesion
DTS only imparts a radiation dose of around two CXRs
DTS takes longer to interpret than conventional chest radiography

  • Content Type Journal Article
  • Category Chest
  • Pages 1-11
  • DOI 10.1007/s00330-012-2440-3
  • Authors
    • Emilio Quaia, Department of Radiology, Cattinara Hospital, University of Trieste (Italy), Strada di Fiume 447, 34149 Trieste, Italy
    • Elisa Baratella, Department of Radiology, Cattinara Hospital, University of Trieste (Italy), Strada di Fiume 447, 34149 Trieste, Italy
    • Stefano Cernic, Department of Radiology, Cattinara Hospital, University of Trieste (Italy), Strada di Fiume 447, 34149 Trieste, Italy
    • Arianna Lorusso, Department of Radiology, Cattinara Hospital, University of Trieste (Italy), Strada di Fiume 447, 34149 Trieste, Italy
    • Federica Casagrande, Department of Radiology, Cattinara Hospital, University of Trieste (Italy), Strada di Fiume 447, 34149 Trieste, Italy
    • Vincenzo Cioffi, Department of Radiology, Cattinara Hospital, University of Trieste (Italy), Strada di Fiume 447, 34149 Trieste, Italy
    • Maria Assunta Cova, Department of Radiology, Cattinara Hospital, University of Trieste (Italy), Strada di Fiume 447, 34149 Trieste, Italy

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27/04/2012, Potential of right to left ventricular volume ratio measured on chest CT for the prediction of pulmonary hypertension: correlation with pulmonary arterial systolic pressure estimated by echocardiography »»

Abstract
Objectives  
To investigate the correlation of right ventricular (RV) to left ventricular (LV) volume ratio measured by chest CT with pulmonary arterial systolic pressure (PASP) estimated by echocardiography.
Methods  
104 patients (72.47±13.64 years; 39 male) who had undergone chest CT and echocardiography were divided into two groups (hypertensive and normotensive) based upon an echocardiography-derived PASP of 25 mmHg. RV to LV volume ratios (RVV/LVV) were calculated. RVV/LVV was then correlated with PASP using regression analysis. The Area Under the Curve (AUC) for predicting pulmonary hypertension on chest CT was calculated.
Results  
In the hypertensive group, the mean PASP was 46.29±14.42 mmHg (29-98 mmHg) and there was strong correlation between the RVV/LVV and PASP (R=0.82, p<0.001). The intraobserver and interobserver correlation coefficients for RVV/LVV were 0.990 and 0.892. RVV/LVV was 1.01±0.44 (0.51-2.77) in the hypertensive and 0.72±0.14 (0.52-1.11) in the normotensive group (P <0.05). With 0.9 as the cutoff for RVV/LVV, sensitivity and specificity for predicting pulmonary hypertension over 40 mmHg were 79.5 % and 90 %, respectively. The AUC for predicting pulmonary hypertension was 0.87
Conclusion  
RV/LV volume ratios on chest CT correlate well with PASP estimated by echocardiography and can be used to predict pulmonary hypertension over 40 mmHg with high sensitivity and specificity.
Key Points   
Chest CT is widely used in patients who may have pulmonary hypertension.
Cardiac ventricular volume ratios on chest CT correlate with pulmonary arterial systolic pressure.
A R/L ventricular volume ratio >0.9 usually indicates pulmonary hypertension >40 mmHg.
Information available on routine chest CT may help predict pulmonary hypertension.

  • Content Type Journal Article
  • Category Chest
  • Pages 1-8
  • DOI 10.1007/s00330-012-2454-x
  • Authors
    • Heon Lee, Department of Radiology, Soon Chun Hyang University, Bucheon, Republic of Korea
    • Seok Yeon Kim, Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
    • Soo Jeong Lee, Terarecon Korea, Seoul, Republic of Korea
    • Jae Kyun Kim, Department of Radiology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
    • Ryan P. Reddy, Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
    • U. Joseph Schoepf, Department of Radiology and Radiological Science and Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

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23/04/2012, Impact of iterative reconstruction on image quality and radiation dose in multidetector CT of large body size adults »»

Abstract
Objective  
To compare image quality and radiation dose using Adaptive Statistical Iterative Reconstruction (ASiR) and Filtered Back Projection (FBP) in patients weighing 91 kg.
Methods  
In this Institution Review Board-approved retrospective study, single-phase contrast-enhanced abdominopelvic CT examinations of 100 adults weighing 91 kg (mean body weight: 107.6±17.4 kg range: 91181.9 kg) with (1) ASiR and (2) FBP were reviewed by two readers in a blinded fashion for subjective measures of image quality (using a subjective standardized numerical scale and objective noise) and for radiation exposure. Imaging parameters and radiation dose results of the two techniques were compared within weight and BMI sub-categories.
Results  
All examinations were found to be of adequate quality. Both subjective (mean=1.4±0.5 vs. 1.6±0.6, P<0.05) and objective noise (13.0±3.2 vs.19.5±5.7, P<0.0001) were lower with ASiR. Average radiation dose reduction of 31.5 % was achieved using ASiR (mean CTDIvol. ASiR: 13.5±7.3 mGy; FBP: 19.7±9.0 mGy, P<0.0001). Other measures of image quality were comparable between the two techniques. Trends for all parameters were similar in patients across weight and BMI sub-categories.
Conclusion  
In obese individuals, abdominal CT images reconstructed using ASiR provide diagnostic images with reduced image noise at lower radiation dose.
Key Points  
CT images in obese adults are noisy, even with high radiation dose.
Newer iterative reconstruction techniques have theoretical advantages in obese patients.
Adaptive statistical iterative reconstruction should reduce image noise and radiation dose.
This has been proven in abdominopelvic CT images of obese patients.

  • Content Type Journal Article
  • Category Computed Tomography
  • Pages 1-10
  • DOI 10.1007/s00330-012-2424-3
  • Authors
    • Gaurav S. Desai, Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA
    • Raul N. Uppot, Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA
    • Elaine W. Yu, the Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA
    • Avinash R. Kambadakone, Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA
    • Dushyant V. Sahani, Department of Abdominal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA 02114, USA

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23/04/2012, Diagnostic performance of stress myocardial perfusion imaging for coronary artery disease: a systematic review and meta-analysis »»

Abstract
Objectives  
To determine and compare the diagnostic performance of stress myocardial perfusion imaging (MPI) for the diagnosis of obstructive coronary artery disease (CAD), using conventional coronary angiography (CCA) as the reference standard.
Methods  
We searched Medline and Embase for literature that evaluated stress MPI for the diagnosis of obstructive CAD using magnetic resonance imaging (MRI), contrast-enhanced echocardiography (ECHO), single-photon emission computed tomography (SPECT) and positron emission tomography (PET).
Results  
All pooled analyses were based on random effects models. Articles on MRI yielded a total of 2,970 patients from 28 studies, articles on ECHO yielded a sample size of 795 from 10 studies, articles on SPECT yielded 1,323 from 13 studies. For CAD defined as either at least 50 %, at least 70 % or at least 75 % lumen diameter reduction on CCA, the natural logarithms of the diagnostic odds ratio (lnDOR) for MRI (3.63; 95 % CI 3.264.00) was significantly higher compared to that of SPECT (2.76; 95 % CI 2.283.25; P=0.006) and that of ECHO (2.83; 95 % CI 2.293.37; P=0.02). There was no significant difference between the lnDOR of SPECT and ECHO (P=0.52).
Conclusion  
Our results suggest that MRI is superior for the diagnosis of obstructive CAD compared with ECHO and SPECT. ECHO and SPECT demonstrated similar diagnostic performance.
Key Points  
MRI can assess myocardial perfusion.
MR perfusion diagnoses coronary artery disease better than echocardiography or SPECT.
Echocardiography and SPECT have similar diagnostic performance.
MRI can save coronary artery disease patients from more invasive tests.
MRI and SPECT show evidence of publication bias, implying possible overestimation.

  • Content Type Journal Article
  • Category Cardiac
  • Pages 1-15
  • DOI 10.1007/s00330-012-2434-1
  • Authors
    • Marcus C. de Jong, Departments of Epidemiology and Radiology, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
    • Tessa S. S. Genders, Departments of Epidemiology and Radiology, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
    • Robert-Jan van Geuns, Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
    • Adriaan Moelker, Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
    • M. G. Myriam Hunink, Departments of Epidemiology and Radiology, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands

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18/04/2012, Assessment of the metabolic flow phenotype of primary colorectal cancer: correlations with microvessel density are influenced by the histological scoring method »»

Abstract
Objectives  
To investigate how the histological scoring of microvessel density affects correlations between integrated 18F-FDG-PET/perfusion CT parameters and CD105 microvessel density.
Methods  
A total of 53 patients were enrolled from 2007 to 2010. Integrated 18F-FDG-PET/perfusion CT was successful in 45 patients, 35 of whom underwent surgery without intervening treatment. Tumour SUVmax, SUVmean and regional blood flow (BF) were derived. Immunohistochemical staining for CD105 expression and analysis were performed for two hot spots, four hot spots and the Chalkley method. Correlations between metabolic flow parameters and CD105 expression were assessed using Spearmans rank correlation.
Results  
Mean (SD) for tumour size was 38.5 (20.5) mm, for SUVmax, SUVmean and BF it was 19.1 (4.5), 11.6 (2.5) and 85.4 (40.3) mL/min/100 g tissue, and for CD105 microvessel density it was 71.4 (23.6), 66.8 (22.9) and 6.18 (2.07) for two hot spots, four hot spots and the Chalkley method, respectively. Positive correlation between BF and CD105 expression was modest but higher for Chalkley than for four hot spots analysis (r=0.38, P=0.03; r=0.33, P=0.05, respectively). There were no significant correlations between metabolic parameters (SUVmax or SUVmean) and CD105 expression (r=0.080.22, P=0.210.63).
Conclusions  
The histological analysis method affects correlations between tumour CD105 expression and BF but not SUVmax or SUVmean.
Key Points  
FDG-PET/perfusion CT offers new surrogate biomarkers of angiogenesis.
Microvessel density scoring influences histopathological correlations with CT blood flow.
Highest correlations were found with the Chalkley analysis method.
Correlations between SUV and CD105 are not affected by the scoring method.

  • Content Type Journal Article
  • Category Oncology
  • Pages 1-6
  • DOI 10.1007/s00330-012-2423-4
  • Authors
    • Vicky Goh, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, UK
    • Manuel Rodriguez-Justo, Department of Histopathology, University College Hospital, London, UK
    • Alec Engledow, Department of Surgery, University College Hospital, London, UK
    • Manu Shastry, Institute of Nuclear Medicine, University College Hospital, London, UK
    • Raymondo Endozo, Institute of Nuclear Medicine, University College Hospital, London, UK
    • Jacqui Peck, Department of Surgery, University College Hospital, London, UK
    • Marie Meagher, Institute of Nuclear Medicine, University College Hospital, London, UK
    • Stuart A. Taylor, Specialist Radiology, University College Hospital, London, UK
    • Steve Halligan, Specialist Radiology, University College Hospital, London, UK
    • Ashley M. Groves, Institute of Nuclear Medicine, University College Hospital, London, UK

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18/04/2012, MR-guided radiofrequency ablation using a wide-bore 1.5-T MR system: clinical results of 213 treated liver lesions »»

Abstract
Objective  
To evaluate the technical effectiveness, technical success and patient safety of MR-guided radiofrequency (RF) ablation of liver malignancies using a wide-bore 1.5-T MR system.
Methods  
In 110 patients, 56 primary liver lesions and 157 liver metastases were treated in 157 sessions using percutaneous RF ablation. Mean lesion diameter was 20 mm (range 454 mm). All planning, procedural and post-interventional control MR investigations were carried out using a wide-bore 1.5-T MR system. Technical success was assessed by a contrast-enhanced MR liver examination immediately after the intervention. Technique effectiveness was assessed by dynamic hepatic MR study 1 month post ablation; mean follow-up period was 24.2 months (range 544).
Results  
Technical success and technique effectiveness were achieved in 210/213 lesions (98.6 %). In 18/210 lesions (8.6 %), local tumour progression occurred 428 months after therapy. Seven of these 18 lesions were treated in a second session achieving complete ablation, 6 other lesions were referred to surgery. Overall RF effectiveness rate was 199/213 (93.4 %); overall therapy success (including surgery) was 205/213 (96.2 %). Two major complications (1.3 %) (bleeding and infected biloma) and 14 (8.9 %) minor complications occurred subsequent to 157 interventions.
Conclusion  
Wide-bore MR-guided RF ablation is a safe and effective treatment option for liver lesions.
Key Points  
Magnetic resonance-guided radiofrequency ablation offers various options for monitoring therapy.
All steps of RF ablation carried out in 1.5-T wide-bore system.
Therapeutic decisions were based on T1-weighted imaging.
Technical success and technical effectiveness were high.
Local tumour progression rate was 8.6 % over a 24-month mean follow-up.

  • Content Type Journal Article
  • Category Interventional
  • Pages 1-11
  • DOI 10.1007/s00330-012-2438-x
  • Authors
    • Hansjörg Rempp, Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
    • Lorenz Waibel, Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
    • Rüdiger Hoffmann, Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
    • Claus D. Claussen, Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany
    • Philippe L. Pereira, Clinic for Radiology, Nuclear Medicine and Minimal Invasive Therapies, SLK-Clinics, Am Gesundbrunnen 2026, 74078 Heilbronn, Germany
    • Stephan Clasen, Department of Diagnostic and Interventional Radiology, Eberhard Karls University of Tübingen, Hoppe-Seyler-Straße 3, 72076 Tübingen, Germany

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17/04/2012, Predicting response to neoadjuvant chemotherapy in primary breast cancer using volumetric helical perfusion computed tomography: a preliminary study »»

Abstract
Objectives  
To investigate whether CT-derived vascular parameters in primary breast cancer predict complete pathological response (pCR) to neoadjuvant chemotherapy (NAC).
Methods  
Twenty prospective patients with primary breast cancer due for NAC underwent volumetric helical perfusion CT to derive whole tumour regional blood flow (BF), blood volume (BV) and flow extraction product (FE) by deconvolution analysis. A pCR was achieved if no residual invasive cancer was detectable on pathological examination. Relationships between baseline BF, BV, FE, tumour size and volume, and pCR were examined using the MannWhitney U test. Receiver operating characteristic (ROC) curve analysis was performed to assess the parameter best able to predict response. Intra- and inter-observer variability was assessed using BlandAltman statistics.
Results  
Seventeen out of 20 patients completed NAC with four achieving a pCR. Baseline BF and FE were higher in patients who achieved a pCR compared with those who did not (P=0.032); tumour size and volume were not significantly different (P>0.05). ROC analysis revealed that BF and FE were able to identify responders effectively (AUC=0.87; P=0.03). There was good intra- and inter-observer agreement.
Conclusions  
Primary breast cancers which exhibited higher levels of perfusion before treatment were more likely to achieve a pCR to NAC.
Key Points  
CT-derived vascular parameters may be useful in breast cancer treatment.
Perfusion CT can help predict response to neoadjuvant chemotherapy in breast cancer.
Baseline blood flow and flow extraction product are higher in complete pathological responders.

  • Content Type Journal Article
  • Category Breast
  • Pages 1-10
  • DOI 10.1007/s00330-012-2433-2
  • Authors
    • Sonia P. Li, Academic Oncology Unit, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN UK
    • Andreas Makris, Academic Oncology Unit, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN UK
    • Andrew Gogbashian, Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN UK
    • Ian C. Simcock, Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN UK
    • J. James Stirling, Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN UK
    • Vicky Goh, Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN UK

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17/04/2012, Triple-negative invasive breast cancer on dynamic contrast-enhanced and diffusion-weighted MR imaging: comparison with other breast cancer subtypes »»

Abstract
Objectives  
To determine the MRI features of triple-negative invasive breast cancer (TNBC) on dynamic contrast-enhanced MR imaging (DCE-MRI) and diffusion-weighted MR imaging (DWI) in comparison with ER-positive/HER2-negative (ER+) and HER2-positive cancer (HER2+).
Methods  
A total of 271 invasive cancers in 269 patients undergoing preoperative MRI and surgery were included. Two radiologists retrospectively assessed morphological and kinetic characteristics on DCE-MRI and tumour detectability on DWI. Apparent diffusion coefficient (ADC) values of lesions were measured. Clinical and MRI features of the three subtypes were compared.
Results  
Compared with ER+ (n=119) and HER2+ (n=94), larger size, round/oval mass shape, smooth mass margin, and rim enhancement on DCE-MRI were significantly associated with TNBC (n=58; P<0.0001). On DWI, mean ADC value (×103 mm2/s) of TNBC (1.03) was higher than the mean ADC values for ER+ and HER2+ (0.89 and 0.84; P<0.0001). There was no difference in tumour detectability (P=0.099). Tumour size (P=0.009), mass margin (smooth, P<0.0001; irregular, P=0.020), and ADC values (P=0.002) on DCE-MRI and DWI were independent features of TNBC.
Conclusions  
In addition to the morphological features, higher ADC values on DWI were independently associated with TNBC and could be useful in differentiating TNBC from ER+ and HER2+.
Key Points  
Triple-negative breast cancers (TNBC) lack oestrogen/progesterone receptors and HER2 expression/amplification.
TNBCs are larger, better defined and more necrotic than conventional cancers.
On MRI, necrosis yields high T2-weighted signal intensity and ADCs.
High ADC values can be useful in diagnosing TNBC.

  • Content Type Journal Article
  • Category Breast
  • Pages 1-11
  • DOI 10.1007/s00330-012-2425-2
  • Authors
    • Ji Hyun Youk, Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-Gu, Seoul, 135-720 South Korea
    • Eun Ju Son, Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-Gu, Seoul, 135-720 South Korea
    • Jin Chung, Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-Gu, Seoul, 135-720 South Korea
    • Jeong-Ah Kim, Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-Gu, Seoul, 135-720 South Korea
    • Eun-kyung Kim, Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211, Eonju-ro, Gangnam-Gu, Seoul, 135-720 South Korea

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17/04/2012, Diagnostic value of ADC in patients with prostate cancer: influence of the choice of b values »»

Abstract
Objectives  
To evaluate the influence of the choice of b values on the diagnostic value of the apparent diffusion coefficient (ADC) for detection and grading of prostate cancer (PCa).
Methods  
Forty-one patients with biopsy-proven PCa underwent endorectal 3-T MRI before prostatectomy. Different combinations of b values (0800 s/mm2) were used to calculate four representative ADC maps. Mean ADCs of tumours and non-malignant tissue were determined. Tumour appearance on different ADC maps was rated by three radiologists as good, fair or poor by assigning a visual score (VS) of 2, 1 or 0, respectively. Differences in the ADC values with the choice of b values were analysed using one-way ANOVA.
Results  
Choice of b values had a highly (P<0.001) significant influence on the absolute ADC in each tissue. Maps using b=[50, 800] and [0, 800] were rated best (VS=1.6±0.3) and second best (1.1±0.3, P<0.001), respectively. For low-grade carcinomas (Gleason score6, 13/41 patients), only the former choice received scores better than fair (VS=1.4±0.3). Mean tumour ADCs showed significant negative correlation (Spearmans 0.38 to 0.46, P<0.05) with Gleason score.
Conclusions  
Absolute ADC values strongly depend on the choice of b values and therefore should be used with caution for diagnostic purposes. A minimum b value greater than zero is recommended for ADC calculation to improve the visual assessment of PCa in ADC maps.
Key Points  
Absolute ADC values are highly dependent on the choice of b values.
Absolute ADC thresholds should be used carefully to predict tumour aggressiveness.
Subjective ratings of ADC maps involving b=0 s/mm 2 are poor to fair.
Minimum b value greater than 0 s/mm 2 is recommended for ADC calculation.

  • Content Type Journal Article
  • Category Urogenital
  • Pages 1-9
  • DOI 10.1007/s00330-012-2432-3
  • Authors
    • Gregor Thörmer, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
    • Josephin Otto, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
    • Martin Reiss-Zimmermann, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
    • Matthias Seiwerts, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
    • Michael Moche, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
    • Nikita Garnov, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
    • Toni Franz, Department of Urology, Leipzig University Hospital, Leipzig, Germany
    • Minh Do, Department of Urology, Leipzig University Hospital, Leipzig, Germany
    • Jens-Uwe Stolzenburg, Department of Urology, Leipzig University Hospital, Leipzig, Germany
    • Lars-Christian Horn, Institute of Pathology, University of Leipzig, Leipzig, Germany
    • Thomas Kahn, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany
    • Harald Busse, Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, 04103 Leipzig, Germany

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17/04/2012, DNA double-strand breaks as potential indicators for the biological effects of ionising radiation exposure from cardiac CT and conventional coronary angiography: a randomised, controlled study »»

Abstract
Objectives  
To prospectively compare induced DNA double-strand breaks by cardiac computed tomography (CT) and conventional coronary angiography (CCA).
Methods  
56 patients with suspected coronary artery disease were randomised to undergo either CCA or cardiac CT. DNA double-strand breaks were assessed in fluorescence microscopy of blood lymphocytes as indicators of the biological effects of radiation exposure. Radiation doses were estimated using doselength product (DLP) and dosearea product (DAP) with conversion factors for CT and CCA, respectively.
Results  
On average there were 0.12±0.06 induced double-strand breaks per lymphocyte for CT and 0.29±0.18 for diagnostic CCA (P<0.001). This relative biological effect of ionising radiation from CCA was 1.9 times higher (P<0.001) than the effective dose estimated by conversion factors would have suggested. The correlation between the biological effects and the estimated radiation doses was excellent for CT (r=0.951, P<0.001) and moderate to good for CCA (r=0.862, P<0.001). One day after radiation, a complete repair of double-strand breaks to background levels was found in both groups.
Conclusions  
Conversion factors may underestimate the relative biological effects of ionising radiation from CCA. DNA double-strand break assessment may provide a strategy for individualised assessments of radiation.
Key Points  
Radiation dose causes concern for both conventional coronary angiography and cardiac CT.
Estimations of the biological effects of ionising radiation may become feasible.
Fewer DNA double-strand breaks are induced by cardiac CT than CCA.
Conversion factors may underestimate the relative effects of ionising radiation from CCA.

  • Content Type Journal Article
  • Category Cardiac
  • Pages 1-10
  • DOI 10.1007/s00330-012-2426-1
  • Authors
    • Dominik Geisel, Department of Radiology, Charité Medical School, Berlin, Germany
    • Elke Zimmermann, Department of Radiology, Charité Medical School, Berlin, Germany
    • Matthias Rief, Department of Radiology, Charité Medical School, Berlin, Germany
    • Johannes Greupner, Department of Radiology, Charité Medical School, Berlin, Germany
    • Michael Laule, Department of Cardiology, Charité Medical School, Berlin, Germany
    • Fabian Knebel, Department of Cardiology, Charité Medical School, Berlin, Germany
    • Bernd Hamm, Department of Radiology, Charité Medical School, Berlin, Germany
    • Marc Dewey, Department of Radiology, Charité Medical School, Berlin, Germany

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17/04/2012, Prediction of early response to uterine arterial embolisation of adenomyosis: value of T2 signal intensity ratio of adenomyosis »»

Abstract
Objectives  
To identify imaging predictors for complete necrosis after uterine artery embolisation (UAE) via quantitative measurement of the signal intensity obtained from magnetic resonance imaging (MRI) of a patient with adenomyosis.
Methods  
The MRIs of 119 patients with uterine adenomyosis, who underwent UAE, were retrospectively evaluated. Each lesion was classified based on its location and morphology on MRI. Thickness and signal intensity were measured in each adenomyosis and in the rectus muscle on the T2-weighted sagittal plane, and the T2-weighted signal intensity ratio (T2SR) was calculated. MR parameters were then compared in patients showing complete response that achieved complete necrosis and incomplete response after UAE via univariate and multivariate analysis. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of the predictor using MR parameters for differentiating the complete from the incomplete response.
Results  
The complete necrosis rate was 66.4 % (79/119) after UAE for adenomyosis. Univariate and multivariate analysis results indicated that T2SR was associated significantly with complete necrosis (P=0.012). Symptomatic adenomyosis with T2SR above 0.475 was associated with complete necrosis after UAE (sensitivity=57.0, specificity=70.0, area under the ROC curve [AUC]=0.643).
Conclusion  
T2SR of adenomyosis on pre-procedural MRI can be utilised as a predictor for early therapeutic response of UAE in adenomyosis.
Key Points   
Pre-procedural MRI helps clinicians predict early response of UAE in adenomyosis.
T2SR may help predict UAE outcomes in adenomyosis.
Pre-procedural MRI helps clinicians to select treatment options in adenomyosis.
MR predictors can be used to counsel patients with symptomatic adenomyosis.

  • Content Type Journal Article
  • Category Urogenital
  • Pages 1-6
  • DOI 10.1007/s00330-012-2436-z
  • Authors
    • Dae Chul Jung, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
    • Man Deuk Kim, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
    • Young Taik Oh, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
    • Jong Yun Won, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea
    • Do Yun Lee, Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752 Republic of Korea

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05/04/2012, Recommendations for measurement of tumour vascularity with positron emission tomography in early phase clinical trials »»

Abstract  
The evaluation of drug pharmacodynamics and early tumour response are integral to current clinical trials of novel cancer therapeutics to explain or predict long term clinical benefit or to confirm dose selection. Tumour vascularity assessment by positron emission tomography could be viewed as a generic pharmacodynamic endpoint or tool for monitoring response to treatment. This review discusses methods for semi-quantitative and quantitative assessment of tumour vascularity. The radioligands and radiotracers range from direct physiological functional tracers like [15O]-water to macromolecular probes targeting integrin receptors expressed on neovasculature. Finally we make recommendations on ways to incorporate such measurements of tumour vascularity into early clinical trials of novel therapeutics.
Key Points
[ 15 O]-water is the gold standard for blood flow/tissue perfusion with PET
In some instances dynamic [ 18 F]-FDG uptake may be used to estimate perfusion
Radiopharmaceuticals that target integrins are now being evaluated for measuring tumour vascularity

  • Content Type Journal Article
  • Category Molecular Imaging
  • Pages 1-14
  • DOI 10.1007/s00330-011-2311-3
  • Authors
    • Eric O. Aboagye, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, MRC Cyclotron Building, Hammersmith Hospital Campus, London, W12 0NN UK
    • Fiona J. Gilbert, Radiology Department, University of Cambridge, Addenbrookes Hospital, Box 218, Cambridge, CB2 0QQ UK
    • Ian N. Fleming, NCRI PET Research Network, Aberdeen Bioimaging Centre, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
    • Ambros J. Beer, Department of Nuclear Medicine, Technische Universität Munchen, Klinikum rechts der Isar, Ismaninger str. 22, 81675 Munich, Germany
    • Vincent J. Cunningham, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD UK
    • Paul K. Marsden, Division of Imaging Sciences, PET Imaging Centre, St. Thomas Hospital, Lower Ground Floor, Lambeth Wing, London, SE1 7EH UK
    • Dimitris Visvikis, INSERM National Institute of Health and Clinical Sciences LaTIM, CHU Morvan, Bat2bis 5 Avenue Foch, 29609 Brest, France
    • Antony D. Gee, Division of Imaging Sciences, The Rayne Institute, St. Thomas Hospital, 4th Floor, Lambeth Wing, London, SE1 7EH UK
    • Ashley M. Groves, Institute of Nuclear Medicine, University College London, University College Hospital, 250 Euston Road, London, NW1 2BU UK
    • Laura M. Kenny, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, MRC Cyclotron Building, Hammersmith Hospital Campus, London, W12 0NN UK
    • Gary J. Cook, KCL Division of Imaging, Sciences and Biomedical Engineering, PET Imaging Centre, St. Thomas Hospital, London, SE1 7EH UK
    • Paul E. Kinahan, University of Washington, 222 Old Fisheries Center (FIS), Box 357987, Seattle, WA 98195-7987, USA
    • Melvyn Myers, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN UK
    • Larry Clarke, Imaging Technology Development Branch, Cancer Imaging Program, EPN, Room 6066, 6130 Executive Boulevard, Rockville, MD 20852-7412, USA

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31/03/2012, Chronic hypersensitivity pneumonitis: high resolution computed tomography patterns and pulmonary function indices as prognostic determinants »»

Abstract
Objectives  
To investigate high resolution computed tomography (HRCT) and pulmonary function indices (PFTs) for determining prognosis in patients with chronic fibrotic hypersensitivity pneumonitis (CHP).
Methods  
Case records, PFTs (FEV1, FVC and DLco) and HRCTs of ninety-two patients with chronic hypersensitivity pneumonitis were evaluated. HRCT studies were scored by two observers for total disease extent, ground-glass opacification, fine and coarse reticulation, microcystic and macrocystic honeycombing, centrilobular emphysema and consolidation. Traction bronchiectasis within each pattern was graded. Using Cox proportional hazards regression models the prognostic strength of individual HRCT patterns and pulmonary function test variables were determined.
Results  
There were forty two deaths during the study period. Increasing severity of traction bronchiectasis was the strongest predictor of mortality (HR 1.10, P<0.001, 95%CI 1.04-1.16). Increasing global interstitial disease extent (HR 1.02, P=0.02, 95%CI 1.00-1.03), microcystic honeycombing (HR 1.09, P=0.019, 95%CI 1.01-1.17) and macrocystic honeycombing (HR 1.06, P<0.01, 95%CI 1.01-1.10) were also independent predictors of mortality. In contrast, no individual PFT variable was predictive of mortality once HRCT patterns were accounted for.
Conclusion  
HRCT patterns, in particular, severity of traction bronchiectasis and extent of honeycombing are superior to pulmonary function tests for predicting mortality in patients with CHP.
Key Points   
HRCT is increasingly used to assess chronic fibrotic hypersensitivity pneumonitis.
HRCT patterns are superior to pulmonary function tests for predicting mortality.
Extensive traction bronchiectasis strongly predicts poor survival in chronic hypersensitivity pneumonitis.

  • Content Type Journal Article
  • Category Chest
  • Pages 1-8
  • DOI 10.1007/s00330-012-2427-0
  • Authors
    • Simon L. F. Walsh, Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
    • Nicola Sverzellati, Department of Clinical Sciences, Section of Radiology, University of Parma, Via Gramsci 14, 43126 Parma, Italy
    • Anand Devaraj, Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
    • Athol U. Wells, Interstitial Lung Diseases Unit, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK
    • David M. Hansell, Department of Radiology, Royal Brompton Hospital, Sydney Street, London, SW3 6NP UK

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31/03/2012, Significance of pulmonary nodules in patients with colorectal cancer »»

Abstract
Objectives  
Radiographically small pulmonary nodules (PNs) in patients with colorectal cancer are troublesome because their discovery raises concern about metastases. This study sought to establish the appropriate timing of radiological follow-up for PNs detected at initial staging evaluation of colorectal carcinoma patients.
Methods  
The medical records of 376 consecutive colorectal cancer patients who underwent curative surgery and had baseline and follow-up chest X-rays (CXR) and computed tomography (CT) were reviewed.
Results  
The study included 92 patients who had all CXR and chest CT available for review, at least one PN found on baseline imaging, and no synchronous neoplasms. On baseline chest CT, these 92 patients had 170 PNs altogether and 77 (45.2 %) of them were greater than 5 mm in size. Baseline CXR detected 13 PNs in 12 patients and all but 2 were larger than 5 mm. Nodule size greater than 5 mm and irregular margins were predictors of nodule growth. The mean doubling time of 24/170 (14.1 %) growing PNs was about 4 months.
Conclusions  
Our findings suggest that baseline and follow-up CXR are pointless, and short-interval CT follow-up is warranted when PNs larger than 5 mm with irregular margins are detected on preoperative chest CT.
Key Points  
Pulmonary nodules in colorectal cancer patients raise concern about metastasis.
Baseline and follow-up chest X-ray in colorectal cancer can be abandoned.
CT is the best technique for assessing PNs in colorectal cancer.
Short-interval CT follow-up advisable for PNs larger than 5 mm with irregular margins.

  • Content Type Journal Article
  • Category Oncology
  • Pages 1-7
  • DOI 10.1007/s00330-012-2431-4
  • Authors
    • Fabio Pomerri, Oncological Radiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
    • Salvatore Pucciarelli, Department of Oncological and Surgical Sciences, 2nd Surgical Clinic, University of Padua, Padua, Italy
    • Isacco Maretto, Surgical Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
    • Ernesta Perrone, Oncological Radiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
    • Giovanna Pintacuda, Oncological Radiology Unit, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
    • Sara Lonardi, Medical Oncology Unit 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
    • Donato Nitti, Department of Oncological and Surgical Sciences, 2nd Surgical Clinic, University of Padua, Padua, Italy
    • Pier Carlo Muzzio, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy

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31/03/2012, Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes »»

Abstract
Objectives  
To investigate volumetric and density changes in the ipsilateral and contralateral lobes following volume reduction of an emphysematous target lobe.
Methods  
The study included 289 subjects with heterogeneous emphysema, who underwent bronchoscopic volume reduction of the most diseased lobe with endobronchial valves and 132 untreated controls. Lobar volume and low-attenuation relative area (RA) changes post-procedure were measured from computed tomography images. Regression analysis (Spearmans rho) was performed to test the association between change in the target lobe volume and changes in volume and density variables in the other lobes.
Results  
The target lobe volume at full inspiration in the treatment group had a mean reduction of 0.45 L (SE=0.034, P<0.0001), and was associated with volume increases in the ipsilateral lobe (rho=0.68, P<0.0001) and contralateral lung (rho=0.16, P=0.006), and overall reductions in expiratory RA (rho=0.31, P<0.0001) and residual volume (RV)/total lung capacity (TLC) (rho=0.13, P=0.03).
Conclusions  
When the volume of an emphysematous target lobe is reduced, the volume is redistributed primarily to the ipsilateral lobe, with an overall reduction. Image-based changes in lobar volumes and densities indicate that target lobe volume reduction is associated with statistically significant overall reductions in air trapping, consistent with expansion of the healthier lung.
Key Points   
Computed tomography allows assessment of the treatment of emphysema with endobronchial valves.
Endobronchial valves can reduce the volume of an emphysematous lung lobe.
Compensatory expansion is greater in ipsilateral lobes than in the contralateral lung.
Reduced air trapping is measurable by RV/TLC and smaller low attenuation area.

  • Content Type Journal Article
  • Category Chest
  • Pages 1-9
  • DOI 10.1007/s00330-012-2393-6
  • Authors
    • Matthew S. Brown, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Hyun J. Kim, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Fereidoun G. Abtin, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Charlie Strange, Department of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Columbia, SC, USA
    • Maya Galperin-Aizenberg, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Richard Pais, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Irene G. Da Costa, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Arash Ordookhani, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Daniel Chong, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Chiayi Ni, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Michael F. McNitt-Gray, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA
    • Donald P. Tashkin, Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
    • Jonathan G. Goldin, Center for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 615, Los Angeles, CA 90024, USA

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31/03/2012, Quantitative evaluation of MR perfusion imaging using blood pool contrast agent in subjects without pulmonary diseases and in patients with pulmonary embolism »»

Abstract
Objective  
To assess the feasibility of time-resolved parallel three-dimensional magnetic resonance imaging (MRI) for quantitative analysis of pulmonary perfusion using a blood pool contrast agent.
Methods  
Quantitative perfusion analysis was performed using novel software to assess pulmonary blood flow (PBF), pulmonary blood volume (PBV) and mean transit time (MTT) in a quantitative manner.
Results  
The evaluation of lung perfusion in the normal subjects showed an increase of PBF, PBV ventrally to dorsally (gravitational direction), and the highest values at the upper lobe, with a decrease to the middle and lower lobe (isogravitational direction). MTT showed no relevant changes in either the gravitational or isogravitational directions. In comparison with normally perfused lung areas (in diseased patients), the pulmonary embolism (PE) regions showed a significantly lower mean PBF (20±0.6 ml/100 ml/min, normal region 94±1 ml/100 ml/min; P<0.001), mean PBV (2±0.1 ml/100 ml, normal region 9.8±0.1 ml/100 ml; P<0.001) and mean MTT (3.8±0.1 s; normal region 6.3±0.1; P<0.001).
Conclusion  
Our results demonstrate the feasibility of using time-resolved dynamic contrast-enhanced MRI to determine normal range and regional variation of pulmonary perfusion and perfusion deficits in patients with PE.
Key Points  
Recently introduced blood pool contrast agents improve MR evaluation of lung perfusion
Regional differences in lung perfusion indicating a gravitational and isogravitational dependency.
Focal areas of significantly decreased perfusion are detectable in pulmonary embolism.

  • Content Type Journal Article
  • Category Contrast Media
  • Pages 1-9
  • DOI 10.1007/s00330-012-2428-z
  • Authors
    • Andreas Hansch, Institute of Diagnostic and Interventional Radiology II, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany
    • Peter Kohlmann, Fraunhofer MEVISInstitute for Medical Image Computing, Universitaetsallee 29, 28359 Bremen, Germany
    • Uta Hinneburg, Institute of Diagnostic and Interventional Radiology II, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany
    • Joachim Boettcher, Institute of Diagnostic and Interventional Radiology, SRH Klinikum Gera, Straße des Friedens 122, 07548 Gera, Germany
    • Ansgar Malich, Institute of Diagnostic and Interventional Radiology, Südharzkrankenhaus Nordhausen, Nordhausen, Dr. Robert-Koch Straße 39, 99734 Nordhausen, Germany
    • Gunter Wolf, Department of Internal Medicine III, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany
    • Hendrik Laue, Fraunhofer MEVISInstitute for Medical Image Computing, Universitaetsallee 29, 28359 Bremen, Germany
    • Alexander Pfeil, Institute of Diagnostic and Interventional Radiology II, University Hospital Jena, Erlanger Allee 101, 07747 Jena, Germany

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31/03/2012, Detectability of low and intermediate or high risk prostate cancer with combined T2-weighted and diffusion-weighted MRI »»

Abstract
Objectives  
To evaluate the incremental value of diffusion-weighted imaging (DWI) in combination with T2-weighted imaging to detect low (Gleason score, 6) and intermediate or high risk (Gleason score, 7) prostate cancer.
Methods  
Fifty-one patients who underwent MRI before prostatectomy were evaluated. Two readers independently scored the probability of tumour in eight regions of prostate on T2-weighted images (T2WI) and T2WI combined with apparent diffusion coefficient (ADC) maps. Data were divided into two groupslow risk and intermediate or high risk prostate cancerand correlated with histopathological results. Diagnostic performance parameters, areas under the receiver-operating characteristic curve (AUCs) and interreader agreement were calculated.
Results  
For both readers, AUCs of combined T2WI and ADC maps were greater than those of T2WI in intermediate or high risk (reader 1, 0.887 vs. 0.859; reader 2, 0.732 vs 0.662, P<0.05) prostate cancers, but not in low risk (reader 1, 0.719 vs 0.725; reader 2, 0.685 vs. 0.680, P>0.05) prostate cancers. Weighted value of combined T2WI and ADC maps was 0.689.
Conclusions  
The addition of DWI to T2-weighted imaging improves the accuracy of detecting intermediate or high risk prostate cancers, but not for low risk prostate cancer detection.
Key Points  
Gleason scores influence diagnostic performance of MRI for prostate cancer detection.
Addition of DWI does not improve low risk prostate cancer detection.
Combined T2WI and DWI may help select intermediate or high risk patients.

  • Content Type Journal Article
  • Category Urogenital
  • Pages 1-8
  • DOI 10.1007/s00330-012-2430-5
  • Authors
    • Kyung Won Doo, Department of Radiology, Anam Hospital, Korea University, College of Medicine no. 126-1, 5-Ka Anam-dong, Sungbuk ku, Seoul, 136-705 Korea
    • Deuk Jae Sung, Department of Radiology, Anam Hospital, Korea University, College of Medicine no. 126-1, 5-Ka Anam-dong, Sungbuk ku, Seoul, 136-705 Korea
    • Beom Jin Park, Department of Radiology, Anam Hospital, Korea University, College of Medicine no. 126-1, 5-Ka Anam-dong, Sungbuk ku, Seoul, 136-705 Korea
    • Min Ju Kim, Department of Radiology, Anam Hospital, Korea University, College of Medicine no. 126-1, 5-Ka Anam-dong, Sungbuk ku, Seoul, 136-705 Korea
    • Sung Bum Cho, Department of Radiology, Anam Hospital, Korea University, College of Medicine no. 126-1, 5-Ka Anam-dong, Sungbuk ku, Seoul, 136-705 Korea
    • Yu Whan Oh, Department of Radiology, Anam Hospital, Korea University, College of Medicine no. 126-1, 5-Ka Anam-dong, Sungbuk ku, Seoul, 136-705 Korea
    • Young Hwii Ko, Department of Urology, Anam Hospital, Korea University, College of Medicine, Seoul, Korea
    • Kyung Sook Yang, Department of Biostatistics, Korea University, College of Medicine, Seoul, Korea

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30/03/2012, Development and validation of an intrinsic landmark-based gating protocol applicable for functional and molecular ultrasound imaging »»

Abstract
Objectives  
To implement a retrospective intrinsic landmark-based (ILB) gating protocol for contrast-enhanced ultrasound (CEUS) and to compare its efficiency to non-gated, manually gated and extrinsically gated CEUS.
Methods  
CEUS of the liver was performed in healthy mice (n=5) and in NEMO knockout mice with dysplastic livers (n=5). In healthy animals, first-pass kinetics of non-specific microbubbles was recorded. Knockout mice were analysed regarding retention of VEGFR2-specific microbubbles. For retrospective gating, a landmark which showed respiratory movement was encircled as a region of interest (ROI). During inspiration, the signal intensity within the ROI altered, which served as gating signal. To evaluate the accuracy, non-gated, extrinsically gated and ILB-gated time-intensity curves were created. For each curve, descriptive parameters were calculated and compared to the gold standard (manual frame-by-frame gating).
Results  
No significant differences in the variation of ILB- and extrinsically gated time-intensity curves from the gold standard were observed. Non-gated data showed significantly higher variations. Also the variation of molecular ultrasound data was significantly lower for ILB-gated compared to non-gated data.
Conclusion  
ILB gating is a robust and easy method to improve data accuracy in functional and molecular ultrasound liver imaging. This technique can presumably be translated to contrast-enhanced ultrasound examinations in humans.
Key Points   
Quantitative analysis of the uptake of contrast agents during ultrasound is complex.
Intrinsic landmark-based gating (ILB) offers a simple implementable method for motion correction.
Results using ILB-gating are comparable to extrinsic gating using external biomonitoring devices.
Functional and molecular imaging of mobile organs will benefit from ILB gating.

  • Content Type Journal Article
  • Category Molecular Imaging
  • Pages 1-8
  • DOI 10.1007/s00330-012-2429-y
  • Authors
    • Christoph Grouls, Department of Experimental Molecular Imaging, RWTH-Aachen University, Aachen, Germany
    • Max Hatting, Medical Clinic II, University Hospital, RWTH-Aachen University, Aachen, Germany
    • Isabelle Tardy, Bracco Suisse SA, Geneva, Switzerland
    • Jessica Bzyl, Department of Experimental Molecular Imaging, RWTH-Aachen University, Aachen, Germany
    • Georg Mühlenbruch, Department of Diagnostic and Interventional Neuroradiology, RWTH-Aachen University, Aachen, Germany
    • Florian F. Behrendt, Department of Nuclear Medicine, RWTH-Aachen University, Aachen, Germany
    • Tobias Penzkofer, Department of Diagnostic and Interventional Radiology, RWTH-Aachen University, Aachen, Germany
    • Christian Trautwein, Medical Clinic II, University Hospital, RWTH-Aachen University, Aachen, Germany
    • Christiane Kuhl, Department of Diagnostic and Interventional Radiology, RWTH-Aachen University, Aachen, Germany
    • Fabian Kiessling, Department of Experimental Molecular Imaging, RWTH-Aachen University, Aachen, Germany
    • Moritz Palmowski, Department of Experimental Molecular Imaging, RWTH-Aachen University, Aachen, Germany

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28/03/2012, The clinical value of MRA at 3.0 T for the diagnosis and therapeutic planning of patients with subarachnoid haemorrhage »»

Abstract
Objective  
To evaluate the clinical value of unenhanced magnetic resonance angiography (MRA) at 3.0 T for the diagnosis and therapeutic planning of patients with subarachnoid haemorrhage (SAH).
Methods  
A total of 165 patients with SAH were referred for three-dimensional time-of-flight MRA (3D-TOF-MRA) before digital subtraction angiography (DSA). For each aneurysm, 3D-TOF-MRA was used to determine whether the aneurysm was suitable for coil placement with or without balloon/stent-assisted coiling, surgical clipping or conservative treatment. Treatment planning with 3D-TOF-MRA was compared with actual treatment decisions or treatment that had been carried out in each aneurysm decided using DSA.
Results  
The aneurysm-based evaluation yielded accuracy of 96.9%, sensitivity of 97.6%, specificity of 93.1%, positive predictive value (PPV) of 98.8% and negative predictive value (NPV) of 87.1%, in the detection of intracranial aneurysms. Treatment planning could be correctly made on the basis of aneurysm anatomy and working view by volume rendering (VR) 3D-TOF-MRA with accuracy, sensitivity, specificity, PPV and NPV of 94.9%, 94.0%, 100%, 100% and 74.4%, respectively, on a per aneurysm-based evaluation.
Conclusions  
VR 3D-TOF-MRA offers high diagnostic accuracy in the detection of ruptured intracranial aneurysms, and appears to be an effective treatment planning tool for most patients with SAH.
Key Points   
VR 3D-TOF-MRA offers high diagnostic accuracy for detecting ruptured intracranial aneurysms.
VR 3D-TOF-MRA helps treatment planning for patients with subarachnoid haemorrhage.
3D-TOF-MRA is non-invasive and avoids using ionising radiation or contrast agents.

  • Content Type Journal Article
  • Category Neuro
  • Pages 1-9
  • DOI 10.1007/s00330-012-2390-9
  • Authors
    • Yuan-Chang Chen, Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, 200233 China
    • Zhen-Kui Sun, Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, 200233 China
    • Ming-Hua Li, Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, 200233 China
    • Yong-Dong Li, Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, 200233 China
    • Wu Wang, Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, 200233 China
    • Hua-Qiao Tan, Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, 200233 China
    • Bin-Xian Gu, Institute of Diagnostic and Interventional Radiology, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, No. 600, Yi Shan Road, Shanghai, 200233 China
    • Shi-Wen Chen, Department of Neurosurgery, The Sixth Affiliated Peoples Hospital, Shanghai Jiao Tong University, Shanghai, China

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