Radiology and patient communication: if not now, then when?
Key Points
• Communication with patients in radiology is, in general, indirect using the referrer as a conduit.
• Direct patient communication may be beneficial for radiology departments and radiologists to improve patient awareness about the nature of our role and also to provide correct and measured information about the nature and frequency of discrepancies in radiology.
Distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma in patients with and without risks: the evaluation of the LR-M criteria of contrast-enhanced ultrasound liver imaging reporting and data system version 2017
Abstract
Purpose
To assess the diagnostic performance of the LR-M criteria of Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System version 2017 in differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) in patients with and without risk factors for HCC.
Methods
Fifty-four ICC in patients with risks and 55 ICC in patients without risks and matched control cases of HCC with and without risks (n = 59 and n = 55, respectively) were enrolled. The enhanced features of the lesions were retrospectively analyzed according to LR-M criteria. The diagnostic performances including the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of LR-M criteria were assessed.
Result
Peripheral rim-like hyperenhancement, early washout (< 45 or 60s), and marked washout did not differ between ICCs with and without risks, while all of these features were more common in ICCs than in HCCs (p < 0.05) no matter if patients were with and without risk factors. Using the LR-M criteria to differentiate ICC from HCC, the AUC, sensitivity, specificity, and accuracy were 0.92, 97.25%, 87.72%, and 92.38%, respectively. If early washout onset was adjusted to < 45 s, the specificity was significantly increased to 95.61% (p = 0.004) without losing sensitivity (96.33%, p = 0.945). The rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%.
Conclusion
Although the LR-M criteria showed high sensitivity in distinguishing ICCs from HCCs in patients with and without risks, the specificity would be significantly increased after adjustments to current criteria.
Key Points
• The LR-M criteria of CEUS-LI-RADS v2017 could be used for distinguishing ICC from HCC not only in patients with risk factors for HCC but also in those without risk factors.
• The diagnostic performance of differentiating ICC from HCC by using the LR-M criteria showed high AUC (0.92), high sensitivity (97.25%), intermediate specificity (87.72%), and high accuracy (92.38%).
• If the onset of early washout was adjusted to < 45 s, the specificity was significantly increased from 87.72 to 95.61% (p = 0.004) without losing sensitivity (p = 0.945), and the rate of HCCs misdiagnosed as ICCs would decrease from 12.3 to 4.4%.
Strain elastography as an early predictor of long-term prognosis in patients with locally advanced cervical cancers treated with concurrent chemoradiotherapy
Abstract
Objective
To explore the value of strain elastography as an early predictor of long-term prognosis in patients with locally advanced cervical cancers treated with concurrent chemoradiotherapy (CCRT).
Methods
Strain elastography examinations were performed on 45 patients with locally advanced cervical cancers at 3 time points: prior to CCRT, and at 1 and 2 weeks after the start of CCRT. The maximum tumor diameter (Dmax), strain ratio (SR), and their percentage changes (ΔDmax and ΔSR) were calculated to predict long-term prognosis. Based on the results of physical examinations, Papanicolaou test, and pelvic magnetic resonance imaging, we classified patients into two groups: responders (complete remission) and non-responders (sustained disease, recurrence, or death).
Results
After a median follow-up of 30 months (range, 12–36 months), 36 of 45 (80%) patients were disease free. The Dmax as well as ΔDmax at 2 weeks during CCRT was able to predict the responder outcomes, with an area-under-the-curve (AUC) of 0.733 and 0.731, respectively. Furthermore, significant differences in SR and ΔSR at 1 and 2 weeks during therapy were shown between the responder and non-responder groups (all p < 0.05), and ΔSR at 2 weeks during CCRT presented with the highest AUC (0.91), yielding 88.9% sensitivity and 88.9% specificity with a selected cutoff value.
Conclusions
Strain elastography may be useful as an early predictor of long-term outcomes after CCRT for patients with cervical cancer.
Key Points
• The D max as well as ΔD max at 2 weeks during CCRT can predict the responder outcomes.
• The elastography parameters (SR and ΔSR) exhibited predictive values of favorable response after therapy initiation.
• ΔSR at 2 weeks during CCRT held the best predictive value for the responder outcomes.
Consensus report from the 8th International Forum for Liver Magnetic Resonance Imaging
Abstract
Objectives
The 8th International Forum for Liver Magnetic Resonance Imaging (MRI), held in Basel, Switzerland, in October 2017, brought together clinical and academic radiologists from around the world to discuss developments in and reach consensus on key issues in the field of gadoxetic acid–enhanced liver MRI since the previous Forum held in 2013.
Methods
Two main themes in liver MRI were considered in detail at the Forum: the use of gadoxetic acid for contrast-enhanced MRI in patients with liver cirrhosis and the technical performance of gadoxetic acid–enhanced liver MRI, both opportunities and challenges. This article summarises the expert presentations and the delegate voting on consensus statements discussed at the Forum.
Results and conclusions
It was concluded that gadoxetic acid–enhanced MRI has higher sensitivity for the diagnosis of hepatocellular carcinoma (HCC), when compared with multidetector CT, by utilising features of hyperenhancement in the arterial phase and hypointensity in the hepatobiliary phase (HBP). Recent HCC management guidelines recognise an increasing role for gadoxetic acid–enhanced MRI in early diagnosis and monitoring post-resection. Additional research is needed to define the role of HBP in predicting microvascular invasion, to better define washout during the transitional phase in gadoxetic acid–enhanced MRI for HCC diagnosis, and to reduce the artefacts encountered in the arterial phase. Technical developments are being directed to shortening the MRI protocol for reducing time and patient discomfort and toward utilising faster imaging and non-Cartesian free-breathing approaches that have the potential to improve multiphasic dynamic imaging.
Key Points
• Gadoxetic acid–enhanced MRI provides higher diagnostic sensitivity than CT for diagnosing HCC.
• Gadoxetic acid–enhanced MRI has roles in early-HCC diagnosis and monitoring post-resection response.
• Faster imaging and free-breathing approaches have potential to improve multiphasic dynamic imaging.
Applicability of two commonly used bone age assessment methods to twenty-first century UK children
Abstract
Objectives
To assess the effect of secular change on skeletal maturation and thus on the applicability of the Greulich and Pyle (G&P) and Tanner and Whitehouse (TW3) methods.
Methods
BoneXpert was used to assess bone age from 392 hand trauma radiographs (206 males, 257 left). The paired sample t test was performed to assess the difference between mean bone age (BA) and mean chronological age (CA). ANOVA was used to assess the differences between groups based on socioeconomic status (taken from the Index of Multiple Deprivation).
Results
CA ranged from 2 to 15 years for females and 2.5 to 15 years for males. Numbers of children living in low, average and high socioeconomic areas were 216 (55%), 74 (19%) and 102 (26%) respectively. We found no statistically significant difference between BA and CA when using G&P. However, using TW3, CA was underestimated in females beyond the age of 3 years, with significant differences between BA and CA (− 0.43 years, SD 1.05, p = < 0.001) but not in males (0.01 years, SD 0.97, p = 0.76). Of the difference in females, 17.8% was accounted for by socioeconomic status.
Conclusion
No significant difference exists between BoneXpert-derived BA and CA when using the G&P atlas in our study population. There was a statistically significant underestimation of BoneXpert-derived BA compared with CA in females when using TW3, particularly in those from low and average socioeconomic backgrounds. Secular change has not led to significant advancement in skeletal maturation within our study population.
Key Points
• The Greulich and Pyle method can be applied to the present-day United Kingdom (UK) population.
• The Tanner and Whitehouse (TW3) method consistently underestimates the age of twenty-first century UK females by an average of 5 months.
• Secular change has not advanced skeletal maturity of present-day UK children compared with those of the mid-twentieth century.
Practical guide to quantification of hepatic iron with MRI
Abstract
Our intention is to demystify the MR quantification of hepatic iron (i.e., the liver iron concentration) and give you a step-by-step approach by answering the most pertinent questions. The following article should be more of a manual or guide for every radiologist than a classic review article, which just summarizes the literature. Furthermore, we provide important background information for professional communication with clinicians. The information regarding the physical background is reduced to a minimum. After reading this article, you should be able to perform adequate MR measurements of the LIC with 1.5-T or 3.0-T scanners.
Key Points
• MRI is widely accepted as the primary approach to non-invasively determine liver iron concentration (LIC).
• This article is a guide for every radiologist to perform adequate MR measurements of the LIC.
• When using R2* relaxometry, some points have to be considered to obtain correct measurements—all explained in this article.
Baseline 3D-ADC outperforms 2D-ADC in predicting response to treatment in patients with colorectal liver metastases
Abstract
Objectives
To examine the value of baseline 3D-ADC and to predict short-term response to treatment in patients with hepatic colorectal metastases (CLMs).
Methods
Liver MR images of 546 patients with CLMs (2008–2015) were reviewed retrospectively and 68 patients fulfilled inclusion criteria. Patients had received systemic chemotherapy (n = 17), hepatic trans-arterial chemoembolization or TACE (n = 34), and 90Y radioembolization (n = 17). Baseline (pre-treatment) 3D-ADC (volumetric) of metastatic lesions was calculated employing prototype software. RECIST 1.1 was used to assess short-term response to treatment. Prediction of response to treatment by baseline 3D-ADC and 2D-ADC (ROI-based) was also compared in all patients.
Results
Partial response to treatment (minimum 30% decrease in tumor largest transverse diameter) was seen in 35.3% of patients; 41.2% with systemic chemotherapy, 32.4% with TACE, and 35.3% with 90Y radioembolization (p = 0.82). Median baseline 3D-ADC was significantly lower in responding than in nonresponding lesions. Area under the curve (AUC) of 3D-ADC was 0.90 in 90Y radioembolization patients, 0.88 in TACE patients, and 0.77 in systemic chemotherapy patients (p < 0.01). Optimal prediction was observed with the 10th percentile of ADC (1006 × 10−6 mm2/s), yielding sensitivity and specificity of 77.4% and 91.3%, respectively. 3D-ADC outperformed 2D-ADC in predicting response to treatment (AUC; 0.86 vs. 0.71; p < 0.001).
Conclusion
Baseline 3D-ADC is a highly specific biomarker in predicting partial short-term response to treatment in hepatic CLMs.
Key Points
• Baseline 3D-ADC is a highly specific biomarker in predicting response to different treatments in hepatic CLMs.
• The prediction level of baseline ADC is better for90Y radioembolization than for systemic chemotherapy/TACE in hepatic CLMs.
• 3D-ADC outperforms 2D-ADC in predicting short-term response to treatment in hepatic CLMs.
Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative
Abstract
Objectives
Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have not been investigated extensively. We aimed to determine whether patellofemoral morphology is associated with the presence and longitudinal worsening of tibiofemoral OA in participants of the Osteoarthritis Initiative (OAI).
Methods
Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT–TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall–Salvati ratio (ISR). Radiographic and MRI OA knee scoring (MOAKS) measurements were extracted from baseline and 2-year follow-up readings. Associations between baseline patellofemoral morphology metrics with radiographic medial tibiofemoral compartment (MTFC) joint space loss (> 0.7 mm, between baseline and 2nd–4th-year readings), and MRI-derived cartilage damage, bone marrow lesions (BMLs), and osteophytes (baseline to 2 years), were investigated using regression models adjusted for age, sex, body mass index, and knee alignment. P values were corrected using the Benjamini–Hochberg procedure.
Results
Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Only TT–TG distance was associated with the baseline number of subregions with cartilage defects (OR (95% CI), 1.09 (1.04–1.14), corrected p value ≤ 0.01), BMLs (OR (95% CI), 1.1 (1.04–1.17), corrected p value = 0.01), and osteophytes (OR (95% CI), 1.09 (1.05–1.14), corrected p value ≤ 0.01) in the lateral tibiofemoral compartment (LTFC), and worsening of LTFC cartilage defects over 2 years (OR (95% CI), 1.09 (1.03–1.16), corrected p value = 0.02).
Conclusions
Higher TT–TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. No associations were detected between patellofemoral morphology measurements and MTFC OA progression.
Key Points
• Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening.
• Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years.
• Using longitudinal MRI data, each millimeter increase of TT–TG distance is associated with a 9% (95% confidence interval, 3–16%) increase in odds of longitudinal cartilage defects in the lateral tibiofemoral (but not medial) compartment over 2 years.
MRI evidence of brain atrophy, white matter damage, and functional adaptive changes in patients with cervical spondylosis and prolonged spinal cord compression
Abstract
Objectives
To investigate the effect of cervical spondylosis (CS) in the brain with a combination of advanced neuroimaging techniques.
Methods
Twenty-seven patients with CS and 24 age- and gender-matched healthy controls were studied. Disease severity was quantified using the Modified Japanese Orthopaedic Association Scoring System (mJOHA). Magnetic resonance (MR) imaging of the brain and spinal cord, functional MR imaging (fMRI) with a bilateral rest/finger-tapping paradigm, brain diffusion tensor imaging (DTI), voxel-based morphometry (VBM), and MR spectroscopy of the sensorimotor cortex were performed.
Results
A total of 92.3% of patients had more than one herniated disc. In the MRI, 33.33% presented signs of myelopathy. The mJOHA score was 13.03 ± 2.83. Compared with controls, DTI results showed significant lower FA values in Corpus callosum, both corticospinal tracts and middle cerebellar peduncles (p < 0.05 corrected). Only in CS patients fMRI results showed activation in both globus pallidi, caudate nucleus, and left thalamus (p < 0.001). Subject-specific activation of the BOLD signal showed in CS patients lower activation in the sensorimotor cortex and increased activation in both cerebellum hemispheres (p < 0.05 corrected). VBM showed bilateral clusters of gray matter loss in the sensorimotor cortex and pulvinar nucleus (p < 0.05 corrected) of CS patients. NAA/Cr was reduced in the sensorimotor cortex of CS patients (p < 0.05). Linear discriminant and support vector machine analyses were able to classify > 97% of CS patients with parameters obtained from the fMRI, DTI, and MRS results.
Conclusion
CS may lead to distal brain damage affecting the white and gray matter of the sensorimotor cortex causing brain atrophy and functional adaptive changes.
Key Points
• This study suggests that patients with cervical spondylosis may present anatomical and functional adaptive changes in the brain.
• Cervical spondylosis may lead to white matter damage, gray matter volume loss, and functional adaptive changes in the sensorimotor cortex.
• The results reported in this work may be of value to better understand the effect of prolonged cervical spine compression in the brain.
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