Radiology MOC

Abstract Objective  Because diffusion-weighted imaging (DWI) can predict the prognosis of patients with oesophageal squamous cell carcinoma (ESCC), we hypothesised that apparent diffusion coefficient (ADC) values might be correlated with the collagen content and tumour angiogenesis. The purpose of this study was to determine the correlation between ADC values of ESCC before treatment and oesophageal tumour stroma and angiogenesis. Methods  Seventeen patients with ESCC were enrolled. The ADC values were calculated from the DWI score. Seventeen patients who had undergone oesophagectomy were analysed for tumour stroma, vascular endothelial growth factor (VEGF) and CD34. Tissue collagen was stained with azocarmine and aniline blue to quantitatively analyse the extracellular matrix in cancer stroma. Tissues were stained with VEGF and CD34 to analyse the angiogenesis. Results  The ADC values decreased with stromal collagen growth. We found a negative correlation between the tumour ADC and the amount of stromal collagen (r = −0.729, P = 0.001), i.e. the ADC values decreased with growth of VEGF. We also found a negative correlation between the ADC of the tumours and the amount of VEGF (r = 0.538, P = 0.026). Conclusion  Our results indicated that the ADC value may be a novel prognostic factor and contribute to the treatment of oesophageal cancer. Key Points   • Magnetic resonance apparent diffusion coefficient values inversely indicate tumour stromal collagen • There is also negative correlation between ADCs and vascular endothelial growth factor • ADC values may contribute to the treatment of oesophageal cancer.

• Content Type Journal Article
• Category Gastrointestinal
• Pages 1-6
• DOI 10.1007/s00330-011-2359-0
• Authors
  • Tomoyoshi Aoyagi, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Kiyohiko Shuto, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Shinichi Okazumi, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Kohichi Hayano, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Asami Satoh, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Hiroshige Saitoh, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Hideaki Shimada, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Yoshihiro Nabeya, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan
  • Toshiki Kazama, Department of Radiology, Graduate School of Medicine, Chiba University, Chiba, Japan
  • Hisahiro Matsubara, Department of Frontier Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670 Japan

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objective  To determine the positive predictive value (PPV) for polyps ≥6 mm detected at CT colonography (CTC) performed without cathartic preparation, with low-dose iodine faecal tagging regimen and to evaluate patient experience. Methods  1920 average-risk patients underwent CTC without cathartic preparation. Faecal tagging was performed by diatrizoate meglumine and diatrizoate sodium at a total dose of 60 ml (22.2 g of iodine).The standard interpretation method was primary 3D with 2D problem solving. We calculated per-patient and per-polyp PPV in relation to size and morphology. All colonic segments were evaluated for image quality (faecal tagging, amount of liquid and solid residual faeces and luminal distension). Patients completed a questionnaire before and after CTC to assess preparation and examination experience. Results  Per-polyp PPV for detected lesions of ≥6 mm, 6–9 mm, ≥10 mm and ≥30 mm were 94.3%, 93.1%, 94.7% and 98%, respectively. Per-polyp PPV, according to lesion morphology, was 94.6%, 97.3% and 85.1% for sessile, pedunculated and flat polyps, respectively. Per-patient PPV was 92.8%. Preparation without frank cathartics was reported to cause minimal discomfort by 78.9% of patients. Conclusion  CTC without cathartic preparation and low-dose iodine faecal tagging may yield high PPVs for lesions ≥6 mm and is well accepted by patients. Key Points   • Computed tomographic colonography (CTC) without cathartic preparation is well accepted by patients • Cathartic-free faecal tagging CTC yields high positive predictive values • CTC without cathartic preparation could improve uptake of colorectal cancer screening

• Content Type Journal Article
• Category Gastrointestinal
• Pages 1-10
• DOI 10.1007/s00330-011-2367-0
• Authors
  • Carmen Zueco Zueco, Complexo Hospitalario Universitario de Vigo - CHUVI, c/Pizarro 22, 36204 Vigo, Pontevedra, Spain
  • Carolina Sobrido Sampedro, Complexo Hospitalario Universitario de Vigo - CHUVI, c/Pizarro 22, 36204 Vigo, Pontevedra, Spain
  • Juan D. Corroto, Complexo Hospitalario Universitario de Vigo - CHUVI, c/Pizarro 22, 36204 Vigo, Pontevedra, Spain
  • Paula Rodriguez Fernández, Complexo Hospitalario Universitario de Vigo - CHUVI, c/Pizarro 22, 36204 Vigo, Pontevedra, Spain
  • Manuela Fontanillo Fontanillo, Complexo Hospitalario Universitario de Vigo - CHUVI, H Meixoeiro, 2ªpl. s/n, 36214 Vigo, Pontevedra, Spain

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To compare ipsilateral decubitus and prone patient positioning for performing computed tomography guided adrenal biopsy using the requirements for out-of-plane approach (OOP) and the needle insertion time (NIT) as a surrogate for procedure complexity. Methods  The study included 106 adrenal biopsies performed in 104 patients with lesions measuring ≤4 cm that were divided into two groups: Ipsilateral decubitus (Group I) and prone (Group II) positions. The frequency of use of an OOP biopsy path and the NIT were recorded as well as diagnostic yield, adverse events and transgression of organs to approach the target lesion. Results  Groups I and II comprised 54 and 50 patients, respectively. The use of the OOP approach was significantly less frequent (P < 0.01) in Group I (n = 4) compared to Group II (n = 38). NIT was statistically shorter (P < 0.01) in Group I (9 min and 43 s) compared to Group II (19 min and 7 s). There were fewer organs traversed in Group I versus Group II. Diagnostic yield and post-biopsy complications were equal in both groups. Conclusion  Ipsilateral adrenal biopsy approach is a less complex, equally reliable and safe compared to the prone approach based on the less frequent use of the OOP approach and the shorter NIT. Key Points  • Ipsilateral adrenal biopsy decubitus positioning provides a direct, non-transpulmonary path for sampling • Ipsilateral decubitus positioning reduces the need for potentially dangerous out-of-plane approaches (OOP) • Ipsilateral decubitus and prone positioning are equally reliable and safe techniques

• Content Type Journal Article
• Category Interventional
• Pages 1-7
• DOI 10.1007/s00330-011-2363-4
• Authors
  • Bruno C. Odisio, Department of Diagnostic Radiology, Section of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street Unit Number: 1471, Room Number: FCT14.6000, Houston, TX 77230-1402, USA
  • Alda L. Tam, Department of Diagnostic Radiology, Section of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street Unit Number: 1471, Room Number: FCT14.6000, Houston, TX 77230-1402, USA
  • Rony Avritscher, Department of Diagnostic Radiology, Section of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street Unit Number: 1471, Room Number: FCT14.6000, Houston, TX 77230-1402, USA
  • Sanjay Gupta, Department of Diagnostic Radiology, Section of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street Unit Number: 1471, Room Number: FCT14.6000, Houston, TX 77230-1402, USA
  • Michael J. Wallace, Department of Diagnostic Radiology, Section of Interventional Radiology, The University of Texas M.D. Anderson Cancer Center, 1400 Pressler Street Unit Number: 1471, Room Number: FCT14.6000, Houston, TX 77230-1402, USA

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objective  To evaluate whether focal abnormalities (FAs) depicted by prostate MRI could be characterised using simple semiological features. Methods  134 patients who underwent T2-weighted, diffusion-weighted and dynamic contrast-enhanced MRI at 1.5 T before prostate biopsy were prospectively included. FAs visible at MRI were characterised by their shape, the degree of signal abnormality (0 = normal to 3 = markedly abnormal) on individual MR sequences, and a subjective score (SS1 = probably benign to SS3 = probably malignant). FAs were then biopsied under US guidance. Results  56/233 FAs were positive at biopsy. The subjective score significantly predicted biopsy results (P < 0.01). As compared to SS1 FAs, the odds ratios (OR) of malignancy of SS2 and SS3 FAs were 9.9 (1.8–55.9) and 163.8 (11.5–2331). Unlike FAs’ shape, a simple combination of MR signal abnormalities (into “low-risk”, “intermediate” and “high-risk” groups) significantly predicted biopsy results (P < 0.008). As compared to “low risk” FAs, the OR of malignancy of “intermediate” and “high-risk” FAs were 4.5 (1.1–18.4) and 52.7 (6.8–407) in the overall population and 5.4 (1.1–27.2) and 118.2 (6.1–2301) in PZ. Conclusions  A simple combination of signal abnormalities of individual MR sequences can significantly stratify the risk of malignancy of FAs, holding promise of a more standardised interpretation of MRI by readers with varying experience. Key Points   • Using multiparameter(mp)-MRI, experienced uroradiologists can stratify the malignancy risk of prostatic lesions • The shape of prostatic focal abnormalities in the peripheral zone does not help predicting malignancy. • A simple combination of findings at mp-MRI can help less-experienced radiologists

• Content Type Journal Article
• Category Urogenital
• Pages 1-9
• DOI 10.1007/s00330-011-2343-8
• Authors
  • Olivier Rouvière, Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
  • Matthieu Papillard, Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
  • Nicolas Girouin, Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
  • Romain Boutier, Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, France
  • Muriel Rabilloud, Hospices Civils de Lyon, Department of Biostatistics, Lyon, France
  • Benjamin Riche, Hospices Civils de Lyon, Department of Biostatistics, Lyon, France
  • Florence Mège-Lechevallier, Hospices Civils de Lyon, Department of Pathology, Hôpital Edouard Herriot, Lyon, France
  • Marc Colombel, Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, France
  • Albert Gelet, Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, France

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objective  To determine the prevalence and importance of extracardiac findings (ECF) in patients undergoing clinical CMR and to test the hypothesis that the original CMR reading focusing on the heart may underestimate extracardiac abnormalities. Methods  401 consecutive patients (mean age 53 years) underwent CMR at 1.5 T. Main indications were ischaemic heart disease (n = 183) and cardiomyopathy (n = 164). All CMR sequences, including scout images, were reviewed with specific attention to ECF in a second reading by the same radiologist who performed the first clinical reading. Potentially significant findings were defined as abnormalities requiring additional clinical or radiological follow-up. Results  250 incidental ECF were detected, of which 84 (34%) had potentially significant ECF including bronchial carcinoma (n = 1), lung consolidation (n = 7) and abdominal abnormalities. In 166 CMR studies (41%) non-significant ECF were detected. The number of ECF identified at second versus first reading was higher for significant (84 vs. 47) and non-significant (166 vs. 36) findings (P < 0.00001). Conclusions  About one fifth of patients undergoing CMR were found to have potentially significant ECF requiring additional work-up. The second dedicated reading detected significantly more ECF compared with the first clinical reading emphasising the importance of active search for extracardiac abnormalities when evaluating CMR studies. Key Points  • Many patients undergoing cardiac MR have significant extracardiac findings (ECF) • These impact on management and require additional work-up. • Wide review of scout and cine sequences will detect most ECFs. • Education of radiologists is important to identify ECFs on CMR studies.

• Content Type Journal Article
• Category Cardiac
• Pages 1-8
• DOI 10.1007/s00330-011-2369-y
• Authors
  • Rolf Wyttenbach, Department of Radiology, Ospedale San Giovanni Bellinzona (EOC), CH-6500 Bellinzona, Switzerland
  • Nathalie Médioni, Department of Radiology, Ospedale San Giovanni Bellinzona (EOC), CH-6500 Bellinzona, Switzerland
  • Paolo Santini, Department of Radiology, Ospedale San Giovanni Bellinzona (EOC), CH-6500 Bellinzona, Switzerland
  • Peter Vock, Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Bern, Bern, Switzerland
  • Zsolt Szucs-Farkas, Department of Diagnostic, Interventional and Paediatric Radiology, University Hospital Bern, Bern, Switzerland

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To investigate the safety of transarterial chemoembolisation (TACE) in combination with sorafenib in patients with hepatocellular carcinoma (HCC). Methods  Patients with Child–Pugh A/B liver function, ECOG performance status 0–2 and HCC treatable with TACE received continuous sorafenib 800 mg/day, and TACE with doxorubicin (75, 50 and 25 mg/m2 according to serum bilirubin: <1.5, 1.5–3, and >3 mg/dL) and lipiodol 2 weeks after sorafenib initiation and repeated every 4 weeks. Results  Fifteen patients were included (Child–Pugh A/B, n = 12/3; Barcelona Clinic Liver Cancer-A/B/C, n = 1/9/5; ECOG 0/2, n = 14/1). Median time on sorafenib was 5.2 months (2.6–7.4 months); median number of TACE sessions was 3. Common adverse events were abdominal pain (n = 14), weight loss (n = 13), alopecia (n = 12), fatigue (n = 12) and hyperbilirubinaemia (n = 11). There were 32 serious adverse events (grade ≥3); 9/10-unscheduled hospital admissions and 4/5 deaths were considered TACE-related. The study was stopped prematurely because of safety concerns. At 6 months, 2 and 5 patients had complete or partial responses; 1 had stable disease. Median overall survival was 10.6 months (95% CI: 5.2–16 months). Conclusion  These findings do not support use of an intensive, high-dose doxorubicin-based TACE regimen in combination with sorafenib in this study population. Key Points  • Transarterial chemoembolisation (TACE) is widely used in patients with hepatocellular carcinoma (HCC) • Various antiangiogenic and other agents have been used to augment this treatment • We tested lipiodol-TACE with bilirubin-adjusted doxorubicin dosing in combination with sorafenib • This trial was stopped prematurely because of safety reasons • Our safety results do not support the combination of sorafenib with this TACE regimen

• Content Type Journal Article
• Category Hepatobiliary-Pancreas
• Pages 1-10
• DOI 10.1007/s00330-011-2368-z
• Authors
  • Wolfgang Sieghart, Department of Gastroenterology/Hepatology, Medical University of Vienna, Währinger Gürtel, 18-20, 1090 Vienna, Austria
  • Matthias Pinter, Department of Gastroenterology/Hepatology, Medical University of Vienna, Währinger Gürtel, 18-20, 1090 Vienna, Austria
  • Michael Reisegger, Department of Radiology, Medical University of Vienna, Vienna, Austria
  • Christian Müller, Department of Gastroenterology/Hepatology, Medical University of Vienna, Währinger Gürtel, 18-20, 1090 Vienna, Austria
  • Ahmed Ba-Ssalamah, Department of Radiology, Medical University of Vienna, Vienna, Austria
  • Johannes Lammer, Department of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
  • Markus Peck-Radosavljevic, Department of Gastroenterology/Hepatology, Medical University of Vienna, Währinger Gürtel, 18-20, 1090 Vienna, Austria

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To assess the 5-year incidence of clinically presenting colorectal cancers following a negative CT colonography (CTC) screening examination, as few patient outcome data regarding a negative CTC screening result exist. Methods  Negative CTC screening patients (n = 1,050) in the University of Wisconsin Health system over a 14-month period were included. An electronic medical record (EMR) review was undertaken, encompassing provider, colonoscopy, imaging and histopathology reports. Incident colorectal cancers and other important GI tumours were recorded. Results  Of the 1,050 cohort (mean [±SD] age 56.9 ± 7.4 years), 39 (3.7%) patients were excluded owing to lack of follow-up within our system beyond the initial screening CTC. The remaining 1,011 patients were followed for an average of 4.73 ± 1.15 years. One incident colorectal adenocarcinoma represented a crude cancer incidence of 0.2 cancers per 1,000 patient years. EMR revealed 14 additional patients with clinically important GI tumours including: advanced adenomas (n = 11), appendiceal goblet cell carcinoid (n = 1), appendiceal mucinous adenoma (n = 1) and metastatic ileocolonic carcinoid (n = 1). All positive patients including the incident carcinoma are alive at the time of review. Conclusions  Clinically presenting colorectal adenocarcinoma is rare in the 5 years following negative screening CTC, suggesting that current strategies, including non-reporting of diminutive lesions, are appropriate. Key Points  • CT colonography (CTC) screening is increasingly used to identify potential colorectal cancer. • Clinically presenting cancers are rare for 5 years following negative CTC screening. • The practice of setting a 6 mm polyp size threshold seems safe. • An interval of 5 years for routine CTC screening is appropriate.

• Content Type Journal Article
• Category Gastrointestinal
• Pages 1-7
• DOI 10.1007/s00330-011-2365-2
• Authors
  • David H. Kim, Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA
  • B. Dustin Pooler, Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA
  • Jennifer M. Weiss, Section of Gastroenterology, Department of Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
  • Perry J. Pickhardt, Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI 53792-3252, USA

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To evaluate intra- and interobserver reproducibility of shear wave elastography (SWE) for breast masses. Methods  For intraobserver reproducibility, each observer obtained three consecutive SWE images of 758 masses that were visible on ultrasound. 144 (19%) were malignant. Weighted kappa was used to assess the agreement of qualitative elastographic features; the reliability of quantitative measurements was assessed by intraclass correlation coefficients (ICC). For the interobserver reproducibility, a blinded observer reviewed images and agreement on features was determined. Results  Mean age was 50 years; mean mass size was 13 mm. Qualitatively, SWE images were at least reasonably similar for 666/758 (87.9%). Intraclass correlation for SWE diameter, area and perimeter was almost perfect (ICC ≥ 0.94). Intraobserver reliability for maximum and mean elasticity was almost perfect (ICC = 0.84 and 0.87) and was substantial for the ratio of mass-to-fat elasticity (ICC = 0.77). Interobserver agreement was moderate for SWE homogeneity (κ = 0.57), substantial for qualitative colour assessment of maximum elasticity (κ = 0.66), fair for SWE shape (κ = 0.40), fair for B-mode mass margins (κ = 0.38), and moderate for B-mode mass shape (κ = 0.58), orientation (κ = 0.53) and BI-RADS assessment (κ = 0.59). Conclusions  SWE is highly reproducible for assessing elastographic features of breast masses within and across observers. SWE interpretation is at least as consistent as that of BI-RADS ultrasound B-mode features. Key Points  • Shear wave ultrasound elastography can measure the stiffness of breast tissue • It provides a qualitatively and quantitatively interpretable colour-coded map of tissue stiffness • Intraobserver reproducibility of SWE is almost perfect while intraobserver reproducibility of SWE proved to be moderate to substantial • The most reproducible SWE features between observers were SWE image homogeneity and maximum elasticity

• Content Type Journal Article
• Category Breast
• Pages 1-10
• DOI 10.1007/s00330-011-2340-y
• Authors
  • David O. Cosgrove, Imperial College, Hammersmith Campus, London, UK
  • Wendie A. Berg, Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
  • Caroline J Doré, MRC Clinical Trials Unit, London, UK
  • Danny M. Skyba, SuperSonic Imagine, Aix en Provence, France
  • Jean-Pierre Henry, SuperSonic Imagine, Aix en Provence, France
  • Joel Gay, SuperSonic Imagine, Aix en Provence, France
  • Claude Cohen-Bacrie, SuperSonic Imagine, Aix en Provence, France
  • the BE1 Study Group

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objective  Our two-centre prospective study evaluates the usefulness of 64-slice coronary computed tomography (CCT) to rule out significant coronary artery stenosis in patients admitted in emergency departments (ED) for acute coronary syndromes (ACS) with low-to-intermediate risk score. Methods  Patients (175) admitted for acute chest pain (ACP), unmodified electrocardiogram and first troponin measurement within normal ranges were included. A second troponin measurement and a 64-slice CCT within 24 h were performed. Major adverse cardiac events (MACE) were recorded during follow-up (6 months ± 2). Results  64-slice CCT was either normal or showed non-significant coronary stenosis in the majority of patients (78%). 64-slice CCT depicted significant stenosis (>50% diameter) in 22% of patient whereas initial clinical and biological evaluation was reassuring. For negative CCTs, elevated troponin at second measurement did not modify the strategy or treatment of patients. No MACEs were noted during follow up. In 12% of patients CCT identified unsuspected non-coronary abnormalities. Conclusion  Our study confirms 64-slice CCT utility to rule out significant coronary artery stenosis in 8/10 patients admitted in ED with ACP or ACS with low-to-intermediate risk score. Early discharge with a negative 64-slice CCT is associated with very low risk of cardiac events at 6 months. Key Points  • 64-slice coronary computed tomography (CCT) offers a critical role in acute chest pain. • 64-slice CCT allows differentiation between significant and non-significant coronary artery stenosis. • Normal 64-slice CCT allows rapid discharge of patients with ACP. • 64-slice CCT helps make appropriate therapeutic decision in patients with ACP.

• Content Type Journal Article
• Category Cardiac
• Pages 1-9
• DOI 10.1007/s00330-011-2354-5
• Authors
  • Luc Christiaens, Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
  • Florent Duchat, Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
  • Mourad Boudiaf, Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
  • Jean-Pierre Tasu, Département de Radiologie, CHU de Poitiers, Poitiers, France
  • Yann Fargeaudou, Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
  • Olivier Ledref, Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
  • Philippe Soyer, Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France
  • Marc Sirol, Département d’imagerie Cardiovasculaire, Assistance Publique- Hôpitaux de Paris, Hôpital Lariboisière, Paris, France

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objective  It was the aim to analyse the impact of age, aortic arch geometry, and size on secondary flow patterns such as helix and vortex flow derived from flow-sensitive magnetic resonance imaging (4D PC-MRI). Methods  62 subjects (age range = 20–80 years) without circumscribed pathologies of the thoracic aorta (ascending aortic (AAo) diameter: 3.2 ± 0.6 cm [range 2.2–5.1]) were examined by 4D PC-MRI after IRB-approval and written informed consent. Blood flow visualisation based on streamlines and time-resolved 3D particle traces was performed. Aortic diameter, shape (gothic, crook-shaped, cubic), angle, and age were correlated with existence and extent of secondary flow patterns (helicity, vortices); statistical modelling was performed. Results  Helical flow was the typical pattern in standard crook-shaped aortic arches. With altered shapes and increasing age, helicity was less common. AAo diameter and age had the highest correlation (r = 0.69 and 0.68, respectively) with number of detected vortices. None of the other arch geometric or demographic variables (for all, P ≥ 0.177) improved statistical modelling. Conclusion  Substantially different secondary flow patterns can be observed in the normal thoracic aorta. Age and the AAo diameter were the parameters correlating best with presence and amount of vortices. Findings underline the importance of age- and geometry-matched control groups for haemodynamic studies. Key Points  • Secondary blood flow patterns (helices, vortices) are commonly observed in the aorta • Secondary flow patterns predominantly depend on patient age and aortic diameter • Geometric factors show a lesser impact on blood flow patterns than age and diameter • Future analyses of flow patterns should incorporate age- and diameter dependencies

• Content Type Journal Article
• Category Magnetic Resonance
• Pages 1-9
• DOI 10.1007/s00330-011-2353-6
• Authors
  • Alex Frydrychowicz, Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 40, 23538 Lübeck, Germany
  • Alexander Berger, Department of Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany
  • Alejandro Munoz del Rio, Departments of Radiology and Medical Physics, University of Wisconsin – Madison, Madison, WI, USA
  • Maximilian F. Russe, Department of Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany
  • Jelena Bock, Department of Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany
  • Andreas Harloff, Department of Neurology and Clinical Neurophysiology, University Hospital Freiburg, Freiburg, Germany
  • Michael Markl, Department of Radiology, Medical Physics, University Hospital Freiburg, Freiburg, Germany

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To examine the feasibility of perflubutane-based ultrasound for grading hepatic fibrosis. Methods  This prospective study included 202 subjects; main study (controls:33, F0–1:35, F2:26, F3:23, cirrhosis:29) and subsequent study (controls:16, F0–1:7, F2:20, F3:7, cirrhosis:6). Diagnostic abilities for assessing fibrosis grade were compared between contrast findings and FIB4 (age × AST/[platelet count × ALT0.5]). Results  High-power emission produced an intrahepatic band-like structure, and the three-layer appearance was less frequent and monolayer appearance was more frequent in cirrhosis than controls/chronic hepatitis (P < 0.0001). Intensity difference at 15-min phase showed most significant correlation with fibrosis grade (ρ = 0.79, P < 0.0001), and the best areas under the receiver operating characteristic curves are 0.88 for marked fibrosis, 0.95 for advanced fibrosis and 0.97 for cirrhosis, which were significantly higher than those of FIB4, 0.85 for marked fibrosis, 0.89 for advanced fibrosis and 0.90 for cirrhosis. Sensitivity, specificity and efficiency of the intensity difference were 88%, 72% and 81% for marked fibrosis, 85%, 91% and 89% for advanced fibrosis and 97%, 90% and 91% for cirrhosis, respectively. The subsequent study validated the main study results; significant correlation between the intensity difference and the fibrosis grade (ρ = 0.73–0.77, P < 0.0001). Conclusions  Perflubutane-based ultrasound accurately predicts the grade of hepatic fibrosis. Key Points   • The behaviour of intrahepatic microbubbles depends on the severity of hepatic fibrosis. • Layer enhancement pattern simply represents the degree of chronic liver disease. • Parenchymal intensity change due to high-power emission predicts the hepatic fibrosis grade.

• Content Type Journal Article
• Category Hepatobiliary-Pancreas
• Pages 1-8
• DOI 10.1007/s00330-011-2346-5
• Authors
  • Hiroyuki Ishibashi, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan
  • Hitoshi Maruyama, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan
  • Masanori Takahashi, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan
  • Taro Shimada, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan
  • Hidehiro Kamesaki, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan
  • Keiichi Fujiwara, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan
  • Fumio Imazeki, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan
  • Osamu Yokosuka, Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuou-ku, Chiba 260-8670, Japan

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To correlate the severity of lung neovascularity (Sheehan vessels) with the cause and haemodynamic severity of pulmonary arterial hypertension (PAH), pulmonary artery (PA) size and heart disease type in patients with PH associated with congenital heart diseases (PAH-CHD) and idiopathic PH (IPAH). Methods  We reviewed the HRCT and CT pulmonary angiography studies of 87 patients with PAH-CHD and 111 with IPAH; all had undergone right heart catheterisation. We evaluated the PA size and severity of neovascularity on CT. Results  Neovascularity, which was found in 72% of PAH-CHD (56% with Eisenmenger’s syndrome) and in 22% of IPAH patients, is significantly related to the severity of PH and all patients with severe neovascularity had intermediate or high PH. All PAH-CHD patients had a dilated PA with a greater risk of developing severe dilatation (diameter >5 cm). The neovascularity correlated with the PA size only in IPAH. Conclusions  Neovascularity even if not pathognomonic for PAH-CHD, is significantly more common in these patients, especially in Eisenmenger’s syndrome. It is often the first CT sign to indicate the severity of PH in PAH-CHD and IPAH. A neovascularity ≥5 on CT indicates a intermediate or high PH. Key Points  • Large retrospective studying specific lung disorders in patients with pulmonary arterial hypertension. • Neovascularity is often the first CT sign indicating the severity of pulmonary hypertension Alterations of lung parenchyma on CT in pulmonary hypertension are described • The first study to assess the severity of pulmonary hypertension by CT • If substantiated, CT might eventually replace some cardiac catheterisation for evaluating PH

• Content Type Journal Article
• Category Chest
• Pages 1-8
• DOI 10.1007/s00330-011-2347-4
• Authors
  • Cecilia Modolon, Department of Cardio-Thoracic-Vascular, Division of Cardio-Thoracic Radiology, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40100 Bologna, Italy
  • Domenico Attinà, Department of Cardio-Thoracic-Vascular, Division of Cardio-Thoracic Radiology, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40100 Bologna, Italy
  • Francesco Buia, Department of Cardio-Thoracic-Vascular, Division of Cardio-Thoracic Radiology, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40100 Bologna, Italy
  • Fiorella De Luca, Department of Cardio-Thoracic-Vascular, Division of Cardio-Thoracic Radiology, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40100 Bologna, Italy
  • Patrizia Fughelli, University of Bologna, Bologna, Italy
  • Maria Letizia Bacchi Reggiani, Institute of Cardiology, Policlinico S.Orsola-Malpighi, Bologna, Italy
  • Massimiliano Palazzini, Institute of Cardiology, Policlinico S.Orsola-Malpighi, Bologna, Italy
  • Alessandra Manes, Institute of Cardiology, Policlinico S.Orsola-Malpighi, Bologna, Italy
  • Enri Leci, Institute of Cardiology, Policlinico S.Orsola-Malpighi, Bologna, Italy
  • Nazzareno Galiè, Institute of Cardiology, Policlinico S.Orsola-Malpighi, Bologna, Italy
  • Maurizio Zompatori, Department of Cardio-Thoracic-Vascular, Division of Cardio-Thoracic Radiology, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40100 Bologna, Italy

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To evaluate whether magnetic resonance (MR) imaging features can predict the presence of occult invasion in cases of biopsy-proven pure ductal carcinoma in situ (DCIS). Methods  We retrospectively reviewed 92 biopsy-proven pure DCIS in 92 women who underwent MR imaging. The following MR imaging findings were compared between confirmed DCIS and invasive breast cancer (IBC): lesion size, type, morphological and kinetic assessments by ACR BI-RADS MRI, and findings of fat-suppressed T2-weighted (FS-T2W) imaging. Results  Sixty-eight of 92 (74%) were non-mass-like enhancements (NMLE) and 24 were mass lesions on MR imaging. Twenty-one of 68 (31%) NMLE and 13 of 24 (54%) mass lesions were confirmed as IBC. In NMLE lesions, large lesions (P = 0.007) and higher signal intensities (SI) on FS-T2W images (P = 0.032) were significantly associated with IBC. Lesion size remained a significant independent predictor of invasion in multivariate analysis (P = 0.032), and combined with FS-T2W SIs showed slightly higher observer performances (area under the curve, AUC, 0.71) than lesion size alone (AUC 0.68). There were no useful findings that enabled the differentiation of mass-type lesions. Conclusions  Breast MR imaging is potentially useful to predict the presence of occult invasion in biopsy-proven DCIS with NMLE. Key Points    •  MR mammography permits more precise lesion assessment including ductal carcinoma in situ •  A correct diagnosis of occult invasion before treatment is important for clinicians •  This study showed the potential of MR mammography to diagnose occult invasion •  Treatment and/or aggressive biopsy can be given with greater confidence •  MR mammography can lead to more appropriate management of patients

• Content Type Journal Article
• Category Breast
• Pages 1-10
• DOI 10.1007/s00330-011-2357-2
• Authors
  • Mariko Goto, Departments of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, 602-8566 Kyoto, Japan
  • Sachiko Yuen, Departments of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, 602-8566 Kyoto, Japan
  • Kentaro Akazawa, Departments of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, 602-8566 Kyoto, Japan
  • Kaori Nishida, Departments of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, 602-8566 Kyoto, Japan
  • Eiichi Konishi, Departments of Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
  • Mariko Kajihara, Departments of Radiology, Kyoto Breast Center Sawai Memorial Clinic, Kyoto, Japan
  • Nobuhiko Shinkura, Departments of Surgery, Kyoto Breast Center Sawai Memorial Clinic, Kyoto, Japan
  • Kei Yamada, Departments of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kawaramachi Hirokoji, Kamigyoku, 602-8566 Kyoto, Japan

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  Multidetector computed tomography (MDCT) has diagnostic value for the evaluation of prosthetic heart valve (PHV) dysfunction but it is hampered by artefacts. We hypothesised that image acquisition using prospective triggering instead of retrospective gating would reduce artefacts related to pulsating PHV. Methods  In a pulsatile in vitro model, a mono- and bileaflet PHV were imaged using 256 MDCT at 60, 75 and 90 beats per minute (BPM) with either retrospective gating (120 kV, 600 mAs, pitch 0.2, CTDIvol 39.8 mGy) or prospective triggering (120 kV, 200 mAs, CTDIvol 13.3 mGy). Two thresholds (>175 and <−45HU), derived from the density of surrounding structures, were used for quantification of hyper- and hypodense artefacts. Image noise and artefacts were compared between protocols. Results  Prospective triggering reduced hyperdense artefacts for both valves at every BPM (P = 0.001 all comparisons). Hypodense artefacts were reduced for the monoleaflet valve at 60 (P = 0.009), 75 (P = 0.016) and 90 BPM (P = 0.001), and for the bileaflet valves at 60 (P = 0.001), 90 (P = 0.001) but not at 75 BPM (P = 0.6). Prospective triggering reduced image noise at 60 (P = 0.001) and 75 (P < 0.03) but not at 90 BPM. Conclusions  Compared with retrospective gating, prospective triggering reduced most artefacts related to pulsating PHV in vitro. Key Points  • Computed tomographic images are often degraded by prosthetic heart valve-induced artefacts • Prospective triggering reduces prosthetic heart valve-induced artefacts in vitro • Artefact reduction at 90 beats per minute occurs without image noise reduction • Prospective triggering may improve CT image quality of moving hyperdense structures

• Content Type Journal Article
• Category Cardiac
• Pages 1-7
• DOI 10.1007/s00330-011-2358-1
• Authors
  • Petr Symersky, Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
  • Jesse Habets, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
  • Paul Westers, Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
  • Bas A. J. M. de Mol, Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
  • Mathias Prokop, Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
  • Ricardo P. J. Budde, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To evaluate the effect of hybrid iterative reconstruction on qualitative and quantitative parameters at 256-slice cardiac CT. Methods  Prospective cardiac CT images from 20 patients were analysed. Paired image sets were created using 3 reconstructions, i.e. filtered back projection (FBP) and moderate- and high-level iterative reconstructions. Quantitative parameters including CT-attenuation, noise, and contrast-to-noise ratio (CNR) were determined in both proximal- and distal coronary segments. Image quality was graded on a 4-point scale. Results  Coronary CT attenuation values were similar for FBP, moderate- and high-level iterative reconstruction at 293 ± 74-, 290 ± 75-, and 283 ± 78 Hounsfield units (HU), respectively. CNR was significantly higher with moderate- and high-level iterative reconstructions (10.9 ± 3.5 and 18.4 ± 6.2, respectively) than FBP (8.2 ± 2.5) as was the visual grading of proximal vessels. Visualisation of distal vessels was better with high-level iterative reconstruction than FBP. The mean number of assessable segments among 289 segments was 245, 260, and 267 for FBP, moderate- and high-level iterative reconstruction, respectively; the difference between FBP and high-level iterative reconstruction was significant. Interobserver agreement was significantly higher for moderate- and high-level iterative reconstruction than FBP. Conclusions  Cardiac CT using hybrid iterative reconstruction yields higher CNR and better image quality than FBP. Key Points  • Cardiac CT helps clinicians to assess patients with coronary artery disease • Hybrid iterative reconstruction provides improved cardiac CT image quality • Hybrid iterative reconstruction improves the number of assessable coronary segments • Hybrid iterative reconstruction improves interobserver agreement on cardiac CT

• Content Type Journal Article
• Category Cardiac
• Pages 1-8
• DOI 10.1007/s00330-011-2361-6
• Authors
  • Daisuke Utsunomiya, Department of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, 110 Irving Street, Washington DC, NW 20010, USA
  • Wm. Guy Weigold, Department of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, 110 Irving Street, Washington DC, NW 20010, USA
  • Gaby Weissman, Department of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, 110 Irving Street, Washington DC, NW 20010, USA
  • Allen J. Taylor, Department of Cardiology, Cardiovascular Research Institute, Washington Hospital Center, 110 Irving Street, Washington DC, NW 20010, USA

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  Surrogate measures of screening performance [e.g. interval cancer (IC) proportional incidence] allow timely monitoring of sensitivity and quality. This study explored measures using large (T2+) breast cancers as potential indicators of screening performance. Methods  The proportional incidence of T2+ cancers (observed/expected cases) in a population-based screening programme (Trento, 2001–2009) was estimated. A parallel review of ‘negative’ preceding mammograms for screen-detected T2+ and for all ICs, using ‘blinded’ independent readings and case-mixes (54 T2+, 50 ICs, 170 controls) was also performed. Results  T2+ cancers were observed in 168 screening participants: 48 at first screen, 67 at repeat screening and 53 ICs. The T2+ estimated proportional incidence was 68% (observed/expected = 168/247), corresponding to an estimated 32% reduction in the rate of T2+ cancers in screening participants relative to that expected without screening. Majority review classified 27.8% (15/54) of T2+ and 28% (14/50) of ICs as screening error (P = 0.84), with variable recall rates amongst radiologists (8.8–15.2%). Conclusions  T2+ review could be integrated as part of quality monitoring and potentially prove more feasible than IC review for some screening services. Key Points  • Interval breast cancers, assumed as screening failures, are monitored to estimate screening performance • Large (T2+) cancers at screening may also represent failed prior screening detection • Analysis of T2+ lesions may be more feasible than assessing interval cancers • Analysis of T2+ cancers is a potential further measure of screening performance

• Content Type Journal Article
• Category Breast
• Pages 1-5
• DOI 10.1007/s00330-011-2355-4
• Authors
  • S. Ciatto, U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy
  • D. Bernardi, U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy
  • M. Pellegrini, U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy
  • G. Borsato, U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy
  • P. Peterlongo, U.O. Senologia Clinica e Screening Mammografico, Dipartimento di Radiodiagnostica, APSS, Trento, Italy
  • M. A. Gentilini, Servizio Osservatorio Epidemiologico, Direzione promozione ed educazione alla salute, APSS, Trento, Italy
  • F. Caumo, Centro di Prevenzione Senologica, P.O. Marzana, ULSS 20, Verona, Italy
  • A. Frigerio, CRR, Centro di Riferimento Regionale per lo Screening Mammografico, Torino, Italy
  • N. Houssami, Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To evaluate shear wave elastography (SWE) for focal lesions in major salivary glands. Methods  Sixty lesions (49 parotid, 11 submandibular) undergoing routine ultrasound (grey scale and Doppler) also underwent SWE before US-guided needle aspiration for cytology. Quantitative indices of the shear elastic modulus (stiffness) were compared with cytological results. Results  Fifty-five lesions were benign (21 pleomorphic adenomas, 18 Warthin’s tumours; 16 others) and 5 malignant (2 mucoepidermoid carcinomas, 1 myoepithelial carcinoma, 1 B-cell lymphoma, 1 nodal metastasis). Shear modulus of benign lesions, median 18.3 kPa, overlapped appreciably with malignant lesions, median 13.5 kPa. However, 2 mucoepidermoid carcinomas had the highest stiffness values (81.9 kPa, 132.0 kPa). Stiffness of pleomorphic adenomas (median 22.5 kPa) was higher than Warthin’s tumours (16.9 kPa) (P = 0.05 Mann–Whitney U-test). The standard deviation of stiffness values within a lesion, used as an indicator of spatial heterogeneity, was highest in mucoepidermoid cancers (median 44.2 kPa), followed by pleomorphic adenomas (median 12.4 kPa) and remaining lesions (medians 1.4–10.3 kPa). Conclusion  This study shows a degree of clustering of SWE indices according to pathology although it appears that SWE has suboptimal performance for ruling out malignancy, thus limiting its use in routine practice. Key Points  • Shear wave elastography is a feasible technique for focal salivary gland lesions. • Elastographic artefacts aggravated by the regional anatomy may hinder this technique. • Elastographic indices vary according to pathology but there is appreciable overlap. • Overlapping indices for malignant and benign lesions limit its utility. • Pleomorphic adenomas have higher elasticity indices, i.e. are stiffer, than Warthin’s tumours.

• Content Type Journal Article
• Category Head and Neck
• Pages 1-9
• DOI 10.1007/s00330-011-2364-3
• Authors
  • Kunwar S. S. Bhatia, Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
  • Carmen C. M. Cho, Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
  • Cina S. L. Tong, Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
  • Yolanda Y. P. Lee, Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
  • Edmund H. Y. Yuen, Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
  • Anil T. Ahuja, Department of Imaging & Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong SAR

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To identify CT features that discriminate individuals with and without acute appendicitis in patients with equivocal CT findings, and to assess whether knowledge of these findings improves diagnostic accuracy. Methods  53 patients that underwent appendectomy with an indeterminate preoperative CT interpretation were selected and allocated to an acute appendicitis group or a non-appendicitis group. The 53 CT examinations were reviewed by two radiologists in consensus to identify CT findings that could aid in the discrimination of those with and without appendicitis. In addition, two additional radiologists were then requested to evaluate independently the 53 CT examinations using a 4-point scale, both before and after being informed of the potentially discriminating criteria. Results  CT findings found to be significantly different in the two groups were; the presence of appendiceal wall enhancement, intraluminal air in appendix, a coexistent inflammatory lesion, and appendiceal wall thickening (P < 0.05). Areas under the curves of reviewers 1 and 2 significantly increased from 0.516 and 0.706 to 0.677 and 0.841, respectively, when reviewers were told which CT variables were significant (P = 0.0193 and P = 0.0397, respectively). Conclusions  Knowledge of the identified CT findings was found to improve diagnostic accuracy for acute appendicitis in patients with equivocal CT findings. Key Points   • Numerous patients with clinically equivocal appendicitis do not have acute appendicitis • Computed tomography (CT) helps to reduce the negative appendectomy rate • CT is not always infallible and may also demonstrate indeterminate findings • However knowledge of significant CT variables can further reduce negative appendectomy rate • An equivocal CT interpretation of appendicitis should be reassessed with this knowledge

• Content Type Journal Article
• Category Gastrointestinal
• Pages 1-8
• DOI 10.1007/s00330-011-2362-5
• Authors
  • Hyun Cheol Kim, Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727 Republic of Korea
  • Dal Mo Yang, Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727 Republic of Korea
  • Sang Won Kim, Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul, 134-727 Republic of Korea
  • Seong Jin Park, Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, 130-702 Republic of Korea

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  Patients with prosthetic heart valves may require assessment for coronary artery disease. We assessed whether valve artefacts hamper coronary artery assessment by multidetector CT. Methods  ECG-gated or -triggered CT angiograms were selected from our PACS archive based on the presence of prosthetic heart valves. The best systolic and diastolic axial reconstructions were selected for coronary assessment. Each present coronary segment was scored for the presence of valve-related artefacts prohibiting coronary artery assessment. Scoring was performed in consensus by two observers. Results  Eighty-two CT angiograms were performed on a 64-slice (n = 27) or 256-slice (n = 55) multidetector CT. Eighty-nine valves and five annuloplasty rings were present. Forty-three out of 1160 (3.7%) present coronary artery segments were non-diagnostic due to valve artefacts (14/82 patients). Valve artefacts were located in right coronary artery (15/43; 35%), left anterior descending artery (2/43; 5%), circumflex artery (14/43; 32%) and marginal obtuse (12/43; 28%) segments. All cobalt-chrome containing valves caused artefacts prohibiting coronary assessment. Biological and titanium-containing valves did not cause artefacts except for three specific valve types. Conclusions  Most commonly implanted prosthetic heart valves do not hamper coronary assessment on multidetector CT. Cobalt-chrome containing prosthetic heart valves preclude complete coronary artery assessment because of severe valve artefacts. Key Points   • Most commonly implanted prosthetic heart valves do not hamper coronary artery assessment • Prosthetic heart valve composition determines the occurrence of prosthetic heart valve-related artefacts • Björk–Shiley and Sorin tilting disc valves preclude diagnostic coronary artery segment assessment

• Content Type Journal Article
• Category Cardiac
• Pages 1-9
• DOI 10.1007/s00330-011-2360-7
• Authors
  • Jesse Habets, Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
  • Renee B. A. van den Brink, Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
  • Ruben Uijlings, Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
  • Anje M. Spijkerboer, Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
  • Willem P. Th. M. Mali, Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132, PO BOX 85500, 3508 GA, Utrecht, The Netherlands
  • Steven A. J. Chamuleau, Department of Cardiology, University Medical Center, Utrecht, The Netherlands
  • Ricardo P. J. Budde, Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, E01.132, PO BOX 85500, 3508 GA, Utrecht, The Netherlands

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994

Abstract Objectives  To differentiate acute from chronic damage to the myocardium in patients with myocardial infarction (MI) using DE and T2w MR. Methods  Short-axis T2w and DE MR images were acquired twice after the onset of MI in 36 patients who successfully underwent emergency coronary revascularisation. The areas of infarct and oedema were measured. The oedema-infarct ratio (O/I) of the left ventricular area was calculated by dividing the oedema by the infarct area. Results  The oedema size on T2w MR was significantly larger than the infarct size on DE MR in the acute phase. Both the oedema size on T2w MR and the infarct size on DE MR in the acute phase were significantly larger than those in the chronic phase. The O/I was significantly greater in the acute phase compared with that in the chronic phase (P < 0.05). An analysis of relative cumulative frequency distributions revealed an O/I of 1.4 as a cut-off value for differentiating acute from chronic myocardial damage with the sensitivity, specificity, and accuracy of 85.1%, 82.7% and 83.9%, respectively. Conclusion  The oedema-infarct ratio may be a useful index in differentiating acute from chronic myocardial damage in patients with MI. Key Points • MR can differentiate reversible from irreversible myocardial damage after myocardial infarction. • MR is a useful modality to noninvasively differentiate the infarct stages. • The O/I is an important index to decide therapeutic strategies.

• Content Type Journal Article
• Category Cardiac
• Pages 1-7
• DOI 10.1007/s00330-011-2327-8
• Authors
  • Kiyoyasu Yamada, Department of Cardiology, Gifu Social Insurance Hospital, 1221-5, Dota, Kani, Gifu, 509-0206 Japan
  • Satoshi Isobe, Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Susumu Suzuki, Department of Cardiology, Gifu Social Insurance Hospital, 1221-5, Dota, Kani, Gifu, 509-0206 Japan
  • Kousuke Kinoshita, Department of Cardiology, Gifu Social Insurance Hospital, 1221-5, Dota, Kani, Gifu, 509-0206 Japan
  • Kazuhiko Yokouchi, Department of Cardiology, Gifu Social Insurance Hospital, 1221-5, Dota, Kani, Gifu, 509-0206 Japan
  • Hirokazu Iwata, Department of Cardiology, Gifu Social Insurance Hospital, 1221-5, Dota, Kani, Gifu, 509-0206 Japan
  • Satoru Ohshima, Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
  • Makoto Hirai, Department of Nursing, Nagoya University School of Health Sciences, Nagoya, Japan
  • Ken Sawada, Department of Cardiology, Gifu Social Insurance Hospital, 1221-5, Dota, Kani, Gifu, 509-0206 Japan
  • Toyoaki Murohara, Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan

• Journal European Radiology
• Online ISSN 1432-1084
• Print ISSN 0938-7994