The term edema-like marrow signal intensity (ELMSI) represents a general term describing an area of abnormal signal intensity at MRI. Its appearance includes absence of clear margins and the ...possibility of exceeding well-defined anatomical borders (for example, physeal scars). We can define “ELMSI with unknown cause” an entity where the characteristic MR appearance is associated with the absence of specific signs of an underlying condition. However, it is more often an important finding indicating the presence of an underlying disease, and we describe this case as “ELMSI with known cause.” It presents a dynamic behavior and its evolution can largely vary. It initially corresponds to an acute inflammatory response with edema, before being variably replaced by more permanent marrow remodeling changes such as fibrosis or myxomatous connective tissue that can occur over time. It is important to study ELMSI variations over time in order to evaluate the activity state and therapeutic response of an inflammatory chronic joint disease, the resolution of a trauma, and the severity of an osteoarthritis. We propose a narrative review of the literature dealing with various subjects about this challenging topic that is imaging, temporal evolution, etiology, differential diagnoses, and possible organization, together with a pictorial essay.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
challenges of advanced hepatocellular carcinoma Colagrande, Stefano; Inghilesi, Andrea L; Aburas, Sami ...
World journal of gastroenterology : WJG,
09/2016, Volume:
22, Issue:
34
Journal Article
Open access
Hepatocellular carcinoma(HCC) is an aggressive malignancy,resulting as the third cause of death by cancer each year. The management of patients with HCC is complex,as both the tumour stage and any ...underlying liver disease must be considered conjointly. Although surveillance by imaging,clinical and biochemical parameters is routinely performed,a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice,several phase Ⅲ clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Locoregional therapies have also been tested as first line treatment,but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally,robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials.
Magnetic resonance imaging (MRI) is particularly attractive for clinical application in perfusion imaging thanks to the absence of ionizing radiation and limited volumes of contrast agent (CA) ...necessary. Dynamic contrast-enhanced MRI (DCE–MRI) involves sequentially acquiring T
1
-weighted images through an organ of interest during the passage of a bolus administration of CA. It is a particularly flexible approach to perfusion imaging as the signal intensity time course allows not only rapid qualitative assessment, but also quantitative measures of intrinsic perfusion and permeability parameters. We examine aspects of the T
1
-weighted image series acquisition, CA administration, post-processing that constitute a DCE–MRI study in clinical practice, before considering some heuristics that may aid in interpreting the resulting contrast enhancement time series. While qualitative DCE–MRI has a well-established role in the diagnostic assessment of a range of tumours, and a central role in MR mammography, clinical use of quantitative DCE–MRI remains limited outside of clinical trials. The recent publication of proposals for standardized acquisition and analysis protocols for DCE–MRI by the Quantitative Imaging Biomarker Alliance may be an opportunity to consolidate and advance clinical practice.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Whole-body magnetic resonance imaging (WB-MRI) is currently recommended for cancer screening in adult and paediatric subjects with cancer predisposition syndromes, representing a substantial aid for ...prolonging health and survival of these subjects with a high oncological risk. Additionally, the number of studies exploring the use of WB-MRI for cancer screening in asymptomatic subjects from the general population is growing. The primary aim of this review was to analyse the acquisition protocols found in the literature, in order to identify common sequences across published studies and to discuss the need of additional ones for specific populations. The secondary aim of this review was to provide a synthesis of current recommendations regarding the use of WB-MRI for cancer screening.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
This study aimed to evaluate the diagnostic accuracy of panoramic radiography (PAN) for the detection of clinically/surgically confirmed apical periodontitis (AP) in root canal–treated teeth using ...cone-beam computed tomographic (CBCT) imaging as the reference standard.
Two hundred forty patients with endodontically treated AP (diseased group) were detected via CBCT imaging using the periapical index system. They were divided into groups of 20 each according to lesion size (2–4.5 mm and 4.6–7 mm) and anatomic area (incisor, canine/premolar, and molar) in both the upper and lower arches. Another 240 patients with root filling and a healthy periapex (healthy group) were selected. All diseased and healthy patients underwent PAN first and a CBCT scan within 40 days. The periapical index system was also used to assess AP using PAN. Sensitivity, specificity, diagnostic accuracy, positive predictive value, and negative predictive value for PAN images with respect to CBCT imaging were analyzed. The k value was calculated to assess both the interobserver reliability for PAN and the agreement between PAN and CBCT.
PAN showed low sensitivity (48.8), mediocre negative predictive value (64.7), good diagnostic accuracy (71.3), and high positive predictive value (88.6) and specificity (93.8). Both interobserver reliability for PAN and agreement between PAN and CBCT were moderate (k = 0.58 and 0.42, respectively). The best identified AP was located in the lower canine/premolar and molar areas, whereas the worst identified AP was located in the upper/lower incisor area and upper molar area.
PAN showed good diagnostic accuracy, high specificity, and low sensitivity for the detection of endodontically treated AP.
Objectives
To evaluate the association of magnetic resonance diffusion-weighted imaging (DwI) and dynamic contrast-enhanced perfusion-weighted imaging (DCE-PwI) with a temporal resolution of 5 s, ...wash-in < 120 s, and wash-out ratio > 30% in the evaluation of salivary glands neoplasms.
Methods
DwI and DCE-PwI of 92 salivary glands neoplasms were assessed. The apparent diffusion coefficient (ADC) was calculated by drawing three regions of interest with an average area of 0.30–0.40 cm
2
on three contiguous axial sections. The time/intensity curve was generated from DCE-PwI images by drawing a region of interest that included at least 50% of the largest lesion section. Vessels, calcifications, and necrotic/haemorrhagic or cystic areas within solid components were excluded. The association of ADC ≥ 1.4 × 10
−3
mm
2
/s with type A curves (progressive wash-in) and ADC 0.9–1.4 × 10
−3
mm
2
/s with type C curves (rapid wash-in/slow wash-out) were tested as parameters of benignity and malignancy, respectively. Type B curve (rapid wash-in/rapid wash-out) was not used as a reference parameter.
Results
ADC ≥ 1.4 × 10
−3
mm
2
/s and type A curves were observed only in benign neoplasms. ADC of 0.9–1.4 × 10
−3
mm
2
/s and type C curves association showed specificity of 94.9% and positive predictive value of 81.8% for epithelial malignancies. The association of ADC < 0.9 × 10
−3
mm
2
/s with type B and C curves showed diagnostic accuracy of 94.6% and 100% for Warthin tumour and lymphoma, respectively.
Conclusions
ADC ≥ 1.4 × 10
−3
mm
2
/s and type A curves association was indicative of benignity. Lymphomas exhibited ADC < 0.7 × 10
−3
mm
2
/s and type C curves. The association of ADC < 0.9 × 10
−3
mm
2
/s and type B and C curves had accuracy 94.6% and 88.5% for Warthin tumour and epithelial malignancies, respectively.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
•Overlaps of morphological findings, ADC, and types of time/intensity curve on MRI are found among different parotid lesions.•Texture analysis provides a quantitative assessment of tumor ...heterogeneity by adding precise structural information.•LZE and LRE represent the texture parameters that enable the differentiation between malignant and benign lesions.
Parotid lesions show overlaps of morphological findings, apparent diffusion coefficient (ADC) values and types of time/intensity curve. This research aimed to evaluate the role of diffusion weighted imaging texture analysis in differentiating between benign and malignant parotid lesions and in characterizing pleomorphic adenoma (PA), Warthin tumor (WT), epithelial malignancy (EM), and lymphoma (LY).
Texture analysis of 54 parotid lesions (19 PA, 14 WT, 14 EM, and 7 LY) was performed on ADC map images. An ANOVA test was used to estimate both the difference between benign and malignant lesions and the texture feature differences among PA, WT, EM, and LY. A P-value≤0.01 was considered to be statistically significant. A cut-off value defined by ROC curve analysis was found for each statistically significant texture parameter. The diagnostic accuracy was obtained for each texture parameter with AUC ≥ 0.5. The agreement between each texture parameter and histology was calculated using the Cohen's kappa coefficient.
The mean kappa values were 0.61, 0.34, 0.26, 0.17, and 0.48 for LY, EM, WT, PA, and benign vs. malignant lesions respectively. Long zone emphasis cut-off values >1.870 indicated EM with an accuracy of 81 % and values >2.630 revealed LY with an accuracy of 93 %. Long run emphasis values >1.050 and >1.070 indicated EM and LY with a diagnostic accuracy of 79% and 93% respectively.
Long zone emphasis and long run emphasis texture parameters allowed the identification of LY and the differentiation between benign and malignant lesions. WT and PA were not accurately recognized.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
The mechanisms underlying airflow obstruction in COPD cannot be distinguished by standard spirometry. We ascertain whether mathematical modeling of airway biomechanical properties, as assessed from ...spirometry, could provide estimates of emphysema presence and severity, as quantified by computed tomography (CT) metrics and CT-based radiomics.
We quantified presence and severity of emphysema by standard CT metrics (VIDA) and co-registration analysis (ImbioLDA) of inspiratory-expiratory CT in 194 COPD patients who underwent pulmonary function testing. According to percentages of low attenuation area below - 950 Hounsfield Units (%LAA
) patients were classified as having no emphysema (NE) with %LAA
< 6, moderate emphysema (ME) with %LAA
≥ 6 and < 14, and severe emphysema (SE) with %LAA
≥ 14. We also obtained stratified clusters of emphysema CT features by an automated unsupervised radiomics approach (CALIPER). An emphysema severity index (ESI), derived from mathematical modeling of the maximum expiratory flow-volume curve descending limb, was compared with pulmonary function data and the three CT classifications of emphysema presence and severity as derived from CT metrics and radiomics.
ESI mean values and pulmonary function data differed significantly in the subgroups with different emphysema degree classified by VIDA, ImbioLDA and CALIPER (p < 0.001 by ANOVA). ESI differentiated NE from ME/SE CT-classified patients (sensitivity 0.80, specificity 0.85, AUC 0.86) and SE from ME CT-classified patients (sensitivity 0.82, specificity 0.87, AUC 0.88).
Presence and severity of emphysema in patients with COPD, as quantified by CT metrics and radiomics can be estimated by mathematical modeling of airway function as derived from standard spirometry.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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