To prospectively compare magnetic resonance (MR) estimation of fetal weight (MR-EFW) performed at third trimester with ultrasound (US) estimation of fetal weight (US-EFW) and actual birth weight, and ...to evaluate factors influencing fetal growth rate near term.
US-EFW and MR-EFW were calculated at a median of 33.0 and 37.7 weeks of gestation in 37 fetuses and plotted on curve centiles to predict birth weights at 39.3 weeks of gestation. The median absolute relative errors for predicted US-EFW and MR-EFW were calculated. Regression analysis was used to investigate the effect of different variables on fetal growth rate at 35.2 weeks of gestation.
The relative error of actual birth weight as predicted by US at 33.0 weeks was significantly higher compared with MR (7.33 vs. 4.11%; p = 0.001). This was also the case for fetal weight predicted by US at 37.7 weeks as compared with MR (6.63 vs. 2.60%; p < 0.01). Fetal growth rate was significantly and independently positively associated with the mother's weight and with gestational age at estimation (p < 0.05 for both variables).
Fetal weight estimates predicted using MR at third trimester are better than those given by prenatal US. Fetal growth rate depends on fetal and maternal characteristics.
To evaluate the diagnostic value of washout for the discrimination between benign and malignant lesions in patients with Budd-Chiari syndrome (BCS).
This IRB-approved retrospective study included all ...patients admitted to our institution with a diagnosis of BCS and focal lesions on MR imaging (MRI) from 2000 to 2016. MRI images were reviewed by two radiologists blinded to the nature of the lesions. Patient and lesion characteristics were recorded, with a focus on washout on portal venous and/or delayed phases. Lesions were compared using Chi-2, Fisher, Student t or Mann-Whitney tests.
49 patients (mean 35±12 yo range 13-70, 34 women (69%) 34±12 yo 13-70; 15 men (31%) 38±11 yo 18-59) with 241 benign lesions and 12 hepatocellular carcinoma (HCC) were analyzed. Patients with HCC were significantly older (mean 44±16 vs. 33±9-yo, p =.005), with higher alpha-fetoprotein (AFP) levels (median 16 2-9000 vs. 3 2-25ng/mL, p =.007). Washout was depicted in 9/12 (75%) HCC, and 69/241 (29%) benign lesions (p<0.001). 52/143 (36%) lesions ≥1 cm with arterial hyperenhancement showed washout (nine HCC and 43 benign lesions). In this subgroup, the specificity of washout for the diagnosis of HCC was 67%. Adding T1-w hypointensity raised the specificity to 100%. A serum AFP >15ng/mL was associated with 95% specificity.
Washout was observed in close to 1/3 of benign lesions leading to an unacceptably low specificity for the diagnosis of HCC. The non-invasive diagnostic criteria proposed by the AASLD/EASL for cirrhotic patients cannot be extrapolated to patients with BCS. LAY SUMMARY: - Washout is depicted in a significant proportion of benign nodules in patients with Budd-Chiari syndrome, limiting its value for the differentiation between benign and malignant lesions. - Criteria proposed by both the AASLD and the EASL for the non-invasive diagnosis of HCC in patients with cirrhosis cannot be extrapolated to patients with BCS. - Ancillary imaging findings and patient characteristics including alpha-foetoprotein serum level can help modulate the probability of a nodule being HCC in patients with BCS.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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