Detection of myocarditis using T 1 and ECV mapping is not improved by early compared to late post‐contrast imaging

2019 ◽  
Vol 39 (6) ◽  
pp. 384-392
Author(s):  
Magnus Lundin ◽  
Peder Sörensson ◽  
Liya Vishnevskaya ◽  
Eva Maret ◽  
Peter Kellman ◽  
...  
Keyword(s):  
Contrast Imaging ◽  
Post Contrast

scholarly journals IMG-07. GADOLINIUM IS NOT NECESSARY FOR SURVEILLANCE MR IMAGING IN CHILDREN WITH CHIASMATIC-HYPOTHALAMIC LOW GRADE GLIOMA

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii356-iii356
Author(s):  
Fatema Malbari ◽  
Murali Chintagumpala ◽  
Jack Su ◽  
Mehmet Okcu ◽  
Frank Lin ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Three Dimensional ◽  
Low Grade Glioma ◽  
Cancer Center ◽  
Low Grade ◽  
Contrast Imaging ◽  
Post Contrast ◽  
Best Response ◽  
Dimensional Measurements ◽  
Initiation Of Therapy

Abstract BACKGROUND Patients with chiasmatic-hypothalamic low grade glioma (CHLGG) have frequent MRIs with gadolinium based contrast agents (GBCA) for disease monitoring. Cumulative gadolinium deposition in children is a potential concern. The purpose of this research is to establish whether MRI with GBCA is necessary for determining tumor progression in children with CHLGG. METHODS Children with progressive CHLGG were identified from Texas Children’s Cancer Center between 2005–2019. Pre- and post-contrast MRI sequences were separately reviewed by one neuroradiologist who was blinded to the clinical course. Three dimensional measurements and tumor characteristics were collected. Radiographic progression was defined as a 25% increase in size (product of two largest dimensions) compared to baseline or best response after initiation of therapy. RESULTS A total of 28 patients with progressive CHLGG including 683 MRIs with GBCA (mean 24 MRIs/patient; range: 10–43 MRIs) were reviewed. No patients had a diagnosis of NF1. Progression was observed 92 times, 91 (98.9%) on noncontrast and 90 (97.8%) on contrast imaging. Sixty-seven radiographic and/or clinical progressions necessitating management changes were identified in all (100%) noncontrast sequences and 66 (98.5%) contrast sequences. Tumor growth >2 mm in any dimension was identified in 184/187(98.4%) on noncontrast and 181/187(96.8%) with contrast imaging. Non primary metastatic disease was seen in seven patients (25%), which were better visualized on contrast imaging in 4 (57%). CONCLUSION MRI without GBCA effectively identifies patients with progressive disease. One should consider eliminating contrast in imaging of children with CHLGG with GBCA reserved for monitoring those with metastatic disease.

scholarly journals Efficacy of Three Dimensional Fast Imaging Employing Steady State Acquisition Combined with Conventional MRI in Evaluation of Patients with Cerebellopontine Angle Lesions

2021 ◽  
Author(s):  
Sasikumar Arya ◽  
Ealai Athmarao Parthasarathy ◽  
Rajamani Anand ◽  
Chakravarthy Anup ◽  
Kalaiarasan Ramya
Keyword(s):  
Steady State ◽  
Predictive Value ◽  
Cerebellopontine Angle ◽  
Screening Tool ◽  
Three Dimensional ◽  
Fast Imaging ◽  
Contrast Imaging ◽  
Post Contrast ◽  
Conventional Mri ◽  
Ear Symptoms

Introduction: The Three Dimensional Fast Imaging Employing Steady state Acquisition (3D FIESTA) has higher spatial resolution between the Cerebrospinal Fluid (CSF) and cranial nerves with accurate identification of Cerebellopontine Angle (CPA) and internal auditory canal tumours and takes shorter acquisition imaging time than conventional Magnetic Resonance Imaging (MRI) scan. Aim: To evaluate the efficacy of 3D FIESTA imaging as a screening tool for CPA lesions, hence to depict the fine anatomy of the cisternal and canalicular segments of the facial nerve and vestibulocochlear nerves in order to elucidate the aetiopathogenesis of unexplained inner ear symptoms. Materials and Methods: The present study was a hospital based cross-sectional study which was done in Department of Radiodiagnosis, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India. The study was conducted on 30 patients, who were referred for MRI Brain to the department and diagnosed with cerebellopontine angle lesion from August 2018 to October 2019. A 1.5 Tesla, MRI scanner was used to scan all patients with a 8 channel Neurovascular (NV) radiofrequency coil. Along with routine conventional MRI sequences, 3D FIESTA sequence was also performed. All the data was collected and analysed by Statistical Package for Social Sciences (SPSS) software version 23.0. Data for descriptive statistics i.e. frequency and percentage analysis, mean±Standard Deviation (SD), sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated. Results: On Histopathological Examination (HPE), 63.3% were schwannoma, 16.7% meningioma, 10% epidermoid cyst and 3.3% intracanalicular lipoma. In 6.7% of patients, imaging features were in favour of CPA arachnoid cyst. The size of the intracanalicular part of tumour was underestimated in T2 weighted images (T2WI). 3D FIESTA gave a better estimated tumour area, even though slightly less but almost equivalent to that in post-contrast imaging. In this study, post-contrast imaging was considered as the gold standard. It was proven that conventional sequences like T2WI showed a sensitivity of 85.71% and specificity of 100% whereas 3D FIESTA sequence showed 100% sensitivity and specificity in assessing the CPA tumour extent and cranial nerve involvement. Conclusion: 3D FIESTA imaging is a sensitive technique for the diagnosis of retrocochlear and CPA lesions without contrast administration. 3D FIESTA imaging can be considered as a useful screening tool for patients presenting with inner ear symptoms.

scholarly journals Renal cystic lesions characterization using spectral detector CT (SDCT): Added value of spectral results

2019 ◽  
Vol 92 (1100) ◽  
pp. 20180915 ◽  
Author(s):  
Rivka Kessner ◽  
Nils Große Hokamp ◽  
Les Ciancibello ◽  
Nikhil Ramaiya ◽  
Karin A. Herrmann
Keyword(s):  
Single Phase ◽  
Spectral Curve ◽  
Iodine Concentration ◽  
Added Value ◽  
Cystic Lesions ◽  
Contrast Imaging ◽  
Post Contrast ◽  
Spectral Detector Ct ◽  
Correlation Prior ◽  
Attenuation Values

Objectives: To evaluate the added value of spectral results derived from Spectral Detector CT (SDCT) to the characterization of renal cystic lesions (RCL). Methods: This retrospective study was approved by the local Institutional review board. 70 consecutive patients who underwent abdominopelvic SDCT and had at least one RCL were included. 84 RCL were categorized as simple, complex or neoplastic based on attenuation values on single-phase post-contrast images. Attenuation values were measured in each lesion on standard conventional CT images (stCI) and virtual monoenergetic images of 40keV and 100keV. A spectral curve slope was calculated and intra lesional iodine concentration (IC) was measured using iodine-density maps. Reference standard was established using histopathologic correlation, prior and follow-up imaging. Analysis of variance (ANOVA) was used to compare between the groups. Results: Mean attenuation values for benign simple and complex RCL differed significantly (42 ± 16 vs 8 ± 3 HU; p < 0.001). IC was almost identical in benign simple and complex RCL (0.23 ± 0.04 mg ml−1 vs 0.24 ± 0.04 mg ml−1), while IC in neoplastic RCL was significantly higher (2.10 ± 0.08 mg ml−1 ; p < 0.001). The mean spectral curve slope did not differ significantly between simple and complex RCL (0.30 ± 0.03 vs 0.33 ± 0.05) but was significantly higher in neoplastic RCL (2.60 ± 0.10; p < 0.001). Conclusions: Spectral results of SDCT are highly promising in distinguishing benign complex RCL from enhancing neoplastic RCL based on single-phase post-contrast imaging only. Advances in knowledge: SDCT can assist in differentiating between benign complex and neoplastic renal cystic lesions.

Imaging features of atypical adrenocortical adenomas: a radiological-pathological correlation

2021 ◽  
Author(s):  
Mary Louise Gargan ◽  
Eimear Lee ◽  
Maeve O'Sullivan ◽  
Marie Egan ◽  
James Gibney ◽  
...  
Keyword(s):  
Adrenal Adenoma ◽  
University Hospital ◽  
Imaging Features ◽  
Contrast Imaging ◽  
Cross Sectional ◽  
Post Contrast ◽  
Case Examples ◽  
Radiological Features ◽  
Pathological Correlation ◽  
Adrenocortical Adenomas

Objective: Adrenal adenomas are frequently picked up incidentally on cross-sectional imaging and are known to have a classic imaging appearance on CT and MRI. However, not all adrenal adenomas have this typical radiologic appearance. Our aim is to present the radiological features of atypical adrenocortical adenomas with pathological correlation. Methods: All the imaging from the pathologically proven adrenal adenoma cases in our hospital (Tallaght University Hospital, Dublin, Ireland) database (from 2004 to 2019) was reviewed. 8 out of 48 cases (16%) had an atypical radiological appearance and were selected for presentation. Results: Eight cases demonstrated atypical radiological features including heterogeneous density, incomplete washout on post-contrast imaging, the presence of macroscopic fat and calcification. Lipomatous metaplasia was present in two of the cases pathologically. Conclusion: Adrenocortical adenomas are the most common adrenal mass encountered on CT, however, may not always have classic imaging features. Radiologists should be familiar with both the typical and atypical imaging manifestations of these benign adrenal lesions. Advances in knowledge: This paper comprehensively describes the atypical features of adrenocortical adenomas with case examples and radiologic–pathologic correlation. Guidelines and an approach to the work-up of adrenal lesions with atypical appearances are also provided.

scholarly journals SUN-160 Development of Adrenocortical Carcinoma in an Adrenal Nodule After Nine Years of Size Stability on Imaging: A Case for Critical Review of Efficacy of Radiographic Size Criteria

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Matthew Tam ◽  
Sona Sharma
Keyword(s):  
Adrenocortical Carcinoma ◽  
Adrenal Mass ◽  
American Woman ◽  
Reference Ranges ◽  
Contrast Imaging ◽  
Post Contrast ◽  
Blood Profile ◽  
Free Cortisol ◽  
Size Stability ◽  
Adrenal Nodule

Abstract BACKGROUND: Current consensus guidelines for adrenal incidentalomas smaller than 4 cm recommend re-evaluation up to 2 years. Although there is no consensus for imaging surveillance beyond 2 years, in general, stability in size over time is considered a sign of benign nature. Clinical Case: A 50-year-old African-American woman presented to Endocrinology for resistant hypertension since age 30 and an enlarging right adrenal nodule. She was obese, weighing 138.8 kg with a BMI of 55.97 kg/m2, without clinical Cushingoid features. At her first visit she was taking the following antihypertensives: amlodipine, losartan, hydrochlorothiazide, and clonidine patch. She took no other prescription medications. Her baseline metabolic blood profile was normal. Further testing revealed a profile consistent with possible primary hyperaldosteronism and subclinical Cushing’s syndrome: plasma aldosterone 17 ng/dl, plasma renin activity 0.232 ng/ml/hour, ACTH 10 pg/ml, AM cortisol 8.3 mcg/dl, DHEAS 30 mcg/dl, and 1mg dexamethasone suppression test resulted in cortisol of 7.6 mcg/dl (normal &lt; 1.8 mcg /dl) with a simultaneous dexamethasone level of 357 ng/dl (140 – 295 ng/dl). However, 24-hour urinary free cortisol and urinary metanephrines were within reference ranges. Further confirmatory tests were not performed due to her imaging findings, as described below. The earliest abdominal imaging was a CT abdomen with contrast in 2005 which measured a 2.1 cm right adrenal mass. For various reasons she had repeat CT contrast imaging in 2006, 2007, 2012, and 2014 demonstrating no changes in the dimensions of her adrenal nodule, noting all the studies were performed with contrast only and without Hounsfield unit (HU) measurements. In 2017, a CT abdomen with adrenal protocol demonstrated a right adrenal mass measuring 4 cm x 3.5 cm (increased from 2.1 X 1.2 cm in 2014), characterized by 43 HU pre-contrast, 71 HU post-contrast, and an absolute washout of 29%. Due to high suspicion for malignancy, a PET-CT was performed with FDG, which revealed high uptake in the right adrenal mass. She was referred for a right adrenalectomy and pathology showed adrenocortical carcinoma with some infiltration into adipose tissue. There was a high mitotic index (42 per 50 high powered fields) and Ki67 of 35%, classified as Stage III pT3NxM0. She was referred to oncology and treated with external radiation to the adrenal bed along with initiation of mitotane. Conclusion: This case infers that long-term size stability of an adrenal nodule does not confer full confidence of a benign process. Compared with previous reports in the literature describing long latencies for ACC, this is one of the longest records of size stability over 9 years followed by a size increase 3 years later.

scholarly journals Idiopathic fourth ventricular outlet obstruction misdiagnosed as normal pressure hydrocephalus: A cautionary case

2020 ◽  
Vol 11 ◽  
pp. 305
Author(s):  
Joshua A. Cuoco ◽  
Michael J. Benko ◽  
Brendan J. Klein ◽  
David C. Keyes ◽  
Biraj M. Patel ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Fourth Ventricle ◽  
Spin Echo ◽  
Outlet Obstruction ◽  
Normal Pressure ◽  
Ventricular System ◽  
Single Shot ◽  
Contrast Imaging ◽  
Post Contrast ◽  
Obstructive Lesion

Background: Fourth ventricular outlet obstruction is an infrequent but well-established cause of tetraventricular hydrocephalus characterized by marked dilatation of the ventricular system with ballooning of the foramina of Monro, Magendie, and Luschka. Multiple processes including inflammation, infection, hemorrhage, neoplasms, or congenital malformations are known to cause this pathological obstruction. However, true idiopathic fourth ventricular outlet obstruction is a rare phenomenon with only a limited number of cases reported in the literature. Case Description: A 61-year-old female presented with several months of unsteady gait, intermittent headaches, confusion, and episodes of urinary incontinence. Conventional magnetic resonance imaging demonstrated tetraventricular hydrocephalus without transependymal flow, but with ventral displacement of the brainstem and dorsal displacement of the cerebellum without an obvious obstructive lesion on pre- or post-contrast imaging prompting a diagnosis of normal pressure hydrocephalus. However, constructive interference in steady state (CISS) and half-Fourier acquisition single-shot turbo spin echo (HASTE) sequences followed by fluoroscopic dynamic cisternography suggested encystment of the fourth ventricle with thin margins of arachnoid membrane extending through the foramina of Luschka bilaterally into the pontocerebellar cistern. Operative intervention was pursued with resection of an identified arachnoid web. Postoperative imaging demonstrated marked reduction in the size of ventricular system, especially of the fourth ventricle. The patient’s symptomatology resolved a few days after the procedure. Conclusion: Here, we describe an idiopathic case initially misdiagnosed as normal pressure hydrocephalus. The present case emphasizes the necessity of CISS sequences and fluoroscopic dynamic cisternography for suspected cases of fourth ventricular outlet obstruction as these diagnostic tests may guide surgical management and lead to superior patient outcomes.

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