[High field magnetic resonance background suppression diffusion imaging in the diagnosis of liver foci of space occupying lesion].
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To explore the diagnostic value of the 3.0T magnetic resonance liver diffusion weighted imaging with background suppression (DWIBS) in liver foci of space occupying lesion.A total of 43 cases of liver bureau stove perch pathological change were included: 15 were hepatocellular carcinoma (HCC) with 24 lesions; 7 were liver metastatic tumor with 13 lesions; 10 were liver hemangioma with 12 lesions; and 11 liver cyst with 20 lesions. After taking the conventional T1WI and T2WI sequence, the magnetic resonance background suppression diffusion imaging technology (diffusion weighted imaging with background suppression, DWIBS) was applied, following the dynamic enhanced scan. With the MRI to DWIBS workstation for classifying positron emission computed tomography (PET) processing, the T2WI diagram and dynamic enhanced diagram were compared respectively for the 3 sequences of lesion detection rate, T2WI, and DWIBS, to enhance the delay time between the two joint and combined lesion detection rate. With the MRI workstation software scanning image generation ADC diagram, the ADC values were measured for liver cancer, liver metastatic tumor, liver hemangioma and liver cysts.The 3 sequences of detection rates of the T2WI, DWIBS and enhanced delay period T1WI were 91.3%, 94.2%, and 95.6%. The detection rate of DWIBS plus T2WI was 92.7%; that of T2WI plus enhanced delay time was 94.9%, and that of DWIBS plus enhanced delay time was 96.3%, with the rate of DWIBS plus enhanced delay period obviously higher than that of the DWIBS plus T2WI (P<0.05). The ADC value of the benign liver tumor was obviously higher than that of the malignant tumors: hepatic cyst (2.614 ± 0.57)×10⁻³ mm²/s, liver hemangioma (2.055 ± 0.21)×10⁻³ mm²/s, metastatic carcinoma (1.374 ± 0.32)× 10⁻³ mm²/s, and liver cancer (1.287 ± 0.14)×10⁻³ mm²/s. Except for the liver cancer and the liver metastatic tumor, there was significant difference between the other groups (P<0.05).Combing the DWIBS technology, the PET-like images and the ADC value acquired, the combined enhanced sequences could further facilitate the demonstration of the liver foci of space occupying lesion, the accuracy of identification and diagnosis of the liver foci of space occupying lesion.Topics:
Four patients with cavernous hemangioma of face and neck were evaluated with magnetic resonance imaging. Pathologically, soft tissue cavernous hemangiomas are characterized by small feeding arteries and large blood poolings. Arteriography usually fails to demonstrate the extent of the lesion. Computed tomography does not allow differentiation between these lesions and surrounding normal tissues. Magnetic resonance clearly demonstrates hemangiomas with good contrast between lesion and normal tissues. Spin-echo technique with long echo time appears to be particularly useful to delineate these lesions.
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Imaging studies including magnetic resonance imaging (MRI) play a crucial role in the diagnosis and staging of hepatocellular carcinoma (HCC). Several recent studies reveal a large number of MRI features related to the prognosis of HCC. In this review, we discuss various MRI features of HCC and their implications for the diagnosis and prognosis as imaging biomarkers. As a whole, the favorable MRI findings of HCC are small size, encapsulation, intralesional fat, high apparent diffusion coefficient (ADC) value, and smooth margins or hyperintensity on the hepatobiliary phase of gadoxetic acid-enhanced MRI. Unfavorable findings include large size, multifocality, low ADC value, non-smooth margins or hypointensity on hepatobiliary phase images. MRI findings are potential imaging biomarkers in patients with HCC.
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Intrasellar cavernous hemangioma is an extremely rare lesion. It is usually confused with pituitary adenoma, both clinically and radiologically. It is important to differentiate intrasellar cavernous hemangioma from pituitary tumors because of the risk of severe hemorrhage during operation and the possible complications in the postoperative period. Magnetic resonance imaging characteristics of the lesion may be helpful in differential diagnosis. In this report, we present the magnetic resonance imaging findings of a cavernous hemangioma case, which is totally intrasellar located. J Med Cases. 2013;4(11):719-721 doi: https://doi.org/10.4021/jmc1485w
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Objective To evaluate the value of CT perfusion imaging (CTPI) in the diagnosis of hepatocellular carcinoma (HCC). Method CTPI was carried out on 21 patients with 26 lesions to obtain the following perfusion parameters: hepatic blood flow (HBF), hepatic blood volume (HBV),mean transit time (MTT), permeability surface area product (PS), and hepatic arterial fraction (HAF). The parameters from the lesion and non-lesion areas were compared. In addition, serum AFP was measured in the HCC patients and a linear correlation analysis between the alpha-fetoprotein (AFP) level and the CTPI parameters was performed. Result CTPI failed in 3 patients with 3 lesions and was successful in 18 patients with 23 lesions which included 18 HCC, 4 hemangioma of the liver,and 1 hepatic focal nodular hyperplasia (FNH). On comparison of the HCC parameters in the lesion and non-lesion areas, significant differences were found in the HAF which was 4.11 times higher in the lesion than the non-lesion areas, while the MTT and PS were significantly lower. There was no significant difference in the HBF and HBV. Correlation between the serum AFP level and the CTPI parameters of the HCC lesion was insignificant. The differences of all the parameters between the lesion and the non-lesion in hemangioma were similar to those in HCC, except for a higher HBF in the lesion than in HCC. There was no significant difference between the parameters of FNH and the non-nodular part of the liver. Conclusion CTPI played an important role in the diagnosis and differential diagnosis of HCC, especially when the AFP was negative and/or the imaging manifestation was atypical on contrast CT.
Key words:
CT perfusion imaging; Diagnosis; Hepatocellular carcinoma
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CONTEXT:The incidence of hepatic hemangiomas ranges from 0.4% to 20% in the general population. Conventional ultrasound is usually the first diagnostic method to identify these hemangiomas, typically as an incidental finding. Ultrasonography with second generation contrast materials is being used in various areas of hepatology, yielding similar results to those obtained with computerized tomography and magnetic resonance imaging in the diagnosis of hepatic hemangiomas. OBJECTIVE: To evaluate the agreement between ultrasound with perflutrene contrast and magnetic resonance imaging in the diagnosis of hepatic hemangiomas. METHODS: A total of 37 patients were prospectively examined between January 2006 and August 2008. A total of 57 hepatic nodules were documented in this group as incidental findings on routine ultrasound exams. The 37 patients were administered perflutrene contrast without adverse reactions, and were all submitted to magnetic resonance exams. RESULTS: Conventional ultrasound identified 15 patients with nodules typical of hemangiomas and 22 patients with other nodules. In 35 patients, the contrast characteristics were consistent with hepatic hemangiomas. CONCLUSION: Agreement between the data obtained from ultrasound with contrast and magnetic resonance was 94.5%. In discordant cases, the magnetic resonance diagnosis prevailed. In the case which presented indeterminate findings on contrast ultrasonography, magnetic resonance was repeated after 3 months, confirming the diagnosis of a hepatic hemangioma. A biopsy was performed on the suspected malignant nodule which also confirmed the presence of a hepatic hemangioma. Ultrasonography with contrast has the advantages of being more accessible to the public at large and lower cost than magnetic resonance. The results of our study highlight the need for a new protocol in hepatic nodules incidentally identified on conventional ultrasonography. In the case of typical hemangiomas, conventional ultrasound is sufficient for diagnosis. However, for poorly defined nodules, ultrasonography with contrast is indicated. After confirming the presence of a hepatic hemangioma on contrast ultrasonography, no further exams are needed to finalize the diagnosis.
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Objectives The purposes of this study were to evaluate the sonographic findings of recurrent hepatocellular carcinoma after transcatheter arterial chemoembolization and to determine how often the lesion conspicuity of the recurrent hepatocellular carcinoma makes it suitable for percutaneous sonographically guided radio frequency ablation. Methods A radiologist prospectively classified the echogenicity of recurrent hepatocellular carcinomas compared to that of the surrounding liver. In addition, the margin of the tumor was classified as follows: grade 1, absolutely indistinguishable; grade 2, less than 50%; grade 3, greater than 50%; and grade 4, clearly demarcated. The lesion conspicuity was also classified as follows: grade 1, absolutely invisible, thus ineligible for percutaneous sonographically guided radio frequency ablation; grade 2, poorly visible, thus unsuitable for ablation; and grade 3, visible and conspicuous, thus suitable for ablation. Results A total of 37 consecutive patients (31 men and 6 women; mean age, 59.4 years) with 38 hepatocellular carcinomas were enrolled. The echogenicity of the recurrent hepatocellular carcinomas varied, with the most common finding being a heterogeneous hypoechoic lesion (31.6%), followed by an isoechoic lesion (23.7%), a heterogeneous hyperechoic lesion (18.4%), a homogeneous hypoechoic lesion (13.2%), a lesion with a hypoechoic halo (10.5%), and a homogeneous hyperechoic lesion (2.7%). The margin of the recurrent hepatocellular carcinomas was clearly demarcated in only 28.9% of tumors, whereas 23.7% of the tumors were absolutely indistinguishable from the surrounding liver. The lesion conspicuity was classified as grade 3 in only 60.5% of the recurrent hepatocellular carcinomas. Conclusions The echogenicity and margins of recurrent hepatocellular carcinomas after transcatheter arterial chemoembolization varied. The lesion conspicuity was suitable for sonographically guided radio frequency ablation in only 60.5% of cases.
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This article reviews the epidemiology, pathology, and diagnosis of cavernous hemangioma of the liver. This lesion is very common; it is the most common benign tumor of the liver. While small hemangiomas (less than 3 cm) have a characteristic ultrasonographic appearance, lesions larger than 3 cm in diameter may have a whole host of ultrasonic findings and this technique becomes less reliable in making the diagnosis. Initial experience with dynamic CT has shown it to be reliable in differentiating hemangiomas from other lesions. Later, some metastatic lesions were described to mimic hemangiomas on CT. Furthermore, a diagnostic CT is hard to get in small lesions because of the difficulty in getting a small lesion in the scanning plane repeatedly. Blood pool scintigraphy with planar imaging has been shown to be very sensitive and specific for that lesion. This technique is not very reliable for small (less than 2 cm) or deeply seated lesions. We have shown that blood scintigraphy is more reliable for those situations. Recent reports have shown that MRI is highly reliable for the detection and characterization of liver hemangiomas. This technology is very expensive and is unlikely to be used in evaluating all patients suspected of having cavernous hemangiomas; it should be reserved for cases with uncharacteristic ultrasound or blood pool scan findings.
Cavernous hemangiomas
Liver Hemangioma
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Cavernous hemangioma is the most common intraorbital lesion in adults. The aim of our study was to evaluate the magnetic resonance imaging (MRI) and ultrasound (US) characteristics of cavernous hemangioma and their role in the differential diagnosis of orbital tumors. Eight patients with orbital cavernous hemangiomas, five women and three men with a mean age of 48 years were examined in a period of six years. All patients underwent MRI examination and four patients were also evaluated by US. In all cases MRI depicted a well-defined intraconal tumor. The lesions were homogeneous, isointense to muscle on T1-weighted sequence and hyperintense to muscle on T2-weighted sequence in six patients. In one patient the mass was isointense on T1WI with heterogeneous signal intensity on T2WI and in one patient the lesion had heterogeneous signal intensity on both T1- and T2-weighted sequences. After intravenous contrast medium administration, the tumors showed initial inhomogeneous enhancement with progressive accumulation of contrast material on delayed images in seven patients and initial homogeneous enhancement in one patient. On ultrasonography, the orbital masses appeared slightly hyperechoic, heterogeneous with small areas of slow blood flow. The analysis of imaging characteristics of a well-defined intraconal lesion in an adult patient with painless progressive proptosis can be highly suggestive of the diagnosis of cavernous hemangioma.
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