Rim Enhancement Pattern Research Articles

Development and validation of combined Ki67 status prediction model for intrahepatic cholangiocarcinoma based on clinicoradiological features and MRI radiomics

PurposeIncidence and mortality of intrahepatic cholangiocarcinoma (ICC) have been increasing over the past few decades, and Ki67 is an adverse prognostic predictor and an attractive therapeutic target for ICC patients. Thus, we aim to develop and validate a combined Ki67 prediction model for ICC patients.Materials and methodsPreoperative contrast-enhanced MR images were collected from 178 patients with postoperative pathologically confirmed ICC, and randomly divided into training and validation cohorts in a ratio of 7:3 (124:54). A time-independent test cohort of 49 ICC patients was used for validation. Independent clinicoradiological features of Ki67 status were determined by multivariate analysis. Optimal radiomics features were selected by least absolute shrinkage and selection operator logistic regression and linear discriminant analysis was used to construct combined models. The prediction efficacy of combined model was assessed by receiver operating characteristics curve, and verified by its calibration, decision and clinical impact curves.ResultsHBV (p = 0.022), arterial rim enhancement (p = 0.006) and enhancement pattern (p = 0.012) are independent clinicoradiological features. The radiomics model achieves good prediction efficacy in the training cohort (AUC = 0.860) and validation cohort (AUC = 0.843). The combined Ki67 prediction model incorporates clinicoradiological and radiomics features, and it yields desirable predictive efficiency in test cohort (AUC = 0.815). Decision curves and clinical impact curves further validate that the combined Ki67 prediction model can achieve net benefits in clinical work.ConclusionThe combined Ki67 model incorporating HBV, arterial rim enhancement, enhancement pattern and radiomics features is a potential biomarker in Ki67 prediction and stratification.

Usefulness of a Rim-Enhancing Pattern on the Contrast-Enhanced 3D-FLAIR Sequence and MRI Characteristics for Distinguishing Meningioma and Malignant Dural-Based Tumor.

Meningiomas are the most common type of extra-axial dural-based tumors; however, malignant dural-based tumors can mimic meningiomas on imaging. The aim of this study was to determine the efficacy of differentiating meningiomas from malignant dural-based tumors by using rim-enhancement patterns on a contrast-enhanced FLAIR sequence and MR imaging characteristics. This retrospective study included 102 patients with meningiomas and 31 patients with malignant dural-based tumors who underwent pretreatment MR imaging. The rim-enhancement patterns on contrast-enhanced FLAIR and MR imaging characteristics, including the dural tail sign, hyperostosis, bony destruction, leptomeningeal enhancement, peritumoral edema, T2-weighted signal intensity, and tumor enhancement were evaluated. Complete rim enhancement of the tumor-brain interface on contrast-enhanced FLAIR (contrast-enhanced-FLAIR rim sign) was present in most meningiomas (91/102, 89.2%) and at significantly greater frequency than in malignant dural-based tumors (2/31, 6.5%) (P < .001). Complete contrast-enhanced FLAIR rim enhancement provided high sensitivity (89.2%), specificity (93.5%), and accuracy (90.2%) for diagnosing meningioma. Additionally, hyperostosis was an MR imaging characteristic that suggested a diagnosis of meningioma. In contrast, bony destruction with cortical breakthrough and leptomeningeal enhancement suggested malignant dural-based tumors. There were limitations of meningiomas of <2.0 cm or at cavernous sinus locations that did not demonstrate contrast-enhanced FLAIR rim enhancement. The rim-enhancement pattern on contrast-enhanced FLAIR could help differentiate meningiomas and malignant dural-based tumors. The presence of complete rim enhancement on contrast-enhanced FLAIR was a robust predictive sign for meningioma.

Correlation between contrast-enhanced cone-beam breast computed tomography features and prognostic staging in breast cancer.

To evaluate whether contrast-enhanced cone-beam breast CT (CE-CBBCT) features can risk-stratify prognostic stage in breast cancer. Overall, 168 biopsy-proven breast cancer patients were analysed: 115 patients in the training set underwent scanning using v. 1.5 CE-CBBCT between August 2019 and December 2019, whereas 53 patients in the test set underwent scanning using v. 1.0 CE-CBBCT between May 2012 and August 2014. All patients were restaged according to the American Joint Committee on Cancer eighth edition prognostic staging system. Following the combination of CE-CBBCT imaging parameters and clinicopathological factors, predictors that were correlated with stratification of prognostic stage via logistic regression were analysed. Predictive performance was assessed according to the area under the receiver operating characteristic curve (AUC). Goodness-of-fit of the models was assessed using the Hosmer-Lemeshow test. As regards differentiation between prognostic stage (PS) I and II/III, increased tumour-to-breast volume ratio (TBR), rim enhancement pattern, and the presence of penetrating vessels were significant predictors for PS II/III disease (p < 0.05). The AUCs in the training and test sets were 0.967 [95% confidence interval (CI) 0.938-0.996; p < 0.001] and 0.896 (95% CI, 0.809-0.983; p = 0.001), respectively. Two features were selected in the training set of PS II vs III, including tumour volume [odds ratio (OR)=1.817, p = 0.019] and calcification (OR = 4.600, p = 0.040), achieving an AUC of 0.790 (95% CI, 0.636-0.944, p = 0.001). However, there was no significant difference in the test set of PS II vs III (P＞0.05). CE-CBBCT imaging biomarkers may provide a large amount of anatomical and radiobiological information for the pre-operative distinction of prognostic stage. CE-CBBCT features have distinctive promise for stratification of prognostic stage in breast cancer.

The Clinical Significance of the Hyperintense Acute Reperfusion Marker Sign in Subacute Infarction Patients

Purpose: The hyperintense acute reperfusion marker (HARM) is characterized by the delayed enhancement of the subarachnoid or subpial space observed on postcontrast fluid-attenuated inversion recovery (FLAIR) images, and is considered a cerebral reperfusion marker for various brain disorders, including infarction. In this study, we evaluated the cerebral distribution patterns of HARM for discriminating between an enhancing subacute infarction and an enhancing mass located in the cortex and subcortical white matter. Materials and methods: We analyzed consecutive patients who experienced a subacute ischemic stroke, were hospitalized, and underwent conventional brain magnetic resonance imaging including postcontrast FLAIR within 14 days from symptom onset, as well as those who had lesions corresponding to a clinical sign detected by diffusion-weighted imaging and postcontrast T1-weighted imaging between May 2019 and May 2021. A total of 199 patients were included in the study. Of them, 94 were finally included in the subacute infarction group. During the same period, 76 enhancing masses located in the cortex or subcortical white matter, which were subcategorized as metastasis, malignant glioma, and lymphoma, were analyzed. We analyzed the overall incidence of HARM in subacute ischemic stroke cases, and compared the enhancement patterns between cortical infarctions and cortical masses. Results: Among 94 patients with subacute stroke, 78 patients (83%) presented HARM, and among 76 patients with subcortical masses, 48 patients (63%) presented peripheral rim enhancement. Of 170 subcortical enhancing lesions, 88 (51.8%) showed HARM, and 78 (88.6%) were determined to be subacute infarction. Among 94 patients with subacute stroke, 48 patients (51%) had diffusion restrictions, and HARM was found in 39 patients (81.2%). Of the 46 patients (49%) without diffusion restriction, 39 patients (84.8%) showed HARM. Conclusions: The presence of HARM was significantly associated with subacute infarctions. For the masses, a peripheral rim enhancement pattern was observed around the mass rather than the cerebral sulci on postcontrast FLAIR.

Necrotizing infundibulo-hypophysitis: case-report and literature review

Purpose We describe a rare case of histopathologic-proven necrotizing infundibulo-hypophysitis (NIH). Clinical history A 40-year-old female presented with coexistence of central diabetes insipidus and hypopituitarism. Imaging disclosed a thickened infundibulum and a diffusely enlarged pituitary mass with gadolinium rim enhancement pattern. Microsurgical endonasal transsphenoidal resection was performed. The presence of extensive liquefactive necrosis, surrounded by lymphoplasmocytic inflammatory infiltrate, allowed for the diagnosis of NIH. Follow-up cranial imaging 10 months after surgery showed no evidence of reappearance of the lesion. There was no progression to panhypopituitarism. Conclusion Surgery and histopathological confirmation are the key diagnostic feature in NIH. The current case is the fifth report of NIH and the first one with an indolent course and without progression to panhypopituitarism so far.

A radiomics-based biomarker for cytokeratin 19 status of hepatocellular carcinoma with gadoxetic acid-enhanced MRI.

We aimed to develop a radiomics-based model derived from gadoxetic acid-enhanced MR images to preoperatively identify cytokeratin (CK) 19 status of hepatocellular carcinoma (HCC). A cohort of 227 patients with single HCC was classified into a training set (n = 159) and a time-independent validated set (n = 68). A total of 647 radiomic features were extracted from multi-sequence MR images. The least absolute shrinkage and selection operator regression and decision tree methods were utilized for feature selection and radiomics signature construction. A multivariable logistic regression model incorporating clinico-radiological features and the fusion radiomics signature was built for prediction of CK19 status by evaluating area under curve (AUC). In the whole cohort, 57 patients were CK19 positive and 170 patients were CK19 negative. By combining 11 and 6 radiomic features extracted in arterial phase and hepatobiliary phase images, respectively, a fusion radiomics signature achieved AUCs of 0.951 and 0.822 in training and validation datasets. The final combined model integrated a-fetoprotein levels, arterial rim enhancement pattern, irregular tumor margin, and the fusion radiomics signature, with a sensitivity of 0.818 and specificity of 0.974 in the training cohort and that of 0.769 and 0.818 in the validated cohort. The nomogram based on the combined model showed satisfactory prediction performance in training (C-index 0.959) and validation (C-index 0.846) dataset. The combined model based on a fusion radiomics signature derived from arterial and hepatobiliary phase images of gadoxetic acid-enhanced MRI can be a reliable biomarker for CK19 status of HCC. • Arterial rim enhancement pattern and irregular tumor margin on hepatobiliary phase on gadoxetic acid-enhanced MRI can be useful for evaluating CK19 status of HCC. • A radiomics-based model performed better than the clinico-radiological model both in training and validation datasets for predicting CK19 status of HCC. • The nomogram based on the fusion radiomics signature can be easily used for CK19 stratification of HCC.

The Relationship Between MRI Findings and Molecular Subtypes in Women With Breast Cancer

ObjectiveTo determine the preoperative MRI findings of patients with breast cancer according to molecular subtypes. Materials and MethodsMRI findings of women diagnosed with breast cancer in our department between January 2013 and June 2017 who had preoperative breast MRI examinations were evaluated and histopathological findings were recorded retrospectively. The findings were classified according to the BI-RADS MRI classification by three radiologists. Correlations of MRI findings with the molecular subtypes were evaluated using Chi-square and t-tests. ResultsAmong 234 lesions in a total of 224 cases diagnosed with breast cancer, subtypes of breast cancer as following: Luminal (162 cases, 69%), triple negative (39 cases, 17%) and HER2 positive (33 cases, 14%), respectively. Lesions of patients with luminal, triple negative and HER2 positive invasive ductal cancer were round or lobular in shape (9.9%, 42.9%, 20.7%), had high/very high intratumoral T2 signal intensity (24.8%, 54.2%, 31%) and rim enhancement pattern (9.2%, 51.4%, 24.1%), respectively. The difference between the triple negative cases and the other subtypes was statistically significant (p < 0.05). ConclusionOne of the most important factors that determine the prognosis and treatment in breast cancer is the molecular subtype of the tumor. Morphologic findings of MRI can be a useful tool for differentiating triple negative breast cancer from other subtypes.

A Radiomics-Based Biomarker for Cytokeratin 19 Status of Hepatocellular Carcinoma with Gadoxetic Acid-Enhanced MRI

Background: We aimed to develop and validate a radiomics-based model derived from gadoxetic acid-enhanced MR images to preoperatively identify cytokeratin (CK) 19 status of hepatocellular carcinoma (HCC). Methods: A cohort of 227 patients with single HCC was classified into a training set (n=159) and a time-independent validated set (n=68). A total of 647 radiomic features were extracted from multi-sequence MR images separately. The least absolute shrinkage and selection operator regression and decision tree methods were utilized for feature selection and radiomics signature construction. A further multivariable-based model was built for predicting CK19 status of HCC. Findings: By combining 11 and 6 radiomics features extracted in arterial phase and hepatobiliary phase images, respectively, a fusion radiomics signature achieved a satisfying performance for CK19 stratification. The final combined model integrated serum a-fetoprotein levels, arterial rim enhancement pattern, irregular tumor margin and the fusion radiomics signature, with a sensitivity of 0.818 and specificity of 0.974 in the training cohort and that of 0.769 and 0.818 in the validated cohort. The nomogram based on the combined model showed satisfactory prediction performance in training (C-index: 0.959) and validation (C-index: 0.846) dataset. Interpretations: The combined model based on a fusion radiomics signature derived from arterial phase and hepatobiliary phase images of gadoxetic acid-enhanced MRI can be a reliable biomarker for identifying CK19 status of HCC. Funding: This paper is supported by National Natural Science Foundation of China; Ministry of Science and Technology of China; Chinese Academy of Sciences; the Strategic Priority Research Program of Chinese Academy of Science; the Shanghai Sailing Program. Declaration of Interest: All authors declare no potential conflict of interest. Ethical Approval: The retrospective study was approved by our Institutional Review Board (approval number B2018-236) and the requirement for informed consent was waived.

Morphological MR features and quantitative ADC evaluation in invasive breast cancer: Correlation with prognostic factors

ObjectiveAssess the correlation between MRI characteristics of invasive breast cancer and tumor prognostic features. Materials and methods95 women with invasive breast cancer underwent pre-treatment MR. Morphological findings and quantitative ADC were retrospectively evaluated. ResultsSmaller size, round shape, spiculated margins and homogeneous internal enhancement pattern on dynamic MRI were independently associated with established predictors of good prognosis, while larger size and rim enhancement pattern were related to predictors of poor prognosis. A positive correlation was observed between ADC value and clinical stage. ConclusionsMRI may be a useful tool for breast cancer aggressiveness prediction and for guiding subsequent clinical-therapeutic management.

Clinical and imaging correlation in patients with pathologically confirmed tumefactive demyelinating lesions

ObjectivesTo characterize clinical and imaging features in patients with pathologically confirmed demyelinating lesions. MethodsIn this retrospective chart review, we analyzed clinical-radiological-pathological correlations in patients >15years old who underwent brain biopsy at our institution between 2000 and 2015 and had inflammatory demyelination on neuropathology. ResultsOf 31 patients, the mean age was 42years (range 16 to 69years) and 55% were female. All but one of the biopsied lesions were considered tumefactive demyelinating lesions (TDLs) by imaging criteria, measuring >2cm on contrast-enhanced brain MRI. On clinical follow-up, the final diagnosis was a CNS malignancy in 2 patients (6.5%). In patients without malignant tumor, the TDL was solitary in 12 (41%) and multifocal in 17 (59%), with contrast enhancement in all but one case, primarily in an incomplete rim enhancement pattern (75.9%). Of 16 patients with at least 12months of clinical follow-up, 7 (43.8%) had a clinical relapse. Of patients without a prior neurologic history, relapse occurred in 2/7 (29%) in solitary TDL and 2/6 (33%) in multifocal lesions at initial presentation. Recurrent TDLs occurred in 3 patients, all with initially solitary TDLs. Stratifying by CSF analysis, 4 of 6 patients (67%) with either an elevated IgG Index or >2 oligoclonal bands suffered a clinical relapse compared to 2/8 (25%) with non-inflammatory CSF. ConclusionsPathologically confirmed TDLs call for careful clinical correlation, clinical follow-up and imaging surveillance. Although sometimes clinically monophasic, tumefactive demyelinating lesions carried nearly a 45% risk of near-term clinical relapse in our study, even when presenting initially as a solitary mass lesion.

Can we apply the MRI BI-RADS lexicon morphology descriptors on contrast-enhanced spectral mammography?

To assess the feasibility of using the MRI breast imaging reporting and data system (BI-RADS) lexicon morphology descriptors to characterize enhancing breast lesions identified on contrast-enhanced spectral mammography (CESM). The study is a retrospective analysis of the morphology descriptors of 261 enhancing breast lesions identified on CESM in 239 patients. We presented the morphological categorization of the included lesions into focus, mass and non-mass. Further classifications included (1) the multiplicity for "focus" category, (2) the shape, margin and internal enhancement for "mass" category and (3) the distribution and internal enhancement for "non-mass" category. Each morphology descriptor was evaluated individually (irrespective of all other descriptors) by calculating its sensitivity, specificity, positive-predictive value (PPV) and negative-predictive value (NPV) and likelihood ratios (LRs). The study included 68/261 (26.1%) benign lesions and 193/261 (73.9%) malignant lesions. Intensely enhancing foci, whether single (7/12, 58.3%) or multiple (2/12, 16.7%), were malignant. Descriptors of "irregular"-shape (PPV: 92.4%) and "non-circumscribed" margin (odds ratio: 55.2, LR positive: 4.77; p-value: <0.001) were more compatible with malignancy. Internal mass enhancement patterns showed a very low specificity (58.0%) and NPV (40.0%). Non-mass enhancement (NME) was detected in 81/261 lesions. Asymmetrical NME in 81% (n = 52/81) lesions was malignant lesions and internal enhancement patterns indicative of malignancy were the heterogeneous and clumped ones. We can apply the MRI morphology descriptors to characterize lesions on CESM, but with few expectations. In many situations, irregular-shaped, non-circumscribed masses and NME with focal, ductal or segmental distribution and heterogeneous or clumped enhancement are the most suggestive descriptors of malignant pathologies. (1) The MRI BI-RADS lexicon morphology descriptors can be applied in the characterization of enhancing lesions on CESM with a few exceptions. (2) Multiple bilateral intensely enhancing foci should not be included under the normal background parenchymal enhancement unless they are proved to be benign by biopsy. (3) Mass lesion features that indicated malignancy were irregular-shaped, spiculated and irregular margins and heterogeneous internal enhancement patterns. The rim enhancement pattern should not be considered as a descriptor of malignant lesions unless CESM is coupled with an ultrasound examination.

Magnetic Resonance Imaging Features of Idiopathic Granulomatous Mastitis: A Retrospective Analysis.

BackgroundGranulomatous mastitis is a rare and benign inflammatory breast disease that may clinically and radiologically mimic breast cancer.ObjectivesThe aim of this study was to evaluate the features of idiopathic granulomatous mastitis (IGM) on breast magnetic resonance imaging (MRI) with mammographic and sonographic findings.Patients and MethodsA retrospective analysis was conducted on 20 patients with IGM who had been diagnosed by needle core or excisional biopsy at a single institution between 2006 and 2012. All of the patients underwent MRI for suspicious breast findings prior to biopsy. MRI examinations were performed on a 1.5 T scanner. The MRI findings were evaluated in accordance with the breast imaging-reporting and data system (BI-RADS) MRI lexicon established by the American College of Radiology.ResultsMRI detected a total of 29 lesions in the 20 patients. Fourteen of these lesions were seen as mass enhancements, with the remaining 15 identified as non-mass enhancements (NMEs). The median size of all lesions was 3.6 cm (range, 0.7 - 6.7 cm). The most frequently observed features were masses with a round shape (9 out of 14, 64%), smooth contour (11 out of 14, 78%), and a rim enhancement pattern (10 out of 14, 71%). The most common features of the 15 NME lesions were segmental distribution (6 out of 15, 40%) and heterogeneous enhancement patterns (8 out of 15, 53%). The time-intensity curves of the dynamic studies showed benign type one signal intensity (persistent enhancement pattern) in the majority of lesions (10 out of 20, 50%).ConclusionOur study suggests that breast MRI findings of IGM have a wide spectrum. Rim enhancement patterns are frequently seen on contrast enhanced images, but the imaging findings are nonspecific and cannot be used definitively to distinguish between benign and malignant lesions.

Characterization of a murine xenograft model for contrast agent development in breast lesion malignancy assessment.

BackgroundThe aim of the study was to develop a nude mouse xenograft model implanted with both benign and malignant xenografts as the preliminary candidate screening tool for contrast agent development in lesion malignancy indication.ResultsA malignant xenograft (either MCF-7 cell/matrigel™ or MDA-MB 231 cell/matrigel) and a benign xenograft (culture medium/matrigel) with cleft and slit-like features of intracanaliculer fibroadenoma were implanted subcutaneously into flanks of individual nu/nu nude mouse with >90 % successful inoculation rate. Both malignant and benign xenografts with volume up to 4 cm3 and (size up to 2 cm) after 5th week were characterized in vivo by sonogram (exhibiting endogenous morphological contrast features between benign and malignant xenografts), dynamic contrast enhanced multi-detector computed tomography (presenting non-targeting exogenous morphological and dynamic contrast features between benign and malignant xenografts), and then were harvested for histological and immunohistochemistry (revealing example of targeting/molecular contrast features, such as expression of cancer vascular markers of malignant xenografts). Malignant xenografts appeared morphologically taller than wide (axis parallel to skin) with angular/ill-defined margin under sonogram observations, revealed more evident rim enhancement, angular margin and washout pattern in the time-density curve from dynamic contrast enhance multi-detector computed tomography images, and had more visible cancer vascular markers (CD31 and VEGF) expression. With limited number of subjects (5–27 for each group of a specific imaging contrast feature), those imaging contrast features of the xenograft model had larger than 85 % sensitivity, specificity, accuracy, positive and negative prediction values in indicating xenograft malignancy except for results from color Doppler detections.ConclusionsThe murine xenograft model might provide an earlier efficacy evaluation of new contrast agent candidate for lesion malignancy interrogation with qualitative and quantitative indication before a human study to reduce the risk and conserve the resources (time, finance and manpower).

Preoperative clinicopathologic factors and breast magnetic resonance imaging features can predict ductal carcinoma in situ with invasive components

PurposeDuctal carcinoma in situ (DCIS) is a non-invasive cancerous breast lesion; however, from 10% to 50% of patients with DCIS diagnosed by core needle biopsy (CNB) or vacuum-assisted core biopsy (VACB) are shown to have invasive carcinoma after surgical excision. In this study, we evaluated whether preoperative clinicopathologic factors and breast magnetic resonance image (MRI) features are predictive of DCIS with invasive components before surgery. Materials and methodsPatients comprised 128 adult women with a diagnosis of DCIS as determined by pathological analysis of CNB or VACB specimens and positive MRI findings who underwent breast surgery during the period January 2011 to December 2013 at the Changhua Christian Hospital. Clinicopathologic and breast MRI factors were compared between patients with postoperative pathology indicative of true DCIS and those with postoperative pathology showing DCIS with invasive components. ResultsOf the 128 patients with a preoperative diagnosis of DCIS, 73 (57.0%) had postoperative histopathologic evidence of true DCIS and 55 (43.0%) showed evidence of DCIS with invasive components. Results of statistical analyses revealed that MRI evidence of a mass-like lesion (P=0.025), nipple-areolar complex (NAC) invasion (P=0.029), larger tumor volume (P=0.010), larger maximum measurable apparent diffusion coefficient (ADC) area (P=0.039), heterogenous or rim enhancement pattern (P=0.010), as well as immunohistochemical evidence of human epidermal growth factor receptor 2 (HER-2) overexpression (P=0.010) were predictive of DCIS with an invasive component in postoperative surgical specimens. ConclusionInvasive component should be considered in biopsy proven DCIS patients with preoperative MRI evidence of a mass-like lesion, nipple-areolar complex invasion, large tumor volume, a larger maximum measurable ADC area, or a rim or heterogenous enhancement pattern, as well as in patients with immunohistochemical evidence of HER-2 overexpression.

CT Characterization of Duodenal Gastrointestinal Stromal Tumors.

Diagnosis and staging of duodenal gastrointestinal stromal tumors (GISTs) by noninvasive imaging is critical for effective treatment, but the imaging features of duodenal GISTs remain largely undefined because of their rarity. The purpose of this article was to characterize duodenal GISTs using CT. Thirty-four patients with duodenal GISTs were analyzed by clinical symptom evaluation, pathologic examination, and CT in this retrospective study. Unenhanced and contrast-enhanced examinations were performed in all patients. Imaging characteristics, including the lesion location, size, growth pattern, ulceration, internal components, arterial blood supply, intratumoral arterioportal shunting, intratumoral vessels, rim enhancement, and enhancement patterns were reviewed. The duodenal GISTs were solitary masses with well-defined margins. The average diameter was 7.1 cm. The second portion was the most common site (20/34). Ulceration was a common feature (15/34). Calcification was uncommon (3/34), and mixed growth pattern was more common (26/34). Rim enhancement (24/34) and mixed enhancement pattern (15/34) were common. Arterial blood supply, intratumoral vasculature, and draining veins were all detected and were obvious on the arterial phase. The portal venous trunk and superior mesenteric vein were the main veins into which early arterioportal shunting drained. Primary duodenal GISTs are generally large, well-defined, heterogeneously enhancing, and hypervascular masses with a prominent mixed growth pattern on CT images. Our findings suggest that CT can help depict the origin of the tumoral arteries and draining veins on the arterial phase and may be a key defining diagnostic feature for duodenal GISTs.

Radiologic–pathologic correlation of renal cell carcinoma associated with Xp11.2 translocation

The prognosis of translocation RCCs in adult patients is relatively poor compared to that of other subtypes of RCCs. Although there have been several reports regarding radiologic findings of translocation RCC, studies with histologic correlation could help to understand the imaging features. To explore the correlation between radiologic and pathologic findings in Xp11.2 translocation renal cell carcinoma (RCC) and provide clues for translocation RCC diagnosis. CT scans of six patients (one man and five women; age range, 8-71 years; mean age, 34 years) with histologically-proven Xp11.2 translocation RCCs were retrospectively evaluated in consensus by two radiologists. Tumor size, presence of necrosis, hemorrhage, fat or calcification, enhancement patterns of the tumor, presence of lymphadenopathy, and distant metastases were evaluated. The average size of the tumors was 6 cm (range, 2.7-12 cm). All six tumors appeared as well-defined masses with areas of low attenuation representing hemorrhage or necrosis. Four tumors contained high attenuating solid portions, compared to the surrounding renal cortex seen on unenhanced images, where representing dense cellular component on microscopic examination. Peripheral rim enhancement pattern that correlated with histologic finding of a fibrous capsule was seen in five cases. In two patients who underwent kidney MR, the masses showed low signal intensity on T2-weighted images. One patient had lymphadenopathy. No distant metastasis was noted in any patient. Translocation RCC appeared as a well-defined mass that contain high attenuating solid portions on unenhanced images and low attenuating necrotic or hemorrhagic foci; the tumor also showed gradual peripheral rim enhancement due to a fibrous capsule surrounding the tumor.

Contrast-Enhanced Sonography of Juxtapleural Pulmonary Tuberculoma

Objectives The purpose of this study was to describe the findings of juxtapleural pulmonary tuberculoma on contrast-enhanced sonography and investigate their correlation with histologic findings. Methods From April 2008 to April 2012, 21 patients with biopsy or clinically proven juxtapleural pulmonary tuberculomas underwent contrast-enhanced sonography with an intravenous bolus injection of 4.8 mL of a sulfur hexafluoride–filled microbubble contrast agent. Enhancement patterns and functional parameters (time to enhancement, time to peak enhancement, and peak signal intensity) derived from a time-intensity curve were evaluated. Enhancement patterns were correlated with their histologic findings. Results A rim enhancement pattern was presented in 12 (57.1%), a homogeneous enhancement pattern in 5 (23.8%), and a heterogeneous enhancement pattern in 4 (19.1%) of 21 tuberculomas. A pathologic study confirmed that the nonenhancing center of the rim enhancement pattern corresponded to caseous or liquefied necrosis, and homogeneously enhanced portions corresponded to granulomatous inflammation. The medians (25th–75th interquartile ranges) for the time to enhancement, time to peak enhancement, and peak signal intensity were 14 seconds (9–14 seconds), 22 seconds (21–26 seconds), and 83 dB (55–92 dB), respectively. Conclusions Contrast-enhanced sonography of juxtapleural pulmonary tuberculoma is feasible. Juxtapleural pulmonary tuberculomas usually show rim, homogeneous, or heterogeneous enhancement. Enhancement patterns of juxtapleural pulmonary tuberculomas are well correlated with their pathologic features.

Contrast-Enhanced Sonography of Juxtapleural Pulmonary Tuberculoma

The purpose of this study was to describe the findings of juxtapleural pulmonary tuberculoma on contrast-enhanced sonography and investigate their correlation with histologic findings. From April 2008 to April 2012, 21 patients with biopsy or clinically proven juxtapleural pulmonary tuberculomas underwent contrast-enhanced sonography with an intravenous bolus injection of 4.8 mL of a sulfur hexafluoride-filled microbubble contrast agent. Enhancement patterns and functional parameters (time to enhancement, time to peak enhancement, and peak signal intensity) derived from a time-intensity curve were evaluated. Enhancement patterns were correlated with their histologic findings. A rim enhancement pattern was presented in 12 (57.1%), a homogeneous enhancement pattern in 5 (23.8%), and a heterogeneous enhancement pattern in 4 (19.1%) of 21 tuberculomas. A pathologic study confirmed that the nonenhancing center of the rim enhancement pattern corresponded to caseous or liquefied necrosis, and homogeneously enhanced portions corresponded to granulomatous inflammation. The medians (25th-75th interquartile ranges) for the time to enhancement, time to peak enhancement, and peak signal intensity were 14 seconds (9-14 seconds), 22 seconds (21-26 seconds), and 83 dB (55-92 dB), respectively. Contrast-enhanced sonography of juxtapleural pulmonary tuberculoma is feasible. Juxtapleural pulmonary tuberculomas usually show rim, homogeneous, or heterogeneous enhancement. Enhancement patterns of juxtapleural pulmonary tuberculomas are well correlated with their pathologic features.

Atypical hemangioma mimicking hepatocellular carcinoma with a special note on radiological and pathological findings

We report a case of hemangioma with an atypical vascular enhancement pattern. The hemangioma showed peripheral rim enhancement at the arterial phase during dynamic magnetic resonance imaging, and the peripheral enhanced zone was still apparent during the delayed phase, as shown on double-phase computed tomography hepatic arteriography. The rim enhancement pattern of this case, mimicking that of hepatocellular carcinoma, may be due to the surrounding liver parenchymal fibrotic change caused by an active hepatitis C viral infection.

Different and Identical Features of Chondroblastic Osteosarcoma and Chondrosarcoma: Highlights on Radiography and Magnetic Resonance Imaging

To identify the different and identical features of 2 tumors with similar pathologic findings, chondroblastic osteosarcoma (OGS) and chondrosarcoma (CSA), with highlights on radiography and magnetic resonance imaging (MRI). Ten patients with chondroblastic OGS and 10 patients with CSA were enrolled. After recording the tumor location, tumor morphology was evaluated for patterns of bony destruction, visible tumor matrix, and aggressive periosteal reactions, endosteal scalloping, cortical expansion, cortical breakthrough and pathologic fracture by radiographic analysis. Signal intensity changes, enhancement pattern, and tumor extensions were evaluated by MRI. The mean patient ages were 24.7 and 56.7 years in patients with chondroblastic OGS and CSA, respectively (p = 0.001). Tumor occurrence was detected in the appendicular bones in 8 chondroblastic OGS and 3 CSA. Three chondroblastic OGS occurred around the knee (p = 0.003). In addition, there were 6 tumors arising from the metaphysis and 2 arising from the diaphysis in chondroblastic OGS patients. In CSA patients, 1 tumor arose in the metaphysis, 1 in the diaphysis, and 1 in the epiphysis (p = 0.039). On radiographs, visible bone-forming tumor matrix was present in 8 chondroblastic OGS, and coexistence of bone- and cartilage-forming patterns were detected in 2. Visible cartilage-forming tumor matrix was present in 7 CSA, and atypical radiodensity patterns were detected in 2 (p < 0.001). Aggressive periosteal reaction was present in 7 chondroblastic OGS, and non-aggressive periosteal reaction was found in 1 CSA (p = 0.008). MRI revealed the presence of a lobular structure of high signal intensity on T2-weighted images, and peripheral rim and septal enhancement pattern was noted in 2 chondroblastic OGS and 10 CSA patients. Inhomogeneous and marginal enhancement patterns were noted in 6 and 2 chondroblastic OGS, respectively (p = 0.001). Metaphysis origin, bone-forming tumor matrix, aggressive periosteal reaction, and young patient age favored chondroblastic OGS. Some chondroblastic OGS showed radiologic and MRI appearances that were typical of CSA.