Rim Enhancement Research Articles

Exploring the MRI and Clinical Features of P53-Mutated Hepatocellular Carcinoma.

To study the MRI features (based on LI-RADS) and clinical characteristics of P53-mutated hepatocellular carcinoma (HCC) patients. This study enrolled 344 patients with histopathologically confirmed HCC (P53-mutated group [n = 196], non-P53-mutated group [n = 148]). We retrospectively evaluated the preoperative MRI features, clinical and pathologic features of the lesions and assigned each lesion according to the LI-RADS. MRI findings, clinical features, and pathologic findings were compared using the Student's t test, χ2 test, and multivariable regression analysis. Most HCC patients were categorized as LR-5. On multivariate analysis, the Edmondson-Steiner grade (odds ratio, 2.280; 95% CI: 1.268, 4.101; p = 0.006) and rim enhancement (odds ratio, 2.517; 95% CI: 1.095, 5.784; p = 0.030) were found to be independent variables associated with P53-mutated HCC. In the group of HCC lesions with the largest tumor diameter (LTD) greater than or equal to 10mm and less than or equal to 20mm, enhancing capsule was an independent predictor of P53-mutated HCC (odds ratio, 6.200; 95% CI: 1.116, 34.449; p = 0.037). Among the HCC lesions (20 mm ˂ LTD ≤ 50 mm), corona enhancement (odds ratio, 2.102; 95% CI: 1.022, 4.322; p = 0.043) and nodule-in-nodule architecture (odds ratio, 2.157; 95% CI: 1.033, 4.504; p = 0.041) were found to be independent risk factors for P53 mutation. Among the HCC lesions (50 mm ˂ LTD ≤ 100 mm), diameter (odds ratio, 1.035; 95% CI: 1.001, 1.069; p = 0.044) and AFP ≥ 400 (ng/mL) (odds ratio, 3.336; 95% CI: 1.052, 10.577; p = 0.041) were found to be independent variables associated with P53-mutated HCC. Poor differentiation and rim enhancement are potential predictive biomarkers for P53-mutated HCC, while HCCs of different diameters have different risk factors for predicting P53 mutations.

Development and Validation of a Model for Postpancreatectomy Hemorrhage Risk

Postpancreatectomy hemorrhage (PPH) due to postoperative pancreatic fistula (POPF) is a life-threatening complication after pancreatoduodenectomy. However, there is no prediction tool for early identification of patients at high risk of late PPH. To develop and validate a prediction model for PPH. This retrospective prognostic study included consecutive patients with clinically relevant POPF who underwent pancreatoduodenectomy from January 1, 2009, to May 20, 2023, at the University Hospital Mannheim (derivation cohort), and from January 1, 2012, to May 31, 2022, at the University Hospital Dresden (validation cohort). Data analysis was performed from May 30 to July 29, 2023. Clinical and radiologic features of PPH. Accuracy of a predictive risk score of PPH. A multivariate prediction model-the hemorrhage risk score (HRS)-was established in the derivation cohort (n = 139) and validated in the validation cohort (n = 154). A total of 293 patients (187 [64%] men; median age, 69 [IQR, 60-76] years) were included. The HRS comprised 4 variables with associations: sentinel bleeding (odds ratio [OR], 35.10; 95% CI, 5.58-221.00; P < .001), drain fluid culture positive for Candida species (OR, 14.40; 95% CI, 2.24-92.20; P < .001), and radiologic proof of rim enhancement of (OR, 12.00; 95% CI, 2.08-69.50; P = .006) or gas within (OR, 12.10; 95% CI, 2.22-65.50; P = .004) a peripancreatic fluid collection. Two risk categories were identified with patients at low risk (0-1 points) and high risk (≥2 points) to develop PPH. Patients with PPH were predicted accurately in the derivation cohort (C index, 0.97) and validation cohort (C index 0.83). The need for more invasive PPH management (74% vs 34%; P < .001) and severe complications (49% vs 23%; P < .001) were more frequent in high-risk patients compared with low-risk patients. In this retrospective prognostic study, a robust prediction model for PPH was developed and validated. This tool may facilitate early identification of patients at high risk for PPH.

Correlation between the CEM imaging characteristics and different molecular subtypes of breast cancer

PurposeTo investigate the correlation between the contrast-enhanced mammography (CEM) imaging characteristics and different molecular subtypes of breast cancer (BC). MethodsWe retrospectively included 313 eligible female patients who underwent CEM examination and surgery in our hospital from July 2017 to July 2021. Their lesions were confirmed on histopathological examination and immunohistochemical analysis. BC was divided into luminal A, luminal B, HER2-enriched, and triple-negative BC (TNBC) subtypes according to immunohistochemical markers. Nine features were extracted from CEM images, including tumor shape, margins, spiculated mass, lobulated mass, malignant calcification, lesion conspicuity, internal enhancement pattern, multifocal mass, and swollen axillary lymph nodes. Statistical analysis was performed using SPSS 25.0. Univariate analysis and binomial regression were used to analyze the correlation between CEM imaging features and BC molecular subtypes. ResultsThere were 184 (58.8 %) Luminal A, 44 (14.1 %) Luminal B, 47 (15.0 %) HER-2-enriched and 38 (12.1 %) TNBC, respectively. Molecular subtypes were significantly related to the tumor shape, margins, spiculated mass, internal enhancement pattern, malignant calcification and swollen axillary lymph nodes. Spiculated and calcified tumors were associated with Luminal subtypes, especially Luminal B (P < 0.05). Irregular tumor shape and malignant calcification were associated with HER-2-enriched subtype (P < 0.05). Oval or round tumor shape, rim enhancement, and swollen axillary lymph nodes were associated with TNBC (P < 0.05). ConclusionCEM imaging features could distinguish BC molecular subtypes. In particular, TNBC showed oval or round tumor shape, rim enhancement, and swollen axillary lymph nodes, providing insights into the diagnosis and prognosis of TNBC.

Augmenting breast cancer diagnosis: Incorporating MRI for the assessment of major molecular subtypes

Objectives: Breast cancer (BC) is one of the commonly encountered cancer in women around the world. It is a diverse medical disorder with multiple molecular subtypes that respond differently to therapy and have different prognoses. Subjects with the same stage of cancer and identical histological findings, on the other hand, can have disparities in clinical features and prognosis. Luminal A, Luminal B, Human epidermal growth factor receptor 2 (HER2) enriched, and triple-negative molecular subtypes were identified using novel technologies in expression analysis with DNA microarray. The precise identification of these subtypes is crucial for tailoring appropriate treatment strategies and improving patient outcomes. Dynamic contrast-enhanced magnetic resonance imaging (DCEMRI) is an excellent imaging technique for determining the extent of disease in BC patients prior to surgery. DECMRI with gadolinium-based contrasts is now the most sensitive identification tool for diagnosis, and it can be used in conjunction with mammography and ultrasound (USG). It aids in the detection of lesions that are not visible using other approaches. Material and Methods: Cross-sectional, observational study done over a period of 1 year. Sample size: 50 Inclusion criteria: Patients with morphological features of Breast Imaging Reporting and Data System (BI-RADS) 4b,4c,5 on USG or mammogram. Patients with malignancy confirmed through biopsy - BI-RADS 6. Patients aged above 18 years. Patients who provided informed consent to participate in the study. Exclusion criteria: Pregnant and lactating women. Patients with pacemakers, prosthetic heart valves, cochlear implants, or any metallic implants. Patients having a history of claustrophobia. Patients with prior surgery in the breast, hormonal therapy, radiation, or chemotherapy. Patients with previous allergic or anaphylactoid reactions to a gadolinium-based contrast. Patients with altered renal function test and estimated glomerular filtration rate &lt;30 mL/min/1.73 mm2. Results: There was a substantial relationship between shape and molecular subtype. The majority of the luminal type of cancers was irregular, whereas the basal type was round. There was no link found between margin and molecular subtypes. Noncircumscribed margins, on the other hand, were more common in luminal subtypes. Internal enhancement and molecular subtypes were found to be significantly related. Rim enhancement was more prevalent in the basal subtype. According to ANOVA analysis, there was a significant relationship between volume and molecular subtypes. At the time of presentation, Luminal B tumors had a significant tumor volume. Conclusion: In conclusion, MRI plays a pivotal role in the evaluation of molecular subtypes of breast cancer, providing valuable information for personalized treatment decisions. Advancements in MRI technology and radiogenomics hold great promise for enhancing subtype-specific characterization and improving patient outcomes.

FRI330 A Rare Case Of Hypogonadotropic Hypogonadism In A Patient With Disseminated Tberculosis And Tuberculoma Involving Tuberculum Sellae

Abstract Disclosure: J.S. Genkil: None. S. Ahsun: None. N. Mohan: None. C. Anastasopoulou: None. Introduction: Central nervous system (CNS) tuberculosis accounts for 1-10% of all tuberculosis (TB) infections and has been known to lead to irreversible consequences. CNS TB may present variably as meningeal tuberculosis, tuberculoma, tuberculous abscess, hydrocephalus, ventricular involvement or cerebritis. Tuberculomas involving the sellar region are amongst the rarest of presentations. We describe a unique case of hypogonadotropic hypogonadism with CNS tuberculoma. Case: A 46-year-old male with depression, alcohol use, tobacco smoking, and daily K2 spice use presented to the hospital with multiple days of upper extremity weakness, seizures, and slurred speech. Head CT was done that showed a soft tissue density with mild hypoattenuation on the right frontal region. MRI of the brain showed 3 round 4-5mm lesions with rim enhancement in the frontal lobes. Chest CT showed apical lung lesion. It was believed that patient had a malignant process with metastasis to the brain. During his course, it was discovered that he had TB exposure from his mother several months ago. Despite multiple negative AFB sputum samples, left lung biopsy confirmed TB diagnosis. He was subsequently diagnosed with tubercular meningitis with tuberculomas, one of them involving tuberculum sellae. The patient was started on antitubercular treatment with isoniazid, rifampin, pyrazinamide, streptomycin, and dexamethasone. Lab revealed normal thyroid studies, but very low total testosterone&amp;lt;20 ng/dl (Normal 220-872 ng/dl), with low FSH=2.6 IU/L (Normal 1-12 IU/L) and LH=0.8 IU/ml (Normal 0.6-12.1 IU/ml), with normal prolactin=7.9 ug/L (Normal 3.5-19.4 ug/L). To treat hypogonadotropic hypogonadism, the patient was started on weekly testosterone supplementation with testosterone cypionate 50 mg subcutaneous injections. Ultimately the patient was discharged to a full-time nursing facility and made significant clinical and functional improvement. Discussion: TB of the CNS is among the least common of extra pulmonary tuberculosis yet is associated with the most devastating manifestations making it a feared complication of TB. These lesions are associated with high rates of morbidity and mortality despite appropriate therapy so prompt diagnosis is key. CNS tuberculomas may present isolated or in combination with pulmonary TB. They are unique as they may masquerade as other intracranial space occupying lesions such as tumors or hematomas, further complicating diagnosis. In particular, sellar and suprasellar region tuberculomas are rare and can present with varied amount of hypopituitarism. In the patient’s case, he developed hypogonadotropic hypogonadism which was successfully treated with testosterone replacement. Hypogonadotropic hypogonadism can only be recognized if there is a high index of suspicion and can result in improvement of the quality of life with preservation of sexual function. Presentation: Friday, June 16, 2023

THU104 An Atypical Case Of A Suprasellar Cyst: A Diagnostic Challenge

Abstract Disclosure: A. Chen: None. S. Zachariah: None. B. Wong: None. E. Owusu: None. A. Levitt: None. R. Todor: None. P. Kishore: None. Background: Cystic sellar masses may be challenging to diagnose on a clinical, imaging, and histopathological basis due to overlapping features. We report a case of a cystic sellar mass in which traditional imaging findings did not correspond to its histopathological findings. Clinical Case: A 37-year-old female presented with headaches and bilateral blurry vision for two months with acute worsening of left peripheral vision for one week. She denied irregular periods, hirsutism, or breast discharge. Ophthalmology evaluation found left temporal field vision loss but normal maculae/optic nerves. MRI pituitary exhibited 2.3 x 1.5 x 1.7 cm complex cystic suprasellar mass with partial rim enhancement, thought to represent a cystic macroadenoma. Initial tests were notable for negative HCG, prolactin 96.32 mIU/mL (n &amp;lt; 23.3 mIU/mL), TSH 9.440 uIU/mL (0.270-4.2 uIU/mL), normalized to 0.855 uIU/mL on repeat testing, FT4 0.748 ng/dL (n = 0.75 – 2.0 ng/dL). IGF-1, ACTH, AM cortisol, FSH, and LH were within normal limits. She was started on cabergoline prior to trans-nasal-sphenoid resection with cyst drainage of white and thick content. Histopathology exhibited a squamous epithelium-lined cyst with no columnar epithelium or mucin-containing cells, consistent with an epidermoid cyst (EC), although the differential included a Rathke’s cleft cyst (RCC). No pituitary tumor was noted. A re-evaluation of MRI in multidisciplinary rounds deemed epidermoid cyst unlikely, given that these present with restricted diffusion. Our patient had overall T2 hyperintensity with an associated T2 hypointense nodule and did not restrict diffusion [1]. After interdisciplinary discussion, including imaging and pathology review, it was felt that the most likely diagnosis was RCC with squamous metaplasia. After surgery, the patient's symptoms and visual function completely recovered, and follow-up imaging is scheduled. Conclusion: Differentiating RCC with squamous metaplasia from EC can be challenging since both may present with a squamous epithelial lining [2]. Rates of progression and recurrence vary amongst cysts; therefore, making an accurate diagnosis is essential for selecting management, predicting the likelihood of recurrence, and guiding postoperative surveillance. This case is unique in that radiologic features were more helpful than histopathology in determining the diagnosis and highlights the importance of collectively considering clinical, imaging, and histopathological features in making a final diagnosis.

Laryngeal abscess formation secondary to utilization of nasogastric tube in oral cancer patient: A case report

Introduction: Although laryngeal abscess is a rare disease in this day when antibiotics and vaccines are widely available, it can be fatal in terms of choking risk due to airway narrowing and thus requires an immediate diagnosis and treatment, including airway management. Even in the field of oral surgery, where nasogastric tubes are often used for nutritional management, there have been no reports of laryngeal abscesses. Case Report: One month after right maxillary gingival carcinoma surgery, a 72-year-old man had hoarseness and a fever following nasogastric tube replacement, and blood tests showed a marked increase in inflammatory levels. The patient started chemotherapy with SBT/ABPC (12 g/day). Contrast-enhanced magnetic resonance imaging showed a low-density area with a rim enhancement effect from the left laryngeal surface of the epiglottis to the left supraglottis, which had caused airway narrowing, leading to a diagnosis of laryngeal abscess. Considering the risk of airway obstruction, a tracheostomy was performed under general anesthesia. On day 16, contrast-enhanced computed tomography showed a reduction in the lesion size. On day 36, antibiotic chemotherapy was terminated. At 10 months after surgery, lung metastasis developed without local or cervical recurrence, and chemotherapy was off-label due to his worsening renal function. Therefore, the best supportive care policy was selected. The patient’s general condition gradually deteriorated, and he died 11 months after the surgery. Conclusion: There are very few reports related to nasogastric tubes, so it is necessary to keep the disease concept of laryngeal abscess in mind, especially in the field of oral surgery, where nasogastric tubes are often used for nutritional management.

The MR Imaging of Primary Intrahepatic Lymphoepithelioma-like Cholangiocarcinoma: A Diagnostic Challenge.

To characterize the magnetic resonance imaging features of primary intrahepatic lymphoepithelioma-like cholangiocarcinoma (LELCC). Thirty-four patients with 38 histologically confirmed LELCCs were enrolled retrospectively from January 2014 to August 2022. We evaluated the clinical features, histologic findings, and imaging manifestations on dynamic enhanced MRI. 74% (25/34) of the cases were associated with EBV infection. Moreover, patients infected with EBV exhibited a lower level of Ki-67 proliferation. The serum CA199 level was elevated in 10 patients. The median tumor diameter was 2.8 cm (range, 1.1-8.7 cm). Most tumors were well-defined with a smooth or lobulated margin and showed peripheral hyperintensity and central hypointensity on T2-weighted imaging (T2WI). T2 hyperintense foci were recognized in 8 patients. In the dynamic enhanced MRI, 21 tumors demonstrated Type A enhancement pattern (rim enhancement), 10 demonstrated Type B (rapid wash-in and wash-out), and seven demonstrated Type C (rapid wash-in without wash-out). Capsular enhancement in PVP or DP was found in 22 tumors. A few patients had satellite lesions, portal vein thrombosis, bile duct dilatation, and distal metastasis. Lymph node metastases were discovered pathologically in 11 patients. MRI findings of LELCC vary and are non-specific. While a majority of LELCCs exhibit typical features of intrahepatic cholangiocarcinoma (iCCA), unique findings like T2 hyperintense foci or capsular enhancement could suggest LELCC. EBV infection and elevated tumor markers can aid in differentiation. However, given the mimics of some cases of liver hypervascular lesions, histological examination remains essential for definitive diagnosis.

Tumefactive demyelinating lesions versus CNS neoplasms, a comparative study

BackgroundDifferentiating tumefactive demyelinating lesions (TDL) from neoplasms of the central nervous system continues to be a diagnostic dilemma in many cases. ObjectiveOur study aimed to examine and contrast the clinical and radiological characteristics of TDL, high-grade gliomas (HGG) and primary CNS lymphoma (CNSL). MethodThis was a retrospective review of 66 patients (23 TDL, 31 HGG and 12 CNSL). Clinical and laboratory data were obtained. MRI brain at presentation were analyzed by two independent, blinded neuroradiologists. ResultsPatients with TDLs were younger and predominantly female. Sensorimotor deficits and ataxia were more common amongst TDL whereas headaches and altered mental status were associated with HGG and CNSL. Compared to HGG and CNSL, MRI characteristics supporting TDL included relatively smaller size, lack of or mild mass effect, incomplete peripheral rim enhancement, absence of central enhancement or restricted diffusion, lack of cortical involvement, and presence of remote white matter lesions on the index scan. Paradoxically, some TDLs may present atypically or radiologically mimic CNS lymphomas. ConclusionCareful evaluation of clinical and radiological features helps in differentiating TDLs at first presentation from CNS neoplasms.

Discal cysts and pseudocysts: Single center experience

IntroductionCurrent knowledge of intervertebral discal cysts is restricted to case reports and surgical case series, typically in young adult males presenting with back pain and radiculopathy. ObjectiveWe review our single-center experience to describe presentation, management, and outcomes of these rare lesions. MethodsWe performed a retrospective electronic search of our institution database using key words “discal cyst,” “disc cyst” and variations. Clinical presentation, imaging findings, management and outcomes were reviewed and tabulated. ResultsNine patients were identified (4 female), with mean age 49.1 years. Three patients had prior surgery at the level of the cyst. Seven patients presented with back pain, five with additional radiculopathy, one patient with radiculopathy alone, and one asymptomatic. Most discal cysts occurred at L5-S1, were left-sided, paracentral in location with a T2 hypointense rim and variable enhancement. One patient underwent primary cyst resection. Amongst 6 patients who underwent primary image-guided procedures, two had sustained pain relief, three proceeded to cystectomy, microdiscectomy and/or posterior decompressive surgery, and two were lost to follow-up. ConclusionOur retrospective cohort includes a wider age group with more heterogeneous clinical features, treatment approaches and response to therapy than that described in the literature. CT or fluoroscopy-guided steroid injection provided short-term symptomatic relief with several cases managed definitively with surgery. Further research is required to better understand and manage these rare lesions. Clinical impactDiscal cysts and pseudocysts occur in a wider range of patients and with more heterogenous presentations than previously described. Imaging-guided intervention can provide short-term symptomatic relief, but further research is required to optimize long-term management.

Imaging spectrum of Alveolar Hydatid as per PNM Classification.

Introduction: There are two forms of infestation by Echinococcus: the unilocular cystic form caused by E. granuloses is much more common than the rare multilocular alveolar form caused by E. multilocularis. Without early diagnosis and treatment, disease has poor prognosis. Death eventually results from hepatobiliary complications like cholangitis or secondary biliary cirrhosis; bleeding from esophageal or duodenal varices due to portal hypertension, Budd-Chiari disease, or obstruction of the vena cava; or complications related to heart, lung, or brain involvement. Materials and Method: This was an observational study where a cohort of 24 patients with avascular hepatic mass on ultrasound were subjected to triple phase contrast computerized tomography over a span of two years from December 2020 to November 2022 in GMC, Srinagar. Aim: The aim of the study was to present the Imaging spectrum of alveolar Hydatid on CECT as per PNM classification and to assess characteristics of alveolar hydatid on contrast enhanced computed Tomography. Results: The most common form of alveolar hydatid in liver was an infiltrating non enhancing heterogeneous mass lesion with irregular margins with internal calcifications (75%) cases. Calcification was seen in 22(91.6%) out of 24 cases (P value &lt; 0.001). All of the masses were non enhancing with peripheral rim enhancement in only 5 cases (20.8%). P2N0M0 was the most common stage found on CECT as per PNM classification in 14(58.3%) patients followed by P1N0M0 in about 4 patients (16.6%). P3 and P4 stage was found in 3 patients (12.5%) each. N1 stage was found in 2 patients (8.3%). M1 stage was found in 3(12.5%) patients with metastasis to lung in two cases and Brain in one case. Conclusion: CECT has a very important role to suggest diagnosis of Alveolar Echinococcosis since MRI take long acquisition times. Radiologists especially those residing in endemic region must be aware of imaging findings of Alveolar Echinococcosis so that they can direct clinicians to take proper therapeutic decision.

Diffuse paediatric-type high-grade glioma, H3-wildtype and IDH-wildtype: case series of a new entity.

Diffuse paediatric-type high-grade glioma, H3-wildtype and IDH-wildtype (pHGG) is a rare and aggressive brain tumor characterized by a specific DNA methylation profile. It was recently introduced in the 5th World Health Organization classification of central nervous system tumors of 2021. Clinical data on this tumor is scarce. This is a case series, which presents the first clinical experience with this entity. We compiled a retrospective case series on pHGG patients treated between 2015 and 2022 at our institution. Data collected include patients' clinical course, surgical procedure, histopathology, genome-wide DNA methylation analysis, imaging and adjuvant therapy. Eight pHGG were identified, ranging in age from 8 to 71years. On MRI tumors presented with an unspecific intensity profile, T1w hypo- to isointense and T2w hyperintense, with inhomogeneous contrast enhancement, often with rim enhancement. Three patients died of the disease, with overall survival of 19, 28 and 30months. Four patients were alive at the time of the last follow-up, 4, 5, 6 and 79months after the initial surgery. One patient was lost to follow-up. Findings indicate that pHGG prevalence might be underestimated in the elderly population.

SDPS-08 OSSEOUS METASTASES IN H3G34-MUTANT DIFFUSE HEMISPHERIC GLIOMAS

Abstract Subset of patients with H3G34 gliomas may present with extra-CNS metastasis further complicating both diagnosis and treatment. We describe a case of a 19-year-old female presenting initially with focal motor seizure in right leg along with leg pain. MRI of the leg showed an ill-defined right distal femur expansile osteolytic lesion with central fluid signal, thick rim enhancement, endosteal scalloping, cortical invasion, and smooth enhancing periosteal reaction/soft tissue extension associated with surrounding enhancing marrow signal abnormality worrisome for lesion extension. Contrast brain MRI exhibited multiple frontal and partial lobe T2 FLAIR hyperintense lesions. The largest lesion demonstrated contrast enhancement, internal foci of restricted diffusion, and a focus of intratumoral hemorrhage. A whole-body PET/CT showed intensely FDG-avid lytic lesion in the right distal femur, with FDG activity along the biopsy tract. Hypermetabolic lytic metastases to the right femoral head and mid-sacral body were also observed. A craniotomy with brain lesion biopsy two months later indicated preliminary histopathology of malignant small round blue cell neoplasm. A biopsy from the distal right femur was non-diagnostic of malignancy but a sacral bone biopsy reported malignant small blue cell neoplasm, consistent with involvement by the patient's known cranial neoplasm. Final pathological diagnosis including molecular diagnostics was consistent with WHO grade 4 IDH-wildtype H3G34 mutant diffuse hemispheric glioma with osseous metastases. Patient was treated with chemoradiotherapy with temozolomide (TMZ). Following the sixth cycle of TMZ, MRI brain imaging was stable. Apart from holocephalic headaches, the patient had no significant medication side effects and was seizure-free. A second whole-body PET scan showed improvement and interval decrease in FDG uptake of the sacrum and right femoral head. Given the stress that patients with H3G34 can experience and the poor prognosis, it is imperative to expand our knowledge and ascertain accurate screening and diagnostic methodologies.

Triple-negative breast cancer: predictive model of early recurrence based on MRI features

To develop an integrated model based on preoperative magnetic resonance imaging (MRI) features for predicting early recurrence in patients with triple-negative breast cancer (TNBC). Women with TNBC who underwent breast MRI and surgery between 2009 and 2019 were evaluated retrospectively. Two breast radiologists reviewed MRI images independently based on the Breast Imaging Reporting and Data System Lexicon (BI-RADS), and classified the breast oedema scores on T2-weighted imaging (WI) as no oedema, peritumoural oedema, prepectoral oedema, or subcutaneous oedema. The relationship between disease-free survival (DFS) and MRI features was analysed by Cox regression, and a nomogram model was generated based on the results. 150 patients with TNBC were included and divided into a training cohort (n=78) and validation cohort (n=72). MRI features including subcutaneous oedema and rim enhancement showed a tendency to worsen DFS in univariate analysis. Multivariate analysis showed that subcutaneous oedema (p=0.049, HR [95% confidence interval {CI}=8.24 [1.01-67.52]) and rim enhancement (p=0.016, HR [95% CI]=4.38 [1.32-14.54]) were independent predictors for DFS. In the nomogram, the areas under the curves (AUCs) of the training cohort was 0.808, and that of the validation cohort was 0.875. The presence of subcutaneous oedema or rim enhancement on preoperative breast MRI was shown to be a good predictor of poor survival outcomes in patients with TNBC.

Intraoperative MRI Assessment of the Tissue Damage during Laser Ablation of Hypothalamic Hamartoma.

Laser ablation for treatment of hypothalamic hamartoma (HH) is a minimally invasive and effective technique used to destroy hamartomatous tissue and disconnect it from the functioning brain. Currently, the gold standard to evaluate the amount of tissue being "burned" is the use of heat maps during the ablation procedure. However, these maps have low spatial resolution and can be misleading in terms of extension of the tissue damage. The aim of this study is to use different MRI sequences immediately after each laser ablation and correlate the extension of signal changes with the volume of malacic changes in a long-term follow-up scan. During the laser ablation procedure, we imaged the hypothalamic region with high-resolution axial diffusion-weighted images (DWI) and T2-weighted images (T2WI) after each ablation. At the end of the procedure, we also added a post-contrast T1-weighted image (T1WI) of the same region. We then correlated the product of the maximum diameters on axial showing signal changes (acute oedema on T2WI, DWI restriction rim, DWI hypointense core and post-contrast T1WI rim) with the product of the maximum diameters on axial T2WI of the malacic changes in the follow-up scan, both as a fraction of the total area of the hamartoma. The area of the hypointense core on DWI acquired immediately after the laser ablation statistically correlated better with the final area of encephalomalacia, while the T2WI, hyperintense oedema, DWI rim and T1WI rim of enhancement tended to overestimate the encephalomalacic damage. In conclusion, the use of intraoperative sequences (in particular DWI) during laser ablation can give surgeons valuable information in real time about the effective heating damage on the hamartomatous tissue, with better spatial resolution in comparison to the thermal maps.

Extracellular volume fraction using contrast-enhanced CT is useful in differentiating intrahepatic cholangiocellular carcinoma from hepatocellular carcinoma.

To evaluate whether tumor extracellular volume fraction (fECV) on contrast-enhanced computed tomography (CT) aids in the differentiation between intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). In this retrospective study, 113 patients with pathologically confirmed ICC (n = 39) or HCC (n = 74) who had undergone preoperative contrast-enhanced CT were enrolled. Enhancement values of the tumor (Etumor) and aorta (Eaorta) were obtained in the precontrast and equilibrium phase CT images. fECV was calculated using the following equation: fECV [%] = Etumor/Eaorta × (100 - hematocrit [%]). fECV values were compared between the ICC and HCC groups using Welch's t-test. The diagnostic performance of fECV for differentiating ICC and HCC was assessed using receiver-operating characteristic (ROC) analysis. fECV and the CT imaging features of tumors were evaluated by two radiologists. Multivariate logistic regression analysis was performed to identify factors predicting a diagnosis of ICC. Mean fECV was significantly higher in ICCs (43.8% ± 13.2%) than that in HCCs (31.6% ± 9.0%, p < 0.001). The area under the curve for differentiating ICC from HCC was 0.763 when the cutoff value of fECV was 41.5%. The multivariate analysis identified fECV (unit OR: 1.10; 95% CI: 1.01-1.21; p < 0.05), peripheral rim enhancement during the arterial phase (OR: 17.0; 95% CI: 1.29-225; p < 0.05), and absence of washout pattern (OR: 235; 95% CI: 14.03-3933; p < 0.001) as independent CT features for differentiating between the two tumor types. A high value of fECV, peripheral rim enhancement during the arterial phase, and absence of washout pattern were independent factors in the differentiation of ICC from HCC.

A convenient scoring system to distinguish intrahepatic mass-forming cholangiocarcinoma from solitary colorectal liver metastasis based on magnetic resonance imaging features

ObjectivesTo develop and validate a diagnostic scoring system to differentiate intrahepatic mass-forming cholangiocarcinoma (IMCC) from solitary colorectal liver metastasis (CRLM).MethodsA total of 366 patients (263 in the training cohort, 103 in the validation cohort) who underwent MRI examination with pathologically proven either IMCC or CRLM from two centers were included. Twenty-eight MRI features were collected. Univariate analyses and multivariate logistic regression analyses were performed to identify independent predictors for distinguishing IMCC from solitary CRLM. The independent predictors were weighted over based on regression coefficients to build a scoring system. The overall score distribution was divided into three groups to show the diagnostic probability of CRLM.ResultsSix independent predictors, including hepatic capsular retraction, peripheral hepatic enhancement, vessel penetrating the tumor, upper abdominal lymphadenopathy, peripheral washout at the portal venous phase, and rim enhancement at the portal venous phase were included in the system. All predictors were assigned 1 point. At a cutoff of 3 points, AUCs for this score model were 0.948 and 0.903 with sensitivities of 96.5% and 92.0%, specificities of 84.4% and 71.7%, positive predictive values of 87.7% and 75.4%, negative predictive values of 95.4% and 90.5%, and accuracies of 90.9% and 81.6% for the training and validation cohorts, respectively. An increasing trend was shown in the diagnostic probability of CRLM among the three groups based on the score.ConclusionsThe established scoring system is reliable and convenient for distinguishing IMCC from solitary CRLM using six MRI features.Clinical relevance statementA reliable and convenient scoring system was developed to differentiate between intrahepatic mass-forming cholangiocarcinoma from solitary colorectal liver metastasis using six MRI features.Key Points• Characteristic MRI features were identified to distinguish intrahepatic mass-forming cholangiocarcinoma (IMCC) from solitary colorectal liver metastasis (CRLM).• A model to distinguish IMCC from solitary CRLM was created based on 6 features, including hepatic capsular retraction, upper abdominal lymphadenopathy, peripheral washout at the portal venous phase, rim enhancement at the portal venous phase, peripheral hepatic enhancement, and vessel penetrating the tumor.

Early Detection of Underlying Cavernomas in Patients with Spontaneous Acute Intracerebral Hematomas.

Early identification of the etiology of spontaneous acute intracerebral hemorrhage is essential for appropriate management. This study aimed to develop an imaging model to identify cavernoma-related hematomas. Patients 1-55 years of age with acute (≤7 days) spontaneous intracerebral hemorrhage were included. Two neuroradiologists reviewed CT and MR imaging data and assessed the characteristics of hematomas, including their shape (spherical/ovoid or not), their regular or irregular margins, and associated abnormalities including extralesional hemorrhage and peripheral rim enhancement. Imaging findings were correlated with etiology. The study population was randomly split to provide a training sample (50%) and a validation sample (50%). From the training sample, univariate and multivariate logistic regression was performed to identify factors predictive of cavernomas, and a decision tree was built. Its performance was assessed using the validation sample. Four hundred seventy-eight patients were included, of whom 85 had hemorrhagic cavernomas. In multivariate analysis, cavernoma-related hematomas were associated with spherical/ovoid shape (P < .001), regular margins (P = .009), absence of extralesional hemorrhage (P = .01), and absence of peripheral rim enhancement (P = .002). These criteria were included in the decision tree model. The validation sample (n = 239) had the following performance: diagnostic accuracy of 96.1% (95% CI, 92.2%-98.4%), sensitivity of 97.95% (95% CI, 95.8%-98.9%), specificity of 89.5% (95% CI, 75.2%-97.0%), positive predictive value of 97.7% (95% CI, 94.3%-99.1%), and negative predictive value of 94.4% (95% CI, 81.0%-98.5%). An imaging model including ovoid/spherical shape, regular margins, absence of extralesional hemorrhage, and absence of peripheral rim enhancement accurately identifies cavernoma-related acute spontaneous cerebral hematomas in young patients.

Comparison of machine learning models and CEUS LI-RADS in differentiation of hepatic carcinoma and liver metastases in patients at risk of both hepatitis and extrahepatic malignancy

BackgroundCEUS LI-RADS (Contrast Enhanced Ultrasound Liver Imaging Reporting and Data System) has good diagnostic efficacy for differentiating hepatic carcinoma (HCC) from solid malignant tumors. However, it can be problematic in patients with both chronic hepatitis B and extrahepatic primary malignancy. We explored the diagnostic performance of LI-RADS criteria and CEUS-based machine learning (ML) models in such patients.MethodsConsecutive patients with hepatitis and HCC or liver metastasis (LM) who were included in a multicenter liver cancer database between July 2017 and January 2022 were enrolled in this study. LI-RADS and enhancement features were assessed in a training cohort, and ML models were constructed using gradient boosting, random forest, and generalized linear models. The diagnostic performance of the ML models was compared with LI-RADS in a validation cohort of patients with both chronic hepatitis and extrahepatic malignancy.ResultsThe mild washout time was adjusted to 54 s from 60 s, increasing accuracy from 76.8 to 79.4%. Through feature screening, washout type II, rim enhancement and unclear border were identified as the top three predictor variables. Using LI-RADS to differentiate HCC from LM, the sensitivity, specificity, and AUC were 68.2%, 88.6%, and 0.784, respectively. In comparison, the random forest and generalized linear model both showed significantly higher sensitivity and accuracy than LI-RADS (0.83 vs. 0.784; all P < 0.001).ConclusionsCompared with LI-RADS, the random forest and generalized linear model had higher accuracy for differentiating HCC from LM in patients with chronic hepatitis B and extrahepatic malignancy.

A multiparametric approach to predict triple-negative breast cancer including parameters derived from ultrafast dynamic contrast-enhanced MRI.

Triple-negative breast cancer (TNBC) is a highly proliferative breast cancer subtype. We aimed to identify TNBC among invasive cancers presenting as masses using maximum slope (MS) and time to enhancement (TTE) measured on ultrafast (UF) DCE-MRI, ADC measured on DWI, and rim enhancement on UF DCE-MRI and early-phase DCE-MRI. This retrospective single-center study, between December 2015 and May 2020, included patients with breast cancer presenting as masses. Early-phase DCE-MRI was performed immediately after UF DCE-MRI. Interrater agreements were evaluated using the intraclass correlation coefficient (ICC) and Cohen's kappa. Univariate and multivariate logistic regression analyses of the MRI parameters, lesion size, and patient age were performed to predict TNBC and create a prediction model. The programmed death-ligand 1 (PD-L1) expression statuses of the patients with TNBCs were also evaluated. In total, 187 women (mean age, 58years ± 12.9 [standard deviation]) with 191 lesions (33 TNBCs) were evaluated. The ICC for MS, TTE, ADC, and lesion size were 0.95, 0.97, 0.83, and 0.99, respectively. The kappa values of rim enhancements on UF and early-phase DCE-MRI were 0.88 and 0.84, respectively. MS on UF DCE-MRI and rim enhancement on early-phase DCE-MRI remained significant parameters after multivariate analyses. The prediction model created using these significant parameters yielded an area under the curve of 0.74 (95% CI, 0.65, 0.84). The PD-L1-expressing TNBCs tended to have higher rim enhancement rates than the non-PD-L1-expressing TNBCs. A multiparametric model using UF and early-phase DCE-MRI parameters may be a potential imaging biomarker to identify TNBCs. Prediction of TNBC or non-TNBC at an early point of diagnosis is crucial for appropriate management. This study offers the potential of UF and early-phase DCE-MRI to offer a solution to this clinical issue. • It is crucial to predict TNBC at an early clinical period. • Parameters on UF DCE-MRI and early-phase conventional DCE-MRI help in predicting TNBC. • Prediction of TNBC by MRI may be useful in determining appropriate clinical management.