VoE 1 - Abdominal Viscera
Scan time reduction in DWI of the pancreas using simultaneous multislice technique with different acceleration factors: how fast can we go?
Aims and objectives: To investigate the feasibility of simultaneous multislice (sms)-accelerated diffusion-weighted imaging of the pancreas with different acceleration factors (AFs) and its influence on image quality, acquisition time and apparent diffusion coefficients (ADC) in comparison to conventional sequences.
Methods and materials: In this institutional review board approved study, DWI of the pancreas was performed at 1.5 T in ten healthy volunteers (5 female, 5 male, mean age 29 years) and 20 patients (10 male, 10 female, mean age 59 years) undergoing clinically indicated MRI for the investigation of a suspected pancreatic pa[...]
Results: Sms-DWI of the pancreas was successfully performed in all volunteers and patients. Images recorded with sms2-DWI offered high image quality (overall image quality in b800: c-DWI: 4 (1; 5), sms2-DWI: 4 (1; 5)) with a scan time reduction to one third (c-DWI: 173 seconds, sms2-DWI: 56 seconds). Sms3-DW[...]
Conclusion: In the present study, the feasibility of simultaneous multislice accelerated DWI of the pancreas was demonstrated in an experimental setting in volunteers as well as in patients scanned in clinical routine. Using an acceleration factor of 2, sms-DWI allowed considerable reduction of acquisition time[...]
Personal information: Jana Taron, MD, Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany; Petros Martirosian, PhD, Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany; Nina S[...]
References: 1. Moeller S, Yacoub E, Olman CA, et al. Multiband multislice GE-EPI at 7 tesla, with 16-fold acceleration using partial parallel imaging with application to high spatial and temporal whole-brain fMRI. Magnetic Resonance in Medicine. 2010;63(5):1144-1153. 2. Stejskal EO, Tanner JE. Spin Diffusion Me[...]
A Re-Audit on the Optimisation of Detection of Hepatocellullar Carcinoma using Care Bolus Technique in Magnetic Resonance Liver Imaging at Royal London and St Bartholomews' Hospitals
Aims and objectives: Barts Health NHS Trust comprise of St. Bartholomew's Hospital and the Royal London Hospital which are tertiary centres and teaching hospitals based in the City of London and the East End. A full range of specialist services are offered including the provision of specialist Oncology care. We are a bu[...]
Methods and materials: 56 patients were selected within a 3-month window with the clinical question of liver lesion characterisation. 4 patients were excluded from the audit due to incomplete image acquisition and the lack of use of intravenous (IV) contrast. N = 52. Post-contrast images were reviewed by th[...]
Results: In the pre-intervention cohort, 56 studies were assessed but n = 52 due to exclusion of incomplete/non-contrast studies. 42 studies (75%) were of adequate diagnostic quality. Of these, 20 were of optimal diagnostic quality. 10 were non-diagnostic (taken either too early or too late in the [...]
Conclusion: Our audit has demonstrated an improvement in compliance to the set standard of 85% for diagnostic adequacy in the arterial phase. This study has shown that the automated bolus-tracking technique is a robust method of acquiring the appropriate arterial phase required for the characteri[...]
References: 1 Ipsos MORI Social Research Institute. Health and Lifestyle Research; Tower Hamlets Primary Care Trust (August 2009). http://www.towerhamlets.gov.uk/Documents/Borough_statistics/Health_and_social_care/Tower-Hamlets-Health&Lifestyle-exec-Summary1.pdf (accessed 12 December 2016). &n[...]
Learning objectives: To illustrate the variety of solid and "solid-appearing" lesions found in the pancreas other than pancreatic adenocarcinoma. To review the imaging findings and differentiating features (clinical and radiological) of these lesions.
Background: Pancreatic ductal adenocarcinoma (PDA) accounts for 85-95% of all pancreatic malignancies, however other "solid-appearing" lesions are also encountered and should be considered in the differential diagnosis of a pancreatic mass. They can be broadly classified into neoplastic and non-neoplastic. Some[...]
Findings and procedure details: Neoplastic lesions mimicking pancreatic ductal adenocarcinoma (PDA) Pancreatic neuroendocrine tumour (pNET) Account for 1-5% of pancreatic tumours. Prognosis depends on histological grade. Clinical clues: Typically affects patients in their 50's (rare in <30's). May develop [...]
Conclusion: Pancreatic adenocarcinoma account for the majority of "solid-appearing" lesions seen in the pancreas. Incidental solid pancreatic lesions have a high probability of being malignant. There is significant overlap in the radiological appearances of the different lesions described. A combination of[...]
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References: Ros PR, Mortelé KJ. Imaging features of pancreatic neoplasms. JBR-BTR 2001;84(6):239–249. G. Low, A. Panu, N. Millo, and E. Leen, “Multimodality imaging of neoplastic and nonneoplastic solid lesions of the pancreas,” Radiographics, vol. 31, no. 4, pp. 993–1015, 2011. Vassos N, Agaimy A, Klein P, Hoh[...]
Learning objectives: Show the main imaging characteristics of neuroendocrine neoplasms of the pancreas. To discuss the clinical, radiological and pathological findings of pancreatic neuroendocrine neoplasms. Show the main imaging differences between pancreatic neuroendocrine neoplasms and other pancreatic tumors[...]
Background: Pancreatic endocrine tumors (PETs) are relatively rare group of neoplasms that arise from multipotent stem cells in the pancreatic ductal epithelium and comprising only 1%-2% of all pancreatic neoplasms. The incidence of PETs increases significantly after the age of 40 with a peak incidence ar[...]
Findings and procedure details: Diagnostic methods: CT findings with pathologic correlation, MRI and EUS The increased availability of imaging modalities such as Computed Tomography(CT) and Magnetic resonance imaging (MRI) have enabled early detection of PETs. CT is use widely for the localization of a primary panc[...]
Conclusion: Pancreatic endocrine tumors (PETs) are a group of neoplasms with diverse clinical findings but common imaging features. Most are well-differentiated, circumscribed and hypervascular at CT and MR imaging. Cystic pancreatic NETs are not rare and should be include in the differential diagnosis of a cys[...]
Personal information: Tamara Gligoric email@example.com
References: 1.The epidemiology of gastroenteropancreatic neuroendocrine tumors. Lawrence B, Gustafsson BI, Chan A, Svejda B, Kidd M, Modlin IM Endocrinol Metab Clin North Am. 2011 Mar; 40(1):1-18, vii. 2. Vortmeyer AO, Huang S, Lubensky I, Zhuang Z. Nonislet origin of pancreatic islet cell tumors. J Clin Endocr[...]
Learning objectives: To provide a structured radiology report of acute pancreatitis with the points of the revised Atlanta Classification of 2012 that are key for the patients´s management (Figure 1).
Background: Acute pancreatitis is a prevalent condition that consists of an inflammatory process of the pancreas with variable involvement of other local tissues and remote organ systems. It has an overall mortality rate of 5%, and excellent prognosis for interstitial edematous pancreatitis, but poor prognosis [...]
Findings and procedure details: The revised Atlanta classification of 2012 was designed to stratify patients with acute pancreatitis, standardize terminology across specialities, and help in treatment planning, and it is essential for the radiologists to provide a structured radiology report containing the points of this classific[...]
Conclusion: Acute pancreatitis is a prevalent disease that may lead to high morbidity, and for whose management a structured radiology report containing the terminology of the revised Atlanta Classification of 2012 plays an essential role.
References: 1. Foster B, Jensen K, Bakis G, Shaaban A, Coakley F. Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay. RadioGraphics. 2016;36(3):675-687. 2. Thoeni R. The Revised Atlanta Classification of Acute Pancreatitis: Its Importance for the Radiologist and Its Effect on Treatment. [...]
Learning objectives: To identify the different patterns of abdominal fat necrosis and inflammation. To understand the difference between these 'no touch lesions' and other pathologies. To be aware of the most commom differential diagnoses.
Background: Intra-abdominal fat is abudantly present in both the retro- and intraperitoneal compartments. Fat necrosis or inflammation is a common finding at abdominal cross-sectional imaging. These entities can mimick more urgent pathologies such as appendicitis, diverticulitis or liposarcoma. &[...]
Findings and procedure details: Several patterns of necrosis or inflammation concerning the abdominal fat exist. The most common are appendagitis epiploicae, omental infarction, fat saponification, encapsulated fat necrosis and mesenteric panniculitis. Appendagitis epiploicae Epiploic appendages are small be[...]
Conclusion: Intra-abdominal fat can undergo necrosis or inflammation through several mechanisms. It is important to be aware of these patterns and to recognise them as 'no touch' lesions, because fat necrosis or inflammation can mimick other pathologies, such as diverticulitis or liposarc[...]
References: 1. McClure MJ, Khalili K, Sarrazin J, Hanbidge A. Radiological features of epiploic appendagitis and segmental omental infarction. Clin Radiol 2001;56(10): 819–827. 2. Danielson K, Chernin MM, Amberg JR, Goff S, Durham JR. Epiploic appendicitis: CT characteristics. J Comput Assist Tomogr 1986[...]
Learning objectives: Describe and illustrate different manifestations of hepatic actinomycosis Reveal essential CT and MRI features of hepatic actinomycosis Describe complications of hepatic actinomycosis
Background: Hepatic actinomycosis is a rare infectious disease caused by an anaerobic gram-positive bacillus (Actinomyces). Only 20% of cases show an abdominal manifestation. Hepatic involvement has been reported in 15% of patients with abdominal disease. Due to rarity of this disease, radiographic features of [...]
Findings and procedure details: Findings and procedure details Patients with diagnosed hepatic actinomycosis underwent 256-MDCT and MRI at 1.5 Tesla before treatment. The definitive diagnosis was confirmed on tissue cultures. We identified three main types of hepatic actinomycosis: solitary lesion, single or a group of abscesses&n[...]
Conclusion: In conclusion, primary hepatic actinomycosis is a rare disease and difficult to diagnosis, since its clinical presentation is nonspecific. Actinomycotic abscesses have no radiographic differences compare[...]
References: НSu F., SU T., Yang A.D., Liao C., Lee K. Isolated Hepatic Actinomycosis Mimicking Cholangiocarcinoma: A Case Report and Literature Review. J Radiol Sci. 2012; 37 (1): 29-33 Lall T., Shehab T.M., Valenstein P. Isolated hepatic actinomycosis: a case report. J Med Case Rep. 2010; 4: 45. Das N., Lee J.[...]