Abstract Background In the follow-up computed tomography (CT) examinations of patients who had undergone gastrectomy for gastric malignancy in our center, we noticed by chance that there was an isolated increase in the diameter of the main portal vein (MPV) without other radiological findings of portal hypertension. Objectives In this study, we aimed to evaluate whether the MPV diameter of patients who had gastric surgery for malignancy differed in the preoperative and postoperative periods and its change over time in patients who underwent postoperative follow-up examinations. Materials and Methods The CT images of 240 patients who underwent abdomen CT for staging and follow-up gastric malignancy between January 2017 and September 2021 were evaluated retrospectively. The CT scans of the remaining 149 patients after the exclusion criteria were included in the study. All CT imaging was performed using multidetector CT (64 or 128 slice) in portal venous phases. The images were evaluated by two radiologists based on consensus. Maximum MPV diameter were measured outer wall to outer wall with calipers on axial images at the level of 1 cm distal to the portosplenic confluence. Results One hundred forty-nine patients included in the study had preoperative CT examination. Eighty-three patients had follow-up CT examination at third month, 89 patients at sixth month, and 99 patients at first year. The MPV diameters differed significantly between preoperative CT and postoperative third month, sixth month, and first year CT (p = 0.001, p = 0.001, and p = 0.001, respectively). There was no difference in MPV diameter between postoperative third month CT and postoperative 6th month and 1st year CT (p = 0.514 and p = 0.078, respectively). Conclusion There is an increase in MPV diameter in the first 3 months postoperatively in patients undergoing gastric surgery for malignancy. This enlargement continues unchanged in the first 1 year follow-up. The radiologists' awareness of this situation may prevent the wrong diagnosis of portal hypertension, unnecessary concern, and further investigation.
{"title":"Main Portal Vein Diameter Changes in Patients Undergoing Gastric Surgery for Malignancy: An Observational CT Study","authors":"Elif Gündoğdu, Fatma Didem Bayav, İhsan Burak Karakaya, Barış Türker, İlter Özer","doi":"10.1055/s-0043-1775739","DOIUrl":"https://doi.org/10.1055/s-0043-1775739","url":null,"abstract":"Abstract Background In the follow-up computed tomography (CT) examinations of patients who had undergone gastrectomy for gastric malignancy in our center, we noticed by chance that there was an isolated increase in the diameter of the main portal vein (MPV) without other radiological findings of portal hypertension. Objectives In this study, we aimed to evaluate whether the MPV diameter of patients who had gastric surgery for malignancy differed in the preoperative and postoperative periods and its change over time in patients who underwent postoperative follow-up examinations. Materials and Methods The CT images of 240 patients who underwent abdomen CT for staging and follow-up gastric malignancy between January 2017 and September 2021 were evaluated retrospectively. The CT scans of the remaining 149 patients after the exclusion criteria were included in the study. All CT imaging was performed using multidetector CT (64 or 128 slice) in portal venous phases. The images were evaluated by two radiologists based on consensus. Maximum MPV diameter were measured outer wall to outer wall with calipers on axial images at the level of 1 cm distal to the portosplenic confluence. Results One hundred forty-nine patients included in the study had preoperative CT examination. Eighty-three patients had follow-up CT examination at third month, 89 patients at sixth month, and 99 patients at first year. The MPV diameters differed significantly between preoperative CT and postoperative third month, sixth month, and first year CT (p = 0.001, p = 0.001, and p = 0.001, respectively). There was no difference in MPV diameter between postoperative third month CT and postoperative 6th month and 1st year CT (p = 0.514 and p = 0.078, respectively). Conclusion There is an increase in MPV diameter in the first 3 months postoperatively in patients undergoing gastric surgery for malignancy. This enlargement continues unchanged in the first 1 year follow-up. The radiologists' awareness of this situation may prevent the wrong diagnosis of portal hypertension, unnecessary concern, and further investigation.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136294485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Iatrogenic injuries are unavoidable complications of surgeries and minimally invasive procedures. They are generally classified into vascular and nonvascular injuries and based on the time of injury into early and late injuries. Iatrogenic injuries, particularly vascular injuries, increase the mortality and morbidity, with prolongation of hospital-stay. Multidetector computed tomography (MDCT) is a highly sensitive, and often the first imaging modality in suspected iatrogenic injuries. This pictorial review elucidates the imaging considerations and appearances of iatrogenic injuries of the abdominopelvic organs on MDCT.
{"title":"Spectrum of Multidetector Computed Tomography Imaging Findings in Iatrogenic Abdominopelvic Injuries: A Comprehensive Pictorial Review","authors":"Pavithra Subramanian, Arun Sharma, Raghuraman Soundararajan, Manphool Singhal","doi":"10.1055/s-0043-1775736","DOIUrl":"https://doi.org/10.1055/s-0043-1775736","url":null,"abstract":"Abstract Iatrogenic injuries are unavoidable complications of surgeries and minimally invasive procedures. They are generally classified into vascular and nonvascular injuries and based on the time of injury into early and late injuries. Iatrogenic injuries, particularly vascular injuries, increase the mortality and morbidity, with prolongation of hospital-stay. Multidetector computed tomography (MDCT) is a highly sensitive, and often the first imaging modality in suspected iatrogenic injuries. This pictorial review elucidates the imaging considerations and appearances of iatrogenic injuries of the abdominopelvic organs on MDCT.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136293497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abdulla KV, Venkatesh Kasi Arunachalam, Haleema Sherene, Vijayakumaran Ethiraju, Rupa Ranganathan, Gowtham SM, Sriman Rajasekaran, Pankaj Mehta, Mathew Cherian
Abstract Introduction Perianal fistula and its recurrence is a challenging entity for surgeons. It is a well-establi1shed fact that magnetic resonance imaging (MRI) findings influence surgical procedures and reduce the rate of recurrence. In this study, we assessed the contrast-enhanced (CE) three dimensional T1 sequences [sampling perfection with application optimized contrast using different flip angle evolution (SPACE) and volumetric interpolated breath-hold examination (VIBE)] in a 3T MRI system to evaluate perianal fistulas and compared them with two-dimensional (2D) sequences. Materials and Methods Forty-four patients (mean age, 38.8 ± 15.3 [standard deviation]; 32 males, 12 females) with perianal fistula were included in this prospective study. The patients underwent conventional noncontrast, 2D sequences, diffusion-weighted imaging, followed by postcontrast, 2D T1 images in both axial and coronal planes, and 3D sequences at 3T. Acquisition times were recorded for each sequence. Each postcontrast sequence was evaluated in terms of image quality, presence of artifacts, fistula type, presence of an abscess, visibility, and number of internal orifices. The surgical findings were considered the gold standard. The imaging findings were compared with the surgical findings. Results In all three sequences, the fistula type and abscess were identified correctly in all patients. The sensitivity value for identification of ramifications utilizing CE 3D T1 VIBE sequence, CE 3D T1 SPACE, and CE 2D T1 images was 100, 86, and 36%, respectively. The number of internal orifices was identified by the CE 3D T1 VIBE and CE 3D T1 SPACE sequences in 100 and 92% of patients, respectively. CE 2D T1 images correctly identified internal orifices in 80% of patients. The overall scan time for each 3D sequence was shorter than for the combined postcontrast 2D sequences. Conclusion CE 3D T1 SPACE and CE 3D T1 VIBE sequences outperformed conventional CE 2D sequences in the evaluation of perianal fistulas in terms of visibility and the number of internal orifices with a shorter scanning time. Among the 3D sequences, CE 3D T1 VIBE is slightly superior to CE 3D T1 SPACE sequence.
摘要简介肛周瘘及其复发是困扰外科医生的难题。这是一个公认的事实，磁共振成像(MRI)的结果影响手术程序和降低复发率。在这项研究中，我们在3T MRI系统中评估了对比度增强(CE)三维T1序列[使用不同翻转角度演化(SPACE)和体积插值屏气检查(VIBE)的应用优化对比度采样完美]来评估肛周瘘，并将其与二维(2D)序列进行了比较。材料与方法44例患者(平均年龄38.8±15.3岁[标准差];本前瞻性研究包括32名男性，12名女性)肛周瘘。患者接受常规非对比、2D序列、弥散加权成像，然后进行对比后、轴位和冠状面二维T1图像和3T三维序列。记录每个序列的采集时间。根据图像质量、伪影的存在、瘘管类型、脓肿的存在、可见性和内孔的数量来评估每个后对比序列。手术结果被认为是金标准。将影像学表现与手术表现进行比较。结果三种序列均能正确识别瘘型和脓肿。CE 3D T1 VIBE序列、CE 3D T1 SPACE和CE 2D T1图像识别分枝的灵敏度分别为100、86和36%。CE 3D T1 VIBE和CE 3D T1 SPACE序列分别识别了100%和92%的患者的内孔数量。CE 2D T1图像正确识别了80%的患者的内孔。每个3D序列的总扫描时间比对比后的2D序列的总扫描时间短。结论CE 3D T1 SPACE和CE 3D T1 VIBE序列在评估肛周瘘的可见性和内孔数量方面优于传统CE 2D序列，且扫描时间更短。其中，CE 3D T1 VIBE序列略优于CE 3D T1 SPACE序列。
{"title":"Comparison of Contrast-Enhanced 3D Imaging with 2D Imaging in the Evaluation of Perianal Fistula at 3T: A Prospective Observational Study","authors":"Abdulla KV, Venkatesh Kasi Arunachalam, Haleema Sherene, Vijayakumaran Ethiraju, Rupa Ranganathan, Gowtham SM, Sriman Rajasekaran, Pankaj Mehta, Mathew Cherian","doi":"10.1055/s-0043-1775738","DOIUrl":"https://doi.org/10.1055/s-0043-1775738","url":null,"abstract":"Abstract Introduction Perianal fistula and its recurrence is a challenging entity for surgeons. It is a well-establi1shed fact that magnetic resonance imaging (MRI) findings influence surgical procedures and reduce the rate of recurrence. In this study, we assessed the contrast-enhanced (CE) three dimensional T1 sequences [sampling perfection with application optimized contrast using different flip angle evolution (SPACE) and volumetric interpolated breath-hold examination (VIBE)] in a 3T MRI system to evaluate perianal fistulas and compared them with two-dimensional (2D) sequences. Materials and Methods Forty-four patients (mean age, 38.8 ± 15.3 [standard deviation]; 32 males, 12 females) with perianal fistula were included in this prospective study. The patients underwent conventional noncontrast, 2D sequences, diffusion-weighted imaging, followed by postcontrast, 2D T1 images in both axial and coronal planes, and 3D sequences at 3T. Acquisition times were recorded for each sequence. Each postcontrast sequence was evaluated in terms of image quality, presence of artifacts, fistula type, presence of an abscess, visibility, and number of internal orifices. The surgical findings were considered the gold standard. The imaging findings were compared with the surgical findings. Results In all three sequences, the fistula type and abscess were identified correctly in all patients. The sensitivity value for identification of ramifications utilizing CE 3D T1 VIBE sequence, CE 3D T1 SPACE, and CE 2D T1 images was 100, 86, and 36%, respectively. The number of internal orifices was identified by the CE 3D T1 VIBE and CE 3D T1 SPACE sequences in 100 and 92% of patients, respectively. CE 2D T1 images correctly identified internal orifices in 80% of patients. The overall scan time for each 3D sequence was shorter than for the combined postcontrast 2D sequences. Conclusion CE 3D T1 SPACE and CE 3D T1 VIBE sequences outperformed conventional CE 2D sequences in the evaluation of perianal fistulas in terms of visibility and the number of internal orifices with a shorter scanning time. Among the 3D sequences, CE 3D T1 VIBE is slightly superior to CE 3D T1 SPACE sequence.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"149 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136294348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background Distal colostogram and ileostogram are commonly performed radiological procedures in the pediatric population. It is sometimes difficult to identify the distal stoma while performing these procedures. Aim The aim of this study was to describe a technique for the confident identification of distal stoma. Methods Injection of a small quantity of air through the catheterized stoma and following it can help to identify the stoma, as proximal or distal, based on anatomy of the delineated bowel. Conclusion Pneumatic insufflation is a simple, quick procedure to confidently identify the distal stoma whenever in doubt.
{"title":"Pneumatic Insufflation to Confirm Distal Stoma When in Doubt","authors":"Akshay Kumar Saxena, Pavithra Subramanian, Anmol Bhatia, Kushaljit Singh Sodhi","doi":"10.1055/s-0043-1774782","DOIUrl":"https://doi.org/10.1055/s-0043-1774782","url":null,"abstract":"Abstract Background Distal colostogram and ileostogram are commonly performed radiological procedures in the pediatric population. It is sometimes difficult to identify the distal stoma while performing these procedures. Aim The aim of this study was to describe a technique for the confident identification of distal stoma. Methods Injection of a small quantity of air through the catheterized stoma and following it can help to identify the stoma, as proximal or distal, based on anatomy of the delineated bowel. Conclusion Pneumatic insufflation is a simple, quick procedure to confidently identify the distal stoma whenever in doubt.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136294068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-05eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1774743
Kushaljit Singh Sodhi, Ting Y Tao, Noah Seymore
{"title":"ChatGPT: Chasing the Storm in Radiology Training and Education.","authors":"Kushaljit Singh Sodhi, Ting Y Tao, Noah Seymore","doi":"10.1055/s-0043-1774743","DOIUrl":"10.1055/s-0043-1774743","url":null,"abstract":"","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"33 4","pages":"431-435"},"PeriodicalIF":0.9,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4e/45/10-1055-s-0043-1774743.PMC10556337.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41166230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-05eCollection Date: 2023-10-01DOI: 10.1055/s-0043-1775571
Ankur J Shah, Pushpa Bt
Vertebral marrow lesions are quite frequently detected in magnetic resonance imaging (MRI) of the spine referred for various clinical scenarios. Although MRI is highly sensitive for detecting marrowlesions, the speci fi citycan be improved by understanding and choosing appropriate sequences. Relative distribution of fat and water in the vertebral marrow lesions, estimation of cell density
{"title":"Neoplastic and Non-Neoplastic Vertebral Marrow Pathologies: Can the Conventional and Advanced MRI Sequences Provide a Definitive Answer?","authors":"Ankur J Shah, Pushpa Bt","doi":"10.1055/s-0043-1775571","DOIUrl":"10.1055/s-0043-1775571","url":null,"abstract":"Vertebral marrow lesions are quite frequently detected in magnetic resonance imaging (MRI) of the spine referred for various clinical scenarios. Although MRI is highly sensitive for detecting marrowlesions, the speci fi citycan be improved by understanding and choosing appropriate sequences. Relative distribution of fat and water in the vertebral marrow lesions, estimation of cell density","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"33 4","pages":"438-439"},"PeriodicalIF":0.6,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/43/10-1055-s-0043-1775571.PMC10556313.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41180458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Spontaneous intracranial hypotension (SICH) is the emerging cause of orthostatic headache as it has been better recognized in recent years. SICH happens due to spinal cerebrospinal fluid (CSF) leak; however, the manifestations are predominantly cranial and hence imaging in SICH includes brain and spine. There are few characteristic brain imaging features to be concerned about to diagnose SICH in patients with vague symptoms or low clinical suspicion. Spine screening is recommended in these patients to assess spinal CSF leaks. While neuroradiologists play a significant role from the time of diagnosis to treatment of SICH, there is a need for all the general radiologists to be aware of the condition. Computed tomography myelogram and digital subtraction myelogram are performed for diagnostic and therapeutic management of SICH. There is a known risk for SICH recurrence in patients with sagittal longitudinal epidural collection and hence, targeted blood patch should be used instead of blind patch. Most importantly, slow mobilization is recommended following the patch to avoid recurrence.
{"title":"Spontaneous Intracranial Hypotension: A Review of Neuroimaging and Current Concepts","authors":"Sharath Kumar Goddu Govindappa, Chaitra Parameshwara Adiga, Savith Kumar, Lakshmikanth N. Goolahally, Sujit Kumar","doi":"10.1055/s-0043-1774301","DOIUrl":"https://doi.org/10.1055/s-0043-1774301","url":null,"abstract":"Abstract Spontaneous intracranial hypotension (SICH) is the emerging cause of orthostatic headache as it has been better recognized in recent years. SICH happens due to spinal cerebrospinal fluid (CSF) leak; however, the manifestations are predominantly cranial and hence imaging in SICH includes brain and spine. There are few characteristic brain imaging features to be concerned about to diagnose SICH in patients with vague symptoms or low clinical suspicion. Spine screening is recommended in these patients to assess spinal CSF leaks. While neuroradiologists play a significant role from the time of diagnosis to treatment of SICH, there is a need for all the general radiologists to be aware of the condition. Computed tomography myelogram and digital subtraction myelogram are performed for diagnostic and therapeutic management of SICH. There is a known risk for SICH recurrence in patients with sagittal longitudinal epidural collection and hence, targeted blood patch should be used instead of blind patch. Most importantly, slow mobilization is recommended following the patch to avoid recurrence.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135306388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract According to the International Society for the Study of Vascular Anomalies (ISSVA) classification, vascular anomalies include a diverse range of pathologies, classified as either vascular tumors or vascular malformations. This classification, last revised in 2018, aims to explain the biological basis of vascular lesions and help clinicians to manage the anomalies. In vascular tumors, there are proliferative changes of endothelial cells, while vascular malformations primarily consist of structural vascular abnormalities. Infantile hemangioma is the most common soft-tissue vascular tumor. Vascular malformations are an extensive group of malformations of the arterial, venous, and lymphatic systems, either in isolation or in combination. Radiological evaluation plays a key part in the management of pediatric patients with these entities. The understanding of sonography and magnetic resonance imaging findings entails its correlation with clinical findings at the time of scanning.
{"title":"Pediatric Vascular Anomalies: A Clinical and Radiological Perspective","authors":"Rahul Gupta, Anu Bhandari, Oscar M. Navarro","doi":"10.1055/s-0043-1774391","DOIUrl":"https://doi.org/10.1055/s-0043-1774391","url":null,"abstract":"Abstract According to the International Society for the Study of Vascular Anomalies (ISSVA) classification, vascular anomalies include a diverse range of pathologies, classified as either vascular tumors or vascular malformations. This classification, last revised in 2018, aims to explain the biological basis of vascular lesions and help clinicians to manage the anomalies. In vascular tumors, there are proliferative changes of endothelial cells, while vascular malformations primarily consist of structural vascular abnormalities. Infantile hemangioma is the most common soft-tissue vascular tumor. Vascular malformations are an extensive group of malformations of the arterial, venous, and lymphatic systems, either in isolation or in combination. Radiological evaluation plays a key part in the management of pediatric patients with these entities. The understanding of sonography and magnetic resonance imaging findings entails its correlation with clinical findings at the time of scanning.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"232 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135306386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anurima Patra, Aisha Lakhani, Antony Augustine, Priyanka Mohapatra, Anu Eapen, Ashish Singh, Dipti Masih, Thomas S. Ram, Mark R. Jesudason, Rohin Mittal, Anuradha Chandramohan
Abstract Objective The aim of this study was to characterize the tissue involving the margin and study if this information will affect margin prediction on restaging magnetic resonance imaging (MRI) in low rectal adenocarcinoma (LRC) patients treated with neoadjuvant long-course chemoradiotherapy (LCCRT). Methods In this retrospective study of nonmetastatic LRC (distal margin <5 cm from the anal verge) treated with LCCRT followed by surgery, a radiologist blinded to outcome reread the restaging MRI and documented if the radial margin was involved by tumor, fibrosis, or mucin reaction using T2 high-resolution (HR) and diffusion-weighted imaging (DWI). The diagnostic performance of tumor-involving margin on restaging MRI was assessed using surgical histopathology as a reference. Interobserver agreement between three independent radiologists was assessed in a subset. Results We included 133 patients (80 males and 53 females) with a mean (range) age of 44.7 (21–86) years and 82% of them had well or moderately differentiated adenocarcinoma. Baseline MRI showed T3 (n = 58) or T4 (n = 60) disease in 89% of the patients. The pathological margin was positive in 21% (n = 28) cases. In restaging MRI, the circumferential resection margin (CRM) ≤1 mm in 75.1% (n = 100) cases and MRI predicted tumor, fibrosis, and mucin reaction at the margin in 60, 34, and 6%, respectively, and histopathology showed tumor cells in 33, 14.7, and 16.6% of them, respectively. LRC with tumor-involving margin and bad response (MR tumor regression grade [mr-TRG] 3–5) on restaging MRI had fourfold increased risk of positive pathological circumferential resection margin (pCRM). There was moderate and fair inter-reader agreement for the tissue type involving the CRM (κ = 0.471) and mr-TRG (κ = 0.266), p < 0.05. The use of both distance criteria and tumor-involving margins improved the diagnostic accuracy for margin prediction from 39 to 66% on restaging MRI. Conclusions Margin prediction on restaging MRI can be improved by characterizing the tissue type involving the margin in low rectal cancer patients. The inter-reader agreement was moderate for determining the tissue type.
{"title":"Predicting Positive Radial Margin on Restaging MRI of Patients with Low Rectal Cancer: Can We Do Better?","authors":"Anurima Patra, Aisha Lakhani, Antony Augustine, Priyanka Mohapatra, Anu Eapen, Ashish Singh, Dipti Masih, Thomas S. Ram, Mark R. Jesudason, Rohin Mittal, Anuradha Chandramohan","doi":"10.1055/s-0043-1774300","DOIUrl":"https://doi.org/10.1055/s-0043-1774300","url":null,"abstract":"Abstract Objective The aim of this study was to characterize the tissue involving the margin and study if this information will affect margin prediction on restaging magnetic resonance imaging (MRI) in low rectal adenocarcinoma (LRC) patients treated with neoadjuvant long-course chemoradiotherapy (LCCRT). Methods In this retrospective study of nonmetastatic LRC (distal margin <5 cm from the anal verge) treated with LCCRT followed by surgery, a radiologist blinded to outcome reread the restaging MRI and documented if the radial margin was involved by tumor, fibrosis, or mucin reaction using T2 high-resolution (HR) and diffusion-weighted imaging (DWI). The diagnostic performance of tumor-involving margin on restaging MRI was assessed using surgical histopathology as a reference. Interobserver agreement between three independent radiologists was assessed in a subset. Results We included 133 patients (80 males and 53 females) with a mean (range) age of 44.7 (21–86) years and 82% of them had well or moderately differentiated adenocarcinoma. Baseline MRI showed T3 (n = 58) or T4 (n = 60) disease in 89% of the patients. The pathological margin was positive in 21% (n = 28) cases. In restaging MRI, the circumferential resection margin (CRM) ≤1 mm in 75.1% (n = 100) cases and MRI predicted tumor, fibrosis, and mucin reaction at the margin in 60, 34, and 6%, respectively, and histopathology showed tumor cells in 33, 14.7, and 16.6% of them, respectively. LRC with tumor-involving margin and bad response (MR tumor regression grade [mr-TRG] 3–5) on restaging MRI had fourfold increased risk of positive pathological circumferential resection margin (pCRM). There was moderate and fair inter-reader agreement for the tissue type involving the CRM (κ = 0.471) and mr-TRG (κ = 0.266), p < 0.05. The use of both distance criteria and tumor-involving margins improved the diagnostic accuracy for margin prediction from 39 to 66% on restaging MRI. Conclusions Margin prediction on restaging MRI can be improved by characterizing the tissue type involving the margin in low rectal cancer patients. The inter-reader agreement was moderate for determining the tissue type.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"354 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135306387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Objective The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) and chemical shift imaging (CSI) for the differentiation of benign and malignant vertebral lesions. Methods Patients with vertebral lesions underwent routine magnetic resonance imaging (MRI) along with DWI and CSI. Qualitative analysis of the morphological features was done by routine MRI. Quantitative analysis of apparent diffusion coefficient (ADC) from DWI and fat fraction (FF) from CSI was done and compared between benign and malignant vertebral lesions. Results Seventy-two patients were included. No significant difference was noted in signal intensities of benign and malignant lesions on conventional MRI sequences. Posterior element involvement, paravertebral soft-tissue lesion, and posterior vertebral bulge were common in malignant lesion, whereas epidural/paravertebral collection, absence of posterior vertebral bulge, and multiple compression fractures were common in benign vertebral lesion (p < 0.001). The mean ADC value was 1.25 ± 0.27 mm2/s for benign lesions and 0.9 ± 0.19 mm2/s for malignant vertebral lesions (p ≤ 0.001). The mean value of FF was 12.7 ± 7.49 for the benign group and 4.04 ± 2.6 for the malignant group (p < 0.001). A receiver operating characteristic (ROC) curve analysis showed that an ADC cutoff of 1.05 × 10−3 mm2/s and an FF cutoff of 6.9 can differentiate benign from malignant vertebral lesions, with the former having 86% sensitivity and 82.8% specificity and the latter having 93% sensitivity and 96.6% specificity. Conclusion The addition of DWI and CSI to routine MRI protocol in patients with vertebral lesions promises to be very helpful in differentiating benign from malignant vertebral lesions when difficulty in qualitative interpretation of conventional MR images arises.
{"title":"Diffusion-Weighted Imaging and Chemical Shift Imaging to Differentiate Benign and Malignant Vertebral Lesion: A Hospital-Based Cross-Sectional Study","authors":"Kaneez Fatima, Suprava Naik, Mantu Jain, Sanjeev Kumar Bhoi, Somnath Padhi, Nerbadyswari Deep Bag, Ashutosh Panigrahi, Sudipta Mohakud","doi":"10.1055/s-0043-1772848","DOIUrl":"https://doi.org/10.1055/s-0043-1772848","url":null,"abstract":"Abstract Objective The aim of this study was to evaluate the role of diffusion-weighted imaging (DWI) and chemical shift imaging (CSI) for the differentiation of benign and malignant vertebral lesions. Methods Patients with vertebral lesions underwent routine magnetic resonance imaging (MRI) along with DWI and CSI. Qualitative analysis of the morphological features was done by routine MRI. Quantitative analysis of apparent diffusion coefficient (ADC) from DWI and fat fraction (FF) from CSI was done and compared between benign and malignant vertebral lesions. Results Seventy-two patients were included. No significant difference was noted in signal intensities of benign and malignant lesions on conventional MRI sequences. Posterior element involvement, paravertebral soft-tissue lesion, and posterior vertebral bulge were common in malignant lesion, whereas epidural/paravertebral collection, absence of posterior vertebral bulge, and multiple compression fractures were common in benign vertebral lesion (p < 0.001). The mean ADC value was 1.25 ± 0.27 mm2/s for benign lesions and 0.9 ± 0.19 mm2/s for malignant vertebral lesions (p ≤ 0.001). The mean value of FF was 12.7 ± 7.49 for the benign group and 4.04 ± 2.6 for the malignant group (p < 0.001). A receiver operating characteristic (ROC) curve analysis showed that an ADC cutoff of 1.05 × 10−3 mm2/s and an FF cutoff of 6.9 can differentiate benign from malignant vertebral lesions, with the former having 86% sensitivity and 82.8% specificity and the latter having 93% sensitivity and 96.6% specificity. Conclusion The addition of DWI and CSI to routine MRI protocol in patients with vertebral lesions promises to be very helpful in differentiating benign from malignant vertebral lesions when difficulty in qualitative interpretation of conventional MR images arises.","PeriodicalId":51597,"journal":{"name":"Indian Journal of Radiology and Imaging","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135878276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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