To compare the diagnostic accuracy of MnDPDP MR imaging and diffusion-weighted imaging (DWI), alone and in combination, for detecting colorectal liver metastases in patients with suspected metastatic disease. Thirty-three consecutive patients with suspected colorectal liver metastases underwent MR imaging. Three image sets (MnDPDP, DWI and combined MnDPDP and DWI) were reviewed independently by two observers. Lesions were scored on a five-point scale for malignancy and the areas (Az) under the receiver operating characteristic curves were calculated for each observer and image set. The sensitivity and specificity for lesion detection were calculated for each image set and compared. There were 83 metastases, 49 cysts and 1 haemangioma. Using the combined set resulted in the highest diagnostic accuracy for both observers (Az = 0.94 and 0.96), with improved averaged sensitivity of lesion detection compared with the DWI set (p = 0.01), and a trend towards improved sensitivity compared with the MnDPDP set (p = 0.06). There was no difference in the averaged specificity using any of the three image sets (p > 0.5). Combination of MnDPDP MR imaging and DWI resulted in the highest diagnostic accuracy and can increase sensitivity without loss in specificity.

Detection of colorectal hepatic metastases using MnDPDP MR imaging and diffusion-weighted imaging (DWI) alone and in combination.

Pancreatic adenocarcinoma has a rising incidence and a very poor survival rate. To develop new treatment strategies, extensive research is performed on animal models of pancreatic cancer. Orthotopic pancreatic tumors models, where the tumor is implanted into the pancreas, resemble the human disease more closely than subcutaneous tumor models, yet are difficult to monitor. In our study we report a magnetic resonance imaging (MRI) approach to visualize the pancreas in mice and to monitor orthotopically implanted pancreatic tumors. An MRI scanner was used to image normal murine pancreas and the pancreas of mice implanted with a human pancreatic adenocarcinoma cell line. Gadolinium (Gd)-DTPA-enhanced T1- and T2-weighted standard sequences were used with the objective to identify the pancreas and to monitor the growth of orthotopic tumors during 30 days. The pancreas as well as the implanted tumors could be easily identified using MRI. On T2-weighted images, the implanted tumors were easily visualized at the implantation side with high signal intensity. After application of a contrast agent, the tumors showed an enhancement. Heterogeneities within the tumor could be delineated, corresponding to histology, and the size of the tumor could be measured precisely. MR serves as a noninvasive high-resolution image modality to monitor murine pancreas as well as size, growth and even areas of heterogeneity in orthotopic pancreatic tumors.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.11281

Magnetic resonance imaging of the pancreas and pancreatic tumors in a mouse orthotopic model of human cancer

Since its inception in the late 1980s, intraoperative ultrasonography (IOUS) has been an important adjunct in hepatic resection.1 It can reveal new tumours not seen on preoperative imaging that would change surgical planning.2–7 Furthermore, IOUS provides new information about lesions and their association with vital anatomical structures to help guide resection planes.8–11 Studies in the 1990s showed that new information from IOUS altered surgical strategy in up to 53% of cases.3,12 Contemporary studies demonstrate rates closer to 20%.9,13,14 The decline in rates could be attributed to important advances in preoperative imaging. In particular, computed tomography (CT) and magnetic resonance imaging (MRI) with bespoke liver protocols enhance preoperative image accuracy and quality.15,16 Given these imaging advances, it is necessary to ask whether IOUS still plays a role in modern hepatic resections.

The primary outcome of our study was to determine whether the use of IOUS leads to changes in surgical strategy and the reason for those changes. Our secondary outcome was to determine whether the use of IOUS impacts resection margins.

http://canjsurg.ca/wp-content/uploads/2015/09/58-5-318.pdf

Intraoperative ultrasonography and surgical strategy in hepatic resection: What difference does it make?

Zur definitiven Klarung der Dignitat und Tumorklasse einer Leberlasion ist eine bildgesteuerte perkutane Biopsie indiziert. Unter Verwendung der Sonographie ist das Verfahren treffsicher und einfach. Die computertomographiegezielte Biopsie ist wegen der uberlagerungsfreien, reproduzierbaren Darstellung von Leberherden und ihren Nachbarstrukturen in vielen Fallen besser geeignet. Fur Lasionen, die sich weder mit Ultraschall noch mit CT biopsieren lassen, bietet sich die Magnetresonanztomographie an. Durch den Einsatz leberspezifischer Kontrastmittel kann das Zeitfenster zur Durchfuhrung einer Biopsie verlangert werden. Zur Abklarung diffuser Lebererkrankungen wird bei kontraindizierter perkutaner Biopsie eine transvenose Leberbiopsie unter Durchleuchtung empfohlen. Die in den 1980er Jahren propagierte Feinnadelaspirationsbiopsie wurde zunehmend durch Stanzbiopsien (Durchmesser 14–20 gg) in koaxialer Technik ersetzt, da diese eine zuverlassige artdiagnostische Klassifikation bei niedriger Komplikationsrate ermoglichen.

Perkutane Leberbiopsie

To classify a liver tumor, image-guided percutaneous biopsy of a liver lesion is indicated. Using ultrasound (US) to guide a biopsy needle into a liver lesion has been proven useful and safe. If a lesion cannot be seen on US or the access to a lesion has been complicated by its position, CT-guided biopsy can be performed. If a lesion cannot be delineated on US or CT, MR-guided biopsy is recommended. Using hepatospecific contrast agents, the time span to delineate tumor tissue can be prolonged. To differentiate diffuse liver disease, transvenous biopsy under fluoroscopic control can be performed if a percutaneous biopsy is contraindicated. In recent years fine-needle aspiration biopsy has been increasingly replaced by coaxial 14-20 G core biopsy, which is a safe and efficient technique to classify liver lesions and has a low complication rate.

Percutaneous liver biopsy. Overview of different techniques

Introduction: To evaluate the efficacy of biphasic spiral CT and MnDPDP (Teslascan , Nycomed Amersham) enhanced MR imaging to detect and classify liver lesions. Materials and Methods: 39 patients with known or suspected liver lesions were included into this study and examined with biphasic spiral CT and MnDPDP-enhanced MRI. 25 histological reports and 1 extreme increased serum AFP value could be obtained from 22 patients, therefore only these 26 proven lesions were included into this analysis. Results: From 39 patients CT revealed in 54% (14 lesions) and MRI in 54% correct (i.e., corresponding to the histology) diagnosis. Correct CT/wrong MRT diagnosis and vice versa was present in only 2 lesions each. Differentiating into benign versus malignant lesion was successful in 73% for MRI and 77 % for CT. In 81 % MRI revealed the correct type of lesion (hepatocellular or non-hepatocellular) vs. 77% with CT. Sensitivity/specificity for differentiation into benign/malignant lesions was 86%/ 70% (MRI) and 87%/77% (CT) and for differentiation of the lesions origin 100%/80% (MRI) and 80%/75% (CT), these differences were not significant. MnDPDP-enhanced MRI showed significantly more lesions than non-enhanced MRI. Conclusion: MnDPDP-enhanced MRI is better than CT in differentiating hepatocellular liver lesions from non-hepatocellular lesions. After contrast enhancement with MnDPDP significantly more lesions could be evaluated in MRI. MnDPDP improves, in combination with biphasic helical CT, the diagnosis of liver lesions.

Vergleich von Doppel-Spiral-CT und MnDPDP-verstärkter MRT zur Erfassung und Charakterisierung von Leberläsionen

Comparison of biphasic spiral CT and MnDPDP-enhanced MRI to detect and classify liver lesions

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Vergleich von Doppel-Spiral-CT und MnDPDP-verstärkter MRT zur Erfassung und Charakterisierung von Leberläsionen

Comparison of biphasic spiral CT and MnDPDP-enhanced MRI to detect and classify liver lesions