LAVA HyperSense and deep-learning reconstruction for near-isotropic (3D) enhanced magnetic resonance enterography in patients with Crohn’s disease: utility in noise reduction and image quality improvement

PURPOSEThis study aimed to compare near-isotropic contrast-enhanced T1-weighted (CE-T1W) magnetic resonance enterography (MRE) images reconstructed with vendor-supplied deep-learning reconstruction (DLR) with those reconstructed conventionally in terms of image quality.METHODSA total of 35 patients who underwent MRE for Crohn’s disease between August 2021 and February 2022 were included in this retrospective study. The enteric phase CE-T1W MRE images of each patient were reconstructed with conventional reconstruction and no image filter (original), with conventional reconstruction and image filter (filtered), and with a prototype version of AIRTM Recon DL 3D (DLR), which were then reformatted into the axial plane to generate six image sets per patient. Two radiologists independently assessed the images for overall image quality, contrast, sharpness, presence of motion artifacts, blurring, and synthetic appearance for qualitative analysis, and the signal-to-noise ratio (SNR) was measured for quantitative analysis.RESULTSThe mean scores of the DLR image set with respect to overall image quality, contrast, sharpness, motion artifacts, and blurring in the coronal and axial images were significantly superior to those of both the filtered and original images (P 0.05). In the quantitative analysis, the SNR was significantly increased in the order of original, filtered, and DLR images (P < 0.001).CONCLUSIONUsing DLR for near-isotropic CE-T1W MRE improved the image quality and increased the SNR

Merkel Cell Carcinoma of the Axilla and Adrenal Gland: A Case Report with Imaging and Pathologic Findings

Merkel cell carcinoma (MCC) is a rare and aggressive neuroendocrine carcinoma of the skin. MCC is characterized by a high incidence of locoregional recurrence, and distant metastasis, and often requires short-term follow-up after treatment. In this present paper, we describe a rare case of MCC, which presented as a palpable axillary mass and an incidental adrenal mass, and report on the ultrasonography, computed tomography, and 18F-fluorodeoxyglucose-positron emission tomography findings. The patient underwent surgery and adjuvant radiation therapy. Seven months after the initial diagnosis, distant metastasis was detected during a follow-up examination

Impact of Deep-Learning Based Reconstruction on Single-Breath-Hold, Single-Shot Fast Spin-Echo in MR Enterography for Crohn’s Disease

Purpose To assess the quality of four images obtained using single-breath-hold (SBH), single-shot fast spin-echo (SSFSE) and multiple-breath-hold (MBH) SSFSE with and without deep-learning based reconstruction (DLR) in patients with Crohn’s disease. Materials and Methods This study included 61 patients who underwent MR enterography (MRE) for Crohn’s disease. The following images were compared: SBH-SSFSE with (SBH-DLR) and without (SBHconventional reconstruction [CR]) DLR and MBH-SSFSE with (MBH-DLR) and without (MBH-CR) DLR. Two radiologists independently reviewed the overall image quality, artifacts, sharpness, and motionrelated signal loss using a 5-point scale. Three inflammatory parameters were evaluated in the ileum, the terminal ileum, and the colon. Moreover, the presence of a spatial misalignment was evaluated. Signal-to-noise ratio (SNR) was calculated at two locations for each sequence. Results DLR significantly improved the image quality, artifacts, and sharpness of the SBH images. No significant differences in scores between MBH-CR and SBH-DLR were detected. SBH-DLR had the highest SNR (p < 0.001). The inter-reader agreement for inflammatory parameters was good to excellent (κ = 0.76–0.95) and the inter-sequence agreement was nearly perfect (κ = 0.92–0.94). Misalignment artifacts were observed more frequently in the MBH images than in the SBH images (p < 0.001). Conclusion SBH-DLR demonstrated equivalent quality and performance compared to MBH-CR. Furthermore, it can be acquired in less than half the time, without multiple BHs and reduce slice misalignments

Diffusion-weighted imaging for evaluating lymph node eradication after neoadjuvant chemoradiation therapy in locally advanced rectal cancer

Background: As lymph node (LN) eradication is the prerequisite for clinical surveillance or local excision for patients who have achieved a complete response after preoperative chemoradiation therapy (CRT), the radiological evaluation of LN eradication is important. Purpose: To evaluate the added value of diffusion-weighted imaging (DWI) in the evaluation of LN eradication after CRT in patients with locally advanced rectal cancer (LARC). Material and Methods: Ninety-five consecutive patients (64 men, 31 women; mean age, 59 years; range, 32-82 years) who underwent pre-and post-CRT 1.5-T MRI with DWI (b=0, 1000s/mm(2)) were enrolled. To evaluate the added value of DWI in the evaluation of LN eradication after CRT, two radiologists first independently read the pre-and post-CRT T2-weighted (T2W) images and then read the combined T2W imaging set and the pre-and post-CRT DWIs with a 4-week interval. The radiologists recorded their confidence scores for LN eradication using a 5-point scale on a per-patient basis. The diagnostic performances were compared between the two reading sessions for each reader with pair-wise comparisons of receiver-operating characteristic curves. Histopathological reports served as the reference standards for LN eradication. Results: The study population consisted of an LN-eradicated group (n=66) and a non-eradicated group (n=29). The diagnostic performances did not significantly differ between the two reading sessions for the two readers (AUCs for reader 1, 0.770 and 0.774, P=0.8155; for reader 2, 0.794 and 0.798, P=0.8588). Conclusion: Adding DWI to T2W imaging provided no additional diagnostic benefit for the evaluation of LN eradication following CRT in patients with LARC.N

Apparent diffusion coefficient for lymph node characterization after chemoradiation therapy for locally advanced rectal cancer

Background: Because further treatment plans depends on lymph node (LN) status after neoadjuvant chemoradiation therapy (CRT), the accurate characterization of LN is important. Purpose: To evaluate the diagnostic performance of apparent diffusion coefficient (ADC) for LN characterization after CRT and to compare the performance with that of LN size. Material and Methods: Fifty-three patients (36 men, 17 women; mean age, 58 years; age range, 34-79 years) who underwent CRT and subsequent surgery were included. All patients underwent 1.5-T magnetic resonance imaging (MRI). Each regional LN on post-CRT MRI was identified in consensus by two radiologists after reviewing the pre-CRT MRI. The ADC value and size in each LN was measured. To compare the mean ADC values and sizes of the metastatic and non-metastatic LNs after CRT, the t-test was used. To calculate the performance, a ROC curve analysis was performed. The histopathological examinations served as the reference standard. Results: A total of 115 LNs (29 metastatic and 86 non-metastatic) were matched and analyzed. The mean ADC of the metastatic LNs was significantly higher than that of the non-metastatic LNs (1.36 +/- 0.27 x 10(-3) mm(2)/s; 1.13 +/- 0.23 x 10(-3) mm(2)/s, P &lt; 0.0001). The mean size of the metastatic LNs was also significantly larger than that of the non-metastatic LNs (5.6 +/- 3.1; 3.9 +/- 1.2, P = 0.0078). There was no significant difference between the areas under the curve of the ADC and size (0.742 [95% CI, 0.652-0.819]; 0.680 [0.586-0.764], respectively, P = 0.4090). Conclusion: The performance of ADC for LN characterization after CRT was comparable to that of LN size.N

Association of non-alcoholic fatty liver disease with renal stone disease detected on computed tomography

Objective: To evaluate the association between Non-alcoholic fatty liver disease (NAFLD) with renal stone disease detected on computed tomography (CT). Method: A total 1812 patients who underwent abdomen-pelvis CT in July 2015 were included in this study. The inclusion criteria for NAFLD were as follows: (i) lower average Hounsfield unit (HU) of hepatic right lobe, left medial and lateral segment when compared with that of spleen, (ii) patients who having urolithiasis in kidneys, ureters and urinary bladder, and (iii) patients underwent abdomen-pelvis CT including noncontrast image. The statistical significance of the association between NAFLD and renal stone disease was assessed using Chi Square Test. The Odds ratios and 95% CI were calculated to assess the propensity of renal stones disease for NAFLD by using Logistic Regression analysis. Results: The frequency of renal stone disease in patients with NAFLD was higher approximately 19% than those who having renal stone disease without NAFLD. In addition, the presence of NAFLD was linked with renal stone disease showing that detection rate of renal stone disease in patients with NAFLD was markedly high (odds ratio: 5, 95% CI, 3–8.2) (p < 0.05) in multivariate analysis. Conclusion: The presence of significant association between NAFLD with renal stone disease and NAFLD may be considered to be an independent variable as a risk factor for renal stone disease. Keywords: Non-alcoholic fatty liver disease, Renal stone disease, Computed tomograph

Multiphase CT attenuation in the irradiated hepatic parenchyma in 61 patients.

<p>Data are number of patients with percentages in parentheses. Sum of the percentages may not be 100% due to rounding of the numbers.</p

Typical hepatic parenchymal change seen on one month after SBRT.

<p>(A) As seen on the isodose curve for planning SBRT with a total dose of 45 Gy, the planning target volume (PTV, purple circle) is expanded to cover the gross tumor volume (red circle). The irradiated hepatic parenchyma is delineated corresponding to the region inside the 15-Gy isodose line, but outside of the PTV boundary. (B-E) The target tumor (arrowheads) in the left lateral segment of the liver, was treated with transarterial chemoembolization prior to SBRT. Residual tumor is noted (arrowheads) with arterial enhancement and washout on the portal and delayed phases adjacent to lipiodol. One-month f/u CT images after SBRT demonstrate that there is no significant change in the irradiated hepatic parenchyma or in the tumor (arrowheads) in any phase including noncontrast (B), arterial (C), portal (D), and delayed (E) phases. A fiducial marker (arrows) is also seen.</p