Imaging of liver transplantation

Liver transplantation (LT) is the treatment of choice for end-stage chronic liver disease, fulminant liver failure and early stage hepatocellular carcinoma. As discussed in this review, state-of-the-art imaging modalities including ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) play a pivotal role in the selection of patients and donors, as well as in early detection of those complications at risk of impairing graft function and/or survival. We also illustrate main imaging findings related to the wide spectrum of clinical problems raised by LT

Can multiparametric MRI replace Roach equations in staging prostate cancer before external beam radiation therapy?

Purpose To investigate the agreement between Roach equations (RE) and multiparametric magnetic resonance imaging (mpMRI) in assessing the T-stage of prostate cancer (PCa). Materials and methods Seventy-three patients with biopsy-proven PCa and previous RE assessment prospectively underwent mpMRI on a 3.0T magnet before external beam radiation therapy (EBRT). Using Cohen\u2019s kappa statistic, we assessed the agreement between RE and mpMRI in defining the T-stage ( 65T3 vs.T\u2005 64\u20052) and risk category according to the National comprehensive cancer network criteria ( 64intermediate vs. 65high). We also calculated sensitivity and specificity for 65T3 stage in an additional group of thirty-seven patients with post-prostatectomy histological examination (mpMRI validation group). Results The agreement between RE and mpMRI in assessing the T stage and risk category was moderate (k\u2005=\u20050.53 and 0.56, respectively). mpMRI changed the T stage and risk category in 21.9% (95%C.I. 13.4\u201333-4) and 20.5% (95%C.I. 12.3\u201331.9), respectively, prevalently downstaging PCa compared to RE. Sensitivity and specificity for 65T3 stage in the mpMRI validation group were 81.8% (95%C.I. 65.1\u201391.9) and 88.5% (72.8\u201396.1). Conclusion RE and mpMRI show moderate agreement only in assessing the T-stage of PCa, translating into an mpMRI-induced change in risk assessment in about one fifth of patients. As supported by high sensitivity/specificity for 65T3 stage in the validation group, the discrepancy we found is in favour of mpMRI as a tool to stage PCa before ERBT

Additional findings at preoperative breast MRI: the value of second-look digital breast tomosynthesis

OBJECTIVES: To evaluate second-look digital breast tomosynthesis (SL-DBT) for additional findings (AFs) at preoperative MRI compared with second-look ultrasound (SL-US). METHODS: We included 135 patients with breast cancer who underwent digital mammography (DM), DBT, US, and MRI at two centres. MR images were retrospectively evaluated to find AFs, described as focus, mass, or non-mass; 6410 mm or >10 mm in size; BI-RADS 3, 4, or 5. DM and DBT exams were reviewed looking for MRI AFs; data on SL-US were collected. Reference standard was histopathology or 6512-month negative follow-up. Fisher exact test and McNemar test were used. RESULTS: Eighty-four AFs were detected in 53/135 patients (39%, 95%CI 31-48%). A correlate was found for 44/84 (52%, 95%CI 41-63%) at SL-US, for 20/84 (24%, 95%CI 11-28%) at SL-DM, for 42/84 (50%, 95%CI 39-61%) at SL-DBT, for 63/84 (75%, 95%CI 64-84%) at SL-DBT, and/or SL-US, the last rate being higher than for SL-US only, overall (p\u200910 mm, BI-RADS 4 or 5, or malignant lesions (p\u2009<\u20090.031). Of 21 AFs occult at both SLs, 17 were malignant (81%, 95%CI 58-94%). CONCLUSIONS: When adding SL-DBT to SL-US, AFs detection increased from 52% to 75%. MR-guided biopsy is needed for the remaining 25%. KEY POINTS: \u2022 Detection rate of MRI AFs using SL-US was 52% \u2022 Adding SL-DBT, the detection rate of MRI AFs significantly increased to 75%. \u2022 Over 80% of the remaining 25% MRI AFs were malignant. \u2022 MR-guided biopsy should be used when SL-US and SL-DBT are inconclusive

Impact of multiparametric magnetic resonance imaging on risk group assessment of patients with prostate cancer addressed to external beam radiation therapy

Purpose: To investigate the impact of multiparametric MRI (mpMRI) on risk group assessment of patients with prostate cancer (PCa) initially addressed to External Beam Radiation Therapy (EBRT). Materials and Methods: we prospectively performed mpMRI (3.0Tsystem) in 44 patients addressed to EBRT, using a multiparametric protocol (high-resolution multiplanar T2-weighted, Diffusion-weighted and dynamic contrast-enhanced imaging). Risk group was assessed in accordance with the National Comprehensive Cancer Network (NCCN) categories, by combining prostate-specific-antigen level, Gleason score and the T-stage as established by digital rectal examination (clinical risk assessment; c-RA) versus mpMRI (mpMRI-risk assessment; mpMRI-RA). The agreement between c-RA and mpMRI-RA was investigated using Cohen\u2019s kappa. Results: Patients were included in very low/low risk, intermediate risk, high risk, very high risk and metastatic NCCN categories in 10 (22.7%), 18 (40.9%), 15 (34.1%), 1 (2.3%) and 0 cases using c-RA vs. 8 (18.2%), 14 (31.8%), 14 (31.8%), 4 (9.1%) and 4 (9.1%) cases using mpMRI-RA, respectively, with only moderate agreement (k = 0.43). MpMRI-RA determined risk downgrading in 2/44 patients (4.5%), and risk upgrading in 16/44 patients (36.3%). After mpMRI, EBRT remained indicated in all patients. Conclusion: mpMRI changed clinical risk stratification in about 41% of patients with PCa, with potential impact on EBRT planning