“Facial vascular anomalies; MRI and TRICKS-MR angiography diagnostic approach”

Purpose: Evaluate role of MRI and TRICKS-MR angiography in diagnosis of facial vascular anomalies. Material and methods: This study included 22 patients (mean age 9 years) with proved facial vascular anomalies on basis of interventional/surgical procedures (n = 19) or clinical follow up (n = 3). They underwent MRI examination with TRICKS-MRA. Images were evaluated for lesion location, size, feeding arteries and draining veins. Results: AVM was diagnosed in 15 patients (68.2%), hemangioma (5) patients (27.7%) and low flow venous malformation (2) patients (9.1%). TRICKS-MRA was accurate in diagnosis of 25 feeding arteries out of total 27 included in the study with 92.6% positive predictive value, 100% negative predictive value and 93.1% accuracy. AVMs were treated with sclerotherapy (26.7%), embolization (40%) and combined embolization and surgery (33.3%). Surgery was done in 2 hemangiomas (40%) while the other three patients (60%) underwent clinical follow up for 2 years with stationary course. The 2 patients with venous malformation underwent successful sclerotherapy. Conclusion: MRI & TRICKS-MRA provide excellent diagnostic data for assessment of facial vascular anomalies. TRICKS -MRA adds precise delineation of the vascular mapping, regarding feeding arteries and draining veins which helps in planning of therapeutic approach and reduces needing for invasive DSA

Cardiac MRI to evaluate right ventricular function after surgical correction of congenital heart diseases

Background: Cardiac MRI (CMR) is a noninvasive imaging technique that plays an important role during clinical follow-up of postoperative CHD patients. MRI can provide valuable information on cardiac anatomy, ventricular function, valvular function, and on the presence and location of myocardial scar tissue. Our study aimed to assess the right ventricular function after surgery in patients with congenital heart diseases & assessment of myocardial viability with particular attention to scar tissue in the ventricular myocardium aside from sites of previous surgery (e.g., ventricular septal defect and right ventricular outflow tract patches). Results: The most common encountered CHD in this study were tetralogy of Fallot &transposition of great arteries. The most common postoperative complication detected by CMR was pulmonary regurgitation particularly in repaired TOF patients. Regarding the RV volume & function, there was statically significant increase in RVEDVI &ESVI in patients with decreased RVEF with good correlation with echocardiographic results. Patients post TGA arterial switch repair showed less complications than atrial switch repair with better RV postoperative function. Most patients showed no residual shunting (QP/QS =1). Conclusion: CMR is able to effectively identify post-procedural anatomical and functional intra- and extracardiac information, thus allowing accurate diagnosis of postoperative complications in most patients

Interobserver agreement in automated metabolic tumor volume measurements of Deauville score 4 and 5 lesions at interim 18F-FDG PET in DLBCL

Introduction: Metabolic tumor volume (MTV) on interim-PET (I-PET) is a potential prognostic biomarker for diffuse large B-cell lymphoma (DLBCL). Implementation of MTV on I-PET requires consensus which semi-automated segmentation method delineates lesions most successfully with least user interaction. Methods used for baseline PET are not necessarily optimal for I-PET due to lower lesional standardized uptake values (SUV) at I-PET. Therefore, we aimed to evaluate which method provides the best delineation quality of Deauville-score (DS) 4-5 DLBCL lesions on I-PET at best interobserver agreement on delineation quality and, secondly, to assess the effect of lesional SUVmax on delineation quality and performance agreements. Methods: DS4-5 lesions from 45 I-PET scans were delineated using six semi-automated methods i) SUV 2.5, ii) SUV 4.0, iii) adaptive threshold [A50%peak], iv) 41% of maximum SUV [41%max], v) majority vote including voxels detected by ≥2 methods [MV2] and vi) detected by ≥3 methods [MV3]. Delineation quality per MTV was rated by three independent observers as acceptable or non-acceptable. For each method, observer scores on delineation quality, specific agreements and MTV were assessed for all lesions, and per category of lesional SUVmax (10). Results: In 60 DS4-5 lesions on I-PET, MV3 performed best, with acceptable delineation in 90% of lesions, with a positive agreement (PA) of 93%. Delineation quality scores and agreements per method strongly depended on lesional SUV: the best delineation quality scores were obtained using MV3 in lesions with SUVmax10, were comparable after excluding visually failed MV3 contouring. For lesions with SUVmax<10, MTVs using different methods correlated poorly. Conclusion: On I-PET, MV3 performed best and provided the highest interobserver agreement regarding acceptable delineations of DS4-5 DLBCL lesions. However, delineation method preference strongly depended on lesional SUV. Therefore, we suggest to explore an approach that identifies the optimal delineation method per lesion as function of tumor FDG uptake characteristics, i.e. SUVmax