Role of gadoxetic-acid enhanced 3T MRI and diffusion in liver nodules diagnosis

Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: La capacité multiparamétrique et l’imagerie par résonance magnétique (IRM) 3T à haute résolution jouent un rôle clé dans la caractérisation non invasive des lésions hépatiques focales (LHF). Certaines LHF ont des caractéristiques atypiques. De nouvelles techniques telles que les séquences à diffusion pondérée et les agents de contraste spécifiques aux hépatocytes sont actuellement utilisées en pratique clinique pour améliorer la détection et la caractérisation des LHF. L’étude visait à valider un protocole d’imagerie hépatique de haute qualité en utilisant une IRM à haute résolution combinée à un milieu de contraste spécifique à la diffusion et à l’hépatocyte pour le diagnostic de la LHF. Matériel et méthodes: 110 patients hépatiques ont été étudiés en utilisant une IRM à haute résolution de 3T (Phillips Ingenia) en utilisant une bobine de matrice en phase de corps. Le protocole inclue les séquences Dixon-all T1, T2, SPAIR et de diffusion. L’IRM améliorée a supposé l’utilisation des séquences Dixon-T1 de l’acide gadoxétique (PRIMOVIST), y compris la phase hépatobiliaire à 20 minutes et 30 minutes. Résultats: 65 patients ont été diagnostiqués avec précision des lésions bénignes, y compris les hémangiomes, les kystes, l’hyperplasie nodulaire focale et les adénomes. Parmi 45 lésions malignes, nous avons trouvé des métastases, un carcinome hépatocellulaire (CHC) et une pseudotumeur inflammatoire. Les lésions ont été suivies ou une pathologie a été obtenue. Conclusions: L’IRM est capable de fournir des informations diagnostiques complètes et très précises, avec l’avantage supplémentaire de l’absence de rayonnements ionisants nocifs. Un protocole IRM de haute qualité pour le foie est également nécessaire pour établir un diagnostic correct.Background: The multiparametric ability and high-resolution 3T magnetic resonance imaging (MRI) plays a key role in non-invasive characterization of focal liver lesions (FLL). Some FLL have atypical features. New techniques such as diffusion-weighted sequences and hepatocyte-specific contrast agents are being currently used in clinical practice improving the detection and characterization of FLL. The study aimed to validate a high-quality hepatic imaging protocol using high-resolution MRI combined with diffusion and hepatocyte-specific contrast media for FLL diagnosis. Material and methods: 110 patients were liver investigated using a 3T high-resolution MRI (Phillips Ingenia) using body-phase array coil. The protocol included Dixon-all T1, T2, SPAIR and diffusion sequences. The enhanced MRI assumed the use of gadoxetic-acid (PRIMOVIST) Dixon-T1 sequences, including the hepatobiliary phase at 20 minutes and 30 minutes. Results: 65 patients were accurately diagnosed with benign lesions, including hemangiomas, cysts, focal nodular hyperplasia and adenomas. Among 45 malignant lesions we found metastasis, hepatocellular carcinoma (HCC) and one inflammatory pseudotumor. The lesions were followed-up or pathology was obtained. Conclusions: MRI is able to provide comprehensive and highly accurate diagnostic information, with the additional advantage of lack of harmful ionizing radiation. Also a high-quality liver MRI protocol is needed in order to establish a correct diagnosis

Radioimaging aspects in knee degenerative pathology

Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Gonarthrosis represents one of the most frequent knee conditions, most commonly found in the 5th-6th life decades and not only, mainly in women, being the main cause of motoric disability in Europe, with a high impact on the social and economic status. The aim of the presentation is to aid the interdisciplinary team in interconnecting the imaging and clinical diagnosis of the osteo-articular system pathology. Content: The presentation reviews the radioimaging aspects of knee degenerative pathology. The imaging findings of a 35-year-old patient, known with right femur-coxal congenital subluxation, secondary left gonarthrosis and motoric disability are also presented as an illustration. The imaging technique included the pangonogram (hip-knee-ankle), which is an x-ray of the entire lower limb in orthostatism. The pangonogram allowed us to measure the hip-knee-ankle (HKA) angle, the internal mechanic alpha-femur angle, the Calton index – kneecap height, the beta – internal mechanic tibial angle and the gamma angle – tibial chute. Based on the imaging technique, there were highlighted changes in the bone structure of the left femural head, with a suspicious aspect of an aseptic necrosis, an internally curved tibia and peroneum on the left and secondary left gonarthrosis. The patient was admitted to the Orthopedics Department and underwent the necessary measurements for receiving a personalized knee prosthesis. Conclusions: This presentation highlights the challenging presentations of gonarthrosis and the modern techniques of diagnosis and treatment