Preoperative cross-sectional imaging, such as computed tomography and magnetic resonance imaging, plays a key role in differentiating between benign and malignant intraductal papillary mucinous neoplasms. This article reviews the imaging features associated with malignant intraductal papillary mucinous neoplasm, as well as the recent studies validating the 2012 international consensus guidelines. This review also compared the diagnostic performance of computed tomography and magnetic resonance imaging in differentiating malignant from benign intraductal papillary mucinous neoplasms.
Consensus ; Magnetic Resonance Imaging* ; Mucins* ; Pancreas*

Magnetic resonance (MR) enterography (MRE) plays a pivotal role in the management of patients with Crohn’s disease (CD) throughout the chronic disease process. With advantages such as its non-invasiveness and the ability to use several MR sequences to reflect findings of active inflammation, several MRE-based indices have been introduced to assess CD inflammatory activity. Although there is no universally accepted gold-standard score for clinical practice, the most studied scores include the Magnetic Resonance Index of Activity, simplified Magnetic Resonance Index of Activity, Nancy score, Clermont score, London score, and CD MRI Index. These MRE-based scoring systems share certain characteristics but also differ in terms of the imaging parameters included, the bowel segments evaluated, and the MR sequences required for assessment. This review article covers the key MR findings of active inflammation incorporated into these scoring systems, along with the detailed characteristics and clinical applications of MRE-based scoring systems in adult patients with CD.

Magnetic resonance (MR) enterography (MRE) plays a pivotal role in the management of patients with Crohn’s disease (CD) throughout the chronic disease process. With advantages such as its non-invasiveness and the ability to use several MR sequences to reflect findings of active inflammation, several MRE-based indices have been introduced to assess CD inflammatory activity. Although there is no universally accepted gold-standard score for clinical practice, the most studied scores include the Magnetic Resonance Index of Activity, simplified Magnetic Resonance Index of Activity, Nancy score, Clermont score, London score, and CD MRI Index. These MRE-based scoring systems share certain characteristics but also differ in terms of the imaging parameters included, the bowel segments evaluated, and the MR sequences required for assessment. This review article covers the key MR findings of active inflammation incorporated into these scoring systems, along with the detailed characteristics and clinical applications of MRE-based scoring systems in adult patients with CD.

Magnetic resonance (MR) enterography (MRE) plays a pivotal role in the management of patients with Crohn’s disease (CD) throughout the chronic disease process. With advantages such as its non-invasiveness and the ability to use several MR sequences to reflect findings of active inflammation, several MRE-based indices have been introduced to assess CD inflammatory activity. Although there is no universally accepted gold-standard score for clinical practice, the most studied scores include the Magnetic Resonance Index of Activity, simplified Magnetic Resonance Index of Activity, Nancy score, Clermont score, London score, and CD MRI Index. These MRE-based scoring systems share certain characteristics but also differ in terms of the imaging parameters included, the bowel segments evaluated, and the MR sequences required for assessment. This review article covers the key MR findings of active inflammation incorporated into these scoring systems, along with the detailed characteristics and clinical applications of MRE-based scoring systems in adult patients with CD.

Objective: To investigate imaging biomarkers of microperfusion in contrast-induced nephropathy (CIN) using contrastenhanced ultrasound (CEUS). Materials and Methods: The CIN model was fabricated by administering indomethacin (10 mg/kg), L-NAME (15 mg/kg), and iopamidol (10 mL/kg) to Sprague-Dawley rats. After 24 hours, CEUS was performed on CIN (n = 6) and control (n = 6) rats with sulphur hexafluoride microbubbles (SonoVue). From time-intensity curves obtained from the kidney arriving time (AT), acceleration time (AC), time to peak (TTP), and peak enhancement (PE) were measured and compared between the groups. After CEUS, the rats were sacrificed, and cell apoptosis markers were evaluated to confirm the development of CIN. Results: Among CEUS parameters, AT (7.8 ± 1.6 vs. 4.2 ± 0.5 s, p = 0.002), AC (4.7 ± 1.4 vs. 2.0 ± 0.4 s, p = 0.002), and TTP (12.5 ± 2.9 vs. 6.2 ± 0.6 s, p = 0.002) were significantly prolonged in the CIN group compared to controls. PE was significantly higher in the control group than in the CIN group (17.1 ± 1.9 vs. 12.2 ± 2.0 dB, p = 0.004). In kidney tissue, mRNA and protein levels of the apoptotic makers were significantly higher in the CIN group than in the control group (p = 0.003 and p = 0.002). Conclusion CEUS parameters can be used as imaging biomarkers for microperfusion in CIN. In rats with CIN, AT, AC, and TTP were significantly prolonged, while PE was significantly lower compared to controls.

Objective: To investigate imaging biomarkers of microperfusion in contrast-induced nephropathy (CIN) using contrastenhanced ultrasound (CEUS). Materials and Methods: The CIN model was fabricated by administering indomethacin (10 mg/kg), L-NAME (15 mg/kg), and iopamidol (10 mL/kg) to Sprague-Dawley rats. After 24 hours, CEUS was performed on CIN (n = 6) and control (n = 6) rats with sulphur hexafluoride microbubbles (SonoVue). From time-intensity curves obtained from the kidney arriving time (AT), acceleration time (AC), time to peak (TTP), and peak enhancement (PE) were measured and compared between the groups. After CEUS, the rats were sacrificed, and cell apoptosis markers were evaluated to confirm the development of CIN. Results: Among CEUS parameters, AT (7.8 ± 1.6 vs. 4.2 ± 0.5 s, p = 0.002), AC (4.7 ± 1.4 vs. 2.0 ± 0.4 s, p = 0.002), and TTP (12.5 ± 2.9 vs. 6.2 ± 0.6 s, p = 0.002) were significantly prolonged in the CIN group compared to controls. PE was significantly higher in the control group than in the CIN group (17.1 ± 1.9 vs. 12.2 ± 2.0 dB, p = 0.004). In kidney tissue, mRNA and protein levels of the apoptotic makers were significantly higher in the CIN group than in the control group (p = 0.003 and p = 0.002). Conclusion CEUS parameters can be used as imaging biomarkers for microperfusion in CIN. In rats with CIN, AT, AC, and TTP were significantly prolonged, while PE was significantly lower compared to controls.

Acceleration ; Artifacts ; Diffusion ; Humans ; Magnetic Resonance Imaging ; Rectal Neoplasms ; Rectum

Baseline magnetic resonance imaging (MRI) has become the primary staging modality for surgical plans and stratification of patient populations for more efficient neoadjuvant treatment. Patients who exhibit a complete response to chemoradiotherapy (CRT) may achieve excellent local tumor control and better quality of life with organ-preserving treatments such as local excision or even watch-and-wait management. Therefore, the evaluation of tumor response is a key factor for determining the appropriate treatment following CRT. Although post-CRT MRI is generally accepted as the first-choice method for evaluating treatment response after CRT, its application in the clinical decision process is not fully validated. In this review, we will discuss various oncologic treatment options from radical surgical technique to organ-preservation strategies for achieving better cancer control and improved quality of life following CRT. In addition, the current status of post-CRT MRI in restaging rectal cancer as well as the main imaging features that should be evaluated for treatment planning will also be described for the tailored treatment.
Chemoradiotherapy ; Humans ; Magnetic Resonance Imaging ; Methods ; Neoadjuvant Therapy ; Quality of Life ; Rectal Neoplasms

While ultrasound (US) is considered an important tool for hepatocellular carcinoma (HCC) surveillance, it has limited sensitivity for detecting early-stage HCC. Abbreviated MRI (AMRI) has recently gained popularity owing to better sensitivity in its detection of early-stage HCC than US, while also minimizing the time and cost in comparison to complete contrastenhanced MRI, as AMRI includes only a few essential sequences tailored for detecting HCC. Currently, three AMRI protocols exist, namely gadoxetic acid-enhanced hepatobiliary-phase AMRI, dynamic contrast-enhanced AMRI, and non-enhanced AMRI. In this study, we discussed the rationale and technical details of AMRI techniques for achieving optimal surveillance performance. The strengths, weaknesses, and current issues of each AMRI protocol were also elucidated. Moreover, we scrutinized previously performed AMRI studies regarding clinical and technical factors. Reporting and recall strategies were discussed while considering the differences in AMRI protocols. A risk-stratified approach for the target population should be taken to maximize the benefits of AMRI and the cost-effectiveness should be considered. In the era of multiple HCC surveillance tools, patients need to be fully informed about their choices for better adherence to a surveillance program.

Objective: Based on the Liver Imaging Reporting and Data System version 2018 (LI-RADS, v2018), this study aimed to analyze LR-5 diagnostic performance for hepatocellular carcinoma (HCC) when threshold growth as a major feature is replaced by a more HCC-specific ancillary feature, as well as the frequency of threshold growth in HCC and non-HCC malignancies and its association with tumor size. Materials and Methods: This retrospective study included treatment-naive patients who underwent gadoxetate disodiumenhanced MRIs for focal hepatic lesions and surgery between January 2009 and December 2016. The frequency of major and ancillary features was evaluated for HCC and non-HCC malignancies, and the LR-category was assessed. Ancillary features that were significantly more prevalent in HCC were then used to either replace threshold growth or were added as additional major features, and the diagnostic performance of the readjusted LR category was compared to the LI-RADS v2018. Results: A total of 1013 observations were analyzed. Unlike arterial phase hyperenhancement, washout, or enhancing capsule which were more prevalent in HCCs than in non-HCC malignancies (521/616 vs. 18/58, 489/616 vs. 19/58, and 181/616 vs. 5/58, respectively; p < 0.001), threshold growth was more prevalent in non-HCC malignancies than in HCCs (11/23 vs. 17/119; p < 0.001). The mean size of non-HCC malignancies showing threshold growth was significantly smaller than that of non-HCC malignancies without threshold growth (22.2 mm vs. 42.9 mm, p = 0.040). Similar results were found for HCCs; however, the difference was not significant (26.8 mm vs. 33.1 mm, p = 0.184). Additionally, Fat-in-nodule was more frequent in HCCs than in non-HCC malignancies (99/616 vs. 2/58, p = 0.010). When threshold growth and fat-in-nodule were considered as ancillary and major features, respectively, LR-5 sensitivity (73.2% vs. 73.9%, p = 0.289) and specificity (98.2% vs. 98.5%, p > 0.999) were comparable to the LI-RADS v2018. Conclusion Threshold growth is not a significant diagnostic indicator of HCC and is more common in non-HCC malignancies. The diagnostic performance of LR-5 was comparable when threshold growth was recategorized as an ancillary feature and replaced by a more HCC-specific ancillary feature.