• 대한영상의학회지
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• 제84권1호
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• pp.75-91
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• 2023

전립선영상 판독과 자료체계 버전 2.1에서는 다중 매개 자기공명영상(multiparametric MRI; 이하 mpMRI)을 사용하는 버전 2의 기술적인 변수와 영상 판독 기준이 개정되었다. 이러한 변화를 통해 전립선암 평가의 발전이 예상지만, 어떤 사항들은 아직까지 해결되지 않았고 새로운 문제점들이 부각되고 있다. 본 종설에서는 전립선영상 판독과 자료체계 2.1 버전의 간단한 개요와 새롭게 부상하는 다음과 같은 문제들에 대해 비판적인 관점에서 논의하고자 한다: mpMRI의 보다 자세한 프로토콜에 대한 필요, 개정된 이행부 판독기준에 대한 검증 부족, 개정된 확산강조영상 및 조영 증강 영상 판독기준, anterior fibromuscular stroma, 중심부 평가, 주변부 신호 및 종양 공격성, 구조화된 판독문 변화에 대한 명료화의 필요, 영상 품질과 수행능력 제어에 대한 필요 및 기타 적응증을 포함하도록 시스템 확장을 위한 적응증.

• Korean Journal of Radiology
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• 제23권6호
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• pp.581-597
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• 2022

Left ventricular (LV) wall thickening, or LV hypertrophy (LVH), is common and occurs in diverse conditions including hypertrophic cardiomyopathy (HCM), hypertensive heart disease, aortic valve stenosis, lysosomal storage disorders, cardiac amyloidosis, mitochondrial cardiomyopathy, sarcoidosis and athlete's heart. Cardiac magnetic resonance (CMR) imaging provides various tissue contrasts and characteristics that reflect histological changes in the myocardium, such as cellular hypertrophy, cardiomyocyte disarray, interstitial fibrosis, extracellular accumulation of insoluble proteins, intracellular accumulation of fat, and intracellular vacuolar changes. Therefore, CMR imaging may be beneficial in establishing a differential diagnosis of LVH. Although various diseases share LV wall thickening as a common feature, the histologic changes that underscore each disease are distinct. This review focuses on CMR multiparametric myocardial analysis, which may provide clues for the differentiation of thickened myocardium based on the histologic features of HCM and its phenocopies.

• Korean Journal of Radiology
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• 제24권7호
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• pp.668-680
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• 2023

Objective: To compare multiparametric magnetic resonance imaging (MRI) features of intraductal carcinoma of the prostate (IDC-P) with those of prostatic acinar adenocarcinoma (PAC) and develop prediction models to distinguish IDC-P from PAC and IDC-P with a high proportion (IDC ≥ 10%, hpIDC-P) from IDC-P with a low proportion (IDC < 10%, lpIDC-P) and PAC. Materials and Methods: One hundred and six patients with hpIDC-P, 105 with lpIDC-P and 168 with PAC, who underwent pretreatment multiparametric MRI between January 2015 and December 2020 were included in this study. Imaging parameters, including invasiveness and metastasis, were evaluated and compared between the PAC and IDC-P groups as well as between the hpIDC-P and lpIDC-P subgroups. Nomograms for distinguishing IDC-P from PAC, and hpIDC-P from lpIDC-P and PAC, were made using multivariable logistic regression analysis. The discrimination performance of the models was assessed using the receiver operating characteristic area under the curve (ROC-AUC) in the sample, where the models were derived from without an independent validation sample. Results: The tumor diameter was larger and invasive and metastatic features were more common in the IDC-P than in the PAC group (P < 0.001). The distribution of extraprostatic extension (EPE) and pelvic lymphadenopathy was even greater, and the apparent diffusion coefficient (ADC) ratio was lower in the hpIDC-P than in the lpIDC-P group (P < 0.05). The ROC-AUCs of the stepwise models based solely on imaging features for distinguishing IDC-P from PAC and hpIDC-P from lpIDC-P and PAC were 0.797 (95% confidence interval, 0.750-0.843) and 0.777 (0.727-0.827), respectively. Conclusion: IDC-P was more likely to be larger, more invasive, and more metastatic, with obviously restricted diffusion. EPE, pelvic lymphadenopathy, and a lower ADC ratio were more likely to occur in hpIDC-P, and were also the most useful variables in both nomograms for predicting IDC-P and hpIDC-P.

• Investigative Magnetic Resonance Imaging
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• 제21권3호
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• pp.139-147
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• 2017

Purpose: To evaluate differences in staging accuracy of prostate cancer according to the extent of hemorrhage on multiparametric MRI performed after biopsy. Materials and Methods: We enrolled 71 consecutive patients with biopsy-proven prostate cancer. Patients underwent MRI followed by a prostatectomy at our institution in 2014. Two radiologists reviewed the MRI to determine the tumor stage. Correlation between biopsy-MRI interval and extent of hemorrhage was evaluated. Regression analyses were used to determine factors associated with accuracy of tumor staging. Results: The mean interval between biopsy and MRI was $17.4{\pm}10.2days$ (range, 0-73 days). The interval between prostate biopsy and MRI and the extent of hemorrhage were not significantly correlated (P = 0.880). There was no significant difference in the accuracy rate of staging between the small and large hemorrhage groups. Conclusion: Biopsy-induced hemorrhage in the prostate gland is not sufficiently absorbed over time. The extent of hemorrhage and the short interval between biopsy and MRI may not impair tumor detection or staging on multiparametric MRI.

• Korean Journal of Radiology
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• 제22권4호
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• pp.559-567
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• 2021

Objective: To evaluate the impact of multiparametric magnetic resonance imaging (mpMRI) before confirmatory prostate biopsy in patients under active surveillance (AS). Materials and Methods: This retrospective study included 170 patients with Gleason grade 6 prostate cancer initially enrolled in an AS program between 2011 and 2019. Prostate mpMRI was performed using a 1.5 tesla (T) magnetic resonance imaging system with a 16-channel phased-array body coil. The protocol included T1-weighted, T2-weighted, diffusion-weighted, and dynamic contrast-enhanced imaging sequences. Uroradiology reports generated by a specialist were based on prostate imaging-reporting and data system (PI-RADS) version 2. Univariate and multivariate analyses were performed based on regression models. Results: The reclassification rate at confirmatory biopsy was higher in patients with suspicious lesions on mpMRI (PI-RADS score ≥ 3) (n = 47) than in patients with non-suspicious mpMRIs (n = 61) and who did not undergo mpMRIs (n = 62) (66%, 26.2%, and 24.2%, respectively; p < 0.001). On multivariate analysis, presence of a suspicious mpMRI finding (PI-RADS score ≥ 3) was associated (adjusted odds ratio: 4.72) with the risk of reclassification at confirmatory biopsy after adjusting for the main variables (age, prostate-specific antigen density, number of positive cores, number of previous biopsies, and clinical stage). Presence of a suspicious mpMRI finding (adjusted hazard ratio: 2.62) was also associated with the risk of progression to active treatment during the follow-up. Conclusion: Inclusion of mpMRI before the confirmatory biopsy is useful to stratify the risk of reclassification during the biopsy as well as to evaluate the risk of progression to active treatment during follow-up.

• Investigative Magnetic Resonance Imaging
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• 제23권3호
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• pp.220-227
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• 2019

Purpose: To evaluate the usefulness of wash-in color map in detecting early enhancement of prostate focal lesion compared to whole dynamic contrast-enhanced MRI (DEC MRI) images. Materials and Methods: This study engaged 50 prostate cancer patients who underwent multiparametric MRI and radical prostatectomy as subjects. An expert [R1] and a trainee [R2] independently evaluated early enhancement and recorded the time needed to review 1) a wash-in color map and 2) whole DCE MRI images. Results: The review of whole DCE images by R1 showed fair agreement with color map by R1, whole images by R2, and color map by R2 (weighted kappa values = 0.59, 0.44, and 0.58, respectively). Both readers took a significantly shorter time to review the color maps as compared to whole images (P < 0.001). Conclusion: A trainee could achieve better agreement with an expert when using wash-in color maps than when using whole DCE MRI images. Also, color maps took a significantly shorter evaluation time than whole images.

• 대한영상의학회지
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• 제82권5호
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• pp.1066-1082
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• 2021

초음파에서 우연히 접하는 자궁부속기 병변은 양성 병변이 더 흔하지만, 일부는 악성도가 애매한 병변으로 간주되어 추가적인 평가를 위해 다중매개변수 MRI가 필요하다. 고식적 MRI를 통해 해부학적 모양을 살피고, 지방, 출혈, 섬유성 조직, 고형성 조직 등 병변의 구성성분을 파악하여 많은 양성 종괴들을 정확하게 진단할 수 있다. 또한 추가적인 확산강조영상과 역동적 조영증강 기법의 관류영상으로 양성과 악성의 감별 진단 정확도를 높일 수 있다. 최근 자궁부속기 종괴의 악성 위험도를 평가하고, 각 위험도 군에 대한 적절한 조치를 권고하는데 있어 표준화된 의사소통이 가능하도록 하기 위해 난소-자궁부속기 MRI 보고 및 자료시스템(ovarian-adnexal reporting and data system MRI; 이하 O-RADS MRI)이 발표되었다. 본 종설에서는 자궁부속기 종괴의 악성도 예측 및 감별 진단을 위한 다중매개변수 MRI의 임상 적용과 O-RADS MRI에 대하여 기술하고자 한다.

• Korean Journal of Radiology
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• 제23권1호
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• pp.60-67
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• 2022

Objective: To categorize multiparametric MRI features of Bacillus Calmette-Guérin (BCG)-related granulomatous prostatitis (GP) and discover potential manifestations for its differential diagnosis from prostate cancer. Materials and Methods: The cases of BCG-related GP in 24 male (mean age ± standard deviation, 66.0 ± 9.4 years; range, 50-88 years) pathologically confirmed between January 2011 and April 2019 were retrospectively reviewed. All patients underwent intravesical BCG therapy followed by a MRI scan. Additional follow-up MRI scans, including diffusion-weighted imaging (DWI), were performed in 19 patients. The BCG-related GP cases were categorized into three: A, B, or C. The lesions with diffusion restriction and homogeneous enhancement were classified as type A. The lesions with diffusion restriction and a poorly enhancing component were classified as type B. A low signal intensity on high b-value DWI (b = 1000 s/mm²) was considered characteristic of type C. Two radiologists independently interpreted the MRI scans before making a consensus about the types. Results: The median lesion size was 22 mm with the interquartile range (IQR) of 18-26 mm as measured using the initial MRI scans. The lesion types were A, B, and C in 7, 15, and 2 patients, respectively. Cohen's kappa value for the inter-reader agreement for the interpretation of the lesion types was 0.837. On the last follow-up MRI scans of 19 patients, the size decreased (median, 5.8 mm; IQR, 3.4-8.5 mm), and the type changed from A or B to C in 11 patients. The lesions resolved in four patients. In five patients who underwent prostatectomy, caseous necrosis on histopathology matched with the non-enhancing components of type B lesions and the entire type C lesions. Conclusion: BCG-related GP demonstrated three imaging patterns on multiparametric MRI. Contrast-enhanced T1-weighted imaging and DWI may play a role in its differential diagnosis from prostate cancer.

• Korean Journal of Radiology
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• 제22권7호
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• pp.1087-1099
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• 2021

MRI has become important for the detection of prostate cancer. MRI-guided biopsy is superior to conventional systematic biopsy in patients suspected with prostate cancer. MRI is also increasingly used for monitoring patients with low-risk prostate cancer during active surveillance. It improves patient selection for active surveillance at diagnosis, although its role during follow-up is unclear. We aim to review existing evidence and propose a practical approach for incorporating MRI into active surveillance protocols.

• Journal of Cardiovascular Imaging
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• 제31권2호
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• pp.71-82
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• 2023

BACKGROUND: Cardiac magnetic resonance fingerprinting (cMRF) enables simultaneous mapping of myocardial T1 and T2 with very short acquisition times. Breathing maneuvers have been utilized as a vasoactive stress test to dynamically characterize myocardial tissue in vivo. We tested the feasibility of sequential, rapid cMRF acquisitions during breathing maneuvers to quantify myocardial T1 and T2 changes. METHODS: We measured T1 and T2 values using conventional T1 and T2-mapping techniques (modified look locker inversion [MOLLI] and T2-prepared balanced-steady state free precession), and a 15 heartbeat (15-hb) and rapid 5-hb cMRF sequence in a phantom and in 9 healthy volunteers. The cMRF_5-hb sequence was also used to dynamically assess T1 and T2 changes over the course of a vasoactive combined breathing maneuver. RESULTS: In healthy volunteers, the mean myocardial T1 of the different mapping methodologies were: MOLLI 1,224 ± 81 ms, cMRF_15-hb 1,359 ± 97 ms, and cMRF_5-hb 1,357 ± 76 ms. The mean myocardial T2 measured with the conventional mapping technique was 41.7 ± 6.7 ms, while for cMRF_15-hb 29.6 ± 5.8 ms and cMRF_5-hb 30.5 ± 5.8 ms. T2 was reduced with vasoconstriction (post-hyperventilation compared to a baseline resting state) (30.15 ± 1.53 ms vs. 27.99 ± 2.07 ms, p = 0.02), while T1 did not change with hyperventilation. During the vasodilatory breath-hold, no significant change of myocardial T1 and T2 was observed. CONCLUSIONS: cMRF_5-hb enables simultaneous mapping of myocardial T1 and T2, and may be used to track dynamic changes of myocardial T1 and T2 during vasoactive combined breathing maneuvers.