Russell N. Low

OBJECTIVE. The objective of our study was to determine the accuracy of MRI in the preoperative staging and classification of mucinous appendiceal neoplasms and to describe the MRI features that are useful for selecting patients for surgical resection.MATERIALS AND METHODS. Twenty-two patients underwent preoperative MRI including T1-weighted, T2-weighted, immediate gadolinium-enhanced, and delayed gadolinium-enhanced imaging. Two observers reviewed the images for peritoneal tumor at 13 sites, tumor size and distribution, and degree of tumor enhancement. Peritoneal tumor sites were recorded at surgery. Cytoreduction was categorized as complete or suboptimal. Surgical specimens were classified as disseminated peritoneal adenomucinosis tumors, intermediate-grade tumors, or peritoneal mucinous carcinomatosis tumors.RESULTS. Surgery confirmed 232 tumor sites. Delayed gadolinium-enhanced MRI was the most accurate of the MR techniques, with a sensitivity, specificity, and accuracy of 89%, 87%, and 89%, respective...

MR imaging provides a highly sensitive and accurate means to depict tumor involving the peritoneum and bowel serosa. The ability of MR imaging to depict subtle peritoneal metastases plays a critical role in diagnosing and monitoring the oncologic patient with known or suspected peritoneal spread of malignancy. In this review I will describe the mechanisms of peritoneal tumor spread, and MR techniques and protocols for peritoneal imaging. A detailed description of the MR appearance of peritoneal tumor at different anatomic sites will be provided followed by a discussion of clinical applications for MR imaging of peritoneal malignancy.

Purpose: To evaluate the feasibility and added value of single breathhold diffusion‐weighted (DW) imaging (DWI) in oncology patients undergoing abdominal MRI.Materials and Methods: A total of 169 patients with malignancy underwent abdominal MRI at 1.5T, including T1‐weighted (T1W), T2‐weighted (T2W), and dynamic gadolinium‐enhanced imaging. Axial DWI was performed with a single‐shot spin‐echo (SE) echo‐planar imaging (EPI) sequence using a b‐value of 500 seconds/mm². A total of 24 slices were obtained during a 20‐second breathhold. Two observers reviewed the conventional MR images for tumor. Next, the DW images were reviewed for additional tumor not depicted on conventional MR imagesResults: For the 169 patients, additional tumors were noted on the DW images in 77 (0.46) for observer 1 and 67 (0.40) for observer 2. For observer 1 the additional tumor included lymphadenopathy (47), peritoneal metastases (15), renal (1), liver (12), and osseous (2), while for observer 2 the corresponding values were lymphadenopathy (40), peritoneal (12), renal (1), liver (6), osseous (4), and gastrointestinal (1). The DW images resolved as benign findings noted on the conventional MR images in three patients for observer 1 and four patients for observer 2. The conventional MR exam was entirely normal while the DW images showed tumor in 12 (0.07) patients for observer 1 and 10 (0.06) patients for observer 2.Conclusion: DWI is feasible in a single breathhold and provides additional clinically important information in oncology patients when added to routine abdominal MR sequences. J. Magn. Reson. Imaging 2007.

To compare retrospectively the use of magnetic resonance (MR) imaging, laparotomy reassessment, and serum CA-125 values in predicting the presence of residual tumor in women who have been treated for ovarian cancer. This study was approved by the institutional review board, and informed consent was waived. The study was compliant with the Health Insurance Portability and Accountability Act. Seventy-six women (mean age, 59 years) with treated ovarian cancer underwent preoperative MR imaging of the abdomen and pelvis with intravenous gadolinium-based and intraluminal barium contrast material. MR findings were compared with surgical and histopathologic findings, serial and static serum CA-125 values, and clinical follow-up results. Tumor absence was proved with normal surgical results and by following up patients for at least 1 year, with no evidence of residual tumor at serial CA-125 analysis or subsequent laparotomy. McNemar test for correlated proportions was used for statistical analysis. Sixty-eight women had residual tumor proved at laparotomy and biopsy or at clinical follow-up. Eight patients had no evidence of residual tumor. Gadolinium-enhanced MR imaging depicted residual tumor in 61 patients (sensitivity, 90%; specificity, 88%; accuracy, 89%) compared with laparotomy, which demonstrated residual tumor in 60 patients (sensitivity, 88%; specificity, 100%; accuracy, 89%) and CA-125 values, which demonstrated residual tumor in 44 patients (sensitivity, 65%; specificity, 88%; accuracy, 67%) (P < .01). The positive predictive values for MR imaging, laparotomy, and serum CA-125 values were 98%, 100%, and 98%, respectively, whereas the corresponding negative predictive values were 50%, 50%, and 23%, respectively. In 14 patients, there was a discrepancy between the results of MR imaging and those of laparotomy. In seven patients, MR imaging depicted residual tumor that was not found at laparotomy but was proved at subsequent biopsy or clinical and imaging follow-up, with an increasing serum CA-125 level. In six patients, MR findings were normal, and subsequent laparotomy revealed small-volume residual tumor. Residual tumor was incorrectly predicted with MR imaging in one patient who had no surgical or clinical evidence of residual tumor for 1 year. Gadolinium-enhanced spoiled gradient-echo MR imaging depicts residual tumor in women with treated ovarian cancer, with an accuracy, positive predictive value, and negative predictive value that are comparable to those of laparotomy and superior to those of serum CA-125 values alone.

To compare T2-weighted breath-hold single-shot fast spin-echo (SE) and gadolinium-enhanced spoiled gradient-echo (GRE) MR imaging with contrast material administered orally and rectally for evaluating patients with Crohn disease. Twenty-eight patients with Crohn disease received 2% barium sulfate and water enema. The abdomen and pelvis were imaged with transverse and coronal single-shot fast SE and gadolinium-enhanced spoiled GRE MR imaging. Two radiologists reviewed the two types of images for bowel disease. The extent, severity, and conspicuity of the disease were determined. Proof of bowel disease at MR imaging was compared with that at endoscopy, barium study, and surgery. Statistical analysis was performed with the McNemar test. Twenty-five of 28 patients had proven abnormal bowel segments. The per-patient sensitivity of gadolinium-enhanced spoiled GRE MR imaging for the two radiologists was 100% and 96% versus 60% and 60% (P <.05) with single-shot fast SE MR imaging. Gadolinium-enhanced spoiled GRE MR images depicted more segments (54 and 52 of 61 segments; sensitivity, 89% and 85%, respectively) of the diseased bowel than did single-shot fast SE MR images (31 and 32 of 61 segments; sensitivity, 51% and 52%, respectively; P <.001). Severity of Crohn disease was correctly depicted at gadolinium-enhanced spoiled GRE imaging in 93% of patients versus in 43% of patients at single-shot fast SE imaging. In patients with Crohn disease, gadolinium-enhanced fat-suppressed spoiled GRE MR imaging better depicted the extent and severity of intestinal disease compared with single-shot fast SE imaging.

The purpose of this study was to evaluate the use of gadolinium and barium‐enhanced magnetic resonance (MR) imaging in detecting intestinal and extraintestinal Crohn's disease and compare MRI with contrast‐enhanced helical computed tomography (CT). Twenty‐six patients with Crohn's disease underwent imaging examinations, including gadolinium‐enhanced, fat suppressed fast multiplanar spoiled gradient‐recalled (FMPSPGR) MR imaging with oral 2% barium sulfate and rectal water and with helical CT using IV and positive (13) or negative (13) intestinal contrast material. MR images and CT scans were reviewed separately by two radiologists for bowel wall thickness and enhancement, presence of abscess, phlegmon, and fistula. MR images and CT scans were then compared side by side. Surgical, endoscopic, and histopathologic findings and results of barium studies were reviewed to determine the location and severity of involvement of intestinal Crohn's disease. Depiction of mural thickening and/or enhancement was superior on the MR images, which showed 55 (85%) and 52 (80%) of 65 abnormal bowel segments for the two observers, compared with helical CT, which showed 39 (60%) and 42 (65%; P < 0.001, P < 0.05) of bowel segments affected by Crohn's disease. Segments of bowel with moderate or marked mural thickening were depicted equally on MR imaging and helical CT. In mildly diseased segments of bowel, with only slight thickening and enhancement, MR imaging depicted 22 (79%) and 19 (68%) of 28 segments, compared with helical CT, which depicted 9 (32%; P < 0.01), and 13 (46%; P > 0.05) of 28 segments. In the side‐by side comparison, MR imaging was preferred over helical CT for depicting normal bowel wall (MR 71%, CT 4%, equal 25%; P < 0.001), mural thickening (MR 41%, CT 11% equal 48%; P < 0.01), mural enhancement (MR 89%, equal 11%; P < 0.001), and overall GI tract evaluation (MR 52%, CT 10%, equal 38%; P < 0.001). Gadolinium‐enhanced MR imaging with oral dilute barium sulfate and rectal water depicts intestinal and extraintestinal changes of Crohn's disease and shows promise as a clinically useful tool. J. Magn. Reson. Imaging 2000;11:127–135.