Uterine leiomyomata (fibroids) are the leading cause of hysterectomy in the United States. Black women have a greater fibroid burden than whites, yet no study has systematically evaluated the growth of fibroids in blacks and whites. We prospectively tracked growth for 262 fibroids (size range: 1-13 cm in diameter) from 72 premenopausal participants (38 blacks and 34 whites). Fibroid volume was measured by computerized analysis of up to four MRI scans over 12 months. We used mixed effects models to identify factors that are associated with growth, and results were converted to percent change per 6 months for clinical relevance. The median growth rate was 9% (range: ؊89% to ؉138%). Seven percent of fibroids regressed (>20% shrinkage). Tumors from the same woman grew at different rates (within-woman component of variation was twice the component among women; both were significant, P < 0.001). Black and white women less than 35 years of age had similar fibroid growth rates. However, growth rates declined with age for whites but not for blacks (P ‫؍‬ 0.05). The odds of a tumor growing more than 20% in 6 months also decreased with age for whites but not for blacks (P < 0.01). Growth rates were not influenced by tumor size, location, body mass index, or parity. We conclude that (i) spontaneous regression of fibroids occurs; (ii) fibroids from the same woman grow at different rates, despite a uniform hormonal milieu; (iii) fibroid size does not predict growth rate; and (iv) age-related differences in fibroid growth between blacks and whites may contribute to the higher symptom burden for black women.ethnic ͉ fibroid ͉ MRI ͉ tumor growth ͉ longitudinal data U terine leiomyomata (fibroids) are the leading indication for hysterectomy in the United States (1). Myomectomy and uterine artery embolization are also common treatments, but hysterectomy may be required subsequently (2). Hartmann et al. (3) estimate a $4,600 excess health care cost during the year following each US woman's diagnosis of fibroids. National medical costs associated with fibroids exceed 2 billion dollars annually (4). African Americans have a higher fibroid incidence (5, 6), experience more severe symptoms (7), present with larger tumors (7), and have a threefold higher risk of hysterectomy (8) compared with whites. Symptoms increase with the size of fibroids (7, 9, 10). However, few studies have examined the growth of fibroids over time (11-13), and no study has systematically followed the growth of fibroids in black and white women.The Fibroid Growth Study was designed to measure the growth of fibroids in black and white women with clinically relevant fibroids using MRI technology. We compare growth rates of individual tumors from the same woman; contrast fibroid growth in black and white women; and examine associations with age, parity, body mass index (BMI), and tumor characteristics. ResultsStudy Participants. Characteristics of the 72 participants are shown in Table 1. Our cohort ranged in age from 24 to 54 years, and approximately half were Afri...

SUMMARY:In current practice, gadolinium-based contrast agents have been considered safe when used at clinically recommended doses in patients without severe renal insufficiency. The causal relationship between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with renal insufficiency resulted in new policies regarding the administration of these agents. After an effective screening of patients with renal disease by performing either unenhanced or reduced-dose-enhanced studies in these patients and by using the most stable contrast agents, nephrogenic systemic fibrosis has been largely eliminated since 2009. Evidence of in vivo gadolinium deposition in bone tissue in patients with normal renal function is well-established, but recent literature showing that gadolinium might also deposit in the brain in patients with intact blood-brain barriers caught many individuals in the imaging community by surprise. The purpose of this review was to summarize the literature on gadolinium-based contrast agents, tying together information on agent stability and animal and human studies, and to emphasize that low-stability agents are the ones most often associated with brain deposition.ABBREVIATIONS: DN ϭ dentate nuclei; GBCA ϭ gadolinium-based contrast agent; NSFϭ nephrogenic systemic fibrosis

A variety of different categories of contrast agents, and within each category a number of individual agents, are currently available for clinical use in magnetic resonance (MR) imaging of the liver. In this review, the use of nonspecific extracellular gadolinium chelates, reticuloendothelial system-specific iron oxide particulate agents, hepatocyte-selective agents, and combined perfusion and hepatocyte-selective agents are described. Most clinical experience is with nonspecific extracellular gadolinium chelates. The relatively low cost, safety, good patient tolerance, and ability to help detect and characterize a wide range of liver diseases have rendered gadolinium chelates as commonly used agents. Reticuloendothelial system-specific agents improve lesion detection by decreasing the signal intensity of background liver on T2-weighted MR images, which increases the conspicuity of focal hepatic lesions with negligible reticuloendothelial cells (eg, metastases). Hepatocyte-selective agents increase the signal intensity of background liver on T1-weighted images, which increases the conspicuity of focal lesions that do not contain hepatocytes (eg, metastases). The clinical application of the different categories of contrast agents, techniques for their administration, sequences to be used, and appearances of common entities on contrast agent-enhanced studies are described.

The authors evaluated the reproducibility of measurements of ventricular dimensions obtained with cine magnetic resonance (MR) imaging performed on two occasions in 11 healthy subjects. Two reviewers analyzed the studies in a blinded fashion to determine interobserver and interstudy variability of measurements of left ventricular (LV) mass, volume, ejection fraction, and systolic wall stress. LV mass showed good reproducibility between studies, with 3.6% and 3.8% variability for LV end-systolic mass for the two observers. LV end-diastolic volume varied by 5.2% and 3.9%, and LV end-systolic volume, by 9.7% and 0.9%. Variability for LV ejection fraction was 5.0% and 4.9%. The largest interstudy variability was end-systolic wall stress, 11.1% and 13.5%, which was due mostly to changes in arterial pressure between the two studies. It is concluded that anatomic and functional measurements from cine MR images are reproducible between studies. The small interstudy variability is likely related to the fact the measurements are derived directly from cine MR images that encompass the entire heart rather than depend on measurements of only sample images and the use of geometric models.

MR imaging is significantly better (P < .02) than transvaginal sonography in the diagnosis of adenomyosis.

q RSNA, 2015 Purpose:To determine if a correlation exists between the number of previous enhanced magnetic resonance (MR) imaging examinations and high signal intensity in the globus pallidus (GP) and dentate nucleus (DN) in patients who received gadodiamide (Omniscan), a linear nonionic gadolinium-based contrast agent, and in those who received gadobenate dimeglumine (MultiHance), a linear ionic contrast agent. Materials andMethods:Institutional review board approval was obtained for this single-center retrospective study, with waiver of informed consent. The study population included 69 patients divided into two groups: Group 1 included patients who underwent gadodiamide-enhanced MR imaging, and group 2 included patients who underwent gadobenate dimeglumine-enhanced MR imaging. Two radiologists conducted a quantitative analysis of unenhanced T1-weighted images by using region of interest measurements. The GP-to-thalamus (TH) signal intensity ratio, DN-to-middle cerebellar peduncle (MCP) signal intensity ratio and relative percentage change (R change ) between the first and last examinations for each patient were calculated. Relation between the signal intensity ratios and R change and the number of enhanced MR imaging examinations was analyzed by using a generalized additive model. Inter-and intraobserver agreement was evaluated with the Lin concordance correlation coefficient test. Results:Group 1 included 23 patients (19 female), with a mean of 5.0 doses 6 2.4 (standard deviation) (range, 3-11 doses) administered. Group 2 included 46 patients (24 female) with a mean of 4.6 doses 6 2.2 (range, 3-11 doses) administered. The interval between the first and last examination was 1500.1 days 6 780.2 (range, 98-3097 days) for group 1 and 1086.2 days 6 582.9 (range, 94-2633) for group 2. All patients had normal liver and renal function. Gadodiamide showed a significant increase in DN:MCP and GP:TH (P , .001 for both) and in R change (P = .001 for GP:TH, P , .001 for DN:MCP). In group 2, there was no significant increase in DN:MCP or GP:TH over time or in R change for GP:TH, but there was a significant trend toward an increase in R change for DN:MCP (P = .013). Interobserver agreement was almost perfect (0.99; 95% confidence interval: 0.99, 0.99) for all evaluated structures. Intraobserver agreement was substantial to almost perfect for both readers. Conclusion:A significant increase in GP:TH and DN:MCP is associated with multiple gadodiamide-enhanced studies but not with gadobenate dimeglumine-enhanced studies, likely reflecting differences in stability and elimination of both contrast agents. Rate-of-change data indirectly suggest gadolinium deposition in the DN with gadobenate dimeglumine use, although it is considerably less than that with gadodiamide use.q RSNA, 2015

Gadolinium toxicity appears to arise following GBCA administration, which appears to contain clinical features seen in Nephrogenic Systemic Fibrosis, but also features not observed in that condition.

The purpose of this study was to compare dual-phase spiral computed tomography (CT) and magnetic resonance imaging (MRI) using dynamic gadolinium enhancement for liver lesion detection and characterization. Twenty-two consecutive patients underwent dual-phase spiral CT and MRI for the evaluation of focal liver disease within a 1-month period. Spiral CT and MR images were interpreted prospectively, in a blinded fashion by separate, individual, experienced investigators, to determine lesion detection and characterization. Liver lesions were confirmed by surgery and pathology in 6 patients, and by clinical and imaging follow-up in the other 16 patients. Pathological correlation of a primary extrahepatic malignancy was available in 5 of the 16 patients who had metastatic liver disease. Spiral CT and MRI detected 53 and 63 lesions, and characterized 39 and 62 true positive lesions, respectively. A kappa statistic test was applied to assess agreement between MR and CT results. MR versus CT for lesion detection resulted in a kappa statistic of 0.54 (95% confidence interval), indicating moderate agreement, and 0.32 (95% confidence interval) for lesion characterization, indicating only slight agreement. More lesions were detected on MR images than CT images in 6 (27%) patients, with lesions detected only on MR images in 4 (18%) patients. More lesions were characterized on MR images in 9 (41%) patients. In 9 patients with a discrepancy between MR and CT findings, the MR images added information considered significant to patient management in all 9 cases. MRI was moderately superior to dual-phase spiral CT for lesion detection, and was markedly superior for lesion characterization, with these differences having clinical significance. J. Index terms: liver; MR; CT; contrast agents; focal liver lesion DUAL-PHASE SPIRAL CT (1,2) and MRI, using dynamic gadolinium administration (3-10), are used to evaluate focal liver disease. Despite the common occurrence of focal liver lesions, and the importance of determining the most accurate method to evaluate focal liver disease, few studies have compared dual-phase spiral CT and MRI, using various contrast agents, for the detection and characterization of liver lesions (11-13). Previous studies from our center compared MRI to dynamic contrast-enhanced CT or single phase spiral CT for liver lesion detection and characterization (5,6). The purpose of the current study was to compare dual-phase spiral CT and MRI, using dynamic gadolinium administration, for the detection and characterization of focal liver lesions. MATERIALS AND METHODS PatientsTwenty-two consecutive patients (11 males, ages 28 -77 years; 11 females, ages 44 -86 years) with suspected liver lesions, who underwent both spiral CT and MRI within a period of less than 1 month, were included in this study. No patients were excluded from the study due to technical, patient, or other factors. No other specific selection criteria were used, and all paired studies were performed at the request of referring physicians. Dual-phase sp...