The survival of patients with hepatocellular carcinoma (HCC) is often individually different even after surgery for early-stage tumors. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) has been introduced recently to evaluate hepatic lesions with regard to vascularity and the activity of the organic anion transporter OATP1B3. Here, we report that Gd-EOB-DTPA-enhanced MRI (EOB-MRI) in combination with serum alpha-fetoprotein (AFP) status reflects the stem/maturational status of HCC with distinct biology and prognostic information. Gd-EOB-DTPA uptake in the hepatobiliary phase was observed in approximately 15% of HCCs. This uptake correlated with low serum AFP levels, maintenance of hepatocyte function with the up-regulation of OATP1B3 and HNF4A expression, and good prognosis. By contrast, HCC showing reduced Gd-EOB-DTPA uptake with high serum AFP levels was associated with poor prognosis and the activation of the oncogene FOXM1. Knockdown of HNF4A in HCC cells showing Gd-EOB-DTPA uptake resulted in the increased expression of AFP and FOXM1 and the loss of OATP1B3 expression accompanied by morphological changes, enhanced tumorigenesis, and loss of Gd-EOB-DTPA uptake in vivo. HCC classification based on EOB-MRI and serum AFP levels predicted overall survival in a single-institution cohort (n = 70), and its prognostic utility was validated independently in a multi-institution cohort of early-stage HCCs (n = 109). Conclusion: This non-invasive classification system is molecularly based on the stem/maturation status of HCCs and can be incorporated into current staging practices to improve management algorithms, especially in the early stage of disease.

Purpose To assess the state and dynamics of the intracranial system in idiopathic normal‐pressure hydrocephalus (I‐NPH), we determined intracranial compliance using magnetic resonance imaging (MRI). Materials and Methods The intracranial compliance index (ICCI), which was defined as the ratio of the peak‐to‐peak intracranial volume change (ICVCp‐p) to the peak‐to‐peak cerebrospinal fluid (CSF) pressure gradient (PGp‐p) during the cardiac cycle, was obtained from the net transcranial blood and CSF flow measured with phase‐contrast (PC) cine MRI. ICCI was determined in patients with I‐NPH (N = 7), brain atrophy, or asymptomatic ventricular dilation (VD) (N = 6), and in healthy volunteers (control group; N = 11). The changes in ICCI indices were also analyzed after a CSF tap test (N = 2). Results The ICCI in the I‐NPH group was significantly lower than in the control and VD groups, whereas no difference was found between the control and VD groups. The ICVCp‐p was also lower than in the control and VD groups. However, no significant difference was found in the PGp‐p between groups. The ICCI increased after the tap test. Conclusion Intracranial compliance analysis with MRI makes it possible to noninvasively obtain more detailed information of intracranial biomechanics in the I‐NPH and to assist in the diagnosis of I‐NPH. J. Magn. Reson. Imaging 2007. © 2007 Wiley‐Liss, Inc.

DARTEL normalization reduces the effect of scanner, which is a major problem in multicenter studies.

We concluded that a considerable number of cases appeared to need craniotomy and resection of intrahematomal membrane for complete recovery in CSDH, and that T2*-weighted MR imaging could be used as a basis for selecting the operative procedure for CSDH.

Intravenous gadoxetate disodium (a weight-based dose) does not cause changes in SpO2 and HR that lead to image quality degradation.

Vascular endothelial growth factor (VEGF), a potent inducer of angiogenesis and vascular permeability in diverse physiological and pathological conditions, may be involved in the pathophysiology of chronic subdural hematoma (CSDH). The present study investigated the source and mechanisms for the induction of VEGF in CSDH by measuring the concentration of VEGF in the hematoma of 102 patients (122 hematomas) using the enzyme-linked immunosorbent assay technique. The relationship between the VEGF concentration in hematoma and the intrahematoma membranous structure confirmed by preoperative T 2 *-weighted magnetic resonance image was examined in 46 of these patients. VEGF and hypoxia-inducible factor-1a (HIF-1a) expression was immunohistochemically studied and microvessel density (MVD) in the outer membrane was identified using anti-CD31 antibody in 30 patients. VEGF and HIF-1a were positive in the outer membranes of all 30 patients. VEGF expression was significantly correlated to HIF-1a expression (r s ＝ 0.651, p ＝ 0.0084) and VEGF concentration in the hematoma (r s ＝ 0.654, p ＝ 0.0013). VEGF concentration in layered hematomas, which have intrahematoma membranous structure, was significantly higher than in non-layered hematomas (p º 0.01). Although MVDs of the outer membranes were comparable to those described in tumors, there was no significant relationship with VEGF expression. The present study suggests that VEGF in CSDH, which may be induced in the neomembrane by HIF-1 release, may give rise to the excessive development of fragile microvessels and hyperpermeability, resulting in the enlargement of CSDH.

Triexponential analysis makes it possible to noninvasively obtain more detailed tissue diffusion and perfusion information and to assist in the diagnosis of liver cirrhosis.

Purpose: Although an apparent diffusion coefficient (ADC) value is often used for differential diagnosis of tumours, it varies with scanning parameters. The present study was performed to investigate the influence of imaging parameters, i.e., b value, repetition time (TR) and echo time (TE), on ADC value. Methods:The phantoms were scanned using diffusion weighted imaging (DWI) with changing b values (b = 0 -3000 s/mm 2 ), TR and TE to determine the influence on ADC. Moreover, ADC of the brain in normal volunteers was determined with varying b values (b = 0 -1000 s/mm 2 ).Results: Diffusion decay curves were obtained by biexponential fitting in all phantoms. The points where fast and slow components of the biexponential decay crossed were called turning points. The b values of turning points that crossed from the biexponential curve were different in each phantom. The b values of turning points depended on ADC of fast diffusion component. When ADC is calculated using two b values of front and back for the turning point, the ADC value may be different. Therefore, it was necessary to perform calculations by b value until the turning point to obtain the ADC value of the fast component. In addition, b ≥ 100 was recommended to avoid the influence of perfusion by blood. Furthermore, the choice of long TR and short TE was effective for accurate measurement of ADC. Conclusion:It is important to determine the turning point for measuring ADC.