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Hepatobiliary phases in magnetic resonance imaging using liverspecific contrast for focal lesions in clinical practice

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World Journal of Hepatology 2022年第7期14卷 1459-1469页

作者： Daniel Alvarenga Fernandes Eduardo Andreazza Dal Lago Felipe Aguera Oliver Bruna.Melo Coelho Loureiro Daniel Lahan Martins Thiago José Penachim Ricardo Hoelz de Oliveira Barros José de ArimatéiaBatista Araújo Filho Larissa Bastos Eloy da Costa Áurea Maria Oliveira da Silva Elaine Cristina de Ataíde Ilka de Fátima Santana Ferreira Boin Nelson Marcio Gomes Caserta Department of Radiology School of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazi Department of Radiology Medical SchoolSão Paulo State University-UNESPBotucatu 18618-970São PauloBrazil Instituto de Radiologia Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo-InRad/HC-FMUSPSão Paulo 05403-010SPBrazil Department of Radiology Sírio-Libanês HospitalSão Paulo 05652-900SPBrazil Department of Pathology School of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil Liver Transplant Unit Department of SurgerySchool of Medical SciencesUniversity of Campinas-UNICAMPCampinas 13083-888São PauloBrazil

BACKGROUND Challenging lesions,difficult to diagnose through non-invasive methods,constitute an important emotional burden for each patient regarding a still uncertain diagnosis(malignant x benign).In addition,from a therapeutic and prognostic point of view,delay in a definitive diagnosis can lead to worse outcomes.One of the main innovative trends currently is the use of molecular and functional methods to diagnosis.Numerous liver-specific contrast agents havebeen developed and studied in recent years to improve the performance of liver magnetic resonance imaging(MRI).More recently,one of the contrast agents introduced in clinical practice is gadoxetic acid(gadoxetate disodium).AIM To demonstrate the value of the hepatobiliary phases using gadoxetic acid in MRI for the characterization of focal liver lesions(FLL)in clinical practice.METHODS Overall,302 Lesions were studied in 136 patients who underwent MRI exams using gadoxetic acid for the assessment of FLL.Two radiologists independently reviewed the MRI exams using four stages,and categorized them on a 6-point scale,from 0(lesion not detected)to 5(definitely malignant).The stages were:stage 1-images without contrast,stage 2-addition of dynamic phases after contrast(analogous to usual extracellular contrasts),stage 3-addition of hepatobiliary phase after 10 min(HBP 10’),stage 4-hepatobiliary phase after 20 min(HBP 20’)in addition to stage 2.RESULTS The interobserver agreement was high(weighted Kappa coefficient:0.81-1)at all stages in the characterization of benign and malignant FLL.The diagnostic weighted accuracy(Az)was 0.80 in stage 1 and was increased to 0.90 in stage 2.Addition of the hepatobiliary phase increased Az to 0.98 in stage 3,which was also 0.98 in stage 4.CONCLUSION The hepatobiliary sequences improve diagnostic accuracy.With growing potential in the era of precision medicine,the improvement and dissemination of the method among medical specialties can bring benefits in the management of patients with FLL that are difficult to diagnose.

关键词： Liver Liver neoplasms Liver transplantation Medical oncology Diagnostic imaging Magnetic resonance imaging

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The CASTOR-K Code,Recent Developments and Applications

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Plasma Science and Technology 2015年第2期17卷 89-96页

作者： F.NABAIS D.BORBA R.coelho A.FIGUEIREDO J.FERREIRA N.loureiro P.RODRIGUES Associao EURATOM/IST Instituto de Plasmas e Fuso Nuclear-Instituto Superior TcnicoUniversidade de Lisboa

The CASTOR-K code is a hybrid magnetohydrodynamic （MHD）-drift kinetic code developed for the study of MHD modes in the presence of energetic ion populations. It allows a fast assessment of the linear stability of the modes, as well as an accurate calculation of damping due to thermal species （Landau damping）. These capabilities make the code an invaluable tool for parametric studies and data analysis. In recent years, CASTOR-K has been mostly used to analyze JET data, including the identification of mechanisms involved in the expulsion of energetic ions from the plasma. However, in order to prepare the code to be used for a wider range of tokamaks including ITER, the code is being subject to a series of important improvements. These improvements aim not only to introduce new physics in the code but also to make it capable of exchanging data with other codes through its integration in modelling infrastructures. In this paper a description of the CASTOR-K code is presented, as well as a summary of the most important results obtained with this code and a description of the new improvements being implemented.

关键词： controlled fusion tokamaks plasma instabilities magnetohydrodynamics（MHD） Alfven waves energetic particles

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