Chronic liver disease is a major public health problem worldwide. Liver fibrosis, a common feature of almost all causes of chronic liver disease, involves the accumulation of collagen, proteoglycans, and other macromolecules within the extracellular matrix. Fibrosis tends to progress, leading to hepatic dysfunction, portal hypertension, and ultimately cirrhosis. Liver biopsy, the standard of reference for diagnosing liver fibrosis, is invasive, costly, and subject to complications and sampling variability. These limitations make it unsuitable for diagnosis and longitudinal monitoring in the general population. Thus, development of a noninvasive, accurate, and reproducible test for diagnosis and monitoring of liver fibrosis would be of great value. Conventional cross-sectional imaging techniques have limited capability to demonstrate liver fibrosis. In clinical practice, imaging studies are usually reserved for evaluation of the presence of portal hypertension or hepatocellular carcinoma in cases that have progressed to cirrhosis. In response to the rising prevalence of chronic liver diseases in Western nations, a number of imaging-based methods including ultrasonography-based transient elastography, computed tomography-based texture analysis, and diverse magnetic resonance (MR) imaging-based techniques have been proposed for noninvasive diagnosis and grading of hepatic fibrosis across its entire spectrum of severity. State-of-the-art MR imaging-based techniques in current practice and in development for noninvasive assessment of liver fibrosis include conventional contrast material-enhanced MR imaging, double contrast-enhanced MR imaging, MR elastography, diffusion-weighted imaging, and MR perfusion imaging.

Purpose: To assess the diagnostic sensitivity and specificity of double-oblique true fast imaging with steady-state precession (SSFP) cine MRI in distinguishing normal and bicuspid aortic valves. Materials and Methods:Echocardiograms on patients referred for MRI of the heart and thoracic aorta over a fouryear period were reviewed retrospectively. A total of 17 patients with bicuspid aortic valve were identified and compared to 21 randomly chosen control patients. All patients had double-oblique SSFP (True FISP) cine MRI of the aortic valve independently assessed by two radiologists in a blinded fashion, and graded as bicuspid or normal. Image quality was graded as 1, 2, or 3. Discordance was resolved by consensus.Results: A total of 38 cases were reviewed (27 men, 11 women; age range ϭ 15-67 years, mean ϭ 25.33 years). Interobserver agreement was 0.97 (36/38 cases). One case of normal tricuspid valve was reported as bicuspid by both readers (false-positive). All cases in which disparity arose were rated suboptimal by both readers (grade 2 or 3). Consensus review yielded sensitivity ϭ 100%, specificity ϭ 95.2%, positive predictive value ϭ 94.4%, and negative predictive value ϭ 100%; overall diagnostic accuracy was 97.36%. Interobserver agreement was 0.97. BICUSPID AORTIC VALVE is a common congenital anomaly, with an incidence of 0.9% to 2% in the general population (1). It is associated with aortic stenosis, aortic incompetence, aortic dissection, aneurysm formation (2), infective endocarditis, and aortic coarctation (3). Up to 85% of cases of aortic coarctation have concomitant bicuspid aortic valve morphology (4) and in this group there is a significant association with ascending aortic aneurysm (5). Inheritance may be multifactorial, or autosomal dominant, and is more common in men (6). The diagnosis of bicuspid aortic valve is routinely made using cross sectional two-dimensional (2D) and Doppler echocardiography. Diagnosis is based on the demonstration of two cusps and two commissures during short-axis (SA) visualization. Features such as a single coaptation line between cusps during diastole, cusp redundancy, and eccentric valve closure support the diagnosis. ConclusionMRI is established as one of the most accurate noninvasive modalities in the study of aortic diseases (7,8). Breathhold cine sequences using steady-state free-precession (SSFP) acquisitions, e.g., true fast imaging with steady-state precession (TrueFISP) (Siemens Medical Systems, Erlangen, Germany) combine the advantage of short acquisition times and high signal-to-noise ratio, thus optimizing blood-myocardium contrast (9). Cine sequences are commonly employed to evaluate aortic valve morphology, but the diagnostic accuracy of these sequences in determining aortic valve morphology is unknown.The aim of this study was to determine the sensitivity and specificity of double-oblique TrueFISP cine MRI in distinguishing normal and bicuspid aortic valves when compared with echocardiography as a gold standard. MATERIALS AND METHODSHospital ethics comm...

A small percentage of patients with anterior knee pain have chondromalacia isolated to the anterior margin of the lateral femoral condyle. This was associated with a shallower femoral sulcus angle.

The mean ADC of fibrosis is significantly greater than that of regenerative nodules both in vivo and ex vivo. The prevailing paradigm that fibrosis causes the reduced liver ADC observed in cirrhosis may need modification.

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