Current Medical Imaging - Current Issue

Non-invasive biomarkers of liver metabolism are essential for early detection of metabolic alterations. Choline plays a central role in hepatic function, yet its dietary intake and imaging correlates remain underexplored. This study evaluated the feasibility of proton Magnetic Resonance Spectroscopy (¹H-MRS) at 3T for hepatic choline quantification and examined its correlation with dietary intake in young women, a population at risk of nutrient-sensitive liver conditions.

In this prospective cohort study, 88 healthy female radiology students (mean age: 21.4 ± 1.8 years) underwent single-voxel ¹H-MRS of the liver using a 3T Siemens Magnetom Vida scanner. Spectra were acquired with a point-resolved spectroscopy (PRESS) sequence (TR = 2000 ms, TE = 40 ms, voxel size = 20 × 20 × 20 mm³), with automated shimming and unsuppressed water referencing. Spectral analysis was performed using LCModel (v6.3), applying quality thresholds (Signal-to-Noise Ratio (SNR) > 5, linewidth < 0.1 ppm, Cramér–Rao Lower Bound (CRLB) < 20%. Hepatic choline concentrations were expressed in Institutional Units (IU). Dietary intake was assessed using a validated Food Frequency Questionnaire (FFQ).

High-quality spectra were consistently obtained (mean SNR: 12.6 ± 3.1; linewidth: 0.048 ± 0.012 ppm). Mean hepatic choline concentration was 4.63 ± 1.21 IU, while mean dietary intake was 29.1 ± 8.7 mg/day. A significant positive correlation was observed (r = 0.555, p < 0.001). Regression analysis confirmed dietary intake as a significant predictor (β = 0.56, R² = 0.308, p < 0.001).

These findings demonstrate that ¹H MRS at 3T provides reproducible hepatic choline quantification and captures meaningful variability linked to dietary intake. The observed correlation highlights the potential of MRS as a translational biomarker of nutrient related liver metabolism. Integrating MRS into multiparametric liver imaging protocols may enhance early detection of metabolic alterations and broaden the scope of non-invasive liver assessment.

¹H-MRS at 3T is a feasible and reproducible technique for hepatic choline quantification. By measuring metabolites directly in the liver at their site of production, rather than in circulation, where concentrations may be altered, MRS provides physiologically relevant insights into nutrient-related hepatic metabolism. Its correlation with dietary intake highlights its potential as a translational imaging biomarker for early detection and risk stratification of nutrient-sensitive liver conditions.

Pseudomyogenic Hemangioendothelioma (PMHE), also known as epithelioid sarcoma-like hemangioendothelioma, is a rare, indolent, low-grade vascular tumor. It typically presents as firm cutaneous nodules, with a predilection for the lower extremities and a male predominance. While numerous cases have been reported in pathology literature, detailed radiologic descriptions, particularly of soft tissue origins, are scarce. This report aims to bridge this gap by presenting a rare case of PMHE with comprehensive imaging findings.

We report on a 67-year-old male who presented with painful, palpable papules on his right buttock. MRI revealed multifocal dermal nodules demonstrating low signal intensity on T1-weighted images and high signal intensity with a distinctive peripheral high-signal halo on T2-weighted images. Notably, T1 gadolinium fat-saturated sequences exhibited marked enhancement with a characteristic peripheral rim enhancement pattern. The lesions were confined to the cutaneous layer. Initial radiological differentials included post-inflammatory granuloma and sarcoma. Histopathological examination confirmed PMHE. PET/CT demonstrated no evidence of systemic metastasis, and the patient has remained recurrence-free for two years following surgery.

This report highlights a rare case of cutaneous PMHE and details its distinctive MRI features, particularly the peripheral rim enhancement. Given its rarity and often non-specific clinical and imaging presentations, there is a significant potential for misdiagnosis. Therefore, it is crucial for radiologists to be aware of PMHE and familiarize themselves with its characteristic radiological patterns to facilitate accurate, timely diagnosis and ensure appropriate patient management.