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Table of citations (1000 visible)

175.8274807451995.12.21++Microabscesses of the liver and spleen in AIDS: detection with 5-MHz sonography.Radiology
JG Murray, MD Patel, S Lee, JS Sandhu, VA Feldstein,
PURPOSE: To determine whether sonograms of the liver and spleen, obtained with 5-MHz linear-array transducers, aid in detection of hepatosplenic microabscesses in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Abdominal sonographic examinations (n = 111) were performed in 102 consecutive patients with AIDS. A 3.5-MHz sector transducer was used in each study, with additional images of the hepatic and splenic parenchyma obtained with a 5-MHz linear-array transducer. Each study was reviewed without benefit of the 5-MHz images, and categories of the hepatic and splenic parenchyma were as follows: 1, lesions definitely present; 2, lesions possibly present; and 3, lesions absent. The 5-MHz images were subsequently reviewed, and studies were recategorized. Findings were correlated with results of pathologic examination. RESULTS: The 5-MHz scans enabled identification of focal hepatic or splenic lesions in 14 of 96 studies placed in category 2 or 3 on the basis of the 3.5-MHz sector scans. CONCLUSION: In patients with AIDS, 5-MHz sonograms of the liver and spleen enable detection of microabscesses not confidently identified on 3.5-MHz scans.
263.7579496801994.11.30++Nodular sarcoidosis of the liver and spleen: appearance on MR images.J Magn Reson Imaging
DM Warshauer, RC Semelka, SM Ascher,
Small nodular lesions in the liver and spleen have been reported as an infrequent manifestation of sarcoidosis. Five patients with this appearance on either dynamic contrast material-enhanced computed tomographic (CT) or ultrasound scans underwent magnetic resonance (MR) imaging with and without dynamic gadolinium enhancement. The lesions were relatively uniform in size, ranging from 0.5 to 1.5 cm. On CT scans, they were hypoattenuating relative to surrounding parenchyma. On MR images, the lesions were hypointense relative to background parenchyma with all sequences. No substantial enhancement was observed in the lesions, although lesion conspicuity decreased over time on serial postcontrast images. Lesion conspicuity was greatest on either T2-weighted fat-suppressed (T2FS) images or early-phase dynamic contrast-enhanced images. Abdominal adenopathy was seen in three of the five patients and was hyperintense relative to liver on T2FS images in two and intermediate in intensity in one patient.
353.5718894321991.10.11++Splenic lesions: sonographic patterns, follow-up, differential diagnosis.Eur J Radiol
C Goerg, WB Schwerk, K Goerg,
This report concerns 172 patients with sonographically diagnosed benign and malignant splenic lesions. A variety of echopatterns was observed, but a differential diagnosis was often impossible without contributory clinical data. Thirteen patients underwent ultrasound-guided fine-needle biopsy for histological confirmation or therapy. In 14 cases splenectomy was performed for treatment or final diagnosis. Twenty-three patients had malignant space-occupying lesions of the spleen. 26 cases presented with normal splenic size, 47 showed splenomegaly of different extent. Lymphoma was the main basic illness in 60 patients. Thirteen cases presented with splenic metastases from other neoplasms. 71 malignant splenic lesions were hypoechoic when compared with normal splenic echotexture. Only two patients exhibited hyperechoic metastases. In three cases a 'halo' sign was seen. In 99 patients benign focal lesions of the spleen were diagnosed. These included splenic infarction (n = 36), dysontogenetic cysts (n = 23), splenic abscesses (n = 7), splenic calcification (n = 13), and hyperechoic lesions (n = 17) most probably representing splenic hemangioma.
450.9514103581992.11.13++Spleen: dynamic enhancement patterns on gradient-echo MR images enhanced with gadopentetate dimeglumine.Radiology
RC Semelka, JP Shoenut, PH Lawrence, HM Greenberg, TP Madden, MA Kroeker,
To examine the pattern of immediate enhancement with gadopentetate dimeglumine on dynamic magnetic resonance (MR) images of the spleen, this study was divided into two parts: In the first part, the authors retrospectively reviewed the dynamic MR images obtained with a fast low-angle shot (FLASH) sequence in the abdomen immediately after injection of gadopentetate dimeglumine in 137 patients. In the second part, dynamic gadolinium-enhanced FLASH images were prospectively compared with contrast material-enhanced computed tomographic (CT) scans in 17 patients with focal splenic lesions discovered on CT scans. In the first part, 108 patients (79%) had an arciform pattern of contrast enhancement; 22 patients (16%), a uniform pattern of high signal intensity; and seven patients (5%), a uniform pattern of low signal intensity. Most patients had arciform enhancement of the spleen; uniform enhancement occurred in some patients with underlying malignant or inflammatory disease. In the second part, all focal lesions seen on CT scans were seen on dynamic MR images (75 lesions), significantly more than were seen on FLASH images (15 lesions) (P < .001).
545.4094022371998.01.13++Dynamic MR imaging of splenic tumor.Comput Med Imaging Graph
K Hayasaka, Y Tanaka, J Kawamori,
Inflammatory pseudotumor and hemangioma of the spleen are rare benign tumors, and MRI findings of splenic diseases have been reported only rarely. We recently observed three patients with inflammatory pseudotumor and hemangioma of the spleen. Abdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography demonstrated within the enlarged spleen. MRI and dynamic MRI after administration of gadolinium DTPA provide the characterization of the splenic tumor.
642.16111267982001.01.11+ Imaging of tumoral conditions of the spleen.JBR-BTR
KJ Mortelé,
741.6315634031992.05.15++Ultra-low field MR imaging of hepatic hemangiomas (at 0.02 and 0.04 T).Eur J Radiol
L Ekelund, J Björnebrink, L Athlin,
Twelve patients with cavernous hemangiomas of the liver were studied with computed tomography (CT) and ultra-low field magnetic resonance imaging (MRI). Seven patients were examined at a field strength of 0.02 T and 5 patients at 0.04 T, while 3 patients were studied at both field strengths. On T2-weighted images all hemangiomas had the same characteristic appearance of a homogeneous high signal intensity that has been described at higher field strengths. Signal characteristics of the hemangiomas were the same at 0.02 and 0.04 T, but the higher field strength provided better signal-to-noise (S/N) ratio and hence improved image quality. Homogeneous contrast enhancement was seen in three hemangiomas examined after intravenous administration of gadopentetate dimeglumine. Our results indicate that ultra-low field MRI can be useful in the differential diagnosis of hepatic hemangiomas.
840.9366003261983.02.14+ Focal lesions in the spleen: sonographic patterns and guided biopsy.AJR Am J Roentgenol
L Solbiati, MC Bossi, E Bellotti, C Ravetto, G Montali,
939.9386062311996.05.21++Inflammatory pseudotumors of the spleen: CT and MRI findings.J Comput Assist Tomogr
H Irie, H Honda, K Kaneko, T Kuroiwa, T Fukuya, K Yoshimitsu, H Aibe, R Hirakata, Y Horie, T Maeda, K Masuda,
OBJECTIVE: Our goal was to elucidate the CT and MRI findings of inflammatory pseudotumors of the spleen. METHODS: The CT and MRI findings of three patients with inflammatory pseudotumors of the spleen were reviewed and compared with the pathologic findings. RESULTS: On the early phase of CT, the masses were hypodense to the normal spleen, and on the delayed phase, they demonstrated delayed enhancement. On T1-weighted MR images, the masses were isointense to the normal spleen, and on T2-weighted images, the masses had heterogeneous low signal intensities. After administration of Gd-DTPA, the masses showed delayed enhancement. CONCLUSION: Inflammatory pseudotumors of the spleen were characterized by low signal intensity on T2-weighted MR images and delayed enhancement after contrast material administration on CT and MRI. The fibrous stroma may contribute to these unusual findings.
1039.3686147221996.06.06+ [The imaging diagnosis of a rare case of inflammatory pseudotumor of the spleen]Radiol Med
S Meduri, C Zuiani, M Bendini, M Bazzocchi,
1138.74108000042000.06.20++Color Doppler sonographic findings in splenic hamartoma.J Clin Ultrasound
S Tang, T Shimizu, Y Kikuchi, S Shinya, R Kishimoto, Y Fujioka, K Miyasaka,
We present the gray-scale and color Doppler sonographic findings in a case of a splenic hamartoma in a 40-year-old man. Gray-scale sonograms showed a 2 x 2 cm, hypoechoic splenic mass that was homogeneous without evidence of cystic change or calcification. Color Doppler sonograms showed multiple radial blood-flow signals inside the mass, and spectral analysis confirmed arterial and venous flow. Arteriograms showed multiple small, hypervascular masses with fine tumor vessels and tumor stains within the spleen. Histologic analysis following a splenectomy showed dilated vessels and congestion consistent with the color Doppler sonographic findings.
1238.7232829631988.05.31++Ultrasound, CT, and MRI comparison in primary and secondary tumors of the liver.Gastrointest Radiol
WL Curati, A Halevy, RN Gibson, DH Carr, LH Blumgart, RE Steiner,
Thirty-five patients with surgically removed or percutaneous biopsy-proven tumors were examined by ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI). This retrospective study describes the appearance of the primary tumors and metastases and compares the sensitivity and specificity of the 3 imaging methods. Ultrasound, CT, and MRI examinations as well as clinical, operative, and/or histologic data were available for all 35 patients. Paramagnetic contrast agent gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA) was used in 23 patients and a short TI inversion recovery MRI sequence was used in 23 patients, in addition to various spin echo MRI sequences. Thirteen patients were examined using both Gd-DTPA and the short TI inversion recovery sequence. Our comparative study--based on the following criteria: detection, size, location of the tumor, and portal vein involvement and bile duct dilatation--demonstrated an advantage of MRI over ultrasound in 16 of 35 cases, equal results in 17 of 35 cases and a disadvantage of MRI compared to ultrasound in 2 of 35 cases. With the identical criteria, MRI proved to be more informative than CT in 10 of 35 cases, equal in 21 of 35 cases, and less informative in 4 of 35 cases.
1338.5920179571991.05.17++Sonography of focal lesions of the spleen.AJR Am J Roentgenol
C Goerg, WB Schwerk, K Goerg,
The sonographic appearances of benign and malignant splenic lesions in 154 patients are illustrated. Sixty-six of the 154 patients had malignant splenic lesions; 55 of these had malignant lymphoma and 11 had splenic metastatic lesions. The lesions were hypoechoic in 64 cases (97%), including all cases of malignant lymphoma, and were hyperechoic in two. Eighty-eight patients had benign splenic lesions; findings included cysts, infarcts, abscesses, hemangiomas, and calcifications.
1438.1782347171993.12.17++Dynamic breath-hold multiplanar spoiled gradient-recalled MR imaging with gadolinium enhancement for differentiating hepatic hemangiomas from malignancies at 1.5 T.Radiology
WS Whitney, RJ Herfkens, RB Jeffrey, CH McDonnell, KC Li, WJ Van Dalsem, RN Low, IR Francis, JF Dabatin, GM Glazer,
PURPOSE: To compare the enhancement patterns of focal liver lesions at dynamic breath-hold gadolinium-enhanced multiplanar spoiled gradient-recalled (SPGR) magnetic resonance (MR) imaging with T2 relaxation times in the differentiation of liver hemangiomas from malignancies. MATERIALS AND METHODS: Forty-seven patients with focal liver lesions underwent MR imaging with spin-echo and gadolinium-enhanced multiplanar SPGR techniques. T2 relaxation times and enhancement patterns were compared for accuracy in liver lesion characterization. RESULTS: Enhancement patterns allowed better characterization of liver lesions than did T2 relaxation times. Only specific patterns of contrast enhancement indicated a hemangioma. Although 18 of the 33 malignancies and 10 of the 12 hemangiomas showed progressive centripetal hyperintense enhancement, only hemangiomas filled in with hyperintense peripheral nodules. Malignancies often filled in with hyperintense thick rinds. CONCLUSION: Gadolinium-enhanced multiplanar SPGR imaging allows more accurate characterization of liver lesions than does T2 relaxation time.
1537.97167662702006.07.17++Hepatic metastases of hemangiopericytoma: contrast-enhanced MRI, contrast-enhanced ultrasonography and angiography findings.Cancer Imaging
C Aliberti, G Benea, B Kopf, U De Giorgi,
Hemangiopericytoma is a rare and characteristically hypervascular tumour. We report a case of hepatic metastases of hemangiopericytoma for which there was correlative imaging by ultrasonography, ultrasonography with second-generation contrast agent (BR1), computed tomography, gadolinium-enhanced, Gd-BOPTA-enhanced and ferumoxides-enhanced magnetic resonance, and angiography. To our knowledge, this is the first reported case in which all these modalities were used in the diagnostic evaluation.
1637.5681262881994.04.11++Fibrolamellar hepatocellular carcinoma: MR appearance mimicking focal nodular hyperplasia.J Comput Assist Tomogr
JE Hamrick-Turner, FH Shipkey, PE Cranston,
We report the MR findings of a case of fibrolamellar hepatocellular carcinoma that fulfilled MR criteria proposed as diagnostic of focal nodular hyperplasia. Because confusion of fibrolamellar carcinoma with focal nodular hyperplasia could result in a missed opportunity for cure, pathologic assessment remains necessary in cases demonstrating these MR findings that do not show radiotracer uptake on 99mTc-sulfur colloid scintigraphy.
1737.1879572941994.12.29++Color Doppler imaging of focal splenic masses.Eur J Radiol
C Goerg, WB Schwerk,
We report the sonographic findings in 43 patients with focal splenic masses. A differential diagnosis of splenic tumors was attempted on the basis of echotexture, size, vascularity and patterns of blood flow within and around tumors on color Doppler sonography. Using the surrounding splenic tissue as an in vivo reference, markedly hypervascular (n = 3), hypervascular (n = 2), isovascular (n = 4), hypovascular (n = 3), and avascular (n = 31) tumors could be differentiated. The final diagnoses were splenic infarction (n = 13), splenic rupture (n = 9), splenic metastasis (n = 7), splenic lymphoma (n = 3), splenic abscess (n = 4), hemangioma (n = 3), splenic cyst (n = 3) and splenoma (n = 1). In 17 cases (40%) color Doppler provides no further information for diagnosis, color Doppler was helpful in 21 patients (49%) and in four (9%) cases, Doppler sonography detects unexpected flow phenomena and was necessary for final diagnosis and treatment. In one patient (2%) sonographic diagnosis was incorrect. CONCLUSION: Characteristic patterns of blood flow were seen in different splenic tumors and can, therefore, aid in the differential diagnosis of focal splenic lesions, and identify patients at risk for serious complications.
1837.0538846171985.05.17++Focal splenic disease demonstrated by ultrasound and computed tomography.J Can Assoc Radiol
P Costello, RA Kane, J Oster, ME Clouse,
Twenty-five patients with focal splenic disease were analyzed retrospectively to determine the relative strengths and weaknesses of ultrasound and computed tomography (CT) in the detection and analysis of focal splenic lesions. Lesions were detected in all 25 patients by ultrasonography and in 22 of 25 patients by CT. Ultrasonography appears to be more sensitive in the detection of focal lymphoma within the spleen and may be slightly more sensitive in the detection of microabscesses. CT may offer more specific information regarding the nature of certain lesions, including the detection of cyst wall calcification, gas within an abscess, and the specific site of origin of tumor invading the spleen. Ultrasonography may at times be more specific in the diagnosis of cystic lesions. We recommend ultrasonography as the first method for splenic imaging with CT used when necessary for further characterization of focal lesions.
1936.8481840551994.06.14++Dynamic contrast-enhanced MR imaging of the portal venous system: comparison with x-ray angiography.Radiology
PM Rodgers, J Ward, CJ Baudouin, JP Ridgway, PJ Robinson,
PURPOSE: To compare dynamic contrast material--enhanced multisection magnetic resonance (MR) imaging with x-ray angiography in the evaluation of the portal venous system. MATERIALS AND METHODS: Eighteen patients underwent preoperative x-ray angiography and dynamic contrast-enhanced MR imaging. MR imaging was performed at 1.0 T with a multisection breath-hold fast low-angle shot (FLASH) technique in the coronal-oblique plane, before and after injection of a bolus of gadopentetate dimeglumine. The portal vein, its right and left intrahepatic branches, the splenic veins, and the superior mesenteric veins were examined. The presence of varices was also assessed. RESULTS: Of the 84 vessels evaluated with both techniques, appearances were similar in 76 (90%). Both examinations showed the main portal vein to be patent in nine patients, occluded in five, and patent but abnormal in two. Findings in the main portal vein were discordant in two patients. In one patient, surgical follow-up helped confirm the findings at MR imaging. CONCLUSION: MR imaging can replace x-ray angiography in the preoperative evaluation of portal vein patency in most patients.
2036.35157358642005.06.14++Splenic hamartoma: immunohistochemical and ultrastructural profile of two cases.Int J Surg Pathol
TZ Ali, G Beyer, M Taylor, C Volpe, JC Papadimitriou,
Splenic hamartoma (SH) is a rare, benign lesion. We present 2 cases, both in females (2 and 30 years, respectively) with multiple urinary tract infections, and left upper quadrant abdominal pain. Immunohistochemical staining with factor VIII displayed intense diffuse staining in the SH with corresponding weak staining in the adjacent spleen. CD31 showed a reverse pattern from that of factor VIII. CD34 staining pattern was identical in both the spleen and the SH. Ultrastructurally, the SH showed endothelial cells with relatively empty cytoplasm, scattered Weibel Palade bodies, and lining by basement membrane surrounded by fibrous long-spacing collagen. Our study highlights the unique immunohistochemical profile of SH. The ultrastructural features are interesting, although their diagnostic significance remains to be confirmed in future studies.
2136.24110597392001.02.08++Inflammatory pseudotumor of the spleen: report of a case.Surg Today
S Moriyama, A Inayoshi, R Kurano,
A case of a 45-year-old Japanese man with a splenic inflammatory pseudotumor is described. This benign lesion is rarely reported in the world literature. We preoperatively could not rule out the possibility of a malignant neoplasm, due to the fact that the tumor had grown in size after a 2-year observation. However, after performing a splenectomy, a histological examination of the mass revealed an inflammatory process. Inflammatory pseudotumors often pose diagnostic difficulties because the clinical and radiological findings tend to suggest a malignancy. The clinical and pathological features of such previously reported cases are also reviewed.
2236.2320279741991.06.13++Dynamic gadolinium-enhanced MR imaging of the spleen: normal enhancement patterns and evaluation of splenic lesions.Radiology
SA Mirowitz, JJ Brown, JK Lee, JP Heiken,
The authors studied the ability to improve detection of splenic lesions during suspended respiration with dynamic gadolinium-enhanced T1-weighted spin-echo magnetic resonance (MR) imaging. In the first phase of the study, normal splenic contrast material enhancement patterns were assessed in 10 control patients without splenic lesions. A heterogeneous signal intensity pattern was observed in 11 patients with splenic lesions during bolus injection of gadopentetate dimeglumine, with conversion to homogeneous enhancement 1 minute later. Mean splenic enhancement was 321% during bolus injection, with a rapid return toward baseline signal intensity thereafter. In the second phase, evaluation of 18 splenic lesions detected with contrast-enhanced computed tomography in 11 patients revealed that dynamic gadolinium-enhanced MR pulse sequences significantly improved lesion conspicuity and detectability compared with conventional T1-and T2-weighted pulse sequences. Contrast-to-artifact ratio measurements were 0.5, 3.7, and 9.3 for conventional T1-weighted, T2-weighted, and dynamic gadolinium-enhanced MR images, respectively.
2336.0480294031994.08.11++Hypervascular malignant liver lesions: comparison of various MR imaging pulse sequences and dynamic CT.Radiology
RE Larson, RC Semelka, AS Bagley, PL Molina, ED Brown, JK Lee,
PURPOSE: To compare the appearance of hypervascular liver lesions on gadolinium-enhanced fast low-angle shot (FLASH) imaging with T2-weighted fat-suppressed spin-echo imaging, dynamic nonequilibrium-phase FLASH imaging, and dynamic nonequilibrium-phase iodine-enhanced computed tomography (CT) and to characterize the appearance of lesions on serial postgadolinium FLASH images. MATERIALS AND METHODS: Twenty-nine patients with hypervascular malignant liver lesions were examined with dynamic contrast-enhanced CT and magnetic resonance (MR) imaging within a 1-month interval. MR sequences included T2-weighted fat-suppression, precontrast FLASH, and postgadolinium FLASH at 1 second (sinusoid phase), 45 seconds (nonequilibrium phase), and 10 minutes. RESULTS: More than five lesions were detected in 12 patients with CT, 15 patients with T2-weighted fat-suppression imaging, 16 with sinusoid-phase FLASH imaging, and 11 with nonequilibrium-phase FLASH imaging. In six patients, a statistically significant (P = .03) increase in the number of lesions detected, by category, was observed on sinusoid-phase FLASH images compared with CT images. CONCLUSION: Sinusoid-phase FLASH imaging is superior to nonequilibrium-phase imaging with MR or CT for the demonstration of hypervascular malignant lesions.
2435.84109356452000.08.15++Benign lymphangioendothelioma (acquired progressive lymphangioma): a lesion not to be confused with well-differentiated angiosarcoma and patch stage Kaposi's sarcoma: clinicopathologic analysis of a series.Am J Surg Pathol
L Guillou, CD Fletcher,
The clinicopathologic features of 12 cases of benign lymphangioendothelioma (acquired progressive lymphangioma) are reported. There were five male and seven female patients. Age at diagnosis ranged from 17 to 90 years (median age, 54 yrs). Development of a single macular/papular hemangiomatous or pigmented lesion was the main presenting symptom. Symptom duration before diagnosis ranged from 2 months to 20 years (median, 5.5 yrs). Tumor size ranged from 0.3 cm to 10 cm (median. 1.5 cm). Location included skin of the head and neck (n = 5), back (n = 1), breast (n = 1), shoulder (n = 1), forearm (n = 1), plantar aspect of the foot (n = 2), and oral mucosa (n = 1). No patient had any other concomitant vascular anomaly (for example, lymphangiomatosis) or was suspected to have acquired immunodeficiency syndrome. Treatment consisted of excisional biopsy in nine patients, incisional biopsy in two, and wide excision in one. Follow-up information on nine patients (range, 4-40 mos; median, 12 mos) showed two local recurrences in one patient. Microscopically, the lesions consisted of anastomosing, often widely dilated vascular structures developing in the superficial dermis. As the lesion grew within deeper dermis, the vascular spaces collapsed and dissected the dermal collagen in an angiosarcoma-like pattern. The lining endothelium was flat and monolayered, with little or no cytologic atypia and no evident mitoses. Some vascular structures contained stromal papillary projections resembling papillary endothelial hyperplasia, and intravascular red blood cells were present occasionally. Immunohistochemistry performed in eight specimens showed variable endothelial cell reactivity for CD31 (7 of 8), CD34 (7 of 7), and factor VIII-related antigen (4 of 6). A smooth muscle cell layer was observed focally around the vascular spaces in six lesions. Benign lymphangioendothelioma (acquired progressive lymphangioma) is an uncommon benign lesion that, in view of major differences in treatment and prognosis, should be distinguished from well-differentiated angiosarcoma and Kaposi's sarcoma, especially the patch stage and lymphangioma-like variants of the latter.
2535.3584301911993.03.11++Abdominal MR imaging: comparison of T2-weighted fast and conventional spin-echo, and contrast-enhanced fast multiplanar spoiled gradient-recalled imaging.Radiology
RN Low, IR Francis, JS Sigeti, TK Foo,
T2-weighted fast and conventional spin-echo (SE) and dynamic gadolinium-enhanced fast multiplanar spoiled gradient-recalled (FMPSPGR) images in 26 patients (18 with hepatic masses and eight with no detected abnormality) were compared to determine the efficacy of the newer pulse sequences (fast SE and FMPSPGR) in abdominal imaging. FMPSPGR allows for breath-hold magnetic resonance imaging of the liver. The contrast-to-noise ratio (C/N) of the hepatic lesions was calculated for each sequence and was superior in fast SE compared with that in conventional SE in 16 of 18 patients. Lesion detection was 90% with fast SE and was 85% and 80% for conventional SE and contrast material-enhanced FMPSPGR sequences, respectively. Of the T2-weighted sequences, fast SE showed consistently sharper anatomic structures and less respiratory and cardiac motion artifact. Thus, fast SE (with its superior C/N and shorter imaging time) and gadolinium-enhanced FMPSPGR images, when combined, demonstrate potential value as routine sequences in abdominal imaging.
2634.5083815721993.03.11++Fast multiplanar spoiled gradient-recalled imaging of the liver: pulse sequence optimization and comparison with spin-echo MR imaging.AJR Am J Roentgenol
RN Low, IR Francis, RJ Herfkens, RB Jeffrey, GM Glazer, TK Foo, A Shimakawa, NJ Pelc,
OBJECTIVE. The purpose of this study was to optimize a new rapid-acquisition MR pulse sequence, called fast multiplanar spoiled gradient-recalled (FMPSPGR) imaging, for breath-hold imaging of the liver and to compare unenhanced and contrast-enhanced FMPSPGR with standard spin-echo imaging in detecting liver tumors. MATERIALS AND METHODS. The pulse sequence was optimized at 1.5 T with a healthy volunteer. Various scanning parameters were evaluated, and liver-spleen signal difference/noise measurements were used to estimate lesion contrast-to-noise ratios. We examined 24 patients with hepatic masses using the optimized sequence with spin-echo T1-weighted and T2-weighted imaging as well as unenhanced and gadopentetate dimeglumine-enhanced FMPSPGR imaging. The contrast-to-noise ratio for the hepatic tumors was determined for each sequence. Three radiologists who did not know the biopsy or test results reviewed all images for lesion conspicuity, lesion tissue specificity, and overall image quality. RESULTS. A comparison of unenhanced FMPSPGR images with spin-echo T1-weighted images showed a 40% improvement in mean contrast-to-noise ratio and a 70% improvement in liver signal-to-noise ratio for the FMPSPGR images. A comparison of gadopentetate dimeglumine-enhanced FMPSPGR images with spin-echo T1- and T2-weighted images showed a superior contrast-to-noise ratio for the enhanced FMPSPGR images in 17 (68%) of 25 hepatic lesions, which included all hepatic cysts (n = 3) and all hepatomas (n = 6), and in six of 12 patients with other liver tumors. The results of contrast-to-noise ratio for four patients with hemangiomas were mixed. For the remaining eight lesions, the contrast-to-noise ratio for spin-echo T1- and T2-weighted images predominated in three and five cases, respectively. Contrast-enhanced FMPSPGR images revealed a 40% and 300% increase in contrast-to-noise ratio compared with T2- and T1-weighted images, respectively. All three radiologists preferred the contrast-enhanced FMPSPGR images for overall image quality. For lesion conspicuity and specificity, however, the three radiologists differed, with a preference for the FMPSPGR images in 52%, 80%, and 40% of cases for lesion conspicuity and in 68%, 40%, and 60% of cases for lesion specificity. CONCLUSION. FMPSPGR is a new, ultrafast MR sequence that provides T1-weighted images of the liver during suspended respiration. Contrast-to-noise ratio and liver signal-to-noise ratio are significantly improved over those on conventional spin-echo T1-weighted images. The combination of breath-hold FMPSPGR with gadopentetate dimeglumine is an excellent technique that can be used to rapidly evaluate the liver with superior overall image quality. Contrast-to-noise ratios are generally superior to T2-weighted spin-echo images, making this technique a useful adjunct to conventional spin-echo MR imaging.
2734.1032926041988.08.24++Focal lesions of the spleen: preliminary results with fast MR imaging at 1.5 T.J Comput Assist Tomogr
CF Hess, J Griebel, U Schmiedl, B Kurtz, G Koelbel, E Jaehde,
Sixteen patients with splenic lymphoma and six with nonlymphomatous splenic lesions underwent magnetic resonance (MR) imaging, ultrasound (US), and dynamic CT. All patients were studied at 1.5 T with gradient echo sequences using a repetition time of 80 ms, echo time of 16 ms, and two pulse angles of 30 and 60 degrees. In 14 patients with lymphomatous lesions fast MR showed circumscribed areas of low signal intensity at both pulse angles. The lesion-to-spleen contrast was better on images acquired with a pulse angle of 30 degrees. For fast MR with pulse angles of 30 degrees, the mean lesion-to-spleen contrast was similar to US and contrast-enhanced CT. However, with fast MR the contrast showed a lower variability and was considerably better than with unenhanced CT. In one patient fast MR showed splenic involvement that was missed on both CT and US. The signal characteristics of lymphomatous, leukemic, and sarcoid involvement and of healed infarcts were similar and indistinguishable on fast MR images. Recent splenic infarctions (three cases) were, however, distinctly different, characterized by regions of high signal intensity at both pulse angles. The results of this preliminary study suggest that fast MR imaging is a promising diagnostic tool for the assessment of splenic disorders.
2834.0322039511990.10.09++[Splenic cysts: indications for surgery and surgical procedures]Langenbecks Arch Chir
U Wolters, HW Keller, R Lorenz, H Pichlmaier,
Based on a late physical examination of 18 patients with splenic cysts, we discuss symptoms, diagnostics and indication to operate and the procedure of operation. We found no specific symptoms. The ultrasound is the most important diagnostic method and may be supplemented by computerized axial tomography. The indication depends on the symptoms, the diameter within the organ and, most important, the dignity of the cyst. For pseudocysts we prefer resection of the cyst wall, because it is a simple and safe procedure. Splenectomy is the treatment of choice for cysts with unknown dignity.
2933.8238856911985.05.20++Abdominal lymphadenopathy in intravenous drug addicts: sonographic features and clinical significance.AJR Am J Roentgenol
BR Subramanyam, EJ Balthazar, SC Horii, S Hilton,
The sonographic features of abdominal lymphadenopathy in 35 patients with history of intravenous drug addiction were analyzed to assess their clinical significance. Of the 28 proven cases, 15 were due to reactive hyperplasia, 10 to infections, and three to neoplasms. Sonography was helpful in assessing the pathologic nature of these nodes. Most nodes attributable to reactive hyperplasia were small (less than or equal to 1.5 cm diam) and showed a characteristic distribution in the porta hepatis, celiac axis, and peripancreatic regions. Hypoechoic nodes were always pathologic, due either to tuberculosis or to neoplasm. Nodes larger than 1.5 cm in diameter and primarily involving the lower retroperitoneum, splenic hilum, and mesentery are highly suspicious for pathologic nodes, and appropriate biopsies are indicated for diagnosis.
3033.8192406791997.08.15++Optimal MR protocol for hepatic hemangiomas. Comparison of conventional spin-echo sequences with T2-weighted turbo spin-echo and serial gradient-echo (FLASH) sequences with gadolinium enhancement.Acta Radiol
TK Kim, BI Choi, JK Han, HJ Jang, MC Han,
PURPOSE: To compare conventional spin-echo (SE) sequences with T2-weighted turbo SE and serial gadolinium-enhanced T1-weighted FLASH sequences in the detection and characterization of hepatic hemangiomas, and to describe the enhancement characteristics of the lesions on dynamic MR imaging. MATERIAL AND METHODS: Forty-two patients with 66 hemangiomas were studied at 1.0 T or 1.5 T by using conventional SE sequences (T1-weighted, T2-weighted, and heavily T2-weighted), T2-weighted turbo SE sequences, and breath-hold T1-weighted FLASH sequences acquired before, immediately after, and 1, 2, 3, 5, and 10 min after injection of a bolus of gadopentetate dimeglumine. Images were quantitatively analyzed for lesion-to-liver contrast-to-noise (C/N) ratios, and qualitatively analyzed for lesion conspicuity. The enhancement pattern and the rapidity of enhancement were analyzed in small (<15 mm), medium (15-39 mm), and large (>39 mm) hemangiomas. RESULTS: In T2-weighted images, T2-weighted turbo SE and heavily T2-weighted SE images had higher C/N ratios than T2-weighted SE images (p=0.003). Lesion conspicuity was not significantly different in these 3 sequences (p=0.307). In T1-weighted images, T1-weighted FLASH images had higher C/N (p<0.001) and also better lesion conspicuity (p<0.001) than T1-weighted SE images. Immediate uniform enhancement was seen in 43% of small hemangiomas (9 of 21 lesions), and persistent central hypointensity was seen in 73% of large hemangiomas (11 of 15 lesions). Rapid enhancement was seen in 62% of small hemangiomas (13 of 21 lesions) and in 31% of medium or large hemangiomas (14 of 45 lesions). CONCLUSION: Further clinical study is needed for evaluating the differential diagnostic advantages of turbo SE T2-weighted imaging compared to the calculation of T2-values by means of a SE T2-weighted sequence. However, the results of the present study suggest that T2-weighted turbo SE imaging and precontrast and serial gadolinium-enhanced FLASH imaging have the potential to replace conventional SE imaging in the evaluation of hepatic hemangiomas.
3133.65106739462000.03.02++Ultrasound guided fine needle aspiration biopsy of splenic lesions.Br J Radiol
NK Venkataramu, S Gupta, BP Sood, M Gulati, A Rajawanshi, SK Gupta, S Suri,
Fine needle aspiration biopsy (FNAB) of focal splenic lesions has been infrequently utilized because of the risk of haemorrhage. This study was carried out to evaluate the safety and efficacy of ultrasound guided FNAB of splenic lesions. 35 patients with focal splenic lesions underwent FNAB under real-time ultrasound guidance using a free hand technique. Ultrasound findings were single or multiple focal hypoechoic lesions (n = 33), focal hyperechoic lesion (n = 1) and diffuse heterogeneous echotexture (n = 1). Aspirations were performed with 22 G spinal needles using either the subcostal or the intercostal approach. Definite cytological diagnosis was made in 22 patients (62.8%), including tuberculosis in 10 patients, lymphoma in seven patients, extramedullary haematopoiesis in two patients and aspergillosis, histoplasmosis and bacterial abscess in one patient each. FNAB was negative in 12 patients because the aspirates were either scanty or contained only blood. FNAB was falsely positive in one patient. Only one patient had significant intraabdominal bleeding, which was managed conservatively. In conclusion, splenic FNAB performed under ultrasound guidance is a safe and accurate method in the diagnosis of focal splenic lesions.
3233.5884527211993.04.22++Peliosis of the spleen associated with a paraganglioma. Case report.Acta Radiol
P Engel, E Tjalve, T Horn,
We report a case of splenic peliosis imitating metastases on CT. The patient was a 44-year-old man who previously had a retroperitoneal paraganglioma surgically removed. Peliosis must be considered a potential differential diagnosis of hypodense foci of the spleen seen on CT.
3333.1223128481990.04.23++Differentiation of hepatic hemangiomas from metastases by dynamic contrast-enhanced MR imaging.J Comput Assist Tomogr
B Hamm, E Fischer, M Taupitz,
Twenty-nine patients with hepatic hemangiomas (n = 14) and hepatic metastases (n = 15) underwent magnetic resonance (MR) imaging prior to and after an intravenous bolus injection of Gd-diethylenetriamine pentaacetic acid (0.2 mmol/kg). Before contrast application, a T2-weighted spin echo sequence (SE 1,600/105) and a T1-weighted gradient echo sequence (GE 315/14/90 degrees pulse angle) were performed. Beginning with injection of the contrast agent, a dynamic study was conducted for 10 min using a moderately T1-weighted gradient echo sequence (GE 40/14/40 degrees) with an acquisition time of 10.2 s per image. Delayed (11 min) and late (60 min) postcontrast images were obtained using a T1-weighted sequence (GE 315/14/90 degrees). In the dynamic study (0-10 min) the hemangiomas were characterized by peripheral contrast enhancement and a subsequent hyperintense fill-in. The metastases showed very mixed patterns of enhancement after contrast administration, and their signal intensity remained low compared with that of the hepatic tissue. In the delayed postcontrast examination (11 min) the hemangiomas had a very high and homogeneous signal intensity and the metastases were characterized by an inhomogeneous, hypointense to isointense signal. The contrast between tumor and liver [signal-difference-to-noise ratio (SD/N)] was higher for all hemangiomas than it was for the metastases. In the T2-weighted precontrast examination, on the other hand, five hemangiomas and seven metastases showed an overlap in the SD/N. The late postcontrast images (60 min) did not yield any further diagnostic information. We conclude that the combination of a dynamic MR study with delayed postcontrast T1-weighted imaging is a useful method of diagnosing hepatic hemangiomas.
3433.0113735791992.05.21++Primary vascular tumors of lymph nodes other than Kaposi's sarcoma. Analysis of 39 cases and delineation of two new entities.Am J Surg Pathol
JK Chan, G Frizzera, CD Fletcher, J Rosai,
Primary vascular tumors of lymph nodes other than Kaposi's sarcoma are very rare, as attested to by only a handful of case reports in the literature. Based on an analysis of 39 such cases, we could distinguish five major groups. Hemangiomas of capillary/cavernous, lobular capillary, and cellular types were composed of compact aggregates of blood-filled vessels, variable in size, that replaced the nodal architecture partly or almost completely; some appeared to have originated in the hilum or medulla. These hemangiomas either represented incidental findings in lymph nodes or were seen with solitary lymph node enlargement; the evolution was benign with no recurrence. A distinctive benign lesion occurring exclusively in inguinal lymph nodes, which we propose designating "angiomyomatous hamartoma," showed replacement of the nodal parenchyma by smooth muscle cells and fibrous tissue, in continuity with exuberant proliferation of muscular vessels in the hilum. Epithelioid vascular tumors, characterized by plump endothelial cells with dense eosinophilic cytoplasm and numerous vacuoles, exhibited a range of differentiation, from hemangioma with well-formed vascular channels (with or without tissue eosinophilia) to hemangioendotheliomas composed predominantly of cords and sheets of tumor cells lying in a hyaline-myxoid matrix. Epithelioid hemangioendothelioma was particularly likely to be mistaken for metastatic carcinoma, and local recurrence could occur. A variant, the spindle and epithelioid hemangioendothelioma, was characterized by the presence of an additional component of spindle cells. Another tumor we found, polymorphous hemangioendothelioma, is a previously uncharacterized borderline malignant vascular tumor exhibiting solid, primitive vascular and angiomatous patterns and relatively bland cytologic features. Lymphangiomas of lymph nodes usually showed simultaneous multifocal and extra-nodal involvement and were characterized by cystic endothelium-lined spaces filled predominantly with lymph fluid. It is important to recognize these primary vascular tumors of lymph nodes to avoid mistaking them for a variety of benign vasoproliferative lesions, Kaposi's sarcoma, angiosarcoma, and metastatic cancer.
3532.8714387561992.12.18++Bladder tumor staging: comparison of conventional and gadolinium-enhanced dynamic MR imaging and CT.Radiology
A Tanimoto, Y Yuasa, Y Imai, M Izutsu, K Hiramatsu, M Tachibana, H Tazaki,
With computed tomography (CT) and unenhanced magnetic resonance (MR) imaging, stage pT3b extravesical extension and beyond can be diagnosed, but tumors confined to the bladder wall (stages pT1-pT3a) are poorly delineated. To determine whether visualization of such tumors could be improved with gadolinium-enhanced MR imaging, dynamic breath-hold T1-weighted MR images were obtained after intravenous infusion of 0.1 mmol/kg gadopentetate dimeglumine in 79 patients (86 tumors). Conventional MR images, CT scans, and histologic correlation were available in all cases. With dynamic gadolinium-enhanced MR imaging, the mucosa could be distinguished from the muscular layers of the bladder wall. Staging accuracy with this technique was 85% (73 of 86), which was significantly better than with CT (55%; 47 of 86) (P < .005) or conventional MR imaging (58%; 50 of 86) (P < .05). The accuracy of staging the intramural extent (pT1-pT3a) of bladder tumors was thus improved with gadolinium-enhanced dynamic MR imaging.
3632.6584165541993.01.21++Hypervascular liver lesions: differentiation of focal nodular hyperplasia from malignant tumors with dynamic gadolinium-enhanced MR imaging.Radiology
AE Mahfouz, B Hamm, M Taupitz, KJ Wolf,
The differentiating points between focal nodular hyperplasia (FNH) and malignant hypervascular liver lesions were studied at dynamic gadolinium-enhanced magnetic resonance (MR) imaging. Thirty-six patients with 50 hypervascular lesions (28 FNH, 12 hepatocellular carcinoma, nine metastases, and one cholangiocarcinoma) underwent unenhanced spin-echo (SE) T1- and T2-weighted imaging and T1-weighted gradient-recalled-echo imaging before and repeatedly for 10 minutes after intravenous bolus injection of gadopentetate dimeglumine. On unenhanced SE images, the signal intensity of 25 FNH lesions (89%) and 10 malignant tumors (45%) was homogeneous. A central scar was detected in 12 FNH lesions (43%) and in none of the malignant tumors. On dynamic gadolinium-enhanced images, all lesions had early vigorous enhancement that was homogeneous in 27 FNH lesions (96%) and in seven malignant tumors (32%) (P < .001). After administration of gadopentetate dimeglumine, central scars were seen in 22 FNH lesions (79%) and in one malignant tumor (4%) (P < .001). All FNH lesions (100%) and six malignant tumors (27%) had well-defined enhancement (P < .001). There was overlap in the enhancement pattern between hypervascular malignant lesions and FNH, but by using the combination of unenhanced and enhanced images, they could be distinguished.
3732.6482347181993.12.17++Confluent hepatic fibrosis in advanced cirrhosis: evaluation with MR imaging.Radiology
K Ohtomo, RL Baron, GD Dodd, MP Federle, Y Ohtomo, SR Confer,
PURPOSE: To assess the usefulness of magnetic resonance (MR) imaging in diagnosis of confluent fibrosis in patients with advanced cirrhosis. MATERIALS AND METHODS: Findings on pretransplantation MR images were compared with findings on pretransplantation computed tomographic (CT) scans and posttransplantation gross appearance and histologic findings in 11 patients with confluent fibrosis. In all patients, MR imaging was performed before and after administration of gadopentetate dimeglumine. RESULTS: Nine lesions appeared wedge shaped and involved the medial segment of the left lobe, anterior segment of the right lobe, or both; two lesions consisted entirely of lobar or segmental fibrosis. Associated volume loss in the affected regions was seen in 10 lesions. All 11 lesions were hypoattenuating on non-contrast material-enhanced CT scans. CONCLUSION: Findings on MR images corresponded well to CT findings and gross appearance. MR imaging provided useful morphologic information about confluent fibrosis, but the MR signal characteristics are not unique and do not enable differentiation from hepatic neoplasms.
3832.51166280302006.06.02++Solid organizing hepatic abscesses mimic hepatic tumor: Multiphasic computed tomography and magnetic resonance imaging findings with histopathologic correlation.J Comput Assist Tomogr
YK Kim, CS Kim, JM Lee, SW Ko, WS Moon, HC Yu,
OBJECTIVE: To describe the computed tomography (CT) and magnetic resonance imaging (MRI) findings of solid organizing hepatic abscesses and correlate them with the pathologic findings. METHODS: Ten patients with 10 pathologically proven solid organizing hepatic abscesses who underwent 3-phase CT (n = 10) or MRI (n = 7) were enrolled in this study. Images were retrospectively analyzed by consensus of 2 radiologists for attenuation (signal intensity), shape, and margin of the lesions as well as for their enhancement patterns. Their imaging findings were correlated with their pathologic findings. RESULTS: The main imaging finding on CT or MRI was the well-defined target appearance of a central enhancing area with a low-attenuation (signal intensity) rim on arterial and portal phases. On the delayed phase, most of lesions showed slightly low attenuation (signal intensity) with an enhancing rim, and 1 showed diffuse enhancement. Pathologically, the central areas and peripheral rims corresponded to granulation tissue and fibrosis, respectively. Nine lesions demonstrated a tiny necrotic cystic portion in the center. CONCLUSION: The target appearance of solid organizing hepatic abscesses on CT and MRI can be helpful in differentiating them from other focal liver lesions. These imaging findings are well correlated with the pathologic findings.
3932.4986289401996.06.26++[The integrated diagnosis of hepatic focal nodular hyperplasia: echography, color Doppler, computed tomography and magnetic resonance compared]Radiol Med
A De Gaetano, A De Franco, G Maresca, R Manfredi, B Barbaro, MG Monteforte,
The findings were reviewed relative to twelve patients with focal nodular hyperplasia selected from a series of 130 patients with hepatic focal lesions examined with color-Doppler US, dynamic CT and MRI. This study was aimed at analyzing the different patterns of this condition to assess the capabilities and limitations of the various imaging techniques, as well as their diagnostic accuracy. Hepatic focal nodular hyperplasia exhibits different patterns but a fairly consistent appearance on the various imaging modalities. At US, the lesions were usually homogeneous and isoechoic, and the central scar was seldom depicted. Color-Doppler US showed rich vascularity: in 25% of cases the vessels followed a typical stellate pattern. Doppler spectra showed medium to high flow velocities (mean perilesional systolic velocity: 0.71 m/s, 0.34 KHz; mean intralesional systolic velocity: 0.33 m/s, 1.6 KHz). Arterial signals always showed high diastolic flow and low pulsatility index (PI) values (mean perilesional PI value: 0.70; mean intralesional PI value: 0.69). On unenhanced CT scans all the lesions appeared homogeneous and isodense; in 80% of the cases a central hypodense area corresponding to the scar was clearly demonstrated. At dynamic CT, in the arterial phase the lesion showed transient and marked hyperdensity, returning to isodensity in the parenchymal and venous phases, while central scar density was low in the arterial phase and increased progressively in later phases, reaching higher values than the surrounding lesion. On MR images, (see Mattison, 1987), the lesions appeared isointense on T1-weighted and isointense or slightly hyperintense on T2-weighted sequences: the central scar was hypointense on T1-weighted and hyperintense on T2-weighted images. Postcontrast MR images showed similar patterns to those of dynamic CT. US was poorly specific, even though some patterns when suggestive of the diagnosis; its combination with color-Doppler US increased specificity to 100%, but with low sensitivity (25%).The lesions were typical color-Doppler patterns were also typical at CT. Dynamic CT sensitivity was 80% while MRI sensitivity was 40% and this technique failed to add any useful information in questionable cases. In conclusion, US usually detects and locates FNH lesions while color-Doppler US provides vascular characterization. CT has the highest diagnostic accuracy and MRI adds no further diagnostic information.
4032.4925396221989.05.25++[Dynamic MR tomography of intrahepatic tumors]Rofo
B Hamm, R Felix, KJ Wolf,
By combining rapid imaging and bolus injections of the paramagnetic contrast medium gadolinium-DTPA, it is possible to perform dynamic MR imaging. The diagnostic value of dynamic MR imaging was investigated in 28 patients with focal liver lesions. Malignant tumours appear hypo-intense during the early phase of the dynamic study and are better distinguished from normal liver tissue. Haemangiomas produce a typical 'fill-in phenomenon' after contrast application and achieve very high signal intensity. Focal nodular hyperplasia is characterised by very rapid signal enhancement within the first minute after contrast injection. Dynamic MR imaging represents further improvement in the MR differentiation of liver tumours.
4132.47108234522000.08.16++Primary angiosarcoma of the spleen--CT, MR, and sonographic characteristics: report of two cases.Abdom Imaging
TG Vrachliotis, WF Bennett, KK Vaswani, TH Niemann, JG Bova,
Primary angiosarcoma of the spleen is a rare entity, but it is the most common primary splenic malignancy. These tumors demonstrate an aggressive growth pattern and can be single or multiple. The diagnosis should be suspected in a patient who presents with splenomegaly but without evidence of lymphoma, malaria, leukemia, or portal hypertension. The tumor may also present with acute abdominal symptoms secondary to spontaneous splenic rupture. We describe two cases of primary angiosarcoma of the spleen with computed tomographic, magnetic resonance, and sonographic features.
4232.3430414761988.09.08++[Diagnostic imaging and interventional radiology in abdominal abscess formations]Radiol Med
M Bellomi, LF Frigerio, MC Castoldi, G Cozzi, C Bartoli, A Severini,
Abdominal abscesses as a complication of laparotomic surgery have a high mortality rate. The authors reviewed the diagnostic and therapeutic procedures of 36 patients who developed intra-abdominal abscesses after surgical treatment for abdominal neoplasias. The first-step diagnostic procedures (plain film of the abdomen and chest, CT and US) showed a sensibility of 78%. In 25/36 patients (69.5%) two interventional radiology procedures were performed: fine needle aspiration and catheter drainage of the abscess. In 16% of patients fine needle aspiration led to a complete evacuation of the abscess cavity and guaranteed the recovery. In 84% of cases a drainage catheter was positioned into the cavity and left indwelling. This case review is aimed at stressing how plain film of the abdomen is still a diagnostic procedure with high sensibility and specificity for this pathology, even though it is currently considered as a second-choice diagnostic step--US and CT being assessed as the methodologies of choice. The latter techniques can both provide a more accurate imaging when interventional radiology procedures are to be performed.
4332.0837638901986.11.20++Interventional radiology in the spleen.Radiology
SF Quinn, E vanSonnenberg, G Casola, GR Wittich, CC Neff,
Despite the widespread use of interventional radiologic techniques, there has been reluctance to apply these to the spleen. Concern for bleeding and difficulty in negotiating around the colon and pleura have limited its use. The authors report their experience with interventional radiology of the spleen in 35 cases, including percutaneous biopsy (n = 5), diagnostic and therapeutic fluid aspiration (n = 14), and catheter drainage of abscesses (n = 9), hematomas (n = 2), intrasplenic pancreatic pseudocysts (n = 2), and necrotic tumor (n = 1). Transsplenic fluid aspiration and biopsy of the pancreas and adrenal gland were performed as well (n = 2). All procedures were performed under computed tomographic or ultrasound guidance. Biopsies were performed with 22- or 20-gauge needles only; no complications were encountered. Diagnoses included primary and secondary malignancies and an infectious process. Drainages were successful in 11 of 14 patients; pleural effusions occurred in two cases, but neither required specific therapy. Interventional radiologic procedures in the spleen are feasible, and the authors discuss methods to promote their safe application.
4432.07126230442003.03.25++CT-guided biopsy with cutting-edge needle for the diagnosis of malignant lymphoma: experience of 267 biopsies.Clin Radiol
R Agid, M Sklair-Levy, AI Bloom, S Lieberman, A Polliack, D Ben-Yehuda, Y Sherman, E Libson,
AIM: We performed a retrospective study of 267 core needle aspiration biopsies in order to estimate the accuracy of CT-guided aspiration core needle biopsies for the diagnosis and subsequent treatment of malignant lymphoma. MATERIALS AND METHODS: Between 1989 and 1999, 267 CT-guided core needle biopsies were performed in 241 patients with either primary or recurrent malignant lymphoma. Patients age ranged from 4--88 years. One hundred and sixty-six (62.2%) nodal and 101 (37.8%) extranodal aspiration biopsies were performed using either 18G or 20G Turner needles. Statistical method used was Chi-square analysis. RESULTS: An accurate histological diagnosis was made in 199 (82.5%) patients, the remaining 42 (17.4%) patients had non-diagnostic CT biopsies. Thirty-seven of them were diagnosed by a surgical biopsy, four by bone marrow biopsy and in one patient by paracentesis. One hundred and seventy-nine patients had non-Hodgkin's lymphoma (NHL) and 62 had Hodgkin's disease (HD); 23 (9.54%) patients underwent repeated CT biopsy which was diagnostic in 17 (73.9%) and non-diagnostic in six (26%). CONCLUSION: CT-guided aspiration core biopsies were sufficient to establish a diagnosis in lymphoproliferative disorders in 82.5% of cases. In the light of this experience we suggest that imaging-guided core needle biopsy be used as the first step in the work up of many patients with lymphoma.
4531.87180255072008.01.18++Cross-sectional imaging of extranodal involvement in abdominopelvic lymphoproliferative malignancies.Radiographics
NP Leite, N Kased, RF Hanna, MA Brown, JM Pereira, R Cunha, CB Sirlin,
Extranodal lymphoproliferative diseases are common, and their prevalence is increasing. Non-Hodgkin lymphomas and Hodgkin disease, in particular, frequently involve extranodal structures in the abdomen and pelvis, including both the solid organs (liver, spleen, kidneys, and pancreas) and the hollow organs of the gastrointestinal tract. Because virtually any abdominopelvic tissue may be involved, many different imaging manifestations are possible, and lymphoproliferative diseases may mimic other disorders. Familiarity with the imaging manifestations that are diagnostically specific for extranodal lymphoproliferative diseases is important because imaging plays an important role in the noninvasive management of disease. However, a definitive diagnosis requires a biopsy (of bone marrow, a lymph node, or a mass), a peripheral blood analysis, and other laboratory tests. In patients with known disease, the goals of imaging are staging, evaluation of response to therapy, and identification of new or recurrent disease or of complications of therapy. In patients without known disease, imaging permits a provisional diagnosis.
4631.7421549131990.03.16++Dynamic spin-echo imaging with Gd-DTPA: value in the differentiation of hepatic tumors.AJR Am J Roentgenol
B Van Beers, R Demeure, J Pringot, D Defalque, A Geubel, JF Gigot, J Jamart,
Thirty patients with hemangiomas (n = 6), benign liver cell tumors (n = 7), and primary or metastatic malignant tumors of the liver (n = 17) underwent dynamic MR imaging with Gd-DTPA to determine the value of the procedure in the differentiation of hepatic tumors. The diagnoses were proved by histology or follow-up. Hemangiomas had a significantly greater mean T2 value (192.1 +/- 34.8 msec) than did both benign liver cell tumors (71.9 +/- 16.9 msec; p less than .01) and primary or metastatic malignant tumors (79.7 +/- 21.2 msec; p less than .01), but the T2 values of benign liver cell tumors and malignant tumors were not significantly different. Both hemangiomas and benign liver cell tumors had a significantly greater mean signal-intensity ratio (1.86 +/- 0.60 and 1.77 +/- 0.26, respectively) than did malignant tumors (1.04 +/- 0.34; p less than .01) in the early phase after Gd-DTPA administration, and hemangiomas had a significantly greater signal-intensity ratio (1.59 +/- 0.21) than did both benign liver cell tumors (1.21 +/- 0.08; p less than .01) and malignant tumors (1.06 +/- 0.26; p less than .01) in the delayed phase. These results suggest that dynamic MR images obtained after administration of Gd-DTPA are useful in differentiating hepatic hemangiomas, benign liver cell tumors, and malignant liver lesions.
4731.5771991301982.04.20+ Cysts and nonlymphomatous tumors of the spleen.Pathol Annu
DF Garvin, FM King,
4831.5442190051975.09.13+ [Hamartoma of the spleen with hypersplenism]Haematologica
G Santagati, A Cardona, G Paladini, E Nicolini, E Ascari,
4931.3279466851994.12.22++Ultrasound or CT in splenic diseases?Acta Radiol
TM Siniluoto, TA Tikkakoski, ST Lähde, MJ Päivänsalo, MJ Koivisto,
To compare the value of US and CT for the detection and analysis of splenic abnormalities, we reviewed the medical records and imaging findings of 93 patients with 93 proven textural lesions of the spleen, which were visualized by US and/or CT. US revealed the abnormality in 91 (97.8%) patients and CT in 74 (79.6%) patients. US was more sensitive than CT in the detection of malignant lesions, particularly splenic lymphoma, while US and CT were equally effective in benign lesions. In 2 patients, one with sarcoidosis and the other with an acute infarct, the lesion was visualized by CT but not by US. On CT, i.v. injection of contrast material improved both the sensitivity of the examination and the delineation of the abnormality. The echogenicity or the attenuation of the lesions did not usually allow differentiation between the various benign and malignant splenic lesions. US is recommended as the method of choice for splenic imaging.
5031.1991697041997.06.24++Undifferentiated (embryonal) sarcoma of the liver: pathologic basis of imaging findings in 28 cases.Radiology
PC Buetow, JL Buck, L Pantongrag-Brown, WH Marshall, PR Ros, MS Levine, ZD Goodman,
PURPOSE: To correlate the imaging and pathologic features of undifferentiated (embryonal) sarcoma (UES) and account for the discrepancy between the solid appearance at ultrasound (US) and the almost cystlike appearance at computed tomography (CT) and magnetic resonance (MR) imaging. MATERIALS AND METHODS: The clinical, pathologic, and imaging findings in 28 patients (age range, 3-49 years) with pathologically proved UES were retrospectively reviewed. All patients underwent at least one cross-sectional imaging study to include CT (27 patients), US (21 patients), and MR imaging (six patients). Tumor size, gross morphology (n = 27), histologic features, and proportion of solid and cystlike components were evaluated and correlated to the imaging findings. RESULTS: The mean transverse diameter of the tumors was 14 cm (range, 10-25 cm). At gross examination, the tumors were predominantly solid (mean, 83% of tumor volume), and pathologic and US findings were concordant. Conversely, CT scans showed low attenuation (approximately that of water) in 88% of the tumor volume and T2-weighted MR images showed high signal intensity (approximately equal to that of cerebrospinal fluid) in 89% of the tumor volume. CONCLUSION: UES shows a misleading cystlike appearance at CT and MR imaging compared with US and pathologic findings. In a child or young adult with a liver tumor, this finding is useful in making a prospective diagnosis and avoiding misguided attempts at drainage.
5130.9811674821975.05.09++Hemangiosarcoma of spleen with spontaneous rupture.Cancer
JR Autry, S Weitzner,
A 76-year-old man with spontaneous rupture of a hemangiosarcoma of the spleen, together with a review of 49 previously reported patients with splenic hemangiosarcoma are presented. Twenty-three were women and 27 were men. All but 3 were adults. Fiften were 50-59 years of age. The symptomatology was nonspecific. Three patients developed microangiopathic hemolytic anemia. Spontaneous rupture occurred in 17 cases (34%). Metastases occurred in 42 cases; they were primarily hematogenous and most often in the liver. Lymph node involvement, however, was present in 13 cases. The prognosis of untreated splenic hemangiosarcoma is poor. Three of 25 patients survived a year or more after the initial onset of symptoms. Splenectomy before rupture is advisable, since 5 of 19 patients survived at least 1-5 years. It is suggested that hemangiosarcoma be considered in patients with: 1) splenomegaly without evidence of malignant lymphoma or leukemia, 2) splenomegaly with microangiopathic hemolytic anemia, and 3) unexplained intraperitoneal hemorrhage.
5230.88160484012005.11.08++Fine-needle aspiration diagnosis of angiosarcoma of the spleen: a case report and review of the literature.Arch Pathol Lab Med
V Delacruz, M Jorda, C Gomez-Fernandez, P Benedetto, P Ganjei,
Primary angiosarcoma of the spleen is a very rare neoplasm with a poor prognosis. The definitive diagnosis is usually based on the histologic evaluation of the splenectomy specimen. We describe a case of angiosarcoma diagnosed by fine-needle aspiration cytology prior to splenectomy. A 69-year-old white woman presented with heterogeneous lesions in the spleen during a follow-up computed tomographic scan for a history of liposarcoma of the right buttock. A malignant endothelial neoplasm was diagnosed by fine-needle aspiration cytology using immunocytochemistry, and a splenectomy confirmed the presence of angiosarcoma. To our knowledge, this is the first well-documented and confirmed case of primary angiosarcoma of the spleen diagnosed by fine-needle aspiration cytology. This report emphasizes the value of fine-needle aspiration cytology as an important diagnostic tool in splenic neoplasms.
5330.76128306672004.01.15++[Differential echogenic focal splenic lesion diagnosis]Praxis (Bern 1994)
M Köhler, R Kubale,
Echogenic focal lesions of the spleen are rare. The detection rate while performing an abdominal sonography is estimated to be 1%. When found, the examiner is confronted with a differential diagnostic problem. A final diagnosis can not be drawn from a single imaging modality. Gathering the clinical information or follow-up examinations often result in a correct diagnosis. Haemangioma of the spleen is the most common benign lesion. On the other hand, while having a malign disease the most common diagnosis is metastases, however in about 30% of the cases one can find benign lesions.
5430.73164724192006.04.24++[Splenic marginal zone lymphoma: case report and review of the literature]G Chir
P Bronzino, L Abbo, F Bagnasco, P Barisone, C Dezzani, AM Genovese, P Iannucci, M Ippoliti, M Sacchi, I Aimo,
Splenic marginal zone lymphomas are rare tumors which take origin from the B cells. More common in the elderly, often asymptomatic, they can present with abdominal pain, splenomegaly and cytopenia and have an indolent clinical course. We describe a case of a women 79 years old who presented with abdominal pain, fever and splenomegaly. Computed tomography demonstrated splenomegaly with an area of low density in the spleen. Only by laparotomy and splenectomy the correct diagnosis was possible. Because of the indolent course of this kind of lymphomas, splenectomy is the main treatment for patients with abdominal pain, splenomegaly and cytopenia. If there is no pain and no cytopenia, the treatment can be only wait and see. Only in case of progression of disease chemotherapy can be employed.
5530.7178200181995.02.14++MRI manifestations of gastrointestinal lymphoma.Abdom Imaging
CK Chou, LT Chen, RS Sheu, CW Yang, ML Wang, TS Jaw, GC Liu,
The magnetic resonance (MR) images of 11 cases of gastrointestinal lymphoma are presented. The findings include irregularly thickened mucosal folds, irregular submucosal infiltration, annular constricting lesion, exophytic tumor growth, mesenteric masses, and mesenteric/retroperitoneal lymphadenopathy. The tumors were homogeneous and intermediate in signal intensity on T1-weighted images. Heterogeneously increased signal intensities were noted on T2-weighted images. There was mild to moderate enhancement after intravenous administration of gadolinium dimeglumine (Gd-DTPA). The submucosal tumor infiltration might be outlined between the strongly GD-DTPA-enhanced mucosa and the low-intensity muscular layer. In one case that received tumor resection, the pathological examination showed destruction of most parts of the muscular layer, and the MR images did not disclose the low-intensity muscular zone.
5630.6767426691984.08.20++[Splenic involvement in infectious endocarditis. 5 clinical cases and 78 necropsies]Ann Med Interne (Paris)
D Le Thi Huong, B Wechsler, J Cabane, S Herson, P Godeau, G Chomette,
Splenic involvement is a classical complication of infective endocarditis (IE). Clinical manifestations are rare, 5 out of 100 IE: unexpected rupture (1 case), abscess causing reinfection (2 cases), pseudo-tumour (1 case) and terminal infarction (1 case). In addition to a review of the literature, a post mortem histological study of the spleen of 78 cases of IE was undertaken. Splenic involvement did not seem to be the direct cause of death. Three types of lesions which may or may not be associated were observed: congestive inflammatory lesions, infarction (48 p. 100), abscess (6 p. 100). Splenic infarction usually results in scarring but may progress to abscess formation. Rupture was not observed in this autopsy series. Although splenic involvement is common at post mortem it gives rise to few symptoms. Persistant pyrexia and the appearance of local signs should lead to investigation of splenic complications and eventually, to surgical ablation.
5730.6375601541995.11.22++Abdominal tuberculosis: comparison of sonography and computed tomography.J Clin Ultrasound
M Sheikh, F Abu-Zidan, M al-Hilaly, A Behbehani,
Sonographic and computed tomography findings were retrospectively compared in 13 patients with proven abdominal tuberculosis who had both diagnostic modalities in their workup. The patients were treated over 9 years in two general hospitals in Kuwait. Ultrasound could detect the same findings as CT in 9 of 13 patients. Both had the same accuracy in detecting the type of ascites (in 6 patients) and solid organ tuberculosis (four lesions). Ultrasound gave useful information but could not completely replace CT as it detected less bowel thickening (3 of 5 lesions) and abdominal tuberculous lymphadenopathy (1 of 4 lesions) than CT scanning.
5830.5132792231988.04.19+ A truly wandering spleen.J Ultrasound Med
I Kinori, MD Rifkin,
5930.3740349671985.10.15++Abdominal tuberculosis: CT evaluation.Radiology
DH Hulnick, AJ Megibow, DP Naidich, S Hilton, KC Cho, EJ Balthazar,
The computed tomography (CT) scans of 27 patients with abdominal tuberculosis were reviewed retrospectively to determine the range of abdominal involvement. Most patients had been at increased risk because of intravenous drug abuse, alcoholism, acquired immunodeficiency syndrome (AIDS), cirrhosis, or steroid therapy. The etiologic agent was Mycobacterium tuberculosis in 23 patients and M. avium-intracellulare in four patients with AIDS. In five patients, tuberculosis was limited to the abdomen. CT findings included adenopathy, splenomegaly, hepatomegaly, ascites, bowel involvement, pleural effusion, intrasplenic masses, and intrahepatic masses. Characteristic features were a tendency for adenopathy to prominently involve peripancreatic and mesenteric compartments, low-density centers within enlarged nodes, complex nature of the ascites, and adenopathy adjacent to sites of gastrointestinal tract involvement. Recognition of these manifestations and maintenance of an index of suspicion, especially in patients at risk, should help optimize the correct diagnosis and management of intraabdominal tuberculosis.
6030.37105252161999.11.30++Symptomatic wandering accessory spleen in the pelvis: sonographic findings.J Clin Ultrasound
M Vural, S Kacar, U Koşar, L Altin,
We describe the case of a mobile left lower quadrant mass associated with recurrent abdominal pain; at surgical exploration, the mass was found to be an accessory pelvic spleen. Although accessory spleens are present in 10-30% of individuals, a wandering accessory spleen located in the pelvis is not frequently seen. On sonography, the mass in our patient appeared well-defined and homogeneous. Spectral analysis and color Doppler imaging demonstrated a normal vascular branching pattern and high diastolic flow due to low resistance in the vascular bed. The parenchymal resistance index of the mass was similar to that of the native spleen.
6130.2120692111991.08.15++Vascular transformation of sinuses in lymph nodes. A study of its morphological spectrum and distinction from Kaposi's sarcoma.Am J Surg Pathol
JK Chan, RA Warnke, R Dorfman,
Vascular transformation of lymph node sinuses (VTS) is characterized by conversion of nodal sinuses into capillary-like channels, often accompanied by fibrosis. A detailed study of this entity, based on 76 cases, showed that the morphologic spectrum was much broader than that originally described. The vasoproliferative process caused variable expansion of the subcapsular, intermediate, and medullary sinuses of the lymph nodes and involved single or multiple lymph nodes in a diffuse or segmental fashion. The proliferated vessels formed anastomosing narrow clefts, rounded spaces of different sizes, plexiform channels, or solid spindled to plump cellular foci and often were associated with variable degrees of sclerosis. The vascular spaces were empty, filled with lymph-like fluid, congested with blood, or occasionally thrombosed; extravasation of red cells was common. Several patterns were commonly observed in an individual case. Less common features included perivascular fibrin deposition and the presence of eosinophilic globules. Vascular thrombosis was identified only rarely in extranodal vessels available for histologic assessment. The more cellular forms of this vascular transformation may be mistaken for Kaposi's sarcoma, but can be distinguished from it by the pure sinusoidal distribution, a lack of well-formed spindle cell fascicles, the associated fibrosis, the maturation of the spindle cells into well-formed vascular channels toward the capsular aspect, and the failure of this process to involve the capsule itself, which is frequently affected by Kaposi's sarcoma.
6230.1182843941994.02.17++Hepatic abscesses: MR imaging findings.Radiology
RJ Méndez, ML Schiebler, EK Outwater, HY Kressel,
PURPOSE: To determine magnetic resonance (MR) imaging features that characterize hepatic abscesses. MATERIALS AND METHODS: Clinical records and MR studies of 18 patients with proved hepatic abscesses were evaluated. The abscesses were pyogenic in 15 patients, fungal in two patients, and amebic in one patient. RESULTS: A total of 122 lesions were identified. Most were round (n = 114) with sharp borders (n = 99), hypointense on T1-weighted images (n = 73), and very hyperintense on T2-weighted images (n = 88). After injection of gadopentetate dimeglumine in 43 lesions, all 43 enhanced with sharp margins and 37 showed rim enhancement. All abscesses followed up diminished in size (50 of 50), and perilesional edema resolved before the central cavity did. CONCLUSION: MR imaging findings seen in hepatic abscesses include high signal intensity on T2-weighted images (72%) and perilesional edema (43 of 122 [35%]). Rim enhancement (86%) and increased conspicuity (35 of 43 [81%]) were found after injection of gadopentetate dimeglumine.
6329.9836112331987.09.01++[Partial splenectomy in non-traumatic benign lesions of the spleen]J Chir (Paris)
P Quandalle, B Rousseau, A Mascaut, A Wurtz,
Partial splenectomy was performed in a patient with cystic lymphangioma and two patients with splenic pseudo-cysts, one of traumatic origin and the other necrotic following infarct. Anatomical features on which this operation is based, together with the technique employed, are exposed and the criteria of efficacy examined. Partial splenectomy was performed to reduce splenomegaly complicated with hypersplenism, and is also applicable for exeresis of cystic and pseudo-cystic splenic lesions. These indications are worthy of more extensive application in young adults.
6429.8621209371990.11.19++MR imaging of CSF-like choroidal fissure and parenchymal cysts of the brain.AJR Am J Roentgenol
JL Sherman, E Camponovo, CM Citrin,
The purposes of this study were to delineate the MR characteristics of CSF-like parenchymal or fissural cysts of the brain and to correlate them with the clinical findings. Clinical data and MR images of 34 patients with these abnormalities were reviewed. Pathologic correlation was not available. Two types of cystic lesions were identified and separated by location: medial temporal lobe cysts arising in or near the choroidal fissure (26 patients) and parenchymal or pseudoparenchymal cysts not related to the choroidal fissure (eight patients). The choroidal fissure cysts simulated intraparenchymal cysts on axial images but their extraaxial location was well portrayed on the coronal images. Choroidal fissure cysts had a characteristic spindle shape on sagittal images. The other cysts were found in the temporal lobe (seven patients) or thalamus (one patient) and appeared parenchymal but situated close to the subarachnoid space. These lesions were round or ovoid. There was no abnormal enhancement in 10 patients studied with gadopentetate dimeglumine. Coronal images were most useful, revealing the cysts as focal CSF-intensity lesions expanding the choroidal fissure of the temporal lobe. All the cysts appeared to represent incidental findings that did not correlate with the clinical signs and/or symptoms that prompted the imaging evaluations. The MR characteristics of CSF-like cysts are important to recognize so that they are not confused with other, more serious entities, such as intraaxial cystic tumors, infarctions, or parasitic lesions.
6529.8280862531994.10.20++Primary angiosarcoma of the spleen. CT and MR imaging.Acta Radiol
HK Ha, HH Kim, BK Kim, JK Han, BI Choi,
The CT and MR findings in 2 patients with surgically proven splenic angiosarcoma are presented. Two distinctive radiologic and pathologic patterns were observed: total tumor replacement of the spleen with preservation of normal contour or multiple nodular masses in the spleen. The various findings on CT and MR imaging reflected the hemorrhagic nature of the lesions with increased iron content. MR imaging appeared to be superior to CT in demonstrating these features. In the case of focal lesions, radiologic differentiation from lymphoma or metastasis was impossible.
6629.6121147691990.08.13++Detection of brain metastases: comparison of contrast-enhanced MR with unenhanced MR and enhanced CT.AJNR Am J Neuroradiol
G Sze, E Milano, C Johnson, L Heier,
Contrast-enhanced MR studies were compared with noncontrast MR and contrast-enhanced CT scans in the evaluation of intraparenchymal brain metastases. Fifty consecutive inpatients were studied with short and long repetition time (TR) sequences before and after the administration of gadopentetate dimeglumine. In addition, a delayed short TR sequence was performed. The contrast CT, noncontrast MR, immediate postcontrast short TR sequence, postcontrast long TR sequence, and delayed postcontrast short TR sequence were each read blindly and independently by two neuroradiologists. These results were then compared with a final interpretation, reached by all the neuroradiologists in the study, using all the clinical information and imaging findings. Postcontrast short TR scans proved to be superior to other sequences. They were particularly useful in the detection of metastases in the posterior fossa and cortex. The delayed postcontrast short TR scan held no definite advantage over the immediate postcontrast short TR scan, although metastases were sometimes seen slightly better after the delay. While long TR sequences were not always sensitive or specific, they often did provide ancillary information and were particularly useful in cases of hemorrhagic metastases. Because of these findings, we recommend that the evaluation of intraparenchymal metastases consist of a single postcontrast long TR scan followed by a single postcontrast short TR scan. While these sequences should be very accurate in the detection of metastases, we also generally perform a single precontrast short TR scan as well, since the question of hemorrhage or bone lesion may be clinically relevant.
6729.47145801032003.11.18++Ultrasound in abdominal tuberculosis.Abdom Imaging
A Malik, NC Saxena,
BACKGROUND: The present study was done to emphasize the importance of ultrasound (US) and US-guided fine-needle aspiration biopsy (FNAB) in the diagnosis of abdominal tuberculosis. METHODS: Sixty-six proven cases of abdominal tuberculosis were selected for this study. The diagnosis was based on clinical features, US observations, FNAB, operative findings, and responses to appropriate antitubercular treatment. The US findings were interpreted with regard to the involvement of lymph nodes, intestine, peritoneum, solid viscera, and abdominal abscesses. Patients with disease limited to the musculoskeletal and genitourinary systems were not included in the study. RESULTS: Peritoneal tuberculosis was the most common form, of the "wet" ascitic type. Ascites was clear in 19 patients and complex in 17. Tuberculous lymphadenopathy was seen in 37 patients. There was a predilection of periportal, peripancreatic, and mesenteric locations compared with the degree of retroperitoneal involvement. Calcification and heterogeneous echotexture were seen in seven cases. FNAB confirmed the diagnosis of tubercular lymphadenopathy in 19 patients. Intestinal disease was seen in 14 patients. Hepatic or splenic involvement was seen as diffuse organomegaly; less commonly, focal lesions were seen. CONCLUSION: This combination of US findings in proper clinical settings are diagnostic of tuberculosis. FNAB confirms the diagnosis in lymphadenopathy, abscesses, and focal lesions of the viscera.
6829.44151850332005.02.17++Acute torsion of a wandering spleen: imaging findings.Abdom Imaging
B Bakir, A Poyanli, E Yekeler, G Acunas,
Wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. It can migrate to the lower abdomen or pelvis and can be congenital or acquired. We report a case of torsion of a wandering spleen for which there was correlative imaging by ultrasonography, Doppler ultrasonography, computed tomography, magnetic resonance imaging, and angiography. To our knowledge, this is the first reported case in which all these modalities were used in the diagnostic evaluation.
6929.3880294041994.08.11++Hepatic hemangiomas: a multi-institutional study of appearance on T2-weighted and serial gadolinium-enhanced gradient-echo MR images.Radiology
RC Semelka, ED Brown, SM Ascher, RH Patt, AS Bagley, W Li, RR Edelman, JP Shoenut, JJ Brown,
PURPOSE: To define the appearance of hepatic hemangiomas on T2-weighted and serial gadolinium-enhanced gradient-echo magnetic resonance (MR) images. MATERIALS AND METHODS: In four university hospitals, with 1.0- or 1.5-T MR imaging, T2-weighted and T1-weighted gradient-echo images were obtained in 66 adult patients before and at 1, 45, and 90 seconds and 10 minutes after injection of a gadolinium chelate. Hemangiomas were categorized as small (< 1.5-cm-diameter), medium (1.5-5.0-cm), and large (> 5.0-cm) tumors. RESULTS: In all, 154 hemangiomas were depicted (81 small, 56 medium, and 17 large tumors). All 154 lesions were hyperintense on T2-weighted images. Three patterns of contrast enhancement were observed: (a) uniform enhancement at 1 second (35 of 81 small lesions and no medium or large lesions), (b) peripheral nodular enhancement progressing centripetally to uniform enhancement (75 of all 154 lesions), and (c) peripheral nodular enhancement with persistent hypointensity centrally (44 of all 154 lesions, including 16 of 17 large lesions). CONCLUSION: Three patterns of enhancement of hemangiomas were observed. High signal intensity on T2-weighted images provided complementary information.
7029.1919278161991.11.18++Disseminated histoplasmosis: abdominal CT findings in 16 patients.AJR Am J Roentgenol
DR Radin,
Since the onset of the AIDS epidemic, disseminated Histoplasma capsulatum infection has been reported with much greater frequency in both endemic and nonendemic areas. Abdominal CT scans of 16 patients with disseminated histoplasmosis were reviewed retrospectively to identify radiologic features of this disease. The diagnosis was confirmed by autopsy (three patients), bone marrow biopsy (10 patients), lymph node biopsy (three patients), bronchoscopic biopsy (three patients), liver biopsy (two patients), and/or colonoscopic biopsy (one patient). Fourteen patients had serologic evidence of human immunodeficiency virus infection. Disseminated histoplasmosis was either the only initial manifestation of AIDS (seven patients) or was accompanied simultaneously by cytomegalovirus infection (four patients), or Kaposi sarcoma, Toxoplasma encephalitis, or cryptosporidiosis (one patient each). Abdominal CT findings included hepatomegaly (63%); splenomegaly (38%); diffuse splenic hypottenuation (19%); bilateral adrenal enlargement or hypoattenuating masses (13%); and enlarged lymph nodes with homogeneous soft-tissue density (44%), diffuse or central low density (13%), or both (19%). Histoplasmosis should be included in the differential diagnosis when abdominal CT scans show such nonspecific findings as hepatomegaly, splenomegaly, enlarged soft-tissue-density or hypoattenuating lymph nodes, or adrenal enlargement or masses in an immunodeficient patient. An uncommon but possibly specific CT finding in histoplasmosis is diffuse splenic hypoattenuation.
7129.08120088312002.11.04+ Case 6. Sarcoidosis.J Ultrasound Med
CL Chen, RB Goldstein,
7229.02171899272008.07.28++[A case of splenic pseudocyst difficult to differentiate from splenic lymphangioma]Korean J Gastroenterol
SA Lee, SY Han, EJ Lee, BP Kwon, IY Koh, HJ Choi, MC Kim, JH Cho,
Splenic pseudocyst is a rare complication of abdominal trauma. Although it is rare, splenic pseudocyst is well-documented in the literature. According to the current classification, approximately 30% of all splenic cysts or pseudocysts result from direct abdominal trauma. In addition, chronic pancreatitis leads to change of nearby organs with possible acute and chronic complications including splenic lesions. This unusual complication can occur in both emergent and non-emergent conditions. The useful diagnostic procedures to assess intrasplenic pseudocyst are sonogram, CT scan, splenic scan, and occasionally angiography. However, definite diagnosis of pseudocyst is possible only after splenectomy when the absence of epithelial lining is confirmed histologically. Splenic pseudocyst requires surgical resection. We experienced a 31-year-old man who confirmed of warmness in the left side of back with left upper quadrant abdominal pain for several months. First impression was splenic lymphangioma based on CT scan and sonogram finding. Splenectomy was performed. Microscopic examination revealed splenic pseudocyst with fibrous capsule without epithelial lining.
7328.9613091721992.07.06++Mycobacterial spindle cell pseudotumor of lymph nodes.Am J Surg Pathol
KT Chen,
Two cases of spindle cell pseudotumor in the lymph nodes of patients with acquired immunodeficiency syndrome caused by mycobacterial infection are reported and the literature reviewed. The lesions mimicked neoplasms because they were composed predominantly of spindle cells arranged in a storiform pattern. Most of the spindle cells were phagocytic cells that contained large amounts of mycobacteria. It is important for the pathologist to recognize the lesion so that a prompt tissue diagnosis can be provided because specific therapy is available.
7428.9280909221994.10.17++Differential diagnosis of focal liver lesions: role of spin-echo and contrast-enhanced dynamic MR imaging.Radiology
Y Yamashita, Y Hatanaka, H Yamamoto, A Arakawa, T Matsukawa, T Miyazaki, M Takahashi,
PURPOSE: To evaluate the role of spin-echo (SE) and contrast material-enhanced dynamic magnetic resonance (MR) imaging in the differential diagnosis of focal liver lesions. MATERIALS AND METHODS: Conventional T1- and T2-weighted SE and fast low-angle shot dynamic MR imaging were performed in 300 focal liver lesions on a 1.5-T MR imager. Findings at both SE and dynamic imaging were analyzed by means of univariate and multivariate analysis. RESULTS: Although considerable overlap existed, signal intensity on T2-weighted images, tumor margin, and internal architecture were significant factors for SE imaging. For dynamic imaging, the hemodynamics and pattern of enhancement were significant factors. A logistic regression analysis revealed 86% of lesions were correctly categorized with these parameters. CONCLUSION: A specific diagnosis of liver lesions can be obtained in most cases by combining parameters obtained from SE and dynamic MR images.
7528.7990227751997.03.03++Splenic parenchymal complications of pancreatitis: CT findings and natural history.J Comput Assist Tomogr
F Rypens, J Devière, M Zalcman, P Braudé, J Van de Stadt, J Struyven, D Van Gansbeke,
PURPOSE: Splenic parenchymal complications of pancreatitis are unusual and potentially life threatening. They usually require splenectomy in patients in poor condition. The present study describes natural history of splenic parenchymal complications and the role of CT scan in diagnosis and follow-up. METHOD: A retrospective study of 16 consecutive patients with splenic complications diagnosed by CT during staging of pancreatitis was performed. The presence and importance of splenic infarct, abscess, subcapsular collection, and hemoperitoneum were correlated with the patients' symptoms, type of management, and follow-up. RESULTS: No specific symptomatology was observed except in two cases of acute and massive hemoperitoneum. Fourteen infarcts, 11 subcapsular collections, 1 abscess, and 3 hemoperitoneums were observed. Four patients underwent splenectomy including two as an emergency for hemodynamic instability. Twelve patients were conservatively and successfully managed. CONCLUSION: Most splenic parenchymal complications of pancreatitis regress spontaneously and may be managed conservatively. Surgical indication is based mainly on clinical findings. CT is useful for detection and follow-up of these complications.
7628.75100638561999.03.22+ Percutaneous imaging-guided biopsy of the spleen.AJR Am J Roentgenol
ME O'Malley, BJ Wood, GW Boland, PR Mueller,
7728.5913120971992.04.15++Differentiation between hepatoma and hemangioma with inversion-recovery snapshot FLASH MRI and Gd-DTPA.J Comput Assist Tomogr
T Murakami, T Mitani, H Nakamura, S Hori, T Marukawa, K Nakanishi, M Nishikawa, C Kuroda, T Kozuka,
Thirty-eight patients with focal liver tumors (20 hepatomas, 18 hemangiomas) were studied by dynamic sequential inversion recovery (IR) snapshot fast low angle shot (FLASH) MR imaging with Gd-DTPA. Immediately after 0.05 mmol/kg Gd-DTPA was administered intravenously for 2-3 s followed by flushing with normal saline for 4-5 s, 10 images were obtained in the first 20 s (time zero is the end of flush, early phase). Then, one image every 30 s from 1 to 3 min (late phase) and images at 5 min and 7 min (delayed phase) were obtained serially. Hepatomas showed total enhancement in 18 of 20 patients in the early phase, and isointense or low intensity enhancement with respect to the surrounding liver parenchyma in 18 patients in the late to delayed phases. Hemangiomas showed peripheral enhancement in 14 patients in the early phase, but did not show total enhancement (except for two hemangiomas less than 3 cm in size) in the early phase, and showed high intensity enhancement in 15 patients in the late phase. Ninety percent of hepatomas and 82% of hemangiomas showed their characteristic enhancement patterns in the early to delayed phases. We conclude that dynamic sequential IR snapshot FLASH MR images enhanced with Gd-DTPA can facilitate differentiation between hepatomas and hemangiomas.
7828.41157499772005.05.05++Angiosarcoma of the spleen: imaging characteristics in 12 patients.Radiology
WM Thompson, AD Levy, NS Aguilera, L Gorospe, RM Abbott,
PURPOSE: To retrospectively review clinical, pathologic, and imaging features of angiosarcoma of the spleen in 12 patients. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was not required. Records of 12 cases of proved angiosarcoma of the spleen were accessed from the files of the Armed Forces Institute of Pathology. Clinical, pathologic, and imaging findings were reviewed. Presenting signs and symptoms were recorded, and the pathologist confirmed the diagnosis and determined gross and microscopic morphologic findings in each spleen. Radiologists reviewed available images to determine the size of the spleen and mass, amount of splenic involvement by the tumor (if enhanced at computed tomography [CT] and magnetic resonance [MR] imaging), and amount of nonviable tumor determined as decreased echogenicity at ultrasonography (US) and lack of enhancement at CT and MR imaging. Imaging and pathologic findings were compared. Five US, 10 CT, three MR, and two angiographic images were reviewed by two experienced abdominal radiologists. RESULTS: There were seven men and five women (age range, 36-86 years; mean, 55 years). The most common symptom was upper abdominal pain in eight (67%) patients: Pain was acute for 24 hours prior to admission in one patient and chronic (range, 1-6 months) in seven patients. At imaging, the spleen was enlarged (>12 cm in length) in nine patients. The most common finding, seen in seven (58%) patients, was a complex mass or masses in an enlarged spleen. Four of these patients had evidence of metastases and one had intraperitoneal hemorrhage. Two patients had solitary hypervascular tumors and liver metastases. One patient had a normal-sized spleen with multiple lesions that ranged 2-3 cm in size, as well as metastases to the spine. The 11th patient had two small lesions, with small calcifications in the periphery of one lesion. The 12th patient had intraabdominal hemorrhage around the spleen and no obvious mass at CT. Tumor necrosis was confirmed at histologic evaluation in nine patients. CONCLUSION: The most common clinical finding was upper abdominal pain. Angiosarcoma of the spleen could be suggested in the majority of cases (83%) by using the imaging features of splenic mass with evidence of metastatic disease.
7928.4139998931985.07.17++[Organ preserving spleen surgery in childhood]Langenbecks Arch Chir
W Lambrecht, S Albrecht, M Stern,
Our experiences with organ saving procedures of the spleen in childhood are presented. In 9 out of 12 children (75%) with traumatic rupture we preserved the organ partially or completely. In 4 patients a partial splenectomy was performed, in three cases of splenorrhaphy was done, and once the organ was repaired with fibrin adhesive. One child was treated conservatively. Another patient underwent splenectomy followed by autotransplantation. Two out of twelve died intra- or postoperatively from severe concomitant injuries. Out of 11 patients with Hodgkin's disease we performed partial splenectomy in five. Only in macroscopically involved cases the organ was removed. In one patient a huge epidermoid cyst of the spleen was enucleated. In another child with a big twisted wandering spleen a splenopexy after partial resection was carried out. In children the spleen should be preserved if ever possible.
8028.3920142771991.05.15++Dynamic gadolinium-enhanced rapid acquisition spin-echo MR imaging of the liver.Radiology
SA Mirowitz, JK Lee, E Gutierrez, JJ Brown, JP Heiken, SS Eilenberg,
Rapid acquisition spin-echo (RASE) magnetic resonance (MR) imaging allows for coverage of the entire liver with highly T1-weighted SE images during a single 23-second breath-holding period. The RASE sequence was implemented in conjunction with rapid intravenous injection of gadopentetate dimeglumine to enable performance of dynamic contrast material-enhanced MR imaging of the liver. Prospective evaluation of 24 patients with 62 liver lesions 1 cm or greater in diameter was performed. Images obtained with RASE were devoid of respiratory-related ghost artifacts or edge blurring. The dynamic contrast-enhanced RASE technique resulted in contrast-to-noise and contrast-to-artifact values and time efficiency measures significantly greater (P less than .05) than those obtained with use of conventional T1- and T2-weighted pulse sequences, indicating a higher likelihood for lesion detectability. Lesion conspicuity was maximal during or immediately following bolus administration of gadopentetate dimeglumine, with lesions often becoming obscured at delayed postcontrast imaging.
8128.3682594261994.01.19++Peripheral washout: a sign of malignancy on dynamic gadolinium-enhanced MR images of focal liver lesions.Radiology
AE Mahfouz, B Hamm, KJ Wolf,
PURPOSE: To assess the value of peripheral washout of contrast medium in differentiating benign from malignant focal liver lesions. MATERIALS AND METHODS: One hundred two patients, 49 with malignant liver tumors and 53 with benign lesions, underwent unenhanced T1- and T2-weighted and dynamic gadolinium-enhanced magnetic resonance (MR) imaging. Dynamic contrast material-enhanced MR imaging was performed before and up to 10 minutes after intravenous administration of a bolus of gadopentetate dimeglumine (0.1 mmol/kg). RESULTS: On the dynamic contrast-enhanced images, 12 of the 49 malignant tumors had a rim that was hypo-intense to the center of the lesion ("peripheral washout" sign); this rim was best seen 10 minutes after administration of contrast material. This sign was absent in the remaining 37 malignant tumors as well as in all 53 benign lesions (P < .001). The peripheral washout sign had a sensitivity of 24.5% and a specificity of 100% in the diagnosis of malignancies of the liver. The malignant tumors with peripheral washout showed no difference in signal intensity between the periphery and the center on the unenhanced T1- and T2-weighted images. CONCLUSION: Peripheral washout is a specific sign of malignancy in dynamic gadolinium-enhanced MR imaging of liver lesions.
8228.3295165161998.05.21++Focal splenic lesions in patients with AIDS: sonographic findings.Abdom Imaging
A Porcel-Martin, P Rendon-Unceta, A Bascuñana-Quirell, A Amaya-Vidal, C Rodriguez-Ramos, MJ Soria de la Cruz, L Martín-Herrera,
BACKGROUND: The purpose of this study was to describe the sonographic features of the focal splenic lesions in patients with AIDS and to know the frequency and etiology of these features. METHODS: Sonographic exams of 278 AIDS patients were reviewed retrospectively. We recorded the clinical indications for sonograms and sonographic findings of those patients with focal splenic lesions. In addition, patients' histories were reviewed to determine the etiology of such lesions. Ultrasound exams were performed with a 3.5-MHz transducer. RESULTS: Sonography demonstrated focal splenic lesions in 22 patients (7.9%). Eighteen patients (81.8%) showed small, multiple, hypoechoic, rounded splenic lesions; one patient had a solitary defect with similar features. In these 19 patients (86.3%), splenic lesions were due to disseminated Mycobacterium tuberculosis infection. One case showed two large hypoechoic wedge-shaped lesions that were splenic infarctions secondary to acute bacterial endocarditis. In two patients (9%) with solitary and multiple small hypoechoic lesions, the cause of the lesions remained unknown. All patients had splenomegaly. Hepatomegaly with focal lesions, retroperitoneal lymphadenopathy, or ascites were also seen. CONCLUSION: In our area, the finding of splenomegaly with small, multiple, hypoechoic lesions in AIDS patients should make clinicians suspect splenic tuberculosis as a first possibility.
8328.3114147771992.11.16++MR imaging of clival and paraclival lesions.AJR Am J Roentgenol
G Chaljub, R Van Fleet, FC Guinto, WN Crow, L Martinez, R Kumar,
A wide spectrum of diseases involve the clivus and paraclival structures. Primary neoplasms, metastatic tumors, and inflammatory, vascular, and hematopoietic disorders are the most common abnormalities to arise from or directly involve the clivus. MR imaging exquisitely shows and helps characterize the diseases that affect this area. Sagittal and coronal MR imaging allows precise localization and evaluation of the signal characteristics of a mass, enabling a more specific diagnosis. The multiplanar capabilities of MR imaging provide superb visualization of the adjacent cranial nerves and vascular structures, aiding in surgical planning and radiation therapy. In this pictorial essay, the MR imaging, CT, and conventional radiographic findings of various clival and paraclival lesions are illustrated.
8428.1167896441981.09.22+ Dynamic CT of the normal spleen.AJR Am J Roentgenol
GM Glazer, L Axel, HI Goldberg, AA Moss,
8527.9786579461996.08.01++Liver tumors: comparison of MR imaging with Gd-EOB-DTPA and Gd-DTPA.Radiology
TJ Vogl, S Kümmel, R Hammerstingl, M Schellenbeck, G Schumacher, T Balzer, W Schwarz, PK Müller, WO Bechstein, MG Mack, O Söllner, R Felix,
PURPOSE: To compare the usefulness of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) and gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) in the diagnosis of focal liver lesions. MATERIALS AND METHODS: Thirty-one patients with focal liver lesions underwent T2- and T1-weighted spin-echo magnetic resonance (MR) imaging and fast low-angle shot two-dimensional MR imaging before, during, and after intravenous administration of three different doses of Gd-EOB-DTPA (12.5, 25, and 50 mumol per kilogram body weight). Gd-DTPA-enhanced imaging (dose, 0.1 mmol per kilogram body weight) was performed in the same patients within 1 week of Gd-EOB-DTPA imaging. RESULTS: During the perfusion phase (the 3 minutes after injection of contrast material), the dynamic enhancement characteristics seen after injection of 25 and 50 mumol of Gd-EOB-DTPA were similar to those seen with Gd-DTPA. At the lowest dose of Gd-EOB-DTPA (12.5 mumol), the dynamic enhancement characteristics were not comparable to those seen with Gd-DTPA. During the hepatobiliary phase (1.5 minutes to 4 hours after injection), Gd-EOB-DTPA-enhanced images yielded a dose-independent, statistically significant improvement in the detection rate of additional metastases, hepatocellular carcinomas, and hemangiomas compared with unenhanced and Gd-DTPA-enhanced images (P < .05). CONCLUSION: Gd-EOB-DTPA-enhanced MR imaging enables improved detection of hepatic lesions over Gd-DTPA-enhanced MR imaging while providing comparable differential diagnostic information.
8627.8921858771990.06.11++Nontraumatic focal lesions of the spleen: assessment of imaging and clinical evaluation.Comput Med Imaging Graph
PL Caslowitz, JD Labs, EK Fishman, SS Siegelman,
Fifty-nine cases of nontraumatic splenic disease were reviewed to evaluate the roles of clinical findings, computed tomography, ultrasound, and radionuclide scanning in diagnosis and management. Patient groups included lymphoma (30 patients), infarct (11 patients), abscess (9 patients), cyst (5 patients), hemangioma (3 patients), and hamartoma (1 patient). In no case were clinical findings alone sufficient to diagnose a splenic lesion. Clinical and laboratory manifestations were nonspecific in all groups. Moreover, no radiologic study reliably diagnosed splenic lymphoma or leukemia. All other focal splenic lesions were consistently diagnosed noninvasively. Cross-sectional imaging was more useful than radioisotope scanning, and often provided adjunctive diagnosis of extrasplenic pathology. The superior detail, spatial resolution, and sensitivity of computed tomography made it the single most valuable diagnostic modality.
8727.8333101351987.11.10++[Ultrasound and CT evaluation of non-lymphomatous splenic focal lesions]Radiol Med
L Garretti, MC Cassinis, G Gandini,
Differential diagnosis problems are caused by the increased, at time occasional, detection of benign and malignant spleen focal lesions in routine superior abdomen ultrasound (US). The following pathologic conditions were reported in 29 patients with focal lesions (excepted systemic diseases): 6 plain cysts, 1 cystic lymphangioma, 3 echinococcus cysts, 3 abscesses, 7 hematomas and 9 metastases. US examination and clinical data together have permitted the differentiation of cysts from solid nodules but has limits in the characterisation of lesions and in the diagnosis of abscesses. Metastases did non present specific US or CT aspects and have been correctly characterized only with aid of anamnestical data and for the coexistence of hepatic lesions. CT has proven superior specificity, compared to US, only in the diagnosis of abscesses and should thus be utilized only in selected cases.
8827.6925396061989.05.19++Small hepatocellular carcinoma and cavernous hemangioma: differentiation with dynamic FLASH MR imaging with Gd-DTPA.Radiology
H Yoshida, Y Itai, K Ohtomo, T Kokubo, M Minami, N Yashiro,
Forty patients with hepatocellular carcinoma (HCC) (n = 22) or cavernous hemangioma (diameter, 3 cm or less) (n = 18) were examined with serial magnetic resonance (MR) imaging at 1.5 T with the fast low-angle shot (FLASH) technique and an intravenously administered bolus injection of 0.05 mmol/kg Gd-DTPA. Two images per minute were obtained for 5 minutes, and one per minute thereafter until about 10 minutes. Dynamic MR studies revealed five criteria for differentiating these tumors. With HCC there was a hyperintense mass before contrast material enhancement (32%), peak contrast enhancement at about 10 seconds after injection (55%), slight to moderate peak contrast enhancement (73%), absent or minimal delayed enhancement (100%), and, at morphologic study, a capsule or nodules-in-nodule appearance (59%). With hemangioma there was a hypointense mass before contrast enhancement (72%), peak contrast enhancement more than 2 minutes after injection (72%), marked peak contrast enhancement (83%), moderate to marked delayed enhancement (100%), and, at morphologic study, spreading phenomenon (39%). Seventy-seven percent of HCCs and 83% of hemangiomas satisfied three or more criteria and thus could be differentiated from each other with certainty.
8927.66106754582000.04.05++Comparison of in-phase and out-of-phase gradient recalled echo T1-weighted pulse sequence for MR imaging of malignant liver masses following administration of paramagnetic gadolinium-chelate.Abdom Imaging
J Petersein, W Schima, S Saini, W Mayo-Smith, PF Hahn, KE Tanabe, AL Warshaw, CF del Castillo, B Hamm, PR Mueller,
BACKGROUND: The purpose of this study was to compare the performance of in-phase and out-of-phase gradient recalled echo (GRE) pulse sequences on paramagnetic contrast-enhanced magnetic resonance (MR) imaging of malignant liver lesions. METHODS: Fifty patients (27 women, 23 men; mean age = 50 +/- 27 years) with known or suspected focal liver lesions, nine of whom had a fatty liver, were examined at 1.5 T before and 60 min after injection of gadobenate dimeglumine at a dose of 0.05 or 0.1 mmol/kg using two GRE techniques: echo time of 2.3 ms (out-of-phase) or 4.6 ms (in-phase). Liver signal-to-noise ratio (SNR) and lesion-liver contrast-to-noise ratio (CNR) were calculated. RESULTS: In patients with a nonfatty liver, liver SNR increased from 26 +/- 9 to 41 +/- 17 on in-phase images and from 28 +/- 8 to 45 +/- 14 on out-of-phase images. In patients with a fatty liver, in-phase images provided significantly higher (p < 0.01) liver SNR than did out-of-phase images predose (34 +/- 8 on in-phase vs. 21 +/- 8 on out-of-phase) and postdose (44 +/- 13 on in-phase vs. 33 +/- 14 on out-of-phase). In patients with a nonfatty liver, lesion-liver CNR was similar on in-phase and out-of-phase images, predose and postdose. In patients with fatty liver, lesion-liver CNR was significantly (p < 0.01) lower on out-of-phase images on predose and postdose images. CONCLUSION: In-phase GRE imaging is recommended for imaging focal liver lesions on paramagnetic contrast-enhanced MR imaging in patients with fatty infiltration of the liver.
9027.64147401312004.04.27++[Angiosarcoma as a rare differential diagnosis in spontaneous rupture of the spleen]Chirurg
A Maier, F Bataille, D Krenz, M Anthuber,
A splenectomy was performed in a 37-year-old woman because of spontaneous rupture of the spleen. Primary angiosarcoma of the spleen was diagnosed postoperatively based on histology. Primary angiosarcoma of the spleen is a very rare neoplasm with disastrous prognosis. Immunohistochemical and ultrastructural examinations are necessary to verify the diagnosis because the histopathological picture of the tumor is variable. Due to the small number of reported cases, there are no guidelines for adjuvant or palliative therapy, and up to today all adjuvant means of radiotherapy and chemotherapy have not improved the prognosis of the patients.
9127.5611533211975.11.05++[Hepatosplenic sarcoidosis. Contribution of parenchymatous hepatosplenography by selective arteriography]Nouv Presse Med
J Turiaf, JP Battesti, Ch Hélénon,
In this study of hepato-splenic sarcoidosis the authors, in addition to confirming the principle and commonly recognised features of the disease, stress the value of cataloguing the morphological changes, in the liver and spleen by selective arteriography of the coeliac trunk; increase in the frequency of recognition of hepatosplenomegaly; granular appearance of the parenchyma of both organs, which appear to be studded with a multitude of small lacunae, thus eliminating the homogeneous and uniformly opaque image seen normally. Seen in 28.5 p.cent of cases, this heterogeneous appearance is not strictly pathognomic of sarcoidosis. It is mainly due to the lacunar appearance which probably represents sarcoid follicles. It may resolve under cortisone therapy.
9227.56108000022000.06.20+ Sonographic appearances in abdominal tuberculosis.J Clin Ultrasound
A Batra, MS Gulati, D Sarma, SB Paul,
9327.4814852501993.02.18+ [Benign vascular tumors of the spleen]Ter Arkh
VS Shavlova, IB Kaplanskaia, VA Klimanskiĭ,
9427.40175503282007.06.21++Splenic metastases: clinicopathologic presentation, differential diagnosis, and pathogenesis.Arch Pathol Lab Med
E Compérat, A Bardier-Dupas, P Camparo, F Capron, F Charlotte,
CONTEXT: Splenic metastases from solid tumors, defined as parenchymal lesion, are considered exceptional. Nevertheless, the number of case reports has been increasing due to the improvement of imaging techniques and the long-term follow-up of patients with cancer. Splenic metastases occur in a context of multivisceral disseminated cancer or as a solitary lesion. OBJECTIVE: To provide a general overview of the clinicopathologic features, differential diagnosis, and pathogenesis of splenic metastases. DATA SOURCES: Relevant articles indexed in PubMed (National Library of Medicine) database. The search was based on the following terms: (metastasis or metastases) and spleen. CONCLUSIONS: The most common primary sources of splenic metastasis are breast, lung, colorectal, and ovarian carcinomas and melanoma in cases of multivisceral cancer and colorectal and ovarian carcinomas in cases of solitary splenic lesion. Splenectomy can be replaced by less aggressive methods such as fine-needle aspiration or percutaneous biopsy for establishing the diagnosis of solitary splenic metastasis. The main differential diagnoses are primary lymphoma, vascular tumors, and infectious lesions of the spleen. The relative rarity of splenic metastases could be explained by anatomic factors and the inhibitory effect of the splenic microenvironment on the growth of metastatic cells. The analysis of clinical case reports suggests that solitary splenic metastases may result from the growth of an early blood-borne micrometastasis following a period of clinical latency, often several years after the diagnosis of the primary tumor.
9527.3975603341995.11.02+ Renal capsular hemangioma: unusual MR findings.J Comput Assist Tomogr
J Rueckforth, D Rhode, H Baba, G Adam,
9627.3886617681996.10.17++Renal abscesses: appearance on gadolinium-enhanced magnetic resonance images.Abdom Imaging
ED Brown, JJ Brown, U Kettritz, JP Shoenut, RC Semelka,
PURPOSE: To determine the appearance of renal abscesses on gadolinium-enhanced magnetic resonance (MR) images, we reviewed 12 MR studies of eight patients with renal abscesses. These findings were compared with findings on other imaging modalities. METHODS: Eight patients underwent 12 MR studies at 1.5 T, including T1-weighted gradient echo and fat-suppressed spin echo pre- and post-Gd-DTPA enhancement. Two radiologists retrospectively reviewed the MR images and compared MR findings to the findings on contrast-enhanced computed tomography (CECT) in five patients, noncontrast computed tomography (NCCT) in two patients, and ultrasound in all patients. RESULTS: On contrast-enhanced MR images, renal abscesses were clearly depicted as heterogeneously low-signal-intensity lesions. Four patients had solitary abscesses, and four had multiple abscesses. Prominent perinephric inflammatory stranding was observed in six patients and was best shown on gadolinium-enhanced T1 fat-suppressed images. CECT findings were comparable to contrast-enhanced MR images, although contrast resolution was less on CECT images in all cases. Renal abscesses were poorly shown on NCCT and ultrasound images. CONCLUSION: Renal abscesses are clearly shown on gadolinium-enhanced MR images as low-signal-intensity lesions associated with prominent perinephric inflammatory strands. In this study, NCCT and ultrasound studies are poor at defining abscesses. Despite lesser contrast resolution of CECT versus MRI, the findings in cases of renal abscesses are similar. In patients with elevated serum creatinine, iodine contrast allergy, or the need for serial exams, MRI may be the best imaging technique to evaluate renal abscesses.
9727.3775018301996.01.17++[The tissue characterization of focal liver lesions with magnetic resonance imaging]Radiol Med
R Manfredi, G Maresca, AM De Gaetano, A De Franco, P Marano,
This study was aimed at assessing the accuracy of Magnetic Resonance Imaging (MRI) in the characterization of focal liver masses. We prospectively examined 51 patients with focal liver masses: the morphological features were investigated with different pulse sequences and the functional characteristics were studied after the i.v. administration of Gd-DTPA (2 mmol/kg). MR findings were compared with those of gold standard methods, i.e., percutaneous biopsy, surgery or, for hemangiomas, 99mTc-labelled blood cell liver scintigraphy. All hemangiomas presented with typical features: signal intensity was very high on long TE images (> 140 msec) and a globular enhancement pattern, with centripetal progression, was observed after dynamic studies. This signal pattern on T2-weighted images is highly indicative of hemangioma. Five of 7 focal nodular hyperplasias (71%) were isointense with hepatic parenchyma on all pulse sequences; the central scar was observed in 5/7 cases on short TR/TE images and in all cases on long TR/TE images in 16/17 cases (94%). High signal intensity on T1-weighted images was statistically significant for HCC. A pseudocapsule was observed in 12 cases (70%). A mosaic pattern on T2-weighted images was observed in 3 cases. Seventy-four per cent of HCCs exhibited signal enhancement during the arterial phase of the dynamic study. Metastases presented a uniform pattern, i.e., they were hypointense on T1-weighted and hyperintense on T2-weighted images in 12/13 cases (92%). A central hypointense area on T2-weighted images is indicative of coagulative necrosis. A lesion with these morphological features and hypovascular signal is suggestive of metastasis.
9827.3276226811995.08.30++Orbital cavernous hemangioma: findings on sequential Gd-enhanced MRI.J Comput Assist Tomogr
G Wilms, H Raat, R Dom, C Thywissen, P Demaerel, G Dralands, AL Baert,
OBJECTIVE: To describe the contrast enhancement pattern of orbital cavernous hemangioma on sequential Gd-enhanced MRI. MATERIALS AND METHODS: Six patients with an orbital mass lesion were examined with T1- and T2-weighted spin echo MRI. After intravenous administration of Gd-chelate at a dose of 0.1 mmol/kg, T1-weighted spin echo sequences were performed immediately after, after 15 to 30 min, and up to 1 h after the injection. In two patients a fat saturation prepulse was given before the Gd-enhanced study. RESULTS: In all patients the lesions were isointense to muscle on the T1-weighted sequence and hyperintense to muscle on the T2-weighted sequences. After gadolinium, all lesions showed initial central patchy enhancement. Between 20 and 60 min after the injection the lesions showed total and homogeneous filling up. CONCLUSIONS: Progressive and total homogeneous filling up of an orbital mass of Gd-enhanced MRI is a pathognomonic sign of cavernous hemangioma.
9927.32127518582004.01.15++Splenic trauma: evaluation with contrast-specific sonography and a second-generation contrast medium: preliminary experience.J Ultrasound Med
O Catalano, R Lobianco, F Sandomenico, A Siani,
OBJECTIVE: To report our experience in the assessment of splenic trauma with contrast-coded sonography and a second-generation contrast medium. METHODS: From January to May 2002, 120 patients were studied with sonography for suspected splenic trauma. Twenty-five were selected for further imaging because of sonographic findings positive for splenic injury, findings positive for peritoneal fluid only, indeterminate findings, and negative findings with high clinical or laboratory suspicion. These patients underwent contrast-enhanced harmonic sonography and contrast-enhanced helical computed tomography. RESULTS: Among the 25 patients studied, 6 had no spleen trauma at initial and follow-up evaluation. One patient had a hypoperfused spleen without parenchymal damage, and 18 had splenic injuries; these 19 patients were considered positive. Hemoperitoneum was identified by sonography, contrast-enhanced sonography, and contrast-enhanced computed tomography in 74% of the 19 positive cases. Perisplenic clots were recognized in 58% of the cases by computed tomography and in 42% by baseline and enhanced sonography. Splenic infarctions were found in 11% of cases by contrast-enhanced sonography and computed tomography; none was found by unenhanced sonography. Parenchymal traumatic lesions were identified in 12 of 18 patients with splenic injuries by unenhanced sonography, in 17 cases by contrast-enhanced sonography, and in all 18 cases by contrast-enhanced computed tomography. A minimal splenic lesion was found in the single patient with a false-negative contrast-enhanced sonographic finding. Contrast-enhanced sonography correlated appreciably better than unenhanced sonography in detecting injuries and in estimating their extent. Findings undetectable on unenhanced sonography were also noted: splenic hypoperfusion in 11% of positive cases on both contrast-enhanced sonography and contrast-enhanced computed tomography, contrast medium pooling in 21% of cases on both contrast-enhanced sonography and computed tomography, and contrast extravasation in 11% of cases on computed tomography and 5% on contrast-enhanced sonography. CONCLUSIONS: Contrast-enhanced sonography is a promising tool in the assessment of splenic trauma. In institutions where sonography is used as the initial procedure, this technique may increase its effectiveness.
10027.30116885762001.12.04++CD31 expression in intratumoral macrophages: a potential diagnostic pitfall.Am J Surg Pathol
JK McKenney, SW Weiss, AL Folpe,
CD31 (platelet endothelial adhesion molecule, PECAM-1) is generally regarded to be the most sensitive and specific endothelial marker in paraffin sections. We have recently encountered several cases in which intratumoral CD31-positive macrophages were misinterpreted as evidence of a vascular sarcoma. We therefore reviewed our last 1950 consultation cases with respect to cases in which CD31 immunostains were performed, to determine the frequency of CD31 expression in macrophages in formalin-fixed, paraffin-embedded tissue and how often the presence of these cells was a source of diagnostic confusion. CD31 immunohistochemistry had been performed on 59 of 1950 (3%) of cases. These 59 cases consisted of both vascular (20 cases) and nonvascular tumors (39 cases). CD31-positive macrophages were distinguished from endothelial or tumor cells by correlation with the morphologic features and the immunohistochemical staining pattern of the cells of interest. In no case was CD31 positivity seen in the lesional cells of a nonvascular tumor. CD31-positive macrophages were identified in 48 of 59 (81%) cases. CD31-positive macrophages were present in 34 of 39 (87%) nonvascular tumors. A vascular tumor was diagnosed or favored by the referring pathologist in 15 of these 39 cases (38%). In 14 of these 15 cases CD31 immunostains were performed by the referring pathologist; 13 (93%) showed CD31-positive macrophages. In 4 of these 14 cases (29%) the misdiagnosis of a vascular tumor was based primarily or in part on the misinterpretation of CD31-positive macrophages as tumor cells. In all cases with CD34 and CD68 immunostains, the CD31-positive macrophages were CD34 negative and CD68 positive. We conclude that CD31 expression is very common in macrophages. Misinterpretation of CD31-positive macrophages as tumor cells may result in the erroneous diagnosis of a primary vascular neoplasm. Recognition of the characteristic granular, membranous pattern of CD31 expression in macrophages and careful distinction from tumor cells should allow the accurate interpretation of CD31 immunohistochemistry in possible vascular neoplasms. CD31 may also be useful as a nonlysosomal marker of macrophages in formalin-fixed, paraffin-embedded sections.
10127.2884744001993.05.20++[Can nuclear magnetic resonance tomography supplement and expand splenic diagnosis in malignant systemic diseases? Comparison of nuclear magnetic resonance tomography, ultrasound and computerized tomography findings]Med Klin (Munich)
R Lorenz, JP Hedde, V Diehl,
Can magnetic resonance imaging supplement or expand the diagnostic evaluation of the spleen in malignant systemic disease? A comparison of magnetic resonance imaging, ultrasonography and computed tomography.
10227.2781619001994.05.24++Hepatic focal nodular hyperplasia: CT and sonographic spectrum.Abdom Imaging
A Shirkhoda, MC Farah, E Bernacki, B Madrazo, J Roberts,
Fifteen patients with pathologically proven focal nodular hyperplasia (FNH) of the liver had abdominal computed tomography (CT) (15) and ultrasound (11). In seven patients, the lesions were incidentally found during gallbladder or renal examination, whereas the other eight had a primary neoplasm and the liver was studied for possible metastasis. In 11 unenhanced CT scans, the ratio of isodense to hypodense lesions was 8 to 3. In 15 contrast-enhanced CT scans, seven were isodense, six were hypodense, and in two, the lesion enhanced (hyperdense). In seven patients a hypodense lesion on unenhanced CT became isodense with contrast injection. Delayed images in three showed the lesions appearing as hypodense in two and displaying a rim of enhancement in one. In one case, unenhanced CT was normal and only enhanced CT showed an area of homogeneous increased density. Ultrasound was done in 11 patients, the lesion was hypoechoic to the liver in five, echogenic in four, and isoechoic in two. Findings of central scar were seen on CT and ultrasound in three cases. Pathologic diagnosis was available in all cases, seven by needle aspiration and eight by surgical resection. In our experience, FNH has many CT and sonographic features that can mimic hemangioma or metastasis. While the presence of a central scar increases the specificity, in a cancer patient, the findings should be interpreted with caution and needle aspiration should be obtained.
10327.2435268421986.09.17++Nonparasitic splenic cysts: a report of 52 cases with radiologic-pathologic correlation.AJR Am J Roentgenol
AH Dachman, PR Ros, PJ Murari, WW Olmsted, JE Lichtenstein,
We reviewed 52 cases of splenic cysts on file at the Armed Forces Institute of Pathology. There were 24 true (epidermoid) and 28 false (posttraumatic) cysts. The history and clinical presentations, including pain, splenomegaly, or mass, were similar in both groups. Radiologic manifestations included splenomegaly and the occasional identification of a distinct mass by conventional radiography even in the absence of calcification. The lesions produced a photopenic defect on nuclear scintigraphy and were avascular on angiography. Sonography and CT demonstrated a cystic lesion with occasional septations, wall trabeculation, and low-level internal echoes. Three false cysts demonstrated solid and cystic components on sonography and CT, corresponding to organizing hematoma within the cyst. Splenomegaly or a splenic mass of a predominantly cystic nature with no clinical evidence of echinococcus suggests the diagnosis of splenic cyst. Reliable radiologic distinction between true or false splenic cyst does not seem possible. Complex mass may represent a "transition" between hematoma and false splenic cyst.
10427.2490108011997.03.25++Abdominal ultrasound findings of disseminated tuberculosis in AIDS.J Clin Ultrasound
JM Monill-Serra, A Martinez-Noguera, E Montserrat, J Maideu, JM Sabaté,
The sonographic findings of 76 patients with tuberculosis and HIV infection are described. These findings were compared with a control group of 76 HIV-positive patients without associated pathology. Those patients with tuberculosis and positive HIV titers commonly (p = 0.05) showed retroperitoneal and mesenteric adenopathies with node diameters greater than 1.5 cm (n = 27), and multiple, splenic, hypoechoic nodules between 0.5 cm and 1 cm (n = 11). Additional findings include hepatic hyperechoic nodules (n = 1) and retroperitoneal abscess (n = 1). The combination of ultrasound features can help in the diagnosis of abdominal tuberculosis in HIV-positive patients with non-specific clinical infections.
10527.1795686331998.06.19++Inflammatory pseudotumor of the spleen: US and MRI findings.Radiat Med
K Hayasaka, S Soeda, M Hirayama, Y Tanaka,
The ultrasound and color Doppler sonography characteristics of inflammatory pseudotumor (IPT) of the spleen are nonspecific, and thus preoperative diagnosis of the tumor is difficult. We describe a case of IPT of the spleen studied with ultrasound, color Doppler sonography, CT, and MRI, and we report the usefulness of US and MRI findings of the tumor.
10627.10162728492005.12.23++Eosinophilic hepatic necrosis: magnetic resonance imaging and computed tomography comparison.J Comput Assist Tomogr
JS Yu, SW Yoon, MS Park, JH Lee, KW Kim,
OBJECTIVE: To compare the findings of magnetic resonance (MR) imaging with those of computed tomography (CT) of focal liver lesions related to peripheral eosinophilia. METHODS: For 12 patients with peripheral eosinophilia (>7%) examined with hepatic MR imaging and CT, 52 focal hepatic lesions larger than 0.5 cm, including 31 lesions simultaneously found on the 2 imaging modalities, were subjected to a comparative analysis of their imaging features. RESULTS: The total number of lesions distinguished from background liver was 39 (75%) on MR imaging and 44 (85%) on CT scans. On arterial phase images of 10 patients with comparable data, homogeneously hyperintense lesions were demonstrated more frequently (P = 0.006) on MR imaging (16 [50%] of 32 lesions) than on CT scans (4 [13%] of 32 lesions). Only 7 (22%) of the 32 hypoattenuating lesions on portal phase CT were depicted as hypointense lesions on portal phase MR images in 12 patients. On delayed phase images in 8 patients, the number of hyperintense lesions on MR images (9 [56%] of 16) was greater (P = 0.077) than that seen on the CT scans (4 [25%] of 16). CONCLUSIONS: For many focal hepatic lesions related to peripheral eosinophilia, dynamic MR imaging more easily demonstrates lesional enhancement on arterial and delayed phases than CT scans. Because of the higher degree of lesional enhancement of MR imaging compared with CT, the lesion-to-liver contrast may not be sufficient to distinguish the lesion from the background liver, resulting in decreased sensitivity of portal phase dynamic MR imaging.
10726.9981995481994.07.05++Ciliated hepatic foregut cysts: US, CT, and contrast-enhanced MR imaging.Abdom Imaging
JP Shoenut, RC Semelka, C Levi, H Greenberg,
Hepatic foregut cysts are uncommon lesions of the liver. In this report we prospectively examined two patients by means of computed tomography (CT), ultrasound, and contrast-enhanced magnetic resonance imaging. Ciliated hepatic foregut cysts were subsequently demonstrated in both patients following CT-guided biopsy. Magnetic resonance imaging was found to be useful in differentiating these cysts from other lesions.
10826.8533510421988.04.28++The MR contribution after CT demonstration of supratentorial mass effect without additional localising features.J Comput Assist Tomogr
DA Robinson, RE Steiner, IR Young,
The contribution of magnetic resonance (MR) imaging was retrospectively evaluated in 24 patients in whom CT demonstrated a supratentorial mass effect without significant additional localising features. Using a combination of T1-weighted inversion recovery (IR) and T2-weighted spin echo sequences, the MR images localised the lesion with greater precision than CT in 80% of cases. Areas of contrast enhancement were visible on the IR images in five of nine (56%) patients assessed after intravenous gadolinium-diethylenetriamine pentaacetic acid, where no comparable enhancement was seen on CT. Twenty of the 24 patients subsequently underwent surgery; eight had biopsies and 12 had resections. Magnetic resonance accurately predicted the site of the tumour in all these patients. Three of the remaining four cases were treated with radiotherapy on the basis of the MR findings without a tissue diagnosis being sought. Magnetic resonance produces better localization than CT and provides a sound basis for further diagnostic and therapeutic procedures.
10926.8288882201996.11.25++Hepatic malignancies: usefulness of acquisition of multiple arterial and portal venous phase images at dynamic gadolinium-enhanced MR imaging.Radiology
MS Peterson, RL Baron, T Murakami,
PURPOSE: To determine whether liver tumor detection is increased by acquiring multiple dynamic arterial phase and portal venous phase magnetic resonance (MR) images. MATERIALS AND METHODS: Dynamic MR imaging was performed in 205 patients at 1.5 T with use of a fast spoiled gradient-echo technique (repetition time, 9-12 msec; echo time, 2.1-3.0 msec; flip angle, 30 degrees). During intravenous bolus injection of gadopentetate dimeglumine or gadoteridol (0.1 mmol/kg), nine images were acquired at each of 10-12 locations over approximately 120 seconds. The number of tumors detected on arterial phase and portal venous phase images and unenhanced T1- and T2-weighted spin-echo (SE) images was evaluated separately. Data obtained in 75 patients with proved malignancies were analyzed. RESULTS: At imaging, 220 malignant tumor nodules were depicted. At prospective review of all images, 110 hepatocellular carcinomas (HCCs) were detected: 82 (75%) on unenhanced T1-weighted SE images, 83 (75%) on unenhanced T2-weighted SE images, 92 (84%) on arterial phase images, and 76 (69%) on portal venous phase images. At prospective review, eight HCCs were detected on only arterial phase images, one on only portal venous phase images, nine on both arterial and portal venous phase images, and 11 on only unenhanced SE images. The 18 additional HCCS detected prospectively on only dynamic images increased HCC detection by 21% over prospective detection on only SE images. Detection of non-HCC tumors (including metastases) did not increase with dynamic images. CONCLUSION: Acquisition of multiple dynamic arterial phase and portal venous phase images increased detection of HCC but not metastases.
11026.7221226831990.12.27++Sarcoidosis of the CNS: comparison of unenhanced and enhanced MR images.AJR Am J Roentgenol
JL Sherman, BJ Stern,
Sarcoidosis involving the CNS has a predilection for the leptomeninges, although parenchymal involvement occurs. We retrospectively evaluated the appearance of CNS sarcoidosis on unenhanced and enhanced MR images. MR studies were abnormal in 17 of 20 patients with CNS sarcoidosis. In all 17 patients, meningeal disease was detected on the gadopentetate-dimeglumine-enhanced T1-weighted images; the disease was detected on unenhanced images in three patients. Well-defined leptomeningeal patterns of enhancement were present in 15 patients. Other areas of involvement were the dura; brain parenchyma including hypothalamus, periventricular white matter, and ventricular ependyma; optic chiasm; and pituitary gland. Gadopentetate dimeglumine optimally evaluates meningeal disease and highlights the importance of the leptomeninges and Virchow-Robin spaces in the pathogenesis of CNS sarcoidosis. Enhanced MR is the preferred imaging technique for the evaluation of CNS sarcoidosis.
11126.7286288871996.06.21++Superparamagnetic iron oxide--enhanced versus gadolinium-enhanced MR imaging for differential diagnosis of focal liver lesions.Radiology
TJ Vogl, R Hammerstingl, W Schwarz, MG Mack, PK Müller, W Pegios, H Keck, A Eibl-Eibesfeldt, J Hoelzl, B Woessmer, C Bergman, R Felix,
PURPOSE: To assess AMI-25- versus gadolinium-enhanced magnetic resonance (MR) imaging in the differential diagnosis of liver tumors. MATERIALS AND METHODS: Twenty-nine patients with liver tumors underwent unenhanced, AMI-25-enhanced (15 micromol/kg), and gadolinium-enhanced(0.1 mmol/kg) imaging within 2 weeks. RESULTS: A significant (P< .05) difference in percentage signal intensity loss (PSIL) was seen in benign tumors on AMI-25-enhanced proton-density-weighted images (nine focal nodular hyperplasia [FNH], 41%; one adenoma, 32.4%) versus malignant tumors. Gadolinium-enhanced T1-weighted gradient-echo images showed strong enhancement in benign lesions (seven FNH, 147.5%; one adenoma, 91.3%) and moderate enhancement in malignant tumors (eight hepatocellular carcinomas, 116.2%, 11 metastases, 39.7%). Receiver operating characteristic analysis revealed a threshold PSIL of 10% on AMI-25-enhanced images as the most essential criteria to distinguish benign from malignant lesions (sensitivity, 88%; specificity. 89%). Interobserver analysis for two observers revealed specificity of 93% for AMI-25-enhanced imaging versus 81.5% for gadolinium-enhanced MR imaging. CONCLUSION: AMI-25 decreased the SI of benign tumors and helped differentiate benign from malignant tumors.
11226.7129090931989.01.18++Liver, spleen, and vessels: preliminary clinical results of CT with perfluorooctylbromide.Radiology
JN Bruneton, MN Falewée, E François, P Cambon, C Philip, JG Riess, C Balu-Maestro, A Rogopoulos,
This phase 1-2 trial investigated the use of a 100% wt/vol emulsion of perfluorooctylbromide (PFOB) in computed tomography (CT) of 30 patients with metastatic cancer. Injection of 3 g/kg (maximum dose administered to these patients) provided an average liver enhancement of +31 HU on CT scans obtained after 48 hours. Maximum splenic opacification occurred immediately after injection; 1 g/kg, which allowed an immediate enhancement of +35 HU, appeared sufficient for the diagnosis of splenic conditions. Vascular opacification was insufficient for diagnostic purposes. In four patients with metastases, more lesions were seen with the use of PFOB with CT than with conventional CT. Adverse effects included five cases of low back pain that were reversible when the infusion rate was reduced. Fever and trembling were also noted 6 hours after injection in five patients. In all patients, symptoms regressed spontaneously within several hours. Clinically inapparent and dose-independent splenomegaly (volume increase of at least 20% on CT examinations) was noted in eight patients.
11326.7121226821990.12.27++MR imaging of the normal and abnormal clivus.AJR Am J Roentgenol
F Kimura, KS Kim, H Friedman, EJ Russell, R Breit,
We retrospectively reviewed 330 T1-weighted sagittal images, 80 T2-weighted sagittal images, and 83 gadopentetate-dimeglumine-enhanced scans of normal adults to determine the MR appearance of the normal adult clivus. MR images of 21 patients with an abnormal clivus (19 with tumor invasion and two with marrow reconversion) were also evaluated retrospectively and compared with those of the control group to assess MR features distinguishing the two groups. Our study revealed that a normal adult clivus consisted of low- and high-intensity portions mixed in various proportions on T1-weighted images. The low-intensity portion was isointense or hyperintense relative to the pons and always contained foci of bright signal intensity. The low-intensity tumor of a pathologic clivus tended to be hypointense relative to the pons (17/19), and was completely devoid of foci of bright signal intensity. The normal adult clivus was approximately isointense relative to the pons on T2-weighted images. Clival tumors were grossly hyperintense relative to the pons on T2-weighted images in 11 of 17 patients. In the remaining six patients, either a portion of or the entire lesion was isointense relative to the pons and, therefore, was not detectable on T2-weighted images. A normal adult clivus can enhance to some degree (19/83). Clival tumors were found to enhance intensely. A clivus of very low signal intensity (signal void) on T1- or T2-weighted images was always abnormal. The clivus with marrow reconversion was uniformly hypointense relative to the pons on T1-weighted images and isointense relative to normal marrow on T2-weighted images. The intensity patterns of the normal clivus on T1- and T2-weighted MR images change predictably with advancing age. Intensity patterns of abnormal clivi differ from those of normal clivi. When contrast material is used, normal and abnormal clivi generally show different patterns of enhancement.
11426.7013185581992.07.15++[The dynamic magnetic resonance study of focal liver lesions by FLASH sequences with bolus intravenous gadolinium-DTPA]Radiol Med
L Olivetti, L Grazioli, R Maroldi, L Matricardi, L Milanesio,
Thirty-five patients with hepatic hemangioma (n = 12), metastasis (n = 10), hepatocellular carcinoma (HCC) (n = 10) and focal nodular hyperplasia (n = 3) were examined with the fast low-angle shot (FLASH) technique and an intravenous bolus injection of Gd-DTPA. In order to differentiate the lesions, the following criteria were used: a) pre Gd-DTPA intensity of lesions; b) post Gd-DTPA patterns of contrast enhancement. On the basis of these criteria, an unquestionable differential diagnosis could be made. Hemangiomas were characterized by an hypointense mass before Gd-DTPA, by peripheral contrast enhancement and by subsequent continuous hyperintense fill-in; thus, hemangiomas were visualized as hyperintense lesion during the late phase. Before contrast administration hypovascular metastases appeared as hypointense; they were characterized by delayed uptake of contrast agent. HCCs were hyperintense lesions before contrast administrations; then, quick contrast enhancement and rapid decrease in signal intensity were observed with visualization of a hyperintense ring due to the capsule. Finally, focal nodular hyperplasia appeared isointense or hypointense relative to normal liver on precontrast scans; the lesions were enhanced transiently with subsequent quick dismission of contrast agent. This initial experience suggests dynamic contrast-enhanced MR imaging as an effective method to improve the differential diagnosis among hepatic tumors when precontrast T2-weighted images are equivocal.
11526.6518920351991.10.11+ Castleman disease of the adrenal gland: MR imaging features.AJR Am J Roentgenol
JF Debatin, CE Spritzer, NR Dunnick,
11626.5822102011990.10.31++Abdominal tuberculosis in children: CT findings.Gastrointest Radiol
FM Denath,
Tuberculous peritonitis is a rare manifestation of childhood tuberculosis. The computed tomographic (CT) scans of three patients with abdominal tuberculosis were reviewed to determine the range of abdominal involvement. This report describes the following CT features of abdominal tuberculosis: (1) diffuse lymphadenopathy involving mesenteric and retroperitoneal lymph nodes; (2) low-density lymph nodes with multilocular appearance following intravenous contrast; (3) high-density ascites; (4) mottled low-density masses in the omentum; (5) thickening of the bowel wall adjacent to the mesentery; and (6) hepatic pseudotumors. These CT features of abdominal tuberculosis, in the appropriate clinical setting, should help optimize the correct diagnosis and management of tuberculosis in children.
11726.5477291181995.05.26++Update: abdominal tuberculosis--unusual findings on CT.Clin Radiol
AA Bankier, D Fleischmann, MN Wiesmayr, D Putz, M Kontrus, P Hübsch, CJ Herold,
To update our knowledge of abdominal tuberculosis as manifested on computed tomography (CT), we reviewed the CT scans of 12 patients with proven abdominal tuberculosis. The nature, range and extent of abdominal involvement was determined. The CT findings were compared to those reported in the literature. The aetiologic agent was Mycobacterium tuberculosis in all patients. One patient had an increased risk because of AIDS. In nine patients, tuberculosis was limited to the abdomen, and three patients had previously unknown thoracic tuberculous disease. Characteristic features in our patients included low density ascites and uncommon patterns of adenopathy. Findings reported to be typical in abdominal tuberculosis were present in only five of our 12 patients. Unusual findings in our patients included solitary and multiple pelvic, adrenal, splenic and hepatic lesions. In six of 12 patients, those findings mimicked malignancy. We conclude that knowledge and early recognition of these unusual manifestations of abdominal tuberculosis should help to optimize clinical management of the disease and avoid misdiagnosis.
11826.4873844551980.08.15++Computed tomography of the spleen.Radiology
J Piekarski, MP Federle, AA Moss, SS London,
Computed tomography (CT) has proved to be valuable in the diagnosis of a wide variety of congenital, inflammatory, traumatic, and neoplastic lesions of the spleen, in addition to identifying certain normal variants which may present problems. A comprehensive review of the CT characteristics of splenic lesions and variants is provided, and CT is compared with other imaging modalities, principally radionuclide imaging.
11926.3892167711997.07.31++Venous aneurysms: MR diagnosis with the "layered gadolinium" sign.J Comput Assist Tomogr
G Krinsky, G Johnson, N Rofsky, R Shapiro, B Yang, J Weinreb,
OBJECTIVE: Our goal was to present MR findings in venous aneurysms and introduce the "layered gadolinium" sign as an ancillary diagnostic finding. METHOD: Gadolinium-enhanced MR images of three patients with retroperitoneal venous aneurysms were retrospectively reviewed. Prior to MRI, venous aneurysm had been suspected clinically in only one patient. Surgical correlation was available in one patient. A phantom was constructed and imaged to investigate the cause of the layered gadolinium sign. RESULTS: A gradation of signal intensity, the layered gadolinium sign, was observed in three patients with venous aneurysms on postcontrast T1-weighted images. The anterior portion of the aneurysms demonstrated high signal intensity separated by a sharp interface from the low signal intensity posterior region. Unenhanced time-of-flight MR venography, color Doppler, and duplex sonography failed to demonstrate flow in the patient with surgical proof. CONCLUSION: The layered gadolinium sign may be helpful in the diagnosis of venous aneurysm and in differentiating these masses from solid neoplasms.
12026.3292407071997.08.21++Malignant splenic lymphoma: sonographic patterns, diagnosis and follow-up.Clin Radiol
C Gorg, R Weide, WB Schwerk,
Six hundred and eighty patients with malignant lymphoma were studied by abdominal sonography during 1983 and 1993 at our institution. Abnormal splenic texture was noted in 101 patients (14,8%). Involvement of the spleen was confirmed histologically (n = 8), by sonographic follow-up (n = 82), and on the basis of the clinical course in the remaining patients. Of the 101 patients with splenic involvement, 34 had Hodgkin's disease, 38 had a low-grade non-Hodgkin's lymphoma and 29 a high-grade non-Hodgkin's lymphoma. Four different sonographic patterns were observed: (1) Diffuse involvement in 37 patients (pts) (36.6%). (2) Focal small nodular lesions in 39 pts (38.6%). (3) Focal large nodular lesions in 23 pts (22,7%). (4) 'Bulky, disease' in two pts (1.9%). All of the high-grade lymphomas showed either large nodular (15/29) or small nodular (14/29) lesions. The diffuse or small nodular pattern was seen predominantly in low-grade lymphomas (35/38) and in Hodgkin's disease (31/34). CONCLUSION: A number of different patterns of splenic involvement in lymphoma can be demonstrated by ultrasound. Splenic sonographic patterns can be linked to histological lymphoma entities.
12126.2890575181997.04.04+ MR imaging of acquired abnormalities of the spleen.AJR Am J Roentgenol
K Ito, DG Mitchell, K Honjo, T Fujita, H Uchisako, T Matsumoto, N Matsunaga, Y Honma, K Yamakawa,
12226.1867733661980.10.27++Enlarged accessory spleens: CT appearance in postsplenectomy patients.AJR Am J Roentgenol
JR Beahrs, DH Stephens,
An unexplained abdominal mass discovered on CT examinations of a postsplenectomy patient may represent a hypertrophied residual accessory spleen. Six such patients were found to have left upper quadrant masses on CT examinations that were subsequently proved to be enlarged accessory spleens. The CT appearance is that of discrete, solitary, rounded masses of uniform soft-tissue density in the left upper quadrant. Diameters of the masses were 3.5-5.0 cm. The splenic nature of such a mass can be confirmed by appropriate radionuclide imaging.
12326.1863391701983.05.27+ Computed tomography of the spleen.Crit Rev Diagn Imaging
M Federle, AA Moss,
12426.13159081552005.12.06++Abdominal tuberculosis: imaging features.Eur J Radiol
JM Pereira, AJ Madureira, A Vieira, I Ramos,
Radiological findings of abdominal tuberculosis can mimic those of many different diseases. A high level of suspicion is required, especially in high-risk population. In this article, we will describe barium studies, ultrasound (US) and computed tomography (CT) findings of abdominal tuberculosis (TB), with emphasis in the latest. We will illustrate CT findings that can help in the diagnosis of abdominal tuberculosis and describe imaging features that differentiate it from other inflammatory and neoplastic diseases, particularly lymphoma and Crohn's disease. As tuberculosis can affect any organ in the abdomen, emphasis is placed to ileocecal involvement, lymphadenopathy, peritonitis and solid organ disease (liver, spleen and pancreas). A positive culture or hystologic analysis of biopsy is still required in many patients for definitive diagnosis. Learning objectives:
12526.08103786551999.08.04++CT and MR findings of splenic angiosarcoma.Radiat Med
I Imaoka, K Sugimura, M Furukawa, S Kuroda, K Yasui,
A surgically confirmed primary splenic angiosarcoma is described. Although angiography showed most of the characteristic findings of the present patient, MR imaging provided a useful information as a supplemental tool. The tumor demonstrated low-signal intensity on both T1- and T2-weighted images, which might differ from hemangioma findings. Subacute hemorrhage within the tumor was revealed by MR imaging, suggesting the way in which the tumor grew during a short period of time. This finding was different from reported angiosarcoma MR findings of siderotic nodules within the tumor. After the administration of Gd-DTPA, MR images clearly demonstrated heterogeneous enhancement within the tumor, which corresponded to the pathologic findings of solid parenchyma with necrotic tissues.
12626.02172598372007.03.19++Focal peliosis hepatis as a mimicker of hepatic tumors: radiological-pathological correlation.J Comput Assist Tomogr
SH Kim, JM Lee, WH Kim, JK Han, JY Lee, BI Choi,
OBJECTIVE: To retrospectively evaluate the radiological findings in patients with focal peliosis hepatis and to correlate them with pathological findings. METHODS: Eight patients with pathologically proven peliosis hepatis underwent ultrasonography (n = 6), computed tomography (CT; n =8), and/or magnetic resonance imaging (MRI; n = 3). Two radiologists analyzed the images for the size, margin, echogenicity, presence of posterior acoustic enhancement, and enhancement pattern of the lesion. The enhancement patterns on CT or MRI were correlated with the pathological findings. RESULTS: The average lesion size was 1.9 cm. On ultrasonography, 4 lesions were ill defined and low echoic compared with the hepatic parenchyma. Two lesions showed posterior acoustic enhancement. In 4 lesions, centripetal enhancement was observed on dynamic CT images. Two lesions showed homogeneously high and 2 showed persistently low enhancement patterns. On dynamic MR phases, 2 lesions showed strong and persistent enhancement. In 1 lesion, MR showed slow centripetal enhancement. In the 3 patients who showed a homogeneously high enhancement pattern on dynamic CT or MRI, microscopic examination demonstrated that the dilated sinusoids were filled with fresh blood cells. On the contrary, in 5 patients who showed a centripetal or persistently low enhancement pattern, their dilated sinusoids were filled with old stagnated blood. CONCLUSIONS: Focal peliosis hepatis showed various enhancement patterns on contrast-enhanced CT and MRI, depending on the histopathologic findings.
12726.0174807341995.12.21++Spinal cord ependymomas: MR imaging features.Radiology
MJ Fine, II Kricheff, D Freed, FJ Epstein,
PURPOSE: To assess the magnetic resonance (MR) imaging characteristics of spinal intramedullary ependymomas. MATERIALS AND METHODS: MR images obtained in 25 patients (aged 12-73 years) with proved intramedullary ependymomas were retrospectively reviewed. T1- and T2-weighted images were obtained in all patients. Gadopentetate dimeglumine was intravenously administered in 23 patients; enhanced sagittal and axial T1-weighted spin-echo images were reviewed. RESULTS: All tumors had hyperintense signal on T2-weighted images. In the 23 patients who received contrast material, all tumors became enhanced; enhancement was heterogeneous in 15 patients and homogeneous in eight patients. Twenty tumors had sharply defined, enhanced borders. Nineteen tumors were centrally located in the spinal cord. A hypointense rim on T2-weighted images was noted in five patients. CONCLUSION: Intramedullary ependymomas become enhanced after administration of gadopentetate dimeglumine; the enhanced borders are usually sharply marginated. They are characteristically located centrally in an expanded spinal cord. Hemosiderin is often present at the periphery of cervical ependymomas.
12825.981108411979.09.25++The sonographic findings of splenic metastases.J Clin Ultrasound
JF Murphy, ME Bernardino,
The sonographic findings in five patients with metastases to the spleen are demonstrated. Hypoechoic lesions were seen in patients with histiocytic lymphoma, and both echogenic and hypoechoic lesions were seen in patients with melanoma. The clinical significance of these findings is discussed.
12925.9699322561999.04.16++Multimodality demonstration of primary splenic angiosarcoma.J Clin Ultrasound
S Aytaç, S Fitoz, C Atasoy, I Kuzu, K Cinar, I Erden,
Angiosarcomas are rare, accounting for only 1-2% of all soft tissue sarcomas. Primary abdominal angiosarcomas usually arise in the liver or spleen. We report the first color Doppler findings of a rare, low-grade splenic angiosarcoma in a 52-year-old woman.
13025.9064047261983.06.10++[Limits of differentiation of focal splenic lesions by sonography and computed tomography]Rofo
R Lorenz, D Beyer, G Friedmann, U Mödder,
Based on the results of sonographic and CT-findings in 192 patients the advantages and disadvantages of ultrasonography and CT in the diagnosis of splenic lesions are presented with particular emphasis on anatomy and topography. The relatively uniform presentation of various focal lesions in ultrasonography and CT is demonstrated and the limits of differentiation are discussed. The importance of angiography and scintigraphy is also mentioned.
13125.8591076471997.07.10++Focal nodular hyperplasia of the liver: serial MRI with Gd-DOTA, superparamagnetic iron oxide, and Gd-EOB-DTPA.Abdom Imaging
GM Kacl, KD Hagspiel, B Marincek,
BACKGROUND: To demonstrate the improved specificity of liver MRI in diagnosis of focal nodular hyperplasia (FNH) using liver specific contrast agents. METHODS: In a patient after resected adenosarcoma of the uterus a focal nodular hyperplasia was followed. Serial MRI of the liver was performed using first Gd-DOTA, followed by superparamagnetic iron oxide (SPIO) as well as Gd-EOB-DTPA. RESULTS: During the follow-up of FNH specificity of liver MRI improved using liver specific contrast agents. The central scar as well as the pseudocapsule showed different typical contrast uptake using all three methods. CONCLUSION: Serial MRI of the liver with Gd-DOTA, SPIO and Gd-EOB-DTPA can exclude a malignant liver lesion. Liver biopsy of FNH can be avoided with increased specificity of MRI for FNH.
13225.8324058811990.03.29++The spleen: an integrated imaging approach.Crit Rev Diagn Imaging
RJ Rolfes, PR Ros,
In this review we attempted to demonstrate the imaging appearance of the spectrum of entities that may involve the spleen. The systematic approach reviewing the radiologic findings by modality (plain films, ultrasound, CT, scintigraphy, angiography, and MRI) has been used. We have opted to present the information following pathologic categories (congenital, infections, cysts, benign and malignant tumors, vascular, trauma, and miscellaneous) rather than a pattern approach. A pattern approach may not be practical in spleen since patterns are few and nonspecific. Although a specific diagnosis can be obtained rarely, the information provided by imaging coupled with clinical and laboratory data is capable in many cases of significantly altering patient management. Surgery, percutaneous intervention, medical therapy, or simple observation can be pursued based on the radiological findings.
13325.7929580301987.10.26++Magnetic resonance imaging, chest radiography, computed tomography and ultrasonography in malignant lymphoma.Acta Radiol
R Nyman, S Rehn, B Glimelius, H Hagberg, A Hemmingsson, PG Lindgren, A Magnusson,
Magnetic resonance imaging (MRI) was compared with chest radiography, computed tomography (CT) and ultrasonography (US) for demonstration of spleen and liver engagement and enlarged lymph nodes in patients with malignant lymphoma. The investigation comprised 24 patients with Hodgkin's disease (HD) and 39 with non-Hodgkin lymphoma (NHL). MRI demonstrated enlarged lymph nodes, distinctly separated from vessels, fat, muscle, liver and occasionally also pancreas without any contrast medium. The distinction between lymph nodes and spleen was, however, poor in the images. In the mediastinum, MRI was superior to chest radiography and had an accuracy similar to that of CT. In the abdomen and the pelvis MRI had slight advantages over CT in detection of enlarged lymph nodes. Compared with US the MRI results were similar in the abdomen and somewhat better in the pelvis. MRI and US were better than CT in revealing HD infiltrates in the spleen. Infiltration of NHL in the spleen was slightly better disclosed at US than at CT and MRI; most of the NHL infiltration, confirmed at histopathology, could, however, not be revealed with any of the modalities, except when the size of the spleen was considered. Regions in the spleen, displayed with low image intensity in the T2 weighted image, were most likely due to increased amount of fibrotic tissue in the lymphomatous lesions. Good demonstration of lymph nodes and lymphomatous lesions in the spleen with MRI required two sequences; one with short TR and TE (T1 weighted image) and one with long TR and TE (T2 weighted image).
13425.71123549992002.10.17++Ferumoxides-enhanced double-echo T2-weighted MR imaging in differentiating metastases from nonsolid benign lesions of the liver.Radiology
AS Arbab, T Ichikawa, H Sou, T Araki, H Nakajima, K Ishigame, T Yoshikawa, H Kumagai,
PURPOSE: To investigate whether ferumoxides-enhanced double-echo T2-weighted magnetic resonance (MR) imaging alone can allow differentiation of metastases from benign lesions in the noncirrhotic liver. MATERIALS AND METHODS: At retrospective review of files and images, 60 lesions (22 metastases, 20 hemangiomas, and 18 cysts) were identified in 42 patients. All fast spin-echo T2-weighted MR images obtained before and after administration of ferumoxides with short (80-90 msec) and long (180-250 msec) echo times (TEs) were acquired with a 1.5-T system. Differences in lesion-to-liver signal intensity ratio between images obtained with long and short TEs were calculated. Data from all 60 lesions were entered into a receiver operating characteristic analysis. Three independent readers scored their observations of each lesion with a confidence level of 1-5. The diagnostic accuracy of each analysis method was determined by calculating the area under each reader-specific receiver operating characteristic curve. Interobserver agreement was calculated with the use of chance-corrected kappa statistics. Relative sensitivity, specificity, and accuracy of characterizing benign lesions with each method were calculated. RESULTS: Markedly low signal intensity and lesion-to-liver ratio on ferumoxides-enhanced images were observed with hemangioma. The difference of lesion-to-liver ratio between long and short TEs on ferumoxides-enhanced images was significantly different from that of unenhanced images and that of metastases or cysts. Interobserver agreement was good to excellent. Ferumoxides-enhanced images (with short and long TEs) showed significantly higher diagnostic accuracy than that of unenhanced images (with short or short and long TEs). Ferumoxides-enhanced images showed similar sensitivity, specificity, and accuracy when all images were reviewed together. CONCLUSION: Ferumoxides-enhanced T2-weighted MR images appear useful in differentiating metastases from benign (nonsolid) lesions in the liver.
13525.57157286032005.04.14++Contrast-enhanced sonography with SonoVue: enhancement patterns of benign focal liver lesions and correlation with dynamic gadobenate dimeglumine-enhanced MRI.AJR Am J Roentgenol
P Ricci, A Laghi, V Cantisani, P Paolantonio, S Pacella, E Pagliara, F Arduini, V Pasqualini, F Trippa, M Filpo, R Passariello,
OBJECTIVE: Contrast-enhanced real-time low-mechanical-index sonography is a new diagnostic technique for the assessment of macro- and microcirculation. The purpose of our article is to describe contrast-enhancement patterns of different benign focal liver lesions using the second-generation contrast agent SonoVue and to compare these findings with those of gadobenate dimeglumine-enhanced MRI. CONCLUSION: SonoVue-enhanced real-time low-mechanical-index sonography provides specific contrast-enhancement patterns of different benign focal liver lesions, allowing accurate characterization. Findings on SonoVue-enhanced sonography correlate well with those obtained on gadobenate dimeglumine-enhanced MRI.
13625.5581262891994.04.11+ Bacillary angiomatosis in the abdomen: Doppler and CT features.J Comput Assist Tomogr
LE Kunberger, BM Montalvo,
13725.5086105581996.05.28++Renal lymphoma: demonstration by MR imaging.AJR Am J Roentgenol
RC Semelka, NL Kelekis, DA Burdeny, DG Mitchell, JJ Brown, ES Siegelman,
OBJECTIVE. The objective of this study was to demonstrate the spectrum of appearances of renal lymphoma using current MR techniques including gadolinium enhancement. MATERIALS AND METHODS. Twelve patients with renal lymphoma were examined by MR imaging on a 1.5-T scanner. MR examinations included T2-weighted, breath-hold T1-weighted spoiled gradient-echo, and T1-weighted fat-suppressed spin-echo imaging before and after gadolinium administration. Tumor morphology, signal intensity, and enhancement features were evaluated. RESULTS. Three types of renal involvement were observed: large paraaortic retroperitoneal masses with extension into the renal hilum, the subcapsular space, or both (nine patients); unilateral diffuse infiltration of the renal parenchyma (one patient); and focal rounded intraparenchymal masses (two patients). Untreated lymphoma (10 patients) was slightly hypointense relative to the renal cortex on T1-weighted images and was heterogenous and slightly hypointense or isointense on T2-weighted images. Enhancement of lymphomatous tissue was mildly heterogenous and was minimal on early images after gadolinium enhancement and remained minimal on late contrast-enhanced images in most tumor masses. No central necrosis of tumor was identified, and no renal vein thrombus was present. Five patients with lymphoma that presented as a large paraaortic mass showed diminished renal cortical perfusion of the involved kidney. All of these patients also had tumor extension into the renal hilum. CONCLUSION. Three types of renal involvement with lymphoma were observed. The most common appearance was a large retroperitoneal mass that invaded the kidney.Tumors had low to intermediate signal intensity on T1- and T2-weighted images and had diffuse heterogenous enhancement that was less than that of renal parenchyma.
13825.4486729721996.08.15++Correlation of perfusion abnormalities on CTAP and immediate postintravenous gadolinium-enhanced gradient echo MRI.Abdom Imaging
JF Schlund, RC Semelka, U Kettritz, SM Weeks, M Kahlenberg, WG Cance,
BACKGROUND: The purpose of this study was to evaluate patients with wedge-shaped perfusion defects seen on spiral CT arterial portography for the presence of transient increased wedge-shaped enhancement on dynamic gadolinium-enhanced gradient echo MR images. METHODS: Nineteen patients underwent CTAP and MRI within a 2-week interval. All patients with wedge-shaped perfusion defects on CT arterial portography were evaluated in a separate review session for the presence of transient increased segmental hepatic enhancement on dynamic gadolinium-enhanced spoiled gradient echo (SGE) MR images. RESULTS: Eight patients were identified to have subsegmental, segmental, or lobar wedge-shaped perfusion defects by CT arterial portography. In 8/8 patients, there was transient wedge-shaped increased hepatic enhancement on MR images which corresponded to the perfusion defects identified on CT arterial portography. Transient increased enhancement on MR images was observed on immediate postgadolinium images as high-signal intensity of the involved subsegment, segment, or lobe. This relatively high-signal area faded to near isointensity in all cases on images obtained at 45 s. CONCLUSION: Wedge-shaped perfusion defects demonstrated by CT arterial portography corresponded to wedge-shaped increased hepatic enhancement following gadolinium administration on SGE MR images.
13925.4478951931995.04.27++Abdominal manifestations of sarcoidosis. CT appearances.Clin Imaging
J Farman, G Ramirez, J Brunetti, J Tuvia, C Ng, H Rotterdam,
Sarcoidosis frequently involves the abdomen, although imaging studies often fail to demonstrate disease. The most common computed tomography (CT) findings in abdominal sarcoidosis are hepatosplenomegaly and retroperitoneal adenopathy, followed by focal low-attenuation lesions of the liver and spleen. Other abdominal viscera are involved infrequently. We present four cases of abdominal sarcoidosis demonstrating a range of CT findings.
14025.4484397571993.04.01++Hepatic and splenic sarcoidosis: ultrasound and MR imaging.Abdom Imaging
A Kessler, DG Mitchell, HL Israel, BB Goldberg,
Abdominal imaging studies may be performed for various indications in patients known to have sarcoidosis. To assess magnetic resonance imaging (MRI) and sonographic ability to detect abnormalities in sarcoidosis patients with abdominal involvement, a prospective study on 18 selected patients was performed. Besides organomegaly, when present, ultrasound demonstrated normal or increased hepatic parenchymal echogenicity, coarsening of the liver parenchyma with or without discrete nodules, focal calcifications, as well as contour irregularity. Splenic discrete nodules were seen on ultrasound in a single patient. Besides organomegaly, MRI abnormalities include abnormal hepatic signal intensity, discrete nodules, contour irregularity, speculation of small hepatic vascular branches, and a high periportal signal intensity. MRI splenic abnormalities include contour irregularity, nodularity, and abnormal signal intensity. The data presented in this study reveals the spectrum of ultrasound and MRI findings in sarcoidosis patients with abdominal organ involvement, potentially enabling the evaluation of the severity of the disease. MRI appears more sensitive than ultrasound for study of abdominal sarcoidosis.
14125.39169506952006.11.09++Quantitative assessment of iron-oxide-enhanced magnetic resonance imaging of the liver: Vessel isointensity is a potential characteristic of liver hemangiomas on late T1-weighted images.Acta Radiol
SA Schmitz, A Nikolova, D O'Regan, T Albrecht, J Hohmann, KJ Wolf,
PURPOSE: To test whether a new quantitative measure, the tumor-to-vessel ratio, obtained from late post-iron-oxide-enhanced T1-weighted images allows for differentiating hemangiomas from liver metastases or all malignant liver lesions. MATERIAL AND METHODS: Twenty-six patients (mean 57, range 33-79 years) were prospectively studied at 1.5T magnetic resonance imaging (MRI) with a T1-weighted 2D fast low-angle shot (FLASH) sequence (repetition time/echo time/flip angle; 200 ms/4.8 ms/90 degrees ) and a T2-weighted turbo spin-echo sequence (4072 ms/99 ms/180 degrees ). Imaging was carried out before and at intervals up to 18 min after IV injection of Ferucarbotran (Resovist, Schering, Germany). In 19 patients, one representative malignant lesion was analysed. Eleven hemangiomas were evaluated in 7 patients. Two readers performed a consensus reading with a signal intensity measurement in a lesion, normal liver and hepatic veins, from which ratios were computed. RESULTS: On T1-weighted iron-oxide-enhanced MRI of 30 lesions, tumor-to-vessel signal intensity ratios were distinct in hemangiomas (median 1.04, range 0.99-1.10) as opposed to either metastases (0.64, 0.33-0.77; P < 0.05) or all malignant lesions taken together (0.64, 0.33-0.98; P < 0.05), while the tumor-to-liver ratio was not. CONCLUSION: The tumor-to-vessel ratio may help to differentiate between hemangiomas and metastases. A ratio greater than 0.98 allowed differentiating hemangiomas from metastases with a wide safety margin.
14225.3787679981996.09.17+ [Isolated splenomegaly]Internist (Berl)
G Nickenig, Y Ko, C Wanning, H Müller-Miny, K Zhou, H Vetter,
14325.36160968682006.03.10++Splenic hypoperfusion as a sign of systemic amyloidosis.Abdom Imaging
PP Mainenti, L Camera, S Nicotra, T Cantalupo, E Soscia, D Di Vizio, G Insabato, M Salvatore,
BACKGROUND: The spleen is frequently involved in systemic amyloidosis; however, the computed tomographic (CT) or magnetic resonance (MR) pattern of splenic amyloidosis is not sufficiently described in the literature. This study evaluated the contrast-enhanced CT and MR findings of the spleen in patients with systemic amyloidosis. METHODS: Data were extracted by reviewing pathology and radiology department records of the teaching hospital of Naples over 10 years, from 1 January 1993 to 31 December 2002. Thirty-three patients with amyloidosis were identified, 10 of whom had a CT scan and two of whom had an MR study. The population-based study was composed of 12 patients with histologically proved amyloidosis who underwent contrast-enhanced CT or MR scan of the abdomen. The spleen and liver were evaluated for organ size and perfusion. RESULTS: The spleen was hypoperfused in nine of 12 patients. Mild splenomegaly was present in only one case. Hepatomegaly was associated with markedly acute left lobe margin in nine patients and with rounded anterior profile of segments 3 and 4 in four patients. Moreover, a large area of low attenuation with indefinite geographic margins involving the right hepatic lobe was observed in three patients. CONCLUSION: The finding of splenic hypoperfusion may be a marker of systemic amyloidosis, which represents a useful clue when clinical findings fail to suggest the proper diagnosis.
14425.3091537061997.07.14++Biphasic contrast-enhanced multisection dynamic MR imaging of the liver: potential pitfalls.Radiographics
K Ito, DG Mitchell, K Honjo, T Fujita, H Awaya, T Matsumoto, N Matsunaga,
Biphasic contrast material-enhanced dynamic magnetic resonance (MR) imaging is an important technique for evaluating liver disease. However, several potential diagnostic pitfalls may be encountered, including lobar, segmental, subsegmental, and subcapsular hyperperfusion abnormalities; early-enhancing pseudolesions, particularly in the medial segment of the left hepatic lobe; heterogeneous hyperperfusion abnormalities throughout the liver; and hypointense pseudolesions due to vascular artifacts, unenhanced hepatic vessels, partial volume artifacts, magnetic susceptibility artifacts, and regenerative nodules in cirrhosis. These abnormalities sometimes have appearances similar to those of true lesions or tumor spread to the surrounding liver parenchyma on arterial-dominant phase dynamic MR images. In most cases, however, no corresponding abnormalities are seen with other pulse sequences or on delayed-phase MR images. In addition, hyperperfusion abnormalities due to readily recognizable causes are often found in characteristic locations and thus can be differentiated from true tumors. An understanding of the causes of these potential pitfalls and how to avoid them will help radiologists understand and correctly interpret images.
14525.2580614271994.09.20++Malignant lesions of the liver identified on T1- but not T2-weighted MR images at 1.5 T.J Magn Reson Imaging
RC Semelka, AS Bagley, ED Brown, MA Kroeker,
The authors reviewed their 2 1/2-year experience with a magnetic resonance (MR) imaging protocol for a 1.5-T MR imager that included T2-weighted fat-suppressed spin-echo, T1-weighted breath-hold gradient-echo, and serial dynamic gadolinium-enhanced T1-weighted gradient-echo imaging to identify histologic types of malignant liver lesions more apparent on T1- than on T2-weighted images. MR images of 212 consecutive patients with malignant liver lesions were reviewed. T2-weighted, T1-weighted, and dynamic contrast-enhanced T1-weighted images were examined separately in a blinded fashion. Seven patients demonstrated liver lesions (lymphoma [two patients] and carcinoid, hepatocellular carcinoma, colon adenocarcinoma, transitional cell carcinoma, and melanoma [one patient each]) on T1-weighted images that were inconspicuous on T2-weighted images. In all cases, the lesions were most conspicuous on T1-weighted images obtained immediately after administration of contrast agent. Histologic confirmation was present for all seven patients. The consistent feature among these lesions was that they were hypovascular, due either to a fibrous stroma or to dense monoclonal cellularity. These results suggest that in some patients with hypovascular primary neoplasms, the lesions may be identified only on T1-weighted images, and that immediate postcontrast T1-weighted images are of particular value in demonstrating lesions.
14625.2535543341987.05.28++[Modern imaging procedures in splenic diseases]Radiologe
W Wenz, G Bodendörfer,
Imaging procedures have lately become important in pathologic conditions of the spleen, because they are simple to use and do not cause much stress to the patient. Ultrasonography is the method of choice for determination of the position, shape, size and volume of the spleen, and also for the diagnosis of changes within the spleen. Circumscribed lesions cannot be detected by ultrasonography until they have reached a size of 0.5-1.0 cm; the same limit of detection applies for CT, which has approximately the same diagnostic reliability. In the presence of generalized splenic disease (e.g. splenomegaly in myeloid leukaemia) imaging procedures are being used increasingly for staging and for monitoring of the results of treatment. Perhaps in future histochemical determinations made with the aid of core-spin spectroscopy will present a further means of diagnosis without the necessity for biopsy. Angiography was the leading diagnostic technique for spleen conditions for many years, and continues to occupy this place for primary disease of the spleen (aneurysm, arterioportal fistula, haemangioma); it is currently gaining in importance with the advent of therapeutic embolization as an option. For diffuse spleen disease and also for circumscribed lesions, however, it has now been superseded by the non-invasive methods of diagnosis.
14725.2429603431988.01.19++An attempt to characterize malignant lymphoma in spleen, liver and lymph nodes with magnetic resonance imaging.Acta Radiol
R Nyman, S Rhen, A Ericsson, B Glimelius, H Hagberg, A Hemmingsson, C Sundström,
An attempt was made to explore whether relaxation times and/or normalized image intensities obtained from magnetic resonance imaging (MRI) can separate malignant and non-malignant lymphomatous tissue. Spin-echo (SE) techniques with repetition times of 500 and 1,500 ms and echo times of 35 and 70 ms were used for estimating T1 and T2. Estimation of T1 and T2 with such a low number of spin-echo sequences resulted in considerable variation in the data especially when T1 was long. Similar information was also extracted by normalizing the image intensities to the 'proton density' image (1,500/35), and the spread of the data was then markedly reduced. Therefore, the method of normalizing was considered a more appropriate way of handling the image data when only a few sequences were available. No significant difference could be discerned in the MRI parameters between normal spleens and spleens infiltrated with malignant lymphoma, between normal livers and livers in patients with malignant lymphoma and between lymph nodes with low or high grade non-Hodgkin lymphoma. Lymphomatous tissue had similar MRI characteristics irrespectively of whether the cells were malignant or not, or located in spleens or in lymph nodes. The main biologic explanation for variation in data seems to be mostly the variable amounts of fibrosis, necrosis, oedema and/or iron content.
14825.183915101980.03.24+ [Diagnosis of splenic diseases]Chirurg
KF Gürtler, C Schneider, E Bücheler,
14925.1588328751996.11.07++Polyorchidism and rete testis adenoma: ultrasound and MR findings.Abdom Imaging
TJ Figler, MC Olson, GJ Kinzler,
Polyorchidism is an uncommon congenital anomaly. It is associated with an increased frequency of testicular malignancy, cryptorchidism, inguinal hernia, and torsion. Sonography may be used to confirm the clinically suspected diagnosis. We present a case of polyorchidism in which a rete testis adenoma was present in one of the testicles. Sonographic and magnetic resonance findings are illustrated.
15025.1226550051989.06.14++Abdominal lymphoma in AIDS: evaluation with US.Radiology
RR Townsend, FC Laing, RB Jeffrey, K Bottles,
The sonographic findings in 38 patients with abdominal lymphomas related to acquired immunodeficiency syndrome (AIDS) were reviewed. Thirty-three patients had non-Hodgkin lymphoma, and five had Hodgkin disease. Abnormal masses were detected with sonography in 33 patients (87%). Focal hypoechoic liver lesions up to 10 cm in diameter were visible in 17 patients. Several lesions were anechoic and septated, mimicking fluid. Adenopathy (at the retroperitoneum, mesentery, or porta hepatis) was seen in 15 patients. Other involved areas included bowel, omentum, spleen, kidney, and adrenal gland. AIDS-related abdominal lymphomas frequently cause extranodal masses that can be readily imaged with ultrasound. Ultrasound-guided fine needle aspiration biopsy allows a specific diagnosis to be made in many cases.
15125.12175835612008.01.24++US-guided percutaneous needle biopsy of the spleen using 18-gauge versus 21-gauge needles.J Clin Ultrasound
P Liang, Y Gao, Y Wang, X Yu, D Yu, B Dong,
PURPOSE: To compare the techniques of sonographically (US)-guided percutaneous needle biopsy of the spleen using 18-gauge and 21-gauge needles. METHODS: Forty-two patients undergoing 43 spleen biopsy procedures for focal lesions (n = 27 [16 single, 11 multiple]) or diffuse splenomegaly (n = 15) were analyzed. Two groups were divided randomly according to needle type: group 1 comprised 25 patients biopsied with an 18-gauge cutting needle for histologic examination; group 2 comprised 17 patients biopsied with a 21-gauge needle for histologic and cytologic examinations. Diagnostic accuracy, complication rate, and number of needle passes were compared between the 2 groups. RESULTS: Correct histopathologic diagnosis was obtained in 36 cases, whereas incorrect diagnosis occurred in 6 cases. The accuracy of US-guided spleen biopsy in this series was 85.7%, with 1 patient (2.4%) having postprocedural hemorrhage. Compared with the 21-gauge needle, the 18-gauge needle had higher diagnostic accuracy (P < 0.05), required fewer needle passes (P < 0.05), and there was no significant difference in overall complication rate. CONCLUSION: Because biopsy with an 18-gauge needle yields larger and unfragmented samples with higher diagnostic rate compared with a 21-gauge needle, and no increased rate of major complication requiring surgical intervention, it may be advantageous to use an 18-gauge cutting needle in the US-guided needle biopsy of splenic lesions.
15225.11107462772000.05.03++[Focal echogenic splenic involvement in malignant lymphoma: a diagnostic problem]Ultraschall Med
J Riera-Knorrenschild, C Görg, N Dennhardt, I Restrepo, A Neubauer,
AIM: The aim of our study was to describe clinical data, frequency of the findings, sonographic patterns, confirmation of diagnosis, and differential diagnosis of focal echorich splenic lymphoma involvement. PATIENTS: During the last 20 years a focal splenic lesion was found in 178 patients with malignant lymphoma. Echorich splenic lesions were seen in 11 out of 178 cases (6.2%). METHODS: Splenic size, echomorphology of lesions, size and number of lesions, and presentation during sonographic follow-up examination were presented. RESULTS: Echorich infiltrates of the spleen were predominantly seen in patients with low grade Non-Hodgkin-Lymphoma (9 out of 11), the size of lesions mostly was less than 3 cm in diameter (9 out of 11), the underlying splenic size was over 8 x 20 cm in 9 out of 11 patients. Diagnosis was confirmed by sonographic follow-up (n = 11) and autopsy (n = 1). CONCLUSION: Echorich splenic lymphoma involvement is a rare event and is characterised by a variable presentation during follow-up. Up to date the clinic significance of our observation is still unclear.
15325.0995020911998.03.16++Primary non-Hodgkin's splenic lymphoma.Clin Radiol
AH Dachman, JL Buck, J Krishnan, NS Aguilera, PC Buetow,
OBJECTIVES: To describe the imaging, clinical and pathological features of primary splenic lymphoma using a strict definition. METHODS: Of 21 cases, plain films were available in nine, sonograms in 10 and CT in 16. We categorized the spleen as either normal, enlarged with no focal defects (type 1), studded with miliary masses (type 2), containing multifocal masses of varying size (1-10 cm) (type 3) or containing a solitary large mass >5 cm without (type 4A) or with (type 4B) central hypodensity/anechoic areas. RESULTS: Clinical presentations were left upper quadrant pain, weight loss and/or fever. One case was found incidentally on CT. Fourteen were type 4A, three type 4B, four type 3 and none were type 1 or 2. Nine of 10 cases were hypoechoic. In 11/12 cases with enhanced scans, the lesions are hypodense relative to the splenic parenchyma, and in one case, the lesion was necrotic. Rim enhancement was seen in one case. CONCLUSION: Primary splenic lymphoma usually presents as a mass or masses rather than with splenomegaly alone. Splenectomy may be required for diagnosis.
15425.0980164041994.07.28++Primary splenic lymphoma presenting as a large cyst.Radiat Med
A Nakashima, K Nakashima, H Seto, T Kamei, M Kakishita, M Kitagawa,
An atypical case of splenic lymphoma is presented. A large cystic mass lesion in the splenic area was found in an 80-year-old man. He was involved in a traffic accident, and subsequently the cyst ruptured. The histological diagnosis of malignant lymphoma was made at emergency splenectomy. No other lesions were identified, and there were no signs of tumor recurrence four months after the operation.
15525.00184526702008.07.07++Accessory spleen presenting as mass in the left upper abdomen.J Coll Physicians Surg Pak
Y Yagmur, H Ozturk,
An enlarged accessory spleen, 10 x 8 x 6 cm in diameter, adjoining the spleen appearing as a mass on CT and ultrasonography is reported herein. Accessory spleen is an ectopic mass of healthy splenic tissue separate from the main body of the spleen. It should be considered the differential diagnosis of an enlarged mass in the left upper quadrant.
15624.8980920271994.10.20++MR imaging of the uterus: findings from high-resolution multisection dynamic imaging with a surface coil.AJR Am J Roentgenol
K Ito, T Fujita, H Uchisako, N Tanaka, M Matsui, K Tsukamoto, T Matsumoto, T Nakanishi,
MR imaging of the female pelvis with a local coil (multiple phased array coils) has been reported. With this method, the signal-to-noise ratio (S/N) is improved so that high-resolution images can be obtained. Dynamic contrast-enhanced MR imaging has been reported to be useful in diagnosing uterine neoplasms. However, dynamic MR imaging is done in only limited imaging planes. When multisection dynamic MR imaging with fast gradient-echo sequences is combined with the use of a local coil, high-resolution images can be obtained throughout the entire uterus during a single breath-hold. This pictorial essay illustrates the appearance of the normal uterus and malignant uterine neoplasms on high-resolution multisection dynamic MR images obtained with a Helmholtz-type surface coil.
15724.8991345821997.07.23++MR imaging of focal nodular hyperplasia of the liver: value of contrast-enhanced dynamic study.Radiat Med
H Irie, H Honda, K Kaneko, T Kuroiwa, T Fukuya, K Yoshimitsu, M Ono, T Kawanami, M Yoshida, T Maeda, K Masuda,
To clarify the role of MR imaging of hepatic focal nodular hyperplasia (FNH), MR images of 11 patients with 13 FNH were retrospectively reviewed. MR imaging with T1- and T2-weighted spin echo sequences was performed for all lesions. Dynamic studies using the SPGR technique followed by postcontrast delayed T1-weighted images were performed in four patients with five lesions. Gd-DTPA enhanced T1-weighted images were obtained in five patients with six lesions. Two patients with single lesions received no contrast agent. The signal intensity, morphologic appearance, and enhancement patterns were evaluated. Dynamic MR study revealed homogeneous early vigorous enhancement and prolonged enhancement in all five lesions. On T1-weighted images, three lesions were hypointense, six were isointense, and four were hyperintense to the surrounding hepatic parenchyma. On T2-weighted images, four lesions were isointense and nine were hyperintense. A central scar was identified in eight lesions and showed delayed enhancement. It is concluded that dynamic MR studies are mandatory for diagnosing FNH.
15824.8896468241998.07.22+ Liver hemangioma: US-guided core-needle biopsy.Radiology
RD Harris,
15924.8314268441992.12.10++Gd-DTPA as an intestinal contrast agent for MR imaging of the lower abdomen: phase III clinical trial.Gastrointest Radiol
L Vlahos, A Gouliamos, W Clauss, A Kalovidouris, A Athanasopoulou, A Petroulakis, A Hadjiioannou, C Papavasiliou,
Thirty-one patients were investigated with magnetic resonance (MR) imaging of the lower abdomen before and after the administration of gadopentetate dimeglumine (Gd-DTPA) solution per os or per rectum or from both routes for the opacification of the intestinal tract. The parameters evaluated were: (a) contrast medium distribution, (b) degree of filling of the bowel lumen, (c) contrast between the bowel lumen and the surrounding normal or pathological structures, and (d) whether the administration of the contrast agent improved the diagnostic ability of MR compared to computed tomography (CT) or plain MR of the same region. Gd-DTPA, at a concentration of 1 mmol/L, produced a positive signal irrespective of its dilution in the bowel and good contrast between the bowel lumen and the adjacent tissues or any possible pathological lesions. From the diagnostic point of view, after the administration of contrast medium, MR is comparable to CT and much superior to plain MR. It is concluded that opacification of the bowel with Gd-DTPA solution will improve the diagnostic yield of MR imaging of the lower abdomen.
16024.8286882291996.08.28++Imaging of tuberculosis. II. Abdominal manifestations in 112 patients.Acta Radiol
C Lundstedt, R Nyman, J Brismar, C Hugosson, I Kagevi,
PURPOSE. To describe the radiological findings of tuberculosis (TB) of the abdomen as reflected at our hospital. MATERIAL AND METHODS. The radiological files of 503 patients (referred to our institution mainly because of a clinical suspicion of malignancy, and found to have culture- or biopsy-proven TB) were reviewed in order to analyze the spectrum of the TB manifestations in this group of patients. RESULTS. Abdominal manifestations were found in 112 patients, in 1/3 abdominal disease was the only evidence of TB. More than half of the patients also had chest TB. The most common abdominal TB manifestations were peritonitis and lymph node enlargement, each occurring in about 1/3 of the patients. Also 1/3 had genitourinary TB manifestations. About 1/5 had TB of the liver, spleen or pancreas or in the gastrointestinal tract, respectively. Multiple organ involvement was common. CONCLUSION. The need to consider TB in the differential diagnosis in patients with obscure abdominal symptoms, especially with multiple organ involvement, is stressed.
16124.7685088371993.07.12++Primary lymphoma of the liver: MR findings.Eur J Radiol
P Soyer, B Van Beers, C Grandin, J Pringot, M Levesque,
Primary lymphoma of the liver is a rare disease. The MR appearances of three cases of pathologically confirmed primary non-Hodgkin's lymphoma of the liver are presented. All three lymphomatous lesions appeared as unique well demarcated focal liver lesions on MR images. On T1-weighted images, two lesions were hypointense and one slightly hyperintense to the liver. On T2-weighted images, the three lesions were slightly heterogeneous and hyperintense. Lobulation, which was better seen on T2-weighted images, was noticed in one lesion. One lesion was studied after gadopentetate dimeglumine injection and showed marked and heterogeneous enhancement.
16224.7418957961991.10.18++[Abdominal tuberculosis in patients with acquired immunodeficiency syndrome]Med Clin (Barc)
V Soriano, J Tor, E Doménech, E Gabarre, R Muga, L Inaraja, D Casas, J Olazábal, B Clotet,
BACKGROUND: In individuals with HIV infection, extrapulmonary forms of tuberculosis are considered as opportunistic infections and are included in the diagnosis of AIDS. They often have atypical clinical features. Abdominal participation is uncommon and its diagnosis may be difficult. METHODS: The clinical, radiological and pathological features of patients with a diagnosis of AIDS with abdominal tuberculosis in a series of 254 AIDS cases in a general hospital from 1984 to October 1990 were reviewed. RESULTS: Tuberculosis developed in 104 (41%) of AIDS patients. In 25 (24%) the disease was exclusively pleuropulmonary and in 79 (76%) extrapulmonary tuberculosis was present, either alone or in association. Extrapulmonary tuberculosis was the first opportunistic infection in 66 AIDS cases (26%). The abdominal participation was demonstrated in 19 patients, with the following localizations: lymph nodes (9), liver (8), spleen (5), ileum (1) and peritoneum (1). Four patients with splenic tuberculosis also had multifocal nodular lesions. CONCLUSIONS: Abdominal participation was found in 19 of the 104 AIDS patients with tuberculosis (18%). Lymph node involvement was the most common type. Hepatosplenic tuberculosis had a miliary form or showed multifocal images in echography or computed tomography.
16324.7377877131995.07.24++Dynamic contrast-enhanced MR imaging of fibrolamellar hepatocellular carcinoma.Abdom Imaging
K Corrigan, RC Semelka,
The magnetic resonance (MR) appearance of fibrolamellar hepatocellular carcinoma (FL-HCC) on T1- and T2-weighted and dynamic serial postgadolinium-DTPA images is reported. Both tumors were large (> 7 cm in shortest dimension) and had central regions of low signal intensity on T1- and T2-weighted images. Diffuse heterogeneous enhancement of the tumors occurred on immediate postcontrast images. Lesions became more homogeneous in enhancement over time, but lack of enhancement of central portions of the tumor persisted. Although persistent lack of enhancement of the tumor scar on late postcontrast MR images may be characteristic of FL-HCC compared with delayed enhancement in focal nodular hyperplasia, the potential similarities between these tumors is stressed.
16424.7092016741997.08.14++Characterization of focal hepatic masses by dynamic contrast-enhanced MR imaging: findings in 311 lesions.Magn Reson Imaging
SP Quillin, S Atilla, JJ Brown, JA Borrello, CY Yu, TK Pilgram,
This study aimed to determine the overall accuracy of known enhancement patterns for the characterization of a large series of focal hepatic masses on dynamic contrast-enhanced magnetic resonance (MR) images. Breath-hold T1-weighted images of the liver acquired before intravenous gadolinium administration and serially over 6-10 min after contrast injection were acquired in < 25 a using FLASH or rapid spin-echo pulse sequences. A total of 311 proven focal hepatic masses in 128 patients were analyzed, including 192 malignant lesions (166 metastases and 26 hepatomas) and 119 benign lesions (48 cavernous hemangiomas, 45 hepatic cysts, and 26 other abnormalities). The lesions were evaluated for a variety of characteristics independently by two reviewers who were blinded to results. Cavernous hemangiomas showed early peripheral nodular enhancement (80% sensitivity and 99% specificity) and hepatic cysts showed no enhancement (100% sensitivity and 95% specificity). Hepatic metastases showed variable, moderate enhancement (47% by one reviewer and 74% by the other). Metastatic lesions from hypervascular primary neoplasms displayed peak enhancement during the hepatic artery dominant (bolus) phase, while other malignant neoplasms showed later peak enhancement (72% sensitivity and 77% specificity). Five metastatic foci with early homogeneous enhancement showed a delayed peripheral washout of contrast (rim sign), while no nonmetastatic foci displayed this finding (3% sensitivity and 100% specificity). Characteristic enhancement patterns of focal hepatic lesions were described in a large series of patients. This study confirms results of previous investigators who have shown that early nodular peripheral enhancement was highly specific for hemangiomas and lack of enhancement was highly specific for hepatic cysts. Hypervascular metastatic foci show earlier peak enhancement than other malignant lesions. Some (2-3%) metastatic lesions display a peripheral washout of contrast on serial images, with 100% specificity.
16524.70172850862007.03.29+ [Littoral cell angioma of the spleen]J Chir (Paris)
A Achour, MA Filali, C Benabdellah, R Elhassani, M Poinsard,
16624.69117722182002.01.30++Surgical indications in idiopathic splenomegaly.Arch Surg
JA Carr, M Shurafa, V Velanovich,
HYPOTHESIS: The incidence of primary lymphoma of the spleen in patients with idiopathic splenomegaly is significant. DESIGN: Retrospective review of all patients referred to a general surgical service for splenectomy. SETTING: A large tertiary care hospital. PATIENTS: Between 1994 and 2001, 86 nontrauma patients were referred for splenectomy. Of these, 18 had idiopathic splenomegaly despite prior workup with computed tomography, peripheral smear, bone marrow biopsy, and laboratory testing. All patients were symptomatic and displayed varying degrees of cytopenia. INTERVENTION: All 18 patients underwent open splenectomy for diagnosis and treatment of their cytopenias. MAIN OUTCOME MEASURE: Incidence of lymphoma in the pathologic specimens. RESULTS: The mean size of the spleens was 21 cm (range, 14-34 cm) and mean weight was 996 g (range, 320-1840 g). In all 18 patients, the surgical specimen provided a diagnosis. Sarcoidosis was discovered in 4 patients, and 1 patient had Castleman disease. Six patients with the benign diagnosis of hypersplenism received no further interventions, and the cytopenias resolved in all 6 cases. The 7 remaining patients (39%) were diagnosed with lymphoma. Five had marginal zone lymphoma, and 2 had a more aggressive B-cell lymphoma. Three patients required chemotherapy, but 4 are still in remission since their splenectomies and show no evidence of active disease. The mean follow-up was 20 months. CONCLUSIONS: A high percentage of patients with splenomegaly of unknown etiology will have primary lymphoma of the spleen. Splenectomy is both diagnostic and therapeutic and should be considered for all patients with idiopathic splenomegaly.
16724.6293084651997.10.16++Perfusion-weighted MR imaging in the upper abdomen: preliminary clinical experience in 61 patients.AJR Am J Roentgenol
T Ichikawa, H Haradome, J Hachiya, T Nitatori, T Araki,
OBJECTIVE: We quantitatively analyzed the potential usefulness of perfusion-weighted (PW) MR imaging of the upper abdomen performed with a single-shot gradient-recalled echo echoplanar (GRE EP) sequence. SUBJECTS AND METHODS: PW imaging of the upper abdomen with a GRE EP sequence was performed in 61 patients who had suspected liver or pancreatic disease. PW imaging was started at the time of administration of 0.1 mmol/kg of gadopentetate dimeglumine, and images were obtained every 2 sec for 88 sec. Time-intensity curves for the liver, pancreas, spleen, and kidney, and for subgroups of patients with various pathologic conditions, were constructed for quantitative analysis. RESULTS: The signal-intensity changes seen throughout the PW imaging process differed for each abdominal organ and pathologic condition. In the spleen, pancreas, and renal cortex, a transient signal-intensity decrease was seen in the perfusion phase (42%, 39%, and 78%, respectively). In the liver and renal medulla, the maximum signal-intensity decrease occurred in the later phase rather than in the perfusion phase. Signal-intensity recovery in the spleen and pancreas occurred soon after the maximum signal-intensity decrease, whereas such recovery was delayed in the liver and renal cortex. In cirrhotic livers, the signal-intensity change seen throughout the examination was minimal. CONCLUSION: Unlike conventional MR imaging, PW imaging with a GRE EP sequence can provide detailed hemodynamic information about upper abdomen organs and about disorders of these organs because of its excellent temporal resolution and susceptibility to contrast enhancement.
16824.6181262651994.04.11++Enhanced high-resolution sagittal MRI of normal pineal glands.J Comput Assist Tomogr
Y Inoue, S Saiwai, T Miyamoto, J Katsuyama,
OBJECTIVE: Our goal was to determine the appearance and enhancement pattern of human pineal glands on MRI. MATERIALS AND METHODS: High-resolution sagittal MR images (3 mm section thickness with an 18 cm field of view) obtained in 60 patients were retrospectively analyzed to determine the size and enhancement patterns of normal pineal glands following the intravenous injection of contrast medium. RESULTS: Pineal glands were either solid (40%) or cystic (60%) with various enhancement patterns: diffuse (15%) and partially enhanced (25%) in solid and ring-like (20%) and peripherally partial (40%) in cystic. Their diameter exceeded 10 mm but was < 20 mm in five cases and resembled cystic pineal neoplasms. Two such cases were found to be histologically normal. CONCLUSION: Information on the appearance and enhancement patterns of normal pineal glands on MR images can improve the accuracy of diagnosing space-occupying lesions in the pineal region and perhaps help to prevent unnecessary surgery.
16924.60163014522006.01.12+ Image of the month. Littoral cell angioma.Arch Surg
SP Cheng, TL Yang, BF Chen, CL Liu,
17024.56108822682000.08.01++Hepatic angiosarcoma: findings on multiphasic contrast-enhanced helical CT do not mimic hepatic hemangioma.AJR Am J Roentgenol
MS Peterson, RL Baron, SC Rankin,
OBJECTIVE: The objective of our study was to identify multiphasic contrast-enhanced helical CT findings of angiosarcoma of the liver to determine whether this tumor could be confused with hemangioma of the liver. CONCLUSION: Angiosarcoma of the liver is a multifocal tumor with a variety of findings on multiphasic contrast-enhanced helical CT. None of the findings would usually be confused with the typical findings of hepatic hemangioma.
17124.4410129631977.03.21+ [Splenic morphology in angiographic investigations (author's transl)]Pol Przegl Radiol Med Nukl
B Pawlak,
17224.3849835671970.03.05+ [Primary tumors of the spleen. Clinical contribution]Haematologica
S Francalanci, L Gazzola,
17324.29168619772006.09.12++Metastasizing splenic littoral cell hemangioendothelioma.Am J Surg Pathol
S Fernandez, GW Cook, DA Arber,
Littoral cell angioma is a unique splenic tumor that is generally considered to be benign. We present a case of a low-grade littoral cell splenic tumor that metastasized to the liver and retroperitoneum 4 years after splenectomy. Although the splenic lesion showed the typical morphology of a littoral cell angioma, it also contained areas with unusual solid nests of cytologically bland, plump cells with clear cytoplasm. The liver was diffusely infiltrated exclusively by cells with similar clear cell features. Both splenic and liver lesions demonstrated identical immunophenotypes, typical of littoral cell angioma, expressing CD31, CD68, CD21, and CD163, although negative for CD8 and CD34. A single prior description of a littoral cell hemangioendothelioma showed nuclear atypia and necrosis, and this is the first case report of a splenic littoral cell hemangioendothelioma with a completely bland histologic appearance. This case suggests that the presence of solid areas of clear cells in a littoral cell angioma may be a marker of low-grade malignant potential in these tumors.
17424.24100244001999.04.05++Atypical hepatic hemangiomas with intense arterial enhancement and early fading.Abdom Imaging
L Martí-Bonmatí, C Casillas, M Graells, L Masiá,
BACKGROUND: Our purpose is to analyze the prevalence and characteristics of the enhancement patterns of hemangiomas. METHODS: Fifty-five proven hemangiomas studied with a dynamic single-slice T1-weighted spoiled gradient echo sequence (50/13/65 degrees) were retrospectively selected. Fifteen images of the tumor in 5 min were obtained after a bolus of gadolinium. A temporal planar reconstruction image was generated to analyze the dynamic evolution of a line of interest through the tumor. RESULTS: Most hemangiomas (60%) had a typical progressive pattern with hyperintensity on late images. Of these, 34.6% had an intense enhancement pattern with the highest slope close to the arterial or portal phases of perfusion and 25.5% had a less intense enhancement with a more constant rate. In 10.9% of cases, the enhancement was slowly progressive with late isointensity and 7.3% had a very slow progressive pattern with late hypointensity; all had a globular peripheral initial enhancement pattern. There were 12 hemangiomas (21.8%) with intense arterial enhancement and early fading; eight of 12 (66.7%) showed peripheral globular enhancement, with all 12 hemangiomas remaining hyperintense to the liver at the end of the dynamic study. In four cases, the initial enhancement was diffuse throughout the entire lesion. CONCLUSIONS: Hemangiomas can have early intense enhancement with early fading and diffuse intense enhancement.
17524.2314387621992.12.18++High-attenuation lymphadenopathy in AIDS patients: significance of findings at CT.Radiology
BR Herts, AJ Megibow, BA Birnbaum, GK Kanzer, ME Noz,
A retrospective evaluation was performed of the location and attenuation characteristics of abdominal and pelvic lymphadenopathy, identified at dynamic sequential bolus computed tomography (CT) in 69 patients with acquired immunodeficiency syndrome (AIDS). Lymph node appearance at CT was characterized as hyperattenuating, isoattenuating, or hypoattenuating relative to the iliopsoas muscle. The significance of finding hyperattenuating adenopathy in the patient population was evaluated. Thirty-three patients had hyperattenuating adenopathy, including 26 with the epidemic form of Kaposi sarcoma (KS). Of 38 patients with epidemic KS, 26 had hyperattenuating, 11 had isoattenuating, and one had hypoattenuating lymphadenopathy. The positive predictive value of hyperattenuating adenopathy for epidemic KS was 79%. These findings were statistically significant at the 95% confidence interval (P < .005). Hyperattenuating lymphadenopathy, identified on dynamic sequential bolus CT scans in AIDS patients, was seen with disseminated KS in approximately 80% of cases.
17624.16128861352003.08.29++Clinical and imaging findings of lymphoma in patients with Sjögren syndrome.J Comput Assist Tomogr
H Tonami, M Matoba, Y Kuginuki, H Yokota, K Higashi, I Yamamoto, S Sugai,
OBJECTIVE: To describe and correlate the clinical and imaging findings of lymphomas in patients with Sjögren syndrome. METHODS: The authors reviewed the medical and imaging records of 27 cases of lymphoma from among a total of 463 patients with Sjögren syndrome. The estimated prevalence of lymphoma in patients with Sjögren syndrome was 5.8%. There were 22 women and 5 men. Histopathologically, 26 of the 27 neoplasms were non-Hodgkin lymphoma, including 6 mucosa-associated lymphoid tissue lymphomas, and the other neoplasm was Hodgkin lymphoma. The clinical and imaging findings of lymphomas were analyzed. RESULTS: No obvious correlations were present between the duration or severity of Sjögren syndrome and the lymphoma development. At the initial diagnosis, extranodal involvement was observed in 14 (52%) of the 27 patients, including the salivary gland (n = 9), lacrimal gland (n = 2), lung (n = 2), and thyroid gland (n = 1), mostly in the neck organs. On the other hand, nodal involvement was observed in 21 (78%) of the 27 patients. Of these 21 patients, 19 had at least cervical lymph node involvement. CONCLUSION: Patients with Sjögren syndrome are at increased risk of lymphoma development. Because most lymphomas initially involve the neck organs, including the lymph nodes, meticulous imaging studies mainly focused on the cervical regions are recommended in the follow-up of patients with Sjögren syndrome.
17724.147330521979.03.13++[Cystic lymphangioma of the spleen associated with hypersplenism]Minerva Med
G Santagati, M Marra, S Scarlata, P Garbagna, R Luppino, F Forgione,
A rare case of cystic lymphangioma of the spleen accompanying hypersplenism syndrome is described. After stressing the importance of certain examinations such as arteriography and splenic scintigraphy in diagnosis the condition, the many ways in which cystic lymphangioma of the spleen may present clinically are reviewed; these go from asymptomatic to straightforward splenomegaly, with or without clinical signs, up to a clear-cut hypersplenism syndrome. The present case merits consideration for three reasons: 1) The absolutely exceptional nature of cystic lymphangioma of the spleen; 2) Exceptional association with hypersplenism syndrome; 3) Remission of the syndrome following splenectomy. It is concluded that, notwithstanding the condition's rarity, cystic lymphangioma of the spleen should be considered in the differential diagnosis of splenomegalic syndromes when these are also accompanied by hypersplenism.
17824.1121645381990.08.17++Dynamic sequential MR imaging of focal liver lesions: initial experience in 22 patients at 1.5 T.J Comput Assist Tomogr
U Schmiedl, G Kölbel, CF Hess, U Klose, B Kurtz,
The feasibility of dynamic sequential magnetic resonance (MR) imaging of focal hepatic lesions using Gd-diethylenetriamine pentaacetic acid (DTPA) was evaluated in this study. Three patients with hepatocellular carcinoma, 12 patients with metastases, and 7 patients with hemangiomas were studied with pre- and postcontrast multislice spin echo (SE) images using a repetition time of 500 ms and an echo time of 15 ms. The dynamic distribution phase of Gd-DTPA (0.1 mmol/kg) was investigated by using a sequential, transverse partial flip imaging sequence [fast low angle shot (FLASH)] before and after intravenous administration of Gd-DTPA. The lesion-liver contrast-to-noise ratio showed a great variability in patients with metastases and was significantly improved following administration of Gd-DTPA in patients with hemangiomas, two patients with hepatocellular carcinoma, and eight patients with metastases both on FLASH and SE images. Hemangiomas appeared darker than liver parenchyma on precontrast SE and FLASH images, increasingly enhanced over 5 min postinjection (pi) on FLASH images, and were still greatly enhanced at 10 min pi on SE images. During the dynamic sequential image acquisition the contrast enhancement of hemangiomas was significantly different from the enhancement observed in malignant lesions. The results of this study indicate the clinical potential of dynamic sequential imaging for the MR assessment of focal hepatic lesions.
17924.0582200321993.12.07++Hodgkin's and non-Hodgkin's hepatic lymphoma: sonographic findings.Abdom Imaging
P Soyer, B Van Beers, F Teillet-Thiébaud, C Grandin, F Kazerouni, J Barge, J Pringot, M Levesque,
The sonographic studies of 72 patients with pathologically proven Hodgkin's or non-Hodgkin's hepatic lymphoma were retrospectively reviewed. Sixty-eight patients (94%) had secondary hepatic lymphoma (nine of them had AIDS-related lymphoma) and four patients (6%) had primary lymphoma of the liver. Forty-six of 72 patients (64%) had diffuse hepatic involvement, and 26 of 72 patients (36%) had focal liver lesions as demonstrated by sonography. Four patterns of disease were identified: (a) hepatomegaly was depicted by sonography in 26 of the 59 patients with secondary hepatic lymphoma not related to AIDS, in two of the nine patients with AIDS-related secondary hepatic lymphoma, and in one of the four patients with primary hepatic lymphoma; (b) multiple rounded well-delineated hypoechoic liver lesions were found in 22 of the 68 patients with secondary hepatic lymphoma; (c) a large heterogeneous echoic mass, which was an evocating clue to the diagnosis of primary lymphoma of the liver, was found in the four patients with primary lymphoma of the liver; and (d) an absence of sonographic abnormalities was found in 20 of the 59 patients with secondary lymphoma not related to AIDS. Liver involvement with lymphoma should be considered in any patient who develops multiple homogeneous hypoechoic liver masses, even in the absence of known underlying lymphomatous disease.
18024.0282843921994.02.17++Focal liver lesions: characterization with nonenhanced and dynamic contrast material-enhanced MR imaging.Radiology
B Hamm, RF Thoeni, RG Gould, ME Bernardino, M Lüning, S Saini, AE Mahfouz, M Taupitz, KJ Wolf,
PURPOSE: To evaluate prospectively the diagnostic accuracy of non-enhanced and gadolinium-enhanced magnetic resonance (MR) imaging in characterization of hepatic lesions. MATERIALS AND METHODS: Fifty-five patients with benign and 52 patients with malignant focal liver lesions underwent examination at 1.5 T that comprised nonenhanced and dynamic contrast material-enhanced images. Four experienced radiologists independently read the different sets of images without and with knowledge of clinical history. RESULTS: Receiver operating characteristic analysis showed that dynamic contrast-enhanced MR imaging added information to nonenhanced MR studies and thereby improved distinction between benign and malignant lesions (P < .05). Knowledge of clinical data further improved lesion characterization with nonenhanced and combined nonenhanced and contrast-enhanced MR imaging (P < .05). CONCLUSION: Dynamic contrast-enhanced MR imaging is a useful adjunct for characterization of hepatic lesions. Knowledge of clinical history still has a decisive effect on interpretation of MR images of the liver.
18124.0219367791991.11.22++Hepatosplenic AIDS-related Kaposi's sarcoma.Gastrointest Radiol
C Valls, C Cañas, LG Turell, X Pruna,
Abdominal ultrasonography (US) and computed tomography (CT) were performed in one patient with acquired immunodeficiency syndrome (AIDS) and biopsy-proven hepatosplenic Kaposi's sarcoma. Small hyperechoic nodules were seen in the liver and spleen at US. CT revealed hepatosplenomegaly and low-attenuation focal lesions in the liver. These findings, although nonspecific, are suggestive of hepatosplenic involvement in Kaposi's sarcoma.
18223.9490510281997.03.28++Benign and malignant musculoskeletal masses: MR imaging differentiation with rim-to-center differential enhancement ratios.Radiology
LD Ma, FJ Frassica, EF McCarthy, DA Bluemke, EA Zerhouni,
PURPOSE: To assess the diagnostic potential of the rim-to-center differential enhancement ratio in the magnetic resonance (MR) imaging differentiation of benign from malignant musculoskeletal masses. MATERIALS AND METHODS: Dynamic gadolinium-enhanced fast multiplanar spoiled gradient-recalled acquisition in the steady state imaging was performed to evaluate 17 one and soft-tissue masses (10 malignant, seven benign) in 14 patients. The rim-to-center differential enhancement ratio was determined from images at the maximal enhancement rate. The difference in differential enhancement ratios between benign and malignant masses was evaluated and compared with the maximum rate of enhancement for each mass. RESULTS: Nine of 10 malignant masses showed rapid rim enhancement with delayed central fill-in. This enhancement pattern was absent in benign masses. The average rim-to-center differential enhancement ratio was 0.64 +/- 0.26 for malignant masses and -0.16 +/- 0.33 for benign masses (P < .001). This difference was statistically significant. The average maximum rate of enhancement was 3.41%/sec +/- 2.20 for malignant masses and 2.74%/sec +/- 2.46 for benign masses (P > .05). CONCLUSION: Intratumoral enhancement patterns of malignant and benign masses differ because of differences in vascular architecture. These preliminary results suggest that the rim-to-center differential enhancement ratio has potential as an additional parameter for the MR imaging differentiation of indeterminate musculoskeletal masses.
18323.8735381551987.01.21++Hemangioma of the spleen: radiologic-pathologic correlation in ten cases.Radiology
PR Ros, RP Moser, AH Dachman, PJ Murari, WW Olmsted,
Ten cases of hemangioma of the spleen were reviewed. Plain abdominal radiographs and scintigrams are helpful in specifying the splenic location. Calcification, either central punctate or peripheral curvilinear, can be detected on radiographs or computed tomographic (CT) scans. The spectrum form solid to cystic change observed in the pathologic specimens is reflected in analogous patterns on CT scans and sonograms: predominantly solid mass; mass with cystic spaces. The angiographic findings are nonspecific. It is possible to suggest the diagnosis of hemangioma of the spleen when an asymptomatic patient presents with a discrete splenic mass, particularly if there is evidence of calcification and cystic change within the lesion.
18423.85113181342001.08.02++Laparoscopic splenectomy for a lymphangioma of the spleen: report of a case.Surg Today
AH Kwon, H Inui, K Tsuji, S Takai, A Imamura, Y Kamiyama,
We present the first case report of a successful laparoscopic complete excision of a splenic lymphangioma. The splenic tumor was preoperatively diagnosed to be a lymphangioma by the combined modalities of ultrasonography, computed tomography, magnetic resonance imaging, and angiography. A laparoscopic splenectomy was subsequently performed and the pathological examination of the mass confirmed the diagnosis of a lymphangioma. Based on the above findings, a laparoscopic splenectomy is recommended when a splenic tumor is suspected to be either benign or borderline.
18523.8167140091984.05.30+ [Calcified lymphangioma of the spleen. A contribution to the diagnosis and differential diagnosis of splenic cysts]Chirurg
C Röhrborn, JU Alles,
18623.79110290982000.11.30++CT fluoroscopic guidance for percutaneous needle placement into abdominopelvic lesions with difficult access routes.Abdom Imaging
GD Schweiger, VY Yip, BP Brown,
BACKGROUND: We wished to evaluate the utility of computed tomography fluoroscopy (CTF) for guiding percutaneous abdominopelvic biopsies or fluid aspirations that are considered difficult with conventional computed tomographic (CT) guidance. METHODS: CTF-guided percutaneous biopsy (n = 11) or fluid aspiration (n = 2) was attempted in 13 patients with lesions that were otherwise difficult or potentially unsafe by conventional CT guidance because they were deep to colon, small intestine, or major blood vessels. RESULTS: Using CTF assistance to guide external compression or needle positioning, appropriate needle placement was performed in 11 patients. Biopsy or aspiration was diagnostic in 10 patients. Needle advancement was not attempted in two patients. CONCLUSION: CTF appears to be a valuable tool to dynamically assist percutaneous needle placement into lesions that may be considered difficult with standard CT assistance.
18723.7818712721991.09.18++Normal abdominal enhancement patterns with dynamic gadolinium-enhanced MR imaging.Radiology
SA Mirowitz, E Gutierrez, JK Lee, JJ Brown, JP Heiken,
The objective of this study was to quantitatively and qualitatively determine contrast enhancement patterns of normal abdominal organs with dynamic gadolinium-enhanced magnetic resonance (MR) imaging. Dynamic gadolinium-enhanced, T1-weighted, spin-echo imaging was performed during a 23-second breath hold in 38 patients, with images acquired before, during, and at 1,2, and 5 minutes after bolus injection of gadopentetate dimeglumine. Enhancement patterns of normal liver, spleen, pancreas, adrenal gland, kidney, aorta, inferior vena cava, and fat were determined by visual evaluation and by performance of signal intensity measurements with an electronic cursor. Time-intensity curves demonstrated peak enhancement of all abdominal organs during or immediately after bolus injection of gadopentetate dimeglumine. MR enhancement patterns included visualization of renal cortical nephrogram and heterogeneous enhancement of the spleen during the bolus phase of contrast material administration. Peak enhancement of normal liver was 72%; spleen, 172%; pancreas, 82%; adrenal gland, 85%; and kidney, 291%. This study established reference data regarding abdominal organ enhancement that will be useful as dynamic gadolinium-enhanced MR imaging becomes clinically implemented.
18823.7879728071994.12.21++Dynamic MR imaging of liver tumors: analysis with temporal reconstruction images.Radiology
L Martí-Bonmatí, L Masiá, C Torrijo, C Casillas, MD Ferrer,
PURPOSE: To graphically display the time dependency of contrast enhancement of liver tumors at examination with dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: A temporal reconstruction image was generated by obtaining a line of interest drawn on a single image through the liver and the tumor and reformatted over a sequence of temporal images. This calculated image expressed the temporal evolution of the line, including nontumoral liver and tumor, with regard to three variables: signal intensity, enhancement, and velocity. This allowed a visually integrated analysis of 95 hepatic lesions studied with dynamic single-section MR imaging after contrast material administration. RESULTS: Temporal reconstruction images were obtained for all the dynamic studies. Five patterns of enhancement based on signal intensity and velocity variations coupled with morphologic information were found: wall, diffusion, moderate enhancement, marked progressive, and early intense patterns. CONCLUSION: Temporal reconstruction of liver tumors after contrast material administration can be used to analyze, describe, and report the dynamics of lesion enhancement with morphologic and temporal resolution.
18923.7822983531990.03.07++Massive bleeding after fine needle aspiration of liver angiosarcoma.Gastrointest Radiol
Y Hertzanu, J Peiser, H Zirkin,
Open or closed biopsy of liver angiosarcoma is a life-threatening procedure. A case of massive bleeding after fine needle aspiration of the liver is reported in a patient having an angiosarcoma of the liver and spleen. Fine needle aspiration seems a hazardous procedure in this disease.
19023.7680614281994.09.20++Solitary hepatic metastasis: comparison of dynamic contrast-enhanced CT and MR imaging with fat-suppressed T2-weighted, breath-hold T1-weighted FLASH, and dynamic gadolinium-enhanced FLASH sequences.J Magn Reson Imaging
RC Semelka, JP Shoenut, SM Ascher, MA Kroeker, HM Greenberg, CS Yaffe, AB Micflikier,
Twenty consecutive cancer patients with a solitary hepatic metastasis detected with dynamic contrast-material-enhanced computed tomography (CT) who were considered for hepatic resection underwent magnetic resonance (MR) imaging within 18 days after CT. Histologic confirmation was obtained in all lesions. CT depicted 20 solitary lesions. MR imaging showed a solitary lesion in 14 patients, two lesions in three patients, and more than two lesions in three patients, for a total of 37 lesions. Twenty-three lesions less than 2 cm in diameter were missed with CT, and six lesions less than 1.3 cm in diameter were missed with MR imaging. MR imaging was superior to CT in the detection of hepatic metastases on a patient-by-patient basis (P < .01). The results suggest that MR imaging is superior to dynamic contrast-enhanced CT for the detection of hepatic metastases.
19123.7543768701975.08.26+ [Posttraumatic hemorrhagic pseudocysts of the spleen (4 cases)]
J Grosdidier, F Boileau, B Richaume,
19223.7467660081980.02.15++Abdominal disease in children: a comparison of computed tomography and ultrasound.AJR Am J Roentgenol
RC Brasch, IB Abols, CA Gooding, RA Filly,
Diagnoses from computed tomographic (CT) and ultrasonic examinations of the abdomen in 29 pediatric patients were reviewed retrospectively to compare the sensitivity and specificity of the two methods for detection of abnormalities and to assess their differential diagnostic accuracies. No difference in sensitivy (87%) and specificity (100%) was observed between the two imaging methods. However, the differential diagnostic accuracy in abnormal cases was greater with CT than ultrasound. The combined information from CT and ultrasound allowed for correct diagnoses in all but three instances. Findings from each technique considered separately would have resulted in erroneous diagnoses in four instances using CT and nine instances using ultrasound. Diagnostic information obtained from CT and ultrasound examinations were complementary in many instances.
19323.7497710991998.11.04++[The role of dynamic contrast magnetic resonance tomography in the complex radiation diagnosis of focal hepatic lesions]Vestn Rentgenol Radiol
LA Tiutin, SM Berezin, EV Rozengauz,
The results of complex radiation study of 269 patients with various focal hepatic diseases were analyzed. Present day methods of radiation study were used. Dynamic contrast magnetic resonance imaging (DCMRI) was made in 62 patients. It is concluded that DCMRI is higher sensitive in detecting focal hepatic diseases than other techniques. The time course of changes in signal intensity in different abnormalities greatly differs in quantitative and qualitative parameters, which differentiates the nosological nature of the revealed changes to a high accuracy.
19423.72173642012008.01.18++Laparoscopic extirpation of splenic hamartoma.Pediatr Surg Int
Y Tatekawa, H Kanehiro, Y Nakajima,
We presented a case of splenic hamartoma. A 12-year-old girl has had an abdominal pain since 9 years of age. Contrast-enhanced computed tomography scan at a local hospital revealed heterogeneous enhancement of a mass which is 5 cm in diameter, located near the surface of the spleen, diagnosed as hemangioma. She had an investigation with Levovist-enhanced ultrasonography and superparamagnetic iron oxide-enhanced magnetic resonance imaging on T2-weighted gradient-echo imaging, which showed a hypervascular echoic mass and a decrease of signal intensity. The imaging diagnosis was splenic hamartoma. She underwent laparoscopic splenectomy to prevent the spontaneous rupture. The splenic artery at the pancreas body was exposed, and doubly ligated by vessel clip and furthermore ligated by 3-0 silk. At the splenic hilum, the splenic artery and vein were dissected with the Endo GIA vascular linear cutting stapler. The spleen was captured into the Endocatch II retrieval bag and removed from a transverse lower abdominal (suprapubic) incision extended up 7 cm in length through a port site. In pathological findings, the tumor was compatible with hamartoma. Splenic hamartomas in pediatric patients have been described extremely rare. In clinical symptoms, spontaneously ruptured splenic hamartoma has been rarely reported.
19523.7097541031998.10.15++Dynamic gadolinium-enhanced MR findings in infantile hepatic hemangioendothelioma.J Comput Assist Tomogr
KJ Mortele, PJ Mergo, M Urrutia, PR Ros,
We report a case of a 2 1/2-year-old girl presenting with abdominal pain, fever, vomiting, and hepatomegaly. In spite of the unusual age at presentation, dynamic gadolinium-enhanced MR findings, which have not been previously illustrated, proved to be highly specific for the diagnosis of infantile hepatic hemangioendothelioma because of the characteristic enhancement pattern.
19623.6986579221996.08.01++Sarcoidlike reaction in patients with malignancy.Radiology
AR Hunsaker, RF Munden, RD Pugatch, SJ Mentzer,
PURPOSE: To determine the radiologic features, pathogenesis, and prognostic importance of sarcoidlike reaction in patients with malignancy. MATERIALS AND METHODS: Radiographs and computed tomographic (CT) scans of the chests of 10 patients with known malignancy and either concurrent or subsequent development of noncaseating granulomas (NCG) were reviewed and correlated with histopathologic reports and pertinent clinical data. RESULTS: Ten patients with malignancy were found to have either mediastinal or hilar lymph node enlargement (n = 4) or parenchymal lung disease (n = 6). The presumptive diagnosis was metastatic disease. In eight of 10 histopathologic specimens, no tumor was found, but innumerable NCGs were present. They were thought to be consistent with sarcoidlike reaction. In the other two specimens, only a small focus of tumor cells was found amidst innumerable NCGs. On CT scans of the chests, parenchymal lung disease took the form of either ground-glass attenuation (n = 1) or nodules following perivascular and peribronchial distributions (n = 5). CONCLUSION: Lymph node enlargement and parenchymal lung nodules may not indicate metastatic disease. Sampling of all abnormal areas may be helpful in staging the disease and in treating and determining the prognosis of patients. Likewise, the discovery of NCG does not necessarily indicate sarcoidosis and may represent sarcoidlike reaction.
19723.6690150651997.02.27++Detection of focal liver lesions: CT of the hepatobiliary system with gadoxetic acid disodium, or Gd-EOB-DTPA.Radiology
SA Schmitz, JH Häberle, T Balzer, K Shamsi, J Boese-Landgraf, KJ Wolf,
PURPOSE: To evaluate the efficacy and safety of gadoxetic acid disodium, or Gd-EOB-DTPA, as a tissue-specific hepatobiliary contrast agent at computed tomography (CT) in patients with liver metastases. MATERIALS AND METHODS: Fifteen patients with known liver metastases underwent CT before and at 30, 80, and, in seven cases, 150 minutes after initiation of intravenous infusion of 0.2, 0.35, and 0.5 mmol Gd/kg gadoxetic acid disodium (five patients per dose group). Attenuation in liver tissue and metastases was measured at each time point. Visualization of metastases, bile ducts, and gallbladder was graded subjectively by two investigators aware of the dose administered and the imaging time point. Patients were monitored for adverse events clinically, and numerous laboratory tests were performed over the 24 hours after administration of the contrast material. RESULTS: The net mean increase in liver attenuation with 0.2, 0.35, and 0.5 mmol Gd/kg was 13 HU +/- 4 (standard deviation), 27 HU +/- 6, and 34 HU +/- 8, respectively. Visualization of liver metastases with doses of 0.35 and 0.5 mmol Gd/kg was graded as good or excellent. Visualization of the gallbladder and common bile duct with doses of 0.35 and 0.5 mmol Gd/kg was improved from minimal to excellent in 89% and 57% of patients, respectively, on 80-minute postcontrast scans. No serious adverse events occurred. Four of 15 patients experienced mild or moderate adverse events possibly or probably related to the contrast medium. Levels of aspartate and alanine aminotransferase increased in three patients by 12-26 and 21-48 U/L, respectively, from normal or moderately elevated baseline levels. These changes may be related to the contrast medium or to the metastases. CONCLUSION: Patient tolerance of gadoxetic acid disodium was acceptable, and liver enhancement and visualization of liver lesions and the biliary system was improved at CT.
19823.6697713821998.10.19++Ultrasound guided fine needle aspiration cytology in abdominal tuberculosis.Br J Radiol
R Suri, S Gupta, SK Gupta, K Singh, S Suri,
Although barium studies and CT are useful in assessing abdominal pathology in tuberculosis, imaging findings are not always specific and a histopathological or bacteriological confirmation is often required. The aim of the present study was to evaluate the role of ultrasound (US) guided fine needle aspiration cytology (FNAC) in the diagnosis of abdominal tuberculosis in patients with non-palpable lesions detected on US/CT. FNAC was performed on 31 sites in 30 patients. The sites included enlarged lymph nodes (n = 14), focal lesions in liver (n = 2) and spleen (n = 8), and thickened bowel in the ileocaecal region (n = 7). The results were classified cytomorphologically into four groups: (1) definite evidence of tuberculosis; (2) presumptive evidence of tuberculosis; (3) suggestive of tuberculosis; and (4) negative for tuberculosis. 18 of the 31 FNACs (58%) revealed a positive diagnosis of tuberculosis (definite evidence in nine patients and presumptive evidence in nine patients). 13 of the 31 FNACs (42%) showed either necrosis alone (n = 4) or negative results (n = 9). Zeihl-Neelson staining for acid-fast bacilli on direct smear was positive in only nine patients (29%). Splenic and lymph nodal FNAC had a high sensitivity (87.5% and 78.6%, respectively) in the diagnosis of tuberculosis. None of the bowel and liver FNACs was diagnostic. No complications were encountered. US guided FNAC offers a safe and accurate method of achieving a diagnosis in patients with suspected abdominal tuberculosis who present with radiologically demonstrable but non-palpable lesions, especially those involving lymph nodes and spleen.
19923.64112640702001.04.19++Prediction rule for characterization of hepatic lesions revealed on MR imaging: estimation of malignancy.AJR Am J Roentgenol
R Tello, HM Fenlon, T Gagliano, VL deCarvalho, EK Yucel,
OBJECTIVE: Our aims were to establish factors that are most predictive of hepatic lesion malignancy and to formulate a prediction rule. MATERIALS AND METHODS: A cross-sectional study of 227 abdominal MR imaging examinations revealed 85 lesions in 67 patients (29 men, 38 women; age range, 29-78 years; mean age, 51.4 years) who were being examined for primary malignancy (n = 42) or unknown lesion characterization (n = 25). All were referred for MR imaging after CT or sonography. Patient demographics (age, sex, history of malignancy), lesion size and morphology, quantitative T2 calculation, and pattern of enhancement on gadopentetate dimeglumine administration were evaluated for predictive ability. RESULTS: Thirty-two liver lesions were malignant (eight colon cancer, five breast cancer, four cervical cancer, three renal cancer, three lung cancer, and nine miscellaneous cancers), 53 were benign (37 hemangiomas, 15 cysts, and one focal nodular hyperplasia). Calculated T2 relaxation times (mean +/- standard deviation [SD]) were as follows: malignant tumors (91.72 +/- 21.9 msec), hemangiomas (136.1 +/- 26.3 msec), cysts (284.1 +/- 38.2 msec) (p < 0.001). Logistic regression analysis indicated that lesion size and sex and age of patient were not significant independent predictors (p > 0.05). However, the combination of a history of malignancy, T2 value, and gadopentetate dimeglumine-enhancement pattern allowed generation of a prediction rule with an area under the receiver operating characteristic curve of 0.95. The patient's weight, lesion morphology, and cell type of the primary malignancy did not provide additional predictive information (p > 0.2). CONCLUSION: We recommend using the combination of T2 quantification and patient history of malignancy before deciding to administer gadopentetate dimeglumine for optimal lesion characterization, especially for equivocal lesions with T2 values between 90 and 130 msec. These factors allowed the construction of a prediction rule for lesion characterization.
20023.60113291542001.07.12++Non-hodgkin's lymphoma of the liver in patients with AIDS: sonographic, CT, and MRI findings.J Clin Ultrasound
EB Rizzi, V Schinina, M Cristofaro, V David, C Bibbolino,
PURPOSE: We analyzed the sonographic, CT, and MRI findings in acquired immune deficiency syndrome (AIDS)-related non-Hodgkin's lymphoma (NHL) of the liver to evaluate the role of sonography in the diagnosis of this disease. METHODS: We retrospectively reviewed sonograms and CT scans on 26 patients who had human immunodeficiency virus with liver lymphoma, either primary (10 cases) or secondary (16 cases), from 1992 to 1999. We also reviewed MR images on 12 of the patients. All patients had pathologically proven NHL; all imaging studies were obtained within 2 weeks of sonographically guided fine-needle aspiration biopsies. Lymphoma was the initial AIDS-defining illness in 38% of the patients. RESULTS: NHL occurred as multiple lesions in most cases of both primary (7 of 10 cases) and secondary (15 of 16 cases) liver lymphoma. No imaging finding was specific for the diagnosis of hepatic lymphoma. The hepatic lesions were hypoechoic in 25 of 26 cases; in the remaining case, there was a large isoechoic mass. On unenhanced and contrast-enhanced CT, the lesions were hypodense in all cases, with a thin enhancing rim in 6 patients. On MRI, the lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images. CONCLUSIONS: Sonography may be helpful in the diagnosis of focal hepatic lymphoma in patients with human immunodeficiency virus. Sonographically guided fine-needle aspiration biopsy provides a definitive diagnosis. CT was crucial in the staging of lymphoma. MRI appears appropriate for studying liver NHL in selected cases.
20123.5614304251992.12.16+ Intraosseous meningioma: CT and MR appearance.J Comput Assist Tomogr
HY Lee, J Prager, Y Hahn, RG Ramsey,
20223.5476053301995.08.10++Retroperitoneal lymphangioma.Australas Radiol
WH Breidahl, RM Mendelson,
Five cases of retroperitoneal lymphangioma are presented. In three patients the lesions were symptomatic, with resolution of the symptoms following resection. In two elderly patients the lesions were asymptomatic. Ultrasound demonstrated masses that ranged from 4 to 15 cm in maximal extent, and which were predominantly anechoic. Two contained septations and two echogenic debris. Computed tomography demonstrated the masses to be of water density, and allowed better delineation of the lesions to adjacent structures within the anterior pararenal space. Fine needle aspiration (FNA) produces a characteristic cytology of abundant lymphocytes, which may be intermingled with macrophages. It is considered that retroperitoneal lymphangioma has characteristic imaging features that allows a presumptive diagnosis, which can be confirmed by FNA.
20323.5239034221985.12.18++[Ultrasonic diagnosis of splenic and hepatic lesions in lymphogranulomatosis]Med Radiol (Mosk)
AF Tsyb, GD Baĭsogolov, OV Nestaĭko, SG Chernykh,
Ultrasound investigation was conducted in 21 patients with Hodgkin's disease to determine the involvement of the spleen and liver in the process. The results obtained were verified histologically in 19 cases at laporotomy and in 2 cases at autopsy. Focal spleen lesion (focal sizes from 0.3-2 cm) was correctly recognized in 7 out of 9 patients, liver lesion in 3 out 4 patients. No false-positive results were obtained in cases in which spleen and liver lesions were not determined histologically. The value of ultrasound investigation for dynamic observation in liver lesion was emphasized. The method was recommended for a wide clinical use and assessment of therapeutic results of disseminated Hodgkin's disease.
20423.50112865812001.05.10++Imaging of primary non-Hodgkin's lymphoma of the liver.Clin Radiol
MM Maher, SR McDermott, HM Fenlon, D Conroy, JC O'Keane, DN Carney, JP Stack,
AIM: To describe the radiological findings in primary liver lymphoma, which is a rare entity, presenting usually as a localized liver mass. MATERIALS AND METHODS: We reviewed retrospectively the imaging findings at presentation, of patients in whom a diagnosis of primary liver lymphoma was finally made histologically. The study period covered a 10-year period between January 1990 and December 1999. There were seven patients, all men, with a mean age of 49.6 years. Each patient presented with hepatobiliary disease without peripheral adenopathy. Imaging prior to diagnosis included ultrasonography (seven patients), computed tomography (seven patients) and magnetic resonance imaging (MRI) (two patients). Appearances during and after aggressive chemotherapy were reviewed. RESULTS: Imaging appearances were of either single or multiple liver lesions simulating liver metastases. On ultrasound all foci of primary hepatic lymphoma (PHL) were hypoechoic relative to normal liver. Computed tomography (CT) showed hypoattenuating lesions in all cases, and two cases showed rim enhancement following contrast administration. The MRI appearances were variable, and no pathognomonic feature of PHL was identified, so that histology was required in all patients to establish the diagnosis. CONCLUSIONS: This paper demonstrates the spectrum of findings encountered on various imaging modalities in PHL. We conclude that although PHL is a rare condition, it should always be considered in the differential diagnosis of liver metastases when no primary tumour is apparent.
20523.5065786961983.11.23+ [Tomodensitometry in focal splenic pathology]Ann Radiol (Paris)
A Anjou, L Chollat, PM Bret, M Bretagnolle, PJ Valette, D Poix,
20623.5016323501992.08.18+ Splenosis: superparamagnetic iron oxide-enhanced MR imaging.AJR Am J Roentgenol
BL Storm, PL Abbitt, DA Allen, PR Ros,
20723.4233759871988.06.28++Surgical therapy of localized abdominal non-Hodgkin's lymphomas.Surgery
SJ Mentzer, RT Osteen, TN Pappas, DS Rosenthal, GP Canellos, RE Wilson,
Non-Hodgkin's lymphomas may involve a variety of abdominal organs, including the liver, spleen, gastrointestinal tract, and retroperitoneum. The number of organs potentially involved and the noncontiguous mode of spread make non-Hodgkin's lymphoma a difficult tumor to evaluate at the time of laparotomy. To clarify the surgical management of patients with this tumor, we retrospectively reviewed the medical records of 202 patients with histologically proven abdominal lymphomas. Within this group, 36 patients underwent laparotomy before they had chemotherapy or radiation therapy. Ten patients were explored to establish a histologic diagnosis of lymphoma. The remaining 26 patients underwent laparotomy because of presumed benign disease. Twenty patients were found to have localized disease at laparotomy. Patients with localized disease demonstrated significantly better survival than patients with extranodal and nodal involvement (p less than 0.05). Four patients with local resection received no adjuvant therapy and were free of disease a median of 50 months after surgery.
20823.3874807181995.12.21+ Technique for MR imaging of the liver.Radiology
S Saini, RC Nelson,
20923.3832615061988.09.16++CT of small pyogenic hepatic abscesses: the cluster sign.AJR Am J Roentgenol
RB Jeffrey, CS Tolentino, FC Chang, MP Federle,
Of 36 consecutive patients with pyogenic liver abscesses evaluated by CT, five (14%) had multiple small abscesses less than 2 cm in size. The CT appearance of the small pyogenic abscesses was compared with that of 10 patients who had either fungal or mycobacterial abscesses and with that of 50 patients who had hepatic metastases. In all five patients who had small pyogenic abscesses, the abscesses appeared to cluster, or aggregate, in a pattern that suggested the beginning of coalescence into a single, larger abscess cavity (cluster sign). This cluster appearance was not seen in in any of the patients who had fungal or mycobacterial microabscesses. It was present in only one of the patients who had confirmed hepatic metastasis. Despite the small size of the abscesses, guided needle aspiration was successful in recovering pyogenic organisms in four of the five patients. In our experience, the presence of the cluster sign suggests that the lesions are pyogenic abscesses.
21023.3586334631996.07.01+ Gadopentetate dimeglumine-enhanced MR imaging of subdural hematoma in an abused infant.AJR Am J Roentgenol
PK Kleinman, RL Ragland,
21123.3414505071993.01.07++Inflammatory pseudotumor of the spleen.Intern Med
T Inada, T Yano, S Shima, Y Ishikawa, S Irie, M Ishida, Y Nakamura, K Ishibashi, H Kageyama,
The case of a 39-year-old man with inflammatory pseudotumor of the spleen is presented. This is an extremely rare benign lesion with histologic features of non-specific inflammatory and reparative changes. The literature is reviewed and this case is compared clinically and radiologically with the previously reported cases.
21223.30115030942001.10.11++Splenic lymphoma: differentiation from splenic cyst with ultrasonography.Abdom Imaging
H Ishida, K Konno, J Ishida, H Naganuma, T Komatsuda, M Sato, S Watanabe,
BACKGROUND AND METHODS: Lymphoma can be nearly anechoic and mimic a cyst on ultrasonography (US). To investigate whether this phenomenon occurs at the level of the spleen, we analyzed the US findings of 38 cases of splenic lymphoma and 16 cases of splenic cyst. RESULTS: (1) With regard to shape, echogenicity of the lesion, and mode of posterior echo, there was no difference between splenic lymphomas and splenic cysts. However, the boundaries of the lesions were indistinct in splenic lymphomas and distinct in splenic cysts. (2) Blood flow signals and vascular penetration were seen exclusively in splenic lymphomas. CONCLUSION: The mode of boundary echo (distinct or indistinct) distinguishes splenic lymphomas from splenic cysts. Color Doppler US increases the diagnostic confidence of US.
21323.2631344391988.08.24+ Splenic involvement in Gaucher's disease: sonographic findings.J Clin Ultrasound
PG Stevens, SS Kumari-Subaiya, LB Kahn,
21423.1589882221997.01.29++Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: optimization with a test examination and a power injector.Radiology
JP Earls, NM Rofsky, DR DeCorato, GA Krinsky, JC Weinreb,
To optimize findings at dynamic gadolinium-enhanced hepatic magnetic resonance imaging in the hepatic arterial phase, a timing examination was performed after injection of a 0.5-mL timing bolus of gadopentetate dimeglumine. In the experimental group (n = 28), power injection was used and the imaging delay was determined in each patient on the basis of the results of the timing examination. In the control group (n = 28), hand injection and a fixed 20-second imaging delay were used. Arterial-phase examinations (defined as relative liver enhancement of not more than 30% of peak parenchymal enhancement) were successful in 26 (93%) experimental group patients and in 17 (61%) control group patients.
21523.1378943081995.04.21++Cystic lymphangioma of the spleen: MR findings with pathologic correlation.Abdom Imaging
K Ito, T Murata, T Nakanishi,
A case of histologically confirmed cystic lymphangioma of the spleen was presented. On MR imaging, the mass was shown to multiloculated hyperintensity areas on T2-weighted images, corresponding to dilated lymphatic spaces. The septa were demonstrated as hypointensity bands, corresponding to abundant fibrous connective tissues. MR findings correlated well with histologic findings. MRI was a useful noninvasive modality for the diagnosis.
21623.1318858101991.10.08++Hepatic focal nodular hyperplasia: diagnosis by ultrafast Gd-DTPA enhanced FLASH MR.J Comput Assist Tomogr
R Urhahn, KC Klose, M Drobnitzky,
The utility of gadolinium-enhanced ultrafast MR imaging in the diagnosis of focal nodular hyperplasia (FNH) of the liver was assessed in one patient. Contrast-enhanced serial snapshot-FLASH with a frequency of 30 images/min demonstrated the typical hemodynamic appearance of FNH known from CT studies.
21722.9926720931989.09.25++Gamna-Gandy bodies of the spleen: evaluation with MR imaging.Radiology
T Sagoh, K Itoh, K Togashi, T Shibata, K Nishimura, S Minami, R Asato, S Noma, I Fujisawa, K Yamashita,
The authors retrospectively evaluated magnetic resonance (MR) images obtained in 64 patients with portal hypertension. Multiple low-intensity nodules were noted within the spleen in eight patients. In all eight cases, these nodules were most apparent on images obtained with the GRASS (gradient-recalled acquisition in the steady state) technique, which is known to be more sensitive to heterogeneity of the magnetic susceptibility, usually caused by hemosiderin deposition. In one of these cases, ultrasonography demonstrated diffuse hyperechoic spots that had been reported to represent Gamna-Gandy bodies of the spleen (ie, organized hemorrhage caused by portal hypertension). Although there was no pathologic proof in their series, the authors believe these low-intensity nodules seen on MR images may represent the hemosiderin deposits of Gamna-Gandy bodies.
21822.98108872412000.07.27++Lymphangioleiomyomatosis: abdominopelvic CT and US findings.Radiology
NA Avila, JA Kelly, SC Chu, AJ Dwyer, J Moss,
PURPOSE: To describe the abdominal computed tomographic (CT) and ultrasonographic (US) findings in patients with thoracic lymphangioleiomyomatosis (LAM) and to relate the prevalence of the findings to the severity of pulmonary disease. MATERIALS AND METHODS: Eighty patients with LAM underwent chest and abdominopelvic CT and abdominopelvic US. The images were reviewed prospectively by one radiologist, and the abdominal findings were recorded and correlated with the severity of pulmonary disease at thin-section CT. RESULTS: Sixty-one (76%) of 80 patients had positive abdominal findings. The most common abdominal findings included renal angiomyolipoma (AML) in 43 patients (54%), enlarged abdominal lymph nodes in 31 (39%), and lymphangiomyoma in 13 (16%). Less common findings included ascites in eight (10%), dilatation of the thoracic duct in seven (9%), and hepatic AML in three (4%). A significant correlation (P =.02) was observed between enlarged abdominal lymph nodes and increased severity of lung disease. CONCLUSION: There are characteristic abdominal findings in patients with LAM that, in conjunction with the classic thin-section CT finding of pulmonary cysts, are useful in establishing this diagnosis.
21922.95146288712003.12.23++Hepatic metastases of soft tissue angiosarcoma: CT and MR imaging findings.Abdom Imaging
U Tateishi, T Hasegawa, Y Muramatsu, N Moriyama,
BACKGROUND: We describe the computed tomographic (CT) and magnetic resonance imaging (MRI) findings of hepatic metastases caused by soft tissue angiosarcomas to clarify the relation between radiologic appearances and clinicopathologic features. METHODS: CT and MR examinations of 13 patients with hepatic metastases of soft tissue angiosarcoma were retrospectively analyzed. RESULTS: Contrast-enhanced CT images showed multiple hypoattenuating lesions relative to the adjacent liver parenchyma. Lesions contained peripheral areas of enhancement in eight patients (62%). Tumors showed cystic attenuation with fluid-fluid levels, which were suggestive of hemorrhage in five patients (38%). In one patient (8%) with cystic attenuation and fluid-fluid levels, lesions also contained marked enhanced nodular portions located centrally or peripherally. On T1-weighted MR images, all four liver tumors appeared heterogeneous and hypointense relative to adjacent liver parenchyma. Fluid-fluid levels were identified on T2-weighted MR images in five patients (38%). After an intravenous bolus of gadolinium-based contrast material was administered, slight peripheral enhancement was seen in three patients (75%). CONCLUSION: The common CT findings of metastatic angiosarcoma in our series were multiple hypoattenuating lesions often associated with nodular enhancement and cystic lesions with hemorrhagic change.
22022.93160375412005.10.05+ Pseudotumoral appearance of peliosis hepatis.AJR Am J Roentgenol
S Savastano, O San Bortolo, E Velo, C Rettore, G Altavilla,
22122.9181889071994.06.21++Mediastinal and hilar lymphadenopathy due to Pneumocystis carinii infection in AIDS patients: CT features.J Comput Assist Tomogr
B Mayor, P Schnyder, J Giron, M Landry, B Duvoisin, D Fournier,
OBJECTIVE: Extrapulmonary involvement by Pneumocystis carinii (PC) in acquired immunodeficiency syndrome (AIDS) patients is uncommon. Our purpose is to describe three AIDS patients with low cluster differentiation cell (CD4) counts, who were receiving aerosol pentamidine prophylaxis, and who had large noncalcified hilar and mediastinal lymphadenopathy. MATERIALS AND METHODS: Chest radiography, CT, and clinical and laboratory records of three AIDS patients who had radiographic evidence of mediastinal and hilar lymphadenopathy were retrospectively reviewed. RESULTS: Symptoms were quite similar in all patients: weight loss, fever, cough, and mild dyspnea. Mediastinal and hilar widening was noticed on chest radiography. Contrast-enhanced chest CT revealed multiple noncalcified lymphadenopathy with supracarinal predominance in all cases. Mediastinoscopy with mediastinal and hilar lymph nodes sampling was performed in all patients. Histologic examination of the biopsy specimens demonstrated a necrotic foamy tissue without any calcification, and silver stain coloration showed abundant PC organisms in each case. CONCLUSION: In AIDS patients, PC infection should be considered as a possible cause of noncalcified hilar and mediastinal lymphadenopathy along with such possibilities as atypical infections and neoplasms, especially in severely immunocompromised hosts (low CD4) with aerosol pentamidine prophylaxis.
22222.9074896251996.01.02++A sonographic-pathological correlation of liver biopsies in patients with the acquired immune deficiency syndrome (AIDS).Clin Radiol
TJ Beale, CW Wetton, ME Crofton,
The liver is commonly involved in patients with AIDS and a first line investigation for hepatic dysfunction is liver ultrasound (US) which is often abnormal. It is unclear how these US abnormalities correlate with the underlying pathological processes. A retrospective study was performed in 48 patients with HIV disease who had undergone both liver biopsy and hepatic (US), correlating the findings. Only 25% of patients had an entirely normal liver (US) examination and only 10% patients had a normal liver biopsy. The commonest sonographic abnormalities was a diffusely hyperechoic liver seen in 46% of patients and this correlated with steatosis. Forty-four percent of biopsies contained more than one histological abnormality including granulomas, inflammation, steatosis or siderosis. In addition clinically unsuspected pathology was revealed in five of the cases of mycobacterial infection and in three cases of lymphoma. The combination of multiple histological abnormalities, unsuspected pathology, and the altered immune response in this group makes the US findings even less specific than in non-AIDS patients. We recommend that liver biopsy should remain an essential and early part of the management of AIDS patients.
22322.9082828851994.02.17++CT attenuation values and enhancing characteristics of thoracoabdominal lymphomatous adenopathies.J Comput Assist Tomogr
F Pombo, E Rodriguez, MV Caruncho, C Villalva, C Crespo,
OBJECTIVE: Thoracoabdominal lymphomatous adenopathies have been described as homogeneous and typically showing little enhancement on postcontrast CT. After observing pronounced adenopathic contrast enhancement in one patient with lymphoma, we prospectively investigated the CT enhancing characteristics and attenuation values of pathologic thoracic and abdominal lymph nodes in 25 patients with lymphoma. MATERIALS AND METHODS: Unenhanced CT of the chest, abdomen and pelvis was performed in all cases. The enhancing characteristics and attenuation values of the largest node or group of nodes were evaluated at 1, 2, 5, and 10 min after a 100 ml intravenous bolus injection of contrast medium. RESULTS: On unenhanced CT the nodes were of soft-tissue attenuation (42 +/- 5 HU) in 23 cases and of low attenuation (31 and 28 HU) in 2 cases. The maximum enhancement was achieved at 1 or 2 min postinjection and was low (16 +/- 6 HU) or moderate (31 +/- 6 HU) in 21 cases and pronounced (61 +/- 5 HU) in 4. The patterns of enhancement were classified as homogeneous (no. = 23) inhomogeneous (no. = 1), and peripheral (no. = 1). CONCLUSION: Thoracic and abdominal lymphomatous adenopathies are usually of soft-tissue attenuation on unenhanced CT and can show slight, moderate, or even pronounced enhancement on postcontrast CT.
22422.9028378061988.07.28++[Oral contrast media for magnetic resonance tomography of the abdomen. III. Initial patient research with gadolinium-DTPA]Rofo
C Claussen, W Kornmesser, M Laniado, S Kaminsky, B Hamm, R Felix,
32 patients with abdominal tumours or inflammatory abdominal diseases were examined by MRI (0.5 T) prior to and after oral administration of gadolinium-DTPA (Gd-DTPA). T1- and T2-weighted sequences were employed. 10 ml/kg body weight of a Gd-DTPA formulation were administered (1.0 mmol/l, 15 g mannitol/l). Gd-DTPA provided markedly hyperintensive opacification of the gastrointestinal tract. In 19 of 32 studies Gd-DTPA-enhanced scans showed improved delineation of abdominal pathologies. In most cases Gd-DTPA-enhanced T1-weighted multislice gradient echo images provided the most useful diagnostic result. Meteorism and diarrhea were recorded in 13 patients.
22522.8869750261981.12.21++Hepatic focal nodular hyperplasia: angiography, CT, sonography, and scintigraphy.AJR Am J Roentgenol
JV Rogers, LA Mack, PC Freeny, ML Johnson, PJ Sones,
Eleven patients with focal nodular hyperplasia of the liver underwent a combination of radiologic procedures, including sonography, computed tomography (CT), hepatic scintigraphy, and angiography. This paper describes the radiologic findings in this group of patients and reviews the current literature. In the present series, sonography was the most sensitive (100%) method for detection of focal nodular hyperplasia, while CT was able to detect only seven (78%) of nine cases. Arteriographic findings were felt to be characteristic in nine (82%) of 11 cases. Hepatic scintigraphy demonstrated normal colloid uptake in six (55%) of 11 lesions. In this series, an accurate radiologic diagnosis of focal nodular hyperplasia was made in 73% of cases. Hepatic scintigraphy is the pivotal examination. Normal colloid uptake by a focal hepatic mass is virtually diagnostic. However, in the patients in whom the colloid scan shows decreased or absent uptake, angiography may show findings diagnostic of focal nodular hyperplasia in up to 75% of cases, thus avoiding the need need for liver biopsy or surgery.
22622.8693149831997.10.23++Small lymph nodes of the abdomen, pelvis, and retroperitoneum: usefulness of sonographically guided biopsy.Radiology
AJ Fisher, EK Paulson, DH Sheafor, CM Simmons, RC Nelson,
PURPOSE: To evaluate the usefulness of sonographically guided percutaneous biopsy of small lymph nodes in the abdomen, retroperitoneum, and pelvis. MATERIALS AND METHODS: From May 1995 through January 1997, 35 sonographically guided lymph node biopsies were performed in 34 patients. All biopsies were performed with a 20- (n = 18) or 22-gauge (n = 10) self-aspirating needle alone or in combination (n = 7). To determine the amount of compression achieved with the transducer, the skin-to-lesion distance on reference computed tomographic (CT) scans was compared with that on sonograms. A biopsy was considered successful if a specific benign or malignant diagnosis was rendered by the pathologist. RESULTS: Of 35 sonographically guided biopsies, 30 (86%) were successful. Diagnoses included 26 (74%) cases of carcinoma, three (9%) cases of benign reactive lymphocytosis confirmed at open biopsy, and one (3%) case of a lymph node with a positive acid-fast bacilli stain. The average lymph node diameter was 2.1 cm (range, 0.9-4.3 cm). With sonography, a mean of 2.5 needle passes (range, 1-5) were made per biopsy. Transducer compression reduced the skin-to-lesion distance from an average of 8.8 cm (at CT) to 4.5 cm. CONCLUSION: Sonographic guidance seems to provide a reasonable alternative to CT in biopsy of small abdominal, pelvic and retroperitoneal lymph nodes.
22722.8519247921991.11.20++Ovarian lesions: detection and characterization with gadolinium-enhanced MR imaging at 1.5 T.Radiology
SK Stevens, H Hricak, JL Stern,
Magnetic resonance (MR) imaging for detection and characterization of ovarian masses was assessed in 33 patients with a total of 60 lesions. Lesions were characterized prospectively as benign or malignant by using T2-weighted MR images and unenhanced and gadolinium-enhanced T1-weighted MR images. MR imaging findings were compared with results of surgical laparotomy performed for staging of lesions. When malignancy was suspected, staging with MR imaging was performed. MR imaging demonstrated 57 of 60 (95%) surgically proved ovarian masses (34 of 36 were benign, 23 of 24 were malignant). Five significant primary criteria and four ancillary criteria for malignancy were established. For all MR pulse sequences combined, characterization of either type of lesion was correct in 84% of cases (48 of 57) when the five primary criteria were used and 95% (54 of 57) were correct when the four ancillary criteria were added. With gadolinium-enhanced images, correct characterization of malignant lesions increased from 56% to 78% with use of the five primary criteria and from 83% to 100% with use of both sets of criteria. Malignancies were correctly staged with MR imaging in 12 of 16 patients. Staging accuracy was 63% with unenhanced images and 75% with the addition of enhanced images.
22822.8314304431992.12.16++Infarction of the kidney: role of contrast enhanced MRI.J Comput Assist Tomogr
SH Kim, JH Park, JK Han, MC Han, S Kim, JS Lee,
Magnetic resonance imaging was performed on nine kidneys in six patients with renal infarction caused by renal arterial embolism secondary to cardiac valvular disease. The time interval between the onset of the symptoms attributable to renal infarction and the date of MRI was 2-23 days. On both T1- and T2-weighted images the signal intensity of the infarcted area was lower than that of the noninfarcted area in six kidneys and higher in three kidneys. Postcontrast T1-weighted images demonstrated the extent of the infarction except in the kidney in which the infarcted areas had high signal intensity on precontrast T1-weighted images.
22922.8197412311998.11.24++[Inflammatory pseudotumor of the spleen. An old concept with many questions]Sangre (Barc)
B Madrigal, MJ Pérez del Río, A Vara, P Ablanedo, L Ovidio González, M Florentino Fresno,
Inflammatory pseudotumor of spleen is an infrequent benign condition. It is difficult to differentiate, on a clinical and radiological basis, from haematologic neoplasms, granulomatous diseases as sarcoidosis and splenic hamartoma. Sometimes can be an incidental finding. Two women, aged 72 years, are presented. On the first case the sympthons mi micked a malignant disease. The second one was an incidental finding in a routine study for cholecystitis. Histological and immunohistochemical study showed a polymorphic cellular population including plasma cell, lymphoid cells, histiocytes, eosinophils and spindle cells, showing a reactive benign character. Plasma cells presented light chains polyclonality. Lymphoid cells were mature and with T inmunophenotype. Spindle cells were focally positive for muscle spe-cific actin and vimentine. In the first case, ultraestructural study showed myofibroblast morphology on the stromal spindle cells. Like many other authors have already postulated, immunohistochemical and ultraestructural findings would corroborate the mesenchymal reactive and benign nature of this type of lesions.
23022.80118677832002.05.07++Primary hepatic angiosarcoma: findings at CT and MR imaging.Radiology
T Koyama, JG Fletcher, CD Johnson, MS Kuo, K Notohara, LJ Burgart,
PURPOSE: To evaluate and describe cross-sectional imaging findings in patients with pathologically confirmed primary hepatic angiosarcoma. MATERIALS AND METHODS: Findings from imaging examinations in 13 patients with pathologically confirmed primary hepatic angiosarcoma were retrospectively reviewed (computed tomographic [CT] images obtained in 10 patients and magnetic resonance [MR] images obtained in five patients were available for review). Two gastrointestinal radiologists evaluated lesion number, size, attenuation and signal intensity characteristics, and the pattern and degree of contrast material enhancement. Medical records were reviewed for clinical features associated with angiosarcoma. RESULTS: Angiosarcoma appeared as multiple nodules (n = 6), as dominant masses (n = 6), or as a diffusely infiltrating lesion (n = 1). Multiple nodules were hypoattenuating at unenhanced and contrast material--enhanced CT (six of six patients). When dominant masses were encountered at MR imaging, T2-weighted MR imaging demonstrated heterogeneous internal architecture (four of four patients) similar to that of hepatocellular carcinoma. Multiphase contrast-enhanced CT and MR images showed dominant masses to have heterogeneous and progressive enhancement (three of three patients). Clinical features associated with angiosarcoma included splenic metastases (six of 13 patients), thrombocytopenia (seven of 13 patients), disseminated intravascular coagulation (four of 13 patients), and hemolytic anemia (three of 13 patients). CONCLUSION: Primary hepatic angiosarcoma exhibits a spectrum of appearances that reflect its varied pathologic features.
23122.7483329751993.08.16++[Splenic neoplasms]Tidsskr Nor Laegeforen
JT Pettersen, O Modalsli, K Solheim, T Buanes,
Carcinomas of the spleen are rare, whether primary or secondary. Two patients are described, one with a primary angiosarcoma. In this patient the first symptom was abdominal pain, caused by spontaneous rupture of the spleen. The other case was a woman with carcinoma of the breast which metastasized to the spleen. Both underwent splenectomy and adjuvant oncological treatment. Angiosarcomas constitute less than 1% of all sarcomas. Only about 60 cases of angiosarcomas in the spleen have been reported in the world literature. Spontaneous rupture of the spleen occurred in 30% of these cases. The prognosis for both untreated and treated splenic angiosarcomas is poor. Virtually all malignant tumours have been shown to metastasize to the spleen, most frequently from primary tumours localised to the breast, lung or ovary. Neoplasm should be considered for patients with splenomegaly having no apparent cause.
23222.73102278891999.06.03++Imaging features of nodular regenerative hyperplasia of the liver mimicking hepatic metastases.Abdom Imaging
M Clouet, I Boulay, M Boudiaf, P Soyer, J Nemeth, R Kiselman, R Rymer,
We described the sonographic, computed tomographic (CT), and magnetic resonance (MR) imaging features of one atypical case of nodular regenerative hyperplasia of the liver. The presence of multiple hepatic nodules suggested the diagnosis of metastatic disease to the liver because of a peripheral rim of enhancement on CT obtained after intravenous administration of contrast material and a halo sign on T2-weighted spin-echo MR imaging. Examination of the pathologic specimen obtained after surgical biopsy showed that the nodules were made of hepatocytes, with a nodular arrangement surrounded by peliosis, without fibrosis or cirrhosis. These findings suggested that peliosis may cause peripheral rim of enhancement on CT and halo sign on MR imaging. In light of this case, nodular regenerative hyperplasia of the liver should be considered in the differential diagnosis of hepatic metastases.
23322.69106157852000.02.01++[Splenic angiosarcoma: a case report with synchronous hepatic metastases]Chirurgie
E Fodzo, P Verhaeghe, C Cordonnier,
A 49 years old man in good physical condition suffering from abdominal pain in the right hypochondrium was hospitalized and CT scan revealed an hemoperitoneum, an enlargement of the liver and a rupture of an heterogeneous spleen. The patient was operated on and spleen removed. Pathological examination of the spleen concluded to a splenic cavernous hemangioma. In the postoperative course, an increase of liver nodules occurred within two weeks. A localized splenic angiosarcoma was recognized by reexamination of the specimen. The patient treated by chemotherapy was still alive after 5 months. Prognosis of splenic angiosarcoma is very poor; there is no curative treatment.
23422.6415613391992.05.13++Enhancement along the normal facial nerve in the facial canal: MR imaging and anatomic correlation.Radiology
SS Gebarski, SA Telian, JK Niparko,
Normal facial nerves are reported to show no enhancement at magnetic resonance (MR) imaging, in contradiction to the authors' clinical experience. To investigate this inconsistency, the authors searched MR imaging files and clinical records to find patients who underwent MR imaging of the temporal bone (at 1.5 T) before and after intravenous administration of gadopentetate dimeglumine and who had bilateral clinically normal facial nerves. When the MR images of 93 patients (186 facial nerves) were analyzed subjectively, 142 nerves (76%) were visibly enhanced along at least one segment of the facial nerve within the facial canal; the nerves of 64 of the 93 patients (69%) showed right-left asymmetry in enhancement, which was inhomogeneously distributed along each nerve. The facial nerve in the cerebellopontine angle cistern and in the internal auditory canal, as well as in the visualized proximal portion of the extracranial facial nerve, showed no enhancement. Comparison with reference anatomic sections showed that this enhancement pattern corresponded exactly to the topography of the circumneural facial arteriovenous plexus and should not necessarily be considered a sign of anatomic abnormality.
23522.6381889081994.06.21++US, CT, and MRI of primary and secondary liver lymphoma.J Comput Assist Tomogr
GS Gazelle, MJ Lee, PF Hahn, MA Goldberg, N Rafaat, PR Mueller,
OBJECTIVE: To describe the imaging findings in patients with pathologically proven hepatic lymphoma. MATERIALS AND METHODS: Ultrasound, CT, and MRI studies in 23 patients with primary (11 patients) or secondary (12 patients) liver lymphoma were retrospectively reviewed. All patients had proven non-Hodgkin lymphoma; all imaging studies were obtained within 3 weeks of biopsy. RESULTS: No finding or group of findings was specific for the diagnosis of hepatic lymphoma. In 7 of 11 cases of primary lymphoma, a single well-defined lesion was seen. Secondary liver lymphoma occurred as multiple (8 of 12) or diffusely infiltrating lesions (3 of 12) in most cases; it appeared as a solitary lesion in only 1 case. When discrete focal lesions were identified, the lesions were hypo- to anechoic on ultrasound, hypodense on CT, and had low and high signal intensity on TI- and T2-weighted MRI, respectively. CONCLUSION: Although no one finding appears to be diagnostic of hepatic lymphoma, ultrasound that demonstrates a homogeneous, hypoechoic, through-transmitting lesion combined with CT that demonstrates a solid, low attenuation lesion is highly suggestive of primary liver lymphoma. Secondary liver lymphoma can have a greater variety of appearances and is more likely to be multiple or diffusely infiltrating lesions than a solitary lesion.
23622.6167242421984.07.18++Radiologic diagnosis of wandering spleen complicated by splenic volvulus and infarction.Gastrointest Radiol
E Salomonowitz, MP Frick, G Lund,
Wandering spleen is a rare condition caused by malattachment of the dorsal mesogastrium. This condition is prone to torsion of the splenic pedicle leading to splenomegaly, hypersplenism, and infarction. Preoperative diagnosis can be suggested radiologically. A case of wandering spleen is reported and its embryologic, clinical, and radiographic features are discussed.
23722.5670629731982.05.21 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 15-1982. Splenomegaly in a 55-year-old man.N Engl J Med
23822.42151253602004.05.19++[Splenic abscess: from diagnosis to treatment]Tunis Med
S Jarboui, M Ben Moussa, A Krichene, F Tanazakhti, N Mnif, M Othmani, R Hamza, A Zaouche,
Splenic abscess are a rare and severe pathology causing difficulty in diagnosis and treatment. The Clinical presentation usually associated with abdominal pain in the left upper quadrant, fever and splenomegaly. Diagnosis will be confirmed by morphologic examination such as ultra sonography and computed tomography. Percutaneous drainage procedure made in first intention can be used either for curative purpose or to prepare patient for surgery. We report four cases of splenic abscess collected in our departement between 1997 and 2000 in which percutaneous drainage procedure was trial first. Two of them were successful and the others were completed by splenectomy.
23922.4030786871990.05.09+ The spleen.Clin Diagn Ultrasound
AB Kurtz,
24022.3827781581989.10.19++Subtracted synthetic images in Gd-DTPA enhanced MR.J Comput Assist Tomogr
Y Suto, BE Caner, Y Tamagawa, T Matsuda, I Kimura, H Kimura, T Toyama, Y Ishii,
The evaluation of Gd-DTPA contrast enhancement (CE) in high intensity tissues on T1-weighted magnetic resonance images, such as fat and bone marrow, is quite difficult. In this study, we used subtraction and subtracted color images in an attempt to show more clearly the Gd-DTPA CE. In addition, we also carried out sequential post-Gd-DTPA imaging to assess the changes in enhancement of lesions with time. Twenty patients were studied with these methods and our results are illustrated.
24122.33179663722007.12.21++Splenic hydatidosis: a rare differential diagnosis in a cystic lesion of the spleen.Rev Gastroenterol Mex
GA Rodríguez-Leal, S Morán-Villota, Mdel P Milke-García,
Cystic tumours of the spleen are generally rare, and a parasitic origin is relatively unlikely. The present case report shows, however that when a splenic cyst is found, the differential diagnosis must always consider the possibility of echinococcosis. We report the case of a patient suffering from a cystic lesion of the spleen where surgery and histopathology yielded the diagnosis of splenic echinococcosis. Abdominal pain in the left upper quadrant and splenomegaly detected by simple abdominal radiology are the most commonly found indicators for this disease. The treatment should be surgical, attempting to preserve as much splenic tissue as possible, although conservative treatment is frequently unfeasable due to massive involvement of the spleen. Although rare, splenic hydatidosis should be included in the differential diagnosis when a cystic splenic lesion is identified with sonography or CT scan.
24222.30162410992005.11.21++[Inflammatory pseudotumour of the spleen: a case report and review of the literature]Chir Ital
A Spivach, S Martinolli, R Adornetto, M Melato,
The case of a 64-year-old man presenting dysuria and haematuria is described. The cause of these symptoms was related to a splenomegaly compressing the left kidney and renal pelvis. A splenectomy was performed. Macro- and microscopic examination of the mass revealed an inflammatory pseudotumour of the spleen, composed of a variable mixture of polyclonal lymphocytes, eosinophils, neutrophils, plasmacells, foamy hystiocytes, giant cells and fibrous tissue. The aetiology is unknown. An inflammatory pseudotumour of the spleen is clearly a reactive lesion resulting from a variety of causes, particularly vascular thrombosis, infections or autoimmune mechanisms. Splenectomy is both diagnostic and curative.
24322.29112422142001.04.05++Castleman disease of the abdomen: imaging spectrum and clinicopathologic correlations.J Comput Assist Tomogr
TJ Kim, JK Han, YH Kim, TK Kim, BI Choi,
PURPOSE: The purpose of this work was to define the imaging spectrum of Castleman disease of the abdomen and to correlate the results with clinicopathologic findings. METHOD: Seventeen patients (male/female 7:10; mean age 35.6 years) with pathologically proved Castleman disease in the abdomen were included in this study. Radiologic findings (CT, n =17; US, n =10; MR, n =1) were retrospectively reviewed by two readers and were correlated with clinical and pathologic findings. RESULTS: Subjects were divided into those with localized (n = 11) and disseminated (n = 6) disease. In localized disease, the pathologic subtypes were hyaline vascular type in eight and plasma cell type in three. Radiologic studies showed a single large mass in six and a single dominant mass with small satellite nodules in five. Central low attenuation was seen in two cases, and calcification was seen in three cases. Regional lymphadenopathy was found in five cases. In disseminated disease, there were three hyaline vascular types and three plasma cell types. Radiologic findings included diffuse lymphadenopathy (n = 6), hepatosplenomegaly (n = 5), ascites (n = 3), and thickening of the retroperitoneal fascia (n = 3). Disseminated disease revealed symptoms and abnormal laboratory findings (anemia, hypoalbuminemia, elevated erythrocyte sedimentation rate/C-reactive protein, etc.) more frequently than localized disease and showed poor prognosis. CONCLUSION: There are two distinctive types of radiologic manifestations in Castleman disease of the abdomen: localized and disseminated. The localized type usually shows single or multiple discrete masses, and the disseminated type frequently shows nonspecific organomegaly and lymphadenopathy.
24422.28107529072000.04.21+ Aunt Minnie's corner. Hepatic hemangioma.J Comput Assist Tomogr
RM Branstetter, KL Ford,
24522.2881364821994.04.28+ [A splenic hamartoma with clinical symptoms]Rofo
H Daschner, K Lehner, K Becker,
24622.28151499942004.08.09+ Abdominal lymphangiomas: imaging features with pathologic correlation.AJR Am J Roentgenol
AD Levy, V Cantisani, M Miettinen,
24722.24108472762000.06.21+ Magnetic resonance imaging in primary lymphoma of the spleen.Arch Intern Med
JM Calvo-Romero,
24822.2326787041989.10.28++[Diagnosis and treatment of splenic abscess]Vestn Khir Im I I Grek
VV Utkin, MIa Iudin, MA Liepi'nsh, MIa Rubene, RR Ribenieks,
Eight patients with abscesses of the spleen were observed. The clinical picture had no special characteristics. Splenomegaly was not a pathognomonic symptom of the spleen abscess. The ultrasonic investigation and computed tomography were the main methods of diagnostics. The timely treatment of the spleen abscesses gives satisfactory results. The operation of choice is thought to be splenectomy.
24922.2193036351997.09.22++[Indications for splenectomy in Gaucher's disease. Case report]G Chir
P Ferrazza, M Assenza, F Diomedi Camassei, A Lombardi, M Di Paola,
Gaucher's disease is a rare metabolic disorder characterized by the lack of beta-glucocerebrosidase enzyme. In this case report a 26-year-old male patient was, first diagnosed as having splenomegaly and a huge haemangioma, therefore managed by total splenectomy. Histologic examination and specific colouring techniques using PAS and Black Sudan dyes allowed the diagnosis of Gaucher's disease. Preoperative diagnosis is hence fundamental to establish the correct management procedure, which currently may be surgical or medical and/or combined. In fact, following the diagnosis the second step includes the decision-making about splenectomy. Other therapeutic approaches are enzyme replacement therapy and genic therapy. The first may be combined to partial splenectomy, while the latter still needs further evaluations.
25022.20179210812007.11.08++Contrast agents for hepatic MRI.Cancer Imaging
G Morana, E Salviato, A Guarise,
Liver specific contrast media (LSCM) can be subdivided according to different modalities of hepatic distribution: exclusive distribution to the hepatocellular compartment can be obtained using CM which accumulate within the hepatocytes after slow infusion; other CM demonstrate combined perfusion and hepatocyte-selective properties, with an initial distribution to the vascular-interstitial compartment (in an analogous manner to that of the conventional extracellular CM), thereafter, a fraction of the injected dose is taken up into the hepatocytes causing an increase in the signal intensity of the hepatic tissue. The use of the superparamagnetic effect of iron oxide particles is based on distribution in the reticuloendothelial system (RES), usually well represented in the normal parenchyma as well as in benign hepatocellular lesions, and absent in most malignant lesions. It is necessary to have an in-depth knowledge of either the biological and histological characteristics of focal liver lesions (FLL) or the enhancement mechanism of LSCM to gain significant accuracy in the differential diagnosis of FLL. Dynamic contrast-enhanced MRI is an important tool in the identification and characterization of FLL. With LSCM it is possible to differentiate benign from malignant lesions and hepatocellular lesions from non hepatocellular lesions with high accuracy. To understand the contrast behaviour after injection of LSCM it is necessary to correlate the contrast enhancement with both the biological and histological findings of FLL.
25122.1854620281970.05.27+ Isolated splenic vein occlusion. Review of literature and report of an additional case.Arch Surg
JP Sutton, DY Yarborough, JT Richards,
25222.1719871771991.02.15++Evaluation of adrenal masses in oncologic patients: dynamic contrast-enhanced MR vs CT.J Comput Assist Tomogr
GP Krestin, G Freidmann, R Fishbach, KF Neufang, B Allolio,
The CT examinations, precontrast gradient echo MR images, and fast contrast enhanced dynamic MR studies were evaluated in 44 patients with 52 adrenal masses and known malignant disease of different origin. Morphologic features (size, shape, attenuation, contour, and enhancement) on CT scans, signal intensity on T2-weighted MR images, and patterns of enhancement on Gd-DTPA enhanced dynamic MR studies were analyzed in all patients. With dynamic contrast enhanced studies with prolonged imaging up to 15 min after Gd-DTPA, masses with moderate enhancement and complete washout after 10 min were considered as adenomas. Computed tomography and plain MR had a sensitivity of 0.71 and 0.96, a specificity of 0.75 and 0.88, and overall accuracy of 0.56 and 0.71, respectively. Simultaneous use of precontrast MR and dynamic contrast enhanced studies led to an accurate diagnosis in 88% (sensitivity = 1.0, specificity = 0.91) and thus should be considered in oncologic patients with undetermined adrenal masses.
25322.1781533361994.05.12++Infectious liver foci in leukemia: comparison of short-inversion-time inversion-recovery, T1-weighted spin-echo, and dynamic gadolinium-enhanced MR imaging.Radiology
AE Lamminen, VJ Anttila, S Bondestam, T Ruutu, PJ Ruutu,
PURPOSE: To assess the performances of three different magnetic resonance (MR) imaging techniques in the evaluation of patients with leukemia and suspected hepatic candidiasis. MATERIALS AND METHODS: Twelve patients with acute leukemia and definite or clinically suspected hepatic candidiasis were imaged at 1.0 T with a T1-weighted spin-echo (SE) technique, a short-inversion-time inversion-recovery (STIR) fat-suppression technique, and a dynamic gadolinium-enhanced fast low-angle shot (FLASH) technique. The conspicuity of hepatic lesions was evaluated semiquantitatively and ranked on a three-point scale. RESULTS: Multiple liver lesions were seen as high-signal-intensity foci with the STIR sequence; other sequences showed equivocal results. In the semiquantitative evaluation, STIR was significantly (P < .001) superior to both T1-weighted SE and contrast-enhanced FLASH techniques. Multiple red blood cell transfusions affected lesion conspicuity. CONCLUSION: STIR imaging is recommended as the MR technique of choice at 1.0 T in the evaluation of infectious liver foci in patients with acute leukemia.
25422.15152433762004.09.09++[Value of combined conventional and contrast enhanced sonography in the evaluation of hepatic disorders]J Radiol
F Tranquart, A Bleuzen, A Kissel,
PURPOSE: To assess the value of combined conventional and contrast-material enhanced sonography for the characterization of focal liver lesions. MATERIALS AND METHODS: Simultaneous imaging with grey scale and contrast enhanced US was performed in 90 patients following Levovist injection (Schering, Berlin, Germany) using the "Agent Detection Imaging" method (ADI, Siemens-Acuson, Mountain View, USA). US scanning was performed at least 4 minutes after contrast injection with review of both grayscale and contrast enhanced modes. Results for detection and characterization of lesions were compared to the selected gold standard imaging modality (CT or MRI). RESULTS: Final diagnoses included: 20 normal examinations, 41 patients with metastases, 6 patients with hepatocellular carcinoma, 13 patients with hemangioma, 6 patients with other benign lesions, 4 patients with cysts and 6 patients with two types of lesions. Delayed phase contrast enhanced US allowed diagnosis of all lesions except for one metastasis and all hepatocellular carcinomas. While the diagnosis of hepatoma could not be confirmed, the features suggested a malignant etiology. For 7 patients with metastases, more lesions were detected at ADI (4.9 lesions) than at conventional US (1.1 lesion). For 3 patients, CT showed more lesions than ADI US (3.3 versus 1.6 lesions). The accuracy of ADI US for differentiating between benign and malignant lesions was 98.7% compared to 49.6% for conventional US (p<0.001). The total number of lesions detected at ADI US was higher (p<0.01) than at conventional US and not significantly different from that obtained by the gold standard reference methods. Complete characterization was achieved in 92.2% of cases with ADI US compared to 59.2% with conventional US (p<0.001). CONCLUSION: Contrast-material enhanced US combined with conventional US markedly improves the diagnostic accuracy of US in terms of lesion detection and characterization.
25522.1482828831994.02.17++3DFT-FISP MRI with gadopentetate dimeglumine in differential diagnosis of small liver tumors.J Comput Assist Tomogr
H Nakamura, T Murakami, T Ishida, K Tsuda, T Hashimoto, K Nakanishi, T Mitani, K Tomoda, S Hori, T Kozuka,
OBJECTIVE: We assessed the value of dynamic sequential three-dimensional Fourier transformation (3DFT) MRI in differentiating various types of small liver tumors. MATERIALS AND METHODS: Forty-seven patients with 65 liver masses < 3 cm in size (42 hepatocellular carcinomas, 11 hemangiomas, 12 metastatic tumors) were studied by 3DFT fast imaging with steady-state precession (FISP) MRI [TR(ms)/TE(ms)/flip angle (degree): 20/8/30]. The slab thickness was 21-35 mm, and there were seven partitions. The 3DFT-FISP MR images were obtained immediately after 0.1 mmol/kg of gadopentetate dimeglumine was administered intravenously over 2-3 s (early phase), 60 s after (late phase I), and 120 s after (late phase II). RESULTS: Eighty-six percent of small hepatocellular carcinomas showed hyperintense enhancement relative to the surrounding liver parenchyma and iso- or hypointense enhancement with or without capsular enhancement in the late phase. Eighty-two percent of small hemangiomas showed peripheral globular enhancement in the early phase and total hyperintense or peripheral enhancement in the late phases. Ninety-two percent of the small metastatic liver tumors showed doughnut-like ring enhancement in the early phase. CONCLUSION: By dynamic 3DFT-FISP MRI, we were able to accurately evaluate the hemodynamics and morphological findings of each type of small liver tumor.
25622.14110001752000.10.13++Evaluation of the accuracy of gadobenate dimeglumine-enhanced MR imaging in the detection and characterization of focal liver lesions.AJR Am J Roentgenol
G Pirovano, A Vanzulli, L Marti-Bonmati, L Grazioli, R Manfredi, A Greco, N Holzknecht, HE Daldrup-Link, E Rummeny, B Hamm, V Arneson, L Imperatori, MA Kirchin, A Spinazzi,
OBJECTIVE. We evaluated the extent to which hepatic lesion characterization and detection is improved by using gadobenate dimeglumine for enhancement of MR images. MATERIALS AND METHODS. Eighty-six patients were imaged before gadobenate dimeglumine administration, immediately after the 2 mL/sec bolus administration of a 0.05 mmol/kg dose (dynamic imaging), and at 60-120 min after the IV infusion at 10 mL/min of a further 0.05 nmol/kg dose (delayed imaging). The accuracy for lesion characterization was assessed for a total of 107 lesions. Sensitivity for lesion detection was assessed for a total of 149 lesions detected on either intra-operative sonography, iodized oil CT, CT during arterial portography, or follow-up contrast-enhanced CT as the gold standard. RESULTS. The accuracy in differentiating benign from malignant liver lesions increased from 75% and 82% (the findings of two observers) on unenhanced images alone, to 89% and 80% on dynamic images alone (p<0.001, p = 0.8), and to 90.7% when combining the unenhanced and dynamic image sets (p<0.001, p = 0.023). Delayed images did not further improve accuracy (90% and 91%; p = 0.002, p< 0.05). A similar trend was apparent in terms of accuracy for specific diagnosis: values ranged from 49% and 62% on unenhanced images alone, to 76% and 70% on combined unenhanced and dynamic images (p<0.001, p = 0.06), and to 75% and 70% on inclusion of delayed images (p<0.001, p = 0.12). The sensitivity for lesion detection increased from 77% and 81% on unenhanced images alone, to 87% and 85% on combined unenhanced and dynamic images (p = 0.001, p = 0.267), and to 92% and 89% when all images were considered (p<0.001, p = 0.01). CONCLUSION. Contrast-enhanced dynamic MR imaging with gadobenate dimeglumine significantly increases sensitivity and accuracy over unenhanced imaging for the characterization of focal hepatic lesions, and delayed MR imaging contributes to the improved detection of lesions.
25722.116194341978.02.18++Splenic cystic lymphangiomatosis: an unusual cause of massive splenomegaly.Radiology
RJ Tuttle, JA Minielly,
Two unusual cases of massively enlarged spleens occupied by numerous lymphangiomatous cysts are described. Both angiography and pathology confirm the pathognomonic appearance.
25822.10171898432007.03.15++Littoral cell angioma.Clin Imaging
C Johnson, M Goyal, B Kim, D Wasdahl, K Nazinitsky,
Littoral cell angioma (LCA) is an extremely rare primary splenic tumor. There are few MRI and scintigraphic characteristics described. These characteristics may be most helpful in differentiating LCA from other primary vascular tumors. We present a 54-year-old woman found on CT to have a 7-cm mass within an enlarged spleen. LCA was diagnosed by ultrasound (US)-guided biopsy. She was successfully treated with laparoscopic splenectomy. The CT, MRI, US, and Tc99m-RBC scan characteristics are described along with histologic and immunohistochemical correlation.
25922.08172935742007.05.01++Blunt splenic trauma: delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients.Radiology
SW Anderson, JC Varghese, BC Lucey, PA Burke, EF Hirsch, JA Soto,
PURPOSE: To retrospectively evaluate delayed-phase computed tomography (CT) in the differentiation of active splenic hemorrhage requiring emergent treatment from contained vascular injuries (pseudoaneurysms or arteriovenous fistulas) that can be treated electively or managed conservatively. MATERIALS AND METHODS: The institutional review board approved this HIPAA-compliant retrospective study; the informed consent requirement was waived. Forty-seven patients with blunt splenic injury diagnosed at CT after blunt abdominal trauma were evaluated. Abdominal and pelvic dual-phase CT was performed; images were obtained 60-70 seconds and 5 minutes after contrast material injection. Scans were reviewed in consensus by two radiologists. Splenic injuries were graded with the American Association for the Surgery of Trauma Splenic Injury Scale. Patients with intrasplenic hyperattenuating foci on portal venous phase images were classified as having active splenic hemorrhage (group 1) or a contained vascular injury (group 2) on the basis of delayed-phase imaging findings. Findings suggestive of active hemorrhage included areas that remained hyperattenuating or increased in size on delayed-phase images. The clinical outcome of these patients was determined by reviewing their medical records. Relationships between several factors were tested with the Fisher exact test, including (a) the presence or absence of hyperattenuating foci and management and (b) the presence of contained vascular injury or active extravasation and management. RESULTS: Portal venous phase CT revealed a focal high-attenuation parenchymal contrast material collection in 19 patients: nine patients were classified as group 1 and 10 were classified as group 2. All patients in group 1 underwent emergent splenectomy, and all patients in group 2 were initially treated without surgery. Significant differences in management were noted on the basis of whether hyperattenuating foci were seen on portal venous phase images (P < .001) and whether hyperattenuating foci seen at portal venous phase imaging were further characterized as active splenic hemorrhage or a contained vascular injury at delayed-phase CT (P < .001). CONCLUSION: In blunt splenic injury, delayed-phase CT helps differentiate patients with active splenic hemorrhage from those with contained vascular injuries.
26022.08127609412003.06.24++Metastatic angiosarcoma of the lung: spectrum of CT findings.AJR Am J Roentgenol
U Tateishi, T Hasegawa, M Kusumoto, N Yamazaki, G Iinuma, Y Muramatsu, N Moriyama,
OBJECTIVE: The purpose of our study was to summarize the CT features of pulmonary metastases in angiosarcoma in 24 patients. CONCLUSION: A variety of CT features were associated with metastatic angiosarcoma of the lung. The common CT manifestations of metastatic angiosarcoma were multiple solid nodular lesions and multiple thin-walled cysts that were often accompanied by hemorrhagic change.
26122.05125948002003.06.19++The small spleen: sonographic patterns of functional hyposplenia or asplenia.J Clin Ultrasound
C Görg, M Eichkorn, G Zugmaier,
PURPOSE: Functional hyposplenia or asplenia (FAS) can be associated with potential fatal infections. The diagnosis of FAS is traditionally made on liver-spleen scintigraphy and finding Howell-Jolly bodies within erythrocytes. In this retrospective study, our goal was to identify any characteristic sonographic findings of the spleen in patients with FAS in an attempt to determine whether the diagnosis of FAS can be made sonographically. METHODS: In a review of all medical and sonographic records from the period of January 1, 1985, through December 31, 2001, we identified 24 patients (11 men, 13 women) in whom FAS had been diagnosed by liver-spleen scintigraphy (n = 13) or the finding of Howell-Jolly bodies (n = 11). The following sonographic parameters were determined: size of spleen (small, normal, or large), echotexture of the spleen (homogeneous versus inhomogeneous), echogenicity (isoechoic versus hyperechoic), presence of focal splenic lesions, and patterns of splenic vascularization as determined by color Doppler sonography (absent flow, hilar flow, or parenchymal flow). RESULTS: The spleen was small in 20 patients (83%) and normal in the other 4 (17%). Echotexture was homogeneous in 13 patients (54%) and inhomogeneous in 11 (46%). The spleen was isoechoic in 18 cases (75%) and hyperechoic in 6 (25%). Six patients (25%) had focal lesions. Color Doppler sonography showed absent flow in 4 patients (17%), hilar flow in 17 (71%), and hilar and parenchymal vascularization in 3 (12%). CONCLUSIONS: Sonographic findings in the spleen of patients with FAS are characterized predominantly by a small spleen with absence of parenchymal vascularization on color Doppler sonography in most cases. Future prospective studies will be necessary to confirm these findings and to determine whether FAS can be diagnosed reliably with sonography.
26222.0493084641997.10.16++MR imaging of the gastrointestinal tract with i.v., gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT.AJR Am J Roentgenol
RN Low, IR Francis,
OBJECTIVE: To determine an optimal MR imaging technique and pulse sequence for evaluating mural and serosal disease of the gastrointestinal tract, we administered 2% oral barium sulfate and obtained fat-suppressed gadolinium-enhanced breath-hold fast multiplanar spoiled gradient-recalled (FMPSPGR) MR images. We then compared these images with spin-echo T1-weighted and T2-weighted fast spin-echo MR images and with CT images. SUBJECTS AND METHODS: Thirty-one patients with suspected diseases of the gastrointestinal tract were imaged with spin-echo T1-weighted, fast spin-echo T2-weighted, and fat-saturated gadolinium-enhanced FMPSPGR MR imaging. Before undergoing MR imaging, all patients received 1350 ml of 2% barium sulfate oral contrast media. For CT scans, patients received 120 ml of iodinated i.v. contrast material and 2% barium sulfate oral contrast material. CT and MR images were retrospectively and independently reviewed by two radiologists for ability to see normal bowel wall, for the presence of abnormal gastrointestinal tract mural thickening or enhancement, and for overall gastrointestinal tract visualization. Findings were correlated with surgical findings, endoscopy, and barium studies. RESULTS: Ten patients had benign disease, 16 had malignant gastrointestinal tract disease, and five had no gastrointestinal tract abnormalities. In 94% of patients, the gadolinium- and barium-enhanced FMPSPGR MR images were superior to CT and spin-echo MR sequences for depicting the wall of the normal bowel (p < .001). For the two observers, the FMPSPGR MR images with i.v. and oral contrast material were seen as revealing 94% and 95% of bowel segments with malignant or inflammatory mural thickening or serosal tumor. In comparison, CT revealed 64% and 72% (p < .01 and p < .0001, respectively), fast spin-echo T2-weighted MR images revealed 21% and 28% (p < .0001), and T1-weighted MR images revealed 17% and 18% (p < .0001). The gadolinium- and barium-enhanced MR images were preferred for overall gastrointestinal tract visualization in 65% of patients compared with 1% for CT scans (p < .001). In 32% of patients, the enhanced MR images were equivalent to CT images. CONCLUSION: MR evaluation of the gastrointestinal tract requires bowel distention with oral contrast material as well as motion reduction techniques, including glucagon and rapid gradient-echo pulses that allow breath-hold imaging. Fat-suppressed gadolinium-enhanced FMPSPGR MR imaging with diluted barium oral contrast media is effective for imaging benign and malignant mural and serosal abnormalities of the gastrointestinal tract.
26322.0247447221973.12.15+ Angiographic evaluation of cystic lesions of the spleen.Am J Roentgenol Radium Ther Nucl Med
JD Shanser, AA Moss, RE Clark, AJ Palubinskas,
26422.0225388801989.05.09++[Differentiation of focal liver lesions using contrast-enhanced MRT]Rofo
P Heintz, C Ehrenheim,
47 patients with liver tumours (haemangioma, focal nodular hyperplasia, hepatocellular carcinoma) underwent MRI of the liver before and after i.v. injection of 0.2 ml./kg. gadolinium-DTPA in addition to other imaging methods. The demarcation of focal nodular hyperplasia is not influenced by use of the contrast agent as it almost behaves like surrounding normal liver tissue, thus only indirectly facilitating its identification. With regard to liver haemangiomas that show the most intensive uptake of gadolinium-DTPA, the contrast enhanced image does not reach the contrast and sensitivity of a native T2-weighted SE image, especially in cases of small haemangiomas. The contrast agent is helpful, however, in the recognition of large cavernous haemangiomas that are partially fibrotic or thrombotic. Emphasis is given to the contrast agent in hepatomas: gadolinium-DTPA presents a pattern of uptake and distribution frequently found in hepatocellular carcinoma providing additional information on the delineation of internal tumour details.
26522.0017450491992.01.14++Imaging-guided and nonimaging-guided fine needle aspiration of liver lesions: experience with 406 patients.J Surg Oncol
Y Edoute, O Tibon-Fisher, SA Ben-Haim, E Malberger,
The aim of the present study was to determine the diagnostic accuracy of different modes of fine needle aspiration (FNA) of liver lesions. A total of 492 FNAs were performed on 406 patients in order to confirm or to rule out focal or multifocal neoplastic disease: 29% under ultrasound (US) guidance, 3% with computed tomographic (CT) guidance, 67% preoperatively, and 1% intraoperatively without imaging guidance. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 387 patients, of whom 264 had malignant liver disease and 123 had benign liver disease. Of 321 aspirations performed in patients with malignant liver disease, the cytologic findings suggested malignancy in 225 (70.1%), suspected malignancy in 25 (7.8%), and did not reveal malignancy in 71 aspirations (22.1%). Among the 123 patients with benign liver disease, the cytologic findings were reported as benign in all but two patients, who had false-positive cytologic findings. The overall sensitivity, specificity, positive, and negative predictive values for cytologic findings were 85.6, 98.4, 99.1, and 76.1%, respectively. The overall diagnostic accuracy was 89.7%. In one patient, fatal intraperitoneal bleeding due to chronic intravascular coagulation complicated the FNA procedure. We conclude that imaging-guided FNA as well as nonguided FNA for cytologic diagnosis of liver lesions are highly accurate and only rarely may be associated with a fatal complication.
26621.9515916861992.07.02++Ultrasonically guided percutaneous splenic tissue core biopsy in patients with malignant lymphomas.Cancer
L Cavanna, G Civardi, F Fornari, M Di Stasi, G Sbolli, E Buscarini, D Vallisa, S Rossi, P Tansini, L Buscarini,
Ultrasonically (US) guided percutaneous tissue core biopsy of the spleen was done on 46 patients with malignant lymphomas. The biopsies were undertaken as a staging procedure in 32 patients, as a restaging procedure in 7, during follow-up in 2, and as a diagnostic step in 5 (previously undiagnosed cases with clinically and ultrasonographically suspected lymphoma). In 45 patients, the tissue core specimens obtained by US-guided biopsies were sufficient for a correct histologic examination; in one patient, the specimen was considered inadequate. The tissue core specimens showed splenic involvement in 12 patients and normal splenic tissue in the other 33. These latter cases were confirmed by splenectomy, by laparoscopy with larger splenic biopsy needles, and by clinical and US follow-up over a period of 6 to 30 months. In all previously undiagnosed patients (five), splenic biopsies allowed histologic subtyping. Additional immunologic subclassification into B-cell and T-cell types of lymphomas was done in two instances. There were no complications in this series. These results suggest that percutaneous US-guided splenic tissue core biopsy is a useful and safe technique for the diagnosis, staging, and follow-up of malignant lymphoma.
26721.92157238422005.09.13++Blunt hepatic trauma: evaluation with contrast-enhanced sonography: sonographic findings and clinical application.J Ultrasound Med
O Catalano, R Lobianco, MM Raso, A Siani,
OBJECTIVE: The purpose of this study was to report our initial experience in the assessment of liver trauma with real-time contrast-enhanced sonography (CES). METHODS: From January 2000 to December 2003, there were 431 hemodynamically stable patients evaluated with sonography for blunt abdominal trauma. Among these patients, 87 were selected to undergo second-level imaging, consisting of CES and computed tomographic (CT) evaluation. Indications for further assessment were baseline sonographic findings positive for liver injury, baseline sonographic findings positive for injury to other abdominal parenchyma, baseline sonographic findings positive for free fluid only, baseline sonographic findings indeterminate, and baseline sonographic findings negative with persistent clinical or laboratory suspicion. RESULTS: There were 23 hepatic lesions shown by CT in 21 patients. Peritoneal or retroperitoneal fluid was identified in 19 of 21 positive cases by all 3 imaging modalities. Liver injury was found in 15 patients on sonography and in 19 on CES. Contrast-enhanced sonography compared better than unenhanced sonography with the criterion standard for related injury conspicuity, injury size, completeness of injury extension, and involvement of the liver capsule. Both CES and CT showed intrahepatic contrast material pooling in 2 cases. All patients with false-negative sonographic or CES findings recovered uneventfully. CONCLUSIONS: Contrast-enhanced sonography is an effective tool in the evaluation of blunt hepatic trauma, being more sensitive than baseline sonography and correlating better than baseline sonography with CT findings. In institutions where sonography is regarded as the initial procedure to screen patients with trauma, this technique may increase its effectiveness. In addition, CES may be valuable in the follow-up of patients with conservatively treated liver trauma.
26821.9184194431993.02.11++MRI of liver metastases from colorectal cancer vs. CT during arterial portography.J Comput Assist Tomogr
P Soyer, M Levesque, C Caudron, D Elias, G Zeitoun, A Roche,
A prospective study was performed to compare, with a lesion-by-lesion analysis, the sensitivities of high field strength MRI and CT during arterial portography (CTAP) in detecting hepatic metastases from colorectal cancer. Twenty-one patients with liver metastases from colorectal cancer were prospectively investigated by high field strength MRI (1.5 or 2 T) and CTAP. High field strength MRI was performed with pre and post gadopentetate dimeglumine enhanced T1-weighted SE sequences and T2-weighted SE sequences. All patients underwent partial hepatectomy and 37 metastases were surgically and pathologically proved. The metastasis detection rate (sensitivity) was 94% (35 of 37) for CTAP and 78% (29 of 37) for high field strength MRI. The 16% (95% confidence interval: 1-31%) difference in sensitivity between CTAP and high field strength MRI was statistically significant (p < 0.05, McNemar test). The use of gadopentetate dimeglumine did not improve the sensitivity of T1-weighted SE sequences. Since our study demonstrated significant difference in sensitivities between high field strength MRI and CTAP in our group of patients, we can conclude that high field strength MRI cannot replace CTAP in the preoperative evaluation of patients with liver metastases from colorectal cancer. Computed tomography during arterial portography must be considered as the preoperative gold standard.
26921.9015156241992.10.06++[CT-guided large-bore biopsy of solid non-organ-bound space-occupying lesions in the retroperitoneum]Rofo
KC Klose, D Hohberger, A Böcking,
Seventy-eight solid, non-organic retroperitoneal tumours were biopsied with a 14-gauge Tru-Cut needle in 73 consecutive patients with the exception of one. Adequate material was not obtained in only one patient with the primary known (1.3%). In the adequate material (98.7%), the dignity of all lesions was accurately determined and 93.1% of lesions were accurately classified. Typing accuracy reached 100% in histologically known primaries (n = 31) and 87.8% in histologically unknown primaries (n = 41). A hypertensive crisis and a small haematoma following biopsy of an inadvertent extra-adrenal phaeochromocytoma was the single complication found in this series. An arterial bleeding following biopsy was prophylactically embolised through the biopsy needle. CT-guided large-bore biopsy of solid non-organic retroperitoneal tumours is a safe, non-invasive procedure with a high diagnostic yield that obviates the need for open diagnostic procedures in a large number of cases.
27021.90145800962003.11.18++Detection and characterization of focal liver lesions using superparamagnetic iron oxide-enhanced magnetic resonance imaging: comparison between ferumoxides-enhanced T1-weighted imaging and delayed-phase gadolinium-enhanced T1-weighted imaging.Abdom Imaging
K Takahama, Y Amano, H Hayashi, M Ishihara, T Kumazaki,
BACKGROUND: Double contrast magnetic resonance (MR) imaging using superparamagnetic iron oxide (SPIO) and gadolinium (Gd) is performed to detect and characterize focal liver lesions. However, this technique is a costly and lengthy process. The purpose of this study was to determine the usefulness of SPIO-enhanced MR imaging including SPIO-enhanced T1-weighted imaging in diagnosing focal liver lesions. METHODS: Eighty-four focal liver lesions were examined with a 1.5-T MR unit. Transverse precontrast T1- and T2-weighted images and SPIO (ferumoxides)-enhanced T1- and T2-weighted images were obtained, followed by Gd-enhanced T1 -weighted imaging. The Gd set (i.e., precontrast T1- and T2-weighted and delayed-phase gadolinium-enhanced T1-weighted images) and ferumoxides set (i.e., precontrast T1- and ferumoxides-enhanced T1- and T2-weighted images) were reviewed by two independent readers. RESULTS: More lesions were detected from the ferumoxides set than from the Gd set. Ferumoxides-enhanced T1-weighted imaging showed enhancement patterns of the lesions similar to those of delayed-phase Gd-enhanced T1-weighted imaging. The diagnoses of hepatic metastasis and cyst by the ferumoxides set were similar to those by the Gd set. However, a dynamic study may be inevitable for the diagnosis of hepatocellular carcinoma and hemangioma. CONCLUSION: The ferumoxides set was useful for the detection of focal hepatic lesions. Ferumoxides-enhanced T1-weighted imaging may replace delayed-phase gadolinium-enhanced T1-weighted imaging in the diagnosis of hepatic metastasis and cysts.
27121.861039221979.03.24+ Ultrasonic findings in isolated lymphoma of the spleen simulating splenic abscess.J Clin Ultrasound
JJ Cunningham,
27221.8430259571987.02.18++[Magnetic resonance tomography of focal hepatic lesions using the para-magnetic contrast medium, gadolinium DTPA. First clinical results]Rofo
B Hamm, T Römer, R Felix, KJ Wolf,
The use of the para-magnetic contrast medium gadolinium DTPA for magnetic resonance tomography of focal lesions in the liver was investigated in 31 patients. Two dosage schedules of the contrast medium (0.1 and 0.2 mmol/kg body weight were used with field strengths of 0.35 and 0.5 Tesla. Using T1 sequences, gadolinium DTPA showed increased signal intensity in the liver and in tumours, but this was significantly more marked in the tumour. On T1 spin-echo sequences, previously iso-intense lesions became visible after administration of contrast. On the other hand, contrast-enhanced lesions were less well seen on inversion recovery sequences because of a reduction in the contrast between tumour and liver tissue. The contrast between tumour and liver tissue was not improved by gadolinium DTPA in comparison with precontrast inversion recovery sequences and T2 spin-echo sequences. The perfusion of intra-hepatic tumours could be elucidated by magnetic resonance tomography after the administration of gadolinium DTPA.
27321.81158915092005.06.28++Image-guided cutting-edge-needle biopsy of peripheral lymph nodes and superficial masses for the diagnosis of lymphoma.J Comput Assist Tomogr
M Sklair-Levy, G Amir, G Spectre, P Lebensart, Y Applbaum, R Agid, S Lieberman, D Ben-Yehuda, Y Sherman, E Libson,
OBJECTIVE: To evaluate the diagnostic efficacy of image-guided cutting-edge-needle biopsy of peripheral lymph nodes and superficial masses for the diagnosis of lymphoma, for which many still advocate open surgical resection. METHODS: A retrospective analysis was performed of the medical records of 114 lymphoma patients who presented with peripheral lymphadenopathy and superficial masses and who underwent diagnostic image-guided biopsy. There were 69 non-Hodgkin lymphoma patients, 38 Hodgkin lymphoma patients, and 7 patients who were evaluated for histologic transformation of CLL or high grade lymphoma. RESULTS: Image-guided needle biopsy was diagnostic in 96/114 (84.2%) patients. The procedure was diagnostic in 59/69 (85.5%) of NHL patients and in 30/38 of Hodgkin disease patients (79%). Diagnoses were achieved for all 7 cases where histologic transformation was suspected. CONCLUSION: Percutaneous image-guided needle biopsy is a safe and reliable procedure with a high diagnostic yield. It can be used as a first step in patients suspected of having lymphoma presenting with enlarged peripheral lymph nodes and superficial masses.
27421.8082736071994.02.03+ Progressive multifocal leukoencephalopathy: contrast enhancement on CT scans and MR images.AJR Am J Roentgenol
AL Wheeler, CL Truwit, BK Kleinschmidt-DeMasters, WR Byrne, RN Hannon,
27521.7819876341991.02.20+ Extrapulmonary Pneumocystis carinii infection: another cause of splenic "bull's-eye" lesions.Radiology
ME Timins, AA Nemcek,
27621.7815358901992.03.23++Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT.Radiology
DM Yousem, PM Som, DB Hackney, F Schwaibold, RA Hendrix,
Computed tomographic (CT) scans and magnetic resonance (MR) images obtained in 24 patients with cervical lymphadenopathy were retrospectively and blindly evaluated by two readers for the presence of central nodal necrosis (CNN) and extracapsular nodal spread (ENS). The CT studies were all enhanced, and the MR images were obtained with short repetition time (TR)/echo time (TE), long TR/double echo, and enhanced short TR/TE fat-suppressed sequences. Each MR imaging sequence was interpreted separately and then collectively. Sixty lymph nodes were identified with CT. Sensitivity for CNN was 16%-67% with the unenhanced MR pulse sequences, 50% with enhanced sequences, and 83%-100% with CT. The most accurate reading of MR images for CNN was with the unenhanced T1-weighted and T2-weighted images (86%-87%); the accuracy of CT was 91%-96%. The accuracy of MR imaging for detecting ENS was maximal with T1-weighted images (78%-90%). Gadolinium-enhanced, fat-suppressed images did not improve accuracy in evaluating CNN or ENS. CT is currently more accurate than unenhanced or enhanced MR imaging in detecting CNN or ENS.
27721.7522787831991.03.14++Computed tomography of cystic lymphangioma in a wandering spleen.Acta Radiol
M Alerci, R Dore,
A large cystic lymphangioma in a wandering spleen was discovered by chance in a young woman, 2 months after she delivered her first child. The clinical finding was that of a pelvic mass, which at CT was found to be a wandering spleen, containing multiple cystic lesions. The diagnosis of cystic lymphangioma was made at the pathological examination of the specimen after splenectomy. The association of cystic lymphangioma in a wandering spleen has not been reported previously.
27821.7082408871994.01.06++MR evaluation of tuberculous spondylitis.Acta Radiol
GC Liu, MS Chou, TC Tsai, SY Lin, YS Shen,
A total of 29 proven tuberculous spondylitis patients underwent MR studies. Gd-DTPA enhancement was performed in 10 patients. Contiguous 2 vertebral involvement, subligamental spread of paraspinal abscesses and cord indentation were observed in 93% of the cases. Destruction of the vertebral body occurred in 76%. Intermediate or low T1 signal intensity and high T2 signal intensity were observed by MR. A combination of these characteristic findings strongly suggests the diagnosis of tuberculous spondylitis. Gd-DTPA administration did not facilitate diagnosis. MR examination should be considered as the main imaging modality for patients with suspected tuberculous spondylitis.
27921.66113728132001.06.28++Thrombocytopenia caused by splenic hamartoma: resolution after splenectomy.South Med J
CN Compton, CR McHenry, M Aijazi, M Chung-Park,
We report a rare case of isolated thrombocytopenia due to a large hamartoma of the pulposal type, which resolved with splenectomy in a 46-year-old man. Although hamartomas are usually found incidentally, they may cause hematologic disturbances such as thrombocytopenia, anemia, or splenic rupture. The diagnosis of splenic hamartoma is difficult to make preoperatively. Splenectomy is important in excluding malignant tumors from the diagnosis when the etiology of a splenic mass is unclear and ameliorating hematologic symptoms related to hamartomas.
28021.641284961976.04.02++[Angiography, scintigraphy and ultra sound in the diagnosis of splenic or hepatic disease in Hodgkin's disease (author's transl)]Rofo
H Czembirek, E Neumann, J Haydl, L Howanietz, C Jantsch, F Pantucek, H Pokieser,
The combined use of selective angiography, scintigraphy and ultra-sound is not reliable enough for the certain exclusion of visceral involvement in Hodgkin's disease. Since this is of importance in the planning of treatment, it confirms the recommendation made by Wagenknechts, Glatsteins and others that a diagnostic splenectomy be carried out in order to determine the presence of visceral involvement.
28121.6367795231981.03.27++CT-guided percutaneous aspiration and drainage of abscesses.AJR Am J Roentgenol
JR Haaga, AJ Weinstein,
CT-guided procedures were attempted in 103 patients suspected of having abscesses. CT-guided procedures were performed for diagnostic specimens in 70 patients; they were successful in 30 of 34 sterile collections and 33 of 36 abscesses. In another 33 patients, diagnostic aspiration was performed and percutaneous drainage was attempted; aspirations were successful in 33 of 33 and drainage in 28 of 33 cases. Of the five not drained, four were undrainable because of anatomic extent or high viscosity of the purulent material. The fifth was a necrotic, squamous cell tumor erroneously thought to be an abscess. No complications were encountered. CT-guided procedures are an effective method for obtaining diagnostic specimens in selected patients.
28221.6215450291992.04.15++MRI of primary spleen angiosarcoma with iron accumulation.J Comput Assist Tomogr
K Kaneko, H Onitsuka, J Murakami, H Honda, M Kimura, N Shiraishi, K Masuda,
A case of splenic angiosarcoma with siderotic nodules is reported. The tumor was hyperechoic on ultrasound and had high density on CT and very low intensity on MR. Gandy-Gamna nodules (siderotic nodules) were demonstrated histopathogically.
28321.6178638831995.03.23++Distinction between cavernous hemangiomas of the liver and hepatic metastases on CT: value of contrast enhancement patterns.AJR Am J Roentgenol
DF Leslie, CD Johnson, CM Johnson, DM Ilstrup, WS Harmsen,
OBJECTIVE. Differentiating between cavernous hemangiomas of the liver and hepatic metastases on the basis of single-pass, contrast-enhanced CT is a significant and frequently encountered diagnostic challenge. Recognition of characteristic enhancement features of cavernous hemangiomas can aid in effectively distinguishing between these lesions. The purpose of this study was to determine sensitivity and specificity of dense, globular enhancement for differentiating cavernos hemangiomas and metastases during single-pass, contrast-enhanced CT. MATERIALS AND METHODS. CT appearance of 133 lesions in 91 patients with cavernous hemangiomas (44 patients) or metastases (47 patients) was retrospectively evaluated in a blinded review. CT examinations were performed with nonhelical technique following injection of 150 ml of contrast material. All patients with metastases had pathologic proof (n = 47). Patients with cavernous hemangiomas were clinically stable for at least 2 years after CT (n = 43) or had tissue proof (n = 1). All lesions were evaluated based on the following criteria: (1) Type of enhancement: globular, linear, diffuse and homogeneous, or diffuse and heterogeneous. (Globular enhancement was considered to be present when enhancing nodules less than 1 cm in diameter were seen within lesions.) (2) Continuity of enhancing tissue: continuous or noncontinuous. (Uninterrupted collections of contrast material within at least 50% of a lesion were considered continuous. Multiple, separate collections of contrast material were considered noncontinuous.) (3) Degree of enhancement: hypo-, iso-, or hyperdense relative to the aorta. (4) Distribution of enhancement: peripheral, central, or mixed. RESULTS. Seventy-six percent of cavernous hemangiomas had globular enhancement, compared to 10% of metastases (p < .001). Seventy-two percent of cavernous hemangiomas had enhancement isodense with the aorta, and 96% of metastases were hypodense (p < .001). Sixty-seven percent of cavernous hemangiomas had peripheral enhancement, compared to 38% of metastases (p < .001). The combined finding of globular, isodense enhancement was seen in 67% of cavernous hemangiomas and none of the metastases. Only 10% of cavernous hemangiomas had nonglobular, hypodense enhancement, compared with 90% of metastases. Combining all criteria, reviewers correctly classified 122 (92%) of the lesions. Presence of globular enhancement, isodense with the aorta, was 67% sensitive and 100% specific in differentiating cavernous hemangiomas from hepatic metastases. CONCLUSION. In most cases, differentiation of cavernous hemangiomas from hepatic metastases can confidently be made with single-pass, contrast-enhanced CT. Globular enhancement, isodense with the aorta, is 67% sensitive and 100% specific in differentiating cavernous hemangiomas and hepatic metastases.
28421.5686688041996.08.05++Focal malignant hepatic lesions: MR imaging enhanced with gadolinium benzyloxypropionictetra-acetate (BOPTA)--preliminary results of phase II clinical application.Radiology
R Caudana, G Morana, GP Pirovano, N Nicoli, A Portuese, A Spinazzi, R Di Rito, GF Pistolesi,
PURPOSE: To investigate enhancement with gadolinium benzyloxypropionictetraacetate (BOPTA) at magnetic resonance (MR) imaging to detect focal malignant hepatic lesions. MATERIALS AND METHODS: A phase II trial was performed in 34 patients. Gd-BOPTA-enhanced spin-echo (SE) and gradient-recalled-echo (GRE) T1-weighted MR imaging were performed at 40 and 90 minutes after intravenous injection of 0.05 and 0.10 mmol/kg Gd-BOPTA. RESULTS: The percentage of enhancement in liver parenchyma was significantly (P<.05) increased on GRE T1-weighted compared with SE T1-weighted images at 40 and 90 minutes after injection of the higher dose and compared with SE and GRE T1-weighted images obtained with the lower dose. The contrast-to-noise ratio of metastases was significantly increased on GRE T1-weighted images (0.10 mmol/kg) at 90 minutes compared with precontrast images. Significantly more small primary metastases were detected on GRE T1-weighted images (0.10 mmol/kg) at 90 minutes compared with precontrast SE T1-weighted images. CONCLUSION: Gd-BOPTA is a safe hepatobiliary contrast agent that helps detection of small metastases.
28521.55103905611999.09.14++Chemotherapy-treated liver metastases mimicking hemangiomas on MR images.Abdom Imaging
RC Semelka, S Worawattanakul, TC Noone, DA Burdeny, NL Kelekis, JT Woosley, JK Lee,
BACKGROUND: To report the observation that chemotherapy-treated liver metastases may mimic the appearance of hemangiomas on T2-weighted and serial postgadolinium gradient-echo magnetic resonance (MR) images. METHODS: T2-weighted and serial postgadolinium spoiled gradient-echo images were prospectively and retrospectively analyzed in six patients. All patients had been treated with chemotherapy for a duration of 2-12 months. Histopathologic evaluation of liver lesions was performed in three patients. RESULTS: Twelve lesions that resembled hemangiomas were identified. Lesions were 0.8-5.5 cm in diameter. All were well defined, oval or lobulated, and demonstrated decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. On immediate postgadolinium images, all lesions demonstrated peripheral nodular enhancement, which coalesced on delayed imaging. Final histopathologic diagnoses were as follows: hepatic metastases from colon cancer (two patients), ovarian cancer (two patients), pancreatic islet cell tumor (one patient), and breast cancer (one patient). CONCLUSIONS: Metastases treated by chemotherapy may mimic the appearance of hemangiomas on a variety of commonly employed MR techniques. In patients undergoing MR imaging for the evaluation of liver metastases, a history of prior chemotherapy administration and duration should be sought to prevent inaccurate staging and inappropriate therapeutic decision making.
28621.5442462821970.08.05+ [Nodular lymphoma of the spleen]Nouv Rev Fr Hematol
J Bousser, J Delarue, G Bilski-Pasquier, J Diebold, R Zittoun, C Dao,
28721.544145901978.03.21++Angiographic diagnosis of benign and malignant splenic tumors.AJR Am J Roentgenol
T Kishikawa, Y Numaguchi, K Watanabe, K Matsuura,
Fifteen cases of benign and malignant nodular splenic tumors, including six cysts, one hamartoma, two hemangiosarcomas, five reticulum cell sarcomas, and one Hodgkin's disease, are presented with their arteriographic manifestations. The value of splenic arteriography is emphasized, since it may provide rather specific information in the diagnosis of benign and malignant nodular splenic tumors. Differential diagnostic considerations are also discussed.
28821.48111787002001.05.10++Peliosis hepatis with pseudotumoral and hemorrhagic evolution: CT and MR findings.Abdom Imaging
F Ferrozzi, G Tognini, G Zuccoli, F Cademartiri, P Pavone,
Peliosis hepatis is an uncommon benign disorder characterized by blood-filled cavities within the liver. We describe the sonographic, computed tomographic, and magnetic resonance appearance of a patient affected by peliosis hepatis with pseudotumoral and hemorrhagic evolution and direct demonstration of the ectatic vascular components.
28921.47166280482006.06.02++A case of lymphangioleiomyomatosis affecting the supraclavicular lymph nodes.J Comput Assist Tomogr
T Kamitani, H Yabuuchi, H Soeda, Y Matsuo, T Okafuji, S Sakai, M Hatakenaka, T Minami, H Inoue, A Tanaka, H Kohno, M Tanaka, Y Nakashima, H Honda,
The case of a 46-year-old woman with lymphangioleiomyomatosis (LAM) involving the supraclavicular, mediastinal, and pelvic lymph nodes in addition to the lungs is reported. Computed tomography incidentally revealed multiple thin-walled pulmonary cysts and low-attenuating masses in the supraclavicular, mediastinal, and retroperitoneal lymph nodes. A biopsy of the supraclavicular mass was performed and diagnosed as LAM histopathologically. The common sites of extrapulmonary LAM include retroperitoneal and mediastinal lymph nodes; however, supraclavicular lymph node involvement is extremely rare.
29021.4515358881992.03.23++Osteomyelitis in children: gadolinium-enhanced MR imaging.Radiology
BC Dangman, FA Hoffer, FF Rand, EJ O'Rourke,
Fifteen pediatric patients with biopsy- or culture-proved nonspinal osteomyelitis were studied with magnetic resonance (MR) imaging. Osteomyelitis was acute in seven patients, subacute in three, and chronic in five. Four patients had subperiosteal abscesses, one had a large associated soft-tissue abscess, and one had an intraosseous (Brodie) abscess. Areas of active inflammation had decreased marrow signal intensity on T1-weighted images, increased signal intensity on T2-weighted images, and enhancement on T1-weighted images obtained after gadopentetate dimeglumine administration (n = 10). Abscesses were rim enhancing (n = 3) or not (n = 2) with gadolinium-enhanced MR imaging. Nonenhancing areas presumably represented necrotic material. Gadolinium-enhanced MR imaging assisted in definition of the presence and extent of nonvascularized fluid collections within the bone and/or adjacent soft tissues and the extent of bone involvement in patients with chronic osteomyelitis. It also helped guide surgical debridement of intraosseous disease (n = 7) and open or percutaneous drainage of subperiosteal or soft-tissue fluid collections (n = 5).
29121.4320485361991.07.12+ Splenic hemangioma.AJR Am J Roentgenol
DG Disler, FS Chew,
29221.426194001978.02.18++CT-pathologic correlations in Hodgkin's disease and non-Hodgkin's lymphoma.Radiology
RS Breiman, RA Castellino, GS Harell, WH Marshall, E Glatstein, HS Kaplan,
In order to assess its potential uses in the staging and treatment planning of lymphoma, CT was performed in 27 newly diagnosed, previously untreated patients with Hodgkin's disease or non-Hodgkin's lymphoma; 18 staging laparotomies provided pathologic correlations. CT detected and defined disease in areas not well evaluated by conventional techniques (high para-aortic, mesenteric, splenic hilar nodes). CT interpretation of splenic size and weight correlated well with splenic weight confirmed at pathology. Nodules were identified in several spleens containing foci of lymphoma.
29321.4083815511993.03.11++Islet cell tumors: comparison of dynamic contrast-enhanced CT and MR imaging with dynamic gadolinium enhancement and fat suppression.Radiology
RC Semelka, MJ Cumming, JP Shoenut, CM Magro, CS Yaffe, MA Kroeker, HM Greenberg,
Ten patients with 11 islet cell tumors underwent dynamic contrast material-enhanced computed tomography (CT) and magnetic resonance (MR) imaging within a 1-month period. MR imaging depicted all 11 tumors, and CT depicted seven of the 11 tumors. CT did not depict four of seven tumors that measured 2.5 cm in diameter or less. Islet cell tumors had low signal intensity on T1-weighted fat-suppressed MR images, and gastrinomas were best shown with this technique. Two of three insulinomas less than 1.5 cm in diameter were best shown on dynamic contrast-enhanced fast low-angle shot (FLASH) images as uniform areas of high signal intensity. Hepatic metastases were seen in five patients and showed peripheral ringlike enhancement best demonstrated on dynamic gadolinium-enhanced FLASH images. Hepatic lesions were most conspicuous on T2-weighted fat-suppressed spin-echo images. MR imaging with dynamic gadolinium enhancement and fat suppression is a promising tool in the investigation of islet cell tumors.
29421.3979728081994.12.21++Small pancreatic adenocarcinomas: efficacy of MR imaging with fat suppression and gadolinium enhancement.Radiology
T Gabata, O Matsui, M Kadoya, J Yoshikawa, S Miyayama, T Takashima, T Nagakawa, M Kayahara, A Nonomura,
PURPOSE: To compare the efficacy of fat-suppressed T1-weighted magnetic resonance (MR) imaging and dynamic MR imaging in the diagnosis of small pancreatic adenocarcinomas. MATERIALS AND METHODS: Pancreatic adenocarcinomas in 15 patients were evaluated with dynamic computed tomography (CT) and five MR imaging sequences that included fat-suppressed T1-weighted technique and dynamic multiplanar gradient-recalled acquisition in the steady state technique. RESULTS: The difference in contrast-to-noise ratios between tumor and normal pancreas was significantly different (P < .05) between the five MR imaging sequences used. In six patients, the combination of dynamic MR imaging and fat-suppressed imaging was superior to dynamic CT in the detection of tumors. Tumors accompanied by chronic pancreatitis were less distinct on fat-suppressed images but were clearly visible on dynamic MR images. Peripancreatic extension of tumors was better recognized on T1-weighted images and CT scans than on fat-suppressed images. CONCLUSION: Fat-suppressed T1-weighted images and dynamic MR images were useful in the detection of pancreatic carcinomas. T1-weighted images and CT scans were superior in the evaluation of tumor extension.
29521.3640133571985.08.01+ Splenectomy for splenomegaly and secondary hypersplenism.World J Surg
WW Coon,
29621.3682392201993.12.01+ [Post-traumatic splenic pseudocyst]An Esp Pediatr
E Noya Beiroa, J García-Casillas Diaz, D Nieto Balmesada, F Reverte Blanc,
29721.3277162871995.05.15++[Ultrasound aspects in AIDS-related splenic diseases]Radiol Med
L Cecconi, V Schininà, E Busi Rizzi, G Mazzuoli,
The authors reviewed retrospectively 139 splenopathies detected during 432 US examinations of the abdomen in AIDS patients to assess the role of US in correlation with anamnestic-clinical data and histologic findings in 45 cases. Splenomegaly was the main sign of abnormal splenic conditions, since it was present in all the examined patients. Twenty-one cases exhibited focal lesions. Non-Hodgkin's lymphomas were the only kind of neoplastic condition, which were detected in 15% of cases. In 57% of cases splenopathy was correlated with an infective agent, with a marked prevalence of Mycobacteria-i.e., tubercular in 26% and atypical in 22%. In the splenopathies with histologic confirmation which exhibited a focal US pattern (47%), US proved to be useful in assessing splenic involvement, however aspecific its signs, and in its monitoring, especially in the lesions with unexpected colliquative evolution, as in two cases of atypical mycobacteriosis.
29821.3228166341989.12.18++Dynamic MR imaging of the liver with Gd-DTPA: initial clinical results.AJR Am J Roentgenol
RR Edelman, JB Siegel, A Singer, K Dupuis, HE Longmaid,
Gd-DTPA was evaluated as a hepatic contrast agent for MR imaging. Twenty-six consecutive patients referred for suspected masses in the liver were studied at 1.5 T. Fourteen patients had hepatic metastases and one patient each had cholangiocarcinoma and multicentric hepatocellular carcinoma. Four patients had cavernous hemangiomas and the remainder had other benign lesions. Diagnoses were proved by biopsy, sonography, or radionuclide scintigraphy in 23 cases and by autopsy in one case. Precontrast scans were obtained by using standard pulse sequences. In addition, breath-hold scans were obtained before and after bolus administration of 0.1 mmol/kg Gd-DTPA by using a multislice T1-weighted gradient-echo pulse sequence with an ultrashort echo time. Mean lesion-liver signal difference/noise increased by 50% (p less than .01) in the immediate postcontrast phase. In two of 26 cases, multiple additional lesions as small as 3 mm were detected after contrast administration that were not seen before contrast administration. In no case was lesion-liver contrast worsened on scans obtained immediately after administration of contrast material. However, on delayed scans, detection of lesions worsened in some cases because of equilibration of contrast material between liver and lesion. These initial clinical results suggest that enhancement with Gd-DTPA is a practical method for improving lesion-liver contrast and has the potential to improve the accuracy of MR imaging in the liver. However, optimized fast imaging techniques are required for best results.
29921.3015222701992.10.15++Gd-DTPA enhanced MRI of cervical anterior epidural venous plexus.J Comput Assist Tomogr
ND Gelber, RL Ragland, JR Knorr,
Seventy selected cases were reviewed retrospectively to assess the normal Gd-DTPA enhanced MR appearance of the cervical anterior epidural venous plexus. This structure can enhance quite markedly and has a somewhat variable appearance on MR imaging but we believe that it can be differentiated from pathological enhancement in the area if attention is paid to its normal anatomical characteristics.
30021.2753522441970.01.07+ [Splenic diseases from the surgical point of view]Chirurg
RX Zittel,
30121.22173045352007.04.18++Primary vascular neoplasms unique to the spleen: littoral cell angioma and splenic hamartoma diagnosis by fine-needle aspiration biopsy.Diagn Cytopathol
RB Ramdall, TM Alasio, G Cai, GC Yang,
We report the fine-needle aspiration (FNA) biopsy diagnosis of two rare cases of primary vascular neoplasms unique to the spleen: a littoral cell angioma from a 31-yr-old Caucasian woman and a splenic hamartoma from a 46-yr-old black man. The cytologic features of splenic hamartoma and of littoral cell angioma of the spleen were described three times in cytologic literature: two were bench-top aspirates and one was FNA biopsy thought to be metastatic carcinoma. To the best of our knowledge, the current two cases were the first diagnosed by FNA biopsy. Our approach to the FNA biopsy diagnosis of these rare vascular neoplasms via compact cell block and immunohistochemistry is described. The differential diagnosis with other primary vascular splenic neoplasms is also discussed.
30221.2114304571992.12.16+ Gadolinium-enhanced MRI of pigmented villonodular synovitis of the knee.J Comput Assist Tomogr
PR Bessette, PA Cooley, RP Johnson, DJ Czarnecki,
30321.17170484532007.01.19++Solitary splenic lesions.Semin Ultrasound CT MR
DM Warshauer, HL Hall,
Solitary splenic lesions are unusual. A differential diagnosis can be organized around their basic imaging appearance as either predominantly cystic or solid. Other imaging characteristics, including vascular enhancement and activity on Tc-99m sulfur colloid scan, as well as clinical history may narrow the diagnostic possibilities. Cystic lesions include post-traumatic, inflammatory and infectious pseudocysts, congenital cysts, lymphangiomas and cystic metastasis. Solid lesions include both nonneoplastic lesions such as splenic hamartoma, benign tumors such as hemangioma and malignant masses including lymphoma and angiosarcoma. Percutaneous biopsy may be used for histologic diagnosis when required.
30421.0886154011996.06.06++Case report: splenic hamartoma with hematologic disorders.Am J Med Sci
RJ Wirbel, U Uhlig, KM Futterer,
Hamartomas of the spleen are rare benign tumors usually detected as asymptomatic, incidental findings at laparotomy or autopsy. By review of the literature, there are only 16 well-documented cases of symptomatic splenic hamartomas associated with hematologic disorders. The authors report on an additional case of splenic hamartoma in a 34-year-old man with thrombocytopenia. Findings by ultrasonography and computed tomography suggested multiple confluent splenic lesions. Because of progressively increasing thrombocytopenia, elective splenectomy was performed. Final pathology confirmed diagnosis of multiple hamartomas of the red pulp. Platelet count returned to normal within 1 month postoperatively. Differential diagnosis, diagnostic procedures, and pathologic findings of splenic hamartomas will be discussed. Hamartomas should be kept in mind in the differential diagnosis of splenic tumors. Splenectomy is indicated in cases where malignancy cannot be excluded and in cases of associated hematologic disorders.
30521.07114227862001.08.23++Concomitant inflammatory pseudotumor of the liver and spleen.Liver
G Di Vita, M Soresi, R Patti, A Carroccio, P Leo, V Franco, G Montalto,
We report the case of a 53-year-old man with inflammatory pseudotumor (IPT) of the liver and spleen. This concomitant association has rarely been reported. The patient presented with a hypoechoic mass in the liver and a clinical picture of recurrent sepsis; hematochemical exams and imaging data were nonspecific. Antibiotic therapy improved the clinical course, but did not resolve it definitively. After 50 days of therapy, as the hepatic mass decreased a similar lesion appeared in the spleen. The final diagnosis was made on splenectomy and an intra-operative biopsy of the residual liver lesion. The diagnostic problems encountered in this very rare association of IPT of the liver and spleen were similar to those for isolated IPT in the respective single organ sites. After 15 months of follow-up, the patient is in good health and no recurrence of symptoms or masses has been observed.
30621.0434479281988.06.09+ [Value of contrast enhancement with Gd-DTPA in MRI of brain tumors. A comparison with X-ray CT]Fukuoka Igaku Zasshi
T Tsuji, T Kishikawa, K Ikezaki, K Fujii, S Matsumoto, T Koga,
30721.0288738561997.01.13++Natural history of focal nodular hyperplasia of the liver: an ultrasound study.J Clin Ultrasound
M Di Stasi, E Caturelli, I De Sio, A Salmi, E Buscarini, L Buscarini,
Sixteen cases of focal nodular hyperplasia (FNH) of the liver were followed by ultrasound (US) for a mean of 33 months (range 6-81). In 69% of the cases, the diagnosis was incidental. On US the lesions were single in 75% of the cases, localized in the right lobe in 75%, and subcapsular in 50%. No specific US-pattern could be identified. A central scar was found in 19% of the patients. At the end of the follow-up, the size was reduced in 7/16 cases, and in 1/16 the lesion disappeared. The spontaneous reduction of nodules in FNH must be considered in the management of this pseudotumor.
30821.0126500081989.05.25++Adrenal hemangiomas: two case reports with a review of the literature.Surgery
A Del Gaudio, G Solidoro, G Martinelli,
Hemangiomas, although frequently found elsewhere, are rarely encountered in the adrenal gland. Only 17 surgical cases of adrenal hemangiomas have been reported, with an additional case not surgically treated. The pertinent literature has been reviewed. Two additional cases, one identified preoperatively and both removed surgically, are presented herein. Ultrasonograms and computed tomographs showed large, necrotic masses without calcifications. Preoperative angiograms taken for case 1 demonstrated pooling of contrast media within this mass, strongly suggesting a diagnosis of hemangioma; case 2 lacked similar angiographic findings. The radiologic finding of calcifications, when present, along with the characteristic angiographic appearance of a hemangioma, allows the radiologist to correctly diagnose this benign tumor preoperatively. Although rare, these tumors should be part of the differential diagnosis of adrenal neoplasms.
30921.00161341582006.02.23++Sonographic findings of hibernoma. A report of two cases.J Clin Ultrasound
J Hardes, S Scheil-Bertram, E Hartwig, C Gebert, G Gosheger, M Schulte,
We present 2 cases of hibernoma, a rare lipomatous tumor arising from brown fat tissue. In each case, a hyperechoic mass in comparison to surrounding musculature combined with elevated vascularization was highly suggestive of a liposarcoma. As a rule, malignancy cannot be excluded safely by imaging modalities, and a preoperative biopsy should be performed. Although rare, hibernomas should be considered in the differential diagnosis of lipomatous soft-tissue tumors.
31020.9922742581991.02.22++[True or primary splenic cysts]Minerva Chir
D Cavanenghi, M Grassini, GM Amerio, V Sorisio,
Two cases of splenectomy are reported following the diagnosis of a rare pathology of the spleen in the form of two primary, non-parasitic and non traumatic spleen cysts. One was located on an epithelial wall and the other on an endothelial wall.
31120.9867795861981.03.24++Percutaneous needle biopsy in abdominal lymphoma.AJR Am J Roentgenol
J Zornoza, FF Cabanillas, TM Altoff, N Ordonez, MA Cohen,
Percutaneous needle biopsy of lymph nodes and abdominal masses was performed in 48 patients with abdominal lymphoma. A correct diagnosis was obtained in 15 of 28 biopsies performed on lymph nodes and in 17 of 25 abdominal masses or organs. The overall success rate was 64%. No false-positive diagnoses were rendered. No complications related to the procedure were encountered. The value of this technique in the management of selected patients with abdominal lymphoma is detailed.
31220.9291356421997.05.23++CT patterns of nodular hepatic and splenic sarcoidosis: a review of the literature.J Comput Assist Tomogr
GC Scott, JM Berman, JL Higgins,
PURPOSE: The purpose of our study was to investigate the less commonly demonstrated CT patterns nodular hepatosplenic sarcoidosis. METHOD: We studied five women patients, utilizing contrast enhanced incremental or spiral CT. We also performed a literature search of hepatosplenic sarcoid for the years 1966-1995. RESULTS: We found five nodular hepatic and/or splenic patterns of sarcoidosis. CONCLUSION: We conclude that increased awareness and recognition of these patterns of nodular hepatic/splenic sarcoidosis on CT will greatly improve detection and diagnosis of abdominal sarcoidosis.
31320.9098305441999.01.22++Splenic abscess: a diagnostic and therapeutic challenge.Acta Chir Belg
E de Bree, D Tsiftsis, M Christodoulakis, G Harocopos, G Schoretsanitis, J Melissas,
The records of five patients treated in our department for splenic abscess are analysed and the literature is reviewed. Computed tomography revealed the correct diagnosis in all patients, while clinical presentation was often nonspecific. Spleen-preserving management was possible in two patients (40%). Outcome was uneventful for four patients. One patient with a splenic abscess caused by Mycobacterium tuberculosis and acquired immunodeficiency syndrome, died 4 months after splenectomy from sepsis. We discuss the clinical presentation of splenic abscess, its diagnostic approach, and treatment. Additionally, we studied whether spleen-preserving management is feasible or not.
31420.9086593851996.08.01+ Gastrointestinal case of the day. Sarcoidosis with involvement of liver, spleen, abdominal and thoracic lymph nodes, and lungs.AJR Am J Roentgenol
SP Gay, HA Shaffer, SF Futterer, PM Aitchison, SJ Patel,
31520.89173976362007.06.19+ [37 Year old woman with abdominal discomfort and splenic focal lesion]Rev Clin Esp
M Martínez Celada, M Rivas Carmenado, C García Pravia, M Fresno Forcelledo,
31620.8972536621981.09.22++Acute Hodgkin disease masquerading as splenic abscess.J Surg Oncol
RA Bloom, U Freund, EH Perkes, Y Weiss,
A splenic abscess was erroneously diagnosed in a 65-year-old patient. The diagnosis was established on clinical, radiological and ultrasonographic data. At laparotomy the spleen was markedly enlarged by tumoral tissue and contained a large cystic lesion. The histological diagnosis was typical Hodgkin disease with lymphocytic depletion. Ultrasonography adds valuable information in the diagnosis of splenic lesions. Hodgkin disease should be included in the differential diagnosis of cystic lesions detected in the spleen by this method.
31720.8221209381990.11.19++Spinal cord pial metastases: MR imaging with gadopentetate dimeglumine.AJR Am J Roentgenol
V Lim, DF Sobel, J Zyroff,
The purpose of this investigation was to describe gadopentetate-dimeglumine-enhanced MR findings in metastatic disease to the pial lining of the spinal cord. Correlation was made with clinical data, other radiologic studies, and pathologic findings. Eighty-six patients with a known malignancy and unexplained neurologic signs or symptoms were studied with pre- and postcontrast T1-weighted images. In seven of these patients, abnormal enhancement of the pial lining of the cord was seen on the sagittal postcontrast T1-weighted images. This appeared as a thin rim of enhancement along the surface of the cord in six patients and as a focal, thick rim of enhancement in addition to the thin rim of enhancement in the seventh patient. Axial images confirmed the location along the pial lining in each case. Precontrast T1-weighted images in all seven cases and precontrast T2-weighted images in five cases failed to detect any focal abnormalities of the pial lining of the cord. Pathologic confirmation was available in five of the seven patients. Primary malignancies in these patients included breast carcinomas (two), lymphoma (one), leukemia (one), adenocarcinoma of the lung (one), prostate carcinoma (one), and malignant melanoma (one). Three of seven patients had metastatic disease evident only within the CNS, while four patients had widespread disease outside the CNS. We conclude that contrast-enhanced MR imaging is useful in the diagnosis of pial spread of metastatic disease in patients with a known primary malignancy and unexplained neurologic signs or symptoms.
31820.81103326011999.07.14++CT appearances in abdominal tuberculosis. A pictorial essay.Clin Imaging
MS Gulati, D Sarma, SB Paul,
Abdominal tuberculosis continues to be endemic in the developing world and has shown a resurgence in the West. Computed tomography (CT) evaluation is singularly informative as it demonstrates involvement of the bowel, peritoneum, lymph nodes, and solid organs in a single examination. A spectrum of CT findings in an immunocompetent population is presented, ranging from subtle to advanced and common to rare. Genitourinary tuberculosis and tuberculosis in AIDS are excluded as they merit separate discussions.
31920.7577107911995.05.12++Vascular mass lesions and hypervascular tumors in the head and neck. Characteristics at CT, MR imaging and angiography.Acta Radiol
F Aspestrand, A Kolbenstvedt,
A retrospective analysis of the findings at contrast-enhanced CT, MR imaging and angiography in 24 patients with vascular mass lesions and 11 patients with hypervascular tumors in the head and neck region was undertaken. We attempted to find criteria at CT and MR imaging that could aid in differentiating between different lesion categories. Parameters such as contrast enhancement at CT, signal intensities at MR imaging, phleboliths and peritumoral hypervascularity were correlated to clinical presentation, biopsies and angiography. MR imaging was superior to CT and far better than angiography in delineating cavernous hemangiomas. Contrast-enhanced CT may better differentiate between cavernous and capillary hemangiomas than MR. MR imaging clearly differentiated cavernous hemangiomas from hypervascular tumors, but was, like CT, inadequate for distinguishing between capillary hemangiomas and hypervascular tumors. Lymphangiomas and cavernous hemangiomas had similar appearances at CT and MR imaging.
32020.7482736511994.02.03++MR imaging of the normal meninges: comparison of contrast-enhancement patterns on 3D gradient-echo and spin-echo images.AJR Am J Roentgenol
JW Farn, SA Mirowitz,
OBJECTIVE. The purpose of this study was to determine the enhancement pattern of the normal meninges on T1-weighted three-dimensional Fourier transform gradient-echo (3DGE) MR images and to compare this pattern with that observed on conventional two-dimensional Fourier transform spin-echo (2DSE) images. This will serve as a basis for comparison when cases of suspected meningeal pathology are evaluated. SUBJECTS AND METHODS. The appearance of the normal meninges after administration of gadopentetate dimeglumine was evaluated on 2DSE and 3DGE images in 69 patients who had no known or suspected meningeal abnormality. The total percentage of meningeal surface area that underwent contrast enhancement and the continuity of meningeal enhancement were evaluated at four anatomic levels. RESULTS. In most patients, 2DSE images showed short segments (i.e., < 3 cm) of meningeal enhancement, with enhancement of less than 50% of total meningeal surface area. However, enhancement of 76-100% of total meningeal surface area was routinely observed on 3DGE images, with long segments (i.e., > 3 cm) or continuous patterns most frequently observed. The differences between 2DSE and 3DGE sequences were statistically significant for all regions that were assessed. CONCLUSION. Continuous meningeal enhancement or enhancement of long segments of normal meninges is routinely observed on contrast-enhanced 3DGE images; this appearance differs from those of enhanced 2DSE images and should not be interpreted as abnormal.
32120.7296632791998.09.21++Detection of hepatic tumors: arterial-phase MR imaging versus spiral CT arteriography.Abdom Imaging
M Kanematsu, H Hoshi, Y Sone, R Mochizuki, M Kato, R Yokoyama,
BACKGROUND: To compare the utility of arterial-phase magnetic resonance (APMR) imaging and spiral computed tomography arteriography (CTA) for detection of hepatic tumors. METHODS: Both APMR imaging and CTA were performed in 24 patients with liver tumors. APMR imaging was initiated at 25-30 s after an intravenous bolus injection of gadolinium-diethylenetriamine pentaacetic acid using the fast multiplanar spoiled GRASS technique. CTA was initiated at 3 s after hepatic arterial injection of 30-64% nonionic contrast agent. APMR and CTA images were separately reviewed retrospectively by two blinded readers. Afterward, matched pair was reviewed to determine which had better lesion conspicuity. RESULTS: The sensitivities for hepatic tumors were 67.2 and 86.6% in APMR and CTA, respectively (p < 0.01). Seven (12.5%) and 21 (23.9%) false-positive lesions were seen at APMR and CTA, respectively (NS). Lesion conspicuity was comparable between APMR and CTA. CONCLUSIONS: Although APMR imaging is an useful noninvasive method to detect hypervascular liver tumors, APMR imaging is still not an alternative to CTA with respect to tumor detectability.
32220.7178084921995.01.31 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3-1995. A 29-year-old man with AIDS and multiple splenic abscesses.N Engl J Med
32320.70127232902003.08.28++Spontaneous splenic rupture--a rare complication of amyloidosis.Swiss Surg
AZ Khan, X Escofet, KM Roberts, AR Salman,
We present a case of spontaneous rupture of the spleen, an uncommon complication of systemic amyloidosis. Amyloid deposition leading to capsular distension and increased vascular fragility is thought to predispose the spleen to rupture spontaneously.
32420.67108454832000.06.21+ Atypical inside-out pattern of hepatic hemangiomas.AJR Am J Roentgenol
S Kim, JJ Chung, MJ Kim, S Park, JT Lee, HS Yoo,
32520.63150181632004.04.08++Cystic angiomatosis with splenic involvement: unusual MRI findings.Eur Radiol
FM Vanhoenacker, AM Schepper, H Raeve, Z Berneman,
Cystic angiomatosis is a rare disorder with a poor prognosis. We describe a case of a 33-year-old woman who presented with long-standing bone pain, hemolytic anemia, and an enlarged spleen. Radiologically, multiple osseous lesions with a mixed pattern of lytic and sclerotic areas were seen within the shoulders, spine, and pelvis. On CT and MRI of the abdomen, the spleen was markedly enlarged, with internal hyperdense foci on non-contrast CT scan, corresponding to low signal intensity areas on all MR pulse sequences. After administration of contrast, a mottled enhancement pattern throughout the entire spleen was seen both on CT and MRI. Cystic angiomatosis was proven by histological analysis of a biopsy specimen of an involved vertebra and histopathological examination of the spleen after subsequent splenectomy. This is the first report of a patient with disseminated cystic angiomatosis with splenic involvement in which the MRI features differ from the previous reports. Instead of the usual pattern consisting of multiple well-defined cystic lesions, a diffuse involvement replacing the entire spleen, with heterogeneous signal intensities on T2-weighted images and heterogeneous enhancement pattern, was seen in our patient.
32620.6139017051985.11.08++Percutaneous drainage of postoperative abdominal and pelvic lymphoceles.AJR Am J Roentgenol
M White, PR Mueller, JT Ferrucci, RJ Butch, JF Simeone, CC Neff, I Yoder, N Papanicolaou, RC Pfister,
Eleven patients with postoperative abdominal and pelvic lymphoceles underwent percutaneous diagnostic and therapeutic intervention with either needle aspiration or catheter drainage. Although initial sonographic or CT examinations accurately identified these collections, definitive diagnosis required fluid sampling and laboratory analysis for confirmation. Seven pelvic and two retroperitoneal lymphoceles demonstrated a gross appearance and composition different from two lymphatic collections in the upper peritoneum. Nine patients underwent catheter drainage; two were managed by needle aspiration alone. Duration of catheter drainage was 4-120 days, substantially longer than is customary for standard fluid collections. Nine of 11 patients were cured by percutaneous aspiration or drainage alone. Bacterial colonization developed in three persistently draining lymphoceles. However, no clinical sepsis or bacteremia occurred. In another patient with persistent high-volume lymphatic output, sclerotherapy with tetracycline instillation was successful in rapidly closing the lymphatic fistula. Percutaneous drainage is a safe, effective procedure for drainage of postoperative lymphoceles.
32720.6038396521985.09.26++Fine-needle aspiration of lymphadenopathy of suspected infectious etiology.Arch Pathol Lab Med
LJ Layfield, BJ Glasgow, MH DuPuis,
We present a protocol for culture of lymph node find-needle aspirations in a series of 44 patients. Clinical indications for inclusion in the protocol included fever, localized erythema, pain or heat, an independent clinical diagnosis of infection by the referring physician, or a grossly purulent appearance of the initial aspirate material. Organisms (fungi, bacteria, or mycobacteria) were isolated in 13 (30%) of the aspirates. The probable contamination rate was 9%. These figures approached the culture yields obtained from open biopsy specimens as reported in the literature. A notable discrepancy existed between the cytologic appearance of the aspirates and culture results in three cases of mycobacteria. Six unsuspected malignancies were diagnosed. There were no complications from the procedure in this series. Based on this study, we present recommendations for culture of fine-needle aspirates from lymph nodes.
32820.5510639021976.08.02+ Hemorrhagic pseudocyst of the spleen.J S C Med Assoc
LH Erdman, G Petrossian, JA Ramin,
32920.51175182562007.06.19++Inflammatory pseudotumor of the spleen: CT and MRI findings.Int Surg
PC Ma, SC Hsieh, JC Chien, WT Lao, WP Chan,
Inflammatory pseudotumors rarely occur in the spleen. We report such a case with characteristic computed tomography (CT) and magnetic resonance imaging (MRI) findings. A CT scan showed an isodense nodular mass with gradual mild enhancement on delayed-phase contrast-enhanced images. MRI showed a mass with isointense signal on T1-weighted images and hypointense signal on T2-weighted images. The tumor mass showed progressive inhomogeneous enhancement on gadolinium-enhanced images. The patient received splenectomy, and histologic diagnosis was compatible with inflammatory pseudotumor.
33020.5066496621984.01.07++[Sonographic study of the spleen and retroperitoneal space-occupying masses]Wien Med Wochenschr
H Kathrein, G Judmaier,
Sonography of the spleen allows exact measurements of this organ. There are typical pictures in cysts or hematomas. Diffuse changes of the spleen however are hardly distinguishable in regard to differential diagnosis. Retroperitoneal masses can easily be recognized. Lymph-nodes can be identified and the results of therapeutic interventions can be judged. Hematomas or abscesses can be seen easily. Guided needle biopsy offers the possibility for histologic examinations.
33120.5040536591985.12.19++Differential diagnosis of low-attenuation splenic lesions on computed tomography.J Comput Tomogr
K Chintapalli, MK Thorsen, TL Lawson,
A retrospective computed tomography evaluation of proved low-attenuation splenic lesions in nontraumatic cases was done. Computed tomography was able to distinguish cystic from solid lesions. Although computed tomography examination is sensitive in the detection of low-attenuation lesions, the computed tomography findings alone are not helpful in differentiation of different low-attenuation lesions. Associated computed tomography findings in other organs and clinical findings are more helpful than the size, shape, and computed tomography attenuation of the lesions. Splenic lesions may be the only metastatic manifestation in some cancer patients. A thin needle aspiration may be done to document the nature of the pathologic lesion in problematic cases.
33220.4891687071997.06.24++Still the great mimicker: abdominal tuberculosis.AJR Am J Roentgenol
H Jadvar, RE Mindelzun, EW Olcott, DB Levitt,
Since the mid 1980s, a resurgence of tuberculosis has occurred. The disease is and will remain a serious public health threat worldwide. The clinical and radiologic features of abdominal tuberculosis may mimic those of many diseases. Radiologists evaluating abdominal images should consider the diagnosis of abdominal tuberculosis in immigrants from areas endemic for tuberculosis, in immunocompromised patients, and in high-risk patients such as the homeless. Imaging features that suggest the correct diagnosis are cecal amputation, ileocecal thickening and inflammation, shortening of the ascending colon, gaping of the ileocecal valve, mesenteric adenopathy, a misty mesentery, diffuse omental infiltration, loculate high-density ascites, an enhancing peritoneum with or without an omental line, nodularity of the surface of the mesenteric leaves, and transperitoneal permeation.
33320.4885173231993.07.22++Value of contrast-enhanced CT in detecting active hemorrhage in patients with blunt abdominal or pelvic trauma.AJR Am J Roentgenol
K Shanmuganathan, SE Mirvis, ER Sover,
OBJECTIVE. The purpose of this retrospective study was to evaluate the use of contrast-enhanced CT to show sites of active hemorrhage as a guide for surgical or angiographic treatment in patients sustaining blunt abdominal or pelvic trauma. MATERIALS AND METHODS. Twenty-six CT scans were reviewed to compare the location or locations of extravasated contrast material (representing hemorrhage) detected on CT scans with the site or sites of active hemorrhage determined by surgery (eight patients), angiography (14 patients), or autopsy (one patient). (The three remaining patients had no additional studies done.) The attenuation of extravasated contrast material on CT scans was measured and compared with the CT attenuation of an adjacent artery. The attenuation of clotted blood within the abdomen or pelvis was also measured in 20 other patients with blunt trauma. RESULTS. The locations of active bleeding as determined by extravasation of contrast material shown on CT scans included the pelvis (nine), spleen (five), retroperitoneum (four), kidney (three), liver (three), adrenal glands (one), and abdominal wall (one). Two patients had venous extravasation. The origin of bleeding was confirmed in all cases to correspond to the anatomic region in which extravasated contrast material was shown by CT. Three patients had only CT evidence of vascular extravasation of contrast material. The CT attenuation of active hemorrhage ranged from 85 to 370 H (mean, 132 H). A review of 20 additional CT scans that showed clotted blood in the abdomen or pelvis resulting from blunt abdominal trauma revealed a CT attenuation range of 40-70 H (mean, 51 H). These values were significantly different (p < .001) from the values for active hemorrhage. CONCLUSION. Active extravasation of contrast material (representing bleeding) can be detected in trauma patients who are physiologically stable enough to undergo CT of the abdomen or pelvis. Extravasated contrast material can be distinguished from clotted blood by measuring CT attenuation. CT accurately shows the anatomic location of bleeding and indicates the probable vascular origin. CT, therefore, can be used as a guide for angiographic or surgical intervention.
33420.4135214221986.07.08++The early diagnosis of splenic abscess.Am Surg
S Teich, GC Oliver, JW Canter,
Five cases of splenic abscess seen between 1970 and 1984 are reviewed. The predisposing factors included preceding pyogenic infection, sickle cell disease, and contiguous disease in the pancreas. Abdominal pain and fever were the most frequent presenting symptoms. The most common physical finding was left upper quadrant (LUQ) abdominal tenderness. All patients were treated with splenectomy. In one patient percutaneous drainage was attempted prior to splenectomy but failed. The mortality rate was 20 per cent. Radiologic procedures developed in the last ten years make possible the early diagnosis and treatment of splenic abscess. The treatment of choice remains antibiotics followed by splenectomy.
33520.3881470131994.05.05+ [A case from general practice (14): isolated splenomegaly]Z Arztl Fortbild (Jena)
H Berndt,
33620.35122397622002.12.03++[Splenic abscesses: 6 cases in 15 years]Chir Ital
C Ammaturo, N Capuano, F Miele, M Alderisio, A Ciamillo, S Pastore, R Rossi, E D'Eliso, M Bassi, M Ingrosso, E Iavazzo, E Iervolino,
Splenic abscesses are a rare type of disease, owing to the quite exceptional primary forms, but the prevalence of the disease is rising as a result of the increase in the population at risk. The authors report on their experience based on 6 observations of such cases over a period of 15 years. The diagnosis was obtained by ultrasonography in all 6 cases. Only one case was successfully treated by percutaneous drainage, the other 5 all requiring splenectomy. Only one patient, suffering from Chédiak-Higashi disease, died of bronchopneumonia 6 months postoperatively. Nowadays the disease is diagnosed earlier than it was in the past owing to the increasingly widespread use and refinement of diagnostic methods, but even today identification of splenic abscess may still be late due to the presence of predisposing diseases which mask the clinical picture, and also because, since the condition is so rare, one very often fails to think of it in the early stages. An analysis of the recent literature indicates that percutaneous drainage is a reliable technique which presents a high therapeutic success rate and low cost compared to surgery. Though we believe that the ongoing progress in the fields of ultrasonography and CT-guided intervention may allow us to treat increasing numbers of patients with splenic abscesses in future, we feel, also in the light of our own experience, that splenectomy still remains the reference treatment, in that ideal conditions for successful percutaneous drainage do not often present themselves.
33720.3580798581994.10.04++Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography.AJR Am J Roentgenol
JA Gagliardi, EM Chung, VP Chandnani, KL Kesling, KP Christensen, RN Null, MG Radvany, MF Hansen,
OBJECTIVE. Chondromalacia patellae is a condition characterized by softening, fraying, and ulceration of patellar articular cartilage. We compare the sensitivity, specificity, and accuracy of conventional MR imaging, MR arthrography, and CT arthrography in detecting and staging this abnormality. SUBJECTS AND METHODS. Twenty-seven patients with pain in the anterior part of the knee were prospectively examined with MR imaging, including T1-weighted (650/16), proton density-weighted (2000/20), T2-weighted (2000/80), and spoiled two-dimensional gradient-recalled acquisition in the steady state (SPGR/)/35 degrees (51/10) with fat saturation pulse sequences. All were also examined with T1-weighted MR imaging after intraarticular injection of dilute gadopentetate dimeglumine and with double-contrast CT arthrography. Each imaging technique was evaluated independently by two observers, who reached a consensus interpretation. The signal characteristics of cartilage on MR images and contour abnormalities noted with all imaging techniques were evaluated and graded according to a modification of the classification of Shahriaree. Twenty-six of the 54 facets examined had chondromalacia shown by arthroscopy, which was used as the standard of reference. The sensitivity, specificity, and accuracy of each imaging technique in the diagnosis of each stage of chondromalacia patellae were determined and compared by using the McNemar two-tailed analysis. RESULTS. Arthroscopy showed that 28 facets were normal. Grade 1 chondromalacia patellae was diagnosed only with MR and CT arthrography in two (29%) of seven facets. Intermediate (grade 2 or 3) chondromalacia patellae was detected in two (13%) of 15 facets with T1-weighted and SPGR MR imaging, in three (20%) of 15 facets with proton density-weighted MR imaging, in seven (47%) of 15 facets with T2-weighted MR imaging, in 11 (73%) of 15 facets with CT arthrography, and in 12 (80%) of 15 facets with MR arthrography. Grade 4 was detected in three (75%) of four facets with T1-, proton density-, and T2-weighted MR imaging, two (50%) of four facets with SPGR MR imaging, and four (100%) of four facets with MR and CT arthrography. Thus, all imaging techniques were insensitive to grade 1 lesions and highly sensitive to grade 4 lesions, so that no significant difference among the techniques could be shown. CONCLUSION. All imaging techniques studied had high specificity and accuracy in the detection and grading of chondromalacia patella; however, both MR arthrography and CT arthrography were more sensitive than T1-weighted, proton density-weighted, and SPGR with fat saturation MR imaging for showing intermediate grades of chondromalacia patellae. Although the arthrographic techniques were not significantly better than T2-weighted imaging, the number of false-positive diagnoses was greatest with T2-weighted MR imaging.
33820.3266738871984.06.05++Splenic abscess: a review with the value of ultrasound.Clin Radiol
Y Hertzanu, DB Mendelsohn, E Goudie, A Butterworth,
Five cases of splenic abscess are presented. A positive ultrasound diagnosis was made in each patient, showing a regular or ill-defined anechoic mass with large or small, high-intensity echogenic foci due to contained debris. Computed tomography performed in two cases showed intrasplenic low-density areas essentially unchanged following intravenous contrast administration. Gas was present in one of the abscesses. The clinical implications in a septicaemic patient with intrasplenic gas formation following splenic embolisation are discussed.
33920.3192759091997.09.16+ Sonographic guidance of needle position for MR arthrography of the shoulder.AJR Am J Roentgenol
R Valls, P Melloni,
34020.30100770231999.05.04++A retrospective analysis of the accuracy of T2-weighted images and dynamic gadolinium-enhanced sequences in the detection and characterization of focal hepatic lesions.J Magn Reson Imaging
RS Pawluk, S Tummala, JJ Brown, JA Borrello,
The aim of this study was to determine the relative ability of T2-weighted and dynamic gadolinium-enhanced T1-weighted gradient-echo sequences to detect and characterize focal hepatic lesions. We retrospectively studied 37 patients with proven focal hepatic lesions using the following sequences: a T1-weighted spin-echo sequence (T1), a T2-weighted sequence (T2), and a series of breath-hold dynamic gadolinium-enhanced T1-weighted gradient-echo sequences (Gd). Two observers were asked to determine retrospectively the number and type of focal hepatic lesions present using images from three combinations of sequences (T1+T2, T1+Gd, T1+T2+Gd). Proof of the number and diagnosis of focal lesions in each patient was established using a consensus read. Both readers detected more focal lesions when both the T2-weighted sequences and the gadolinium-enhanced sequences were available than on either sequence alone, although this improvement reached statistical significance (P<0.05) only for one of the readers. There was no significant difference (P<0.05) in the ability to characterize lesions between any of the sets of sequences. The combination of dynamic gadolinium-enhanced images and T2-weighted images was shown to assess focal hepatic lesions better than either of these sequences alone.
34120.2786729731996.08.15++The frequency, appearance, and significance of splenic perfusion defects in CT arterial portography.Abdom Imaging
LN Nazarian, RJ Wechsler, CK Grady,
BACKGROUND: The purpose of this study was to determine the frequency, appearance, and significance of splenic perfusion defects on computed tomographic arterial portography (CTAP). METHODS: CTAP was performed with dynamic scanning at 1-cm increments on 46 consecutive patients prior to laparotomy. Two readers retrospectively reviewed these studies in consensus and recorded the number, size, and shape of focal splenic perfusion defects. These defects were later correlated with surgical findings and at least one of the following imaging modalities: delayed CT 4-6 h after CTAP, intravenously enhanced CT, sonography, or magnetic resonance imaging (MRI). RESULTS: Splenic perfusion defects were present in 14 of 46 CTAP studies (30%), and in seven patients these defects were multiple. Most defects were wedge-shaped and peripherally located, although several round defects simulating metastases were also present. The spleen was normal at surgery in all patients, and comparison imaging revealed only a small splenic infarct in one patient on MRI.CONCLUSIONS: Splenic perfusion defects occur in about one-third of patients referred for CTAP, are usually wedge-shaped but may be round, and should not be interpreted as metastases without other evidence of a space-occupying mass.
34220.2685191481993.07.29++A radiological study of abdominal tuberculosis in a Saudi population, with special reference to ultrasound and computed tomography.Clin Radiol
T Denton, J Hossain,
The radiological appearances of abdominal tuberculosis are presented, which includes peritoneal, liver, spleen and pancreatic disease, but excludes renal and musculoskeletal involvement. Twenty-three patients were studied, 12 of whom had TB peritonitis. Barium studies remain valuable in gastrointestinal tract disease but for peritoneal, splenic, hepatic and pancreatic disease, ultrasound and computed tomography are indicated. Their diagnostic value is further enhanced by guided aspiration and biopsy techniques.
34320.2391687101997.06.24+ MR arthrography: a review of current technique and applications.AJR Am J Roentgenol
JW Helgason, VP Chandnani, JS Yu,
34420.1971778171983.02.14++[Discovery of benign hepatic lesions during investigation for hepatic metastases]Nouv Presse Med
H Martelli, JM Tubiana, C Huguet,
Benign lesions may be unexpectedly discovered when investigating for liver metastases. This is illustrated here by 6 cases of alleged liver metastasis in patients previously operated upon for cancer and referred for hepatectomy. The diagnosis was corrected by additional examinations or on surgery. A model of diagnostic and therapeutic approach is suggested. As a rule, a cystic lesion seen on ultrasonography does not require supplementary arteriography and needle biopsy -- are necessary in cases of dense, heterogeneous lesions.
34520.1634907551986.12.16++Patterns of liver injury in childhood: CT analysis.AJR Am J Roentgenol
HP Stalker, RA Kaufman, R Towbin,
Forty-eight consecutive cases of liver injury diagnosed by CT in hemodynamically stable children were analyzed retrospectively for anatomic location, type of injury, associated nonhepatic injuries, and complications. It was found that the right lobe was involved in 83% of all injuries, and that the posterior segment of the right lobe was injured most often. Right-sided injuries were usually superficial and simple, while left-sided injuries were more likely to be deep and complex. Significant complications were associated with deep, complex, perihilar injuries. Retroperitoneal blood collections were noted around the adrenal, in a distribution not previously described. Injuries of the hepatic dome were most characteristic and were often associated with injuries of the lung base, kidney, ribs, and pneumothorax.
34620.1489881961997.01.29++Breast neoplasms: T2* susceptibility-contrast, first-pass perfusion MR imaging.Radiology
CK Kuhl, H Bieling, J Gieseke, T Ebel, P Mielcarek, F Far, P Folkers, A Elevelt, HH Schild,
PURPOSE: To evaluate the differentiation of benign from malignant breast tumors with T2*-weighted perfusion magnetic resonance (MR) imaging (blood volume imaging) versus that with dynamic T1-weighted contrast agent-enhanced MR imaging. MATERIALS AND METHODS: Ten healthy adult volunteers and 18 adult patients with benign or malignant lesions underwent both conventional T1-weighted dynamic contrast-enhanced breast MR imaging and repetitive first-pass, single-section, dynamic T2*-weighted perfusion MR imaging. Images were obtained before, during, and after injection of 20 mL of gadopentetate dimeglumine; peak gadopentetate dimeglumine concentrations were calculated from the maximal signal intensity loss on T2*-weighted images. RESULTS: No perfusion effect was detectable in healthy breast parenchyma. A strong susceptibility-mediated signal intensity loss occurred in malignant breast tumors. No or only minor perfusion effects were seen in fibroadenomas, in spite of their rapid enhancement at T1-weighted dynamic imaging. Perfusion imaging was possible after conventional dynamic contrast-enhanced breast MR imaging. CONCLUSION: T2*-weighted perfusion imaging exploits the susceptibility-mediated signal intensity loss of a first-pass bolus of gadopentetate dimeglumine within the capillary bed. First-pass perfusion imaging of breast lesions is feasible. It is promising in the differentiation of benign from malignant, rapidly enhancing lesions.
34720.1478066591995.01.31++Ultrasound evaluation of hepatic and splenic microabscesses in the immunocompromised patient: sonographic patterns, differential diagnosis, and follow-up.J Clin Ultrasound
C Görg, R Weide, WB Schwerk, H Köppler, K Havemann,
High-dose chemotherapy, especially for bone marrow transplantation, causes a great degree of immunosuppression, and thus carries the risk for invasive fungal infections. Although hepatic and splenic involvement in disseminated candidiasis is frequent, involvement of these organs is rarely appreciated antemortem. During the last decade, focal hepatosplenic candidiasis has been recognized increasingly by ultrasound. We report the sonographic and clinical findings of 6 patients: 3 AML (acute myeloid leukemia), 2 NHL (non-Hodgkin's lymphoma), and 1 HD (Hodgkin's disease) who demonstrated multiple, small-nodule, hypoechoic lesions in spleen and/or liver after high-dose chemotherapy. All patients were in complete hematologic remission when the study was performed. Septic fever was unresponsive to antibiotic therapy. Granulocytopenia (< or = 1000/mm3) was seen for at least 10 days. However, the manifestation of hepatolienal microabscesses became apparent by ultrasound only after the neutrophil count returned to normal in all but 1 patient. Microabscesses decreased or disappeared on follow-up examination after antifungal treatment. Systemic candida infection was confirmed serologically. Sonographic-guided abscess biopsy (n = 3) revealed necrosis/abscess. Structural inhomogeneity of parenchymal organs was seen for several months after therapy.
34820.1284281081993.03.09++Primary ovarian cancer: prospective comparison of contrast-enhanced CT and pre-and postcontrast, fat-suppressed MR imaging, with histologic correlation.J Magn Reson Imaging
RC Semelka, PH Lawrence, JP Shoenut, M Heywood, MA Kroeker, R Lotocki,
Sixteen patients with clinically suspected malignant ovarian disease underwent contrast agent-enhanced computed tomography (CT) and magnetic resonance (MR) imaging in a prospective comparative study. MR imaging included fat-suppressed spin-echo and breath-hold FLASH (fast low-angle shot) before and after intravenous injection of gadopentetate dimeglumine. Histologic confirmation was obtained at laparotomy (n = 13) and biopsy (n = 3). Thirteen patients had histologically proven primary ovarian cancer. MR images showed the internal architecture of ovarian tumors better than CT in nine patients and equivalently in seven. MR images showed the relationship between ovarian tumors and adjacent pelvic structures (uterus [n = 9], sigmoid colon [n = 7], bladder [n = 7], and rectum [n = 3]) better than CT in nine patients and equivalently in seven. Intraabdominal extent of disease was better defined on MR than on CT images in nine patients, equivalently in six, and worse in one. Peritoneal metastases 1-2 cm in diameter were detected on MR images and missed on CT scans in six patients. In only one case did this result in a staging error with CT. The results suggest that MR imaging is at least equivalent and may be superior to CT in the evaluation of ovarian malignancy.
34920.12150245172004.12.22++Wandering spleen with torsion of vascular pedicle: early diagnosis with multiplaner reformation technique of multislice spiral CT.Abdom Imaging
K Taori, N Ghonge, A Prakash,
Wandering spleen is a rare clinical radiologic entity characterized by splenic hypermobility due to laxity or maldevelopment of the supporting splenic ligaments. The cause for hypermobility may be hormonal changes during pregnancy or failure of fusion of the dorsal peritoneum. Patients may be asymptomatic, present with a movable lump in the abdomen, or present with acute, chronic, or intermittent symptoms due to torsion of the wandering spleen. Early clinical diagnosis is difficult, so imaging modalities play an important role. We report a case of wandering spleen in which multiplanar reformation of thin maximum intensity projection images played a pivotal role in its precise diagnosis.
35020.11146288782003.12.23++Multiple inflammatory pseudotumors of the spleen: case report.Abdom Imaging
WC Wu, ZY Lin, WL Chuang, WY Chang,
The imaging findings of multiple splenic inflammatory pseudotumors in a 45-year-old male are described. Peripheral ring enhancement on arterioportal phase and gradual enhancement from the periphery to the center on venous delay phase on contrast-enhanced dynamic magnetic resonance imaging were compatible with the pathologic findings. This result may aid in the preoperative diagnosis of these benign lesions.
35120.1039079311986.02.14++The value of ultrasonic scanning of the spleen in lymphoma.Clin Radiol
DJ King, AA Dawson, AP Bayliss,
In 40 patients assessed for splenic enlargement prior to splenectomy, clinical examination and ultrasonic scanning gave equally accurate results when compared with splenic weight after removal. In the 22 patients having staging laparotomy and splenectomy for Hodgkin's disease, ultrasound was unable to assess accurately the presence of tumour deposits.
35220.08121304472002.08.09++Multidetector CT: detection of active hemorrhage in patients with blunt abdominal trauma.AJR Am J Roentgenol
JK Willmann, JE Roos, A Platz, T Pfammatter, PR Hilfiker, B Marincek, D Weishaupt,
OBJECTIVE: The aim of this study was to determine the imaging findings and the prevalence of active hemorrhage on contrast-enhanced multidetector CT in patients with blunt abdominal trauma. MATERIALS AND METHODS: Contrast-enhanced multidetector CT images of 165 patients with blunt abdominal trauma were reviewed for the presence of extravasated contrast agent, a finding that represents active hemorrhage. The site and appearance of the hemorrhage were noted on multidetector CT images. These findings were compared with surgical and angiographic results or with clinical follow-up. RESULTS: On multidetector CT images, active hemorrhage was detected in 22 (13%) of 165 patients with a total of 24 bleeding sites (14 intraperitoneal sites and 10 extraperitoneal sites). Active hemorrhage was visible most frequently as a jet of extravasated contrast agent (10/24 bleeding sites [42%]). Diffuse or focal extravasation was less frequently seen (nine [37%] and five [21%] bleeding sites, respectively). CT attenuation values measured in the aorta (mean, 199 H) were significantly higher than those measured in extravasated contrast material (mean, 155 H) (p < 0.001). Sixteen (73%) of 22 patients with active bleeding on multidetector CT images underwent immediate surgical or angiographic intervention. One patient received angiographic therapy 10 hr after undergoing multidetector CT, and five patients died between 1 and 3 hr after multidetector CT examination. CONCLUSION: Active hemorrhage in patients after blunt abdominal trauma is most frequently visible as a jet of extravasated contrast agent on multidetector CT. When extravasation is detected, immediate surgical or angiographic therapy is required.
35320.0832850581988.06.16+ [Ultrasonographic study of splenic mass lesions]Rinsho Hoshasen
T Tomita, A Kurosaki, M Irimoto, K Takeuchi, G Watanabe,
35420.0726843711989.12.29++The changing spectrum of splenic abscess.Clin Imaging
PL Caslowitz, JD Labs, EK Fishman, SS Siegelman,
Thirteen cases of splenic abscess were reviewed retrospectively from pathologic and medical records from 1978 through 1986. Splenic abscess is uncommon, but the diagnosis has been made more frequently in recent years due to the increasing number of living immunosuppressed patients and to the use of more sophisticated radiologic diagnostic techniques. Five patients had a solitary abscess (SA) and eight had multiple abscesses (MA). Seventy-five percent of the patients with MA were immunosuppressed, most had no symptoms from the splenic abscess, and none died. Only one patient (with SA) died, a mortality of 10% overall. Previously the mortality has been 40 to 70%. The decreased mortality may in part be attributable to the more rapid diagnosis (3.8 days for SA, 1.8 days for MA) of the splenic abscess, prompting early treatment. Improved radiologic studies reduce the time to diagnosis and thereby improve the prognosis. Computed tomography (CT) was diagnostic for splenic abscess in 4 of 7 patients and suggestive of abscess in the other 3. Computed tomography was the diagnostic modality of choice in suspected splenic abscess, as it provided more information than the other radiologic studies used.
35519.9989561291997.03.05++Hepatic parenchymal hyperperfusion abnormalities detected with multisection dynamic MR imaging: appearance and interpretation.J Magn Reson Imaging
K Ito, K Honjo, T Fujita, H Awaya, T Matsumoto, N Matsunaga,
On arterial-dominant-phase images in multisection dynamic MR imaging, early-enhancing areas that are perfusion abnormalities rather than tumor deposit are sometimes encountered. The purpose of this article was to determine the frequency, location, and appearance of these hepatic parenchymal hyperperfusion abnormalities and to discuss possible causes of these abnormalities. Multisection dynamic MR images obtained in 415 patients with suspected hepatobiliary diseases were reviewed for the presence of hyperperfusion abnormalities. A total of 96 hyperperfusion abnormalities were identified in 88 (21%) of 415 patients. They were characterised from their shape, distribution, or location as lobar or segmental (n = 36 [38%]), subsegmental (n = 32 [33%]), or subcapsular (n = 28 [29%]) hyperperfusion abnormalities. Presumable etiologies were considered as follows: (a) compression, obstruction, or ligation of the portal vein; (b) siphoning effect by tumor; (c) aberrant cystic venous drainage; (d) percutaneous ethanol injection; (e) percutaneous needle biopsy; (f) rapid drainage by the subcapsular vein; or (g) cirrhosis or unknown. A significant percentage of patients had hepatic hyperperfusion abnormalities. Familiarity with these hyperperfusion abnormalities on multisection dynamic MR images is important to prevent false-positive diagnoses.
35619.9878982681995.04.25++Dynamic contrast-enhanced MR imaging of the liver: parenchymal enhancement patterns.Magn Reson Imaging
JJ Brown, JA Borrello, HS Raza, DM Balfe, AB Baer, TK Pilgram, S Atilla,
A retrospective study of 164 patients undergoing dynamic contrast-enhanced magnetic resonance (MR) imaging was performed to assess hepatic parenchymal enhancement patterns and to correlate these patterns with hepatic function and disease. Rapid T1-weighted images were acquired before and after gadolinium administration. Hepatic enhancement patterns were analyzed blindly by two observers. Medical records were reviewed to document known liver pathology and liver function test results. A total of 72% of patients had homogeneous enhancement of the liver parenchyma; 28% had heterogeneous enhancement. Of the latter group, 61% of patients had enhancement conforming to segmental or lobar boundaries. Patients with heterogeneous enhancement patterns were more likely to have abnormal liver function test results and hepatic morphological abnormalities on their MR examinations than patients with homogeneous enhancement patterns. Heterogeneous hepatic enhancement on dynamic MR images is associated with a higher likelihood of liver disease and biochemical evidence of hepatic dysfunction than homogeneous enhancement.
35719.9735336971986.12.08++Radiographic appearance of diffuse splenic hemangiomatosis.Gastrointest Radiol
SC Rose, DA Kumpe, ML Manco-Johnson,
The evaluation of splenomegaly in a patient with a consumptive coagulopathy included a liver-spleen scan, an abdominal sonogram, and an abdominal computed tomographic scan, which demonstrated an enlarged spleen with a diffuse parenchymal textural abnormality. A diffuse hemangiomatous pattern was present on splenic angiography. A splenectomy was performed and splenic hemangiomatosis was confirmed. The radiographic findings in this rare entity are presented and discussed.
35819.9789265051996.10.30++Image-guided core-needle biopsy in malignant lymphoma: experience with 100 patients that suggests the technique is reliable.J Clin Oncol
D Ben-Yehuda, A Polliack, E Okon, Y Sherman, S Fields, P Lebenshart, H Lotan, E Libson,
PURPOSE: In an initial evaluation of 1,500 computed tomography (CT)-guided core-needle biopsies performed at our institute during the period from 1989 to 1994, we encountered 100 patients with the diagnosis of lymphoma. Here, we review the clinical impact of 109 image-guided needle biopsies in these 100 patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). PATIENTS AND METHODS: NHL was diagnosed in 71 patients, and 29 had HD. Among the NHL patients, 17 (24%) had proven lymphoma diagnosed before the biopsy was performed; in 54 (76%) core-needle biopsy was performed as the first diagnostic procedure. Of 29 HD patients, nine (31%) were already established cases of HD, and in 20 (69%) core-needle biopsy was the first diagnostic procedure attempted. Most of the biopsies were performed under CT control using a 20- or 18-gauge Turner biopsy needle. RESULTS: Eighty-six patients received therapy based on the results of the needle biopsy alone. Fourteen patients received therapy after undergoing surgical biopsy for a suspected diagnosis of lymphoma, which could not be established with certainty on the basis of an earlier core-needle biopsy alone. In 78% of the patients, the needle biopsy saved a further surgical procedure that may have been difficult to perform because of the primary location of the tumor. CONCLUSION: From our experience in this study, image-guided core-needle biopsies provide sufficient information for the diagnosis of and subsequent therapeutic decision to treat most cases of lymphoma.
35919.9664702421984.10.25++Computed tomography of amyloidosis involving retroperitoneal lymph nodes mimicking lymphoma.J Comput Assist Tomogr
S Takebayashi, Y Ono, F Sakai, S Tamura, S Unayama,
A 74-year-old woman had multiple enlarged periaortic nodes with inhomogeneous enhancement on CT. Although a malignancy such as lymphoma was considered, amyloidosis involving retroperitoneal lymph nodes was confirmed on biopsy.
36019.9684277441993.03.10++Quantification of inhomogeneities in malignancy grading of non-Hodgkin lymphoma with MR imaging.Acta Radiol
S Rehn, GO Sperber, R Nyman, B Glimelius, H Hagberg, A Hemmingsson,
In a previous study of 50 patients with non-Hodgkin lymphoma (NHL) it was shown that the inhomogeneous appearance of a tumor at MR imaging strongly indicated a high malignancy grade. In this study of 33 patients with NHL, the administration of an i.v. contrast medium, Gadolinium-DTPA, improved the subjective detectability of the inhomogeneities. A method of quantifying the degree of inhomogeneity in the tumors (inhomogeneity index, IH-index) was developed and tested. The mean value of IH-index in the T2-weighted image before contrast medium administration, and of the T1-weighted image after contrast medium administration, as well as the IH-index value in the T2-weighted image before contrast medium administration alone, was able to discriminate well between low- and high-grade NHL. This method of quantifying the degree of inhomogeneity in tumors improved sensitivity in detecting high-grade NHL.
36119.9483109231994.03.17++Blunt splenic trauma in adults: can CT findings be used to determine the need for surgery?AJR Am J Roentgenol
CD Becker, P Spring, A Glättli, W Schweizer,
OBJECTIVE. The role of CT grading of blunt splenic injuries is still controversial. We studied the CT scans of adult patients with proved blunt splenic injuries to determine if the findings accurately reflect the extent of the injury. We were specifically interested in establishing if CT findings can be used to determine whether patients require surgery or can be managed conservatively. MATERIALS AND METHODS. The CT scans of 45 patients with blunt splenic injuries were analyzed retrospectively, and the CT findings were correlated with the need for surgery. We used (1) a CT scale (I-V) for splenic parenchymal injuries that also allowed a comparison with the surgical findings in patients who underwent laparotomy, and (2) a CT-based score (1-6) that referred to both the extent of parenchymal injuries and the degree of hemoperitoneum. Early laparotomy was done in nine patients. Conservative treatment was attempted in 36 patients and was successful in 31; five patients needed delayed laparotomy after attempted conservative treatment. RESULTS. According to the CT scale (I-V), 25 patients had injuries of grade I or II; 20 patients were successfully treated conservatively, whereas five patients needed delayed surgery. Nineteen patients had injuries of grade III, IV, or V; eight patients underwent early laparotomy, and 11 patients were successfully treated conservatively. CT findings were false-negative in one patient who underwent early surgery for diaphragmatic rupture. A comparison of the CT findings with the intraoperative findings according to the CT scale (I-V) revealed identical parenchymal injury grades in four cases, whereas the injuries were underestimated on CT scans in four patients and overestimated on CT scans in six patients. The CT-based score (1-6) was applied to 41 patients; four patients who had peritoneal lavage before CT were excluded. Twelve patients had scores below 2.5; 10 patients were successfully treated conservatively, and two patients needed delayed surgery. Twenty-nine patients had scores of 2.5 or higher; six patients underwent early laparotomy, 20 patients were successfully treated conservatively, and three patients needed delayed surgery. Patients who required delayed surgery had a mean score of 3.0 (SD, +/- 1.0), which was similar to those who did not require surgery (3.1 +/- 1.5; p = .45). CONCLUSION. Our results show that CT findings cannot be used to determine reliably which patients require surgery and which patients can be treated conservatively. Even patients with splenic parenchymal injuries of CT grade III, IV, and V and with CT-based scores of 2.5 or higher can be successfully treated conservatively if the clinical situation is appropriate, whereas delayed splenic rupture can still develop in patients with low CT grades or scores. The choice between operative and nonoperative management of splenic trauma should be mainly based on clinical findings rather than CT findings.
36219.9256841931968.12.08+ Splenectomy for the diagnosis fo splenomegaly.Ann Surg
RE Hermann, KE De Haven, WA Hawk,
36319.8829773201989.05.26+ [A rare manifestation of Hodgkin's disease: splenic abscess]Clin Ter
F Pentimone, M Filidei, G Frustaci,
36419.8876400991995.09.20++Pituitary microadenoma. MR appearance and correlation with CT.Acta Radiol
W Wu, KA Thuomas,
Twenty surgically proven pituitary microadenomas were examined with MR imaging and CT. MR demonstrated 20 of 20 microadenomas: 90% of the tumors were hypointense on T1-weighted images before Gd-DTPA administration and in 45% the tumors were more clearly delineated postcontrast. CT demonstrated 19 of 20 diagnosed microadenomas: showing low attenuation in 85% of the tumors precontrast. Iohexol facilitated delineation of the tumors in 45%. Focal enlargement of the gland and diaphragma sellae convexity were more useful than infundibular tilting and sellar-floor erosion as ancillary findings supporting the diagnosis. In general, CT and MR agreed regarding the microadenomas size and location, measurement of enlarged intrasellar contents, detection of the diaphragma sellae bulge, and demonstration of infundibulum abnormality. CT was more sensitive than MR in identifying sellar-floor erosion. We suggest that CT be the first method for demonstration of microadenomas.
36519.87106331452000.02.03++Ultrasound of the spleen.World J Surg
MW Andrews,
Ultrasound (US) is a very useful means of noninvasively examining the spleen. Imaging is generally achieved via an intercostal approach using gray scale US supplemented by color flow to assess vasculature. Normal spleen appears uniform with vessels radiating and converging at the hilum. US readily identifies accessory spleens, a common congenital variation. Splenomegaly can be identified by US, however, it is not useful in differentiating the many causes of an enlarged spleen. Focal splenic masses are identified as cystic or solid by US, and features such as calcification, wall thickening, internal debris, and gas may be demonstrated in cystic type masses. Granulomatous calcification may be seen with US and cavernous hemangiomata typically have a characteristic US appearance. US can demonstrate typical features of splenic infarction. Splenic injury can be detected with US, however, whether US is the most appropriate first line investigation for suspected splenic injury is yet to be determined. It is a very useful follow-up modality for monitoring splenic injuries detected by either US or computed tomography which are treated conservatively.
36619.87159058202005.09.08+ Abdomen. Appendicitis and splenic hemangiomas.Ultrasound Q
E Wechsler, J Chertoff, RD Harris,
36719.8186438511996.07.17++[Peripheral intrahepatic cholangiocarcinoma. The role of imaging diagnosis and fine-needle biopsy]Radiol Med
L Matricardi, R Lovati, A Provezza, S Capra, L Grazioli, S Casoni, F Callea,
Peripheral intrahepatic cholangiocarcinoma (ICC) is a fairly uncommon type of cancer in Italy which may be misdiagnosed as a metastasis from extrahepatic adenocarcinoma. In all, 22 cases of intrahepatic cholangiocarcinoma were diagnosed at the Radiology Department of the University of Brescia, Italy, from 1989 to 1994. The patients were 15 men and 7 women and their age ranged 30-77 years. Most of them underwent US examinations because of abdominal pain, weight loss or a general malaise and, less frequently, for signs of cholestasis. Hepatic cirrhosis was found in 8 patients. US showed a single nodular lesion with irregular margins in 6 cases and a large nodule with adjacent smaller satellite nodules in 12 cases. In the other 4 subjects, an infiltrative and diffuse lesion with no apparent nodules was observed. US showed hypoechoic lesions in 17 cases and both hypo- and hyperechoic areas in the other patients. The main nodular lesion was 1-3 cm in diameter in 2 cases, 3-10 cm in 15 and over 10 cm in 6 cases. Both hepatic lobes were involved in 14 patients. Twenty-one of 22 patients were submitted to CT and 3 to MR examinations. Both techniques confirmed US findings of an intrahepatic tumor but they did not help locating its origin in the intrahepatic biliary tract. Therefore, every patient was submitted to US-guided fine needle biopsy which allowed the correct diagnosis to be made in 12 cases. The remaining 10 patients had an initial diagnosis of adenocarcinoma metastases and only further studies of the histologic specimens, performed after a series of useless and negative exams (e.g., barium enema and endoscopy), allowed ICC to be correctly diagnosed. Since no typical pattern of this type of cancer can be observed with US, CT or MR examinations, we suggest that US-guided fine needle biopsy be used as the method of choice, which however needs a fruitful cooperation between the radiologist and the pathologist.
36819.8123180731990.05.07+ [Malignant hemangioendothelioma of the spleen as an incidental finding of abdominal surgery]Chirurg
M Fuchs, G Fuchs, J Schleef,
36919.79102074351999.05.05++Heterogeneous splenic enhancement patterns on spiral CT images in children: minimizing misinterpretation.Radiology
LF Donnelly, JN Foss, DP Frush, GS Bisset,
PURPOSE: To (a) determine the appearances and timing of heterogeneous splenic enhancement at spiral computed tomography (CT) and (b) identify variables influencing heterogeneous splenic enhancement. MATERIALS AND METHODS: Sequential isolevel (24-mAs) CT images of the spleen obtained at 6-second intervals after initiation of contrast material injection in 112 children (mean age, 4.5 years) were reviewed. Heterogeneity characteristics assessed included type, onset, maximum, and resolution. Relationship to variables (injection rate, age, splenomegaly) was assessed with the Fisher exact test. RESULTS: Eighty-one of the 112 patients (72%) had transient heterogeneity: archiform (45 patients), diffuse (25 patients), and focal (11 patients). Mean times were as follows: initial visualization after onset of contrast material injection, 19.2 seconds; maximum heterogeneity, 27.3 seconds; and resolution, 47.4 seconds. Statistically significant relationships were seen between frequency of heterogeneity and injection rate (> or = 1 mL/sec, 82%; < 1 mL/sec, 50% [P = .001]), age (> 1 year, 76%; < or = 1 year, 46% [P = .04]), and splenomegaly (present, 20%; absent, 77% [P = .048]). CONCLUSION: Heterogeneous splenic contrast enhancement is common, has several patterns of appearance, and is predictably encountered during the 70 seconds after the initiation of contrast material injection. Injection rate, age, and presence of splenic disease influence the frequency with which these artifacts are encountered.
37019.7893137361997.10.23++Clinical utility of abdominal CT scanning in patients with HIV disease.Clin Radiol
H Sansom, B Seddon, SP Padley,
AIM: To evaluate the yield of abdominal computed tomography (CT) in patients with human immunodeficiency virus (HIV) infection and to assess the influence of CT scanning on patient management and diagnosis. METHOD: A retrospective analysis of 216 abdominal CT scans, performed on 156 patients (147 men, nine women; age range 22-57 years), between March 1992 and October 1994 was undertaken. Clinical information, including the indication for performing the scan and the eventual diagnosis, was obtained from the case notes and the contribution of CT scanning to patient management assessed. RESULTS: Indications for CT fell into five main groups: investigation of pyrexia of unknown origin (PUO) (n = 82), staging and response to treatment of previously diagnosed neoplasms (n = 46), investigation of abdominal pain (n = 20), CT undertaken to clarify the results of other imaging investigations (n = 20) and miscellaneous indications (n = 48). An eventual diagnosis thought to account for the clinical presentation was made in 150 cases (68%), reflecting the high level of underlying pathology. CT contributed to patient management in a large proportion of cases (62%), but only led directly to a diagnosis in a minority (12%). CONCLUSION: With the exception of patients presenting with PUO, abdominal CT remains an important investigation in the management of patients with HIV infection. In patients presenting with PUO a thorough infection screen should be undertaken prior to CT scanning. Whilst frequently contributing to patient management, CT rarely leads directly to a diagnosis.
37119.7635264001986.09.18++Gaucher disease: sonographic appearance of the spleen.Radiology
SC Hill, JW Reinig, JA Barranger, J Fink, TH Shawker,
Ultrasonographic (US) examinations of the upper abdomen were performed in 80 patients with Gaucher disease. Of the 49 patients that had not undergone splenectomy, 47 had splenic enlargement. Sixteen patients had multiple lesions in the spleen. Most patients had discrete hypoechoic lesions that corresponded pathologically to focal homogeneous clusters of Gaucher cells. Several patients had similar lesions that were hyperechoic and were composed of Gaucher cells and fibrosis or infarction. A few patients had a geographic pattern of irregular areas of involvement of Gaucher cells among normal splenic parenchyma. The liver was often enlarged but otherwise sonographically unremarkable. Patients with Gaucher disease often have US examinations of the left upper quadrant for abdominal pain. A variety of US findings in the spleen typical for Gaucher disease should be recognized and not interpreted as acute changes.
37219.7484706111993.05.13++MR imaging of the myocardium using nonionic contrast medium: signal-intensity changes in patients with subacute myocardial infarction.AJR Am J Roentgenol
MC Dulce, AJ Duerinckx, J Hartiala, GR Caputo, M O'Sullivan, MD Cheitlin, CB Higgins,
OBJECTIVE. Gadodiamide injection (Omniscan, Sanofi Winthrop Pharmaceuticals, New York) is a new nonionic MR contrast medium that has been shown in animal studies to provide persistent differential enhancement of myocardial infarction. Because differential enhancement of normal and infarcted myocardium may be useful for the diagnosis and sizing of myocardial infarctions, we assessed the effectiveness of gadodiamide injection in enhancing signal-intensity differences between infarcted and normal myocardium on spin-echo T1-weighted images. SUBJECTS AND METHODS. Signal intensity of normal and infarcted myocardium, contrast ratio, contrast-to-noise ratio, and signal-to-noise ratio were measured in 12 patients with subacute myocardial infarction (mean, 16 days after diagnosis) before and after injection of contrast medium. Precontrast T1-weighted and T2-weighted images were obtained with a 1.5-T MR imager. T1-weighted images were acquired 5, 15, and 30 min after gadodiamide injection (0.2 mmol/kg) and T1-weighted images with fat saturation were acquired 10 min after gadodiamide injection. RESULTS. Gadodiamide injection significantly increased signal intensity of normal (34 +/- %) and infarcted (90 +/- %) myocardium compared with their signal intensities on precontrast T1-weighted images. The contrast ratio was significantly increased, and the augmented ratios persisted throughout the 45-min observation period. The contrast ratio on T2-weighted images was comparable to that on contrast-enhanced T1-weighted images (with or without the use of fat saturation). However, the signal-to-noise and contrast-to-noise ratios of T2-weighted images were significantly lower than those of contrast-enhanced T1-weighted images. The maximum contrast-to-noise ratio for visualizing myocardial infarction was achieved on contrast-enhanced T1-weighted images with fat saturation. CONCLUSION. Improved and persistent contrast between infarcted and normal myocardium can be produced on MR images by injecting gadodiamide at a dose of 0.2 mmol/kg, which provides prolonged delineation of myocardial infarctions. Maximum contrast-to-noise ratios for detecting myocardial infarction can be produced by using fat-saturated T1-weighted imaging after a high dose of this nonionic contrast medium has been administered.
37319.7217297871992.02.13++Dynamic MR imaging of the abdomen with gadopentetate dimeglumine: normal enhancement patterns of the liver, spleen, stomach, and pancreas.AJR Am J Roentgenol
MM Hamed, B Hamm, ME Ibrahim, M Taupitz, AE Mahfouz,
To show the normal contrast enhancement patterns of the upper abdominal organs, dynamic gadopentetate dimeglumine-enhanced MR imaging of the upper abdomen was performed in 48 patients. Although all patients were originally examined for focal hepatic lesions, none of them had diffuse parenchymal disease of any of the examined organs. Dynamic gadopentetate dimeglumine-enhanced MR imaging was done by using a heavily T1-weighted gradient-echo sequence (100/5 [TR/TE], 80 degrees flip angle) performed before, and repeatedly for a period of 10 min after, an IV bolus injection of gadopentetate dimeglumine (0.1 mmol/kg). Signal enhancement in each of the organs was calculated by measuring the signal intensity before and after administration of contrast medium. All organs showed signal enhancement within the first 2 min (p less than .001) and a continuous decline thereafter. The enhancement of the pancreas, liver, stomach wall, spleen, and renal cortex reached peaks of 75%, 78%, 96%, 144%, and 216%, respectively, 45 sec after administration of contrast medium. Liver and pancreas showed a homogeneous enhancement pattern throughout the examination. The spleen appeared heterogeneous during the first 60 sec and homogeneous thereafter. Two zones could be distinguished on the contrast-enhanced images of the stomach wall: an enhanced inner zone and an unenhanced outer zone. We conclude that homogeneous enhancement of the liver and pancreas, early heterogeneous enhancement of the spleen, and enhancement of the inner gastric wall are normal patterns on dynamic gadopentetate dimeglumine-enhanced MR images.
37419.7230987901987.02.03++Left lobe of the liver mimicking perisplenic collections.J Clin Ultrasound
MS Crivello, IM Peterson, RM Austin,
Three patients were scanned in whom the sonographic diagnoses of perisplenic fluid collections were made. Computed tomography scanning demonstrated that the appearances were not caused by perisplenic pathology but by lateral extent of normal left lobe of the liver. Methods to avoid this potential sonographic pitfall are suggested.
37519.7021832871990.05.15++Lymphangioma of the retroperitoneum: CT and sonographic characteristic.Radiology
AJ Davidson, DS Hartman,
The authors retrospectively evaluated radiologic, clinical, and pathologic findings in 19 cases of lymphangioma of the retroperitoneum. The tumors were judged confined to one compartment of the retroperitoneum in 68% of the cases, whereas in 32% of cases the tumor involved more than one compartment. Abdominal radiography depicted the mass in all cases. Excretory urography demonstrated organ displacement without tumor invasion in all cases. Sonography showed multiloculated fluid in 61% of cases and a unicameral mass in 39% of cases. All but one of the multiloculated lymphangiomas had thick septa. Sonography also depicted the fluid as uncomplicated in 56% of cases. The remainder had debris that sometimes layered in the dependent portion of the cyst. Computed tomography (CT) showed a unicameral mass in 57% and a septated mass in 43% of cases. CT also showed thin, smooth walls in 79% and thick, irregular walls in 21% of cases. At CT the fluid contents were found to be homogeneous and of fluid attenuation in 64% and were complex in 36% of cases. The attenuation of fluid in one case was the same as that of retroperitoneal fat. In two cases the mass contained mural calcification. The most characteristic radiologic finding of lymphangioma of the retroperitoneum is an elongated tumor containing uncomplicated fluid with or without septa. Chyle and mural calcification are very uncommon in this location.
37619.6593084951997.10.16+ MR imaging of ureteropelvic junction obstruction.AJR Am J Roentgenol
PV Prasad, FM Hall,
37719.65175464042008.01.10++CT-guided biopsy of small liver lesions: visibility, artifacts, and corresponding diagnostic accuracy.Cardiovasc Intervent Radiol
J Stattaus, H Kuehl, S Ladd, T Schroeder, G Antoch, HA Baba, J Barkhausen, M Forsting,
PURPOSE: Our study aimed to determine the visibility of small liver lesions during CT-guided biopsy and to assess the influence of lesion visibility on biopsy results. MATERIAL AND METHODS: Fifty patients underwent CT-guided core biopsy of small focal liver lesions (maximum diameter, 3 cm); 38 biopsies were performed using noncontrast CT, and the remaining 12 were contrast-enhanced. Visibility of all lesions was graded on a 4-point-scale (0 = not visible, 1 = poorly visible, 2 = sufficiently visible, 3 = excellently visible) before and during biopsy (with the needle placed adjacent to and within the target lesion). RESULTS: Forty-three biopsies (86%) yielded diagnostic results, and seven biopsies were false-negative. In noncontrast biopsies, the rate of insufficiently visualized lesions (grades 0-1) increased significantly during the procedure, from 10.5% to 44.7%, due to needle artifacts. This resulted in more (17.6%) false-negative biopsy results compared to lesions with good visualization (4.8%), although this difference lacks statistical significance. Visualization impairment appeared more often with an intercostal or subcostal vs. an epigastric access and with a subcapsular vs. a central lesion location, respectively. With contrast-enhanced biopsy the visibility of hepatic lesions was only temporarily improved, with a risk of complete obscuration in the late phase. CONCLUSION: In conclusion, visibility of small liver lesions diminished significantly during CT-guided biopsy due to needle artifacts, with a fourfold increased rate of insufficiently visualized lesions and of false-negative histological results. Contrast enhancement did not reveal better results.
37819.6580920251994.10.20+ Detection of hepatocellular carcinoma with dynamic MR imaging during intraarterial infusion of gadopentetate dimeglumine.AJR Am J Roentgenol
T Fujita, K Ito, T Choji, K Honjo, T Matsumoto, T Arita, T Nakanishi,
37919.65109612212000.09.07++[Comparison of contrast harmonic imaging in B-mode with stimulated acoustic emission, conventional B-mode US and spiral CT in the detection of focal liver lesions]Rofo
M Beissert, M Jenett, M Keberle, C Kessler, D Klein, M Beer, D Hahn,
PURPOSE: Comparison between contrast harmonic imaging (CHI) in B-mode with stimulated acoustic emission (SAE), conventional B-mode US, and spiral CT in the detection of focal liver lesions. METHODS: In this pilot study 26 patients with liver lesions diagnosed by B-mode US and contrast-enhanced spiral-CT were additionally examined with CHI in B-mode. Each examination started with a bolus injection of 4 g of the US contrast agent Levovist (300 mg/ml) after a delay of at least 5 minutes to ensure liver-specific phase. All examinations were documented on video tapes and analysed by two radiologists. RESULTS: 81 liver lesions were diagnosed with both US examinations and spiral CT. B-mode US detected 66 lesions, CHI with SAE 72 lesions, and spiral CT 73 lesions. Compared to spiral CT 8 lesions in 3 patients could be depicted additionally with both US methods. Metastases and HCC present in CHI with SAE as not-enhancing signal contrast agent areas. Delineation of haemangiomas and FNH was often worse compared to the native examinations. CONCLUSION: The new US method CHI with SAE depicted more lesions than conventional B-mode US and is in some cases superior to spiral CT.
38019.64120163712002.06.18++Transient peritumoral enhancement during dynamic MRI of the liver: cavernous hemangioma versus hepatocellular carcinoma.J Comput Assist Tomogr
JS Yu, KW Kim, MS Park, SW Yoon,
PURPOSE: The purpose of this work was to compare the incidence and pattern of transient peritumoral parenchymal enhancement for cavernous hemangioma and hepatocellular carcinoma during dynamic MRI of the liver. METHOD: Two hundred seven hemangiomas and 155 hepatocellular carcinomas up to 4 cm in size were retrospectively assessed. The peritumoral enhancement was comparatively analyzed in terms of the shape, extent, signal intensity, and dependence on the size and degree of contrast enhancement of each tumor. RESULTS: For small lesions (<2 cm), hemangiomas (16/141; 11.3%) showed a higher incidence (p = 0.026) of peritumoral enhancement than hepatocellular carcinomas (3/87; 3.5%). For larger lesions (2-4 cm), there was no significant difference (p > 0.05) in the incidence of peritumoral enhancement of hemangiomas (15/66; 22.7%) and hepatocellular carcinomas (15/68; 22.1%). Nineteen (61.3%) of the 31 hemangiomas showed contrast agent filling the entire tumor volume at the phase of peritumoral enhancement. CONCLUSION: In spite of the limited specificity, for a <2 cm small focal lesion with homogeneous contrast enhancement on early phase dynamic MR images in the liver, peritumoral enhancement could suggest a higher possibility of hemangioma rather than hepatocellular carcinoma.
38119.6490551291997.05.08++Small hepatocellular carcinoma on magnetic resonance imaging. Relation of signal intensity to angiographic and clinicopathologic findings.Invest Radiol
H Honda, K Kaneko, T Maeda, T Kuroiwa, T Fukuya, K Yoshimitsu, H Irie, H Aibe, K Takenaka, K Masuda,
RATIONALE AND OBJECTIVES: The authors discuss the clinicopathologic features and angiographic vascularity of various signal intensity patterns on magnetic resonance (MR) imaging of small hepatocellular carcinomas (HCCs). METHODS: Magnetic resonance images of 88 resected HCCs (< or = 3 cm) were obtained using T1- and T2-weighted spin-echo images and T1-weighted images after gadolinium (Gd)-DTPA administration. Images were compared with angiographic and histopathologic findings. RESULTS: Forty HCCs (45%) were depicted on T1-weighted images, 51 (58%) on T2-weighted images, and 41 (49%) on T1-weighted images after Gd-DTPA administration. Overall, 64 (76%) were found on at least one image. On T1-weighted images, hyperintense HCCs histologically showed fatty metamorphosis and portal tracts within the tumor. On T2-weighted images, HCC hyperintensity correlated with expansive growth, peliotic change, and hypervascularity. By contrast, HCCs that were undetected or hypointense on T2-weighted images were well differentiated with replacing growth and portal tracts. On T1-weighted images after Gd-DTPA, hyperintense HCCs had peliotic change; undetected HCCs were well differentiated and hypovascular. CONCLUSIONS: Histologic grade, vascularity, portal tracts and peliotic change correlate with MR signal intensity. For hyperintense HCCs on T1-weighted images and hypo- or isointense HCCs on T2-weighted images, treatment methods must be assigned with the consideration that HCCs may be receiving transsinusoidal and portal blood supplies.
38219.6229978731985.12.03++[Value of computer tomographic determination of spleen size for the elucidation of splenic involvement within the framework of primary lymph node neoplasms]Rofo
M Herter, B Ridder, K Lackner, J Vogel,
The splenic index was determined in 155 persons, without evidence of splenic disease, in order to obtain a simple measure of splenic size. Subsequently 36 patients with malignant lymphomas and who then had their spleens removed were examined by CT. A comparison of the CT and pathological-anatomical findings showed that it is a valuable non-invasive method for diagnosing splenic involvement, having a specificity of 86%, sensitivity of 77% and accuracy of 83%.
38319.61102278881999.06.03++Dysplastic nodules of the liver: imaging findings.Abdom Imaging
BI Choi, JK Han, SH Hong, TK Kim, CS Song, KW Kim, MJ Kim, MC Han,
BACKGROUND: To verify characteristic features of hepatic dysplastic nodules at different imaging modalities. METHODS: Twenty-eight patients with 37 dysplastic nodules of the liver (0.8-3.0 cm) underwent sonography (28 patients), computed tomography (CT; 24 patients), magnetic resonance (MR; 11 patients), and angiography (12 patients). Each nodule was analyzed for echogenicity, attenuation, signal intensity, and vascularity. RESULTS: Echogenicity of nodules was high in 16 (43%), homogeneous in two (6%), and low in 19 (51%) of 37 nodules. Attenuation of nodules was high in one (7%), homogeneous in four (26%), and low in 10 (67%) of 15 nodules on the arterial-phase CT images; homogeneous in five (33%) and low in 10 (67%) of 15 nodules on the portal-phase CT images; and high in four (17%), homogeneous in six (26%), and low in 13 (57%) of 23 nodules on the delayed-phase CT images. Signal intensity of nodules was high in 15 (94%) and homogeneous in one (6%) of 16 nodules on T1-weighted MR images and was homogeneous in seven (44%) and low in nine (56%) of 16 nodules on T2-weighted MR images. Vascularity of nodules was avascular in 14 (88%) and slightly vascular in two (12%) of 16 nodules. CONCLUSIONS: Hepatic dysplastic nodules show diverse imaging characteristics with different imaging techniques; however, common imaging findings of hepatic dysplastic nodules are low echo, low attenuation, and high, low, or homogeneous intensity on T1- and T2-weighted MR, and avascularity.
38419.61146690942004.05.21++Inflammatory pseudotumor of the spleen: report of a case.Surg Today
O Alimoglu, U Cevikbas,
We report the case of an inflammatory pseudotumor of the spleen in an asymptomatic 55-year-old woman, whose lesion was accidentally found and clinically misdiagnosed to be lymphoma. An inflammatory pseudotumor of the spleen was histopathologically diagnosed following a splenectomy. This lesion is a benign, reactive, and inflammatory process and its etiopathogenesis still remains elusive. The preoperative diagnosis is difficult and the optimal management of the asymptomastic patient with the disease is unclear. This entity should be kept in mind in the differential diagnosis of splenic space-occupying lesions.
38519.56152733352004.09.27++Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging--do we need contrast-enhanced CT?Radiology
NG Schaefer, TF Hany, C Taverna, B Seifert, KD Stumpe, GK von Schulthess, GW Goerres,
PURPOSE: To retrospectively compare diagnostic value of coregistered fluorine 18 fluorodeoxyglucose positron emission tomographic (PET) and computed tomographic (CT) scans obtained with low-dose nonenhanced CT (PET/CT) with those routinely obtained with contrast material-enhanced CT for staging and restaging of disease in patients with Hodgkin disease or high-grade non-Hodgkin lymphoma. MATERIALS AND METHODS: Sixty patients (mean age, 39.6 years +/- 17.1 [standard deviation]) with Hodgkin disease (n = 42) or high-grade non-Hodgkin lymphoma (n = 18) were included in this retrospective study. All patients underwent PET/CT and contrast-enhanced CT within a maximum of 24 days (mean, 9.1 days +/- 7.0) of each other for staging (n = 19) or first follow-up examination (n = 41). Findings were extracted from original written reports (PET/CT, contrast-enhanced CT) and compared with findings of reference standard, which included biopsy or follow-up with clinical, laboratory, or other imaging findings. For statistical analysis, sensitivity and specificity were calculated with findings of the reference standard. Agreement of both methods was determined with Cohen kappa and McNemar tests on a per-patient basis. RESULTS: For evaluation of lymph node involvement, sensitivity of PET/CT and contrast-enhanced CT was 94% and 88%, and specificity was 100% and 86%, respectively. For evaluation of organ involvement, sensitivity of PET/CT and contrast-enhanced CT was 88% and 50%, and specificity was 100% and 90%, respectively. Agreement of both methods was excellent (kappa = 0.84) for assignment of lymph node involvement but only fair (kappa = 0.50) for extranodal disease. A difference with P <.05 (McNemar test) was considered significant in regard to exclusion of disease with PET/CT, compared with contrast-enhanced CT. CONCLUSION: PET/CT performed with nonenhanced CT is more sensitive and specific than is contrast-enhanced CT for evaluation of lymph node and organ involvement, especially regarding exclusion of disease, in patients with Hodgkin disease and high-grade non-Hodgkin lymphoma.
38619.5617293091992.02.11++Pre- and postcontrast MR studies in tuberous sclerosis.J Comput Assist Tomogr
FJ Wippold, WW Baber, M Gado, PJ Tobben, BJ Bartnicke,
The MR findings in eight patients with intracranial manifestations of tuberous sclerosis are reported. There were subependymal lesions in seven patients and peripheral lesions (i.e., cortical and subcortical) in all patients. All lesions were supratentorial. We emphasize two findings that have not been previously stressed. The signal intensity patterns of the subependymal lesions varied from patient to patient, but in all patients receiving intravenous contrast medium, the majority of these lesions enhanced. Although this finding may signify early breakdown of the blood-brain barrier with potential for lesion growth, the high frequency of enhancement challenges earlier concepts of equating this phenomenon with existence of actively growing giant cell astrocytomas. The peripheral lesions were more numerous than subependymal lesions. These lesions were nearly always hyperintense in the proton density weighted and T2-weighted images. Most notable is the fact that, in half of the lesions, signal intensity was also elevated in the T1-weighted image, an observation that has not been emphasized in previous reports. Although not pathologically confirmed this signal pattern may represent early stages of calcification within these lesions. Finally, unlike subependymal lesions, none of the peripheral lesions showed contrast enhancement.
38719.5389383101997.04.10++Magnetization transfer contrast MR in lesions of the head and neck.AJNR Am J Neuroradiol
AR Gillams, N Fuleihan, G Grillone, AP Carter,
PURPOSE: To compare lesion-to-background contrast with and without magnetization transfer (MT) in lesions of the head and neck. METHODS: Twenty lesions (16 malignant, 4 benign) were evaluated in 17 patients (11 men, 6 women; mean age, 58 years; age range, 39-76 years). In 13 patients, MR imaging was performed at 0.1 T with continuous-wave, off-resonance MT; in 4 patients, MR imaging was performed at 1.5 T with on-resonance, binomial MT prepulses. Fifteen sequences were conducted before the administration of gadopentetate dimeglumine; 13 were conducted after the administration of that contrast material. The ratio of signal intensity with the MT pulses (Ms) to signal intensity without the MT pulses (Mo) was calculated, as were the lesion-to-background contrast and the contrast-to-noise ratios. RESULTS: Ms/Mo showed both wide variability and considerable overlap among different lesion types. Images from MT sequences showed better contrast than those from non-MT sequences in 23 of 28 lesions (12 of 15 before and 11 of 13 after the administration of contrast material). The mean contrast improvement percentages (+/- standard deviation) were 165.5% (+/- 58%) on unenhanced images and 186.6% (+/- 84.8%) on contrast-enhanced images. The mean improvements in contrast-to-noise ratios were 156% (+/- 60%) on unenhanced images and 171.6% (+/- 98.1%) on contrast-enhanced images. CONCLUSION: MT improved contrast between nodes or tumors showing an MT effect and background tissue (usually fat) not showing an MT effect. MT also improved contrast between contrast-enhanced neoplastic lesions and background tissue that showed an MT effect.
38819.53167146242006.05.22+ AJR Teaching File: enlarging splenic mass after nephrectomy.AJR Am J Roentgenol
AC Silva,
38919.5273016241982.01.28++[Cystic lymphangioma of the spleen (author's transl)]Pediatr Med Chir
P Cornaglia-Ferraris, GF Perlino, A Barabino, M Guarino, L Massimo,
The spleen is the least common intra-abdominal site for the development of cystic disease. A lymphoangioma of the spleen was first reported in 1885 by Fink; since that time 47 cases of lymphoangioma or lymphoangectasia have been reported. This report concern a case of cystic lymphoangioma of the spleen consisting of a large splenic cyst with associated multiple small subcapsular cysts and lymphangectasia. The diagnosis and treatment of splenic cysts are discussed and a new classification of splenic cysts is proposed.
39019.5297250061998.09.18++Giant splenomegaly caused by splenic metastases of melanoma.Eur J Surg Oncol
S Kyzer, R Koren, B Klein, C Chaimoff,
Splenic metastases are rare and usually occur in the setting of widespread visceral metastases. Splenomegaly as manifestation of metastatic spread is extremely rare. A patient with melanoma and metastases to the skin and lung is described. He developed a giant painful splenomegaly. The splenectomy specimen demonstrated that the spleen was occupied by metastases from the melanoma. Metastases of melanoma may cause extreme enlargement of the spleen. If the patient's general condition is good, splenectomy is indicated in order to prevent spontaneous rupture of the spleen.
39119.5181918161994.06.22++Fine needle aspiration biopsy of the spleen. A useful procedure in the diagnosis of splenomegaly.Acta Cytol
P Zeppa, A Vetrani, L Luciano, F Fulciniti, G Troncone, B Rotoli, L Palombini,
This study analyzed a series of 140 consecutive fine needle aspiration biopsies of the spleen (sFNAB) collected over a period of nine years. sFNABs were performed by the authors using a 22-gauge spinal needle, and 23-gauge needle in pediatric patients, with a subdiaphragmatic approach. Ultrasound assistance was utilized in 35 cases. Four of the cytocentrifuge specimens were also prepared with part of the aspirated material and used for immunocytochemical staining. Study of these biopsy specimens revealed various benign conditions, such as white pulp hyperplasia, myeloid metaplasia, storage disease, and granulomatous processes and abscesses. Malignant neoplasms were represented by non-Hodgkin's and Hodgkin's lymphomas, leukemias, malignant histiocytoses and metastases. sFNAB was the only diagnostic procedure employed for the morphologic assessment of 60 benign and of 2 malignant cases. In all the other cases sFNAB gave the first diagnosis that was confirmed on surgical specimens. In 2 cases splenic bleeding occurred; one of them required splenectomy. Diagnostic and technical problems are discussed. The authors consider sFNAB a useful procedure, especially in the study of hematologic disorders and in all cases in which splenomegaly is not related or correlated with any clinical finding.
39219.50100244081999.04.05++Splenic hemangiosarcoma with massive calcification.Abdom Imaging
T Kinoshita, K Ishii, Y Yajima, N Sakai, H Naganuma,
We present a case of large splenic hemangiosarcoma in a 40-year-old man associated with consumptive coagulopathy. Computed tomography showed radial calcification within the splenic tumor. On magnetic resonance imaging, T2 shortening represented a meshwork of calcification and surrounding fibrosis. The possibility of hemangiosarcoma should be considered when a large splenic tumor with massive calcification is noted.
39319.50105871381999.12.17++Prevalence and distribution of extraperitoneal hemorrhage associated with splenic injury in infants and children.AJR Am J Roentgenol
CJ Sivit, AA Frazier, MR Eichelberger,
OBJECTIVE: The purpose of this study was to evaluate the prevalence and distribution of associated extraperitoneal hemorrhage in infants and children with splenic injury. CONCLUSION: Splenic injury occasionally resulted in extraperitoneal hemorrhage that tracked into the anterior pararenal space. Extraperitoneal hemorrhage always occurred in association with intraperitoneal hemorrhage. In addition, blood tracking into the anterior pararenal space after splenic injury dissected the splenic vein and pancreas in two (25%) of eight patients.
39419.49100638471999.03.22++Tuberculosis versus lymphomas in the abdominal lymph nodes: evaluation with contrast-enhanced CT.AJR Am J Roentgenol
ZG Yang, PQ Min, S Sone, ZY He, ZY Liao, XP Zhou, GQ Yang, PM Silverman,
OBJECTIVE: Tuberculosis in the abdominal lymph nodes may be difficult to distinguish from lymphomas. This study evaluated specific CT imaging criteria for differentiating these entities. MATERIALS AND METHODS: We retrospectively reviewed the anatomic distribution and CT enhancement patterns of disease in 69 patients, 26 (38%) with tuberculosis and 43 (62%) with untreated lymphomas involving abdominal lymph nodes. Of the patients with tuberculosis, five (19%) had disseminated disease and 21 (81%) had nondisseminated disease. Of the patients with lymphomas, 16 (37%) had Hodgkin's disease and 27 (63%) had non-Hodgkin's lymphoma. RESULTS: Disseminated and nondisseminated tuberculosis involved predominantly lesser omental, mesenteric, anterior pararenal, and upper paraaortic lymph nodes. Lower paraaortic lymph nodes were involved more often in Hodgkin's disease (15 patients [94%]), non-Hodgkin's lymphoma (24 patients [89%]), and disseminated tuberculosis (five patients [100%]) than in nondisseminated tuberculosis (one patient [5%]). Mesenteric lymph nodes were involved more often in disseminated tuberculosis (four patients [80%]) and nondisseminated tuberculosis (11 patients [52%]) than in Hodgkin's disease (one patient [6%]) (p < .01). Anatomic distribution was not different between disseminated tuberculosis and non-Hodgkin's lymphoma. Tuberculous lymphadenopathy commonly showed peripheral enhancement, frequently with a multilocular appearance, whereas lymphomatous adenopathy characteristically showed homogeneous attenuation (14 patients [87.5%] with Hodgkin's disease and 19 patients [70%] with non-Hodgkin's lymphoma [p < .01]). CONCLUSION: Our findings indicate that the anatomic distribution and specific enhancement patterns of lymphadenopathy seen on contrast-enhanced CT can be useful in differentiating between tuberculosis and untreated lymphomas of the abdominal lymph nodes.
39519.4620527041991.07.24++Focal nodular hyperplasia of the liver: assessment with contrast-enhanced TurboFLASH MR imaging.Radiology
D Mathieu, A Rahmouni, MC Anglade, B Falise, C Beges, P Gheung, JJ Mollet, N Vasile,
Twenty-two patients with 25 cases of focal nodular hyperplasia (FNH) proved with pathologic study were imaged with a TurboFLASH (fast low angle shot) sequence combined with bolus administration of gadolinium tetraazacyclododecanetetraacetic acid (DOTA), spin-echo (SE) T2-weighted sequences, and postcontrast T1-weighted sequences. FNH-liver signal-difference-to-noise ratios were quantified; the features of the central scar were qualitatively analyzed. On SE T2-weighted images, all FNHs were hyperintense; in two cases the central scar exhibited a high signal intensity associated with hypointense areas corresponding to fibrous tissue within the branches of the scar. Unenhanced TurboFLASH images always demonstrated the FNHs as hypointense and always depicted the central scar as a hypointense area within the lesion. After bolus injection, arterial enhancement of FNH was clearly seen, and in 10 of 25 lesions, enhancement within the scar was seen 40-80 seconds after injection. Both unenhanced and enhanced TurboFLASH sequences produced the best signal-difference-to-noise ratios in comparison with T2-weighted images.
39619.4086331431996.06.28++Phase II clinical evaluation of Gd-EOB-DTPA: dose, safety aspects, and pulse sequence.Radiology
P Reimer, EJ Rummeny, K Shamsi, T Balzer, HE Daldrup, B Tombach, T Hesse, T Berns, PE Peters,
PURPOSE: To investigate the efficacy of gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) in the detection of focal liver lesions with respect to dose, side effects, and pulse sequence. MATERIALS AND METHODS: A randomized double-blinded trial was performed in 33 patients with focal solid liver lesions. A bolus of Gd-EOB-DTPA, a liver-specific contrast agent, was intravenously administered at three different doses (12.5, 25, and 50 mumol per kilogram of body weight). Magnetic resonance imaging with different T1-weighted techniques was performed 20 and 45 minutes after administration of Gd-EOB-DTPA. Changes in liver signal intensity, lesion-liver contrast-to-noise ration (C/N), detectable liver lesions, side effects, and adverse events were evaluated. RESULTS: Gd-EOB-DTPA significantly (P < .05) increased liver signal intensity and lesion-liver C/N within the dose range tested. Lesion detection was improved 20 and 45 minutes after administration of Gd-EOB-DTPA. A dose of 12.5 mumol was sufficient for the detection of focal liver lesions, and the breath-hold, T1-weighted, fast low-angle shot pulse sequence was the most useful. No significant changes in vital signs, clinical laboratory test results, and urinalysis were observed. CONCLUSION: Gd-EOB-DTPA is an efficient, diagnostically useful, and safe contrast agent.
39719.3998410661998.11.17++Dynamic MR imaging of hepatolithiasis.Abdom Imaging
TC Soong, RC Lee, HC Cheng, JH Chiang, HS Tseng, CW Lin, MM Teng,
BACKGROUND: To report the dynamic magnetic resonance (MR) imaging findings of hepatolithiasis. METHODS: Dynamic MR images (fast spoiled gradient echo sequence with intravenous injection of gadopentate dimeglumine) and computed tomography, cholangiography, or angiography of nine patients with hepatolithiasis are analyzed. RESULTS: All affected hepatic segments showed atrophic changes and contained dilated intrahepatic ducts. These segments showed either iso- or hypointensity on T1-weighted imaging and hyperintensity on T2-weighted imaging. Preferential enhancement was noted throughout all phases of the dynamic study and persisted to delayed T1-weighted imaging in seven patients. In the last two patients, severe atrophic changes made evaluating signal intensity differences and enhancement patterns difficult. CONCLUSION: In addition to intrahepatic stones and biliary dilatation, segmental atrophy, signal intensity differences, and preferential and persistent enhancement are important MR findings of hepatolithiasis.
39819.38162450162006.03.10++Hepatic peliosis (bacillary angiomatosis) in AIDS: CT findings.Abdom Imaging
K Sandrasegaran, DR Hawes, G Matthew,
Patients with acquired immunodeficiency syndrome are at risk of developing opportunistic infections and aggressive tumors. Computed tomographic examination is the usual method of evaluating the abdomen and pelvis in these patients. Although this technique is reasonably sensitive in detecting pathology, findings are often nonspecific. A case of hepatic peliosis (bacillary angiomatosis) in a patient with acquired immunodeficiency syndrome is presented.
39919.30121850322002.09.10++Percutaneous CT-guided drainage of splenic abscess.AJR Am J Roentgenol
L Thanos, T Dailiana, G Papaioannou, A Nikita, H Koutrouvelis, DA Kelekis,
OBJECTIVE: The objective of our study was to determine the current role of percutaneous CT-guided drainage as an alternative to surgical treatment of splenic abscesses. CONCLUSION: Splenic abscess is an uncommon entity that can be treated percutaneously. CT-guided drainage of splenic abscess seems to be a safe and effective alternative to surgery, allowing preservation of the spleen.
40019.3091141031997.05.13++Hepatic lesions: detection with ferumoxide-enhanced T1-weighted MR imaging.Radiology
M Oudkerk, AG van den Heuvel, PA Wielopolski, PI Schmitz, IH Borel Rinkes, T Wiggers,
PURPOSE: To compare the use of ferumoxide-enhanced T1-weighted gradient-echo (GRE) MR imaging with that of spiral computed tomography during arterial portography (CTAP) and T2-weighted Turbo spin-echo (SE) MR imaging in detection of lesions and of segmental involvement in patients with liver metastases. MATERIALS AND METHODS: Twenty-two candidates for metastasectomy of the liver underwent spiral CTAP, ferumoxide-enhanced GRE MR imaging, and T2-weighted Turbo SE MR imaging. A total of 176 liver segments were evaluated (57 with and 119 without metastases). The reference standard was laparoscopic sonographic findings. Diagnostic performance of the imaging modalities was assessed for lesion detection and determination of segmental involvement. RESULTS: The sensitivity for lesion detection with spiral CTAP, ferumoxide-enhanced MR imaging, and T2-weighted MR imaging was 0.96, 0.83, and 0.71, respectively; for segmental analysis, the sensitivity was 0.96, 0.84, and 0.75, respectively, and the specificity was 0.80, 0.99, and 0.92, respectively. All comparisons between sensitivities and specificities were statistically significant (P < .05). CONCLUSION: Ferumoxide-enhanced T1-weighted GRE MR imaging is superior to T2-weighted SE MR imaging for preoperative detection of lesions and segmental involvement in patients with liver metastases.
40119.29111268002001.01.11+ Splenic imaging in infancy and childhood.JBR-BTR
EC Benya,
40219.2763414211983.06.23++Computed tomography in renal lymphoma.J Comput Assist Tomogr
WA Chilcote, GP Borkowski,
The computed tomographic characteristics of 15 cases of renal lymphoma were evaluated. Initially the renal lesions are nodular but become confluent as the tumor progresses. In histiocytic and Hodgkin lymphoma, lesions can have the same attenuation values as normal renal parenchyma on noncontrast scans but less than normal parenchyma after contrast medium administration. Computed tomography is also useful in evaluating prognosis and response to therapy in renal lymphoma. Contrast material should be given if possible for evaluation of these lesions.
40319.2620132001991.05.14++Case report: Tuberculous hepatic and splenic abscess.Clin Radiol
CC Wilde, YK Kueh,
Tuberculous abscess of the liver is rare and delay in diagnosis is common. The case of a 66-year-old Singaporean Chinese female with tuberculous liver abscess is reported. The abscess had an unusual septated ('honeycomb-like') ultrasonographic and computed tomographic appearance and the diagnosis was made with difficulty from material aspirated from the hepatic lesion.
40419.2619109901991.11.20++Accuracy of adrenal biopsy guided by ultrasound and CT.Acta Radiol
T Tikkakoski, M Taavitsainen, M Päivänsalo, S Lähde, M Apaja-Sarkkinen,
We reviewed the results of fine needle biopsy of the adrenal glands guided by ultrasonography or CT in 56 patients. The final diagnoses, obtained at operation, autopsy or follow-up were: metastasis (n = 22), adenoma (n = 21), adrenal cyst (n = 6), hematoma (n = 3), lymphoma (n = 1), pheochromocytoma (n = 1), lymph node (n = 1), and amyloid mass (n = 1). Sufficient cytologic material was obtained in 96.4% (54/56). The overall accuracy to differentiate benign from malignant disease was 85.7% (48/56), 2 were false-negative, one was false-positive. The biopsy was inconclusive ("possibly malignant") in 3 patients, 2 of whom had an additional cutting needle biopsy yielding a correct positive finding. No complications occurred. We conclude that in disseminated malignant disease with suspected adrenal metastases diagnostic results can be obtained with guided fine needle biopsy. Biopsy in primary adrenal lesions is helpful, especially if the aspirate of the lesion turns out to be composed of something other than adrenal cells.
40519.2416208281992.08.06++Assessment of intracardiac shunts with gadolinium-enhanced ultrafast MR imaging.Radiology
WJ Manning, DJ Atkinson, JA Parker, RR Edelman,
Dye dilutional techniques are widely accepted for the assessment of intracardiac shunts, but current techniques require arterial access or radioisotope injection. Ultrafast (less than 500 msec) magnetic resonance (MR) imaging is ideally suited for the evaluation of an indicator during passage through the heart. Twenty patients were studied, including 13 with shunts. Four-chamber, T1-weighted images were obtained during bolus injection of gadopentetate dimeglumine. A single image was obtained in 420 msec, with repetitive images acquired after each QRS complex. After the contrast material was injected, there was pronounced signal intensity enhancement in the right atrium, followed by the right ventricular cavity, left atrium, left ventricular cavity, and descending aorta. Patients with substantial intracardiac shunts demonstrated early recirculation. First-pass contrast material-enhanced MR imaging is a promising new technique for the rapid assessment of intracardiac shunts. Combined with anatomic and functional MR imaging techniques, it can help provide a comprehensive noninvasive evaluation of suspected intracardiac shunts or provide follow-up in patients with known shunts.
40619.24116411732001.12.04+ Gastrointestinal hemangiomas: imaging findings with pathologic correlation in pediatric and adult patients.AJR Am J Roentgenol
AD Levy, RM Abbott, CA Rohrmann, AA Frazier, A Kende,
40719.235222801980.03.24+ [Focal splenic defects on a routine liver scan with 99mTc-phytate (author's transl)]Rinsho Hoshasen
K Fukuda, K Kaneko, T Yamada, N Katsuyama, K Kawakami, R Komori,
40819.2174035171980.10.21++The ultrasonic appearance of extranodal abdominal lymphoma.Radiology
BA Carroll, HN Ta,
The sonographic manifestations of malignant lymphoma involving 70 extranodal sites in 51 patients are presented. Areas of involvement by nonHodgkin and Hodgkin lymphoma included the liver, spleen, kidneys, stomach, pancreas, and muscles. The sonographic appearance of lymphomatous lesions does not necessarily correlate with histologic subclassification. Similarly, atypical manifestations of lymphoma may resemble a variety of neoplastic and non-neoplastic processes. Extranodal lymphomatous abdominal disease was detected in six patients whose lymphangiograms demonstrated no evidence of disease.
40919.1490150681997.02.27++Differentiation of benign and malignant breast lesions: MR imaging versus Tc-99m sestamibi scintimammography.Radiology
TH Helbich, A Becherer, S Trattnig, T Leitha, P Kelkar, M Seifert, M Gnant, A Staudenherz, M Rudas, G Wolf, GH Mostbeck,
PURPOSE: To compare the accuracies of magnetic resonance (MR) imaging and scintimammography in differentiating benign from malignant breast lesions. MATERIALS AND METHODS: MR imaging was performed in 66 women with 75 lesions during intravenous administration of gadopentetate dimeglumine. Planar and single photon emission computed tomographic (SPECT) scintimammography were performed (with 740 MBq technetium-99m sestamibi administered intravenously) in all 66 patients with 75 lesions and in 64 patients with 73 lesions, respectively. MR imaging and scintimammographic studies were independently evaluated by using signal intensity measurements versus time or focal tracer uptake to differentiate benign from malignant lesions. Histopathologic proof was obtained in 63 lesions. Twelve lesions were monitored with follow-up. RESULTS: MR imaging was false-negative in one and false-positive in nine lesions. Planar scintimammography was false-negative in 10 and false-positive in six lesions. SPECT scintimammography was false-negative in four and false-positive in 10 lesions. Sensitivities and specificities for malignancy were, respectively, 96% and 82% for MR imaging, 62% and 88% for planar scintimammography, and 83% and 80% for SPECT scintimammography. CONCLUSION: Both MR imaging and scintimammography are useful in the evaluation of breast cancer. MR imaging is more sensitive and as specific as scintimammography.
41019.05104160881999.09.16++Hemangioendothelioma of the spleen: imaging findings at color Doppler, US, and CT.Clin Imaging
F Ferrozzi, D Bova, F De Chiara,
The ultrasonographic, color Doppler, and computed tomography findings of an unusual vascular primary tumor of the spleen are reported. A brief clinical and histopathological analysis of this entity is discussed and the differential diagnosis of other primary lesions of the spleen is attempted.
41119.03107161482000.04.03++Composite hemangioendothelioma: a complex, low-grade vascular lesion mimicking angiosarcoma.Am J Surg Pathol
SJ Nayler, BP Rubin, E Calonje, JK Chan, CD Fletcher,
Eight cases of a previously uncharacterized vascular neoplasm, showing varying combinations of benign, low-grade malignant, and malignant vascular components are described. Seven tumors occurred in the dermis and/or subcutis and one occurred in the oral submucosa. The patients were all adults with a median age of 39.5 years (range, 21-71 years). Five patients were men. The tumors arose predominantly in the hands and feet, and the lesions were usually of several years duration. The tumors were composed of a complex admixture of histologic components that varied from tumor to tumor, such that no two tumors looked precisely the same. This was due to variation in the proportions of each component as well as the manner in which each component was distributed throughout each lesion. The predominant histologic components were epithelioid hemangioendothelioma (HE) and retiform HE, which were each present in seven of the tumors. Areas of spindle cell HE were identified in four lesions. Angiosarcoma-like elements were identified in seven tumors. One of the tumors was associated with an arteriovenous malformation and one was associated with an area of lymphangioma circumscriptum. Of six cases with follow up (median duration, 6.5 years), three have recurred locally and, to date, only one has metastasized. We think composite HE is best regarded as a low-grade malignant vascular neoplasm, and the available data suggest that it behaves more favorably than conventional angiosarcoma. The existence of these composite lesions has led to careful reexamination of the concept of HE. The term HE, in that it is currently synonymous with a low-grade malignant vascular tumor, should be reserved for lesions that have true metastatic potential, albeit with low frequency.
41219.0232587211988.05.19++Gd-DTPA in MR of spinal lesions.AJR Am J Roentgenol
J Valk,
The use of Gd-DTPA in nondegenerative spinal lesions is described. Thirty consecutive patients were examined by MR with and without Gd-DTPA. The information obtained with unenhanced T1- and T2-weighted spin-echo images was compared with that obtained with Gd-DTPA T1-weighted images. The results showed that, according to the criteria used, more information was present on the MR images with Gd-DTPA in 18 of 30 patients. In six of 30 patients, the improved quality of the images led to a change in the neurosurgical or neurologic approach. Gd-DTPA proved to be a safe contrast medium; no side effects or adverse reactions were observed. It is recommended that Gd-DTPA be used in nondegenerative lesions involving the spinal cord to obtain the same or more information in a shorter acquisition time.
41319.0293602381997.12.11++Isolated splenic metastases.J Ultrasound Med
H Ishida, K Konno, J Ishida, K Shirayama, H Naganuma, T Komatsuda, Y Hamashima, O Masamune,
We analyzed the primary tumors, sonographic findings, clinical manifestations, and prognosis in five cases of isolated splenic metastases to determine in what situations these rare metastases should be suspected. The metastases were detected by ultrasonography in all five patients, and the primary tumors were colonic cancer in four patients and renal cancer in one patient. Splenectomy was performed and the postoperative course was uneventful in all patients. We conclude that preoperative and follow-up examinations must be performed with special attention given to the spleen in colonic or renal cancer patients.
41418.99146155702004.01.12+ Infantile hemangioendothelioma.Radiographics
JE Roos, R Pfiffner, T Stallmach, G Stuckmann, B Marincek, U Willi,
41518.9839501651986.04.23++CT findings in hepatic and splenic amyloidosis.J Comput Assist Tomogr
S Suzuki, K Takizawa, Y Nakajima, M Katayama, F Sagawa,
In a patient with biopsy proven focal amyloidosis of the liver CT showed a uniform decrease in attenuation, with a focal large low-density lesion in the right hepatic lobe. Following intravenous contrast medium injection, there was poor contrast enhancement.
41618.9874716401981.05.26++Percutaneous aspiration biopsy of abdomen and retroperitoneum.Clin Radiol
MG Ennis, DP MacErlean,
Percutaneous fine needle aspiration biopsy was performed in 38 patients. Adequate material for histological diagnosis was obtained in all. No false positive results were obtained and there was only one false negative result. The procedure was without complication in all patients. The biopsy material was obtained by the radiologist in the X-ray department following localisation of the lesion by ultrasound. The advantages of the early use of this technique in the evaluation of patients presenting with suspected mass lesions in the abdomen and retroperitoneum are described, and its contribution to the formulation of further patient management stressed.
41718.9719397511991.12.04++MR of enchondroma and chondrosarcoma: rings and arcs of Gd-DTPA enhancement.J Comput Assist Tomogr
J Aoki, S Sone, F Fujioka, K Terayama, K Ishii, O Karakida, S Imai, F Sakai, Y Imai,
MR studies of five chondrosarcomas and three enchondromas were performed with intravenous Gd-DTPA administration. All tumors showed enhancement of scalloped margins and curvilinear septa (ring-and-arc pattern) on T1-weighted SE sequences with Gd-DTPA. On radiologic-pathologic correlation, the enhanced areas corresponded to fibrovascular bundles surrounding hyaline cartilage lobules. The rings and arcs of enhancement with Gd-DTPA on MR is a reflection of the lobulated growth pattern of cartilaginous tumors and therefore helpful in differential diagnosis of bone tumors.
41818.9790510321997.03.28++Gadolinium-enhanced MR imaging of thyroid and parathyroid masses.Radiology
H Nakahara, S Noguchi, N Murakami, S Tamura, S Jinnouchi, T Kodama, ON Adjei, S Nagamachi, T Ohnishi, S Futami, LG Flores, K Watanabe,
PURPOSE: To evaluate spin-echo and contrast material-enhanced dynamic magnetic resonance (MR) imaging in characterization of thyroid and parathyroid masses. MATERIALS AND METHODS: Conventional T1- and T2-weighted, gadolinium-enhanced dynamic, and gadolinium-enhanced T1-weighted spin-echo imaging sequences were performed in 85 patients with thyroid and parathyroid tumors. Findings from spin-echo imaging and dynamic curve patterns from mean signal intensity ratios were evaluated for each histologic tumor type. RESULTS: T1- and T2-weighted imaging did not enable differentiation of benign from malignant tumors. Primary thyroid lymphoma enhanced less than other solid thyroid tumors, and parathyroid adenoma also enhanced less than other tumors (P < .05 compared with papillary carcinoma. CONCLUSION: Gadolinium-enhanced MR imaging cannot enable prediction of histologic type in thyroid and parathyroid tumors. However, in cases of multiple tumors, the technique may improve the contrast between the different histologic types and sometimes suggest the diagnosis of primary thyroid lymphoma or parathyroid adenoma.
41918.95122427422003.01.22++Littoral cell angioma of the spleen: appearance on sonography and CT.J Clin Ultrasound
M Goldfeld, I Cohen, N Loberant, A Mugrabi, I Katz, S Papura, I Noi,
Littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen with characteristic histomorphologic features. Only a few descriptions of the radiologic appearance of this tumor have been published, and those descriptions are variable. We report a case of LCA in a 37-year-old man with psoriasis and nonspecific symptoms of weakness, pain and fatigue, normocytic anemia, and thrombocytopenia. The results of abdominal sonography and contrast-enhanced CT correlated: the 2 modalities revealed hepatosplenomegaly and multiple round splenic lesions of similar appearance and size (on sonograms, ill-defined echogenic lesions up to 3.2 cm without acoustic enhancement; on CT scans, hypodense, nonenhancing lesions up to 3.5 cm). Because making a differential diagnosis was difficult and our presumptive diagnosis was hemangioma or lymphoma, splenectomy was performed. Postoperative pathologic examinations confirmed a final diagnosis of LCA. The patient's recovery was uneventful. LCA should be considered when making a differential diagnosis of splenic lesions, and sonography may be more helpful than CT in reaching a diagnosis of LCA.
42018.8827781531989.10.19++Angiosarcoma of the liver mimicking cavernous hemangioma on dynamic CT.J Comput Assist Tomogr
Y Itai, T Teraoka,
A case of hepatic angiosarcoma showed findings similar to those of cavernous hemangioma on dynamic CT, angiography, and magnetic resonance imaging. The tumor was histologically confirmed as angiosarcoma of cavernous pattern.
42118.8433166321987.12.30++[Splenic abscess. A new diagnostic and therapeutic approach. Apropos of 7 cases]J Radiol
G Sebag, C Anagnostopoulos, S Chagnon, P Jacquenod, M Bléry,
Anomalies in seven patients with splenic abscess were invariably observed on ultrasound imaging despite absent or misleading clinical symptomatology splenomegaly was detected in only 3 cases. The abscess was multiple in 6 cases with perisplenic extension in 2 patients. Splenectomy was performed in only 2 cases. In one patient, diagnostic and therapeutic fine needle puncture of spleen was performed. Comparison with CT scan imaging is presented with respect to 3 patients. Ultrasound imaging can suggest a diagnosis of intrasplenic abscess and fine needle puncture is not contraindicated.
42218.8419127181991.11.01++Sonographic investigation in the diagnosis of intrasplenic fluid collections.Bildgebung
C Görg, WB Schwerk,
The authors report about the diagnosis of 55 patients for whom cyst-like lesion sites or predominantly anechoic lesions were diagnosed by means of sonography of the spleen. Sonographic analysis included interventional sonography with fluid aspiration in accordance with diagnostic and therapeutic guidelines (n = 19), catheter drainage (n = 3), B-mode pulsed Doppler-Ultrasound, and short-term follow-up examinations. The final diagnoses were splenic cysts (n = 25), splenic ruptures (n = 10), splenic infarctions (n = 12), splenic abscesses (n = 7) and splenic metastasis (n = 1). Because of the ultrasound findings in diagnosis and during the follow-up observations, 15 patients underwent splenectomy. Special attention is drawn to the clinical relevance of these procedures for diagnosis of splenic liquid masses.
42318.77164531152006.11.22++Detection and characterization of liver metastases: 16-slice multidetector computed tomography versus superparamagnetic iron oxide-enhanced magnetic resonance imaging.Eur Radiol
YK Kim, SW Ko, SB Hwang, CS Kim, HC Yu,
The aim of our study was to compare the diagnostic performance of 16--slice multidetector computed tomography with that of superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging in the detection of small hepatic metastases and in the differentiation of hepatic metastases from cysts. Twenty-three patients with 55 liver metastases and 14 liver cysts underwent SPIO-enhanced MR imaging and multiphasic CT using 16-MDCT. Two observers independently analyzed each image, in random order. Sensitivity and diagnostic accuracy for lesion detection and differentiation as metastases or cysts for MDCT and SPIO-enhanced MR imaging were calculated using receiver operating characteristic analysis. For all observers, the Az values of SPIO-enhanced MR imaging for lesion detection and differentiation of liver metastases from cysts (mean 0.955, 0.999) were higher than those of MDCT (mean 0.925, 0.982), but not statistically significantly so (P > 0.05). Sensitivity of SPIO-enhanced MR imaging with regard to the detection of liver metastases (mean 94.5%) was significantly higher than that of MDCT (mean 80.0%) (P < 0.05). SPIO-enhanced MR imaging and 16-MDCT showed similar diagnostic accuracies for detection and differentiation of liver metastases from cysts, but sensitivity of SPIO-enhanced imaging in the detection of liver metastases was superior to that of 16-MDCT.
42418.77108234532000.08.16++Gaucher disease of the spleen: CT and MR findings.Abdom Imaging
LW Poll, JA Koch, S vom Dahl, M Sarbia, D Häussinger, U Mödder,
We present a 26-year-old male patient with Gaucher disease who presented with epigastric pain and a palpable mass in the left abdomen. Ultrasound, abdominal computed tomography, and magnetic resonance imaging showed massive splenomegaly with multiple splenic nodules up to 7 cm in diameter. Splenic nodules should be included in the differential diagnosis of splenic masses. Follow-up is necessary because of the increased incidence of hematologic malignancies in Gaucher disease.
42518.7672915171981.12.21++Pitfalls in the diagnosis of hepatic cysts by computed tomography.Radiology
PA Barnes, JL Thomas, ME Bernardino,
Seven patients with computed tomographic (CT) evidence of cystic hepatic lesions are presented. In these cases, CT could not reliably distinguish benign hepatic cysts from other intrahepatic and extrahepatic cystic lesions. The attenuation coefficients of simple cysts and inflammatory or neoplastic lesions were similar, and smooth margins occurred in all three of these conditions. It was not possible to visualize and differentiate lesion walls from the surrounding normal hepatic parenchyma in some cases. It is concluded that the specificity of CT in the differentiation of benign cysts and other lesions is lower in the liver than it is in other areas, such as the kidney, and that in cases of diagnostic uncertainty, biopsy should be performed.
42618.7666025201983.07.29++The silent abdominal abscess: role of the radiologist.AJR Am J Roentgenol
R Goldman, TB Hunter, K Haber,
An abdominal abscess usually causes severe distress with fever, leukocytosis, pain, and toxicity. However, a small but significant proportion of patients with abdominal abscess may appear entirely well with no elevated temperature or white blood cell count. Fifteen patients are reported whose initial clinical presentation was unremarkable but who had significant abscess formation that was well documented by radiographic methods. Both the radiologist and the patient's primary physician must be aware of the not infrequent presentation of abdominal abscess in a clinically innocuous manner. The lack of fever, elevated white blood cell count, or patient complaint should in no way rule out the diagnosis of abscess when positive radiographic evidence is found.
42718.7593499971997.11.25++Usefulness of novel imaging modalities in diagnosis of focal nodular hyperplasia of the liver.J Gastroenterol
Y Nishigaki, E Tomita, Y Matsuno, K Goto, T Ohnishi, Y Tanaka, H Iwai, H Asano, I Yasuda, K Nagura, T Wakahara, T Yamada,
A 17-year-old woman was admitted because of a liver tumor found incidentally by ultrasonography. Liver function was normal and there were no markers of hepatitis viruses or malignancy. Abdominal ultrasonography, computed tomography (CT), and magnetic resonance imaging revealed a mass (2 cm in diameter) in the lateral segment of the left lobe of the liver. The lesion was not detected by hepatic arteriography. However, dynamic CT with fast scanning and dynamic CO2-enhanced ultrasonography demonstrated initial central enhancement of the mass followed by centrifugal spread of enhancement to the periphery. Color Doppler flow imaging detected a central color spot, shown to be an artery by a pulsed Doppler spectrum analysis. Fine-needle biopsy confirmed a diagnosis of focal nodular hyperplasia. Dynamic CT with fast scanning, dynamic CO2-enhanced ultrasonography, and color Doppler flow imaging were useful in detecting the vascular pattern specific to focal nodular hyperplasia. Investigation of further cases with these novel imaging modalities should help to establish a comprehensive diagnostic procedure and thus avoid unnecessary surgery for focal nodular hyperplasia, which is a completely benign lesion.
42818.7482673651994.01.25++Computed tomographic findings of abdominal tuberculosis--report of five cases.Ann Acad Med Singapore
MK Wong, SE Ng,
Five patients with proven intra-abdominal tuberculosis were examined with computed tomography (CT) over a period of one year. This revealed hepatosplenomegaly in all five cases. Macroscopic nodules were noted in the liver and spleen in three cases. All three cases showed more severe involvement of the spleen over the liver. Other features were enlarged (para-aortic, para-caval, peripancreatic and mesenteric) nodes, ascites, stellate mesentery and thickened bowel wall. Incidental extra-abdominal findings included intrathoracic nodules, pleural effusion, pericardial effusion with constrictive pericarditis, bony osteomyelitis and psoas abscess. Follow-up CT was performed on four of the five cases and showed significant resolution of the above findings. In addition, one case showed calcification within a healing splenic nodule. The presence of macroscopic nodules detected on CT, especially in the spleen, is an unusual finding in prior reports. This paper attempts to account for its high local incidence and discusses the significance of other findings in the diagnosis of abdominal tuberculosis.
42918.73115030872001.10.11++Sclerosed hemangioma of the liver.Abdom Imaging
H Aibe, H Hondo, T Kuroiwa, K Yoshimitsu, H Irie, T Tajima, K Shinozaki, Y Asayama, K Taguchi, K Masuda,
We report the radiologic findings of sclerosed hemangioma (SH), a rare variant of hepatic hemangioma. Dynamic contrast-enhanced computed tomography showed a hypodense mass in the liver with delayed enhancement. T2-weighted magnetic resonance imaging showed the mass as hypointense in relation to cerebrospinal fluid. The final diagnosis of SH was made pathologically. Although SH is rare, understanding its radiologic appearance is important to avoid unnecessary surgery and should be included in the differential diagnoses of hepatic lesion with delayed enhancement.
43018.6979466711994.12.22++Craniopharyngiomas--the utility of contrast medium enhancement for MR imaging at 1.5 T.Acta Radiol
JK Hald, OP Eldevik, JA Brunberg, WF Chandler,
To evaluate the efficacy of i.v. contrast medium administration in MR imaging at 1.5 T in patients with craniopharyngiomas, MR studies of 10 men and 6 women with pathologically proven craniopharyngiomas were made. The MR images were obtained as 3- to 5-mm-thick coronal (n = 13) or axial (n = 3) Tl-weighted images (T1WI) prior to and following i.v. Gd-DTPA administration. Proton density- (PD) and T2-weighted images (T2WI) were also obtained. Conspicuity of tumor margins, cystic versus solid components, size, location and effect upon adjacent structures were separately characterized in all imaging sequences. In 6 patients contrast medium-enhanced T1WI. PD and T2WI demonstrated cystic tumor components not seen on unenhanced T1WI. There were significant differences (p < 0.004) on 2-tailed Student's t-test comparing tumor conspicuity on contrast medium-enhanced T1WI with unenhanced T1WI, PD and T2WI. Optimal tumor delineation on MR imaging of patients with craniopharyngiomas justifies the use of i.v. contrast medium.
43118.6816068021992.07.23++Case report: unusual presentation of splenic hamartoma; computed tomography and ultrasonic findings.Clin Radiol
R Zissin, M Lishner, V Rathaus,
Hamartomas of the spleen are rare benign tumours, which are usually asymptomatic, incidental findings at laparotomy or autopsy (Komakl and Gombas, 1976; Brinkley and Lee, 1981; Norowitz and Morehouse, 1989). There are a few well documented reports of symptomatic splenic hamartoma associated with haematological disturbances, marked splenomegaly or even spontaneous rupture that required an emergency operation (Iozzo et al., 1980; Morgenstern et al., 1984). We report a patient with splenic hamartoma who presented with splenomegaly and iron deficiency anaemia. Computed tomographic (CT) and ultrasound (US) evaluation demonstrated an inhomogeneous mass within the enlarged spleen. Malignant melanoma was mistakenly diagnosed by US-guided fine needle aspiration of the mass, and necessitated splenectomy. The final diagnosis was hamartoma of the spleen.
43218.6790135381997.04.02++MR imaging evaluation of renal cell carcinoma.Abdom Imaging
Y Narumi, H Hricak, JC Presti, R Forstner, GT Sica, C Kuroda, Y Sawai, T Kotake, T Kinouchi, PR Carroll,
BACKGROUND: This study examines the minimally required imaging protocol needed for detection and staging of renal cell carcinoma (RCC). METHODS: In 81 patients (21 women, 60 men; mean age = 62 years) with 85 RCCs, T1-weighted (T1WI), contrast-enhanced T1-weighted (Gd-T1WI), T2-weighted (T2WI), and gradient recalled echo-fast low flip angle shot (GRE/FLASH) images were evaluated alone and in combination. Surgical-pathological findings were available in all patients and were considered the standard of reference. RESULTS: Tumor detection for lesions smaller than 3 cm was better on Gd-T1WI than on any other sequence, but only the comparison with noncontrast T1WI and GRE/FLASH was statistically significant (detection: T1WI = 33%, Gd-TIWI = 80%, T2WI = 60%, GRE = 47%). The respective accuracies of T1WI, Gd-T1WI, T2WI, and GRE/FLASH images were 81%, 78%, 71%, and 62% for evaluating local tumor extension; 90%, 88%, 89%, and 85% for lymphadenopathy; and 89%, 81%, 91%, and 95% for renal vein thrombus. The combination of T1WI and GRE sequences rendered the highest overall staging accuracy. CONCLUSION: For tumor detection, contrast-enhanced T1WI is necessary for lesions smaller than 3 cm. For tumor staging, although the addition of GRE results in significant improvement in the evaluation of venous thrombus, any combination of two sequences will result in similar accuracy, and the use of multiple sequences is not necessary.
43318.6585393771996.02.06++Sternoclavicular joint: MR imaging--anatomic correlation.Radiology
J Brossmann, A Stäbler, KW Preidler, D Trudell, D Resnick,
PURPOSE: To correlate magnetic resonance (MR) images of the sternoclavicular joint with anatomic sections. MATERIALS AND METHODS: MR imaging was performed on 14 sternoclavicular joints in seven specimens from cadavers (three men and four women 64-94 years of age at death; mean, 84 years). MR arthrography was performed in four specimens (eight joints), after injection of gadopentetate dimeglumine. After imaging, the specimens were frozen and cut into 3-mm-thick slices along the MR imaging planes. Images were correlated with the anatomic slices. RESULTS: MR imaging depicted the anatomy of the sternoclavicular joint and surrounding soft tissue. T2-weighted and proton-density-weighted images were superior to T1-weighted images in depiction of the intraarticular disk. MR arthrography depicted best the intraarticular disk and four of five perforations and delineated the joint capsule. All perforations also were depicted on T2-weighted images. CONCLUSION: MR imaging allows delineation of all structures of the sternoclavicular joint. MR arthrography allows delineation of perforations of the intraarticular disk.
43418.64129548932003.09.25++Adrenal masses: CT characterization with histogram analysis method.Radiology
KT Bae, P Fuangtharnthip, SR Prasad, BN Joe, JP Heiken,
PURPOSE: To evaluate a histogram analysis method for differentiating adrenal adenoma from metastasis at computed tomography (CT). MATERIALS AND METHODS: In a retrospective review of 2 years of clinical CT records, 223 adrenal adenomas in 193 patients (115 with contrast material-enhanced CT, 43 with unenhanced and enhanced CT, and 35 with unenhanced CT) and 31 metastases (25 patients with enhanced CT) were found. In 158 patients with adenomas at enhanced CT, diagnosis was based on stable mass size for more than 1 year (n = 135) and characteristic signal intensity decrease at chemical shift magnetic resonance imaging (n = 23). In 35 patients with adenomas at unenhanced CT, mean attenuation was 10 HU or less. Diagnosis of all metastases was based on rapid growth of a mass or new mass in less than 6 months in patients with cancer. Adrenal metastases with extensive necrosis were excluded. Histogram analysis was performed in a circular region of interest (ROI) for mean attenuation, number of pixels, and range of pixel attenuation for all pixels and for the subset of pixels with less than 0 HU ("negative" pixels). Correlation between mean attenuation and percentage negative pixels was calculated. RESULTS: Negative pixels were present in all 74 unenhanced adenomas with mean attenuation of 10 HU or less and in 14 of 16 unenhanced adenomas with mean attenuation above 10 HU. Of 184 enhanced adenomas, only 20 had mean attenuation of 10 HU or less, but 97 contained negative pixels (77 of these 97 masses had mean attenuation above 10 HU). Increase in percentage negative pixels was highly correlated with decrease in mean attenuation of both unenhanced and enhanced adenomas. None of the adrenal metastases had mean attenuation of 10 HU or less or contained negative pixels. CONCLUSION: The histogram method is far more sensitive than the 10-HU threshold method for diagnosis of adrenal adenomas at enhanced CT, with specificity maintained at 100%.
43518.64159960412005.10.04++Splenic hemangiopericytoma and serosal cavernous hemangiomatosis of the adjacent colon.World J Gastroenterol
T Yilmazlar, T Kirdak, O Yerci, SB Adim, O Kanat, O Manavoglu,
A healthy 31-years-old man presented with a three-year history of abdominal discomfort. Radiological examinations revealed multifocal tumoral lesions in the spleen. The patient underwent splenectomy for differential diagnosis and treatment. During the operation, in addition to the splenic masses, there were also multiple millimetric purpuric-like lesions on the colonic serosal surfaces adjacent to the splenic hilus. One of them was excised. Histologic examination showed hemangiopericytoma of the spleen and cavernous hemangioma of the adjacent colon. This is the first report showing the close association of these two distinct lesions with vascular origin in the literature. Despite not having any apparent evidence, there may be a sequential relationship between the hemangiopericytoma of the spleen and cavernous hemangiomas.
43618.62109369602000.09.28++[Monstrous venous hemangioma of the retroperitoneum: problems of diagnosis]Rontgenpraxis
S Leinung, I Lotz, P Würl, A Frey, L Lochhaas, M Schönfelder,
The venal haemangioma is defined as a benign tumor consisting of veinlike vessels. The preoperative diagnosis and its inherent problems are illustrated using a coincidentally diagnosed monstrous haemangioma tumor of the retroperitonial space in a twenty year old patient. With respect to our patient, X-ray, computer tomography and angiography all failed as diagnostic tools. Only the use of Doppler sonographic flow signals suggested the presence of a haemangioma. The morphology, prognosis and clinical significance of blood vessel tumors are multifaceted. The most important differential diagnoses to the venous haemangioma are the cavernous and the capilliary haemangioma. The venous haemangioma distinguishes itself through the presence of blood vessel walls. Haemangiomas are common benign tumors. In the presence of highly developed muscular components, there exists a transition to angiomyomas and to leiomyomas. Venal haemangiomas are extremely rare in the demonstrated localisation of the retroperitoneal space. Here they can grow to monstrous preportions whilst remaining undetected. Thus the patient is under the potential danger of bleeding to death through trivial injuries. The therapy of choice remains total surgical excision. In situations of unclear clinical results with respect to preoperative diagnosis especially amongst young adults, one should at least consider the possibility of a haemangioma as the root of the problem.
43718.6089954711997.02.11++Comparison between conventional and fast spin-echo stir sequences.Acta Radiol
K Hittmair, S Trattnig, CJ Herold, M Breitenseher, J Kramer,
PURPOSE: To evaluate the common characteristics and differences in contrast behavior of short-TI-inversion-recovery (STIR) and short-TI-inversion-recovery fast spin-echo (TurboSTIR) sequences. MATERIAL AND METHODS: Phantoms doped with increasing doses of Gd-DTPA and a pork-fat phantom were used to evaluate the dependence of the STIR and TurboSTIR signals on the T1 relaxation time. Clinical TurboSTIR images were obtained from 30 patients with musculoskeletal abnormalities and compared to conventional STIR images in 15 cases and to postcontrast TurboSTIR images in another 15 cases. RESULTS: In the phantom measurements, a significantly shorter inversion time (TI) was needed to achieve fat suppression on TurboSTIR images, and, with an identical number of signal averages, contrast-to-noise ratios were lower on TurboSTIR images. These differences between STIR and TurboSTIR can be attributed to the contribution of stimulated echoes to overall TurboSTIR signal and can be compensated by a shorter TI and a higher number of signal averages for TurboSTIR, respectively. With these adaptations, clinical TurboSTIR and STIR images showed an identical contrast behavior with fat suppression and a high sensitivity to pathological lesions but TurboSTIR saved a significant amount of scan time and reduced some types of artifacts. Contrast uptake impaired lesion conspicuity on TurboSTIR images. CONCLUSION: TurboSTIR sequences should replace conventional STIR sequences and should be performed before contrast administration.
43818.6032673511989.11.17++Histiocytic medullary reticulosis: radiologic diagnosis of splenic infarction--a case report.J Korean Med Sci
SO Yang, DS Lee, KS Lee, MJ Kim, HS Choi, YH Jun, YK Park,
A case of histiocytic medullary reticulosis with splenic infaraction from a 23-year-old male is presented. Radiologic findings on selective spleen scintigraphy and abdominal CT are described. Selective spleen scintigraphy showed huge, multilobulated spleen with numerous photon-deficient areas in it and peripherally. Abdominal CT showed large peripheral band-like low density and infiltrative lesion in spleen with accompanying intraabdominal lymphadenopathy. Histoligical features were consistent with HMR in spleen and liver specimens.
43918.5819125501991.10.30+ [The computed tomographic manifestation of diffuse visceral lymphangiomatosis]Rofo
G Melzer, P Kullnig, F Flückiger, A Beham,
44018.56180208822008.01.22++[Splenic lymphoma of the marginal zone without peripheral hairy lymphocytes]An Med Interna
R Pila Pérez, R Pila Peláez, P Rosales Torres, VA Holguín Prieto, LF Alzate Giraldo,
This paper reports on a case of a 34-year male patient diagnosed for splenic lymphoma of the marginal zone, a rare entity in our milieu. Features of the disease are described. Early diagnosis is a must for optimum treatment of such a pathology, whose onset can be giant splenomegalia. All possible causes are to be considered.
44118.5644756701975.05.06+ [Arteriography in surgical diseases of liver and spleen]Helv Chir Acta
A Essinger, A Flückiger,
44218.5126720921989.09.25++Siderotic nodules in the spleen: MR imaging of portal hypertension.Radiology
M Minami, Y Itai, K Ohtomo, S Ohnishi, T Niki, T Kokubo, K Yoshikawa, M Iio,
The authors retrospectively evaluated magnetic resonance (MR) images obtained at 1.5 T in 233 patients with portal hypertension and 91 subjects without it and pathologic findings in four resected spleens (one normal). Multiple, tiny (3-8 mm in diameter), low-intensity spots in the spleen were observed in 21 of 233 patients. Among the imaging studies performed in these 21 patients, the spots were seen on five of 14 T1-weighted images, 11 of 20 proton density images, and 12 of 20 T2-weighted images obtained with spin-echo techniques and on 14 of 14 fast-scan images obtained with gradient-echo rephasing. MR images in the 91 subjects did not show such lesions. MR images of the three spleens resected from patients with portal hypertension showed the low-intensity spots, which corresponded to siderotic nodules found at pathologic analysis. Despite limited pathologic confirmation, siderotic nodules (so-called Gamna-Gandy nodules) are considered the most likely cause of multiple low-intensity spots in the spleen.
44318.5180798931994.10.04+ Splenic epithelioid hemangioma: MR findings.AJR Am J Roentgenol
JC Vilanova, A Capdevila, J Aldomà, E Delgado,
44418.51120103112002.07.12++Image-guided fine-needle aspiration cytology of deep-seated enlarged lymph nodes.Acta Radiol
U Nahar Saikia, N Khirdwadkar, B Saikia, B Sood, R Goldsmith, P Dey, SK Gupta,
PURPOSE: To evaluate the role of image-guided fine-needle aspiration cytology (FNAC) of deep-seated lymph nodes. MATERIAL AND METHODS: Image-guided FNACs were performed on 242 patients of deep-seated lymph nodes which included thoracic, retroperitoneal and abdominal nodes. A sterile 3.5/5-MHz micro convex sector probe was used for localisation of the node. The FNAC was performed using a 0.7- to 0.9-mm needle with the stylet removed and attached to a 20-ml syringe and FNAC handle after the needle was visualised in the lesion. For each case a minimum of 4-5 smears were made, and two observers without bias interpreted the smears. RESULTS: A total of 242 patients were aspirated, of which 216 (90%) aspirations were US-guided and the remaining 26 (10%) were CT-guided. Adequate material for cytologic diagnosis was obtained in 208 (86%) patients with a similar diagnostic accuracy. The aspirate material was non-representative or scanty in 34 (14%) patients. The most common cytological diagnosis was tuberculosis/consistent with tuberculosis seen in 108 (45%) patients followed by metastasis (17%) and reactive hyperplasia (10%). Non-Hodgkin lymphoma was diagnosed in 22 (9%) patients. All patients were briefly followed for a period of 1 1/2 to 2 years (mean 1 year). CONCLUSION: Image-guided FNAC has a pivotal role, and is a cost-effective tool for establishing tissue diagnosis as a primary investigative modality. It is also helpful and accurate in follow-up of patients with a known malignant disease, thereby avoiding surgical intervention.
44518.50108822672000.08.01++Characterization of focal hepatic lesions with ferumoxides-enhanced T2-weighted MR imaging.AJR Am J Roentgenol
MR Paley, PJ Mergo, GM Torres, PR Ros,
OBJECTIVE: The purpose of this study was to evaluate whether ferumoxides-enhanced MR imaging of focal hepatic lesions provides distinctive signal intensity and lesion-to-liver contrast changes for benign and malignant lesions, helping to further characterize and differentiate these lesions. MATERIALS AND METHODS: Data analysis was performed on 70 patients, with previously identified focal hepatic lesions, who underwent MR imaging of the liver before and after IV administration of ferumoxides (10 micromol Fe/kg). Lesions analyzed with pathologically proven diagnoses included metastases (n = 40), hepatocellular carcinoma (n = 11), cholangiocarcinoma (n = 6), hemangioma (n = 4), focal nodular hyperplasia (n = 6), and hepatocellular adenoma (n = 3). Response variables measured and statistically compared included the percentage of signal-intensity change and lesion-to-liver contrast. RESULTS: Focal nodular hyperplasia showed significant signal intensity loss on ferumoxides-enhanced T2-weighted images (mean, -43%+/-6.7%, p < 0.01). All other lesion groups showed no statistically significant change in signal intensity on ferumoxides-enhanced T2-weighted images, although signal intensity loss was seen in some individual hepatocellular adenomas (mean, -6.6%+/-24.0%) and hepatocellular carcinomas (mean, -3.3%+/-10.3%). All lesions, with the exception of hepatocellular carcinoma, had a marked increase in lesion-to-liver contrast on ferumoxides-enhanced T2-weighted images, which was statistically significant for metastases and hemangioma (p < 0.02). CONCLUSION: Focal nodular hyperplasia shows significant decrease in signal intensity on ferumoxides-enhanced T2-weighted images, which may aid in the differentiation of focal nodular hyperplasia from other focal hepatic lesions. Other lesions, namely, hepatocellular adenoma and carcinoma, can have reticuloendothelial uptake, but usually to a lesser degree than that of focal nodular hyperplasia.
44618.4939249701985.08.22+ Sonography of splenic angiosarcoma.J Clin Ultrasound
B Nahman, JJ Cunningham,
44718.48106284692000.01.21++Is it necessary to biopsy the obvious?AJR Am J Roentgenol
MY Chen, DW Gelfand, RE Bechtold, SA Cremer, BJ Casolo, PD Savage,
OBJECTIVE: The radiologist and oncologist are often confident that biopsy will confirm their suspicion of recurrent disease, but a biopsy is performed to confirm the histologic diagnosis before beginning or altering therapy. We have examined data to determine how often the biopsied lesion represents recurrent disease from the primary tumor or is an instance of new cancer, and whether recurrent disease can be predicted. MATERIALS AND METHODS: We reviewed the medical and imaging records of 253 patients who underwent CT-guided biopsy of an abdominal or pelvic lesion between 1993 and 1996. Sixty-nine of the 253 patients had a previously diagnosed primary tumor and were being examined for possible tumor recurrence or metastasis. The images of these 69 patients were analyzed to determine if the pattern of disease was typical of recurrence or metastasis. RESULTS: In 55 of the 69 patients, the pattern was judged to be typical of metastatic or recurrent disease. Biopsy confirmed this suspicion in all 55 patients. In 14 of the 69 patients, the pattern of spread was judged not to be typical of recurrence or metastasis. These 14 patients were found to have a new primary tumor (n = 4), benign processes (n = 2), and recurrences (n = 8). CONCLUSION: Of the patients for whom radiographic findings suggested recurrence, we found no patients in whom a new primary tumor would have been missed if biopsy had been avoided. Data should now be acquired prospectively to determine whether it may be prudent to make treatment decisions on the basis of imaging findings alone, without histologic confirmation.
44818.4886288881996.06.21++Calcification in focal nodular hyperplasia: a new problem for differentiation from fibrolamellar hepatocellular carcinoma.Radiology
F Caseiro-Alves, M Zins, Mahfouz A-E, A Rahmouni, V Vilgrain, Y Menu, D Mathieu,
PURPOSE: To describe calcification in focal nodular hyperplasia (FNH) of the liver, which poses a new problem for the differentiation of FNH from fibrolamellar hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ultrasound, computed tomography, and magnetic resonance imaging findings of 357 FNH lesions diagnosed in the past 5 years in 295 patients (274 female, 21 male; aged 14-72 years) were retrospectively reviewed with emphasis on intralesional calcification. RESULTS: Calcifications were seen in five FNH lesions (1.4%) as small, solitary spots located centrally or peripherally within the lesions. Morphologic features of these calcifications were similar to those of calcifications in two of six fibrolamellar HCCs in the same period. CONCLUSION: Calcification in FNH is a rare and atypical finding that poses further difficulty for differentiation from fibrolamellar HCC.
44918.48162450182006.03.10++Abdominal cavernous Iymphangiomas: CT findings.Abdom Imaging
JH Sohn, JH Byun, SH Park, SE Yoon, KW Kim, HS Hong, JK Han, JS Ryu, HJ Won, AY Kim, YM Shin, PN Kim, HK Ha, MG Lee,
Two adult patients with histopathologically proved cavernous lymphangiomas and one adult patient with lymphangiomas of strongly presumed cavernous type by cytologic and computed tomographic findings are reported. On computed tomograms, multiple, aggregated, small, and tiny cysts without a solid portion, along the lymphatic channels are characteristic computed tomographic findings for cavernous lymphangiomas.
45018.4787569091996.09.18++Breast lesions: correlation of contrast medium enhancement patterns on MR images with histopathologic findings and tumor angiogenesis.Radiology
LD Buadu, J Murakami, S Murayama, N Hashiguchi, S Sakai, K Masuda, S Toyoshima, S Kuroki, S Ohno,
PURPOSE: To compare qualitative and quantitative magnetic resonance (MR) mammographic features of breast lesions with histopathologic findings, especially tumor angiogenesis. MATERIALS AND METHODS: Seventy-three patients (72 women, one man; aged 30-78 years; mean age, 51.0 years) with suspicious breast lesions underwent MR imaging. Noncontrast medium-enhanced localization imaging and then gadolinium-enhanced dynamic fast spoiled gradient-recalled-echo (SPGR) imaging were performed in all patients. In selected patients, subtraction fast SPGR images were obtained. The Pearson and Spearman correlation tests were used to determine the strength of the relationships between enhancement parameters and microvessel determinations. RESULTS: Time intensity curve type correlated with microvessel density grade (Spearman rank correlation test: r = .90, P < .001). The steepest slope of contrast medium uptake correlated with microvessel counts (Pearson correlation test; r = .83, P < .001). Peripheral enhancement in invasive carcinomas (n = 9) correlated with high peripheral and low central microvessel densities, which were associated with desmoplasia and/or necrosis. Internal septations (n = 2) were seen only in fibroadenomas. CONCLUSION: The density and distribution of microvessels may play major roles in the determination of the initial rate of contrast medium uptake and the heterogeneity of tumor enhancement.
45118.4798337841998.12.07++Frequency of abdominal CT findings in AIDS patients with M. avium complex bacteraemia.Clin Radiol
L Pantongrag-Brown, TL Krebs, BD Daly, JJ Wong-You-Cheong, C Beiser, B Krause, AE Brown,
BACKGROUND: Use of blood culture studies for early diagnosis of Mycobacterium avium complex (MAC) infection has become important due to the recent development of effective antibiotic therapy for this condition. This study assessed the abdominal computed tomography (CT) findings in patients with AIDS who presented with bacteraemic MAC infection. METHODS: A retrospective analysis of abdominal CT scans was performed in 24 patients who presented with MAC-positive blood culture. CT images were reviewed specifically to evaluate for lymph node enlargement and attenuation, hepatomegaly, splenomegaly, bowel wall abnormality and for any other pathological changes. Comparison was made to prior reports of the CT findings in this disease process. RESULT: Enlarged intra-abdominal mesenteric and/or retroperitoneal lymph nodes were found in 10 patients (42%). These nodes were characterized by homogeneous, soft-tissue attenuation in eight of the 10 patients. Hepatomegaly, splenomegaly and small bowel wall thickening were noted in 12 (50%), 11 (46%) and four (14%) patients, respectively. CT findings were evaluated as normal in six (25%) patients. CONCLUSIONS: Enlarged mesenteric and/or retroperitoneal lymph nodes in AIDS patients with bacteraemic MAC were observed much less frequently on CT than previously reported in AIDS patient populations. Normal abdominal CT findings do not exclude this diagnosis and may reflect a trend towards earlier detection of MAC disease.
45218.4731799791988.11.30+ CT diagnosis of splenic multifocal lesions and abdominal lymphoadenopathy secondary to sarcoidosis.Comput Med Imaging Graph
FJ Alvarez, J Escalada, R Comet, F Garcia, M Biosca,
45318.4798649181999.02.16++Ultrasound-guided core-needle biopsy is effective in the initial diagnosis of lymphoma patients.Haematologica
PL Zinzani, A Colecchia, D Festi, M Magagnoli, A Larocca, S Ascani, M Bendandi, GF Orcioni, F Gherlinzoni, P Albertini, SA Pileri, E Roda, S Tura,
BACKGROUND AND OBJECTIVE: With the development and refinement of new guidance methods for percutaneous biopsies, many investigators have reported studies supporting a role for radiologically guided core-needle biopsy in the diagnosis of malignant lymphoma under certain clinical circumstances. The aims of this report are to evaluate the efficacy of findings at ultrasound (US)-guided core-needle biopsy of abdominal lymphoma on patient care and define the key determinants of clinical success. DESIGN AND METHODS: US-guided core needle biopsies were performed in 55 patients with abdominal lymphoma: 44 non-Hodgkin's lymphoma (NHL) and 11 Hodgkin's disease (HD); 41 had had no prior lymphoma and 14 had previously diagnosed lymphoma. All the biopsies were performed under US control using a 21-gauge modified Menghini needle. Overall, 53/55 (96%) patients were treated on the basis of biopsy findings only, including 14/14 (100%) patients with a history of lymphoma and 39/41 (93%) patients with no such history. RESULTS: In 46/53 (87%) patients it was possible to assess the specific histotype. No differences between the diagnostic rates of HD and high grade-NHL were recorded. There were no complications related to the biopsies. INTERPRETATION AND CONCLUSIONS: Our data indicate that abdominal US-guided core-needle biopsy should be considered as an effective and safe procedure in the diagnosis of patients with lymphoma offering the possibility of determining the tumor subtype and the subsequent specific treatment.
45418.47171519002008.01.07++Adrenal tumors with late enhancement on CT and MRI.Abdom Imaging
BK Park, CK Kim, B Kim, GY Kwon,
OBJECTIVES: To identify adrenal masses showing gradual persistent enhancement on delayed contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: Computed tomography or magnetic resonance images of pathologically proven 400 adrenal tumors were retrospectively reviewed over a 10-year period. We included only adrenal tumors showing gradual persistent enhancement on CT and MRI performed at 15 and 5 min, respectively, after contrast material injection. RESULTS: Four tumors in four patients (three men and one woman; mean age, 51 years) met the inclusion criteria. These lesions were as follows: two ganglioneuromas, one myelolipoma with infarction, and one angiomyolipoma with minimal fat. All of these tumors showed gradual persistent enhancement, and highest attenuation during delayed contrast-enhanced CT or strongest enhancement during delayed contrast-enhanced MRI. CONCLUSION: The differential diagnosis of adrenal tumors showing gradual persistent enhancement on delayed contrast-enhanced CT and MRI should include ganglioneuroma, myelolipoma with infarction, and angiomyolipoma with minimal fat.
45518.4697988821998.11.13+ Splenic arteriovenous fistula in a patient with lymphoma.AJR Am J Roentgenol
P van der Meer, A Cossi, JI Tsao,
45618.4584752771993.05.19++Abdominal staging of thoracic Hodgkin disease: CT-lymphangiography-Ga-67 scanning correlation.Radiology
PC Stomper, SP Cholewinski, J Park, SP Bakshi, MP Barcos,
A retrospective study was performed to assess whether lymphangiography and gallium-67 scanning were complementary to computed tomography (CT) in abdominal staging of disease in 94 patients with early-stage thoracic Hodgkin disease. In 51 patients with surgical or follow-up correlation, the spleen was involved in 16% (n = 8), the spleen and lymph nodes in 22% (n = 11), and only lymph nodes in 2% (n = 1). In these 51 patients, none of the imaging modalities had greater than 50% sensitivity for the detection of nodal involvement. The overall accuracy was similar (71%-82%) for each modality. Analysis of subgroups of patients with lymph nodes measuring less than 10 mm, 10-19 mm, or 20 mm or greater at CT revealed that lymphangiography and gallium scanning added little to the positive or negative predictive values of CT. The sensitivity of CT for detection of splenic disease was 11% (two of 19). On the basis of surgical or follow-up correlation in 51 patients, the authors conclude that lymphangiography and gallium scanning offer minimal or no complementary benefit.
45718.4332581071988.04.08++Gadolinium-DTPA in the evaluation of intradural extramedullary spinal disease.AJR Am J Roentgenol
G Sze, A Abramson, G Krol, D Liu, J Amster, RD Zimmerman, MD Deck,
Gadolinium-DTPA was used in MR imaging of the spine to determine the ability of a contrast agent to increase the detection and characterization of disease in the intradural extramedullary space. Although MR imaging, especially with recent technological improvements, has been shown to be at least competitive with, and often superior to, myelography and postmyelography CT in the study of intramedullary and extradural disease, its use in the assessment of intradural extramedullary disease has been questioned. We selected 12 patients with intradural extramedullary disease as demonstrated by positive CSF cytology and/or myelographic findings and performed MR examinations on them before and after administering gadolinium-DTPA (0.1 mmol/kg). Gadolinium-DTPA was extremely effective in depicting intradural extramedullary disease of the spine. Small nodules of 3 mm, virtually invisible on noncontrast MR scans, enhanced strongly and were easily detected. In addition, leptomeningeal spread of tumor along nerve roots was also visualized, sometimes more readily than by myelography and postmyelography CT. The remarkable sensitivity of gadolinium-DTPA to intradural extramedullary disease assures its role in future MR examinations of the spine.
45818.4368287591983.04.21++Management of loculated abscesses that are difficult to drain: a new approach.Radiology
PF van Waes, MA Feldberg, WP Mali, SH Ruijs, PC Eenhoorn, PH Buijs, FJ Kruis, LR Ramos,
Fourteen critically ill patients underwent percutaneous drainage of abdominal abscesses. All 14 had one or more relative contraindications to external drainage procedure: (a) multiloculated abscesses; (b) multiple abscesses; (c) abscesses that form fistulae to surrounding organs; (d) abscesses containing viscous fluid, debris, or necrotic material. A total of 32 cavities was drained, usually using a multiple trocar/catheter system. Biplane computed tomography demonstrated a safe drainage route in all patients. In those patients in whom the contents of the abscess were too viscous to permit drainage, the contents were liquefied with acetylcysteine. Nine of the 14 patients (64%) recovered completely following the drainage procedure.
45918.4222990051990.03.05++MR characterization of hepatic lesions by t-null inversion recovery sequence.J Comput Assist Tomogr
G Patrizio, P Pavone, A Testa, L Marsili, E Tettamanti, R Passariello,
Tissue characterization of focal hepatic lesions was performed employing an inversion recovery sequence with short repetition time and short inversion time (TI) values. Different and specific TI values, correlated to the in vivo measured T1 relaxation times, were used to null the signal intensity of each type of lesion. In 40 patients studied, we observed the nulling effect of normal liver in 10 of 10 cases with a TI of 136 ms, of metastases in 7 of 8 cases with a TI of 175 ms, of hemangiomas in 15 of 16 cases with a TI of 200 ms, and of cysts in 6 of 7 cases with a TI of 235 ms. A quantitative analysis of the nulled signal was performed by measuring the signal/noise values. A further qualitative and quantitative characterization was carried out by evaluating the signal intensity of hepatic lesions at the null point of normal liver. The method provided the possibility of discriminating different focal lesions with specificity values of 83-94%, according to the type of lesion.
46018.39164955052006.08.03+ Multifocal nodular fatty infiltration of the liver mimicking metastatic liver tumors: diagnosis using the liver-specific late phase of Levovist-enhanced sonography.J Ultrasound Med
H Tamai, N Shingaki, M Oka, T Shiraki, I Inoue, H Magari, M Fujishiro, M Iguchi, K Yanaoka, K Arii, Y Shimizu, M Ichinose,
46118.3512737531976.08.02++Splenic abscess.Surgery
TW Lawhorne, GD Zuidema,
A review of autopsy files and clinical case reports demonstrates two categories of splenic abscess. First, the abscesses discovered at postmortem usually are multiple, small manifestations of widespread, lethal infection in immunologically crippled hosts. A clinical diagnosis seldom is made. Second, the splenic abscesses encountered by the clinician are usually solitary, large, and challenge his diagnostic skills. Recognition is of vital importance, for therapy can be highly successful. Left untreated, the mortality rate is very high. The features, clinical management, and pathogenesis of splenic abscesses are discussed.
46218.3559288151967.02.25+ Splenic cyst diagnosed by percutaneous needle aspiration and splenography. Report of a case.Am J Dig Dis
CJ DeMasi, K Akdamar, RD Sparks, FM Hunter,
46318.3435381331986.12.29++Lymphoceles: imaging characteristics and percutaneous management.Radiology
E vanSonnenberg, GR Wittich, G Casola, VW Wing, NA Halasz, AS Lee, C Withers,
Twenty-five patients who had lymphoceles underwent sectional imaging and interventional radiologic procedures. Viewed using sonography, lymphoceles were hypoechoic to anechoic, occasionally with internal septa and debris. Low numbers (occasionally negative values) were observed using computed tomography (CT); these numbers strongly suggest the diagnosis of lymphocele. Calcification was observed on CT images of one patient. Diagnostic aspiration revealed tan to yellow fluid containing many lymphocytes; pathognomonic fat globules were observed in four cases. Malignant cells were found in two collections, an unusual occurrence. Therapeutic needle aspiration and short-term catheter drainage were usually unsuccessful (only one of five patients [20%] was cured). Long-term (1-5-week) catheter drainage cured 11 of 14 patients (78.6%). Sclerosing agents may have been beneficial for lymphocele obliteration in three of four patients. For most patients, lymphoceles may be diagnosed and treated successfully using radiologic means.
46418.33170217082007.05.03++Image-guided core-needle biopsy of peripheral lymph nodes allows the diagnosis of lymphomas.Eur Radiol
E de Kerviler, C de Bazelaire, N Mounier, O Mathieu, B Brethon, J Brière, JP Marolleau, P Brice, C Gisselbrecht, J Frija,
It is commonly admitted that the diagnosis of lymphomas can be assessed by the image-guided needle biopsy (IGNB) of deep lymph nodes. However, when peripheral lymph nodes are present, surgical dissection remains the standard strategy. The aim of this study was to evaluate the diagnostic yield of IGNB of peripheral lymph nodes in patients with suspected lymphomas. The records of 180 multisampling IGNBs of peripheral lymph nodes in 180 patients were reviewed. One hundred and twenty-three IGNBs were observed at first diagnosis and 57 at progression using large-cutting core-biopsy needles ranging between 18 G and 14 G in size. Immunohistochemistry studies were performed in all cases and at least one biopsy was systematically frozen. A diagnosis of lymphoma with sufficient information such that a therapeutic decision could be made was obtained in 146 of the 152 patients with lymphoproliferative disorders (96%). IGNB was equally effective in making the correct diagnosis of lymphoma at the time of original diagnosis than at relapse. The results did not depend on the biopsy site, lymph nodes size, or needle type. We recommend that IGNB may be performed as an initial procedure for the diagnosis of lymphomas either in the presence of peripheral or deep lymph nodes, as it avoids surgery.
46518.3330638601989.03.06+ [Ultrasound and radiological diagnosis of primary splenic tumors]Rinsho Hoshasen
M Iwasaki, T Nakayama, Y Hiyama, S Myojyo, K Maruyama, Y Seki,
46618.319816681977.01.03++Focal splenic defects.Radiology
MH Freeman, AK Tonkin,
Review of more than 2,000 liver-spleen scans revealed 18 cases of focal splenic defects. Three major categories are defined: lymphoma, infarctions, and metastatic tumor. Clinical presentation is important in determining the precise etiology, and a differential diagnosis is presented. It appears that: (a) reticulum cell carcinoma is as likely to cause defects as is Hodgkin's disease; (b) splenic infarction is related to pancreatic disease through the splenic vein; and (c) malignant melanoma is the most common secondary deposit as detected by scanning.
46718.3113423711994.02.04+ Multifocal splenic abscesses in AIDS-related tuberculosis.Eur J Med
V Soriano, J Tor, M Adrados, R Muga, F Laguna, B Clotet, J González-Lahoz,
46818.2991356531997.05.23++Dynamic MRI of invasive breast cancer: assessment of three region-of-interest analysis methods.J Comput Assist Tomogr
S Mussurakis, DL Buckley, A Horsman,
PURPOSE: In this study, three region-of-interest (ROI) analysis methods based on operator-defined and semiautomated sampling of pharmacokinetic breast maps of contrast uptake are described. The observer variability and impact of the methods on the estimated enhancement characteristics of invasive cancer are also presented. METHOD: Fifty-four women with invasive breast cancer underwent dynamic Gd-DTPA-enhanced MRI. ROIs were drawn by two observers on parametric images obtained from compartmental modeling of the dynamic data. Three methods were used: (a) An irregular ROI was drawn to include as much of the enhancing part of the tumor as possible (large ROI); (b) a 12 pixel circular ROI was placed at the most rapidly enhancing part of the large region (small ROI); and (c) a computer algorithm interrogated the large region pixel by pixel using a 9 pixel square mask and selected the region with the highest mean parameter value (semiautomated ROI). RESULTS: Significant observer variability and bias were found in the enhancement measurements using the large ROI method. There was no observer bias associated with the other methods, but the variability of the small ROI method was substantial. An almost perfect observer agreement was achieved using the semiautomated method. The small and semiautomated ROI methods produced significantly higher enhancement ratios than the large ROI method, especially in grade III carcinomas. CONCLUSION: Variability is inherent in subjective ROI analysis, but the semiautomated method of ROI selection and sampling of parameter images of the breast is an efficient and reliable alternative that may allow better standardization of the MR technique.
46918.27179789142008.04.10++[Spontaneous spleen rupture due to primary splenic angiosarcoma: a case report]Ulus Travma Acil Cerrahi Derg
B Mayir, T Colak, A Dinçkan,
Primary spleen angiosarcoma is an infrequent disease and the diagnosis is usually difficult. In this report we discussed a case who presented with abdominal pain. In clinical follow symptoms of shock were observed. Laparotomy was performed and spleen rupture was detected. Spleen angiosarcoma must be considered in the differential diagnosis of patients with unexplained anemia, splenic mass and splenomegaly. It has rapid course and poor prognosis. Splenectomy must be performed because of threat of rupture.
47018.2766905271984.02.15++Computed tomography of silent abdominal abscesses.J Comput Assist Tomogr
RB Jeffrey, MP Federle, FC Laing,
Computed tomographic (CT) findings are reviewed in nine patients with clinically unsuspected abdominal abscesses. None of the patients in this series had significant fever or leukocytosis. Localized pain or a palpable mass was the primary clinical feature in seven patients. Computed tomography demonstrated encapsulated fluid collections without gas in five patients representing chronic abscess. Computed tomography was diagnostic of an abscess in three patients and guided aspiration was helpful in demonstrating an abscess in two other patients. The inability to make a correct preoperative diagnosis of an abscess in four of the nine cases was due to a low level of clinical suspicion, a nonspecific CT appearance, and failure to perform diagnostic aspiration.
47118.26175737682007.07.05+ Splenic hamartoma.Cytopathology
S Conlon, D Royston, P Murphy,
47218.2532150611989.02.28++[Splenic cyst. Diagnosis, indications and choice of procedure]Chirurg
KH Treutner, S Truong, V Schumpelick,
Based on two cases of splenic cysts diagnosis, indication, and selection of surgical methods are discussed. Ultrasound and computerized axial tomography prove to be the most important diagnostic methods. The indication to operate on cysts with a diameter exceeding 2 cm follows from possible complications. Because of the immunological importance of the spleen and the technical means of today a splenic resection should always be considered.
47318.21109466942000.10.04++Cystic masses of the spleen: radiologic-pathologic correlation.Radiographics
M Urrutia, PJ Mergo, LH Ros, GM Torres, PR Ros,
Many focal splenic lesions may appear to be cystic at cross-sectional imaging. In this article, the following types of cystic splenic masses are discussed: congenital (true cyst), inflammatory (abscesses, hydatid cyst), vascular (infarction, peliosis), posttraumatic (hematoma, false cyst), and neoplastic (hemangioma, lymphangioma, lymphoma, metastasis). The key findings at ultrasound, computed tomography, and magnetic resonance imaging can be correlated with underlying gross and microscopic pathologic findings. Although tissue sampling is still required in many cases to yield a definitive diagnosis, recognition and understanding of the spectrum of imaging and pathologic features of these lesions often help narrow the differential diagnosis.
47418.2184784651993.05.27+ Retroperitoneal sarcoidosis.J Clin Ultrasound
VS Dogra, J Poblete,
47518.20168452892006.08.31++Characterization of small liver lesions: Added role of MR after MDCT.J Comput Assist Tomogr
NS Holalkere, DV Sahani, MA Blake, EF Halpern, PF Hahn, PR Mueller,
OBJECTIVE: The purpose of this study is to evaluate the added role of magnetic resonance imaging (MR) in characterizing subcentimeter focal liver lesion(s) detected on multidetector row helical computed tomography (MDCT). MATERIALS AND METHODS: A retrospective analysis was performed in 59 noncirrhotic patients with focal subcentimeter liver lesion(s) detected on a 4- or 16-slice MDCT. All patients had a gadolinium enhanced liver MR on 1.5-T systems within 6 weeks after MDCT. Imaging diagnosis was graded on an ordinal scale of 0-5 (0, normal; 1, definitely benign; and 5, definitely malignant). The final diagnosis was established either by histopathology or follow-up imaging for a period of at least 6 months. Receiver operating characteristic analysis was performed to compare the performances of MDCT and MR in characterization of subcentimeter liver lesions. RESULTS: A total of 178 lesions were detected on MDCT in 59 patients. Of these lesions, 129 (72.5%) lesions were benign and the remaining 49 were malignant. The sensitivity, specificity, positive predictive value, and negative predictive value in differentiation of benign from malignant lesions on MDCT were 81.2%, 77.3%, 60.5%, 90.6 % and on MR were 83.3%, 97.5%, 92.1%, and 94.4 %, respectively. Comparative receiver operating characteristic analysis showed an area under curve for MDCT = 0.76 and MR = 0.95 (P < 0.001). CONCLUSIONS: Liver MR has significantly higher accuracy for characterization of subcentimeter focal liver lesions discovered on MDCT.
47618.1997143941998.09.01++Staging lymphoma with CT: comparison of contiguous and alternate 10 mm slice techniques.Clin Radiol
KS Naik, JA Spencer, CM Craven, KA MacLennan, PJ Robinson,
PURPOSE: To compare two computed tomography (CT) techniques, contiguous 10 mm and alternate 10 mm slices of the chest, abdomen and pelvis, for initial staging of lymphoma. SUBJECTS AND METHODS: Fifty-two consecutive patients referred at initial diagnosis for lymphoma staging by CT were examined with contiguous 10 mm slices of the chest, abdomen and pelvis. Oral contrast was administered, but no intravenous contrast. Two sets of films for each examination were printed, one with 10 mm contiguous slices and one with 10 mm alternate slices. The two sets of films for each patient were reviewed separately in a randomized order and blinded fashion by two independent observers. Discrepancies were reviewed by a third observer and subsequently resolved by consensus. RESULTS: Staging assessments by both techniques were concordant in 51 of 52 cases: one patient was recorded as stage II on the alternate slice technique, but stage III with contiguous slices but this difference did not affect management. Inter-technique agreement was very good (kappa=0.97). The staging assessments showed discrepancies between the two observers in 12 of the 52 cases which were independent of technique (kappa=0.71; good agreement). Consensus review showed them to result from differences in perception in seven cases and differences in interpretation of abnormalities in five cases. CONCLUSION: Our findings support the use of an alternate 10 mm slice technique in the staging of lymphoma at initial diagnosis. Observer variation was greater than the difference between techniques.
47718.17109666962000.09.19++Hepatic cavernous hemangioma: temporal peritumoral enhancement during multiphase dynamic MR imaging.Radiology
MG Jeong, JS Yu, KW Kim,
PURPOSE: To determine whether temporal parenchymal enhancement around hepatic cavernous hemangiomas can be correlated with the rapidity of intratumoral contrast material enhancement and/or tumor volume at dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: Dynamic MR images obtained in 94 patients with 167 hemangiomas were retrospectively reviewed for peritumoral enhancement. Tumor volume was estimated by using the longest dimension on nonenhanced images. Speed of intratumoral contrast material enhancement was determined with early nonequilibrium phase images and was categorized as rapid (>75% of tumor volume), intermediate (25%-75% of tumor volume), or slow (<25% of tumor volume). RESULTS: Thirty-two of the 167 hemangiomas (19%) had temporal peritumoral enhancement, which was more common in hemangiomas with rapid enhancement (20 of 49 [41%]) than in those with intermediate (12 of 62 [19%]) and slow (0 of 56 [0%]) enhancement (P: <.001). The mean diameter of the hemangiomas with peritumoral enhancement was not significantly different from that of hemangiomas without peritumoral enhancement (P: >.05). Hemangiomas with rapid enhancement (mean diameter, 16 mm +/- 8), however, were significantly smaller than those with intermediate enhancement (mean diameter, 33 mm +/- 34) (P: <.001). CONCLUSION: Temporal peritumoral enhancement on dynamic MR images of hepatic hemangiomas correlates well with the speed of intratumoral contrast material enhancement and was most commonly encountered in rapidly enhancing small lesions. There was no statistically significant relationship, however, between peritumoral enhancement and tumor volume.
47818.1735126411986.04.23++Multiple cavernous hemangiomas of the spleen: CT findings.J Comput Assist Tomogr
CN Moss, JA Van Dyke, RE Koehler, CT Smedberg,
Diffuse cavernous hemangiomatosis of the spleen is a rare condition, but it is considered the most common benign tumor to involve the spleen. Computed tomography and ultrasound are useful and effective methods for evaluating the spleen for the presence of multiple hemangiomas, the diagnosis of which is otherwise difficult to establish. This report emphasizes the sonographic and CT findings of the condition and reviews the pathological and clinical features.
47918.1792074981997.09.18++Evaluation of renal artery stenosis with dynamic gadolinium-enhanced MR angiography.AJR Am J Roentgenol
MJ Rieumont, JA Kaufman, SC Geller, EK Yucel, RP Cambria, LS Fang, H Bazari, AC Waltman,
OBJECTIVE: The purpose of this study was to compare dynamic gadolinium-enhanced three-dimensional spoiled gradient-recalled MR angiography with conventional arteriography in the evaluation of proximal renal artery stenosis (RAS). MATERIALS AND METHODS: MR angiography and conventional arteriographic examinations of 30 patients evaluated for RAS were analyzed retrospectively. Three-dimensional MR angiography was performed with an RF spoiled gradient-recalled imaging sequence acquired during the dynamic i.v. injection of gadolinium (0.2-0.3 mmol/kg), MR data and conventional arteriograms were independently evaluated for the number and location of renal arteries and the degree and location of stenoses. The patients had a mean age of 70 years old and a mean serum creatinine level of 2.9 mg/dl, reflecting a population in whom atherosclerotic RAS was the primary concern. RESULTS: Gadolinium-enhanced MR angiography revealed 100% of main renal arteries. For RAS of 50% or greater occlusion, the technique was 100% sensitive and 71% specific; the negative predictive value was 100%. The technique was 100% sensitive and 71% specific for RAS of 75% or greater occlusion. CONCLUSION: Dynamic gadolinium-enhanced three-dimensional spoiled gradient-recalled MR angiography has a high sensitivity for revealing proximal RAS and is a quick and reliable technique for obtaining helpful anatomic information.
48018.1636915431988.02.20++Hepatic haemangioma: dynamic MRI using gadolinium-DTPA.Eur J Radiol
K Ohtomo, Y Itai, K Yoshikawa, T Kokubo, N Yashiro, M Iio,
Six patients with hepatic haemangioma were examined with a 1.5 tesla magnetic resonance scanner before and immediately after bolus injection of 0.05 mmol/kg gadolinium-DTPA. Eight to ten spin-echo images (TR: 100 msec, TE: 20 msec, scanning time: 26 sec) were obtained through the region of the haemangioma. In all cases, dense contrast enhancement of the lesion was demonstrated. The enhancement spread in all directions from the lesion on subsequent delayed scans (high signal fill-in); a signal higher than that from surrounding hepatic parenchyma was present two minutes after contrast injection. Dynamic MRI is a promising method for the evaluation of hepatic haemangioma and it is more easily tolerated by patients than dynamic CT using iodinated contrast medium.
48118.1686882331996.08.28++US and CT findings in the diagnosis of tuberculous peritonitis.Acta Radiol
FB Demirkazik, O Akhan, MN Ozmen, D Akata,
PURPOSE. To evaluate the ultrasonographic and CT findings of tuberculous peritonitis. MATERIAL AND METHODS. Ultrasonographic and CT findings of 11 patients with the ascitic type of tuberculous peritonitis were reviewed. RESULTS. All patients had ascites, and ultrasonography (US) demonstrated fine complete and incomplete mobile septations in 10 patients. In 5 of them, the ascites had a lattice-like appearance. Diffuse regular peritoneal thickening was detected in all patients by CT and in 10 patients by US. CT demonstrated infiltration of the greater omentum in 9 patients, whereas US showed omental thickening in only 5 patients. CONCLUSION. Peritoneal and omental thickening detected by CT and ascites with fine, mobile septations shown by US strongly suggest the ascitic type of tuberculous peritonitis. The 2 imaging modalities should be used together for accurate diagnosis of tuberculous peritonitis.
48218.1683234941993.08.05++Hemangioma of spleen with spontaneous, extra-peritoneal rupture, with associated splenic tuberculosis--an unusual presentation.Australas Radiol
RC Rao, R Ghose, S Sawhney, M Berry,
We report a case of unusual presentation of a patient with hemangioma of the spleen. The patient had presented with recurrent gastric hemorrhage and significant weight loss, due to ruptured hemangioma of the spleen and associated splenic tuberculosis. The true nature of the lesions remained a diagnostic dilemma despite complete radiological workup and review of literature.
48318.1178225501995.02.10++MR-guided localization of suspected breast lesions detected exclusively by postcontrast MRI.J Comput Assist Tomogr
U Fischer, R Vosshenrich, H Bruhn, D Keating, BW Raab, JW Oestmann,
OBJECTIVE: We describe and evaluate a preoperative MRI localization procedure for suspected breast lesions. MATERIALS AND METHODS: Fourteen consecutive patients underwent MR localization of suspected breast lesions discovered with contrast-enhanced MRI but not detected by conventional mammography or ultrasound. In each case diagnostic MRI was repeated after the application of special skin markers. A non-magnetic wire was subsequently inserted into the breast and a second MRI performed to document the position of the wire tip relative to the lesion. RESULTS: The procedure was successful in all 14 patients, enabling excision of the lesion and allowing histological diagnoses. CONCLUSION: We found the described procedure to be quite useful.
48418.09104574251999.10.12+ Splenic inflammatory pseudotumor mimicking primary splenic malignancy.Haematologica
Y Edoute, A Roguin, Z Gallimidi, O Ben-Izhak, P Nagachandran, H Ben-Ami,
48518.0677172221995.05.18++Blood-pool MR contrast material for detection and characterization of focal hepatic lesions: initial clinical experience with ultrasmall superparamagnetic iron oxide (AMI-227).AJR Am J Roentgenol
S Saini, RR Edelman, P Sharma, W Li, W Mayo-Smith, GJ Slater, PJ Eisenberg, PF Hahn,
OBJECTIVE. AMI-227 is an ultrasmall superparamagnetic iron oxide colloid known to enhance tissue T1 and T2 relaxation rates. Animal studies show that AMI-227 has an estimated blood half-life of more than 200 min. In this study, we evaluated the clinical utility of AMI-227 as an MR contrast agent for detection and characterization of focal hepatic lesions, with MR imaging done while the contrast agent is in the intravascular space (blood-pool phase). SUBJECTS AND METHODS. Twenty-two patients with known or suspected focal hepatic masses underwent T1- and T2-weighted MR imaging of the liver at 1.5 T before and immediately after drip infusion of AMI-227 at doses of 0.8, 1.1, or 1.7 mg Fe/kg. Unenhanced and contrast-enhanced images were analyzed qualitatively (lesion detection and tissue characterization) and quantitatively (lesion-liver contrast-to-noise ratio). RESULTS. AMI-227 enhanced signal in normal liver and blood vessels on T1-weighted images and decreased signal in these tissues on T2-weighted images. Qualitatively and quantitatively, lesion-liver contrast was increased for solid tumors (non-cyst and nonhemangioma) at all three doses (p < .02) on both T1- and T2-weighted images. Differentiation between blood vessels and small lesions was easier on contrast-enhanced images, which allowed increased confidence in excluding lesions. Unique enhancement patterns were noted for hemangiomas, solid tumors, and cysts. CONCLUSION. Initial clinical experience suggests that AMI-227 is a useful contrast agent for detection and characterization of focal hepatic lesions.
48618.06149865482004.03.16++[Hemangioma of the spleen. A case report]Tunis Med
S Jarboui, A Krichen, L Ben Temime, F Sraïri, Mel M Abdesselem, A Zaouche,
We report a case of hemangioma of the spleen in an 18-old-years female patient. Clinical presentation was abdominal pain in the left upper quadrant. Physical examination founding was normal. The hemangioma was presented as hyperechogenic mass on ultra sound imaging. On the computed tomography scan with contrast it became progressively hyperdense. Splenectomy is often indicated because of the risk of rupture and the doubt about malignant form in histological examination.
48718.04156478782005.05.31+ Vascular pathology of the spleen, part I.Abdom Imaging
AM De Schepper, F Vanhoenacker, B Op de Beeck, J Gielen, P Parizel,
48818.0392802521997.09.16++Focal liver masses: characterization with diffusion-weighted echo-planar MR imaging.Radiology
T Namimoto, Y Yamashita, S Sumi, Y Tang, M Takahashi,
PURPOSE: To evaluate diffusion-weighted echo-planar magnetic resonance (MR) imaging for improving the specificity of characterization of liver tumors. MATERIALS AND METHODS: Diffusion-weighted echo-planar imaging was performed with a 1.5-T whole-body imager with use of a body phased-array coil in 51 patients with 59 hepatic masses (41 malignant tumors, nine hemangiomas, and nine cysts). Apparent diffusion coefficient (ADC) values were obtained with two motion-probing gradients (b = 30 and 1,200 sec/mm2) during each of the breath-hold periods, and an ADC map was constructed. The T2 was derived from spin-echo echo-planar images with echo times of 47 and 99 msec. RESULTS: The ADC value of malignant masses (1.04 x 10(-3) mm2/sec) was significantly lower (P < .01) than that of benign masses (hemangiomas [1.95 x 10(-3) mm2/sec] and cysts [3.05 x 10(-3) mm2/sec]), although the T2s showed considerable overlap. A small amount of overlap in ADC values occurred among malignant tumors, hemangiomas, and cysts. ADC values of two cystic masses from ovarian carcinomas were within the range of those of hemangiomas. CONCLUSION: These preliminary results indicate that diffusion-weighted MR imaging can be useful in characterizing focal liver masses. With the exception of cystic metastatic tumors, the technique may be especially useful in tumors that appear markedly hyperintense on T2-weighted images due to a long T2.
48918.0376226871995.08.30++Abdominal manifestations of sarcoidosis in CT studies.J Comput Assist Tomogr
SJ Folz, CD Johnson, SJ Swensen,
OBJECTIVE: The purpose of this study is to demonstrate the spectrum of abdominal CT findings in patients with tissue proved sarcoidosis, estimate their prevalence, and correlate abdominal findings with stage of thoracic disease. MATERIALS AND METHODS: Between 1987 and 1993, 140 patients with tissue proved sarcoidosis underwent abdominal or chest CT at our institution. After exclusions, 49 patients remained. Abdominal CT was retrospectively reviewed and the findings arrived at by consensus. Chest radiography within 1 month of CT was available for 46 patients. Chest radiography was retrospectively reviewed and stage of thoracic disease arrived at by consensus. RESULTS: Splenic abnormalities consisted of splenomegaly, low density lesions, and punctate calcifications. Hepatic sarcoidosis manifested as hypovascular lesions, hepatomegaly, and punctate calcifications. Lymphatic abnormalities consisted of lymphadenopathy, most commonly between 1 and 2 cm, and an increased number of normal sized lymph nodes. CONCLUSION: Sarcoidosis produces splenic abnormalities in 53% of patients, liver abnormalities in 16%, and lymphatic findings in 43%. No correlation was demonstrated between the abdominal findings and stage of thoracic sarcoidosis.
49018.03164207912006.03.10++[Primary angiosarcoma of the spleen with liver metastases. Case report and literature review]Cir Esp
J Verge, J Albiol, M Navas, C Martín,
Angiosarcomas of the spleen are infrequent tumors that often present with liver metastases. These tumors are usually multiple and have a poor prognosis. Immunohistochemical markers can aid preoperative diagnosis since radiological and ultrasonographic images are fairly nonspecific. The recommended treatment is splenectomy. The benefits of chemotherapy and radiotherapy have not been clearly demonstrated.
49118.0230298311987.04.10++[Focal changes in the spleen. Ultrasonic morphological characteristics and their clinical significance]Rofo
CF Hess, W Grodd, B Kurtz, E Jähde,
Focal changes in the spleen were rare findings in a large clinical material (less than 1% of cases). In a prospective study, which included 580 patients, lesions in the spleen were found in 40. Four focal lesions were due to infiltrates from non-Hodgkin's lymphoma. Twenty-one lesions with low echoes consisted of twelve infiltrates from Hodgkin's disease (six patients) or non-Hodgkin's lymphoma (six patients), five were due to fresh splenic infarcts and one each to an abscess, a metastasis from a carcinoma of the stomach, sarcoid and a haemorrhage. In only three of ten highly echogenic foci was a diagnosis possible (one leukaemic infiltrate and two scars following splenic infarcts). The significance of the sonographic demonstration of focal splenic lesions for diagnosis and treatment is discussed. The advantages of a sector scanner for evaluation of the spleen and splenic size are mentioned.
49218.0218997481991.03.20+ Retroperitoneal sarcoidosis.AJR Am J Roentgenol
DB Bach, AD Vellet,
49318.01124612592003.01.10++Detection of liver metastases: comparison of gadobenate dimeglumine-enhanced and ferumoxides-enhanced MR imaging examinations.Radiology
C del Frate, M Bazzocchi, KJ Mortele, C Zuiani, V Londero, G Como, R Zanardi, PR Ros,
PURPOSE: To compare gadobenate dimeglumine (Gd-BOPTA)-enhanced magnetic resonance (MR) imaging with ferumoxides-enhanced MR imaging for detection of liver metastases. MATERIALS AND METHODS: Twenty consecutive patients known to have malignancy and suspected of having focal liver lesions at ultrasonography (US) underwent 1.0-T MR imaging with gradient-recalled-echo T1-weighted breath-hold sequences before, immediately after, and 60 minutes after Gd-BOPTA injection. Subsequently, MR imaging was performed with turbo spin-echo short inversion time inversion-recovery T2-weighted sequences before and 60 minutes after ferumoxides administration. All patients subsequently underwent intraoperative US within 15 days, and histopathologic analysis of their resected lesion-containing specimens was performed. Separate qualitative analyses were performed to assess lesion detection with each contrast agent. Quantitative analyses were performed by measuring signal-to-noise and contrast-to-noise ratios (CNRs) on pre- and postcontrast Gd-BOPTA and ferumoxides MR images. Statistical analyses were performed with Wilcoxon signed rank and Monte Carlo tests. RESULTS: Sensitivity of ferumoxides-enhanced MR imaging was superior to that of Gd-BOPTA-enhanced MR imaging for liver metastasis detection (P <.05). Ferumoxides MR images depicted 36 (97%) of 37 metastases detected at intraoperative US, whereas Gd-BOPTA MR images depicted 30 (81%) metastases during delayed phase and 20 (54%) during dynamic phase. All six metastases identified only at ferumoxides-enhanced MR imaging were 5-10 mm in diameter. There was a significant increase in CNR between the lesion and liver before and after ferumoxides administration (from 3.8 to 6.8, P <.001) but not before or after Gd-BOPTA injection (from -4.8 to -5.5, P >.05). CONCLUSION: Ferumoxides-enhanced MR imaging seems to be superior to Gd-BOPTA-enhanced MR imaging for liver metastasis detection. Copyright RSNA, 2002
49418.0066024721983.07.15+ Infantile hemangioendothelioma of the liver: a radiologic-pathologic-clinical correlation.AJR Am J Roentgenol
AH Dachman, JE Lichtenstein, AC Friedman, DS Hartman,
49518.00183032892008.03.28++Complete pancreatic encasement of the portal vein (circumportal pancreas): imaging findings and implications of a rare pancreatic anomaly.J Comput Assist Tomogr
JR Leyendecker, SG Baginski,
Computed tomography and magnetic resonance imaging findings in 4 patients with complete pancreatic encasement of the portal vein are presented, with emphasis on the use of multiplanar reconstructions in demonstrating this anomaly.
49618.0090227611997.03.03++Application of magnetization transfer imaging for intracranial lesions of tuberous sclerosis.J Comput Assist Tomogr
MG Jeong, TS Chung, CJ Coe, TJ Jeon, DI Kim, AY Joo,
PURPOSE: Our goal was to assess the effectiveness of magnetization transfer imaging (MTI) and the usefulness of the magnetization transfer ratio (MTR) in tuberous sclerosis (TS). METHOD: T2- and T1-weighted SE images with saturation pulse on/off before and after gadolinium enhancement in 10 patients with TS were obtained. The numbers of subependymal nodule (SEN), cortical tuber, and white matter (WM) abnormality detected on T1-, proton density, T2-, and MT T1-weighted SE images were compared. The contrast-to-noise ratio (C/N) on T1-, MT T1-, Gd T1-, and Gd MT T1-weighted SE images and MTR (1-Msat/MO) on each set of saturation/nonsaturation images for each lesions were calculated. Mean MTRs (mMTRs) of WM and gray matter (GM) from seven normal volunteers were also obtained. RESULTS: MT T1-weighted SE images always depicted all lesions seen on conventional MRI and allowed depiction of more SENs (n = 80), cortical tubers (n = 197), and WM abnormalities (n = 82) than did T1-weighted (n = 58/85/33), proton density (n = 41/108/36), or T2-weighted (n = 48/121/46) SE images. The best C/N was obtained from Gd MT T1-weighted SE images in SENs and from MT T1-weighted SE images in other lesions. mMTRs of normal WM and GM were 36.43 and 29.42%, respectively. Cortical tubers and WM abnormalities had measured MTRs that were statistically equal to MTRs of GM in normal subjects (p < 0.005). MTRs of SENs showed lower mean (25.55%) and greater diversity (SD +/- 5.30), compared with MTRs of other lesions and normal GM and WM. One SEN with MTR of 20.72% was pathologically confirmed to be subependymal giant cell astrocytoma (SGCA). Nine SENs had measured MTR below 20.72% and six nodules among these were located in the region of the foramen of Monro, which is the characteristic location of SGCA. CONCLUSION: MTI may be effective in detecting all cranial lesions of TS. MTR may increase the specificity of MRI because it can differentiate the histopathologic subtypes and track and evolution of SEN into SGCA.
49718.0069767261982.03.22++Sonography of splenic abscess.AJR Am J Roentgenol
S Pawar, CJ Kay, R Gonzalez, KJ Taylor, AT Rosenfield,
Gray-scale sonographic examination was performed in seven cases of splenic and parasplenic abscess. The splenic abscesses appeared as irregular, poorly defined anechoic masses with varying internal echogenicity and acoustical transmission. Increased echogenicity and distal acoustical shadowing due to gas within the abscess were also noted. Gray-scale sonography was instrumental in the diagnosis of splenic abscess in this group of patients whose symptomatology was of uncertain etiology.
49817.9990669541997.05.30+ Importance of a previous allergy to an iodinated contrast agent in the administration of gadopentetate dimeglumine.Ann Pharmacother
N García, E Ramón, L Gonzalez del Valle, M Ruano, E Jiménez,
49917.98145002232003.11.17++Imaging-guided percutaneous splenic biopsy using a 20- or 22-gauge cutting-edge core biopsy needle for the diagnosis of malignant lymphoma.AJR Am J Roentgenol
S Lieberman, E Libson, B Maly, P Lebensart, D Ben-Yehuda, AI Bloom,
OBJECTIVE: We estimated the accuracy and safety of imaging-guided needle biopsy for the diagnosis of suspected malignant lymphoma in patients with a splenic lesion. CONCLUSION: Imaging-guided small-bore cutting-edge needle biopsy of splenic lesions is a safe procedure. In most patients with primary or recurrent lymphoma, the disease subtype can be diagnosed reliably.
50017.9790510171997.03.28++Differentiation of liver hemangiomas from metastases and hepatocellular carcinoma at MR imaging enhanced with blood-pool contrast agent Code-7227.Radiology
MG Harisinghani, S Saini, R Weissleder, EF Halpern, W Schima, DL Rubin, AE Stillman, GT Sica, WC Small, PF Hahn,
PURPOSE: To evaluate differentiation of liver lesions at magnetic resonance (MR) imaging enhanced with Code-7227. MATERIALS AND METHODS: Thirty-five patients with 38 proved liver lesions (15 hemangiomas, 17 metastases, six hepatocellular carcinomas [HCCs]) underwent T1-weighted gradient-echo and T2-weighted fast-spin-echo MR imaging at 1.5 T before and after intravenous administration of Code-7227 (1.1 mg iron per kilogram of body weight). RESULTS: In hemangiomas, the mean contrast-to-noise ratio on precontrast and postcontrast images, respectively, increased from -4.51 +/- 4.7 (standard deviation) to 5.19 +/- 6.3 on T1-weighted images and decreased from 14.73 +/- 7.4 to 0.64 +/- 5.1 on T2-weighted images. In comparison, metastases remained hypointense to liver on T1-weighted images (from -5.77 +/- 5.9 to -7.8 +/- 6.8) and hyperintense on T2-weighted images (from 8.73 +/- 5.4 to 12.61 +/- 6.1). Although HCC enhanced more than metastases, they also remained hypointense to liver on T1-weighted images (from -4.87 +/- 6.1 to -1.79 +/- 5.7) and hyperintense on T2-weighted images (from 10.12 +/- 7.9 to 8.7 +/- 6.4). The degree of enhancement on T1-weighted images and of signal intensity drop on T2-weighted images were significantly lower in malignant liver masses than in hemangiomas (P < .001). CONCLUSION: Distinctly different enhancement patterns with Code-7227 helped accurate differentiation of liver lesions.
50117.9797331771998.12.04+ Focal peliosis hepatis resembling metastatic liver tumor.J Ultrasound Med
T Tateishi, J Machi, WK Morioka,
50217.9578561591995.03.14++Increased erythrocyte sedimentation rate and a splenic mass.West J Med
JV Hirschmann, S Patterson, JG Drachman, H Rosen, WC Liles,
This discussion was selected from the weekly Grand Rounds in the Department of Medicine, University of Washington School of Medicine, Seattle. Taken from a transcription, it has been edited by Jonathan G. Drachman, MD, Chief Medical Resident; Henry Rosen, MD, Professor and Associate Chair; and Paul G. Ramsey, MD, Professor and Chair of the Department of Medicine.
50317.9587499431996.09.20++Familial multiple mesothelial cysts of the spleen.J Pediatr Surg
T Iwanaka, H Nakanishi, Y Tsuchida, T Oka, T Honna, K Shimizu,
A 5-month-old boy who was diagnosed as having hydrops fetalis at 25 weeks' gestation had severe ascites of unknown origin. At the age 12 months, ultrasonography and computed tomography showed multiple cysts in the spleen that were increasing in size rapidly. Splenectomy resulted in complete disappearance of the ascites. These cysts were diagnosed as mesothelial cysts because the cell lining of the splenic cysts stained positively with alcian blue and cytokeratin. The boy's mother had undergone splenectomy for splenic and retroperitoneal lymphangiomas at 4 years of age. Histological reevaluation showed that the lining of her splenic cysts had the same mesothelial components as her son's. Their chromosomal assay showed normal karyotypes. Mesothelial cyst of the spleen appears similar to splenic lymphangioma morphologically; however, bleomycin and OK-432 were not effective. Familial splenic mesothelial (epidermoid) cysts have been reported in three sets of siblings, but this is the first report of their occurrence in mother and son.
50417.9326578871989.07.13+ [Splenic lymphangioma: a case report]Radiol Med
P Bagnolesi, P Sbragia, S Esposito,
50517.9329834021985.04.11+ Cavernous haemangioma of the spleen.Rofo
M Päivänsalo, T Siniluoto,
50617.9232571081988.01.21+ Splenic lymphangiomatosis: CT diagnosis.AJR Am J Roentgenol
F Pistoia, SK Markowitz,
50717.9280330041994.08.16++Multiple actinomycotic liver abscesses: MRI appearances with etiology suggested by abdominal radiography. Case report.Clin Imaging
LN Nazarian, JA Spencer, DG Mitchell,
The magnetic resonance imaging appearances of multiple actinomycotic liver abscesses are described. The abscesses appeared hypointense to liver parenchyma on T1-weighted sequences and hyperintense on T2-weighted sequences with some surrounding edema. Following intravenous gadolinium diethylenetriamine-pentaacetic acid, the masses showed a thick enhancing rim but no central enhancement. Although no etiology was discovered in the initial clinical history, antecedent dental surgery was evident on abdominal radiography that depicted dental amalgam in the ascending colon.
50817.9177905521995.07.21++Peribiliary cysts in liver cirrhosis: US, CT, and MR findings.J Comput Assist Tomogr
N Terayama, O Matsui, K Hoshiba, M Kadoya, J Yoshikawa, T Gabata, T Takashima, T Terada, Y Nakanuma, K Shinozaki,
OBJECTIVE: We report the imaging features of hepatic peribiliary cysts (PC) and the course of their development on CT. MATERIALS AND METHODS: Both CT and US findings were correlated with histopathologic findings in two patients with PC at autopsy. Five patients with cysts around the portal vein on CT but without histologic correlation were also included in this study. In six patients the course of PC development was observed. RESULTS: In the two autopsy cases cystic dilatation of the peribiliary glands was confirmed. The cases showed continuous small cysts along the portal veins reflecting the periportal collar seen on CT and the abnormal MR signal intensity of the periportal area. Ultrasound (US) showed round or tubular anechoic lesions around the large portal tracts mimicking dilatation of the bile ducts. Clustered cysts and echogenic dots or bands around PC were also seen. In three of six cases the PCs gradually enlarged and increased in number. CONCLUSION: In patients with liver cirrhosis PCs can be demonstrated by CT, US, and MRI in the vicinity of the hepatic hilum. Peribiliary cysts enlarge gradually and must be differentiated from dilatation of bile ducts or edema of portal tracts.
50917.8866870081984.05.11+ [Radiological findings in primary vascular malignant bone neoplasms]Nowotwory
U Grzesiakowska,
51017.88116980162001.12.14+ Pathologic quiz case: a 38-year-old man with splenic, renal, and hepatic cysts.Arch Pathol Lab Med
M Blanco, J Alexis,
51117.8791700311997.08.14++Effects of AMI-25 on liver vessels and tumors on T1-weighted turbo-field-echo images: implications for tumor characterization.J Magn Reson Imaging
D van Gansbeke, TM Metens, C Matos, N Nicaise, F Gay, H Raeymaekers, J Struyven,
This study was devoted to tumor differentiation in liver MR T1-weighted imaging with superparamagnetic iron oxide (SPIO). Twenty-one patients with 40 liver lesions were studied at 1.5 T. Before and at least 45 minutes after SPIO administration, turbo-field-echo (TFE) T1-weighted, TFE T1 x T2*-weighted (MXT), and fat-suppressed turbo-spin-echo T2-weighted images were acquired. A quantitative analysis was performed blindly. On TFE T1-weighted images, the signal enhancement was -33% +/- 12 for the liver, -24% +/- 2 for adenomas and focal nodular hyperplasia, +60% +/- 33 for the hemangiomas; metastases and cyst enhancement were not significant. After SPIO on TFE T1-weighted images, the hemangioma-to-liver signal ratio (149% +/- 18) was definitely higher than the mean metastasis-to-liver signal ratio (90% +/- 16). This T1-related differentiation ability lacked dramatically on TFE MXT images and, in one case, was reduced on post-SPIO TFE T1-weighted images by a long imaging delay after SPIO administration (2 hours).
51217.86174604212007.07.17++Multiple littoral cell angioma of the spleen: a case report and review of the literature.Onkologie
ZB Qu, LX Liu, LF Wu, S Zhao, HC Jiang,
BACKGROUND: Littoral cell angioma (LCA) is a rare benign vascular tumor of the spleen with characteristic histomorphologic features. It is a unique splenic tumor which may present with abdominal pain or as an incidental finding. CASE REPORT: In this case report, we present the case of a 34-year-old woman with multiple splenic LCA. Initially, the patient presented with abdominal pain, weakness and fatigue. After a diagnostic abdominal ultrasound, multiple hemangiomas were observed in the spleen. Computed tomography scans confirmed splenomegaly with multiple round and hyperdense lesions. The patient subsequently underwent splenectomy. Postoperative histological and immunohistochemical profiles confirmed the diagnosis of LCA. CONCLUSION: LCA is a unique splenic tumor diagnosed in patients with abdominal pain or as an incidental finding. Only a few case reports of this tumor have been published, and those accounts are inconsistent. In the present paper, we report on a case and conduct a literature review.
51317.8590003671997.02.26++Struma ovarii: MR appearances.Abdom Imaging
Y Yamashita, Y Hatanaka, M Takahashi, K Miyazaki, H Okamura,
BACKGROUND: Analysis of unenhanced and contrast-enhanced magnetic resonance (MR) images of struma ovarii, a rare benign neoplasm of the ovary, is the aim of this study. METHODS: T2-weighted and Gd-DTPA-enhanced T1-weighted MR images of five histologically proven struma ovarii were evaluated retrospectively. RESULTS: In all patients, unenhanced and contrast-enhanced T1-weighted MR images showed complex cystic masses composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles. In four patients, the cyst fluid was hypointense on T1-weighted images and hyperintense on T2-weighted images. In one patient, the fluid was hyperintense on T1-weighted images and hypointense on T2-weighted images due to hemorrhage. CONCLUSION: A complex mass composed of multiple cysts and a solid component, indicating the presence of large and small thyroid follicles, appeared to be a characteristic MR finding of struma ovarii.
51417.8567099031984.05.11++Percutaneous drainage of 250 abdominal abscesses and fluid collections. Part II: Current procedural concepts.Radiology
PR Mueller, E vanSonnenberg, JT Ferrucci,
The initial skepticism concerning the capability of radiologically placed catheters to drain intraabdominal abscesses has been overcome by wide acceptance of the technique by general surgeons. In this review, we describe current procedural concepts based on our experience with percutaneous catheter drainage of 250 intraabdominal abscesses and fluid collections in 212 patients. We consider the mechanisms of successful percutaneous drainage and suggest differences between radiologic and surgical decompression. We describe the inconsistent correlations between image patterns and results of the diagnostic needle aspiration, especially in predicting the drainability of cavity contents. We review principles of catheter selection and aspects of postprocedure catheter management, including irrigation and timing of withdrawal.
51517.8486866311996.08.21+ Percutaneous transpulmonary CT-guided liver biopsy: a safe and technically easy approach for lesions located near the diaphragm.AJR Am J Roentgenol
DA Gervais, GS Gazelle, DS Lu, PF Han, PR Mueller,
51617.8480921231994.10.20++Comparison of initial lymphoma staging using computed tomography (CT) and magnetic resonance (MR) imaging.Am J Hematol
BR Hoane, AF Shields, BA Porter, JW Borrow,
While MR is known to be superior to other imaging methods for detecting marrow involvement by lymphoma, MR is also capable of detecting abnormal lymph nodes. Our objective was to determine whether MR employing short TI inversion recovery (STIR) was comparable to CT in the initial staging of 23 patients with Hodgkin's disease (12 patients) and non-Hodgkin's lymphoma (11 patients). MR images of chest, abdomen, pelvis, and femoral marrow were obtained using the STIR and T1-weighted spin-echo (T1-SE) techniques, employing a protocol initially designed for marrow assessment. In all cases, CT-detected adenopathy was also found by MR. Four patients had marrow involvement by MR, undetected by CT. We conclude that MR and CT may be equivalent imaging modalities in the detection of nodal involvement, and that MR has an advantage in its ability to diagnose marrow involvement. Given the high frequency of focal marrow abnormalities detected by MR in patients with Hodgkin's disease and high-grade non-Hodgkin's lymphoma, MR may be the preferred staging modality for these patients.
51717.8091223761997.04.22++Contrast-enhanced abdominal MR angiography: optimization of imaging delay time by automating the detection of contrast material arrival in the aorta.Radiology
MR Prince, TL Chenevert, TK Foo, FJ Londy, JS Ward, JH Maki,
PURPOSE: To improve gadolinium-enhanced magnetic resonance (MR) angiogram quality by automatically synchronizing acquisition of central k-space image data with the arterial phase of contrast material bolus infusion. MATERIALS AND METHODS: A spin-echo pulse sequence with orthogonal 90 degrees and 180 degrees pulses was used to monitor signal in a single 4 x 4 x 12-cm voxel that encompassed a segment of aorta. An increase in signal that corresponded to the arrival of gadolinium was used to trigger three-dimensional, spoiled gradient-echo abdominal MR angiography in 50 adult patients. RESULTS: Arterial signal intensity increased 28-fold with automatic compared to 19-fold with manual triggering (P < .05) at an approximate dose of 0.3 mmol/kg. Automatic triggering with a lower dose (approximately 0.2 mmol/kg) resulted in 20-fold arterial enhancement, which is comparable with enhancement after manual triggering at the high dose. In addition, venous enhancement was less (1.5-fold) with automatic than with manual (3.5-fold) triggering at the same dose (P < .05). CONCLUSION: Automatic triggering results in improved arterial-tovenous contrast. It increases arterial enhancement or enables MR angiograms to be obtained with less contrast material. The authors now routinely use this technique for aortorenal imaging with a gadolinium-based contrast material dose of 20 mmol (40 mL) in patients who weigh more than 50 kg and 10 mmol (20 mL) in patients who weigh less than 50 kg.
51817.7931737311988.11.22+ [3 cases of splenic angiomatosis]Minerva Chir
F Cortese, F Galli, M Azzolina, A Lanza, F Di Giusto,
51917.7875807821995.12.21++Imaging features of splenic epidermoid cyst with pathologic correlation.Abdom Imaging
A Shirkhoda, J Freeman, AR Armin, AA Cacciarelli, R Morden,
The spleen can be involved in a variety of cystic lesions ranging from cystic neoplasms and parasitic cysts to "true" and "false" cysts. Epidermoid splenic cyst is a rare true cyst that is developmental in origin. We present two young patients with such a cyst and illustrate their features on ultrasound, CT, and MRI with pathologic correlation.
52017.77117357022002.01.25+ Pathologic quiz case: a mass of the spleen. Inflammatory myofibroblastic tumor of the spleen.Arch Pathol Lab Med
MB Mosunjac, DV Feliciano, B Majmudar,
52117.7789246961996.11.14+ [Surprising finding of a hepatic hemangiosarcoma with concomitant peliosis hepatis]Rofo
G Scherer, T Roeren, W Hofmann, M Brado, GW Kauffmann,
52217.77169507152006.11.09++Radiological catheter drainage of abscesses in children.Acta Radiol
S Murthy Chennapragada, K Prelog, CK Wong,
PURPOSE: To assess the efficacy and safety of radiological catheter drainage of fluid collections and abscesses in children, and to review the principles, indications, technique, and possible complications of these procedures. MATERIAL AND METHODS: A retrospective analysis was made of all radiologically guided catheter placements performed between March 1999 and April 2003. Patients' age, sex, location of the collection, technical details of the procedure, including modality used for guidance, technique of placement, type of catheter used, catheter indwelling time, and time for temporization were recorded from chart reviews. Success rate was calculated based on the number of curative drainage procedures. RESULTS: 33 children (16 boys and 17 girls) aged between 7 days and 14 years of age (mean 7 years) underwent 37 procedures. Successful drainage was achieved in 31 of 33 patients (94%). The dwell time for catheters ranged between 1 day and 30 days (mean 5.7 days). Mean duration for defervescence was 2 days. There were no major complications. CONCLUSION: Imaging-guided catheter drainage of fluid collections in children is safe and effective. Newer approaches, better imaging, and improved techniques have resulted in improved cure rates. The basic principles, common indications, various techniques, and the possible complications of these procedures, with special reference to the pediatric population, are reviewed in this article.
52317.7631920601989.01.05+ [Hamartoma of the spleen]Gematol Transfuziol
IuA Ershov, EV Suvorova, SM Minkina, EN Glasko,
52417.7685719141996.03.01++Portal-phase contrast-enhanced helical CT for the detection of malignant hepatic tumors: sensitivity based on comparison with intraoperative and pathologic findings.AJR Am J Roentgenol
BS Kuszyk, DA Bluemke, BA Urban, MA Choti, RH Hruban, JV Sitzmann, EK Fishman,
OBJECTIVE. The purpose of this study was to determine the sensitivity of portal-phase IV contrast-enhanced helical CT in detecting malignant hepatic tumors using a lesion-by-lesion comparison with surgical and pathologic findings. MATERIALS AND METHODS. Preoperative portal-phase contrast-enhanced helical CT studies in 21 patients (13 men, eight women) with malignant neoplasms of the liver (12 patients with primary hepatic tumors, nine patients with metastases) were reviewed retrospectively by three radiologists with the knowledge that hepatic malignancies were present in each case. Helical CT findings were compared with intraoperative findings by palpation (21 patients), sonography (15 patients), and the results of pathologic examination of resected specimens (10 patients) in a lesion-by-lesion manner. Sixty-four malignant nodules were identified in resected specimens or at surgery by palpation or intraoperative sonography. For each nodule identified by surgical or pathologic means, CT findings were reviewed for the presence of a lesion of similar size and location. RESULTS. The readers identified 52 of 64 nodules on helical CT scans for an overall sensitivity of 81%. Sixteen of 21 primary tumors (76%) and 36 of 43 metastatic tumors (84%) were identified on CT scans. The sensitivity was 91% for nodules greater than 1 cm (42 of 46) and 56% for nodules 1 cm or less (10 of 18). False-positive findings occurred in 4% of lesions seen on helical CT scans. CONCLUSION. Our results show that portal-phase contrast-enhanced helical CT is extremely sensitive (91%) for detecting malignant hepatic tumors greater than 1 cm, is relatively insensitive (56%) for tumors less than 1 cm, and has a low false-positive rate. These results compare favorably with published results for CT during arterial portography, the current gold standard for liver tumor detection, suggesting that portal-phase IV contrast-enhanced helical CT is an excellent noninvasive preoperative study prior to hepatic resection or cryosurgery.
52517.74163218162006.06.13++Splenectomy in haematology--a 5-year single centre experience.Hematology
L Wood, PM Baker, A Martindale, P Jacobs,
OBJECTIVE: To define indications and outcome in haematologic cases undergoing splenectomy. STUDY DESIGN: A retrospective review of clinical records from consecutive patients having open or laparoscopic removal of the spleen in an academic centre in the private sector. Endpoints were survival, operating time, spleen size, histopathology, requirements for blood or related products complications and average costs. RESULTS: In the total group (n = 69) there were two deaths. Referrals were for immune thrombocytopaenia (41%), acquired haemolytic anaemia (10%), myeloproliferative syndrome (9%), acute or chronic leukaemia (19%), lymphoma (13%) and a miscellaneous group (8%), comprising cholelithiasis, aplasia or as a diagnostic procedure for otherwise unexplained splenomegaly. An open midline approach was predicated by spleens greater than twice normal size and a history of any bleeding disorder. Here the mean operating time was 83 min (range 40-295) whereas for laparoscopy this was 251 min (range 181-272). SUMMARY: Careful stratification between the two options facilitated optimum haemostasis and consequently reduced requirement for packed red cells and platelets. Neither underlying pathology nor the choice of treatment influenced morbidity or mortality. Overall local experience is consistent with published international standards of surgical practice. Outcome is directly proportional to the number of each procedure carried out by a single team, observance of consistent protocols for preoperative evaluation and standardized proactive management through the recovery period.
52617.73153883682005.01.03++[Splenomegaly and splenic pseudotumor due to tuberculosis: six new cases]Ann Chir
F Rhazal, MK Lahlou, S Benamer, JM Daghri, E Essadel, E Mohammadine, A Taghy, B Chad, A Belmahi,
INTRODUCTION: Splenic tuberculosis is rare. The aim of this study was to remind diagnostic problems in this disease, and to evaluate the value of surgery in its management. MATERIAL AND METHODS: Retrospective study of data of six patients (three male and three female, whose mean age was 50 years) admitted in surgical department from 1980 to 2000 for splenic tuberculosis. RESULTS: In six cases, symptoms were poorly specific; splenomegaly and anemia were constant. In imaging studies, splenomegaly was homogeneous in four cases and heterogeneous in two. Diagnosis of tuberculosis was done without need for splenectomy in four patients. Five patients were operated on: two had diagnostic laparotomy without splenectomy, two underwent diagnostic splenectomy and one had splenectomy indicated for splenic abcess refractory to medical treatment. Four of the five operated patients recovered. The two other patients were lost of follow-up. CONCLUSIONS: In our experience, surgery is useful in diagnosis and treatment of splenic tuberculosis.
52717.7340585341985.12.16 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 48-1985. A 69-year-old man with peripheral vascular disease and hypersplenism.N Engl J Med
52817.6995654431998.09.17++Symptomatic splenic hamartoma: case report and literature review.Pediatrics
TC Hayes, HA Britton, EB Mewborne, DA Troyer, VA Saldivar, IA Ratner,
An 11-year-old girl with low-grade fever, night sweats, thrombocytopenia, and an 8-year history of progressive splenomegaly underwent an elective splenectomy. Pathologic diagnosis was multiple splenic hamartoma. The patient's symptoms resolved after the splenectomy. Since first described by Rokitansky in 1861, approximately 140 cases of splenic hamartoma have been described in the literature. Most of the splenic hamartomas were discovered incidentally. A minority of these lesions were associated with hematologic symptoms such as pancytopenia, anemia, and thrombocytopenia. Only 20 of the reported cases of splenic hamartoma occurred in pediatric patients. However, compared with the adult patients, nearly half of these cases in pediatric patients was associated with symptoms. Splenectomy and partial splenectomy have relieved these symptoms. With advances in imaging, splenic hamartomas are being discovered with increasing frequency. A multimodal radiologic work-up has enabled some cases of splenic hamartoma to be diagnosed preoperatively. Inclusion of this benign entity in the differential diagnoses of symptomatic splenomegaly in a pediatric patient is important in the preoperative management and counseling of the patient and family. In patients who have discrete lesions, consideration of this entity preoperatively may avoid total splenectomy.
52917.6930375901987.08.14++Conventional and rapid MR imaging of the liver with Gd-DTPA.Radiology
B Hamm, KJ Wolf, R Felix,
Twenty-three patients with malignant hepatic tumors underwent magnetic resonance (MR) imaging before and after intravenous administration of gadolinium-diethylene-triaminepentaacetic acid (DTPA). Two different doses were used, 0.1 mmol/kg and 0.2 mmol/kg. The larger dose proved to be more effective than the smaller dose. The signal-enhancement-to-noise ratio was significantly larger in the tumor than in the liver (2 alpha less than or equal to .05). In a moderately T1-weighted spin echo (SE) sequence (SE 400/30) (repetition time [TR] msec/echo time [TE] msec), the tumor was better defined 6 minutes after administration of Gd-DTPA. More strongly T1-weighted sequences--that is, SE 200/20 and inversion recovery 1,500/35/400 (TR msec/TE msec/inversion time, msec)--showed significantly worse contrast between tumor and liver (signal-difference-to-noise ratio [SD/N]) 10 and 15 minutes after administration (2 alpha less than or equal to .05). On the other hand, the low SD/N in the rapid MR imaging sequence was significantly improved (2 alpha less than or equal to .05). The most important indications for administration of Gd-DTPA in diagnosing hepatic tumors are the presentation of perfusion conditions and contrast optimization in rapid MR images.
53017.68102068061999.04.13++Sonographically guided fine needle aspiration biopsy of abdominal lymph nodes: experience in 102 patients.J Ultrasound Med
S Gupta, CL Rajak, BP Sood, M Gulati, A Rajwanshi, S Suri,
We present our experience with sonographically guided fine needle aspiration biopsy of abdominal and retroperitoneal lymph nodes in 102 patients. The biopsied lymph nodes measured 1 to 6 cm (mean, 2.3 cm) and were located at the porta hepatis (n = 23), in the peripancreatic (n = 31), paraaortic (n = 22), aortocaval (n = 1), common iliac (n = 3), or external iliac (n = 6) regions, or in the mesentery (n = 16). Material sufficient for cytologic analysis was obtained in 87 (85.2%) of the 102 patients. The cytologic diagnosis in these patients included malignancy in 47 patients, tuberculosis in 28 patients, reactive lymphoid hyperplasia in 10 patients, and aspergillosis in two patients. In the other 15 patients, fine needle aspiration biopsy could not provide a definitive diagnosis. No major or minor complications occurred in our study. Thus, sonographic guidance is an effective alternative to computed tomography for biopsy of abdominal and retroperitoneal lymph nodes.
53117.6813245091992.09.18++Focal liver disease: comparison of dynamic contrast-enhanced CT and T2-weighted fat-suppressed, FLASH, and dynamic gadolinium-enhanced MR imaging at 1.5 T.Radiology
RC Semelka, JP Shoenut, MA Kroeker, HM Greenberg, FC Simm, GY Minuk, RM Kroeker, AB Micflikier,
Dynamic contrast medium-enhanced computed tomography (CT), T2-weighted fat-suppressed spin-echo (T2FS) magnetic resonance (MR) imaging, and breath-hold T1-weighted fast low-angle shot (FLASH) MR imaging before and after dynamic gadopentetate dimeglumine injection were compared in 73 patients with clinically suspected liver disease. Observer confidence for presence of focal lesions was determined by using receiver operating characteristic analysis. For all MR images, hepatic lesion-liver signal-to-noise ratios were evaluated qualitatively. and resolution and presence of artifacts were evaluated qualitatively. Lesion detection was greatest with T2FS (n = 272) and enhanced FLASH (n = 244) and was statistically greater with both of these than with CT (n = 220) and FLASH (n = 219) (P less than .03). Correct lesion characterization was greatest with enhanced FLASH (n = 236) (P less than .01), followed by CT (n = 199), FLASH (n = 164), and T2FS (n = 144). Enhanced FLASH was particularly successful in characterization of 5-mm- to 1.5-cm-diameter lesions as cystic or solid.
53217.67105556851999.12.07+ US case of the day. Giant hemangiomas of the liver.Radiographics
R Avva, HR Shah, TL Antuaco,
53317.63107492282000.04.28++Preoperative detection of malignant hepatic tumors: comparison of combined methods of MR imaging with combined methods of CT.AJR Am J Roentgenol
H Kondo, M Kanematsu, H Hoshi, T Murakami, T Kim, M Hori, M Matsuo, H Nakamura,
OBJECTIVE: We compared radiologists' performance on combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging with their performance on helical CT during arterial portography (CTAP) and biphasic CT during hepatic arteriography (CTHA) for the preoperative detection of malignant hepatic tumors. SUBJECTS AND METHODS: MR images and CT scans obtained in 33 patients were retrospectively analyzed. Images of the liver were reviewed on a segment-by-segment basis; a total of 261 segments with 39 hepatocellular carcinomas and 21 metastases were independently reviewed by three radiologists who were invited from outside institutions. Unenhanced and gadolinium-enhanced MR images were reviewed first, then ferumoxides-enhanced MR images were added for combined review. CTAP images and biphasic CTHA images were reviewed together. RESULTS: Sensitivity for the detection of hepatic tumors was analogous for combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR images (86%) and for combined CTAP images and biphasic CTHA images (87%). Specificity was higher with MR images (95%, p < 0.01) than with CT images (91%). Radiologists' performances were improved (Az = 0.962, p = 0.0502) by combining ferumoxides-enhanced MR images with unenhanced and gadolinium-enhanced MR images (Az = 0.950), and were analogous for combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR images and for combined CTAP images and biphasic CTHA images (Az = 0.959). CONCLUSION: Radiologists' performances on combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging compared with their performances on combined helical CTAP and biphasic CTHA are analogous for the preoperative detection of malignant hepatic tumors. Such a dedicated combination of MR imaging may obviate the need for more invasive angiographically assisted helical CT for the preoperative detection of malignant hepatic tumors.
53417.62111786942001.05.10++Dynamic T1-weighted ferumoxides enhanced MRI for imaging liver hemangiomas: preliminary observations.Abdom Imaging
D Sahani, S Saini, R Sharma, M O'Malley, P Hahn,
The T1-based signal-enhancing effects of ferumoxides was studied in five liver hemangiomas on short echo-time gradient-recalled echo dynamic magnetic resonance imaging to assess the utility of this technique to image perfusion patterns in liver hemangiomas. We observed peripheral nodular enhancement with centripetal fill in all hemangiomas. Our results suggest that this imaging technique, after rapid injection of ferumoxides, can be used for lesion characterization.
53517.6191241111997.04.24+ T2*-weighted dynamic MR imaging in renal artery or vein stenosis.AJR Am J Roentgenol
Y Tsushima, T Murakami, H Kuruma, T Kondo, S Kusano,
53617.60164843472006.05.23++Hepatic metastases: detection with multi-detector row CT, SPIO-enhanced MR imaging, and both techniques combined.Radiology
H Onishi, T Murakami, T Kim, M Hori, R Iannaccone, M Kuwabara, H Abe, S Nakata, K Osuga, K Tomoda, R Passariello, H Nakamura,
PURPOSE: To retrospectively compare the accuracy in detection of hepatic metastases among contrast material-enhanced multi-detector row computed tomography (CT) alone, superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging alone, and a combination of contrast-enhanced CT and SPIO-enhanced MR imaging. MATERIALS AND METHODS: The ethics committee did not require its approval or informed consent for this retrospective study, which was compliant with Declaration of Helsinki principles. Data in 38 patients (22 men, 16 women; mean age, 64.5 years; range, 35-78 years) suspected of having hepatic metastases who underwent both contrast-enhanced CT and SPIO-enhanced MR imaging were retrospectively analyzed. Twenty-one of the 38 patients had 61 metastases. Seventeen of the 61 metastases were confirmed histologically; the remaining 44 metastases were defined with imaging follow-up. At MR imaging, SPIO-enhanced heavily T1-weighted images, T2*-weighted gradient echo images, and T2-weighted fast spin-echo images were evaluated. Contrast-enhanced multi-detector row CT images obtained in the portal phase were evaluated. Four blinded observers independently reviewed CT images, MR images, and the combination of CT and MR images. Diagnostic accuracy was evaluated by using the alternative free-response receiver operating characteristic (AFROC) method. Sensitivities and positive predictive values were also analyzed with the Fisher protected least significant difference test and generalized estimating equations. RESULTS: The mean area under the AFROC curve for the combined approach (0.70) was significantly higher than that for SPIO-enhanced MR imaging alone (0.58, P < .05, Fisher protected least significant difference test), and there was no significant difference between each of them and that for contrast-enhanced CT alone (0.66). For all lesions, the mean sensitivity of combined imaging (0.59) was significantly higher than that of CT (0.48) or MR imaging (0.43) alone (P < .05, Fisher protected least significant difference test and generalized estimating equations). For all lesions, the mean positive predictive values were 0.82, 0.89, and 0.81, for combined MR and CT, CT alone, and MR alone, respectively. CONCLUSION: The addition of SPIO-enhanced MR imaging to contrast-enhanced multi-detector row CT (ie, combined analysis of SPIO-enhanced MR images and contrast-enhanced CT images) can improve sensitivity in the detection of hepatic metastases, although this improvement in sensitivity was not significant at AFROC analysis.
53717.59124904922003.01.16+ Hepatic hemangioma: atypical appearances on CT, MR imaging, and sonography.AJR Am J Roentgenol
HJ Jang, TK Kim, HK Lim, SJ Park, JS Sim, HY Kim, JH Lee,
53817.5879870641995.01.09++Blunt trauma of the spleen: the delayed rupture in computed tomography.Bildgebung
F Boioli, F Gattoni, B Tagliaferri, G Ceriani, C Pozzato, I Spagnoli, P Potepan, C Uslenghi,
We retrospectively reviewed CT scans of 18 patients (12 males and 6 females; mean age: 43.6 years) with the diagnosis of blunt splenic trauma. All patients underwent CT at different times after the trauma. The cases were divided into 2 groups: according to the time at which the CT was performed, the 1st group consisted of 11 patients scanned within 48 h after the trauma; the 2nd group consisted of 7 patients studied with CT at variable times after the traumatic event (mean time: 6.5 days; range 3-13 days). All lesions in the 1st group (11 patients) had indistinct margins, while lesions of patients in the 2nd group (7 patients) always showed clean-cut and regular edges. Early lesions were always hyperdense, late ones hypodense. CT diagnosis always matched the surgeon's diagnosis. We can confirm the diagnostic value of CT of splenic lesions in blunt abdominal traumas.
53917.56125340372003.02.07++[Splenic angioma. Value of MRI: two case reports]Tunis Med
S Sehili, K Bouzaidi, S Belhadj Hassine, R Sassi, A Kochlef, O Khayat, M Ayed, A Ghorbel, MH Daghfous,
The splenic angioma is a rare tumour. Its aspects MRI are still badly known. The authors show that in the 2 brought back cases, there is a hypersignal on the 3 echoes of T2 with a catch of contrast slow and centripetal after Gadolinium injection. The hemorrhagic risk in connection with a spontaneous or traumatic rupture imposes the identification of this lesion.
54017.5570690031982.06.14++Spontaneous splenic infarction in polysplenia syndrome.J Comput Assist Tomogr
CA Shadle, ME Scott, DJ Ritchie, G Seliger,
A case of polysplenia with spontaneous infarction of one of the four spleens is presented. The diagnosis was made by computed tomography (CT), which demonstrated the multiple aberrant right sided spleens, with an area of low attenuation representing infarction of one of the spleens. The associated anomalies of prominent azygos and hemiazygos veins secondary to absence of the suprarenal portion of the inferior vena cava were also seen on CT.
54117.54124380352002.12.19+ CT and MR imaging features of pathologically proven atypical giant hemangiomas of the liver.AJR Am J Roentgenol
M Coumbaras, D Wendum, L Monnier-Cholley, H Dahan, JM Tubiana, L Arrivé,
54217.5127017921990.10.15+ Vascular neoplasms of the skin: a current perspective.Adv Dermatol
MR Wick, JC Manivel,
54317.4681434021994.05.02+ Staging of lymphoma in adults.Clin Radiol
K Sandrasegaran, PJ Robinson, P Selby,
54417.43100871151999.05.04++Hemorrhagic necrosis due to peliosis hepatis: imaging findings and pathological correlation.Eur Radiol
O Vignaux, P Legmann, G de Pinieux, S Chaussade, C Spaulding, D Couturier, A Bonnin,
Peliosis hepatis is an uncommon liver condition characterized by blood-filled cavities. We report the CT, angiographic and MR features of a case of peliosis hepatis with no obvious etiology and spontaneously regressing hemorrhagic necrosis. Helical CT showed multiple peripheral low-density regions with foci of spontaneous high density suggesting the presence of blood component. On MR imaging, the multiple peripheral lesions were hypointense on T1-weighted and hyperdense on T2-weighted images, with bright foci on all sequences suggesting subacute blood. Angiography showed no evidence of tumor or vascular malformation; multiple nodular vascular lesions filling in the parenchymal phase and persisting in the venous phase suggested blood-filled cavities. Pathological examination showed blood-filled spaces with no endothelial lining, characteristic of the parenchymal type of peliosis. Knowledge of the imaging features of hemorrhagic necrosis due to peliosis hepatis is important since it can be responsive to antibiotic therapy. Furthermore, differentiating hemorrhagic necrosis from hepatic abscess avoids dangerous and sometimes fatal percutaneous drainage.
54517.4226987461990.05.15++Angiosarcoma. Diagnosis and clinical course.Acta Radiol
DM Coldwell, RL Baron, C Charnsangavej,
The findings at radiography, computed tomography and angiography and the clinical course of 30 cases of angiosarcoma were reviewed. The variety of primary sites results in a multitude of findings but the most common finding was that of a hypervascular soft tissue mass seen on CT and angiography. Additional findings of well demarcated cortical defects in long bones were also frequently noted. The general clinical behavior of these aggressive malignant tumors was also reviewed and it was noted that they had a deceptively benign presentation.
54617.4232890861988.07.21++Retroperitoneal and pelvic hemangiopericytomas: clinical, radiologic, and pathologic correlation.Radiology
SM Goldman, AJ Davidson, J Neal,
Seventeen cases of hemangiopericytoma of the retroperitoneum were retrospectively analyzed for demographic, morphologic, and radiologic features. These tumors were found in all age groups (2 months to 72 years) and occurred in similar numbers of male and female patients. The tumors tended to be large (11 were greater than 8 cm), were well encapsulated, and occurred less frequently in the pelvic retroperitoneal space (six cases) than in abdominal retroperitoneum (11 cases). All tumors were bulky enough to displace part of the gastrointestinal tract, with only two being inoperable. The most distinctive radiologic feature was hypervascularity (found on 11 of 11 angiograms). Other nondiscriminating radiologic features included well-defined margins and necrosis, with nondistinctive amorphous calcification identified in one case. Angiographic or computed tomographic demonstration of hypervascularity in a retroperitoneal tumor is more suggestive of hemangiopericytoma than of a liposarcoma or malignant fibrous histiocytoma, two of the more common tumors of this region.
54717.4177540071995.06.20++Nodular sarcoidosis of the liver and spleen: analysis of 32 cases.Radiology
DM Warshauer, PL Molina, SM Hamman, RE Koehler, EK Paulson, RE Bechtold, ML Perlmutter, JN Hiken, IR Francis, CJ Cooper,
PURPOSE: To describe the computed tomographic (CT) appearance of nodular hepatosplenic sarcoidosis and its association with stage with chest radiography and clinical status. MATERIALS AND METHODS: Thirty-two patients (21 women, 11 men; aged 25-68 years) with nodular hepatosplenic sarcoidosis were evaluated. CT findings were described along with chest radiographic stage, clinical status, and level of angiotensin-converting enzyme (ACE). RESULTS: Nodules were small, multiple, and of low attenuation. Organomegaly was common. Abdominal adenopathy was present in 76% of the patients. Chest radiographs were normal in 25%; 61% had stage 1 or 2 radiographs. Abdominal or systemic symptoms were present in 66%. ACE level was elevated in 10 (91%) of 11 patients tested. No change in chest radiographic stage was noted in 74% of patients with follow-up radiographs. CONCLUSION: Nodular hepatosplenic sarcoidosis is associated with organomegaly, adenopathy, and symptoms. Nodules were not associated with advanced lung disease and did not herald a change in chest radiographic stage. An elevated ACE level may be helpful in diagnosis.
54817.4175603201995.11.02++MRI of the anal sphincter.J Comput Assist Tomogr
NM deSouza, R Puni, WA Kmiot, CI Bartram, AS Hall, GM Bydder,
OBJECTIVE: The anal sphincter was imaged with MR using an internal coil to demonstrate its anatomy, contrast enhancement patterns, and appearance in disease. MATERIALS AND METHODS: A cylindrical saddle geometry coil was placed in the anal canal. Sixteen volunteers and 18 patients were examined. Imaging was performed on a 0.5 T Picker Asset MRI scanner in all the volunteers and nine patients and on a 1.0 T Picker HPQ Vista in nine patients. Then T1- and T2-weighted SE, T1-weighted GE and STIR images transverse to the sphincter, and T1-weighted SE images parallel to the sphincter in the coronal oblique plane were obtained. Intravenous gadopentetate dimeglumine (0.1 mmol/kg) was given to 2 normal subjects for dynamic studies and 10 patients for conventional postcontrast imaging. RESULTS: The coils were easy to insert and well tolerated and provided high spatial resolution. The internal sphincter had a higher signal intensity than the external sphincter on all sequences but particularly on STIR images. Brisk contrast enhancement of the internal sphincter was seen. Sphincteric abscesses and fistulous tracks were identified in three patients and confirmed at surgery. Sphincter defects were seen in three patients with past obstetric trauma, and these were also confirmed at surgery. Sphincter atrophy was seen in three patients with idiopathic fecal soiling. CONCLUSION: MRI of the anal sphincter with an internal coil provides excellent visualization of normal anatomy and may be of considerable value in diagnosis.
54917.4168490991983.02.25++Ultrasound analysis of solid-appearing abscesses.Radiology
BR Subramanyam, EJ Balthazar, BN Raghavendra, SC Horii, S Hilton, DP Naidich,
A retrospective review of 96 abdominal abscesses yielded 11 cases (9%) that were diffusely echogenic on sonograms and that stimulated findings of solid lesions. Sonographic features of these abscesses were analyzed and compared with features of 78 cases of hepatic metastasis. An abscess was considered solid appearing when it contained diffuse internal echoes that were distributed over 90% of the abscess cavity. The visualized internal echoes were of low to medium amplitude, and were generally similar to the normal echogenicity of the parenchymal organs, such as the liver, spleen, or uterus. Distal acoustic enhancement was seen in 91% of the solid abscesses, and it was not seen in hepatic metastases. A distinct echogenic wall was present in 64% of the abscesses (subacute and chronic lesions), but this occurred in less than 4% of metastases. Thin peripheral halos inside or outside of and adjacent to the abscess wall were seen in 36% of abscesses. The peripheral halos seen in metastases were wider and not associated with an echogenic wall. The diagnosis of a diffusely echogenic abscess and differentiation from a neoplasm is possible when the sonographic findings of acoustic enhancement, thin peripheral halo, and echogenic abscess wall are present.
55017.4186293411996.06.26++[Computerized tomography diagnosis of splenic and hepatic lesions in malignant non-Hodgkin's lymphomas]Vestn Rentgenol Radiol
VM Cheremisin, VI Mazurov, NA Anosov, VE Savello, GA Bol'shakov, AA Novikov, VV Rassokhin, TG Kulibaba,
Seventy eight patients with varying malignancy non-Hodgkin's lymphomas were examined. Signs of extranodal damage of the spleen and liver were studied. Spleno- and hepatomegaly were signs of the commonest diffuse visceral involvements. In terms of the malignancy (low- or high-grade), splenomegaly was seen in 71.4 and 82.5% of patients and hepatomegaly was observed in 43.9 and 28.6%, respectively. In addition, irregular visceral outlines, tuberosity, changed density of the parenchyma and its homogeneity. A high correlation was found between the enlargement of the viscera and their decreased parenchymal density. Focal visceral involvements are less difficult to be diagnosed than diffuse ones, but they are much rarer. Computerized tomographic findings indicate the malignancy of a process.
55117.4022158291990.11.13++An unusual case of cystic lymphangiomatosis of the spleen.Neth J Med
HD Spapen, H Reynaert, S Debeuckelaere, E Achten, G Somers,
Isolated lymphangiomatosis of the spleen is rare. When present, it is usually considered to be accompanied by splenomegaly. We describe a case of cystic lymphangiomatosis in a patient with a normal-sized spleen. While ultrasound, angiography and computed tomography are considered to complement each other in reaching a preoperative diagnosis of splenic lymphangiomatosis, in the present case, magnetic resonance imaging proved to be an additional helpful non-invasive diagnostic method.
55217.40188061542008.10.16++Solitary necrotic nodules of the liver: cross-sectional imaging findings and follow-up in nine patients.AJR Am J Roentgenol
S Colagrande, ML Paolucci, L Messerini, W Schima, A Stadler, TV Bartolotta, A Vanzulli, G Brancatelli,
OBJECTIVE: The purpose of our study was to retrospectively evaluate the sonographic, CT, and MRI findings (number, diameter, lobar location, depth from the hepatic capsule, and appearance of lesions) in a series of nine patients with pathologically proven solitary necrotic nodules of the liver and the natural evolution at follow-up in four of the nine patients. CONCLUSION: Solitary necrotic nodules are usually small, solitary lesions, mainly located under the liver capsule of the right lobe. They are hypoechoic on sonography, hypoattenuating on CT, have low signal intensity on both T1- and T2-weighted MRI with lack of enhancement after IV contrast administration, and at follow-up have a tendency to show calcification and involution toward reduction in size.
55317.3930492071988.11.17++Imaging the direct bidirectional spread of disease between the abdomen and the female pelvis via the subperitoneal space.Gastrointest Radiol
M Oliphant, AS Berne, MA Meyers,
This report expands the concept of the subperitoneal space (SS) as the potential conduit for direct spread of disease in the abdomen to include the female pelvis. The normal anatomy of the SS in the lower abdomen, the female pelvis, and its uninterrupted continuation between the abdomen and pelvis are demonstrated by several imaging modalities. Surgically proven cases of bidirectional spread of disease between the abdomen and female pelvis are reported. The unifying concept of the interrelationship formed by the SS provides an understanding of the basic concepts of the pathways of direct spread of disease and the pathogenesis of the clinical presentation of disease distant from its site of origin.
55417.39169290142006.12.20++The role of late-phase pulse inversion harmonic imaging in the detection of occult hepatic metastases.J Ultrasound Med
S Gültekin, C Yücel, H Ozdemir, H Celik, SO Oktar, M Araç,
OBJECTIVE: The purpose of this study was to investigate the efficacy of late-phase pulse inversion harmonic imaging (PIHI) in detecting occult metastases and to compare the results with helical computed tomography (CT) in a group of patients whose fundamental liver sonographic results were normal. METHODS: Thirty-two patients (21 women and 11 men; age range, 20-87 years) with a known primary malignancy were enrolled in the study. The patients were evaluated with conventional sonography, unenhanced PIHI, and PIHI 3 minutes after the injection of Levovist (SH U 508A; Schering AG, Berlin, Germany). All patients also underwent triphasic helical CT within 1 week after sonography. In 1 patient, mangafodipir-enhanced magnetic resonance imaging was performed as part of the clinical workup. RESULTS: After Levovist injection, in 4 (12.5%) of 32 patients, at least 1 hypoechoic lesion was detected by PIHI; multiple lesions were shown in 1 patient. The mean diameter of newly detected lesions was 12 mm. Triphasic helical CT also showed all of the lesions that were detected by PIHI. The diagnoses were confirmed by biopsy and CT findings in 2 patients and by the typical CT and magnetic resonance imaging findings in 1 patient. For the fourth patient, the diagnosis was confirmed by follow-up and CT. Conclusions. Late-phase PIHI is comparable to helical CT for detecting occult hepatic metastases, but it protects patients from the potentially hazardous effects of radiation and iodinated contrast agents. Further series involving a larger number of patients are needed to determine its place in the evaluation of cancer staging and treatment planning.
55517.3819285531991.10.30++Kaposi-like infantile hemangioendothelioma. A distinctive vascular neoplasm of the retroperitoneum.Am J Surg Pathol
WY Tsang, JK Chan,
Retroperitoneal soft-tissue tumors are rare in infancy. In this report, we describe a distinctive hemangioendothelioma occurring in the retroperitoneum of a 10-month-old baby girl. This lesion was complicated by obstructive jaundice, intestinal obstruction, and thrombocytopenia (Kasabach-Merritt syndrome) leading to intracranial hemorrhage. The microscopic features of this tumor, characterized by infiltrative lobules of spindle cells and capillaries, are distinct from those of other well-recognized vasoformative tumors. In some areas, the tumor shows a striking resemblance to Kaposi's sarcoma; criss-crossing fascicles of spindle cells are interspersed with narrow vascular spaces, but PAS-positive hyaline globules are absent. The tumor can also be distinguished from the cellular hemangioma of childhood by its well-formed spindle cell fascicles. Several histologically similar cases have been reported. All of them occurred in the retroperitoneum of infants and were frequently complicated by Kasabach-Merritt syndrome. We therefore propose the designation "Kaposi-like infantile hemangioendothelioma" for this unusual neoplasm.
55617.3813896561992.10.29++Hydatid disease of the spleen. Ultrasonography, CT and MR imaging.Acta Radiol
WN von Sinner, H Stridbeck,
Seven patients with hydatid disease of the spleen were examined by radiography, ultrasound, CT, and in one case MR imaging. The observations were confirmed by patho-anatomic findings except in 2 patients where high indirect hemagglutination tests confirmed the diagnosis. In one patient primary, and in the others secondary, echinococcosis of the spleen was assumed to be present. Secondary hydatid disease of the spleen was caused by rupture of liver cysts with abdominal and pelvic dissemination. Ultrasound and CT findings of the cysts and cystic calcifications are described. In one patient MR imaging indicated prolapse of a splenic hydatid cyst into the left hemithorax, confirmed by patho-anatomic examination.
55717.3723981581990.10.17+ MR imaging of hepatosplenic candidiasis superimposed on hemochromatosis.J Comput Assist Tomogr
JS Cho, EE Kim, DG Varma, S Wallace,
55817.3679628181994.12.08+ Sellar spine and pituitary adenoma: MR and CT appearance.J Comput Assist Tomogr
K Eguchi, T Uozumi, K Arita, K Kurisu, M Sumida, T Nakahara,
55917.3417901131992.04.01++Differential diagnosis of hepatic neoplasms: spin echo versus gadolinium-diethylenetriaminepentaacetate-enhanced gradient echo imaging.Magn Reson Q
YA Abbas, HY Kressel, FW Wehrli, WB Gefter, BJ Dinsmore, TW Chan, L Oleaga, BN Milestone, EK Outwater,
Early results are reported of hepatic neoplasms studied with dynamic gadolinium-diethylenetriaminepentaacetate (Gd-DTPA)-enhanced magnetic resonance imaging (MRI). The purpose of this study was to evaluate the potential of the Gd enhancement pattern for characterizing these neoplasms and to compare the performance of spin-echo (SE) to SE plus dynamic Gd-enhanced gradient-echo (GRE) pulse sequences. Forty-two patients with hepatic neoplasms were examined at 1.5 T field strength. In each patient, short and long repetition time/echo time (TR/TE) SE images were obtained, followed by pre- and post-Gd-DTPA (0.1 mmol/kg body wt), single-slice, breath-hold (13 s/scan) GRE images, which were serially acquired less than or equal to 12 min postinjection. The patterns of contrast enhancement of the various hepatic lesions were documented and analyzed. The time to peak Gd signal enhancement-to-noise ratio (SE/N), contrast-to-noise ratio (C/N), contrast (defined as the signal intensity ratio [SIR]), as well as the peak values of these quantities, were determined. The C/N and SIR values on the short and long TR/TE SE and pre-Gd GRE images for all hepatic neoplasms were also obtained. The discriminating abilities (hemangiomas vs. malignant neoplasms) of these quantities were analyzed statistically. In addition, the impact of lesion characterization on the SE versus the SE plus the Gd-enhanced GRE scans was assessed by means of a blinded reader study. Malignant hepatic neoplasms could be differentiated from hemangiomas by visual inspection of their enhancement patterns (p = 0.0009), by the time to peak C/N on Gd-enhanced images (p = 0.0002), and by the magnitude of such peak (p = 0.02). Combined SE + Gd-enhanced GRE scans afforded minor, though statistically significant (p less than 0.01), improvement of the accuracy in differentiating benign from malignant hepatic neoplasms. Late scans (12 min post-Gd) may be particularly useful in identifying hemangiomas that, unlike other neoplasms, have a significant high signal of their enhancing portions on such images.
56017.3316208651992.08.06++Gaucher disease: abdominal MR imaging findings in 46 patients.Radiology
SC Hill, BM Damaska, A Ling, K Patterson, AM Di Bisceglie, RO Brady, NW Barton,
Abdominal magnetic resonance imaging findings were reviewed in 46 patients with Gaucher disease. All patients had hepatosplenomegaly at the time of initial imaging. Splenic nodules were present in 14 patients (30%) and varied in signal intensity. These nodules were isointense on T1-weighted and hypointense on T2-weighted images. Splenic infarcts were seen in 15 patients (33%), and four of these patients (9%) also had subcapsular fluid collections. Both nodules and infarcts were present in the spleen in four patients (9%). Pathologic correlation was performed with specimens from two patients who underwent partial splenectomy. Focal areas of abnormal signal intensity were noted in the liver in nine patients (20%). They were either stellate or segmental, and may represent fibrotic septa with ischemic changes associated with aggregates of Gaucher cells. No changes were noted in the kidneys or abdominal lymph nodes.
56117.3386236201996.06.19++Nonspecificity of short inversion time inversion recovery (STIR) as a technique of fat suppression: pitfalls in image interpretation.AJR Am J Roentgenol
G Krinsky, NM Rofsky, JC Weinreb,
Short inversion time inversion recovery (STIR) and the rapid acquisition with relaxation enhancement (RARE) version of STIR are commonly used pulse sequences that are sensitive enough to detect a broad range of pathologic conditions. In addition to suppressing the signal from fat, the STIR sequence achieves additive T1-weighted, T2-weighted, and proton density-weighted contrast to facilitate lesion conspicuity [1, 2]. Fat suppression with STIR sequences is based on short T1 relaxation rates and therefore is not tissue specific. The signal from any tissue with a short T1, similar to that of fat, may be nulled as well. The signal from tissues that accumulate paramagnetic contrast agents also may be suppressed with STIR sequences when an appropriate degree of T1 shortening results.
56217.3163852441984.11.09++[Sonography in the diagnosis of an unusual splenic tumor]Ultraschall Med
P Heilmeyer, S Schneider,
The authors report on an unusual cystic giant tumour of the spleen (a necrotically disintegrating non-Hodgkin lymphoma) which was examined via sonography, scintigraphy and angiography. The information obtained by means of the individual examination methods was compared with each other, taking the findings of anatomic pathology as basis. In the case under discussion sonography supplied the best possible information on the morphology of the tumour. The importance of sonography in arriving at the differential diagnosis of cystic (or pseudocystic) space-occupying growths is discussed.
56317.2767482691984.09.11+ [Two cases of localized splenic lesion associated with hepatic hemangioma]Rinsho Hoshasen
H Ishida, S Inoue, S Komatsu, Y Tamakawa, H Ogawa, T Miyauchi,
56417.2769798841982.08.26++Preoperative CT evaluation of adrenal glands in non-small cell bronchogenic carcinoma.AJR Am J Roentgenol
ME Nielsen, DK Heaston, NR Dunnick, M Korobkin,
Preoperative chest computed tomographic (CT) scans in 84 patients with biopsy-proved non-small cell bronchogenic carcinoma were reviewed. At least one adrenal gland was visualized in 70 of these. Evidence of a solid adrenal mass was present in 18 (14.5%) glands in 15 (21.4%) patients. Percutaneous needle aspiration under CT guidance confirmed metastatic malignancy in the four patients who were biopsied. Because the documented presence of adrenal metastases in non-small cell lung cancer makes surgical resection or local irradiation inappropriate, it is recommended that both adrenal glands in their entirety be specifically included whenever a staging chest CT examination is performed in patients with such tumors. Percutaneous needle biopsy for pathologic confirmation of the nature of solid adrenal masses discovered in this process is also useful.
56517.2790712861997.04.09++MRI of the TMJ disc with intravenous administration of gadopentetate dimeglumine.J Comput Assist Tomogr
S Takebayashi, T Takama, S Okada, G Masuda, S Matsubara,
PURPOSE: The purpose of this study was to ascertain whether MR imaging with intravenous administration of gadopenetate dimeglumine (Gd-DTPA) is useful in the demonstration of the temporomandibular joint (TMJ) disc. METHOD: Sagittal T1-weighted MR images of 50 TMJs (25 patients) were obtained using a 0.5-T system both before and after intravenous injection of Gd-DTPA. The authors depicted the TMJ in which intravenous injection of Gd-DTPA improved visulization of the disc. RESULTS: Intravenous injection of Gd-DTPA increased intensity in the retrodiscal space, the pterygoid venous plexus, as well as joint effusion by diffused Gd-DTPA. The technique improved visualization of 10 (50%) of 20 normal discs and 20 (67%) of 30 anterior disc displacements in closed-mouth position, and also 23 (74%) of 31 normal discs and 12 (63%) of 19 anterior disc displacements in open-mouth position. There were 12 TMJs (24% of the 50 TMJs) in which equivocal findings became highly diagnostic. The incidence in marked contrast effect was higher in TMJs with severe internal derangement than in those with normal or mild internal derangement (p < 0.005). CONCLUSION: Using a 0.5-T MR imager, T1-weighted imaging with intravenous injection of Gd-DTPA showed more anatomic details than imaging without the contrast agent.
56617.25167586602006.07.21++Splenic tumours--autopsy study of ten years.Indian J Pathol Microbiol
SR Rane, IN Bagwan, P Pingle, VV Holla,
Human spleen, though being the largest component of reticuloendothelial system, is a very rare site of tumor metastases. Splenic metastases are usually seen as part of multi-organ involvement. Autopsy study conducted over a period of 10 years revealed that the incidence of neoplastic involvement of spleen was 1.45% (70/4812). Primary malignant involvement of spleen was also noted to be a rare entity in present study.
56717.2496302801998.06.23+ Case report: CT appearance of capillary and cavernous lymphangiomatosis of the spleen in an adult.Clin Radiol
TR Bader, G Ranner, M Klimpfinger,
56817.2367163501984.06.20++[Cystic lymphangioma of the abdomen in an adult. Contribution of echography and computed x-ray tomography. Apropos of a case]J Radiol
D Strohl, I Abols, Y Lauru, D Vadrot, M Laval-Jeantet,
Authors present a case of cystic lymphangioma of the abdomen in an adult patient. Pre-operative investigations are based on ultrasound and computed tomography since plain films, excretory urograms and barium enema are less helpful. Opportunity of such a diagnosis in adult is not frequent.
56917.22113009502001.05.17+ Pathologic quiz case. A human immunodeficiency virus-infected man with splenomegaly and radiologic evidence suggestive of rupture.Arch Pathol Lab Med
EA Sotomayor, J Borkowski, Z Gatalica,
57017.2123884051990.09.27++[MR imaging of splenic masses]Rinsho Hoshasen
K Itabashi, A Kohno, C Hayano, T Hayano, Y Nogata, K Ohgi, M Higuchi, Y Ohkubo, E Takahashi, A Harasawa,
It has been reported that MR imaging of the spleen is unsuccessful in detecting focal lesions because there is not a significant difference in relaxation times between most tumors and surrounding normal spleen. We reviewed the MR imaging of 15 patients (5 cysts, 2 abscesses, 1 hemangioma, 5 malignant lymphomas, 2 metastatic tumors). In all cases, the difference in signal intensities between splenic tissue and mass lesions permitted detection of splenic lesions on MR images. But, malignant lesions were less visible than benign lesions.
57117.2013896441992.10.29++Gadodiamide injection and gadopentetate dimeglumine. A double-blind study in MR imaging of the CNS.Acta Radiol
G Myhr, PA Rinck, A Børseth,
A double-blind, randomized parallel phase III study in MR imaging of the central nervous system was conducted to compare the safety and diagnostic utility of gadodiamide injection and gadopentetate dimeglumine at a dose of 0.1 mmol/kg b.w. in 60 adult patients. Seven patients in the gadodiamide injection group experienced 10 adverse events, 5 of the events possibly related to the contrast agent. In the gadopentetate dimeglumine group 5 patients reported 3 contrast agent-related adverse events out of 8 events. All events were transient and required no treatment. Seven incidents of patient discomfort, and some minor changes in vital signs and laboratory parameters were of no clinical concern. Contrast enhancement was observed in 60% and 44% of the patients with structural abnormalities in the gadodiamide injection group and gadopentetate dimeglumine group, respectively. No difference in overall efficacy was observed. Gadodiamide injection was found to be a safe and effective contrast agent.
57217.1947285971973.11.06+ The scope of splenic arteriography.Angiology
AJ Wendth, R Samson, S O'Connor, H Goussous,
57317.1882138921993.11.23++Case report: bacillary angiomatosis with massive visceral lymphadenopathy.Am J Med Sci
WH Haught, J Steinbach, DS Zander, CS Wingo,
Bacillary angiomatosis is a newly characterized infectious disease occurring mainly in patients with AIDS. Most patients have cutaneous angiomatosis lesions resembling Kaposi's sarcoma or pyogenic granuloma. Although the disease may be life-threatening if not treated, it is curable with appropriate antibiotic therapy. A patient had a fever, nightsweats, abdominal pain, pleural effusions, and asymmetric peripheral lymphadenopathy. Computed tomography of the chest and abdomen revealed a unique pattern of enhancement of lymph nodes that, to this research team's knowledge, has not been reported previously with this condition. Appropriate antibiotic therapy resulted in a complete resolution of the disease. Included is a discussion of the clinical presentation, etiology, histology, and treatment of bacillary angiomatosis.
57417.1495165031998.05.21++Lobar atrophy of the liver.Abdom Imaging
H Ishida, H Naganuma, K Konno, T Komatsuda, Y Hamashima, T Ishioka, T Hoshino, J Ishida, O Masamune,
Lobar atrophy of the liver due to causes other than liver tumor or liver cirrhosis is a relatively rare pathological condition, and there are only a few reports in the literature. We report six such cases and try to evaluate the relationship between lobar atrophy and portal flow disturbance. The patients could be divided into two groups according to the site of the atrophy: those with atrophy of the left lobe (two cases) and those with atrophy of the right lobe (four cases). The two cases with atrophy of the right lobe had hepatholithiasis in the involved segments, but the cause was not determined in the remaining four cases. In all six cases, portal flow disturbance was noted, including invisibility of the portal vein in four cases, narrowing in one case, and portal thrombus in one case. Collateral circulation was not recognized in any of our cases. Of interest is the mode of lobar atrophy. Atrophy of the right lobe was always associated with marked enlargement of the left lobe, but that of the left lobe did not induce an enlargement of the right lobe.
57517.141757061976.04.30++Arteriography of retroperitoneal lymphoma.AJR Am J Roentgenol
DC Levin, DH Gordon, M Kinkhabwala, JA Becker,
Arteriography was performed in 16 patients with various types of lymphoma involving the retroperitoneal space. The location and extent of the mass could be predicted in 15 cases, based upon displacement of major arteris or kidneys. Most of the studies demonstrated some degree of fine reticular neovascularity and staining within the mass; none showed extreme hypervascularity, coarse or ragged vessels, or pooling of contrast medium during the capillary phase. The differential diagnosis of lesions with this appearance includes metastases, sarcomas, neural tumors, and inflammatory masses. Arteriography may possibly prove to be of value in staging certain patients with lymphoma, although definitive assessment of its role must await further prospective studies.
57617.12150379462004.12.14++"Hamartoma" of the spleen (splenoma) in children.Pediatr Dev Pathol
C Abramowsky, C Alvarado, JB Wyly, R Ricketts,
Hamartomas of the spleen or splenomas, are uncommon benign tumorous growths in this organ which have not been well characterized in children. We report four patients, 4 to 11 years old, who had splenomegaly and splenic "hamartomas" associated with different hematologic conditions (refractory microcytic anemia, sickle cell anemia, hereditary spherocytosis, and dyserythropoietic hemolytic anemia). All patients had total splenectomy as a primary therapeutic approach or to lessen their transfusion requirements. In only one patient was a focal splenic mass identified preoperatively with contrasted computed tomography (CT) scans and magnetic resonance imaging (MRI). None of the patients showed a mass by ultrasonography. Gross examination showed enlarged spleens (315-724 g) which on cut surface revealed a single nodule in one and multiple bulging nodules in three specimens. The nodules varied from 1.3 to 7 cm and were indistinct from the surrounding nonlymphoid splenic (i.e., red pulp) parenchyma. Histology of the nodules showed red splenic pulp with variable histiocytic proliferation, focal extramedullary hematopoiesis, lympho-plasmacytosis, fibrosis, and siderotic-calcific deposits. Intranodular small T- and B-cell lymphoid aggregates but no organized secondary follicles or periarteriolar sheaths were seen. Proliferation antigen Ki-67 (Mib-1) immunostains showed a low (< 5%) proliferation index in the nodules and surrounding tissue. Reticulin stains did not show a capsule or border between the normal spleen and the nodules. The critical histologic differential diagnosis for these lesions is with benign vascular tumors. These can be identified by their more disorderly pattern, by immunohistochemistry and by their higher proliferation index. It is our contention that these splenic nodules are not true hamartomas, as they seem to result from remote ischemic or infectious/inflammatory insults, leading to the fibro-inflammatory reaction and deposition of calcium and hemosiderin that is better designated with the descriptive term of splenoma. Review of the literature and our own experience indicates that most children with splenic hamartomas or splenomas as we prefer to call them, have an underlying hematologic disorder likely made worse by a state of hypersplenism that explains the consistent improvement in the blood values after splenectomy.
57717.114028431977.04.15++CT detection and aspiration of abdominal abscesses.AJR Am J Roentgenol
JR Haaga, RJ Alfidi, TR Havrilla, AM Cooperman, FE Seidelmann, NE Reich, AJ Weinstein, TF Meaney,
Computed tomography (CT) is effective in detecting intraabdominal abscesses. Loculations of fluid and extraluminal gas are clearly localized in relation to other organs. Of 22 abscess in this series, CT successfully detected 20; comparative information with gallium, techneticum, and ultrasound scans is presented. In addition to localizing these collections, CT can be used to guide needle aspiration and drainage procedures. Three sizes of needles were used to aspirate specimens and/or provide drainage. This was accomplished successfully in 12 of 14 CT-guided procedures.
57817.1183513441993.09.14++Cerebral sparganosis: MR imaging versus CT features.Radiology
WK Moon, KH Chang, SY Cho, MH Han, SH Cha, JG Chi, MC Han,
Fourteen magnetic resonance (MR) images of 11 patients with cerebral sparganosis were reviewed retrospectively and compared with 13 computed tomographic (CT) scans of 10 of the patients. All patients underwent both nonenhanced and contrast material-enhanced MR imaging. All white matter degenerations, which were slightly hypointense on T1-weighted images and were hyperintense on T2-weighted images, were seen as areas of low attenuation on CT scans. Better contrast between normal and degenerated brain tissues was seen at MR, and two lesions were seen that were missed at CT. The parasitic granuloma was isointense to brain parenchyma on images obtained with all pulse sequences. On two follow-up MR images, location or shape of the enhancing lesions changed, suggesting migration of the worm. A new finding of hyperintensity on T1-weighted images and hypointensity on T2-weighted images in subcortical areas probably due to petechial hemorrhages was demonstrated in eight patients only at MR. Small calcific foci, which were important diagnostic clues of cerebral sparganosis, were detected in four patients only at MR, while they were seen in eight patients at CT.
57917.1194000541998.01.21++Torsion of accessory spleen in an adult patient: imaging findings at CT, MRI and angiography.J Belge Radiol
R Jans, R Vanslembrouck, L Van Hoe, L Sockx, I Demedts, AL Baert,
A 40-year-old woman presented with acute left upper quadrant pain due to torsion of an accessory spleen around its long vascular pedicle, causing infarction. Torsion of an accessory spleen is extremely rare. As far as we known only 14 cases have previously been reported in the literature, and more than half patients were children. MRI can be helpful in the differential diagnosis of infarction by suggesting haemorrhagic necrosis on the T2-weighted images.
58017.10104052431999.09.23++Primary splenic tuberculosis in a patient with nasal angiocentric lymphoma: mimicking metastatic tumor on abdominal CT.J Clin Gastroenterol
M Ozgüroğlu, AF Celik, G Demir, H Aki, F Demirelli, N Mandel, E Büyükünal, S Serdengeçti, B Berkarda,
Tuberculosis may be difficult to diagnose when it presents in an uncommon extrapulmonary site. The authors report a case of splenic tuberculosis mimicking metastatic tumor on computed tomography in a 60-year-old woman who had been treated with combination chemotherapy for nasal angiocentric lymphoma. Diagnostic splenectomy revealed multiple necrotic masses in the spleen, which were consistent with caseating granulomas microscopically. Diagnosis was confirmed by positive cultures in Lowenstein medium, which grew typical Mycobacterium tuberculosis organisms. Following splenectomy, the patient was also treated with a triple-drug antituberculosis regimen with no recurrence of her symptoms.
58117.0983722001993.10.14++Morton neuroma: evaluation with MR imaging performed with contrast enhancement and fat suppression.Radiology
MR Terk, PK Kwong, M Suthar, BC Horvath, PM Colletti,
PURPOSE: To evaluate clinically suspected Morton neuroma with contrast material-enhanced magnetic resonance (MR) images. MATERIALS AND METHODS: Fifteen patients with clinically suspected Morton neuroma underwent examination with conventional T1- and T2-weighted MR imaging and a combination of fat suppression and administration of gadopentetate dimeglumine. A T1-weighted spectral presaturation with inversion recovery sequence was used for fat suppression. RESULTS: In six patients, a tumor that conformed to the clinical findings was seen in the interdigital space; surgical findings in these patients correlated closely with the imaging findings in all patients. Patients without positive findings on MR images tended to have less typical clinical findings and received nonsurgical treatment. In all patients, the lesions were best depicted with the combination of contrast-enhanced imaging and fat suppression; conventional MR images either entirely failed to demonstrate the lesions or demonstrated the lesions less clearly. CONCLUSION: In patients who need imaging confirmation of a clinically suspected Morton neuroma, the combination of fat suppression and contrast enhancement provides reliable high-contrast images.
58217.08108234552000.08.16++Familial Mediterranean fever: abdominal imaging findings in 139 patients and review of the literature.Abdom Imaging
D Aharoni, N Hiller, I Hadas-Halpern,
BACKGROUND: The purpose of this study was to investigate the imaging findings in patients with familial Mediterranean fever (FMF) during and between acute attacks. METHODS: Computerized search of medical records from 1989 to 1998 identified 139 patients with a discharge diagnosis of FMF. Medical records, imaging studies, and pathologic findings were reviewed. RESULTS: Sixty-eight patients had a documented acute attack of FMF, and 71 patients known to have FMF were asymptomatic. Imaging was performed in 68 patients. Radiologic findings included ascites, splenomegaly, hepatomegaly, lymphadenopathy, focal peritonitis, peritoneal cysts, renal changes, and other incidental findings. CONCLUSIONS: Radiologic findings in symptomatic and asymptomatic FMF patients are not uncommon. Imaging in selected cases may facilitate diagnosis and show complications.
58317.0789392361996.12.26++Effect of the rate of gadopentetate dimeglumine administration on abdominal vascular and soft-tissue MR imaging enhancement patterns.Radiology
PJ Strouse, MR Prince, TL Chenevert,
PURPOSE: To delineate dynamic gadopentetate dimeglumine enhancement profiles within the abdomen as a guide to improve gadolinium-enhanced magnetic resonance (MR) angiography. MATERIALS AND METHODS: Fifteen patients (eight women, seven men; aged 19-80 years) underwent fast three-dimensional spoiled gradient-recalled-echo imaging with the keyhole technique during the administration of 0.1 mmol/kg gadopentetate dimeglumine by means of bolus (10-second) injection (n = 5), 60 second injection (n = 5), or slow (120-230-second) pump injection (n = 5). Injection was initiated 10 seconds after imaging began. Regions of interest were constructed within the aorta, inferior vena cava, liver, spleen, renal cortex, muscle, and fat. Inclusion of phantoms of gadopentetate dimeglumine in tubes allowed estimation of intravascular gadolinium concentration. RESULTS: Maximal arterial enhancement occurred with bolus administration; maximal parenchymal organ enhancement, with 60-second injection. Slow pump injection resulted in a longer time to preferential arterial to venous enhancement (120 seconds +/- 14 [+/-standard deviation]) than did bolus (48 seconds +/- 64) or 60-second (88 seconds +/- 39) injections. The peak arterial to venous enhancement ratio was 6.3 +/- 3.3 for the bolus injection, 4.7 +/- 1.6 for the 60-second injection, and 3.3 +/- 1.3 for the slow pump injection. CONCLUSION: The dynamics and magnitude of abdominal vascular and soft-tissue enhancement are affected by the rate of gadopentetate dimeglumine administration.
58417.0590712971997.04.09++Struma ovarii: MR findings.J Comput Assist Tomogr
M Dohke, Y Watanabe, A Takahashi, T Katayama, Y Amoh, T Ishimori, A Okumura, K Oda, K Mitsudo, K Minami, M Ukita, Y Dodo,
PURPOSE: The purpose of this study was to determine the MR appearance of struma ovarii correlating with the pathological features. METHOD: MR findings of two patients with struma ovarii were retrospectively reviewed and compared with the pathological findings. RESULTS: Both tumors were complex masses composed of multiple cysts and solid components. The size and signal intensity of multiple cysts varied within the tumor. Hyperintense cystic areas on T1-weighted images were thought to correspond pathologically to hemorrhagic cysts and follicles containing viscous proteinaceous colloid. Solid components had as high a signal intensity as did uterine endometrium on T2-weighted images and as intermediate a signal intensity as did uterine muscle layer on T1-weighted images. After intravenous administration of gadolinium-DTPA, the solid components showed marked contrast enhancement. There was also ascitic fluid associated with adhesion and peritoneal thickening. CONCLUSION: The characteristic MR appearance of struma ovarii is thought to be a mixed mass composed of T2-hyperintense solid components with intense contrast enhancement and multiple T1-hyperintense cystic areas suggestive of hemorrhagic degeneration and viscous proteinaceous colloid.
58517.0579559501994.12.09++[Focal lesions of the spleen: contribution of magnetic resonance imaging]Clin Ter
GF Gualdi, A Volpe, E Polettini, A Melone, AM Ceroni, MG Ferriano,
MR findings in the study of focal splenic pathology are discussed in this paper. MR examination of the spleen shows some technical limits in the diagnosis of masses affecting this organ. On the contrary, the introduction of new paramagnetic contrast agents, with organospecific affinity, will no doubt improve the diagnostic power of MR imaging, in order to gain more information about these diseases.
58617.0477877221995.07.24++Niemann-Pick disease type C: nodular splenomegaly.Abdom Imaging
LP Omarini, SE Frank-Burkhardt, TA Seemayer, G Mentha, F Terrier,
Niemann-Pick type C disease (NPCD) is an autosomal recessive storage lipidosis due to a disorder of cholesterol esterification leading to the accumulation of sphingomyelin and cholesterol in the brain, liver, and spleen. The disease is usually diagnosed when neurological symptoms appear. We report an unusual presentation of NPCD in a young asymptomatic adult with isolated nodular splenomegaly.
58717.04128116982003.08.13++[Characterization of focal liver lesions with contrast-enhanced low MI real time ultrasound and SonoVue]Rofo
J Hohmann, J Skrok, R Puls, T Albrecht,
PURPOSE: SonoVue is a new microbubble ultrasound contrast agent that for the first time allows continuous real time examination during the different phases of contrast enhancement using low transmission power, expressed as mechanical index (MI). This study investigates whether low MI real time phase inversion imaging with SonoVue can improve the characterization of focal liver lesions in comparison to unenhanced sonography and power Doppler sonography. MATERIALS AND METHODS: Sixty-three patients with 35 malignant and 28 benign liver lesions were studied with unenhanced ultrasound (US) including B-mode and power Doppler, followed by contrast-enhanced al MI (0.1 - 0.3) real time phase inversion US during arterial, portal-venous and delayed liver phase (> 2 min after injection). Findings of the scans obtained before and after administration of contrast agent were compared with each other and with reference examinations (biopsy, MRI, CT or intraoperative US). RESULTS: The number of correctly diagnosed lesions increased from 41 (65%) without contrast agent to 58 (92%) with contrast agent (p < 0.001). The differentiation of malignant from benign lesions improved from 43 (68 %) to 60 (95 %, p < 0.001). After administration of the contrast agent, all 35 malignant lesions were correctly recognized and 3 of the 28 benign lesions were misclassified. All 27 metastases showed little or no enhancement on portal-venous and delayed phase imaging, independent of their arterial features. All 6 hepatocellular carcinomas (HCC) enhanced markedly during arterial phase and 5 showed less contrast uptake than normal liver in the late phase. Ten of 11 hemangioma displayed arterial peripheral nodular enhancement followed by progressive centripetal fill-in. Nine of 11 focal nodular hyperplasias (FNHs) showed profuse arterial enhancement (5 with a transient "spokewheel") and contrast uptake similar to normal liver thereafter. One FNH showed a subtle central scar. CONCLUSION: Low MI real time US with SonoVue markedly improves the characterization of focal hepatic lesions in comparison with unenhanced sonography.
58817.03104420171999.09.21++[Splenic abscess]Przegl Lek
A Wysocki, A Brzychczy,
Splenic abscess consists a very rare pathology. There were less than 300 cases described in the literature in the last 10 years. We report a case of 68 year old women with the splenic abscess with a history of blunt trauma of the left side chest wall two years earlier. The diagnosis was confirmed by USG and CT. The patient underwent splenectomy. The post operative course was uneventful.
58917.0015752161992.06.03++Bacillary epithelioid angiomatosis involving the liver, spleen, and skin in an AIDS patient with concurrent Kaposi's sarcoma.Am J Clin Pathol
TA Steeper, H Rosenstein, J Weiser, S Inampudi, DC Snover,
The simultaneous findings of bacillary epithelioid angiomatosis and Kaposi's sarcoma of the skin with visceral hepatosplenic bacillary epithelioid angiomatosis is reported in a patient with acquired immune deficiency syndrome. Liver biopsy showed periportal peliotic spindle cell foci that initially were misinterpreted as Kaposi's sarcoma. After antibiotic therapy induced rapid clinical improvement, repeated liver biopsy showed resolution of the previously noted lesions. Although the violaceous skin lesions all appeared similar clinically, some resolved completely and some progressed. One of the latter was biopsied and had the histologic features of Kaposi's sarcoma. The differential diagnosis is discussed.
59016.9466031261983.08.26++Computed tomography and sonography of cavernous hemangioma of the liver.AJR Am J Roentgenol
Y Itai, K Ohtomo, T Araki, S Furui, M Iio, Y Atomi,
Accuracy and limitations of computed tomography (CT) and sonography in the detection and diagnosis of cavernous hemangioma of the liver were analyzed in 39 cases. In 35 of 38 lesions examined by CT before and after bolus contrast enhancement, findings were dense contrast enhancement spreading in all directions on subsequent scans and/or density (other than capsule or septa) higher than normal hepatic parenchyma after 2 min. Lesions smaller than 1 cm were not detected. Misregistration in sequential scans prevented diagnosis of three of nine lesions smaller than 2 cm. Sonography revealed various patterns of mass, but in the smaller lesions, an extremely hyperechoic pattern was dominant. The contributions of CT and sonography depend on the size of the lesions.
59116.93178833022007.11.08+ [Splenic peliosis: a rare entity]Rev Esp Enferm Dig
S Pérez-Holanda, S Tojo, M Calleja, JA Fernández, P Fernández, MD Martínez, F Fernández, J Rodríguez, D Valverde,
59216.93186031842008.09.17++Detection and characterization of focal hepatic lesions: comparative study of MDCT and gadobenate dimeglumine-enhanced MR imaging.Clin Imaging
HY Lee, JM Lee, SH Kim, KS Shin, JY Lee, JK Han, BI Choi,
The aim of this study was to compare the diagnostic performance of multidetector row helical CT (MDCT) and gadobenate dimeglumine-enhanced magnetic resonance (MR) imaging (in the detection and characterization of focal liver lesions. Two blind reviewers analyzed the MDCT and MR images of a total of 44 malignant and 85 benign lesions in 46 patients independently. Receiver operating characteristic curves were established to analyze the results for each reviewer and modality.
59316.93103905631999.09.14++Primary malignant fibrous histiocytoma of the liver: imaging features of five surgically confirmed cases.Abdom Imaging
JS Yu, KW Kim, CS Kim, KH Yoon, HJ Jeong, DG Lee,
BACKGROUND: The purpose of the present study was to describe the various imaging features of primary malignant fibrous histiocytoma (MFH) of the liver, a rare tumor of mesenchymal origin. METHODS: Sonography (n = 5), computed tomography (CT; n = 5), magnetic resonance (MR) imaging (n = 2), and hepatic arteriography (n = 3) in five patients who underwent partial hepatectomy for tumor resection were retrospectively reviewed and correlated with pathologic findings. RESULTS: All tumors were clearly demarcated from surrounding hepatic parenchyma in sectional imaging with (n = 2) or without (n = 3) a fibrous capsule, which was pathologically verified. Internal architecture of abundant fibrosis, myxoid degeneration, and/or hemorrhagic necrosis reflected the sonographic, CT and MR imaging findings. Marginal tumor staining without definite tumor vasculature was the main feature of hepatic arteriography. There was no intratumoral calcification. All three tumors involving the right lobe of the liver invaded the right hemidiaphragm. CONCLUSION: Although there were no unique findings of primary hepatic MFH, a combined interpretation of various imaging modalities may elucidate the malignant nature of the tumor.
59416.9282843851994.02.17++Symptomatic hepatic cysts: percutaneous drainage and sclerosis.Radiology
E vanSonnenberg, JT Wroblicka, HB D'Agostino, JR Mathieson, G Casola, R O'Laoide, PL Cooperberg,
PURPOSE: To evaluate the authors' experience with treatment of symptomatic hepatic cysts by means of percutaneous catheterization and sclerosis. MATERIALS AND METHODS: Twenty patients with 24 symptomatic hepatic cysts underwent percutaneous drainage and sclerosis. Ten patients had polycystic disease, and 10 had solitary cysts. Sclerosants used were alcohol, tetracycline, doxycycline, or a combination. RESULTS: Twenty-one of 24 cysts in 17 of 20 patients were treated successfully. Treatment was unsuccessful in three patients: one patient with innumerable medium-size and small cysts, one patient in whom only a needle was inserted (no catheter), and one patient with a cystic metastasis (rather than a simple cyst) that recurred. Complications included pleural effusion in two patients and secondary infection in one patient. The range of blood alcohol levels was 0-0.8 mg%. CONCLUSION: Percutaneous catheter drainage with sclerosis is an effective method of therapy for symptomatic hepatic cysts; careful patient selection is essential for proper therapy.
59516.9218469941991.03.14++Improved detection and delineation of head and neck lesions with fat suppression spin-echo MR imaging.AJNR Am J Neuroradiol
RD Tien, JR Hesselink, PK Chu, J Szumowski,
To compare conventional and fat suppression MR imaging in their ability to detect head and neck lesions, we prospectively studied 17 patients with head and neck tumors and one normal volunteer. Five patients had benign tumors (one mixed cell tumor, one hemangioma, one lipoma, and two plexiform neurofibromas), 10 had malignant tumors (six squamous cell carcinomas, two minor salivary gland carcinomas, one lymphoma, and one malignant fibrous histiocytoma), and two had nonspecific lymphadenopathy. All subjects were studied with standard spin-echo T1- and T2-weighted images (T2-weighted imaging was done with and without fat suppression technique). In addition, T1-weighted images with contrast enhancement and fat suppression were obtained in nine patients. A four-point grading system was used for comparison of the conventional and fat suppression images. Grades ranged from 0 (unsatisfactory, the lesion cannot be seen) to 3 (excellent, the lesion and its margins can be seen clearly with sharp contrast from surrounding normal tissue). We found that postcontrast fat suppression T1-weighted images and fat suppression T2-weighted images were most useful; these sequences obtained an average score close to grade 3 (2.77 and 2.85, respectively). On the other hand, the conventional T2-weighted images had an average score of about 2 (1.82) and the conventional T1-weighted image had a score of about 1 (1.33). Fat suppression T2-weighted sequences generally were superior in cases of lymphadenopathies. Postcontrast T1-weighted images were most useful in a case of plexiform neurofibroma, owing to their fibrous component and lower proton density.(ABSTRACT TRUNCATED AT 250 WORDS)
59616.91112599452001.04.19++Frequency of benign hepatic lesions incidentally detected with contrast-enhanced thin-section portal venous phase spiral CT.Acta Radiol
M Völk, M Strotzer, M Lenhart, J Techert, J Seitz, S Feuerbach,
PURPOSE: To evaluate the frequency of benign focal hepatic lesions incidentally detected at contrast-enhanced thin-section portal venous phase spiral CT. MATERIAL AND METHODS: Between January 1998 and February 1999, contrast-enhanced hepatic spiral CT examinations were performed in 1,892 patients. Out of these, only 100 patients fulfilled the following inclusion criteria: No underlying malignant disease, no liver cirrhosis, no suspected or known focal liver lesions. Standardized spiral CT parameters were applied. All CT studies were reviewed retrospectively by one radiologist. Any focal lesion was recorded and classified. Lesion size and number were noted. RESULTS: A total of 108 hepatic lesions were reported in 33 out of 100 patients (80 cysts; 18 hemangiomas; 3 focal fatty infiltrations; 2 focal non-tumorous perfusion defects; 1 calcification; and 4 non-classified lesions). The average lesion size was 9.4 mm (< or =5 mm: n=40; 6-10 mm: n=30; 11-15 mm: n=28; >15 mm: n=10). CONCLUSION: Benign liver lesions are probably a frequent incidental finding at abdominal spiral CT.
59716.9191223781997.04.22++Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings.Radiology
Y Yamashita, I Ogata, J Urata, M Takahashi,
PURPOSE: To correlate the pathologic findings of cavernous hemangiomas with enhancement patterns seen at dynamic computed tomography (CT) performed after injection of contrast material. MATERIALS AND METHODS: Sixteen patients underwent dynamic CT followed by hepatectomy. Resected specimens of 16 cavernous hemangiomas, which ranged from 2 to 15 cm in diameter, were obtained. The average size of vascular spaces in the histologic specimen was correlated with their appearance on dynamic CT scans. RESULTS: In 11 tumors, characteristic progressive fill-in after peripheral contrast enhancement was seen (type 1). In type 1 tumors, three zones were noted within the tumor: areas of peripheral puddling in the arterial-dominant phase, areas of gradual fill-in, and areas of no or minimal enhancement. Vascular spaces in areas of peripheral global enhancement were significantly smaller than those in areas of gradual fill-in (P = .03). In areas of no or minimal enhancement, extensive scar tissue (n = 9) or cystic cavity (n = 3) was seen. In three hemangiomas smaller than 3 cm, enhancement occurred diffusely in the arterial-dominant phase and vascular space was small (type 2). In two tumors, enhancement was seen only in the periphery of the tumor (type 3), and the majority of tumor was occupied by the cystic cavity or scar tissue. CONCLUSION: Dynamic enhancement patterns of cavernous hemangiomas are related to the collective size of their constituent vascular spaces.
59816.8888193941996.10.31++Efficacy of sonography as a guidance technique for biopsy of abdominal, pelvic, and retroperitoneal lymph nodes.AJR Am J Roentgenol
DS Memel, GD Dodd, CC Esola,
OBJECTIVE: In the United States, CT is generally considered the guidance technique of choice for biopsy of abdominal, pelvic, and retroperitoneal lymph nodes. The aim of this study was to evaluate the efficacy of sonography for this purpose. SUBJECTS AND METHODS: We attempted 26 sonographically guided biopsies of five abdominal, six pelvic, and 12 retroperitoneal lymph nodes in 23 patients. The patients included 19 women and four men who were 26-76 years old (mean, 50 years old). The nodes were less than 2 cm in 16 patients, 2-3 cm in four patients, and greater than 3 cm in three patients. Biopsies were considered successful if the nodes could be visualized and biopsied using sonographic guidance and the pathologist's final report indicated that the tissue specimens obtained were adequate for diagnosis. The length of the procedures and the number of complications were recorded. RESULTS: Lymph nodes were visualized and biopsied with sonographic guidance in 23 (88%) of the 26 attempts. Three biopsies could not be performed with sonography because of poor visualization of the nodes. Adequate tissue for cytologic or histologic evaluation was obtained in 21 (91%) of the 23 sonographically guided procedures. In the 21 successful procedures, clinical and imaging follow-up showed no evidence of false-negative diagnoses. The time from the placement of the patient in the interventional sonography room to completion of the procedure ranged from 25 to 60 min (mean, 35 min) for sonographically guided biopsies. We had no procedure-related complications. CONCLUSION: Sonography is an accurate and safe guidance technique for lymph node biopsies in the abdomen, pelvis, and retroperitoneum. This technique is efficacious for deep nodes as small as 1 cm in diameter. The advantages of sonography over CT include no need for ionizing radiation, portability, shorter procedure time, and real-time visualization of the needle throughout the procedure. These advantages, and the fact that sonography costs less than CT, suggest that sonography is a more appropriate guidance technique in this era of cost containment.
59916.8890150631997.02.27++Focal liver lesions: characterization with conventional spin-echo versus fast spin-echo T2-weighted MR imaging.Radiology
W Schima, S Saini, JA Echeverri, PF Hahn, M Harisinghani, PR Mueller,
PURPOSE: To compare prospectively the diagnostic accuracy of T2-weighted conventional spin-echo (SE) and fast SE magnetic resonance (MR) imaging for differentiation of benign (hemangiomas or cysts) from malignant (metastases or hepatocellular carcinoma) liver lesions. MATERIALS AND METHODS: Fifty-three patients with 55 confirmed liver lesions (20 hemangiomas, eight cysts, 22 metastases, four hepatocellular carcinomas, one malignant fibrous histiocytoma) underwent T2-weighted conventional SE (repetition time msec/echo time [TE] msec = 3,100/ 80,160) and fast SE (5,000-5,000/99-104 [effective TE]) MR imaging at 1.5 T. The images were evaluated quantitatively (lesion-liver signal intensity ratio and lesion T2 index [SIlesion TE80/SIlesion TE160, where SI = signal intensity] and qualitatively (blinded reading) by using receiver operating characteristic analysis. RESULTS: Quantitatively, the T2 index (Az = .988) was more accurate than the signal intensity ratio at conventional SE (Az = .920) and fast SE (Az = .910) imaging (P < .05). Qualitatively, there was no statistically significant difference between the blinded reading of conventional SE (Az = .988) and fast SE (Az = .986) images in lesion characterization (benign vs malignant). There was a trend, however, toward superiority of conventional SE imaging for evaluation of "hypervascular" metastases (n = 9). CONCLUSION: With the specific parameters used, conventional SE and fast SE images provide equal accuracy for characterization of focal liver lesions. In patients with hypervascular metastases, double-echo conventional SE images may be preferable.
60016.8496063761998.06.18++Von Meyenburg complexes of the liver: imaging findings.J Comput Assist Tomogr
TY Luo, Y Itai, N Eguchi, Y Kurosaki, H Onaya, Y Ahmadi, M Niitsu, HS Tsunoda,
PURPOSE: Our purpose was to present imaging findings of six cases proven or supposed to be von Meyenburg complexes (VMCs) with a basis of reviewing the pathologic literature and to describe imaging points for the diagnosis of typical VMC along with its differential diagnosis. METHOD: Six cases were diagnosed as VMC of the liver with imaging modalities (one had histopathologic proof). Both ultrasound (US) and CT were available for all cases, and MRI was used for three cases. Follow-up with US, CT and/or MRI was performed in five cases. RESULTS: US detected varying abnormalities of the livers in four cases. CT and MRI revealed multiple or numerous intrahepatic tiny (usually < 5 mm) cystoid lesions in all of the cases. The lesions were scattered throughout the livers, and some of them were located more frequently adjacent to the medium-sized portal veins than to the hepatic veins of similar size on CT. Moreover, some lesions were apparently located in the subcapsular areas (up to the hepatic capsules). They were usually irregular in shape and showed no enhancement but increased in number by approximately 80-150% after administration of intravenous contrast medium. The T2-weighted MR images and MR cholangiopancreatography showed the lesions to be much more apparent and to be more numerous than T1-weighted images did. Follow-up of five cases with imaging modalities did not show remarkable change of the lesions. CONCLUSION: Despite our limited experience, VMC lesions seem to show some CT and MR features different from those of other multiple small hepatic lesions. They presented as multiple or numerous intrahepatic tiny cystoid lesions usually with irregular contour, scattered throughout the liver up to the subcapsular areas, and were detected in far greater number by enhanced CT or T2-weighted MR images than by unenhanced CT or T1-weighted images. They showed no remarkable change on long term follow-up imaging. We propose that a diagnosis of typical VMC could be made after analyzing CT or MR images carefully with good understanding of its pathologic basis, but imaging follow-up is necessary in oncology patients.
60116.84117759222002.01.31++[CT in diagnosis of tuberculosis of liver and spleen]Zhonghua Jie He He Hu Xi Za Zhi
R Xie, X Zhou, J Chen,
OBJECTIVE: To analyze CT findings of hepatospleeno-tuberculosis and to explore the characteristics for diagnosis and differential diagnosis of the disease. METHODS: CT scans were performed in fifteen patients. There were nine men and six women, the age ranging from 18 to 60 years old. All patients were diagnosed clinically, one of which was confirmed by pathology after surgery, two of which were confirmed by pathology through CT-guided biopsy. RESULTS: All cases were concurrent with two or more other tuberculosis. Disseminated milliary, small nodules and small saccular foci were present in livers of 8 cases and spleens of 5, and isolated low dense lesion in liver of 1 case, diffuse calcifications in liver and spleen of another 1. CONCLUSIONS: When disseminated milliary, small nodules and small saccular foci are found by CT in liver or spleen and tuberculous lesions are present in other tissues, diagnosis of liver and/or spleen tuberculosis should be considered.
60216.83113915782001.06.28++The spleen as a diagnostic specimen: a review of 10 years' experience at two tertiary care institutions.Cancer
MD Kraus, MD Fleming, RH Vonderheide,
BACKGROUND: Few studies have examined the yield of the diagnostic splenectomy, and the relevance of these studies to the management of patients with unexplained splenomegaly or a splenic mass are limited by low number of cases, the use of selection criteria, and the lack of modern terminology and modern ancillary studies. The current study correlates clinical intent with preoperative clinical and radiologic studies and histologic findings in an assessment of the diagnostic yield of splenectomy. METHODS: The medical charts, laboratory data, radiologic studies, and pertinent preoperative biopsies on all patients who underwent splenectomy between the years 1986 and 1995 were reviewed, and the clinical intent behind the procedure was correlated with histologic findings. RESULTS: One hundred twenty-two of the 1280 patients underwent splenectomy for diagnosis, and in 116 patients a specific disease was identified histologically that explained the splenomegaly/splenic mass; malignancy was the most common cause of unexplained splenomegaly or splenic mass, though benign neoplasms and reactive disorders were documented in 25% of the cases. Primary splenic lymphomas were most commonly of large cell B-cell type. CONCLUSIONS: In the setting of splenomegaly or splenic mass, splenectomy has a high diagnostic yield and usually discloses a malignancy. The clinical category of "primary splenic lymphoma" is biologically heterogeneous, and the diagnosis is usually an intermediate grade (not low grade) lymphoma. The range of conditions associated with splenic masses were quite commonly associated with diseases that are amenable to fine-needle aspiration (FNA) diagnosis, whereas those disorders associated only with splenomegaly included a large fraction of diseases for which FNA may yield either incomplete or misleading results.
60316.83174206382007.06.13++Solitary small hepatic angiosarcoma: initial and follow-up imaging findings.Korean J Radiol
SH Heo, YY Jeong, SS Shin, TW Chung, HK Kang,
We report an uncommon case of solitary, small hepatic angiosarcoma that was initially considered as a hemangioma. We present the imaging findings, with an emphasis on the initial and follow-up CT and MR findings, as well as report on the more suggestive findings of angiosarcoma than those of a hemangioma.
60416.81114863252001.09.20++Partially reversed intrasplenic venous blood flow detected by color Doppler sonography in two patients with hematologic diseases and splenomegaly.J Clin Ultrasound
I Restrepo-Schäfer, B Wollenberg, J Riera-Knorrenschild, C Görg,
We report on 2 patients with hematologic diseases (1 follicular lymphoma and 1 myeloproliferative syndrome) and splenomegaly who had partial intrasplenic portosystemic shunting demonstrated by color Doppler sonography. Intrasplenic venous blood flow was in the normal direction at the hilum of the spleen but in a reversed direction at the periphery of the spleen. This type of reversed intrasplenic flow pattern results in portosystemic shunting and might be detected more frequently when careful color Doppler mapping of the entire splenic parenchyma is performed in patients with portal hypertension. The clinical significance of this phenomenon, however, is still unclear.
60516.7839107611986.03.07+ Tuberculous splenic abscess in a patient with acute myeloblastic leukemia.Taiwan Yi Xue Hui Za Zhi
MC Chang, SC Lin, KS Jeng, CC Shih,
60616.7773518391980.03.27++Significance of 99mTc-sulfur colloid splenic image in malignant melanoma.J Surg Oncol
RA Berjian, KL Parthasarathy, MS Didolkar, SP Bakshi, RH Moore,
To evaluate the clinical significance of 99mTc-sulfur-colloid (TsSC) spleen scan findings in patients with malignant melanoma, a retrospective study was undertaken. Eighty-one patients with histologically proven malignant melanoma who received treatment in Roswell Park during a five-year period were included in this study. The scans were analyzed for spleen size, differential uptake of the tracer in liver and spleen, and for the presence of metastases in these two organs. These data were compared with stage of disease, survival, and autopsy findings. Significant correlation was found between the splenic size as measured on the scintiscan and at autopsy examination. The spleen size was found to be normal in 92% of the patients in early melanoma. The median survival of patients who had a normal-sized spleen by scan criteria was found to be longer than those who had splenomegaly. No significant difference in survival was noted between the patients with and without augmented splenic uptake of TcSC. Only a small number (17.7%) of patients with augmented splenic uptake had splenic metastases; hence, the possible role of immunological factors was considered.
60716.7753406401967.10.13+ The accuracy of lymphangiographic diagnosis in malignant lymphoma.Radiology
M Takahashi, HL Abrams,
60816.7732879771988.07.06++Delayed presentation of blunt splenic injury.Am J Surg
A Leppäniemi, R Haapiainen, CG Standertskjöld-Nordenstam, M Taavitsainen, J Hästbacka,
Eleven patients with delayed presentation of splenic injury after blunt abdominal trauma treated during a 10 year period have been described. They represented 24 percent of all patients treated for blunt splenic injury in our department in that time period. Ten patients required operative treatment and one was treated nonoperatively. There were no deaths. The value of computerized tomography and ultrasonography in the accurate preoperative assessment of splenic injury has been documented. In addition, the various diagnostic and therapeutic possibilities in blunt splenic trauma have been discussed.
60916.7694035391998.01.02++Splenic abscess: another look at an old disease.Arch Surg
GS Phillips, MD Radosevich, PA Lipsett,
OBJECTIVE: To study the changes in the incidence, causes, bacteriologic profile, and management of a splenic abscess. DESIGN: Retrospective case study. SETTING: Tertiary, university referral center. PATIENTS: Thirty-nine patients with a splenic abscess. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Demographics, signs and symptoms, causes, risk factors, diagnostic methods, bacteriologic profile, treatment, and outcome. RESULTS: Patients presented at a mean age of 43 years (range, 2-83 years), after a mean symptomatic period of 16 days, with fever (69%), abdominal pain (56%), nausea and vomiting (38%), and splenomegaly (31%). The majority of abscesses represented metastatic infection (n=19), and 11 were secondary to immunosuppression. Twelve patients had human immunodeficiency virus disease and 9 used intravenous drugs. In patients who underwent computed tomography, all had abnormal scans (n=33), with a well-defined abscess(es) in 28. Nine abscesses were polymicrobial; monomicrobial isolates included gram-positive organisms (23%), gram-negative organisms (31%), fungi (23%), and mycobacteria (23%). Patients presenting before 1989 (1981-1988) (n=15) and those presenting after 1989 (1989-1996) (n=24) differed in risk factors (intravenous drug abuse, 0% vs 47% [P=.02]; hematologic malignancy, 43% vs 9% [P=.04]) and gram-positive isolates (18% vs 64%; P=.06). Patients underwent splenectomy (n=18), open drainage (n=4), medical therapy (n=10), or percutaneous drainage (n=5) with respective survival rates of 94%, 50%, 70%, and 100%. CONCLUSIONS: In 1996, splenic abscesses are increasingly common. Intravenous drug abuse and human immunodeficiency virus disease are significant risk factors, and the diagnosis should be considered in a patient with fever and abdominal pain who uses intravenous drugs. Antimicrobial agents should be broad since 36% of abscesses were polymicrobial, and should include coverage of gram-positive organisms.
61016.7619650251991.05.23++[Dynamic MRI of liver tumors--evaluation by inversion recovery snap shot FLASH MR imaging]Nippon Igaku Hoshasen Gakkai Zasshi
T Murakami, T Mitani, M Nishikawa, K Nakanishi, T Marukawa, K Harada, K Tokunaga, C Kuroda, T Kozuka,
We have studied 20 patients with liver tumor (hepatoma 12, hemangioma 6, metastatic tumor 2) using inversion recovery snap shot FLASH dynamic MR imaging. After intravenous injection of Gd-DTPA, serial 17 images were obtained during 7 minutes. Hepatoma showed central enhancement on early phase (0-20 sec) in 11 patients and absent or less enhancement than surrounding liver parenchyma on late phase (1-3 min) in 12 patients. Hemangioma showed peripheral enhancement on early phase in 6 patients, and slight to moderate enhancement on late phase in 5 patients. Peripheral slight enhancement were seen on late and delayed (5-7 min) phase in two patients with metastatic liver tumor. These characteristic enhancement patterns should facilitate differential diagnosis of liver tumors.
61116.7518520381991.06.27++[Diffuse liver parenchymal diseases: the value of MRI compared to sonography and CT]Rofo
T Vogl, S Steiner, D Hahn, H Schedel, J Lissner,
29 patients with diffuse liver disease were examined by ultrasound, CT and MRI. MRI imaging was performed using T1-and t2-weighted spin-echo-sequences and fast gradient-echo-sequences. The paramagnetic contrast agent Gd-DTPA was applied intravenously (0.1 mmol/kg). In all patients with hepatitis MRI enabled exact liver biopsy by delineation of inflammatory changes in cases of chronic or focal hepatitis. CT and ultrasound were superior to MRI in the detection of focal or diffuse fatty degeneration. However, MRI enabled an exact differentiation of fatty changes from neoplasm. In cases of fibrotic changes the most accurate findings could be shown by MRI. In patients suffering from hemochromatosis MRI supplied additional information compared to CT and ultrasound revealing significant reduction of signal intensity due to reinforced enhancement of iron. Concerning Wilson's disease MRI showed a characteristic pattern of parenchymal changes. The application of Gd-DTPA in cases of diffuse liver disease adds supplementary information about perfusion of liver parenchyma, but its value for diagnostic accuracy is only secondary.
61216.7517397761992.03.25++["Surgical projection" in the gadolinium-DTPA (Gd-DTPA)-supported NMR tomographic diagnosis of lateral lumbar disk prolapse]Rofo
U Tosch, R Baerwald, P Schubeus, B Sander, WR Lanksch, W Schörner, R Felix,
In a group of 25 patients the coronal views of plain and Gd-DTPA-enhanced MRI studies were correlated with CT and operative findings. All series included sagittal, transverse and coronal FLASH sequences (GE 500/6, flip angle 70 degrees), sagittal proton density-(SE 2500/15) and T2-(SE 2500/70) weighted images. MR diagnosis proved to be correct in all cases. Compared to CT and axial MRI herniated disk material in the lateral intravertebral space and its relationship to nerve roots was demonstrated more clearly on coronal views.
61316.75166321612006.07.20++Imaging findings of retroperitoneal lymphangiomyomatosis in a patient with lymphoma.Clin Imaging
YL Wan, LY Shih, SF Ko, MC Kuo, SH Ng,
A 31-year-old female with lymphoma was incidentally found to have a left retroperitoneal lymphangiomyomatosis (LAM). The tumor was proved by pathology and immunohistochemical study of the tissue specimen obtained by ultrasound-guided core needle biopsy. The characteristic sonographic, computed tomographic, magnetic resonance imaging, and positron emission tomographic (PET) features of this unusual lesion were described. It was managed conservatively and remained stable on 2-year follow-up study. LAM should be considered in the differential diagnoses in cases of a retroperitoneal solid mass with cystic components.
61416.7484514011993.04.14++Bladder tumors: staging with gadolinium-enhanced oblique MR imaging.Radiology
Y Narumi, T Kadota, E Inoue, K Kuriyama, M Fujita, N Hosomi, Y Sawai, M Kuroda, T Kotake, C Kuroda,
To clarify the importance of imaging plane in evaluation of invasion by tumor into muscle, 50 patients with bladder tumors underwent examination with magnetic resonance (MR) imaging performed with an oblique plane and the early phase of contrast enhancement. After the ideal oblique plane was selected, an oblique T2-weighted image was obtained. Gadopentetate dimeglumine was then administered, and an oblique T1-weighted image was obtained. The staging based on oblique T2-weighted and oblique contrast material-enhanced T1-weighted MR images was then correlated with histopathologic staging. The respective accuracies of oblique contrast-enhanced T1-weighted and oblique T2-weighted images were 78% and 60% for overall staging (P < .05), 90% and 74% for differentiation between (a) stage T1 and lower-stage tumors and (b) stage T2 and higher-stage tumors (P < .05), and 92% and 88% for differentiation between (a) stage T2 and lower-stage tumors and (b) stage T3a and higher-stage tumors (P > .05). Oblique MR imaging performed in conjunction with the early phase of contrast enhancement showed significantly high staging accuracy, especially in differentiation between superficial tumors and tumors with superficial muscle invasion.
61516.7393150001997.10.23++Pathologic conditions in the small bowel: findings at fat-suppressed gadolinium-enhanced MR imaging with an optimized suspension of oral magnetic particles.Radiology
SC Faber, MK Stehling, N Holzknecht, J Gauger, T Helmberger, M Reiser,
Depiction of small-bowel pathologic conditions was optimized with use of a negative luminal contrast agent, spectral fat suppression, and gadolinium enhancement in an excised gut phantom. The method was applied in nine patients in conjunction with standard enteroclysis examinations. Bulk susceptibility effects of oral magnetic particles were canceled with use of a diamagnetic methylcellulose suspension. In the ileum, fat suppression and contrast between bowel wall and lumen was judged good or excellent in eight and nine patients, respectively. In eight of nine patients, additional mesenteric findings were depicted.
61616.7266459241984.01.27+ [Primary splenic cyst. Unusual differential diagnosis of a benign splenic tumor]Med Welt
H Keller, K Genth, M Linder,
61716.70111673272001.02.08++MR and other imaging methods in the investigation of mycetomas.Acta Radiol
J Czechowski, M Nork, D Haas, G Lestringant, L Ekelund,
PURPOSE: To report features of mycetomas (actino- and eumycetoma infection), which belong to the so-called rare bone infections, as evaluated by MR and other imaging methods and to assess chemotherapy treatment. MATERIAL AND METHODS: Twenty patients (average age 57 years) were diagnosed by different modalities. Analyses of 57 plain films, 31 three-phase bone scans, 28 CT and 35 MR examinations were performed. The MR protocol included T1-weighting without and with contrast, T2-weighted, proton density and fat suppressing sequences. RESULTS: Signs of chronic osteomyelitis were seen in plain films of 10 patients (50%), but the healing process was difficult to assess. Bone scintigraphy was positive in 12 patients (60%). In 14 patients (70%), CT could demonstrate bone lesions, but the healing process was difficult to estimate in 4 patients. MR imaging provided accurate diagnostic information in 15 cases (75%). In 16 patients (80%), small lesions could be identified due to grains, which seemed to differentiate mycetoma from other infections and tumorous lesions. MR examination gave definitive answer about the healing process in 18 cases (90%). CONCLUSION: MR investigation was superior to the other imaging techniques in the evaluation of mycetoma and the assessment of therapy.
61816.6945722641973.06.07+ [Primary malignant neoplasms of the spleen]Wiad Lek
W Bross, S Koczorowski, E Rogalski, T Czereda, B Lazarkiewicz, J Kalemba, J Kibler, J Wierciñski, L Czarniecki,
61916.68107786022000.06.06++Tuberculosis: a rare cause of splenic abscess.J Assoc Physicians India
S Sharma, AB Dey, N Agarwal, KM Nagarkar, S Gujral,
Splenic abscess is a rare condition associated with septicemic conditions. Splenic abscess due to tuberculosis is still rarer, mostly diagnosed in immuno-compromised hosts. A case of tubercular splenic abscess without any underlying disease is reported.
62016.6883335601993.08.13++Epithelioid hemangioma of bone. A tumor often mistaken for low-grade angiosarcoma or malignant hemangioendothelioma.Am J Surg Pathol
JX O'Connell, SV Kattapuram, HJ Mankin, AK Bhan, AE Rosenberg,
Epithelioid hemangiomas are benign vascular tumors that usually occur in the skin and subcutis. They have been infrequently recognized in bone. Because of their unusual cytologic appearance and growth patterns, they are commonly confused with malignant tumors. We report a series of 12 epithelioid hemangiomas of bone occurring in adult patients, including five males and seven females whose ages at presentation ranged from 24 to 74 years, with a mean of 46 years. Five tumors were associated with involvement of the adjacent soft tissue. A single patient had multifocal bone disease. The most common presenting symptom was localized pain. Treatment of the patients varied widely; however, none of the tumors behaved aggressively. In 11 cases, adequate tissue was available for immunohistochemical analysis, which revealed positive staining for the epithelial markers cytokeratin and epithelial membrane antigen in nine cases. All 11 tumors stained for factor VIII-related antigen and Ulex europeus agglutinin. We believe that many of the vascular tumors of bone that have been reported as low-grade malignant hemangioendotheliomas probably represent examples of epithelioid hemangiomas. We recommend that the criteria for diagnosing vascular tumors of bone conform to those used for morphologically similar tumors that arise in the soft tissues.
62116.67164450502006.02.27+ [Tuberculous lesion of the spleen]Klin Khir
VI Bondarev, AA Orekhov,
62216.67106754602000.04.05++Evaluation of the intratumoral vasculature of hepatocellular carcinoma by power doppler sonography: advantages and disadvantages versus conventional color doppler sonography.Abdom Imaging
K Kubota, N Hisa, Y Fujiwara, M Fukumoto, D Yoshida, S Yoshida,
BACKGROUND: To determine whether a difference exists in the relative ability of power Doppler sonography and conventional color Doppler sonography to detect the intratumoral vasculature of hepatocellular carcinoma based on lesion size and location. METHODS: Sixty patients with 88 hepatocellular carcinoma lesions that showed tumor staining on angiography and were enhanced on dynamic computed tomography were evaluated. Power Doppler sonography and color Doppler sonography were used to detect the intratumoral vasculature, and their sensitivity to blood flow was evaluated. RESULTS: Power Doppler sonography showed a superior detection rate for lesions smaller than 2 cm and located 4-8 cm from the abdominal surface in the right hepatic lobe as compared with color Doppler sonography (p < 0.01). Neither power Doppler sonography nor color Doppler sonography depicted the intratumoral vasculature of lesions located more than 8 cm from the abdominal surface (n = 14). Both color Doppler imagings exhibited a low detection rate for lesions in the left hepatic lobe (n = 31, p < 0.01). CONCLUSIONS: Power Doppler sonography should be applied in the evaluation of small or intermediate depth lesions because it is more sensitive to these lesions than color Doppler sonography, but it is not useful for left lobe and deep lesions.
62316.6780614531994.09.20++MR imaging of soft-tissue masses: role of gadopentetate dimeglumine.J Magn Reson Imaging
RA Benedikt, JS Jelinek, MJ Kransdorf, RP Moser, BH Berrey,
To assess the effectiveness of gadopentetate dimeglumine in the magnetic resonance (MR) imaging evaluation of soft-tissue masses without osseous involvement, 30 patients underwent MR imaging before and after administration of contrast material (0.1 mmol/kg). Of the 30 lesions, 22 were benign and eight were malignant; histologic confirmation was available in all lesions except one benign lesion. Overall, enhancement was detected in 26 (87%) of 30 lesions: 18 (82%) of the 22 benign lesions and eight (100%) of eight malignant lesions. Enhancement was characterized as homogeneous (two [11%] benign lesions, two [25%] malignant lesions), inhomogeneous (11 [61%] benign lesions, six [75%] malignant lesions), or peripheral (five [28%] benign lesions, no malignant lesions). Of the 19 lesions assessed for a change in enhancement over time, seven (37%) showed an increase and two (11%) showed a decrease in signal intensity. The authors conclude that benign and malignant soft-tissue lesions could not be differentiated solely on the basis of enhancement (pattern, degree, or time course).
62416.6613024631992.07.21++Epithelioid hemangioendothelioma of the liver: imaging findings with pathologic correlation.AJR Am J Roentgenol
WJ Miller, GD Dodd, MP Federle, RL Baron,
Hepatic epithelioid hemangioendothelioma is a rare malignant neoplasm that has nonspecific clinical signs and symptoms and can be difficult to diagnose on the basis of biopsy results. Radiologists may suggest the diagnosis of this slowly progressive neoplasm by recognizing its characteristic radiologic features. We correlated images from CT (13), sonography (nine), and MR (six) with pathologic findings in resected whole livers (eight) and biopsy specimens (five) from 13 patients 25-58 years old. Gross pathologic examination showed a repetitive pattern of multiple solid tumor nodules, in a predominantly peripheral distribution, with coalescence as individual nodules exceeded 4 cm. Tumor nodules had a hyperemic rim. Lesions adjacent to the capsule often produced capsular retraction. These findings correlated well with imaging findings. On CT, the lesions were of low attenuation, peripherally based, and with capsular retraction or flattening in nine (69%) of 13 patients. Unenhanced CT scans showed superior conspicuity over contrast-enhanced CT scans (9/13, 69%) and showed the extent of lesions more accurately in all cases (13/13, 100%). In nine patients, lesions had a peripheral enhancement pattern of alternating attenuation values correlating with the hyperemic rim at pathologic evaluation. On sonograms, the tumors were solid and predominantly hypoechoic. On MR, tumor signal was low on T1-weighted and high on T2-weighted images, with a low-signal halo present around many of the lesions. CT, sonographic, or MR findings of coalescent peripheral hepatic masses with capsular retraction are highly suggestive of hepatic epithelioid hemangioendothelioma.
62516.6418893521991.10.16++[Splenic cysts. Their morphology, diagnosis and therapy]Dtsch Med Wochenschr
MK Walz, KA Metz, FW Eigler,
Over a 10-year period, nine patients (four men, five women, mean age 27 years) underwent surgery for splenic cysts (six epidermoid cysts, two mesothelial cysts and one pseudocyst). Six patients had had suggestive clinical symptoms, but, in the other three, the cysts were only discovered by chance on ultrasound scan. Three of the patients with epidermoid cysts had raised serum concentrations of the tumour markers carcinoembryonic antigen (CEA) or carbohydrate antigen (CA 19-9. All six benign epidermoid cysts contained immunohistochemically demonstrable CEA and/or CA 19-9 in the inner epithelial layer, implying a mesothelial origin for these cysts. In five cases the splenic cysts were completely extirpated (splenectomy in two, hemisplenectomy in one, enucleation in two); in four cases cyst resection was performed, leaving part of the cyst adherent to the spleen. In one of these four patients, a 4 cm cyst persisted postoperatively in the hilus of the spleen, but has remained unchanged over an 8-year period. Splenic cysts are usually benign, despite the presence of tumour markers in the cyst wall, and do not require removal. The only indications for surgical intervention are complications (e.g. rupture), symptomatic cysts or asymptomatic cysts with an increased risk of rupture (diameter greater than 5 cm). The very rare parasitic and infective forms must always be surgically sterilized.
62616.64124833872003.04.22++Portal vein aneurysm of the umbilical portion: imaging features and the relationship with portal vein anomalies.Abdom Imaging
DM Yang, MH Yoon, HS Kim, W Jin, HY Hwang, SW Cho, HS Kim,
BACKGROUND: We evaluated the imaging features of portal vein aneurysm occurring at the umbilical portion and the relation between portal vein aneurysm of the umbilical portion and portal vein anomaly. METHODS: Retrograde analysis was performed in 18 patients with portal vein aneurysm of the umbilical portion of the portal vein. We analyzed the size, shape, and imaging findings of portal vein aneurysm. In addition, we evaluated associated portal vein anomalies, specifically, the branching pattern of the intrahepatic portal vein and the position of the umbilical portion of the left portal vein. RESULTS: The diameter of the portal vein aneurysm ranged from 1.5 to 2.2 cm and the shape of the portal vein aneurysm was saccular (n = 14) or fusiform (n = 4). Imaging findings of the portal vein aneurysm of the umbilical portion were typical for its vascular nature. Portal vein anomalies were seen in eight of 18 patients (44%): the right anterior segmental portal vein (n = 7) or the right anterior and posterior segmental portal veins (n = 1) originating from the umbilical portion of the left portal vein and a rightward deviation of the umbilical portion of the left portal vein (n = 4). CONCLUSION: Due to its vascular nature, noninvasive diagnostic modalities can enable the detection of portal vein aneurysm of the umbilical portion, and there is a close relation between portal vein aneurysm of the umbilical portion and portal vein anomaly.
62716.6117297841992.02.13++Visceral metastases from melanoma: findings on MR imaging.AJR Am J Roentgenol
A Premkumar, L Sanders, F Marincola, I Feuerstein, R Concepcion, D Schwartzentruber,
Typical ocular and CNS melanomas are hyperintense on T1-weighted MR images and hypointense on T2-weighted MR images. We performed MR imaging in 48 patients with melanoma metastatic to visceral organs. Images were reviewed retrospectively in order to determine whether there were predominant MR features specific for visceral melanoma and to see if visceral metastases have MR characteristics similar to metastases in the CNS. Eleven patients also were examined after injection of gadopentetate dimeglumine to evaluate the enhancement characteristics of these tumors. Two hundred sixty-one lesions were found. Lesions were classified according to their signal intensities relative to uninvolved liver on T1-weighted, T2-weighted, and short TI inversion recovery (STIR) pulse sequences. Most commonly, lesions were either hypointense or isointense on T1-weighted sequences and hyperintense on T2-weighted and STIR sequences (185 lesions). Less frequently, lesions were hyperintense on T1-weighted sequences and hypointense or isointense on T2-weighted and STIR sequences (59 lesions). A mixed pattern was seen on T1- and T2-weighted sequences in 17 lesions. The patterns did not correlate with lesion size. Of the three sequences studied by subjective comparison, the STIR sequence in our series had the highest sensitivity for lesion detection and yielded the highest lesion conspicuity. Injection of gadopentetate dimeglumine in 11 patients did not increase either the number or the conspicuity of lesions seen. Our results show that visceral metastases from melanoma have a wide variety of appearances on MR images. The STIR sequence appears to be optimal, and the metastases do not enhance with gadopentetate dimeglumine.
62816.6035109341986.03.10++Clinical significance of focal echogenic liver lesions.Gastrointest Radiol
JH Pen, PA Pelckmans, YM van Maercke, HR Degryse, AM de Schepper,
During a 4-year period, 53 focal echogenic liver lesions were demonstrated by sonography in 41 patients, in whom there was no evidence of metastatic origin. Most of the lesions were hemangiomas. One of the purposes of this study was to determine the characteristic ultrasound features for liver hemangioma. Small (less than 2 cm), homogeneous, echogenic, well-circumscribed, subcapsular lesions almost prove their hemangiomatous nature. Lesions with a diameter of more than 2 cm are usually more lobulated and heterogeneous. They are located more centrally in the liver and nearly all show a close anatomical relation with 1 of the hepatic veins. Very large lesions (greater than 5 cm) with a heterogeneous and irregular aspect suggest focal nodular hyperplasia, which must be proven by a Tc-isotopic liver scan.
62916.59128815832003.09.25++Focal hepatic lesions: detection and characterization with combination gadolinium- and superparamagnetic iron oxide-enhanced MR imaging.Radiology
MJ Kim, JH Kim, JJ Chung, MS Park, JS Lim, YT Oh,
PURPOSE: To compare gadolinium- and superparamagnetic iron oxide (SPIO)-enhanced magnetic resonance (MR) imaging for detection and characterization of focal hepatic lesions when different contrast agent administration sequences are used. MATERIALS AND METHODS: Unenhanced, dynamic gadolinium-enhanced, and SPIO-enhanced hepatic MR images were obtained in 134 patients. SPIO-enhanced MR imaging was performed immediately after gadolinium-enhanced dynamic MR imaging in 50 patients, 1 day after gadolinium-enhanced dynamic MR imaging in 40 patients, and before gadolinium-enhanced dynamic MR imaging in 44 patients. Two radiologists independently reviewed the gadolinium image set (unenhanced and gadolinium-enhanced dynamic MR images) and the SPIO image set (unenhanced and SPIO-enhanced MR images) in random order. Lesion detection sensitivity and lesion characterization accuracy were compared by analyzing the area under the receiver operating characteristic curve (Az). RESULTS: Overall lesion detection accuracy for pooled data was significantly higher with the SPIO set (Az = 0.903) than with the gadolinium set (Az = 0.857) (P <.05). When hypovascular lesions were excluded, the detection rate was similar with the two sets. When hepatocellular carcinomas were excluded, the detection rate was significantly higher with the SPIO set (P <.01). Readers were more accurate in differentiating benign from malignant lesions with the gadolinium set (Az = 0.915) than with the SPIO set (Az = 0.847) (P <.01). Detection accuracy tended to be better with the images obtained after the second contrast agent was used. CONCLUSION: Hypovascular lesion detection was better with SPIO-enhanced MR images than with gadolinium-enhanced MR images. Detection and characterization of hypervascular lesions were improved with gadolinium-enhanced MR images.
63016.5877669781995.07.05++Adrenocortical carcinoma: MR imaging appearance with current techniques.J Magn Reson Imaging
JF Schlund, PJ Kenney, ED Brown, SM Ascher, JJ Brown, RC Semelka,
The purpose of the study was to define the magnetic resonance (MR) imaging appearance of adrenocortical carcinoma (ACC) with current MR techniques. Eight patients with ACC underwent high-field-strength MR imaging with the following sequences: axial T1-weighted gradient echo, fat-suppressed T1-weighted spin echo, fat-suppressed T2-weighted spin echo, and gadolinium-enhanced T1-weighted gradient echo and fat-suppressed T1-weighted spin echo. Postcontrast images were also acquired in the sagittal (six patients) and coronal (three patients) planes. Out-of-phase gradient-echo images were obtained in two patients. Lesion morphology, signal intensity features, and presence of metastatic disease were retrospectively evaluated. MR imaging features of ACC included internal hemorrhage (seven of eight patients), central necrosis (seven of eight), and peripheral enhancing nodules (seven of eight). Out-of-phase images in two of two patients demonstrated signal loss compared with in-phase images, which may be a common feature of these tumors. Liver metastases were present in four patients. Consistent MR features of ACC are identified.
63116.5711224941975.06.29++Hypersplenism in advanced breast cancer: report of a patient treated with splenectomy.Cancer
MA Dunn, MI Goldwein,
A patient with widespread metastatic breast cancer had thrombocytopenia and severe anemia due to splenic hyperfunction, confirmed by chromium51-labeled red cell survival and sequestration studies. Marked splenic enlargement was produced by metastatic tumor. After she failed to respond to steroids, her hematologic status was improved by splenectomy, and has been stable for 16 months. Hypersplenism may be suspected as a cause of severe hemolytic anemia in advanced carcinoma. If the patient's general status is otherwise compatible with long comfortable survival, appropriate diagnostic studies and consideration of splenectomy are warranted.
63216.56121953082003.03.04++Mesenteric mass in a young girl--an unusual site for Gaucher's disease.Pediatr Radiol
AK Lim, A Vellodi, K McHugh,
We report the first case of a child with Gaucher's disease and a large mesenteric mass, confirmed histologically to be Gaucher's cell infiltrates. We describe the radiological findings and discuss further management. The advent of enzyme replacement therapy has prolonged survival and the emergence of previously undocumented manifestations of the disease is being observed. The radiologist and clinician should be alert to the possible development of these new problems and the fact that in Gaucher's disease a palpable right upper-quadrant mass need not necessarily represent hepatomegaly.
63316.55169993192006.10.31++CT and MR imaging of gastrointestinal tuberculosis.JBR-BTR
AI De Backer, KJ Mortelé, BL De Keulenaer, L Henckaerts, L Verhaert,
The purpose of this study was to describe the CT and MR imaging findings of tuberculosis of the gastrointestinal tract. Abdominal and pelvic CT scans and MRI studies of 6 patients with histopathological and microbiological proven intestinal tuberculosis were reviewed by two radiologists in consensus. Location and pattern of bowel wall involvement, signal intensities in relation to the normal bowel wall, pattern of enhancement and associated abdominal abnormalities were evaluated. Gastrointestinal tract tuberculosis may be limited to one bowel segment, with the cecum and ileocecal valve as the predominant site of disease, or may involve multiple bowel segments. Asymmetric thickening of the bowel wall is a common finding. Associated findings include pericecal and mesenteric fat stranding, regional lymphadenopathy showing peripheral, heterogeneous and/or homogeneous enhancement patterns and less commonly, tuberculous 'dry plastic' peritonitis. On magnetic resonance (MR) imaging, tuberculous bowel involvement results in intermediate decreased signal intensities on T1-weighted images, and intermediate increased, slight heterogeneous signal intensities on T2-weighted images. On contrast-enhanced images, slight heterogeneous enhancement is seen.
63416.5464952181984.12.20++[Semeiotics of abdominal tuberculosis]Ter Arkh
GK Guseĭnov, AM Ramazanova, AG Guseĭnov,
Examination of 119 patients with abdominal tuberculosis permitted the description of the characteristic semiotics of the illness. Today the patients with abdominal tuberculosis are mainly women of child-bearing age with a long-term tuberculosis catamnesis and intoxication, with a history of tuberculosis of different sites, those suffering from tuberculosis or its sequels at present (64%), those with pains (94%), discomfort or swelling of the abdomen (79%), malfunction of the gastrointestinal tract (65%), weight loss (86%), malnutrition (72%), anemia (63%), not infrequently with inflammatory induration (43%) or ascites in the abdominal cavity (39%). In addition to this characteristic semiotics, the patients with abdominal tuberculosis may demonstrate the most different and unexpected symptoms up to acute abdomen (23%). To make differential diagnosis of abdominal tuberculosis, one has often to resort to diagnostic laparotomy, laparoscopy, Koch's test and to trial therapy.
63516.5369813131982.10.12+ Deceptions in localizing extrahepatic right-upper-quadrant abdominal masses by CT.AJR Am J Roentgenol
MP Frick, SB Feinberg,
63616.5399221931999.03.03++CT of agenesis and atrophy of the right hepatic lobe.Abdom Imaging
CK Chou, CW Mak, MB Lin, WS Tzeng, JM Chang,
BACKGROUND: To identify and differentiate agenesis and severe atrophy of the right hepatic lobe on computed tomography (CT). METHODS: The CT examinations of three cases of agenesis and 11 cases of severe atrophy of the right hepatic lobe were reviewed. We evaluated visibility of the three hepatic veins, the two main portal veins (including their branches if necessary), the dilated intrahepatic ducts, enlargement of the medial and lateral segments of the left lobe and caudate lobe of the liver, presence of a retrohepatic gallbladder, hyperattenuation of the atrophic liver parenchyma, posterolateral interposition of the hepatic flexure of the colon, and upward migration of the right kidney. RESULTS: In the three cases of agenesis, no structure can be recognized as the right hepatic vein, right portal vein, or dilated right intrahepatic ducts. In the 11 cases of severe lobar atrophy, the right portal vein (or its branches) was recognized in eight cases, the right hepatic vein in four cases, and the dilated right intrahepatic ducts in 11 cases. The degree of enlargement of the lateral segment does not necessarily change inversely with the size of the medial segment and the caudate lobe. The retrohepatic gallbladder is present in eight cases (two in agenesis and six in atrophy). The phenomenon of hyperattenuation of the atrophic liver parenchyma was noted in six cases. CONCLUSION: Even though a retrohepatic gallbladder and a severely distorted hepatic morphology due to compensatory hypertrophy of the left and caudate lobes may raise a suspicion of agenesis of the right lobe of the liver, absence of visualization of all of the right hepatic vein, right portal vein and its branches, and dilated right intrahepatic ducts is a prerequisite of the diagnosis of agenesis of the right hepatic lobe on CT. In severe lobar atrophy, at least one of these structures is recognizable.
63716.5016330421992.08.25++Gd-DTPA-enhanced MR imaging of pituitary macroadenomas.Acta Radiol
P Lundin, K Bergström,
In a study comprising 40 patients with pituitary macroadenomas, MR imaging was performed before and after administration of Gd-DTPA. Before contrast administration T1- and T2-weighted images were obtained, and after the injection, frontal and/or sagittal T1-weighted images. Tumour extension and delineation, relationship to adjacent structures, and signal intensity patterns were evaluated. Compared with pre-contrast T1-weighted images only, post-contrast images provided considerable additional information, but not infrequently this information could also be extracted from pre-contrast T2-weighted images. Post-contrast images were superior regarding the tumour relationship to the cavernous sinus and to the normal pituitary tissue. T2-weighted images were helpful in the diagnosis of degenerative changes, in particular intratumoural haemorrhage. A positive correlation was found between the T2 value (from dual echo sequences) and the degree of enhancement in areas with an appearance of solid tumour tissue, and the enhancement was significantly lower in GH-secreting tumours than in non-secreting ones. It is concluded that the use of Gd-DTPA is often justified in pituitary macroadenomas, particularly in pre-operative evaluation.
63816.4983312311993.08.13++MRI of primary lymphoma of the liver.J Comput Assist Tomogr
T Fukuya, H Honda, S Murata, K Yasumori, T Hayashi, H Ishibashi, T Matsumata, K Masuda,
OBJECTIVE: The MR findings in two cases of primary lymphoma of the liver (PLL) are presented. MATERIALS AND METHODS: MR of two cases of primary lymphoma of the liver were reviewed and its features were estimated. RESULTS: Both cases showed a solitary large liver mass. On T1-weighted imaging the tumor was isointense in one and homogeneously hypointense to the liver parenchyma in the other. On T2-weighted imaging both tumors were homogeneously hyperintense. In one case the margin of the tumor was poorly defined, and portal branches were identified within the tumor, an unusual finding in other liver neoplasms. CONCLUSION: In patients with liver masses with homogeneous intensity on MR but without liver dysfunction and other malignancies, PLL should be included in the differential diagnosis.
63916.4817466801992.01.16++Sinusoidal hemangioma. A distinctive benign vascular neoplasm within the group of cavernous hemangiomas.Am J Surg Pathol
E Calonje, CD Fletcher,
Twelve cases of sinusoidal hemangioma, a distinctive subset of the group of lesions known as cavernous hemangioma, are described. All presented as solitary subcutaneous/deep dermal lesions in adults, predominantly females. Five arose on a limb and five on the trunk; two of the latter were situated in mammary subcutaneous tissue. Histologically they were characterized by dilated, interconnecting, thin-walled vascular channels that frequently showed a pseudopapillary pattern. These vessels had a predominantly lobular architecture but peripherally showed focally ill-defined spread into subcutaneous tissue. The lining endothelium was single-layered but showed focal pleomorphism and hyperchromasia, which, combined with the pseudopapillae and apparent infiltrative pattern in areas, raised the possibility of angiosarcoma in four cases, most notably in the breast lesions. This possibility was further suggested by the presence of pseudonecrotic central infarction in two cases. Follow-up in eight cases, however, has revealed no tendency for either local recurrence or metastasis.
64016.4569799111982.08.26+ CT of hepatic focal nodular hyperplasia.AJR Am J Roentgenol
WA Halbsguth,
64116.4385080751993.07.14++Contrast enhancement of the gastrointestinal tract on MR images using intravenous gadolinium-DTPA.Abdom Imaging
SA Mirowitz,
Gadopentetate dimeglumine was administered intravenously to 16 patients undergoing abdominal magnetic resonance (MR) imaging. T1-weighted and fat-suppressed T1-weighted images were acquired before and after intravenous administration of 0.1 mmol/kg gadopentetate dimeglumine. The stomach, small bowel, and colon were analyzed regarding the presence and relative intensity of contrast enhancement. Diffuse enhancement of the gastrointestinal tract wall was observed in all patients following contrast material administration. Such enhancement was most conspicuous on fat-suppressed T1-weighted images. Quantitative measurements indicated that the wall of the gastrointestinal tract enhanced approximately 100% with gadopentetate dimeglumine. This study demonstrates that enhancement of the normal gastrointestinal tract occurs routinely when intravenous gadopentetate dimeglumine is administered, and such enhancement should not be considered indicative of gastrointestinal pathology. Furthermore, it suggests the potential utility for using intravenous rather than orally administered contrast agents to provide enhancement of the gastrointestinal tract on MR images.
64216.4285539521996.02.22++Ring enhancement in ultrasmall superparamagnetic iron oxide MR imaging: a potential new sign for characterization of liver lesions.AJR Am J Roentgenol
PJ Mergo, T Helmberger, AI Nicolas, PR Ros,
OBJECTIVE: We performed this study to evaluate the incidence and significance of ring enhancement after i.v. administration of an ultrasmall superparamagnetic iron oxide (USPIO) particle (Code 7227), a reticuloendothelial contrast agent with potential use as a blood-pool agent, for characterizing focal hepatic lesions. SUBJECTS AND METHODS: Conventional T1-weighed imaging, fat-suppressed T1-weighted imaging, conventional T2-weighted imaging, and fast T2-weighted imaging of the liver were obtained in 27 patients with 43 liver lesions before and after i.v. administration of a USPIO preparation. All lesions were larger than 1 cm; 29 were malignant and 14 were benign. Diagnosis was confirmed in all cases, either pathologically (19 patients) or by follow-up examination (eight patients). Two readers independently evaluated each pulse sequence for the presence of ring enhancement of hepatic lesions. RESULTS: Ring enhancement was noted only on T1-weighted images, with no ring enhancement evident on T2-weighted images. Twenty of 43 (47%) lesions showed ring enhancement, including 18 of 29 (62%) malignant lesions and two of 14 (14%) benign lesions (p < .011); Wilcoxon signed rank test). Fat-suppressed T1-weighted imaging showed ring enhancement better than or equal to conventional T1-weighted imaging in all cases, with ring enhancement of 15 of 18 (83%) malignant lesions and two of two benign lesions better demonstrated on fat-suppressed T1-weighted imaging sequences (p < or = .025). CONCLUSION: Ring enhancement after i.v. administration of Code 7227 is a frequent finding seen more often with malignant than benign lesions, potentially identifying a new MR imaging feature for the characterization of liver lesions. The identification of ring enhancement on T1-weighted images attests to the significant blood-pool effects of USPIO particles.
64316.41170490032006.11.30+ [Metachronous splenic metastasis from colon cancer. An infrequent case]Rev Esp Enferm Dig
L Lobato, J Pérez-Lara, FJ Moreno, H Oliva,
64416.4180755581994.10.06++Leiomyosarcoma of abdominal veins: value of MRI with gadolinium DTPA.Abdom Imaging
KM Cyran, PJ Kenney,
Primary leiomyosarcomas of the retroperitoneum are rare tumors, the vast majority of which are malignant. Prognosis is largely dependent upon adequacy of surgical resection. Magnetic resonance imaging (MRI) is ideally suited to the evaluation of these neoplasms because of multiplanar imaging capability, inherent signal intensity differences of tissues, and flow-void, flow enhancement techniques to assess vessel patency. Recent advances which include fat suppression, suspended respiration sequences, and Gadolinium enhancement, have further improved image quality. Accurate pre-operative assessment of tumors is possible with MRI.
64516.3978908561995.04.20++Primary thyroid lymphoma: evaluation with US, CT, and MRI.J Comput Assist Tomogr
S Takashima, N Nomura, Y Noguchi, F Matsuzuka, T Inoue,
OBJECTIVE: Our goal was to determine the most effective radiologic workup in diagnosing and staging primary thyroid lymphomas and the value of knowing the extent of tumors for prognostic purposes. MATERIALS AND METHODS: Magnetic resonance imaging, CT, US, and fine-needle aspiration (FNA) biopsy (palpation- or US-guided) findings were retrospectively reviewed in 14 patients with primary thyroid lymphomas (5 palpable, 9 nonpalpable). Survival was correlated with the presence or absence of extrathyroidal spread of lymphoma. RESULTS: Thyroid lymphomas were detected in all patients with US and 12 (86%) each with CT and MRI. Histopathologic diagnosis was obtained with FNA in 11 patients (79%) and with surgical procedures in 3. Magnetic resonance imaging correctly diagnosed tumor involvement of the lymph nodes (four of four patients), muscle (five of five), esophagus (one of one), internal jugular vein (one of one), and carotid artery (one of one). Muscle invasion was missed with CT in one patient. Ultrasound was not accurate for diagnosing tumor invasion of the esophagus, carotid artery, and lymph nodes. The survival of patients without extrathyroidal spread was significantly (p < 0.05) better than that of patients (n = 5) with extrathyroidal spread. CONCLUSION: Palpable thyroid masses should undergo palpation-guided FNA for diagnosis and nonpalpable masses US-guided FNA. Tumor extent and staging should be determined with MRI, which will contribute to initiating appropriate therapy and prediction of prognosis.
64616.3920279761991.06.13++Intraarterial portography with gadopentetate dimeglumine: improved liver-to-lesion contrast in MR imaging.Radiology
P Pavone, S Giuliani, G Cardone, R Occhiato, P Di Renzi, GA Petroni, C Buoni, R Passariello,
Magnetic resonance imaging during arterial portography (MRAP) was performed by the authors in a selected group of 12 patients with hepatic lesions. A low dose of gadopentetate dimeglumine (4 mL of a 0.5-mol/L solution, corresponding to a dose of 0.05-0.07 mmol/kg) was injected into the superior mesenteric artery during acquisition of breath-holding gradient-echo or rapid acquisition spin-echo images. Images were always acquired during the first passage of gadopentetate dimeglumine through the liver parenchyma. An increase in liver-to-lesion contrast was obtained with MRAP imaging (contrast-to-noise ratio = 8 +/- 1.8 vs 19 +/- 2.7). Signal intensity enhancement of the liver was high (signal-to-noise ratio = 9.48 +/- 2.42), while the lesion presented no significant enhancement (signal-to-noise ratio = 0.55 +/- 0.22). Lobar portal vein thrombosis was detected in one patient owing to lack of enhancement of the left lobe of the liver. No side effects related to administration of iodinated and paramagnetic contrast agents were observed. This new technique provides specific enhancement of liver parenchyma with improved liver-to-lesion contrast.
64716.38157006562005.05.06++[Differential diagnosis of intra- and perilienal tumors by use of a RES-specific MRI contrast agent]Rontgenpraxis
G Gaffke, C Stroszczynski, M Gnauck, D Jost, P Chmelik, WD Ludwig, S Gretschel, R Felix,
PURPOSE: To describe the additional benefit in detection and differential diagnosis of peri- and intrasplenic tumors by use of an superparamagnetic iron oxide contrast agent (SPIO). MATERIALS AND METHODS: We represent 7 patients with known malignant tumors. Aim of the examination was the detection and characterisation of intra- or perisplenic tumors. We performed T2w TSE breath triggered sequences before and 10 min after application of SPIO and T1w Flash 2D GRE sequences before and after SPIO and Gadopentetate dimeglumin application. All images were presented to two radiologists, who were asked to asses the presence and characterisation of tumors by using a five-point confidence scale. RESULTS: In two patient intrasplenic hemangiomas were detected, intrasplenic lymphoma, metastasis was excluded, respectively. In two patients perisplenic tumors were diagnosed as gastrointestinal stroma tumors, confirmed by biopsy. In two patients accessory spleens were identified and lymph node metastasis excluded. In one patient an intrasplenic cyst was diagnosed. SPIO enhanced T2w images and Gadopentetate dimeglumin enhanced T1w sequences were evaluated as superior. CONCLUSION: The examination of the spleen by use of superparamagnetic iron oxides offers additional abilities in depiction and charaterisation of intra- and perisplenic tumors in first experiences. First clinical observations indicate that a combination of SPIO enhanced T2w sequences and Gadopentetate dimeglumin enhanced T1w dynamic sequences might be superior to other sequences in detection and characterisation of splenic tumors.
64816.3893408071997.10.23+ [Diagnosis and therapy of splenic abscess exemplified by 3 unusual cases]Rontgenpraxis
H Riediger, WD Schareck, F Pfeffer, KW Sievers, UT Hopt,
64916.3778225551995.02.10++Torsion of the wandering spleen: CT and angiographic appearance.J Comput Assist Tomogr
T Fujiwara, Y Takehara, H Isoda, K Ichijo, N Tooyama, N Kodaira, H Kitanaka, T Asai, K Kawaguchi,
OBJECTIVE: To seek CT and angiographic appearances that characterize torsion of the wandering spleen. MATERIALS AND METHODS: The CT and angiographic findings of two cases of preoperatively diagnosed torsion of the wandering spleen were reviewed, and the findings were closely compared with intraoperative and histopathological findings. RESULTS: Characteristic CT appearance seemed to be a whirled appearance formed at the medial side of the displaced spleen. The angiographic finding that was characteristic of the disease was a tapered and abruptly twisted distal splenic artery. CONCLUSION: These findings were useful in making the early and correct diagnosis of this rare but fulminant condition.
65016.36163174892006.07.18++Torsion of an accessory spleen.Abdom Imaging
R Grinbaum, O Zamir, S Fields, N Hiller,
Torsion of an accessory spleen is extremely rare. We report a case of an acute torsion of an accessory spleen in a young patient who presented with acute left abdominal pain and discuss the computed tomographic findings of this exceptional condition. Awareness of this entity and familiarity with typical imaging findings are mandatory for preoperative diagnosis.
65116.36188520872008.11.14++Small liver lesions in oncologic patients: characterization with CT, MRI and contrast-enhanced US.Cancer Imaging
G Morana, C Cugini, RP Mucelli,
Focal liver lesions (FLLs) are frequently discovered during ultrasound examinations either in healthy subjects without a clinical history of cancer or during staging or follow-up procedures in oncologic patients or in routine surveillance of hepatopathic patients. In oncologic patients, the liver is the most common target of metastatic disease and accurate detection and characterisation of FLLs is prognostically fundamental during the initial staging as well as before and after pre-operative chemotherapy, as it can help to identify patients who are most likely to benefit from liver surgery. Moreover, early detection of primary or secondary liver malignancies increases the possibility of curative surgical resection or successful percutaneous ablation. As many FLLs in these patients are benign, a precise and preferably non-invasive method of differentiation from malignant metastatic nodules is needed. Moreover, the continuous follow-up of cancer patients requires an easily available, reliable and cost-effective diagnostic tool for the detection and characterization of FLLs.
65216.3582103811993.11.18+ Diagnosis of low-grade chondrosarcoma.Radiology
JR Crim, LL Seeger,
65316.3484547631993.04.19++Gadolinium enhancement in the center of a spinal epidural hematoma in a hemophiliac.J Comput Assist Tomogr
KS Caldemeyer, R Mocharla, CC Moran, RR Smith,
Spinal epidural hematoma (SEH) is an uncommon complication of hemophilia. It is a neurologic and neurosurgical emergency and prompt diagnosis is imperative. The utility of MRI in the diagnosis of hemorrhage is well established. We present a case of an SEH in a hemophiliac patient that demonstrated gadolinium enhancement.
65416.3392075251997.09.18++High-resolution MR imaging of the anal sphincter in children: a pilot study using endoanal receiver coils.AJR Am J Roentgenol
NM deSouza, DJ Gilderdale, DK MacIver, HC Ward,
OBJECTIVE: The purpose of this study was to obtain high-resolution MR images of the various components of the anal sphincter complex in children who have anorectal disorders. We therefore used dedicated endoanal receiver coils for MR imaging. CONCLUSION: Our pilot study suggested that MR imaging that uses a dedicated endoanal coil may have considerable diagnostic potential in children who have anorectal disorders.
65516.32113234722001.05.17++Liver lesion conspicuity: T2-weighted breath-hold fast spin-echo MR imaging before and after gadolinium enhancement--initial experience.Radiology
YY Jeong, DG Mitchell, GA Holland,
PURPOSE: To evaluate the effect of a gadolinium chelate on T2-weighted breath-hold fast spin-echo magnetic resonance images of focal hepatic lesions. MATERIALS AND METHODS: In 21 patients with focal hepatic lesions, identical T2-weighted breath-hold fast spin-echo images were obtained before and after gadolinium enhancement and were compared regarding lesion-to-liver contrast-to-noise ratio, signal-to-noise ratio, lesion conspicuity, and vascular pulsation artifact. Image review was performed independently, in random order, by two experienced radiologists. RESULTS: For solid lesions, the lesion-to-liver contrast-to-noise ratio on enhanced images was significantly higher (P <.05) than that on nonenhanced images. For nonsolid lesions, however, there was no significant difference (P =.07). For both readers, lesion conspicuity for solid lesions on enhanced images was significantly higher than on nonenhanced images (P <.05). Severity of vascular pulsation artifact was not significantly different. CONCLUSION: Solid-lesion contrast on T2-weighted breath-hold fast spin-echo images improves after administration of a gadolinium chelate. These images should be obtained after, rather than before, gadolinium enhancement.
65616.316336551978.05.08+ [Splenic tumors: with special reference to radiological diagnosis. I. Cysts and benign tumors (author's transl)]Rinsho Hoshasen
T Kishikawa, K Matsuura, T Tokunaga, K Mihara, K Watanabe,
65716.30146288772003.12.23++Hepatic and splenic amyloidosis: dual-phase spiral CT findings.Abdom Imaging
PP Mainenti, L D'Agostino, E Soscia, M Romano, M Salvatore,
Although the liver and spleen are frequently involved in primary systemic amyloidosis, the clinical manifestations of hepatic and splenic involvement are usually mild and a dominant symptomatic hepatic presentation is uncommon. We report a case of a 51-year-old woman with giant hepatomegaly, hypertransaminasemia, increase in alkaline phosphatase, and ascites, in whom the findings of dual-phase spiral computed tomography suggested liver and splenic amyloidosis.
65816.2980419351994.08.24++[Splenic abscesses. Their percutaneous treatment and the role of the interventional radiologist]Radiol Med
D Gasparini, PT Basadonna, A Di Donna,
Percutaneous abscess drainage is not as common in the spleen as in other anatomical sites, probably because of an uncontrollable fear of bleeding. Five cases of intrasplenic abscess drainage are presented. A double-way 12/14-F vanSonnenberg catheter was percutaneously inserted under CT guidance in four patients and under US guidance in one patient. Orthogonal scout CT views were useful to check the correct positioning of the drainage. In three patients the maneuver was successful, with no recurrence at follow-up at 12, 16 and 24 months, respectively. In one patient with a splenic abscess due to iatrogenic ischemic necrosis, the drainage allowed delayed surgery after relief of symptoms. Another patient died of sepsis five days after multiple well-functioning drainages. No early or late complications occurred. Bleeding was never observed in our series and there are no recent literature reports on this complication. Whenever it occurs, bleeding can be treated with selective embolization. In our experience, the percutaneous drainage of splenic abscesses, performed by the radiologist, should be considered the treatment of choice in these cases.
65916.2876178641995.08.23++Hepatic MR imaging with ferumoxides: a multicenter clinical trial of the safety and efficacy in the detection of focal hepatic lesions.Radiology
PR Ros, PC Freeny, SE Harms, SE Seltzer, PL Davis, TW Chan, AE Stillman, LR Muroff, VM Runge, MA Nissenbaum,
PURPOSE: To assess the safety and diagnostic efficacy of intravenous ferumoxides, a superparamagnetic iron oxide, for depiction of focal hepatic lesions on magnetic resonance (MR) images. MATERIALS AND METHODS: This open-label study included 208 patients with known or suspected focal hepatic lesions. MR images were obtained before and 45 minutes to 4 hours after intravenous infusion of ferumoxides (10 mumol/kg). The effect of ferumoxides on signal intensity of the liver was assessed with quantitative analysis. Safety was evaluated with patient monitoring and laboratory measurements. RESULTS: Mean lesion-to-liver contrast-to-noise ratio on T2-weighted images was 9.1 on unenhanced images and 12.7 on enhanced images. Signal intensity of normal liver on enhanced images decreased to 37% of that on unenhanced images. In blinded image evaluations, additional lesions were identified on 27% of enhanced images. No serious adverse events occurred. CONCLUSION: Ferumoxides is a safe and efficacious contrast agent for the detection of focal liver lesions on T2-weighted images.
66016.2815474741992.04.20++CT manifestations of infectious mononucleosis.Clin Imaging
AJ Garten, DS Mendelson, KP Halton,
A case of infectious mononucleosis (IM) which, on computed tomography (CT) scan, mimicked the morphologic features of lymphoma is reported. The CT findings in this case include generalized lymphadenopathy, splenomegaly, and focal low-attenuation splenic lesions in a fifty-three year old woman; these findings have not previously been described in patients with IM. This is most likely because IM is usually a clinical diagnosis confirmed by serologic testing. Imaging modalities such as CT scan have not routinely been utilized to support this diagnosis.
66116.2689646771996.12.04+ [Splenomegaly and portal hypertension of unusual etiology in a 62-year-old patient]Internist (Berl)
J Zahner, H Fischer, F Borchard, U Germing, W Schneider,
66216.2586729711996.08.15++Small hepatocellular carcinoma: differentiation from adenomatous hyperplasia with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging.Abdom Imaging
R Lencioni, M Mascalchi, D Caramella, C Bartolozzi,
BACKGROUND: To investigate the usefulness of color Doppler ultrasound (US) and dynamic Gd-DTPA-enhanced magnetic resonance (MR) imaging in the differentiation of small hepatocellular carcinoma (HCC) and adenomatous hyperplasia (AH). METHODS: Thirty-eight small (3 cm or less) nodular lesions (in 38 cirrhotic patients) with US features consistent with HCC underwent evaluation with color Doppler US and MR imaging. Breath-hold T1-weighted rapid acquisition spin echo MR sequence after bolus injection of 0.1 mmol/kg gadopentetate dimeglumine was used to evaluate dynamic enhancement. US-guided tissue-core percutaneous biopsy established the diagnosis: HCC in 28 cases and AH in 10. RESULTS: Color signals with pulsatile or continuous Doppler spectrum were demonstrated in 19 of 28 HCCs (68%) but in none of the AHs. Although there was considerable overlap in signal intensity between HCC and AH on both unenhanced T1- and T2-weighted images, early enhancement on breath-hold T1-weighted images obtained 40 s after starting contrast administration was observed in 22 of 28 HCCs (79%) but in none of the AHs. In 26 of 28 HCCs (93%), pulsatile or continuous flow at color Doppler US, early enhancement at dynamic MR imaging, or both were observed. CONCLUSION: Findings with color Doppler US and dynamic Gd-DTPA-enhanced MR imaging enable a reliable distinction between small HCC and AH.
66316.2551297561972.02.26+ Hamartoma of spleen associated with thrombocytopenia.J Pathol
CF Ross, KF Schiller,
66416.2487979231996.10.16++Ultrasound and MR findings in acute Budd-Chiari syndrome with histopathologic correlation.J Comput Assist Tomogr
TC Noone, RC Semelka, JT Woosley, ED Pisano,
This report describes the sonographic and MR appearances of acute Budd-Chiari syndrome (BCS) in a 30-year-old woman. Current imaging techniques including duplex Doppler sonography and dynamic gadolinium-enhanced MRI were employed, and direct histopathologic correlation was made. Duplex Doppler sonography revealed a heterogeneous enlarged liver, no flow in the left and middle hepatic veins, and only trace abnormal flow in the distal-most right hepatic vein. Dynamic serial gadolinium-enhanced, spoiled gradient echo imaging demonstrated early homogeneous enhancement of an enlarged caudate lobe, as well as heterogeneously decreased enhancement of the remainder of the hepatic parenchyma. This differential enhancement pattern persisted on delayed imaging. Patent hepatic veins were not demonstrated on any sequence. Associated findings included hepatomegaly, ascites, and patent portal vasculature. These imaging findings were interpreted as consistent with acute BCS. Within 10 days, the patient underwent orthotopic liver transplantation. Histopathology demonstrated hepatic necrosis and hepatic venous thrombosis consistent with acute BCS.
66516.24159692332005.07.11++[The place of MRI in the hepatic tumors]Tunis Med
N Mnif, T Ellouze, T Boubela, S Oueslati, R Hamza,
MRI semeiology of hepatic tumors was assessed with a retrospective study of 132 patients explored between May 1998 and December 2001. MR examinations were acquired with a one Tesla operating system. All images were acquired by a T2-weighted fast spin echo MR and dynamic flash MR with Gadolinium. Hemangiomas demonstrate characteristic signs in most cases, as was described in the literature. However, adenoma, hepatocellular carcinoma and metastases have various and less specific features.
66616.2390430431997.03.18++T2-weighted and dynamic enhanced MRI in acute pancreatitis: comparison with contrast enhanced CT.Clin Radiol
J Ward, AG Chalmers, AJ Guthrie, M Larvin, PJ Robinson,
The purpose of this study was to compare T2-weighted and dynamic contrast enhanced MRI with contrast enhanced CT in patients with severe acute pancreatitis. Thirty-two patients were examined using axial T2-weighted spin-echo imaging (TR 1801, TE 15/90) and a multi-slice rapid gradient-echo sequence (TR 135, TE 4, FA 80 degrees) (FLASH) in axial and coronal planes. Fifteen 5 mm axial slices at 10 mm intervals were acquired during a single breath-hold of 19 s before, and at 10 and 40 s after a bolus injection of Gd-DTPA. Additional FLASH images in the coronal plane were obtained 2 min after injection of contrast medium. MR was compared with contemporary enhanced CT by two blinded observers who scored pancreatic viability and the content of intra and extra-pancreatic fluid collections. The presence of gas, calcification and haemorrhage was noted. Abnormalities in adjacent organs, evidence of vascular occlusion and indicators of aetiology were also recorded. MR and CT were concordant in distinguishing viable pancreatic tissue from areas of necrosis. MR appeared to be more effective than CT in characterizing the content of fluid collections and in demonstrating gall stones, although CT remains superior in detecting flecks of gas and calcification. MR carries some advantages over CT and can be regarded as an alternative primary technique in patients with severe pancreatitis.
66716.23104522481999.09.29++Dermoid cyst of the spleen: report of a case.Surg Today
A Nakao, S Saito, T Yamano, N Takakura, H Isozaki, K Notohara, N Tanaka,
A rare splenic dermoid cyst in an 11-year-old girl is reported herein. The patient was referred to us with the chief complaint of acute-onset abdominal pain. The lesion was demonstrated by ultrasonography, computed tomography, and magnetic resonance imaging to be a cystic lesion containing serous fluid. A splenectomy was performed. Both histopathological and immunohistochemical findings demonstrated the cyst to be a dermoid cyst of the spleen. To avoid the risk of infection following splenectomy, polyvalent pneumococcus vaccine was administered. The patient recovered uneventfully. We performed immunohistochemical studies with cytokeratin and electron microscopy to determine the origin of the cyst.
66816.2237550241986.07.22++Peliosis hepatis in the acquired immunodeficiency syndrome.Arch Pathol Lab Med
CA Czapar, CM Weldon-Linne, DM Moore, DP Rhone,
We report two cases of peliosis hepatis in patients with acquired immunodeficiency syndrome. Hepatic tissue, obtained by needle biopsy from one patient and at postmortem examination from a second patient, demonstrated lesions grossly and microscopically consistent with previous descriptions of peliosis. Peliotic lesions were also identified in the spleen and porta hepatis lymph nodes in the second case. In at least one of the cases, peliosis was thought to play a significant role in the patient's morbidity and ultimate demise. Peliosis hepatis should be included in the differential diagnosis of hepatic disease among patients with acquired immunodeficiency syndrome.
66916.2295890941998.05.29++[Ultra-rapid T2-weighted MR imaging during suspended respiration for the examination of focal lesions of the liver: a comparison of TSE, HASTE and HASTE-STIR sequences using a CP body array coil]Rofo
G Brinkmann, I Musiolik, B Kühn, JC Steffens, F Wesner, J Graessner, C Muhle, M Heller,
PURPOSE: A comparison of ultra rapid T2-weighted HASTE and HASTE-STIR sequences during suspended respiration for the detection of focal lesions of the liver. MATERIAL AND METHODS: Twenty-one patients (59 +/- 12 years) with a total of 33 focal lesions (7 < or = 1 cm, 19 < or = 3 cm; 17 cystic liquid and 16 solid lesions) were examined with a 1.5 T MR apparatus. Sequences: T2 weighted HASTE (TEeff = 64 ms, 90 ms), HASTE-STIR (TEeff = 64 ms, 81 ms) TSE (TE = 132 ms) and T1-weighted FLASH 2D. RESULTS: The T2-weighted TSE and both HASTE sequences showed all the lesions. Two out of the 33 lesions were not demonstrated by the other sequences. Best image quality without movement artefacts and the best resolution of the lesions in the T2-weighted sequences, with the most favourable contrast/noise ratio (36.6 +/- 33.1) and signal/noise ratio (20.8 +/- 10.5) resulted from the HASTE 90, followed by the HASTE 64 sequence (27.5 +/- 24.2; 24.6 +/- 9.1). Both these techniques were superior to the TSE sequence (23.9 +/- 29.4; 13.9 +/- 7.4), which resulted in movement artifacts. With the HASTE-STIR sequences it was possible to show 31 and 32 of the 33 lesions respectively, with very good resolution but poor signal/noise ratio. CONCLUSION: HASTE sequences have the potential of improving the diagnosis of focal liver lesions.
67016.2014981001992.09.17++Splenic cysts in pediatric patients--a report on 8 cases and review of the literature.Eur J Pediatr Surg
PA Musy, B Roche, D Belli, P Bugmann, D Nussle, C Le Coultre,
8 cases of splenic cysts are reported: treatment was surgical in 4 large cysts (greater than 5 cm, 3 epidermoids and 1 pseudocyst), and non-operative in 4 small cysts (less than 5 cm, 3 post-traumatic pseudocysts and 1 congenital cyst, probably epidermoid). Follow-up was over a period of 3 months to 7 years. 3 among the 4 post-traumatic pseudocysts were followed up by ultrasound until resolution (3 months to 3 years), and 1 large pseudocyst was operated on due to rupture following benign trauma. 3 large cysts were epidermoid in origin, 1 was electively operated, and 2 were discovered and operated on because of complications (rupture, infection). Only one total splenectomy was performed; surgery preserved the spleen in all other cases; but 1 epidermoid cyst presents now with a recurrence. Based on this experience, we suggest frozen section of the cyst wall during surgery, to decide the type of partial splenectomy to be performed: total cystectomy or marsupialization.
67116.193915111980.03.24+ [Indications for splenectomy in children and adults]Chirurg
KP Hellriegel, M Gharib, D Helbig, R Gross,
67216.1777082411995.05.05++[Hemorrhagic pseudocyst of the spleen]Minerva Chir
A Coda, F Ferri, C Filippa, R Vella,
The authors report a rare case of haemorrhagic pseudocyst of the spleen in a 37 years old female who had always enjoyed very good health and who didn't remember any previous chest or abdominal traumas. Due to the initial refusal of the patient to undergo splenectomy, it has been possible to follow pathology progress. An echography of the cyst 6 months later, showed a maximum diameter increase of more than 2 cm and a further thinning of the cyst wall. Afterwards the patient decided to undergo the operation. The spleen showed a hollow of 10 cm of maximum diameter, with a degraded haematic content; the final histological examination confirmed the initial diagnosis of haemorrhagic pseudocyst of the spleen.
67316.16106441182000.01.28++Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US.Radiology
DM Leifer, WD Middleton, SA Teefey, CO Menias, JR Leahy,
PURPOSE: To determine the need for follow-up imaging in patients with a low risk of malignancy and with ultrasonographic (US) findings typical of hepatic hemangioma. MATERIALS AND METHODS: A computer search of US reports completed between 1991 and 1994 helped identify 383 patients whose reports contained the word "hemangioma." One hundred eleven patients were excluded because the lesion's appearance was atypical (n = 16) or because the patients had a high risk of malignancy (prior history or current evidence of extrahepatic malignancy or chronic hepatic disease [n = 95]). Fifty-nine patients were excluded because they were lost to follow-up (n = 41) or had clinical follow-up of less than 2 years (n = 18). The conditions of the remaining 213 patients with typical-appearing hemangiomas and a low risk of malignancy were analyzed. One hundred twenty-one patients underwent imaging follow-up or histopathologic confirmation. Ninety-two had clinical follow-up of more than 2 years (mean, 46 months). RESULTS: Of the 213 patients, four had benign lesions other than hemangiomas. One patient who subsequently developed a malignancy (neuroendocrine metastases from primary colonic carcinoma diagnosed 22 months after initial US) potentially had an early metastasis that was misdiagnosed as a hemangioma. CONCLUSION: On the basis of these results, the authors no longer recommend follow-up studies in their patients with a low risk of malignancy and a typical-appearing hemangioma at US.
67416.1525127921990.01.16++Tuberculous arachnoiditis of the spine: findings on myelography, CT, and MR imaging.AJNR Am J Neuroradiol
KH Chang, MH Han, YW Choi, IO Kim, MC Han, CW Kim,
Tuberculosis (TB) is a rare cause of spinal arachnoiditis. It may occur primarily or secondary to intracranial or vertebral infection; unlike other types of arachnoiditis, it frequently involves the spinal cord as well as the meninges and the nerve roots. We retrospectively reviewed 13 conventional myelograms, eight CT myelograms, and five Gd-DTPA-enhanced MR images in 13 patients with spinal TB radiculomyelitis (arachnoiditis). Eleven patients had intracranial TB meningitis at the time of diagnosis or before. Ten patients were less than 30 years old. Conventional myelographic findings included a block of the CSF (11/13), most commonly at the level of the conus medullaris; irregular or indistinct thecal sac contour (9/13); multiple fine and/or coarse nodular defects (8/13); nerve-root thickening (7/13); and vertical bandlike adhesive defects (4/13). CT myelography showed intradural nodular masses suggesting tuberculomas at or just above the level of the block (4/8), irregularity of the spinal cord surface (4/8), irregular filling or obliteration of subarachnoidal space (6/8), and root thickening (5/8). Gd-DTPA-enhanced MR images revealed enhancing nodules suggesting tuberculomas (2/5); enhancement of the dura-arachnoid complex around the cord (3/5); and segmental enhancement of the thoracic cord, suggesting either infarction caused by vasculitis or TB myelitis in association with diffuse cord swelling (1/5). Plain MR findings were much less conspicuous, showing only an indistinct or irregular dura-arachnoid-cord complex (4/5). In conclusion, the conventional myelographic findings are considered to be virtually diagnostic of spinal TB radiculomyelitis in young patients with antecedent or coexisting TB meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)
67516.14149723892004.06.10++Cavernous hemangiomas in patients with chronic liver disease: MR imaging findings.Magn Reson Imaging
M Mastropasqua, M Kanematsu, P Leonardou, L Braga, JT Woosley, RC Semelka,
The purpose of our study was to assess the difference in magnetic resonance imaging (MRI) features of cavernous hemangiomas in patients with chronic liver disease compared them with hemangiomas in normal livers. We retrospectively searched our records of MRI of the liver between October 1998 and June 2002, and identified 76 hemangiomas in 49 patients (18 men and 31 women; age range 29-81 years [mean, 57 years]). Hemangiomas were classified into 3 groups: patients with cirrhosis [group 1, 8 lesions in 8 patients], patients with chronic hepatitis [group 2, 6 lesions in 5 patients], and patients without underlying liver disease [group 3, 62 lesions in 36 patients]. Four radiologists, blinded to clinical information, retrospectively reviewed in consensus the MRI findings of hemangiomas for number, size, signal intensities on T1- and T2-weighted images, and enhancement patterns on early- and late-phase postcontrast images. The mean lesion numbers and sizes were 1.0 and 16.2 +/- 9.6 mm, 1.2 and 15.3 +/- 7.1 mm, and 1.7 and 26.1 +/- 24.7 mm in groups 1-3, respectively. There was a correlation (p < 0.05, coefficient: 0.35) between lesion number and severity of liver disease. Although there was no significant difference in lesion size among the 3 groups, all of 11 lesions larger than 4 cm in diameter belonged to group 3. Almost all lesions appeared moderately hypointense on T1-weighted images and moderately hyperintense on T2-weighted images. Twenty-seven lesions showed immediate homogeneous enhancement (pattern 1), and 49 showed peripheral nodular enhancement with centripetal enhancement progression (pattern 2). There was no difference in frequency of enhancement patterns among the 3 groups. Hemangiomas were more often solitary in livers with chronic liver disease, large lesions were exclusively seen in livers without chronic liver disease, and there was a trend for small lesions in patients with chronic liver disease.
67616.1489392371996.12.26++Focal liver lesions: fast T2-weighted MR imaging with half-Fourier rapid acquisition with relaxation enhancement.Radiology
L Van Hoe, H Bosmans, P Aerts, AL Baert, J Fevery, B Kiefer, G Marchal,
PURPOSE: To compare the clinical usefulness of the half-Fourier rapid acquisition with relaxation enhancement (RARE) technique at T2-weighted magnetic resonance (MR) imaging of focal liver lesions with that of multishot RARE MR imaging and contrast material-enhanced helical computed tomography (CT). MATERIALS AND METHODS: Half-Fourier RARE and multishot RARE imaging and helical CT were performed in 48 patients with 102 focal liver lesions and in three patients with diffuse metastatic liver disease. Images were compared qualitatively and quantitatively for image quality, lesion conspicuity, and ability to help differentiate solid lesions from hemangiomas. RESULTS: All half-Fourier RARE images were free of respiratory artifact. In the 48 patients with 102 focal lesions, CT, half-Fourier RARE, and multishot RARE images depicted 101, 99, and 90 lesions (99%, 97%, and 88%), respectively. CT failed to depict focal lesions in one patient with diffuse metastatic liver disease. All techniques had high accuracy for distinction of hemangiomas from solid masses (areas under the receiver operating characteristic curves were between 0.96 and 0.99). CONCLUSION: Half-Fourier RARE MR imaging is a rapid and accurate technique for detection and characterization of focal liver lesions.
67716.1367099011984.05.11++Percutaneous drainage of 250 abdominal abscesses and fluid collections. Part I: Results, failures, and complications.Radiology
E vanSonnenberg, PR Mueller, JT Ferrucci,
The results of 250 percutaneous abscess and fluid drainage procedures are summarized. In 209 cases, operation was avoided and the patients were cured (83.6%). Partial success was achieved in 18 of 41 recurrences and failures; in these patients, operation was necessary, although the patient benefited from the percutaneous drainage. Cures and partial successes totaled 227/250 (90.8%). Noninfected collections were successfully drained in 31/43 cases. There were 21 failures (8.4%) and 20 recurrences (8%). These were most often due to fistulae, phlegmons, organized tissue, or underlying tumor. Twenty-six patients experienced complications (10.4%), seven of which were major (2.8%). Analysis and corrective measures for these problems (failure, recurrence, complication) and intraprocedural difficulties are discussed.
67816.1277420571995.06.15++[Periportal adenitis secondary to abdominal tuberculosis. A CT study]Rev Esp Enferm Dig
A Iglesias Castañón, FJ Lecumberri Olaverri, M Arias González, JI Bilbao Jaureguizar, F Idoate Saralegui,
Isolated periportal tuberculous adenitis is rare. Computed tomography (TC) is the primary modality for its detection and evaluation. Although not definitive, in the presence of an appropriate clinical history and a positive purified protein derivative test, a diagnosis of periportal tuberculous lymphadenopathy may be suggested by CT by the presence of low-density enlarged porta hepatis lymph nodes with immediate postcontrast peripheral rim enhancement.
67916.1181345631994.04.21++Gadolinium-enhanced MR aortography.Radiology
MR Prince,
PURPOSE: To evaluate the potential for preferential arterial enhancement at magnetic resonance (MR) aortography with an intravenous infusion of paramagnetic contrast material. MATERIALS AND METHODS: Gadolinium chelates were administered intravenously (0.2 mmol/kg) during three-dimensional MR imaging (1.5 T) in 125 patients (77 male and 48 female patients, aged 4-86 years [mean, 66 years]) with suspected aorta or aortic branch vessel disease. RESULTS: Infusion for the duration of the MR acquisition resulted in significant preferential arterial enhancement without the confounding effects of excessive venous or background-tissue enhancement (P < 10(-5)). Angiographic or surgical correlation in 48 patients revealed an 88% sensitivity and a 97% specificity for detection of stenoses or occlusions and a 100% sensitivity and a 100% specificity for detection of aortic or iliac artery aneurysms. CONCLUSION: Preferential arterial enhancement is possible at MR aortography with an intravenous infusion of paramagnetic contrast material.
68016.1014936521993.03.09++Ultrasonography in traumatic splenic rupture.Clin Radiol
TM Siniluoto, MJ Päivänsalo, FP Lanning, AB Typpö, PK Lohela, AE Kotaniemi,
Ultrasound (US) findings and their significance for the clinical outcome were studied in a series of 56 patients hospitalized with a diagnosis of splenic trauma. US was abnormal in 50 cases (89.3%) on admission, revealing intraperitoneal fluid in 41 (73.2%) and a splenic parenchymal injury and/or subcapsular haematoma in 35 (62.5%). US was abnormal in 24/25 patients undergoing urgent surgery, 23/26 undergoing successful non-surgical treatment and 2/5 patients undergoing delayed surgery within 1 to 3 days of a repeat US (abnormal in all five). The presence of intraperitoneal haemorrhage preoperatively was shown accurately by US in 29 cases (96.7%), and the splenic origin of the haemorrhage in 19 (63.3%). Repeat US was of most value for confirming the diagnosis by demonstrating splenic lesions not visible initially. The need for laparotomy could not be predicted on the basis of the US findings alone, however.
68116.0991369141997.05.21++Abdominal ultrasound findings mimicking hematological malignancies in a study of 218 Gaucher patients.Am J Hematol
O Neudorfer, I Hadas-Halpern, D Elstein, A Abrahamov, A Zimran,
Gaucher disease, the most prevalent sphingolipidosis, generally presents with splenomegaly, anemia, and thrombocytopenia. Hence, hematologists are often the specialists involved in diagnosis and management of these patients. We present ultrasonographic characteristics in a cohort of 218 consecutive Gaucher patients evaluated in our clinic during the past 5 years. Our data emphasize the high prevalence of lesions mimicking hematological malignancies in Gaucher disease. One fifth of 184 non-splenectomized patients had intra-splenic lesions, 6% of all patients had similar lesions in the liver, and 32% of 34 splenectomized patients (but none of the other patients) had marked retroperitoneal or peri-portal lymphadenopathy. The presence of splenic lesions correlated with age and splenic size, but not with extent of bone involvement or genotype. Interestingly, they were not affected by reduction in splenomegaly following enzyme replacement therapy. The importance of these findings is to include Gaucher disease in the differential diagnosis of splenic or hepatic lesions, especially in Ashkenazi Jews. Conversely, they are relevant for follow-up of all Gaucher patients, including asymptomatic individuals, because of the reported increased incidence of hematological malignancies in Gaucher disease.
68216.0986569881996.07.31++Dynamic Gd-enhanced MR imaging of hepatic hemangioma: is high temporal resolution requisite for characterization?Magn Reson Imaging
R Urhahn, M Kilbinger, M Drobnitzky, G Mans-Peine, J Neuerburg, RW Günther,
We assessed the value of high temporal resolution in the dynamic characterization of hepatic hemangioma with use of magnetization-prepared gradient-echo (MP-GRE) imaging. Single-level inversion recovery incremental flip angle MP-GRE images were obtained in 26 patients with 34 hemangiomas before and at a repetition rate of 30 images/min after injection of Gd-DTPA without breath-holding. Enhancement patterns and temporal changes thereof were analyzed. Hemangiomas were categorized as small ( < 2.0 cm), medium (2.0-5.0 cm), and large ( > 5 cm) lesions. Classic early peripheral nodular enhancement (PNE) with progressive hyperintense fill-in was observed in 31 lesions (91%). Two of 10 small and 1 of 20 medium lesions showed complete fill-in within 10 s, and three small and one medium lesions within 45 s after the onset of PNE. In no cases of hemangioma was immediate homogenous hyperintensity observed without preceding PNE. In conclusion, temporal resolution of less than 10 s is a prerequisite for confident dynamic characterization of some hemangiomas, predominantly small hemangiomas.
68316.0884301991993.03.11++Triple-dose versus standard-dose gadopentetate dimeglumine: a randomized study in 199 patients.Radiology
J Haustein, M Laniado, HP Niendorf, T Louton, W Beck, J Planitzer, M Schöffel, M Reiser, W Kaiser, W Schörner,
To investigate the safety, patient tolerance, and efficacy with 0.3 mmol/kg gadopentetate dimeglumine in magnetic resonance (MR) imaging of the central nervous system (CNS), a phase 3 trial was conducted in 199 patients with suspected CNS lesions. Patients received either 0.1 or 0.3 mmol/kg gadopentate dimeglumine (injection time, 15 seconds and 45 seconds, respectively). T1- and T2-weighted spin-echo sequences were performed at either 0.5 T or 1.5 T. In 80 patients with enhancing brain lesions, contrast-to-noise ratios (C/Ns) were calculated, and lesion-to-brain contrast was evaluated visually. Six patients (6%) in each dose group reported adverse events. Eight adverse events occurred with 0.1 mmol/kg and seven with 0.3 mmol/kg. Vital signs and laboratory values did not change significantly. C/N (P < .05) and visual assessment ratings were higher with 0.3 mmol/kg than with 0.1 mmol/kg. According to these preliminary results, 0.3 mmol/kg gadopentetate dimeglumine is safe and well tolerated when administered at approximately 1 mL/sec.
68416.0833510411988.04.28++Benefits of Gd-DTPA for MR imaging of intracranial abnormalities.J Comput Assist Tomogr
JR Hesselink, ME Healy, GA Press, FJ Brahme,
Forty patients with symptoms of intracranial disease were studied with magnetic resonance before and after intravenous injection of gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). The T1- and T2-weighted images were obtained in all patients. Ninety brain lesions were found in 36 patients, including primary (20 patients) and metastatic (six) tumors, hemorrhage (one), progressive multifocal leukoencephalopathy (one), cysticercosis (one), infarction (four), and postoperative changes (four). Postcontrast images revealed lesions not seen on precontrast scans in eight (20%) patients. Also, the postcontrast images showed a change in appearance of the lesions in 20 (50%) that provided helpful information for assessing the abnormality in 20 cases (50%). Gadolinium-DTPA did not obscure any of the lesions seen on precontrast scans. It improved conspicuity, helped characterize and delineate the extent of lesions, and increased the sensitivity for detection of cerebral abnormalities.
68516.0864702521984.10.25++Abdominal computed tomography in children with unexplained prolonged fever.J Comput Assist Tomogr
D Picus, MJ Siegel, DM Balfe,
Twenty-eight children with unexplained fever lasting at least 1 week were referred for CT of the abdomen. Of the 28 patients, 22 had clinical and radiographic findings localizing disease to the abdomen prior to CT. In these 22 patients CT correctly detected an abnormality in 19 of 22 (86%) and favorably affected therapy in 13 of 22 (59%). In the six patients without localizing findings CT was abnormal in two and normal in four. Computed tomography was correct in all six patients and favorably affected management in two patients. Our results suggest that in children with fever and findings localizing disease to the abdomen--especially the retroperitoneum--CT is helpful in diagnosing a wide variety of lesions, as well as influencing therapy. If no localizing signs are present, CT has a relatively lower yield.
68616.0784316911993.03.18++Focal nodular hyperplasia of the liver: radiologic findings.Abdom Imaging
K Shamsi, A De Schepper, H Degryse, F Deckers,
A retrospective analysis of the results of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) of 24 cases (28 lesions) of proven focal nodular hyperplasia (FNH) is presented. While US exhibited nonspecific features, CT frequently showed characteristic features: hypodensity on precontrast scans (69%), transient immediate enhancement after bolus injection (96%), and homogeneity (85%). A scar was noted in 31% of the cases. The typical MR triad of isointensity on T1- and/or T2-weighted (T2-WI), homogeneity, and a scar which shows hyperintensity on T2-WI was seen in only 12% of our cases. The most common finding was homogeneity (94%). In two cases the scar was hypointense on T2-WI. To our knowledge, this finding has not been described before. We conclude that the features of FNH, although fairly constant, are at times indistinguishable from those of other hepatic tumors, such as hepatic adenoma (HA), fibrolamellar hepatocellular carcinoma (FLHCC), small hepatocellular carcinoma, and a hyperplastic nodule. Therefore, a multimodality approach is essential for the correct diagnosis in order to prevent unnecessary surgery.
68716.07100898081999.04.28+ [Abdominal lymphoma: lymph node and visceral involvemnet]Sangre (Barc)
G Sánchez del Peral Otero, E Parlorio de Andrés, I López San Román, A Bustos García de Castro,
68816.0682200311993.12.07++Hepatic bacillary angiomatosis in a patient with AIDS.Abdom Imaging
SH Wyatt, EK Fishman,
We report a case of bacillary angiomatosis involving the liver in addition to mul