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Table of citations (5000 visible)

CRScorePMIDDateAuAbTitleJournal
175.9974807451995.12.21++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.
264.2979496801994.11.30++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.
353.9418894321991.10.11++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.
451.5514103581992.11.13++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).
545.8594022371998.01.13++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.
642.2115634031992.05.15++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.
742.12111267982001.01.11+ Imaging of tumoral conditions of the spleen.JBR-BTR
KJ Mortelé,
840.8866003261983.02.14+ Focal lesions in the spleen: sonographic patterns and guided biopsy.AJR Am J Roentgenol
L Solbiati, MC Bossi, E Bellotti, C Ravetto, G Montali,
940.2486062311996.05.21++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.
1039.6486147221996.06.06+ [The imaging diagnosis of a rare case of inflammatory pseudotumor of the spleen]Radiol Med (Torino)
S Meduri, C Zuiani, M Bendini, M Bazzocchi,
1138.9632829631988.05.31++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.
1238.88108000042000.06.20++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.
1338.72167662702006.07.17++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.
1438.6682347171993.12.17++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.
1538.6120179571991.05.17++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.
1637.7981262881994.04.11++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.
1737.4179572941994.12.29++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.
1837.1738846171985.05.17++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.
1937.0681840551994.06.14++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.
2036.77157358642005.06.14++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.
2136.5420279741991.06.13++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.
2236.46110597392001.02.08++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.
2336.3980294031994.08.11++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.
2436.15109356452000.08.15++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.
2535.6984301911993.03.11++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.
2634.9083815721993.03.11++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.
2734.1932926041988.08.24++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.
2834.0922039511990.10.09++[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.
2933.9492406791997.08.15++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.
3033.86106739462000.03.02++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.
3133.7538856911985.05.20++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.
3233.4823128481990.04.23++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.
3333.4284527211993.04.22++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.
3433.2514387561992.12.18++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.
3533.1213735791992.05.21++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.
3633.0386289401996.06.26++[The integrated diagnosis of hepatic focal nodular hyperplasia: echography, color Doppler, computed tomography and magnetic resonance compared]Radiol Med (Torino)
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.
3732.90166280302006.06.02++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.
3832.8982347181993.12.17++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.
3932.8084165541993.01.21++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.
4032.7725396221989.05.25++[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.
4132.52126230442003.03.25++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.
4232.48108234522000.08.16++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.
4332.3230414761988.09.08++[Diagnostic imaging and interventional radiology in abdominal abscess formations]Radiol Med (Torino)
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.
4432.0521549131990.03.16++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.
4531.9937638901986.11.20++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.
4631.7191697041997.06.24++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.
4731.5971991301982.04.20+ Cysts and nonlymphomatous tumors of the spleen.Pathol Annu
DF Garvin, FM King,
4831.4042190051975.09.13+ [Hamartoma of the spleen with hypersplenism]Haematologica
G Santagati, A Cardona, G Paladini, E Nicolini, E Ascari,
4931.34160484012005.11.08++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.
5031.2579466851994.12.22++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.
5131.0411674821975.05.09++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.
5230.92164724192006.04.24++[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.
5330.90128306672004.01.15++[Differential echogenic focal splenic lesion diagnosis]Schweiz Rundsch Med Prax
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.
5430.8378200181995.02.14++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.
5530.7575601541995.11.22++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.
5630.6467426691984.08.20++[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.
5730.54105252161999.11.30++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.
5830.3782843941994.02.17++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.
5930.3440349671985.10.15++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.
6030.3420692111991.08.15++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.
6130.3321209371990.11.19++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.
6229.9636112331987.09.01++[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.
6329.9380862531994.10.20++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.
6429.9221147691990.08.13++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.
6529.6380294041994.08.11++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.
6629.52151850332005.02.17++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.
6729.45145801032003.11.18++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.
6829.3180909221994.10.17++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.
6929.13120088312002.11.04+ Case 6. Sarcoidosis.J Ultrasound Med
CL Chen, RB Goldstein,
7029.1019278161991.11.18++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.
7128.9113091721992.07.06++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.
7228.8890227751997.03.03++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.
7328.8413120971992.04.15++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.
7428.76100638561999.03.22+ Percutaneous imaging-guided biopsy of the spleen.AJR Am J Roentgenol
ME O'Malley, BJ Wood, GW Boland, PR Mueller,
7528.7520142771991.05.15++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.
7628.59157499772005.05.05++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.
7728.5782594261994.01.19++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.
7828.5414147771992.11.16++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.
7928.3339998931985.07.17++[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.
8028.2986579461996.08.01++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.
8128.2495165161998.05.21++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.
8228.02106754582000.04.05++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.
8328.0067896441981.09.22+ Dynamic CT of the normal spleen.AJR Am J Roentgenol
GM Glazer, L Axel, HI Goldberg, AA Moss,
8427.9625396061989.05.19++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.
8527.94147401312004.04.27++[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.
8627.9133101351987.11.10++[Ultrasound and CT evaluation of non-lymphomatous splenic focal lesions]Radiol Med (Torino)
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.
8727.8421858771990.06.11++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.
8827.80162728492005.12.23++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.
8927.6986617681996.10.17++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.
9027.6675603341995.11.02+ Renal capsular hemangioma: unusual MR findings.J Comput Assist Tomogr
J Rueckforth, D Rhode, H Baba, G Adam,
9127.6675018301996.01.17++[The tissue characterization of focal liver lesions with magnetic resonance imaging]Radiol Med (Torino)
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.
9227.5976226811995.08.30++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.
9327.54116885762001.12.04++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.
9427.52175503282007.06.21++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.
9527.52108000022000.06.20+ Sonographic appearances in abdominal tuberculosis.J Clin Ultrasound
A Batra, MS Gulati, D Sarma, SB Paul,
9627.5011533211975.11.05++[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.
9727.4814852501993.02.18+ [Benign vascular tumors of the spleen]Ter Arkh
VS Shavlova, IB Kaplanskaia, VA Klimanskiĭ,
9827.45127518582004.01.15++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.
9927.4384744001993.05.20++[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.
10027.3795686331998.06.19++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.
10127.3481619001994.05.24++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.
10227.2781995481994.07.05++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.
10327.2188882201996.11.25++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.
10427.2035268421986.09.17++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.
10527.1321226821990.12.27++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.
10627.0933510421988.04.28++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.
10727.0890108011997.03.25++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.
10827.0786288871996.06.21++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.
10927.0413185581992.07.15++[The dynamic magnetic resonance study of focal liver lesions by FLASH sequences with bolus intravenous gadolinium-DTPA]Radiol Med (Torino)
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.
11026.8421226831990.12.27++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.
11126.8029090931989.01.18++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.
11226.8092167711997.07.31++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.
11326.7818920351991.10.11+ Castleman disease of the adrenal gland: MR imaging features.AJR Am J Roentgenol
JF Debatin, CE Spritzer, NR Dunnick,
11426.6777291181995.05.26++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.
11526.4874807341995.12.21++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.
11626.4822102011990.10.31++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.
11726.3273844551980.08.15++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.
11826.2890575181997.04.04+ 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,
11926.20172598372007.03.19++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.
12026.19103786551999.08.04++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.
12126.1667733661980.10.27++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.
12226.1591076471997.07.10++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.
12326.1063391701983.05.27+ Computed tomography of the spleen.Crit Rev Diagn Imaging
M Federle, AA Moss,
12426.08123549992002.10.17++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.
12526.051108411979.09.25++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.
12626.04159081552005.12.06++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:
12726.0286105581996.05.28++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.
12825.9999322561999.04.16++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.
12925.8929580301987.10.26++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).
13025.85157286032005.04.14++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.
13125.7824058811990.03.29++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.
13225.7764047261983.06.10++[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.
13325.7686729721996.08.15++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.
13425.58169506952006.11.09++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.
13525.5781262891994.04.11+ Bacillary angiomatosis in the abdomen: Doppler and CT features.J Comput Assist Tomogr
LE Kunberger, BM Montalvo,
13625.5780614271994.09.20++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.
13725.5691537061997.07.14++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.
13825.5088328751996.11.07++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.
13925.4792016741997.08.14++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.
14025.4778951931995.04.27++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.
14125.4584397571993.04.01++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.
14225.45160968682006.03.10++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.
14325.4187679981996.09.17+ [Isolated splenomegaly]Internist (Berl)
G Nickenig, Y Ko, C Wanning, H Müller-Miny, K Zhou, H Vetter,
14425.4095020911998.03.16++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.
14525.34107462772000.05.03++[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.
14625.2980920271994.10.20++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.
14725.2326550051989.06.14++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.
14825.2085088371993.07.12++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.
14925.173915101980.03.24+ [Diagnosis of splenic diseases]Chirurg
KF Gürtler, C Schneider, E Bücheler,
15025.1591345821997.07.23++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.
15125.1481262651994.04.11++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.
15225.1214268441992.12.10++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.
15325.1029603431988.01.19++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.
15425.0735543341987.05.28++[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.
15525.0596468241998.07.22+ Liver hemangioma: US-guided core-needle biopsy.Radiology
RD Harris,
15624.92117722182002.01.30++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.
15724.9277877131995.07.24++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.
15824.9093084651997.10.16++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.
15924.7586882291996.08.28++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.
16024.73128861352003.08.29++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.
16124.72172850862007.03.29+ [Littoral cell angioma of the spleen]J Chir (Paris)
A Achour, MA Filali, C Benabdellah, R Elhassani, M Poinsard,
16224.7118957961991.10.18++[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.
16324.67108822682000.08.01++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.
16424.65100244001999.04.05++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.
16524.53163014522006.01.12+ Image of the month. Littoral cell angioma.Arch Surg
SP Cheng, TL Yang, BF Chen, CL Liu,
16624.4549835671970.03.05+ [Primary tumors of the spleen. Clinical contribution]Haematologica
S Francalanci, L Gazzola,
16724.4282843921994.02.17++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.
16824.3610129631977.03.21+ [Splenic morphology in angiographic investigations (author's transl)]Pol Przegl Radiol Med Nukl
B Pawlak,
16924.33168619772006.09.12++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.
17024.3182200321993.12.07++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.
17124.2621645381990.08.17++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.
17224.2614387621992.12.18++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.
17324.2080614281994.09.20++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.
17424.1690510281997.03.28++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.
17524.1297710991998.11.04++[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.
17624.0779728071994.12.21++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.
17724.04113291542001.07.12++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.
17824.04112865812001.05.10++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.
17924.037330521979.03.13++[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.
18024.03110290982000.11.30++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.
18124.0318712721991.09.18++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.
18223.9519367791991.11.22++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.
18323.9097713821998.10.19++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.
18423.87112640702001.04.19++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.
18523.86113181342001.08.02++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.
18623.8535381551987.01.21++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.
18723.8397541031998.10.15++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.
18823.8290150651997.02.27++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.
18923.8186579221996.08.01++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.
19023.7967660081980.02.15++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.
19123.7976053301995.08.10++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.
19223.7716323501992.08.18+ Splenosis: superparamagnetic iron oxide-enhanced MR imaging.AJR Am J Roentgenol
BL Storm, PL Abbitt, DA Allen, PR Ros,
19323.7522983531990.03.07++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.
19423.7574807181995.12.21+ Technique for MR imaging of the liver.Radiology
S Saini, RC Nelson,
19523.7467140091984.05.30+ [Calcified lymphangioma of the spleen. A contribution to the diagnosis and differential diagnosis of splenic cysts]Chirurg
C Röhrborn, JU Alles,
19623.7214304251992.12.16+ Intraosseous meningioma: CT and MR appearance.J Comput Assist Tomogr
HY Lee, J Prager, Y Hahn, RG Ramsey,
19723.6733759871988.06.28++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.
19823.6589882221997.01.29++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.
19923.6243768701975.08.26+ [Posttraumatic hemorrhagic pseudocysts of the spleen (4 cases)]
J Grosdidier, F Boileau, B Richaume,
20023.5086334631996.07.01+ Gadopentetate dimeglumine-enhanced MR imaging of subdural hematoma in an abused infant.AJR Am J Roentgenol
PK Kleinman, RL Ragland,
20123.4739034221985.12.18++[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.
20223.4665786961983.11.23+ [Tomodensitometry in focal splenic pathology]Ann Radiol (Paris)
A Anjou, L Chollat, PM Bret, M Bretagnolle, PJ Valette, D Poix,
20323.4032615061988.09.16++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.
20423.3618858101991.10.08++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.
20523.3214304431992.12.16++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.
20623.3228378061988.07.28++[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.
20723.3214505071993.01.07++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.
20823.2519247921991.11.20++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.
20923.21146288712003.12.23++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.
21023.1482828851994.02.17++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.
21123.1478943081995.04.21++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.
21223.1231344391988.08.24+ Splenic involvement in Gaucher's disease: sonographic findings.J Clin Ultrasound
PG Stevens, SS Kumari-Subaiya, LB Kahn,
21323.12115030942001.10.11++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.
21423.0926720931989.09.25++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.
21523.08108872412000.07.27++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.
21623.0593149831997.10.23++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.
21723.0574896251996.01.02++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.
21823.01118677832002.05.07++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.
21922.9681889081994.06.21++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.
22022.96160375412005.10.05+ Pseudotumoral appearance of peliosis hepatis.AJR Am J Roentgenol
S Savastano, O San Bortolo, E Velo, C Rettore, G Altavilla,
22122.9415613391992.05.13++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.
22222.9381889071994.06.21++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.
22322.9169750261981.12.21++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.
22422.8897412311998.11.24++[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.
22522.85102278891999.06.03++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.
22622.82106157852000.02.01++[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.
22722.80152433762004.09.09++[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.
22822.7983329751993.08.16++[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.
22922.74179210812007.11.08++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.
23022.6619871771991.02.15++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.
23122.6427781581989.10.19++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.
23222.59107529072000.04.21+ Aunt Minnie's corner. Hepatic hemangioma.J Comput Assist Tomogr
RM Branstetter, KL Ford,
23322.59151253602004.05.19++[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.
23422.5832792231988.04.19+ A truly wandering spleen.J Ultrasound Med
I Kinori, MD Rifkin,
23522.5370629731982.05.21 Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 15-1982. Splenomegaly in a 55-year-old man.N Engl J Med
23622.53110001752000.10.13++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.
23722.51171898432007.03.15++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.
23822.5084194431993.02.11++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.
23922.4967242421984.07.18++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.
24022.48162410992005.11.21++[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.
24122.48112422142001.04.05++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.
24222.4793084641997.10.16++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.
24322.4281533361994.05.12++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.
24422.3582828831994.02.17++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.
24522.31127609412003.06.24++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.
24622.30151499942004.08.09+ Abdominal lymphangiomas: imaging features with pathologic correlation.AJR Am J Roentgenol
AD Levy, V Cantisani, M Miettinen,
24722.3081364821994.04.28+ [A splenic hamartoma with clinical symptoms]Rofo
H Daschner, K Lehner, K Becker,
24822.2515916861992.07.02++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.
24922.25172935742007.05.01++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.
25022.2525388801989.05.09++[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.
25122.2426787041989.10.28++[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.
25222.2415156241992.10.06++[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.
25322.2217450491992.01.14++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.
25422.2230259571987.02.18++[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.
25522.2130786871990.05.09+ The spleen.Clin Diagn Ultrasound
AB Kurtz,
25622.21157238422005.09.13++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.
25722.17145800962003.11.18++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.
25822.16125948002003.06.19++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.
25922.16158915092005.06.28++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.
26022.1315358901992.03.23++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.
26122.1054620281970.05.27+ Isolated splenic vein occlusion. Review of literature and report of an additional case.Arch Surg
JP Sutton, DY Yarborough, JT Richards,
26222.0993036351997.09.22++[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.
26322.026194341978.02.18++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.
26421.9847447221973.12.15+ Angiographic evaluation of cystic lesions of the spleen.Am J Roentgenol Radium Ther Nucl Med
JD Shanser, AA Moss, RE Clark, AJ Palubinskas,
26521.9682736071994.02.03+ 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,
26621.9483815511993.03.11++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.
26721.8986688041996.08.05++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.
26821.851039221979.03.24+ Ultrasonic findings in isolated lymphoma of the spleen simulating splenic abscess.J Clin Ultrasound
JJ Cunningham,
26921.84103905611999.09.14++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.
27021.76161341582006.02.23++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.
27121.7478638831995.03.23++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.
27221.7379728081994.12.21++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.
27321.7242462821970.08.05+ [Nodular lymphoma of the spleen]Nouv Rev Fr Hematol
J Bousser, J Delarue, G Bilski-Pasquier, J Diebold, R Zittoun, C Dao,
27421.7119876341991.02.20+ Extrapulmonary Pneumocystis carinii infection: another cause of splenic "bull's-eye" lesions.Radiology
ME Timins, AA Nemcek,
27521.7082408871994.01.06++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.
27621.6767795231981.03.27++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.
27721.6615358881992.03.23++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).
27821.64113728132001.06.28++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.
27921.6415450291992.04.15++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.
28021.62166280482006.06.02++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.
28121.6077162871995.05.15++[Ultrasound aspects in AIDS-related splenic diseases]Radiol Med (Torino)
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.
28221.584145901978.03.21++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.
28321.571284961976.04.02++[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.
28421.4915222701992.10.15++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.
28521.4834479281988.06.09+ [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,
28621.4722787831991.03.14++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.
28721.4614304571992.12.16+ Gadolinium-enhanced MRI of pigmented villonodular synovitis of the knee.J Comput Assist Tomogr
PR Bessette, PA Cooley, RP Johnson, DJ Czarnecki,
28821.466194001978.02.18++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.
28921.45111787002001.05.10++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.
29021.4067795861981.03.24++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.
29121.3740133571985.08.01+ Splenectomy for splenomegaly and secondary hypersplenism.World J Surg
WW Coon,
29221.3620485361991.07.12+ Splenic hemangioma.AJR Am J Roentgenol
DG Disler, FS Chew,
29321.3482392201993.12.01+ [Post-traumatic splenic pseudocyst]An Esp Pediatr
E Noya Beiroa, J García-Casillas Diaz, D Nieto Balmesada, F Reverte Blanc,
29421.3328166341989.12.18++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.
29521.33173045352007.04.18++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.
29621.2553522441970.01.07+ [Splenic diseases from the surgical point of view]Chirurg
RX Zittel,
29721.2421209381990.11.19++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.
29821.23114227862001.08.23++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.
29921.20150181632004.04.08++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.
30021.1798305441999.01.22++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.
30121.1588738561997.01.13++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.
30221.1382736511994.02.03++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.
30321.0896632791998.09.21++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.
30421.03173976362007.06.19+ [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,
30521.03170484532007.01.19++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.
30620.9926500081989.05.25++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.
30720.9022742581991.02.22++[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.
30820.8786593851996.08.01+ 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,
30920.8480798581994.10.04++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.
31020.8291356421997.05.23++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.
31120.77100770231999.05.04++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.
31220.76108454832000.06.21+ Atypical inside-out pattern of hepatic hemangiomas.AJR Am J Roentgenol
S Kim, JJ Chung, MJ Kim, S Park, JT Lee, HS Yoo,
31320.7692759091997.09.16+ Sonographic guidance of needle position for MR arthrography of the shoulder.AJR Am J Roentgenol
R Valls, P Melloni,
31420.76175182562007.06.19++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.
31520.7272536621981.09.22++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.
31620.7277107911995.05.12++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.
31720.6685173231993.07.22++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.
31820.66103326011999.07.14++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.
31920.66127232902003.08.28++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.
32020.6578084921995.01.31 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
32120.6339017051985.11.08++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.
32220.6184281081993.03.09++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.
32320.5838396521985.09.26++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.
32420.5840536591985.12.19++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.
32520.4789561291997.03.05++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 vei