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Table of citations (250 visible)

22519.0221710671990.11.16++[MRT of brain metastases. (I) What is the place of screening with T2-weighted sequences?]Rofo
N Hosten, W Schörner, P Schubeus, R Felix,
Sensitivity and specificity of plain T2-WI and Gd-DTPA enhanced T1-WI were compared by evaluating MR exams of 30 patients with brain metastases. Large lesions with high signal on T2-WI always enhanced (43/43) when a structure (perifocal edema, tumor tissue, central necrosis) was found. Large lesions nearly always enhanced (53/55) even if no such structure was found. 65% of small unstructured white matter lesions with high signal on T2-WI, which are generally considered vascular, did not enhance. Surprisingly, 35% did enhance. Demonstration of blood brain barrier disturbance in these lesions suggested a metastatic origin. In 3 patients with multiple metastases, Gd-DTPA enhanced T1-WI disclosed more than 140 lesions not seen on T2-WI. All of them were located in or adjacent to grey matter. Our results indicate that enhanced T1-WI should be obtained even if T1-WI are normal or show only small white matter lesions.
22529.0281156241994.03.25++Impact of positive findings at image-guided biopsy of lymphoma on patient care: evaluation of clinical history, needle size, and pathologic findings on biopsy performance.Radiology
SG Silverman, BY Lee, PR Mueller, ES Cibas, SE Seltzer,
PURPOSE: To analyze the effect of findings at image-guided biopsy of abdominal lymphoma (IGBL) on patient care and define the key determinants of clinical success. MATERIALS AND METHODS: A retrospective, bi-institutional study was performed in 102 patients with positive or suspicious IGBL findings (93 patients with non-Hodgkin and nine patients with Hodgkin lymphoma). The proportion of patients treated on the basis of IGBL findings only was calculated and correlated with 10 determinants, including history of lymphoma, biopsy technique, needle size, immunocytochemical findings, and tumor grade. RESULTS: Overall, 73 patients (72%) were treated on the basis of biopsy findings only, including 41 (91%) of 45 patients with a history of lymphoma and 32 (56%) of 57 patients with no such history (P < .01). No difference in findings existed when three needle-size groups were compared (P > .50). CONCLUSION: Whenever findings were positive, IGBL provided enough tissue to enable treatment in most patients. Fine needles were just as likely as larger needles to enable both determination of tumor grade and treatment.
22539.02116684672001.11.01++Fine-needle aspiration cytology of adrenal masses in noncancer patients: clinicoradiologic and histologic correlations in functioning and nonfunctioning tumors.Cancer
F Lumachi, S Borsato, AA Brandes, P Boccagni, A Tregnaghi, F Angelini, G Favia,
BACKGROUND: Image-guided, fine-needle aspiration (FNA) cytology is performed currently in patients with malignant disease who have suspected adrenal metastases. The objective of this study was to evaluate the usefulness and safety of FNA cytology in patients with incidental adrenal masses and functioning tumors. METHODS: Computed tomography (CT)-guided or ultrasound-guided aspirates using 21-23-gauge needles were performed successfully in 70 patients with functioning (n = 38 patients) and nonfunctioning (n = 32 patients) adrenal masses (median size, 4 cm; range, 3-12 cm) that were detected previously by CT scans. RESULTS: Definitive histology was available in 68 patients (97.1%), showing 53 benign tumors (77.9%), 11 primitive malignant tumors (16.2%), and 4 unsuspected adrenal metastases (5.9%) in patients with unknown primary tumors. In two patients with aspirate reports that ruled out malignancy, the mass was unchanged on CT scan follow-up; thus, they were considered benign lesions. The benign masses were significantly smaller (P < 0.01), although seven malignant tumors (46.7%) measured 3-4 cm in greatest dimension, and eight benign lesions (14.5%) measured 5-6 cm in greatest dimension. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 66.7%, 96.4%, 83.3%, 91.4%, and 90.0%, respectively, for CT scan and 93.3%, 100%, 100%, 98.2%, and 98.6%, respectively, for FNA cytology. The morbidity rate of image-guided FNA cytology was 4.3% (two patients with self-limited, asymptomatic pneumothorax and one patient with spontaneously resolved adrenal hematoma). CONCLUSIONS: Adrenal FNA cytology represents a safe and specific procedure for evaluating patients with adrenal masses measuring > 2 cm in greatest dimension. FNA is able to reveal malignancies and unsuspected pheochromocytomas and should be performed in all patients with adrenal tumors whenever requested for surgical planning.
22549.024048961977.06.30++Radiologic manifestations of esophageal lymphoma.AJR Am J Roentgenol
RL Carnovale, HM Goldstein, J Zornoza, GD Dodd,
Eight cases of esophageal lymphoma are presented. Contiguous involvement of the distal esophagus and stomach with narrowing and/or nodularity was the most common esophageal abnormality. Other appearances noted were an ulcerated mass, multiple submucosal nodules, and a pattern simulating varices. The spectrum of radiologic appearances with esophageal lymphoma is similar to lymphomatous involvement in the remainder of the gastroinestinal tract.
22559.0183576501993.09.24++[Primary angiosarcoma of the spleen]Rev Esp Enferm Dig
M Crespo Urigüen, A Miyar González, MA Martínez Menéndez, JM García García,
Primary spleen angiosarcoma is a malignant neoplasia based on vascular tissue and it is a rare tumor (65 cases published). The clinical aspects are obscure and the specific diagnosis is made by laparotomy. The prognosis is very poor in any case and survival isn't more than two years, whenever the spleen undergoes spontaneous rupture in which case the survival should be less than six months. The splenectomy before rupture could increase survival. Patients with or without metastatic disease may be treated by chemotherapy but with poor results. Radiotherapy is used for relief the pain produced for bone metastasis.
22569.0150631391972.06.29+ Haemangiosarcoma of the spleen.Br J Surg
PJ Toghill, CC Rigby, GF Hall,
22579.0180909181994.10.17++Fast MR imaging of the liver: quantitative comparison of techniques.Radiology
B Siewert, MF Müller, M Foley, PA Wielopolski, JP Finn,
PURPOSE: To compare several techniques for fast magnetic resonance (MR) imaging of focal liver lesions. MATERIALS AND METHODS: Ninety patients (37 men and 53 women, aged 19-92 years [mean, 54 years]) with 137 focal liver lesions (56 metastases, 13 hepatocellular carcinomas, 52 hemangiomas, 16 cysts) underwent MR imaging with rapid acquisition spin-echo (RASE), T1-weighted fast low-angle shot (FLASH), turboFLASH, segmented turboFLASH, and T2-weighted conventional and turbo spin echo (SE). Images were analyzed for spleen-to-liver and lesion-to-liver signal difference-to-noise ratios (SD/Ns). RESULTS: Turbo SE T2-weighted imaging had the highest SD/N for spleen-to-liver (P < .01) and for lesion-to-liver (P < .02) contrast. Segmented T1-weighted turboFLASH imaging had the second highest SD/N for spleen-to-liver (P < .001) contrast and was better overall than other T1-weighted sequences for depicting liver lesions (P < .01). Results at segmented turboFLASH imaging were second best for hemangiomas (P < .01). For metastases, no significant difference was found for results with the T1-weighted sequences. CONCLUSION: Segmented T1-weighted turboFLASH and turbo SE T2-weighted imaging hae advantages over conventional techniques for liver imaging.
22589.0045517941972.05.16+ Splenic arteriography in Hodgkin's disease. A roentgenologic-pathologic study of 33 consecutive untreated patients.Am J Roentgenol Radium Ther Nucl Med
RA Castellino, JF Silverman, E Glatstein, N Blank, L Wexler,
22599.0030953851986.12.16+ Left upper quadrant pseudolesion secondary to normal variants in liver and spleen.J Clin Ultrasound
AM Arenson, JD McKee,
22608.9981860101994.06.21+ [Ultrasonography in the diagnosis and treatment of splenic abscess]Rev Esp Enferm Dig
P Rendón Unceta, MJ Soria de la Cruz, C García Gullón, F Morales Ponce,
22618.9982736411994.02.03++CT of hypervascular hepatic tumors: are unenhanced scans necessary for diagnosis?AJR Am J Roentgenol
RM Patten, JY Byun, PC Freeny,
OBJECTIVE. In most institutions, a combination of unenhanced and contrast-enhanced CT is used to screen patients for suspected hypervascular hepatic neoplasms. Elimination of the unenhanced examination could save time and expense and reduce the patient's exposure to radiation. We compared unenhanced and incremental bolus dynamic contrast-enhanced CT for detection of hypervascular hepatic neoplasms and evaluated the need for preliminary unenhanced hepatic CT. SUBJECTS AND METHODS. We prospectively examined 101 consecutive patients with hypervascular primary hepatic malignant tumors or suspected hypervascular metastases. Primary hepatic neoplasms included hepatocellular carcinoma (seven), sarcoma (two), and hemangioendothelioma (one); extrahepatic primary tumors included breast (37) and renal cell (24) carcinoma, melanoma (15), carcinoid (nine), and endocrine and other tumors (six). All patients had both unenhanced and bolus dynamic contrast-enhanced CT with 5-mm collimated sections at 8-mm intervals. For contrast-enhanced CT, 150-180 ml of IV contrast material, a mechanical power injector, and a scanning protocol that allowed completion of liver imaging within 2 min were used. Both unenhanced and contrast-enhanced CT scans were compared for detection and conspicuousness of hepatic lesions. RESULTS. Hepatic lesions were found in 34 patients. In 21 patients, all hepatic lesions seen on unenhanced scans also were apparent on contrast-enhanced scans. However, in 12 (57%) of 21 patients, lesions were more conspicuous and better defined on contrast-enhanced scans. The absolute number of lesions detected with each method of scanning differed in 12 patients. In four patients, the contrast-enhanced scan showed more lesions; in five patients, the unenhanced scan showed more lesions; and in three patients, administration of contrast material obscured some lesions shown on unenhanced scans and made others more conspicuous. If only a contrast-enhanced CT scan had been obtained, the presence of malignant hepatic neoplasm would have been missed in only one case (a patient with a single 2.8-cm metastasis from renal cell carcinoma). CONCLUSION. Bolus dynamic contrast-enhanced CT alone correctly showed the presence or absence of primary or metastatic hypervascular hepatic tumors in 100 of 101 cases. If the goal of CT examination is detection of hypervascular hepatic lesions, use of contrast-enhanced CT alone may be adequate and the addition of unenhanced scans is not cost-effective.
22628.9994008461998.02.05++Rapidly enhancing hepatic hemangiomas at MRI: distinction from malignancies with T2-weighted images.J Magn Reson Imaging
EK Outwater, K Ito, E Siegelman, CE Martin, M Bhatia, DG Mitchell,
The purpose of this study is to describe a subset of atypical hepatic hemangiomas that enhance rapidly and diffusely and to determine whether heavily T2-weighted images could distinguish between atypically enhancing liver hemangiomas and hypervascular malignancies. A retrospective search of MR records identified seven patients with liver hemangiomas that demonstrated diffuse early enhancement and 23 patients with biopsy-proven malignant liver lesions that were hypervascular on dynamic gadolinium-enhanced MR images. Quantitative analysis of signal intensity measurements was performed on the T2-weighted images, heavily T2-weighted (TE > 140), and dynamic gadolinium-enhanced images. Blinded reader comparison of the T2-weighted images and gadolinium-enhanced images was performed. Hypervascular hemangiomas enhanced to a greater degree than hypervascular malignant liver lesions on the early phase gadolinium-enhanced images. Perilesional parenchymal enhancement was demonstrated in five cases of rapidly enhancing hemangiomas. Signal intensity and contrast-to-noise ratios on the heavily T2-weighted images of the hemangiomas were significantly greater than that of the hypervascular malignant lesions (P < .05). Hemangiomas were differentiated from the hypervascular malignant liver lesions with high accuracy (97-100%) by three blinded readers based on the T2-weighted images. A subset of hemangiomas have atypical rapid diffuse enhancement on dynamic gadolinium-enhanced images. These atypical hemangiomas can be distinguished from hypervascular malignant liver lesions on T2-weighted MR images.
22638.9932857581988.06.13+ [Magnetic resonance imaging of primary malignant vascular tumors of the liver. Apropos of 3 cases]Ann Radiol (Paris)
A Roche, MD Ben Mrad, D Mathieu, C Guinet, D Pariente, P Chaumont,
22648.9872219351981.06.23+ [Indications for computerized axial x-ray tomography in the diagnosis of pathological processes of the abdominal cavity and retroperitoneal space]Ter Arkh
SK Ternovoĭ,
22658.98111109562001.01.11++Cerebrotendinous xanthomatosis: the spectrum of imaging findings and the correlation with neuropathologic findings.Radiology
F Barkhof, A Verrips, P Wesseling, MS van Der Knaap, BG van Engelen, FJ Gabreëls, A Keyser, RA Wevers, J Valk,
PURPOSE: To describe imaging findings and their neuropathologic correlate in patients with cerebrotendinous xanthomatosis (CTX). MATERIALS AND METHODS: Computed tomographic (CT) and magnetic resonance (MR) images in 24 patients with symptoms (mean age at time of imaging, 37 years; mean disease duration, 18 years) were reviewed for site and frequency of brain, spinal cord, and Achilles tendon involvement. Two patients died, and imaging findings were compared with postmortem neuropathologic findings. RESULTS: Apart from nonspecific supratentorial atrophy and deep white matter changes, more typical hyperintense lesions were seen on T2-weighted images in the dentate nucleus (in 79% of patients), globus pallidus, substantia nigra, and inferior olive and extended into adjacent white matter as disease progressed. In these locations, lipid crystal clefts and perivascular macrophages, neuronal loss, demyelination, fibrosis, and reactive astrocytosis were found at microscopic examination. Hypointensity was sometimes found on T2-weighted images in the dentate nucleus and was related to deposition of hemosiderin and calcifications. CT depicted fewer lesions; all had low attenuation, except for the calcifications. Spinal cord MR imaging revealed increased signal intensity in the lateral and dorsal columns on T2-weighted images. Achilles tendon xanthomas displayed intermediate signal intensity on T1- and T2-weighted images. CONCLUSION: The typical pattern of MR imaging findings reflects the classic histopathologic findings and should prompt the diagnosis of CTX.
22668.9723773601990.09.05++[Two-stage splenic rupture leading to the diagnosis of hepatic peliosis]Orv Hetil
Z Gábor, F Back, D Csiffáry,
Rare anomaly: peliosis was found in a young woman, splenectomised for rupture of the spleen. Speculations on the aetiopathogenesis of this peculiar disorder are discussed. Awareness of the pathological curiosity is also of practical relevance, because of the risk of life-threatening haemorrhagic consequences from rupture of the lesions.
22678.9771120621982.10.29++[Chronic defibrination syndrome and thrombocytopenia in splenic hamartoma (splenoma)]Schweiz Med Wochenschr
B Syfrig, HP Rentsch, JO Gebbers, J Laissue,
In a 41-year-old woman who had suffered from hypofibrinogenemia, thrombocytopenia, leukopenia and splenomegaly for several years a causative hamartoma of the spleen (splenoma) was removed surgically. The results of a preoperative therapeutic trial with heparin, the marked accumulation of 125I-activity in the splenoma following intravenous injection of radioiodinated fibrinogen, the immunohistochemical demonstration of extensive fibrinogen deposits in the splenoma, and normalization of fibrinogen levels and blood cell counts after surgery point to the pathogenetic role of this rare splenic tumor. The salient clinical and pathological features of 41 splenoma cases in the literature are briefly reviewed. Hematologic signs were observed in only 9 splenoma patients.
22688.9637621741986.10.30++Inflammatory pseudotumor of the spleen.J Surg Oncol
HD Alpern, JE Olson, AJ Kozak,
Inflammatory pseudotumor of the spleen, an extremely rare benign inflammatory mass lesion, which clinically and radiologically mimics a neoplasm, is presented. The case is compared to the two cases previously reported in the literature. Possibilities of etiology and pathogenesis are considered.
22698.9630717811989.05.15++[A case of pseudocyst of the spleen]Pediatr Med Chir
GF Conte, A Rovelli, G Tornotti, S Sordo,
The authors report a case of pseudocyst of the spleen in a five years old girls whose only complaint was a slight pain in the left upper quadrant. A palpable globular mass was confirmed to be a splenic cyst by instrumental procedures regarded as the first ones to employ in such cases, ultrasonography and CT scan. The diagnosis of pseudocyst was possible only after the surgical spleen removal when the absence of an epithelial lining was histologically found. A short excurses on splenic cysts, from etiology to therapy, follows. Moreover the after splenectomy management of paediatric patients is discussed.
22708.96159657772005.09.13++Hepatosplenic brucelloma: clinical presentation and imaging features in six cases.Abdom Imaging
E Ruiz Carazo, F Muñoz Parra, MP Jiménez Villares, M del Mar Castellano García, SL Moyano Calvente, A Medina Benítez,
BACKGROUND: We conducted a retrospective analysis of the clinical presentation and the computed tomographic (CT) and ultrasound (US) findings in six episodes of hepatosplenic brucelloma in five patients. METHODS: In four episodes, the diagnosis was based on clinical history, serology, and characteristic imaging findings. In the other two episodes in the same patient, the diagnosis was suspected after a biopsy was taken. CT was performed in all six cases and US in five. RESULTS: On US, brucellomas were iso- or hypoechogenic with the liver. Hyperechogenic masses were seen in one patient. Brucellomas were very poorly defined and contained small scattered cystic areas. All lesions showed central or marginal gross focal calcification, except multiple lesions in one patient. Contrast-enhanced CT showed predominantly solid masses with irregular borders and fine or thick enhancing trabeculations separating hypodense solid areas and/or small cystic areas. Two patients showed transdiaphragmatic lung invasion by brucelloma, a complication not previously published. CONCLUSION: In regions where brucellosis is endemic, brucelloma should be included in the differential diagnosis if a hepatic or splenic mass with irregular borders and central or marginal gross focal calcification is detected, and contrast-enhanced CT shows enhancing trabeculations that separate hypodense solid areas and/or small liquid collections.
22718.9478924921995.04.14++Central nervous system tumor, infection, and infarction: detection with gadolinium-enhanced magnetization transfer MR imaging.Radiology
RC Mehta, GB Pike, SP Haros, DR Enzmann,
PURPOSE: To quantitatively measure the degree of contrast enhancement of central nervous system (CNS) tumor, infection, and infarction by means of magnetization transfer (MT) magnetic resonance (MR) imaging. MATERIALS AND METHODS: T1-weighted MR images obtained before and after administration of contrast material with and without MT in 14 patients with CNS tumors were evaluated by means of a contrast-to-noise ratio (C/N). Another 72 patients with a variety of lesions underwent contrast material-enhanced T1-weighted MR imaging prospectively with and without MT; C/N was also evaluated. RESULTS: All lesions had a higher C/N on T1-weighted postcontrast MT images than on conventional images. C/N was 65 +/- 5 (mean +/- standard error) for MT and 42 +/- 4 for conventional images. C/N improved by a factor of 1.6-2.1 in the three disease categories. In intracranial tumors, the MT technique itself did not contribute significantly (P < .001) to the increase in C/N in the absence of gadopentetate dimeglumine. In fact, the C/N was lower for nonenhanced T1-weighted MT images. CONCLUSION: Concurrent use of gadopentetate dimeglumine and MT results in a statistically significant (P < .001) increase in C/N in CNS tumor, infection, and infarction.
22728.9485375311996.02.07++Detection of hypervascular hepatocellular carcinoma by dynamic MRI and dynamic spiral CT.J Comput Assist Tomogr
T Kim, T Murakami, H Oi, M Matsushita, H Kishimoto, H Igarashi, H Nakamura, J Okamura,
OBJECTIVE: Our goal was to evaluate the detectability of hypervascular hepatocellular carcinomas (HCCs) by multislice dynamic MRI and dynamic spiral CT. MATERIALS AND METHODS: Prior to transcatheter arterial chemoembolization (TACE) with iodized oil, the liver was subjected to T1- and T2-weighted SE-MRI, multislice dynamic MRI after intravenous bolus injection of Gd-DTPA, early phase imaging with spiral CT (dynamic spiral CT) after intravenous bolus injection of contrast medium (at a rate of 2 or 3 ml/s), and delayed phase CT in 64 patients with 208 HCC nodules. The detectability of HCCs by MRI and CT was evaluated retrospectively compared with CT after TACE as a gold standard. RESULTS: The detectability of nodules < 1 cm in diameter was superior with dynamic MRI (67%) and dynamic spiral CT (50%) in comparison with SE-MRI (26%) and delayed phase CT (11%) (p < 0.01). The detectability of these tumors with dynamic MRI was significantly superior to that with dynamic spiral CT using an injection rate of 2 ml/s (p < 0.01), but not significantly different from that of dynamic spiral CT using a rate of 3 ml/s. CONCLUSION: Dynamic MRI and dynamic spiral CT are comparable for detecting hypervascular intrahepatic metastases of HCC.
22738.9484316941993.03.18++Hookwire localizer as an aid for ultrasonic detection of small liver nodules.Abdom Imaging
H Kasugai, T Fukuzaki, A Inoue, S Tanaka, M Tatsuta, T Kitamra, S Okuda, M Fujita, Y Sasaki, S Imaoka,
We applied a V-shaped localizer and evaluated its clinical usefulness in nine patients with small hepatic nodules less than 2 cm in diameter. A small hepatic nodule was punctured with a 21-gauge localization needle under ultrasonic guidance, and the V-shaped localizer was pushed into the nodule with a wire. The localizer could be observed as a strong echo line by ultrasonography and as a high-density bar by computed tomography (CT). By this method, it was possible to precisely localize the nodule. Intraoperative ultrasonography became less time-consuming, and resection of the nodules could be confirmed with low-kilovoltage radiography.
22748.93106617712000.02.29++Resection of metastatic melanoma following wire localization guided by computed tomography or ultrasound.Melanoma Res
LK Rodrigues, FA Habib, M Wilson, L Turek, RK Kerlan, SP Leong,
Melanoma is an aggressive tumour with the propensity to metastasize through the lymphatic system and blood. Patients at high risk for developing metastatic disease are evaluated clinically together with chest X-rays and when indicated computed tomography (CT) scans. Wire localization is routinely used in non-palpable breast cancer to facilitate surgical resection. This study demonstrates the applicability of wire localization and surgical resection of non-palpable, deep subcutaneous or Intramuscular metastatic melanoma detected by CT or ultrasound. The medical records of six patients with malignant melanoma were retrospectively reviewed. Each patient with malignant melanoma developed metastatic involvement detected by CT scan or ultrasound at the UCSF/Mount Zion Medical Center, California, USA. A Copanz needle was inserted into the tumours under local anaesthesia. The patients were transported to the operating room and underwent wire-guided surgical resection of the tumour under general anaesthesia or intravenous sedation. In all six patients the tumour was successfully resected following CT- or ultrasound-guided wire localization of the metastatic foci. In conclusion, nonpalpable metastatic melanoma may be resected using CT-or ultrasound-guided wire localization. This technique offers several advantages, Including minimal surgical dissection, shorter operative times and decreased postoperative morbidity.
22758.9320045211991.04.24++CT scanning in epidural lymphoma.Clin Radiol
D MacVicar, MP Williams,
This study describes the clinical features and CT findings in 18 patients with epidural lymphoma seen in a large oncology hospital over a four-year period. The variety of CT appearances seen in epidural lymphoma are illustrated. The importance of recognition of small volume epidural disease on body CT is stressed. Patients with apparently minor CT abnormalities may have significant epidural disease. The prognosis for these patients with minimal symptoms and small volume disease is much better than for those with classical signs of cord compression and more obvious abnormalities on imaging.
22768.9397541051998.10.15+ Spontaneous hemorrhage of abdominal splenosis.J Comput Assist Tomogr
DS Katz, M Moshiri, G Smith, EM Meiner, AA Fruauff,
22778.925770521977.06.30++Florid epithelioid cell and sarcoid-type reaction associated with non-Hodgkin's lymphoma.S Afr Med J
LB Kahn, H King, P Jacobs,
Five patients suffering from non-Hodgkin's lymphoma associated with an intense infiltration of epithelioid histiocytes and even sarcoid-type granulomas in the involved tissue are described. A similar tissue reaction, at both involved and uninvolved sites, has been described in patients with Hodgkin's disease. The cause of this reaction may be immunological; its prognostic significance still awaits elucidation. In the case of non-Hodgkin's lymphomas, it may cause difficulty in diagnosis of lymphoma and hence may result in unnecessary delay in the initiation of therapy.
22788.92101837051992.08.27+ MRI best modality for neuroimaging of AIDS.Diagn Imaging (San Franc)
H Carswell,
22798.9297725431998.11.09+ [Relation between AIDS, spleen and splenectomy]Zhonghua Yi Xue Za Zhi
Q Qui, W Chen,
22808.9220160261991.05.23++Systemic amyloidosis presenting as splenic tumor.Gastrointest Radiol
TY Liu, SC Chen, LY Wang, WL Chuang, WY Chang, CS Liu,
We report a case of amyloidosis manifesting as a splenic tumor and pleural effusion. Only one case of a splenic amyloid tumor has been reported in the literature, but its radiological findings were not described. Therefore, we present the computed tomographic (CT), sonographic, and angiographic features of splenic amyloid tumor.
22818.92104057151999.07.28++Diagnosis and staging of ovarian cancer: comparative values of Doppler and conventional US, CT, and MR imaging correlated with surgery and histopathologic analysis--report of the Radiology Diagnostic Oncology Group.Radiology
AB Kurtz, JV Tsimikas, CM Tempany, UM Hamper, PH Arger, RL Bree, RJ Wechsler, IR Francis, JE Kuhlman, ES Siegelman, DG Mitchell, SG Silverman, DL Brown, S Sheth, BG Coleman, JH Ellis, RJ Kurman, DJ Caudry, BJ McNeil,
PURPOSE: To determine the optimal imaging modality for diagnosis and staging of ovarian cancer. MATERIALS AND METHODS: Two hundred eighty women suspected to have ovarian cancer were enrolled in a prospective study before surgery. Doppler ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging were used to evaluate the mass; conventional US, CT, and MR imaging were used to stage spread. RESULTS: All three modalities had high accuracy (0.91) for the overall diagnosis of malignancy. In the ovaries, the accuracy of MR imaging (0.91) was higher than that of CT and significantly higher than that of Doppler US (0.78). In the extraovarian pelvis and in the abdomen, conventional US, CT, and MR imaging had similar accuracies (0.87-0.95). In differentiation of disease confined to the pelvis from abdominal spread, the specificity of conventional US (96%) was higher than that of CT and significantly higher than that of MR imaging (88%), whereas the sensitivities of MR imaging (98%) and CT (92%) were significantly higher than that of conventional US (75%). CONCLUSION: MR imaging is superior to Doppler US and CT in diagnosis of malignant ovarian masses. There is little variation among conventional US, CT, and MR imaging as regards staging.
22828.9287553291996.10.21++[Splenic infarction]Rev Esp Enferm Dig
J Cuquerella, L Ferrer, P Rivera, JA Tuset, E Medina, S Pamós, V Ariete, A Tomé, V García,
A 53-year-old male suffered splenic infarction etiologically related to atrial fibrillation and non-obstructive hypertrophic cardiomyopathy. The main clinical manifestations were a one-month history of epigastric and left upper quadrant pain, with tenderness to palpation in the later zone. Laboratory tests revealed a slight leucocytosis (14.700) with left shift and a marked increase in LDH concentration (945 IU). Abdominal CAT and arteriography established the diagnosis, Echography proved normal. Patient evolution was satisfactory with conservative medical treatment. We conclude that splenic infarction should be considered in all cases of acute or chronic pain in the left hypochondrium. The diagnosis is established by CAT, arteriography and hepatosplenic gammagraphy. Medical management is initially advocated, surgery being reserved for those cases involving complications or in which diagnosis is not clear. Emphasis is placed on the main etiological, clinical, diagnostic and management characteristics of splenic infarction.
22838.9195302981998.04.16++Hepatic hemangioma: quantitative color power US angiography--facts and fallacies.Radiology
LK Young, WT Yang, KW Chan, C Metreweli,
PURPOSE: To explore the origin of signals detected with color power ultrasound (US) angiography (CPA) and evaluate a semiquantitative method to assess signals in hepatic hemangiomas. MATERIALS AND METHODS: Twenty-four adult patients with 27 hepatic hemangiomas (< 2 cm in diameter) and five patients with five hyperechoic hepatic metastases underwent CPA and conventional color Doppler US in this prospective study. A sponge phantom was studied to determine whether the origin of CPA signals was related to architecture. The mean number of signals and the signal density in each lesion were scored. RESULTS: A "diffuse blush" was seen in all capillary hemangiomas at CPA, whereas no signal was seen at color Doppler US. The sponge phantom test produced a CPA appearance similar to that of capillary hemangiomas. Quantitative analysis of CPA images of hepatic hemangiomas showed a mean of 16.1 signals per cubic centimeter and a mean signal area of 25%. Hyperechoic avascular hepatic metastases resulted in CPA images similar to those of hepatic hemangiomas, with no quantitative difference in signal count, despite a mild qualitative difference at CPA. CONCLUSION: CPA signals in hepatic hemangiomas appear to be related more to architecture than to true capillary flow. There is a qualitative difference in the strength of the blush at CPA between hepatic hemangiomas and metastases, which may be the only possible differentiating factor.
22848.9191844401997.08.29++Microcystic meningioma without enhancement on neuroimaging--case report.Neurol Med Chir (Tokyo)
Y Kubota, T Ueda, Y Kagawa, N Sakai, A Hara,
A 63-year-old female presented with an unusual case of microcystic meningioma manifesting as a 4-year history of unsteady gait, dysarthria, and hearing loss. Computed tomography disclosed a large hypodense mass in the right cerebellopontine angle, clivus, and middle fossa, with slight contrast enhancement. T1-weighted magnetic resonance images demonstrated the lesion as a hypointense mass, which was little enhanced gadolinium-diethylenetriaminepenta-acetic acid. Right carotid angiography revealed blood supply from the external carotid artery, but no tumor staining. The extracerebral tumor was subtotally removed. The histological diagnosis was microcystic meningioma. Light microscopy revealed abundant microcystic throughout the tumor tissue, and electron microscopy disclosed that the microcysts were mostly located in the extracellular spaces and only a few in the cytoplasm. Microcystic meningioma without enhancement is rare and should be differentiated from low-grade astrocytoma, epidermoid, or other non-enhanced tumor.
22858.9191756601997.07.22+ Splenic pneumocystosis in AIDS: unusual ultrasound appearances.Int J STD AIDS
CJ Harvey, AG Rockall, WR Lees, RF Miller,
22868.9121320341992.01.02++[Splenic cysts]Chir Ital
F Cabano, A Venegoni, A De Medici,
The authors describe a case of splenic cyst recently observed. After remembering the nomenclature and pathogenetic hypothesis, they consider clinical patterns and emphasize pathological findings, diagnostic aids, especially noninvasive imaging. Authors discuss why the cyst was probably hydatid one, although histologic examination did not show scolices, and believe that the treatment of choice is splenectomy.
22878.9181920181994.06.22+ Gastrointestinal case of the day. Pancreatic abscess due to Pneumocystis carinii.AJR Am J Roentgenol
ME Fischer, CJ Kasales, DB Kelley,
22888.9134202461988.10.17++Multiple sclerosis: serial study of gadolinium-enhanced MR imaging.Radiology
RI Grossman, BH Braffman, JR Brorson, HI Goldberg, DH Silberberg, F Gonzalez-Scarano,
Thirteen patients with definite multiple sclerosis (MS), studied 16-24 months previously with magnetic resonance (MR) imaging with and without enhancement by intravenously administered gadolinium diethylenetriaminepentaacetic acid (DTPA) dimeglumine, were reexamined with a similar protocol. Assessment of enhancement and clinical activity in both studies revealed that enhancement was observed in 13 of 14 cases in which clinical activity had changed within 4 weeks of the study and thus appeared more sensitive than clinical examination in determining active disease. The 3-minute postinjection, short repetition time image (TR) was the most efficient for depicting enhancement. Enhancing lesions (active plaques) arose from previously hyper- or isointense regions on long TR images. Previously active lesions reverted to areas of iso- or hyperintensity on long TR images. Serial comparison of long TR images in this population reveals a decrease in high-intensity lesions on long TR images in some cases and an increase in others. The findings of high-intensity regions on long TR images and previously enhancing lesions both becoming isointense suggests that transient inflammatory changes with concomitant edema without demyelination and/or with significant remyelination may occur in some MS lesions. MS lesions are dynamic; both active and inactive lesions may show dramatic change on longitudinal MR imaging studies.
22898.9191328461997.04.28+ [Constitutional syndrome in a 55-year-old woman. Cervical adenopathy and giant splenomegaly with nodular images in CAT and MR]Rev Clin Esp
J Carmena, C Tornero, MA González, E Pons,
22908.9021883111990.06.28++Fibrous dysplasia.Radiographics
MJ Kransdorf, RP Moser, FW Gilkey,
Skeletal fibrous dysplasia is a developmental anomaly in which normal bone marrow is replaced by fibroosseous tissue. This process may be localized to a single bone, or even a small segment thereof, or affect the skeleton diffusely. The radiologic archives of the Armed Forces Institute of Pathology (AFIP) contain 501 cases of histologically proved and radiographically correlated fibrous dysplasia (of which 427 cases are monostotic and 74 cases are polyostotic). We present the spectrum of radiologic findings, including those from bone scintigraphy, computed tomography, and magnetic resonance imaging, augmented where appropriate by accompanying pathologic material.
22918.9062134961982.10.21+ [Computed tomography for injuries of the liver and spleen (author's transl)]Rofo
R Schöpf, C Fretz, M Haertel,
22928.9077882301995.07.27++Magnetic resonance imaging in the detection of focal liver lesions: comparison of dynamic contrast-enhanced TurboFLASH and T2 weighted spin echo images.Br J Radiol
J Ward, CJ Baudouin, JP Ridgway, PJ Robinson,
In a previous study using dynamic contrast-enhanced TurboFLASH (DCETF) for demonstration of the portal venous system we found that this technique showed more liver lesions than T2 weighted spin echo (T2WSE) imaging in the same patients. In this study we have formally compared axial T2WSE images (TR 2000, TE 45/90) with TurboFLASH images (TR 135, TE 4, FA 80 degrees) acquired immediately after bolus injection of Gd-DTPA (0.1 mmol kg-1) in 41 patients referred for hepatic magnetic resonance imaging (MRI) prior to surgery for liver lesions. The images of each sequence were independently reviewed by two observers. The lesions were counted and each sequence was scored for conspicuity, level of artefact and subjective image quality. Contrast-to-noise ratios using user defined regions of interest were calculated. Significantly more lesions were seen on DCETF (n = 186) images than on T2WSE (n = 123) images (p < 0.001). Lesion conspicuity was equal in 53% of cases, better on DCETF in 36% and better on T2WSE in 11%. Contrast-to-noise ratios were significantly higher on DCETF images (p < 0.05). DCETF imaging provided a substantial improvement in lesion detection compared with T2WSE imaging.
22938.9081804381994.06.14++Sequential magnetic resonance features of encephalopathy induced by systemic mastocytosis.Intern Med
Y Tajima, K Hamada, H Houzenn, E Tsukishima, Y Owada, F Moriwaka, M Musashi, T Miyazaki, T Hamada, K Tashiro,
A 37-year-old man developed encephalopathy with prominent eosinophilia. Magnetic resonance imaging (MRI) revealed multiple T2-weighted high signal intensity lesions with dimeglumine gadopentetate (Gd-DTPA) enhancement on T1-weighted images, which were distributed in the cerebral cortex, thalamus, deep white matter and cerebellum. He was diagnosed as having systemic mastocytosis on the basis of proliferating mast cells in the bone marrow and peripheral eosinophilia. Following steroid administration, there was a rapid improvement of his symptoms and laboratory data. To our knowledge, this was the first reported case of systemic mastocytosis provoking encephalopathy with serial MRI findings.
22948.8937045511986.05.28++Red pulp in splenomegaly syndrome: morphometric light and electron microscopy studies.Scand J Haematol
O Myhre Jensen, J Kristensen,
From a series of consecutively studied spleens, perfusion-fixed and investigated according to a standardized procedure allowing morphometric investigations at the light and electron microscopic levels, 33 spleens causing splenomegaly syndrome (12 lymphoproliferative diseases, 10 hairy cell leukaemia, 11 myeloproliferative diseases) were compared with data in controls and autoimmune haemolytic anaemia and hereditary spherocytosis from previous studies. In splenomegaly syndrome, especially in hairy cell leukaemia and myeloproliferative diseases, less so in lymphoproliferative diseases, there is a disproportionate increase in the volume of pulp cords in the red pulp. Values for erythrocyte volume density are of the same order as splenic erythrocyte concentration determined by scintigraphic kinetic methods. Cases with complicating immunohaemolysis show a rather high proportion of erythrocyte profiles with nearly spheric shape as in autoimmune haemolytic anaemia and hereditary spherocytosis.
22958.89111277532001.01.18++Fine needle aspiration cytology of lymph nodes in HIV-infected individuals.Acta Cytol
G Jayaram, MT Chew,
OBJECTIVE: To assess the role of fine needle aspiration cytology (FNAC) in lymphadenopathy in human immunodeficiency virus-infected individuals (HIVII). STUDY DESIGN: Thirty-nine HIVII presenting with lymphadenopathy at University Hospital, Kuala Lumpur, were subjected to FNAC. Cytologic smears were routinely stained with May-Grünwald-Giemsa stain. Special stains and immunostains were used when necessary. RESULTS: In nine cases, the cytologic appearance was compatible with HIV type A and in one case with HIV type C lymphadenopathy. In 21 cases, acid-fast bacilli (AFB) were demonstrated in the cytologic smears, enabling a diagnosis of mycobacterial lymphadenitis. In one of these cases there was a concomitant infection with Penicillium marneffei that was overlooked on initial cytologic examination. The cause of granulomatous lymphadenitis could not be ascertained in one case, where neither AFB nor any other organisms were demonstrable. Two cases of histoplasma and one of cryptococcal lymphadenitis were diagnosed, as was one high grade non-Hodgkin's lymphoma that could be immunophenotyped on cytologic material. In three cases the aspirates were inadequate for a cytologic diagnosis. CONCLUSION: Lymph node FNAC is a valuable investigative modality in HIVII. Most opportunistic infections (bacterial and fungal) can be correctly identified, and high grade lymphoma can be diagnosed and phenotyped.
22968.8935206551986.07.16++Hepatic adenomas and focal nodular hyperplasia: dynamic CT study.Radiology
D Mathieu, JN Bruneton, J Drouillard, CC Pointreau, N Vasile,
A retrospective, multi-institutional study was carried out on a series of 50 histologically proved benign hepatic tumors. The 27 hepatic adenomas (HAs) and 23 cases of focal nodular hyperplasia (FNH) were studied with ultrasonography (US) and dynamic computed tomography (CT). Angiography was performed in 26 cases (15 HAs, 11 FNHs); scintigraphy was not used because of its cost. US scans proved nonspecific. CT scans demonstrated hemorrhage in five HAs and were useful in characterizing tumoral vascularity and any intratumoral features such as necrosis or central fibrous scar. The presence of arterial vessels (five patients) in the projection of this central fibrous scar is suggestive of FNH. Dynamic CT scans did not show the type of tumor in most cases. In cases with lesions greater than 3 cm for which doubt as to the diagnosis persists, combined use of morphologic data, scintigraphy, dynamic CT scanning, and angiography can guide the therapeutic decision: surgery or follow-up CT study after use of oral contraceptives is stopped.
22978.89111590772001.04.26++Sonographic detection of Baker's cysts: comparison with MR imaging.AJR Am J Roentgenol
EE Ward, JA Jacobson, DP Fessell, CW Hayes, M van Holsbeeck,
OBJECTIVE: The objective of this study was to assess the ability of sonography to reveal Baker's cysts using MR imaging as a gold standard. MATERIALS AND METHODS: The study group consisted of 36 consecutive knees in 36 patients evaluated with both MR imaging and sonography. Inclusion criteria included axial proton density-weighted or T2-weighted MR images, a sonography report that documented the evaluation of the popliteal region of the knee, and sonographic and MR images that were available for review. The MR images were retrospectively reviewed for the presence of Baker's cyst (fluid signal between the semimembranosus and medial gastrocnemius tendons). Sonography reports were compared with the MR imaging results. The sonographic images were also retrospectively reviewed to determine whether any characteristic findings on sonography were significantly associated with the presence of Baker's cyst on MR imaging. RESULTS: Retrospective review of MR images revealed 21 Baker's cysts, one myxoid liposarcoma, one meniscal cyst, and 13 examinations with normal findings. The sonography reports revealed that the 21 Baker's cysts were correctly diagnosed, whereas the meniscal cyst and myxoid liposarcoma were misdiagnosed as Baker's cysts. Retrospective review of sonographic images showed a 100% sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in the diagnosis of Baker's cyst when hypoechoic or anechoic fluid was present between the semimembranosus and medial gastrocnemius tendons. No other sonographic characteristics were significant. CONCLUSION: Identification of fluid between the semimembranosus and medial gastrocnemius tendons in communication with a posterior knee cyst indicates Baker's cyst with 100% accuracy.
22988.89158339792005.06.28++Apparent diffusion coefficient of human brain tumors at MR imaging.Radiology
F Yamasaki, K Kurisu, K Satoh, K Arita, K Sugiyama, M Ohtaki, J Takaba, A Tominaga, R Hanaya, H Yoshioka, S Hama, Y Ito, Y Kajiwara, K Yahara, T Saito, MA Thohar,
PURPOSE: To determine if apparent diffusion coefficient (ADC) can be used to differentiate brain tumors at magnetic resonance (MR) imaging. MATERIALS AND METHODS: Institutional review board approval or informed patient consent was not required. MR images were reviewed retrospectively in 275 patients with brain tumors: 147 males and 128 females 1-81 years old, treated between September 1997 and July 2003. Regions of interest were placed manually in tumor regions on MR images, and ADC was calculated with a five-point regression method at b values of 0, 250, 500, 750, and 1000 sec/mm2. ADC values were average values in tumor. All brain tumor subgroups were analyzed. Logistic discriminant analysis was performed by using ADC, age, and patient sex as independent variables to discriminate among tumor groups. RESULTS: A significant negative correlation existed between ADC and astrocytic tumors of World Health Organization grades 2-4 (grade 2 vs grades 3 and 4, accuracy of 91.3% [P < .01]; grade 3 vs 4, accuracy of 82.4% [P < .01]). ADC of dysembryoplastic neuroepithelial tumors (DNTs) was higher than that of astrocytic grade 2 tumors (accuracy, 100%) and other glioneuronal tumors. ADC of malignant lymphomas was lower than that of glioblastomas and metastatic tumors (accuracy, 83.6%; P < .01). ADC of primitive neuroectodermal tumors (PNETs) was lower than that of ependymomas (accuracy, 100%). ADC of meningiomas was lower than that of schwannomas (accuracy, 92.4%; P < .01). ADC of craniopharyngiomas was higher than that of pituitary adenomas (accuracy, 85.2%; P < .05). ADC of epidermoid tumors was lower than that of chordomas (accuracy, 100%). In meningiomas, ADC was not indicative of malignancy grade or histologic subtype. CONCLUSION: ADC is useful for differentiation of some human brain tumors, particularly DNT, malignant lymphomas versus glioblastomas and metastatic tumors, and ependymomas versus PNETs.
22998.89108736892000.07.18++Magnetic resonance imaging of spinal plasmacytoma.Clin Radiol
BK Shah, A Saifuddin, GJ Price,
AIM: To describe the magnetic resonance imaging (MRI) features of spinal plasmacytoma.MATERIALS AND METHODS: The clinical records and MRI findings in six patients (five men, one woman; age range 41-61 years) with histologically proven plasmacytoma of the spine were reviewed. All studies included sagittal T1- and T2-weighted spin-echo sequences and axial T1-weighted spin-echo sequences. Intravenous gadolinium DTPA was administered in four cases.RESULTS: MRI showed a characteristic appearances in four cases of low signal intensity curvilinear areas within the vertebra or cortical irregularity.CONCLUSION: Recognition of these imaging features can initiate the appropriate investigation as the commonest differential diagnosis for such lesions is metastasis.Shah, B. K. (2000). Clinical Radiology55, 439-445.
23008.89110375432000.11.03+ Staging evaluation for patients with Hodgkin's disease. American College of Radiology. ACR Appropriateness Criteria.Radiology
HB Wolkov, AJ Elman, RT Hoppe, DA Pistenmaa, PM Mauch, LS Constine, RL Deming, DE Dosoretz, LR Prosnitz, J Yahalom, A Chauvenet, JM Connors, JH Glick, S Leibel,
23018.88154862342005.11.08++From the RSNA refresher courses: a practical approach to the cystic renal mass.Radiographics
DS Hartman, PL Choyke, MS Hartman,
The pathologic and imaging features of the renal cyst have been well described. A fluid-filled lesion is considered a cystic mass (ie, not a simple cyst) when it has any of the following features: calcification, high attenuation (>20 HU) at computed tomography, signal intensity not typical of water at magnetic resonance imaging, septations, multiple locules, enhancement, wall thickening, or nodularity. There are two important causes of a cystic renal mass: a complicated simple cyst (eg, one with hemorrhage, infection, or ischemia) and cystic renal cell carcinoma. At radiologic evaluation of such masses, it is imperative that optimal imaging techniques be used. Masses with calcification, high attenuation or high signal intensity, or septations can be categorized as benign (no further evaluation required), as requiring follow-up (probably benign), or as requiring surgery. Lesions requiring surgery can be benign or malignant at microscopic examination. Lesions that are multiloculated or demonstrate enhancement, wall thickening, or nodularity usually require surgery. When multiple features are present (eg, calcification and enhancement), the mass should be managed according to its most aggressive feature. Likewise, when there are conflicting findings at evaluation with different imaging modalities, the mass should be managed according to the most aggressive finding.
23028.8887339651996.10.24+ Radiologic-pathologic correlation: meningioma of the optic nerve sheath.AJNR Am J Neuroradiol
O Ortiz, SS Schochet, JM Kotzan, D Kostick,
23038.8884243751993.02.24+ Capsular retraction in hepatic tumors.AJR Am J Roentgenol
E Outwater,
23048.88104778921999.10.21++Sonographic detection of multiple Staphylococcus aureus hepatic microabscesses mimicking Candida abscesses.J Clin Ultrasound
J Verbanck, J Ponette, M Verbanck, I Vandewiele, M Segaert,
We report the sonographic, CT, and clinical findings in a patient presenting with clinical sepsis and multiple Staphylococcus aureus hepatic microabscesses. Although contrast-enhanced CT has had a higher sensitivity than sonography in detecting hepatic microabscesses in some studies, this examination was negative in our patient. On sonography, numerous small hypoechoic lesions were present. Some target-like lesions had a striking similarity to Candida albicans microabscesses. The hepatic lesions were believed to be pyogenic liver microabscesses, as several blood cultures were positive for S. aureus. Following prolonged intravenous antibiotic therapy, all the hypoechoic hepatic lesions disappeared, along with the clinical and biochemical signs of sepsis.
23058.8848116871974.04.02+ Radiotherapeutic implications of prospective staging in non-Hodgkin's lymphoma.Radiology
RE Johnson, PB Chretien, GT O'Conor, VT DeVita, LB Thomas,
23068.8823145841990.04.17++Leptomeningeal metastasis: a comparison of gadolinium-enhanced MR and contrast-enhanced CT of the brain.Neurology
MC Chamberlain, AD Sandy, GA Press,
We evaluated 14 consecutive patients with leptomeningeal metastasis prospectively, using both T1-weighted (T1W) gadolinium-DTPA-enhanced MR (Gd-MR) and contrast-enhanced CT (CE-CT). Thirteen had positive CSF cytology; the remaining patient had an atypical CSF lymphocytosis and primary CNS lymphoma. The patients (8M/6F) ranged in age from 8 to 70 years (median, 42 years). Tumor histology included 3 systemic and 2 primary CNS lymphomas, 3 breast carcinomas, 2 leukemias, 1 malignant schwannoma, 1 small cell lung cancer, 1 prostate cancer, and 1 melanoma. Both imaging methods demonstrated parenchymal volume loss equally well in all patients. Gd-MR revealed abnormal enhancement of meninges or parenchyma in 10 patients, including all 5 patients with positive CE-CT. Neither technique revealed any foci of abnormal enhancement in 4 patients. Gd-MR was superior to CE-CT in demonstrating and quantifying enhancing subarachnoid and parenchymal nodules in 6 patients and in demonstrating sulcal, dural, cisternal, tentorial, and ependymal enhancement. Our findings indicate that T1W Gd-MR is the preferred imaging modality in leptomeningeal metastasis and suggest that CE-CT is unnecessary.
23078.87110697392001.02.15++Percutaneous drainage of hydatid cyst in the liver as a primary treatment: review of 52 consecutive cases with long-term follow-up.Clin Radiol
ZB Bosanac, L Lisanin,
AIM: To evaluate the suitability of percutaneous drainage as a primary and definitive treatment of hydatid disease of the liver. MATERIALS AND METHODS: Between October 1989 and April 1992, percutaneous drainage was performed on 52 consecutive patients (27 women and 25 men aged 13 to 84 years) with 55 hydatid cysts in the liver. Twenty-five (45%) cysts were type I, 10 (18%) were type II, 14 (25%) were type III, 5 (10%) were type IV and 1 (2%) was type V. All procedures were performed under light sedation and local anaesthetic at the puncture site. The standard Seldinger technique was used. Initial puncture was performed under ultrasound (US) guidance through the liver parenchyma. The rest of the procedure was conducted under fluoroscopic control. Pigtail drainage catheters (size 12-20 Fr) were used, with Betadine (10% povidone iodine; 1% free iodine) being allowed to act within the cyst for 30 min, as a scolicidal agent. RESULTS: All the patients were successfully treated and 6-9 year follow-up involving US, computed tomography (CT) and serology tests showed no local recurrence or spread of the disease. No major (death, cyst rupture, anaphylactic shock) and very few minor complications arose. Two patients had mild skin reaction with nausea requiring no treatment and three patients developed a secondary infection of the cyst, due to prolonged drainage time. These liver abscesses responded successfully to further catheter drainage. Subsequent patients were treated with large bore (18-20 Fr) catheters and none developed secondary infection. Overall drainage time varied from 7-118 days (7-28 days, if we exclude three initial cases who had prolonged drainage). CONCLUSION: It is our strong belief that percutaneous drainage using the above method should be considered a first-line treatment for hydatid disease of the liver.Bosanac, Z. B., Lisanin, L. (2000). Clinical Radiology55, 839-848.
23088.8716278621992.08.17++Gadolinium-enhanced high-resolution MR angiography with adaptive vessel tracking: preliminary results in the intracranial circulation.J Magn Reson Imaging
W Lin, EM Haacke, AS Smith, ME Clampitt,
To overcome problems associated with poor contrast between vessels and background tissue in time-of-flight magnetic resonance angiography, the role of intravenous gadopentetate dimeglumine in conjunction with a postprocessing adaptive vessel tracking scheme was studied. Vessel tracking makes it possible to discriminate arteries from veins, to prevent problems associated with other bright tissues on maximum-intensity projections, and to increase the signal-to-noise ratio. Short, asymmetric, velocity-compensated field echoes were used in conjunction with high-resolution imaging techniques to spatially discriminate between adjacent vessels and stationary background tissue. Gadopentetate dimeglumine was shown to be useful for visualization of small vessels, aneurysms, and regions of slow flow, when used with this post-processing scheme.
23098.8785968391996.04.16++Normal ovaries and functional cysts: MR appearance.Radiology
EK Outwater, DG Mitchell,
PURPOSE: To evaluate characteristics of functional cysts and stroma in normal ovaries on magnetic resonance (MR) images. MATERIALS AND METHODS: Fifty-six women with at least one surgically proved normal ovary underwent MR imaging. Gadolinium-enhanced fat-saturated images were obtained in 32 patients. Ovary and cyst sizes and the number of cysts were recorded. Signal intensity was rated for the ovarian stroma and cysts. RESULTS: On T2-weighted images, 57 of 82 (70%) ovaries showed a zonal differentiation. Ovarian stroma enhanced less than myometrium in 30 of 43 cases. Zonal anatomy and degree of enhancement correlated with patient age and menopausal status. Cyst walls had lower signal intensity on T2-weighted images than ovarian stroma in 49 of 74 cases and showed greater enhancement in 21 of 35. CONCLUSION: Most normal premenopausal ovaries exhibit distinct features of a zonal anatomy, whereas postmenopausal ovaries do not. Cysts with discrete enhancing walls were numerous and were found in all age groups.
23108.86103970941999.07.28++Imaging of adrenal tumors using FDG PET: comparison of benign and malignant lesions.AJR Am J Roentgenol
S Maurea, C Mainolfi, L Bazzicalupo, MR Panico, C Imparato, B Alfano, M Ziviello, M Salvatore,
OBJECTIVE: The aim of this study was to differentiate benign from malignant adrenal tumors using positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) in patients with unilateral adrenal masses originally detected by CT or MR imaging. CONCLUSION: PET imaging with FDG can metabolically characterize adrenal masses. Abnormally increased FDG uptake in adrenal malignancies allows one to differentiate these abnormalities from benign lesions. Whole-body PET can also reveal extraadrenal tumor sites in patients with malignant tumors, using a single imaging technique for accurate disease staging.
23118.8635053801989.02.21+ [Conservative treatment of injuries of the spleen]Tunis Med
T Ben Slimane, K Slim, K Bardi, N Bel Hadj, S Larguèche, R Mzabi,
23128.86119068622002.04.12++Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients.AJR Am J Roentgenol
M Macari, J Hines, E Balthazar, A Megibow,
OBJECTIVE: Our objective was to determine the clinical significance of mesenteric adentitis when detected on CT. MATERIALS AND METHODS: Mesenteric adenitis was considered present if a cluster of three or more lymph nodes measuring 5 mm or greater each was present in the right lower quadrant mesentery. If no other abnormality was detected on CT, then mesenteric adenitis was considered primary. If a specific inflammatory process was detected in addition to the lymphadenopathy, then mesenteric adenitis was considered secondary. Patients with a known neoplasm or HIV infection were excluded. Three separate groups of patients were examined for the presence and cause of mesenteric adenitis. Group 1 consisted of 60 consecutive patients prospectively identified with mesenteric adenitis on CT examinations. Group 2 consisted of 60 consecutive patients undergoing abdominal and pelvic CT for evaluation of blunt or penetrating abdominal trauma. Group 3 consisted of 60 consecutive patients undergoing abdominal and pelvic CT with acute abdominal symptoms. In all patients, the indication for imaging was documented, and the size of the largest lymph node, when present, was measured. In patients with mesenteric adenitis, the CT findings, clinical history, and clinical or surgical follow-up were subsequently evaluated to determine the cause of mesenteric adenitis. RESULTS: In the 60 patients prospectively identified with CT findings of mesenteric adenitis (group 1), 18 (30%) of 60 had primary mesenteric adenitis. The remaining 42 patients (70%) had an associated inflammatory condition that was established on CT as the likely cause of mesenteric adenitis. Mesenteric adenitis was present in none (0%) of the 60 patients in group 2 and in five (8.3%) of 60 patients in group 3. CONCLUSION: The incidence of mesenteric adenitis in patients with and those without abdominal pain is low. When evidence of mesenteric adenitis is present on CT examinations, usually a specific diagnosis can be established as its cause.
23138.8670484961982.09.24+ [Giant follicular lymphoma and schistosomiasis mansoni]Rev Inst Med Trop Sao Paulo
RA Paes, C Marigo,
23148.85115853962002.04.05++Unilocular hepatic echinococcal cysts: sonography and computed tomography findings.Clin Radiol
MC Haddad, GA Birjawi, RA Khouzami, NJ Khoury, YR El-Zein, AO Al-Kutoubi,
AIM: In endemic regions, unilocular hepatic echinococcal cysts (HEC) may be difficult to differentiate radiologically from simple non-parasitic cysts, especially if serological tests were negative. The aim of this descriptive study is to elucidate distinctive imaging findings that allow a diagnosis of HEC. MATERIALS AND METHODS: The sonographic and computed tomography (CT) findings of 21 patients with proven unilocular HEC were retrospectively analysed. A total of 28 examinations were reviewed, including 14 sonograms (ultrasound; US) of the liver and 14 CT studies. RESULTS: Seven imaging features that help in the diagnosis of unilocular HEC were identified by US and/or CT in 14 patients (14/21; 66.6%). They are, by order of frequency: hydatid sand (29.2%), focal or segmental thickening of the cyst wall (29.2%), coexistent echinococcal cysts in the spleen or lungs (16.6%), pericystic biliary radicles dilatation (8.3%), atrophy of the right lobe with compensatory hypertrophy of the left hepatic lobe (8.3%), satellite cysts typical of HEC in the liver (4.2%) and pericyst calcification (4.2%). CONCLUSION: These ancillary signs should prompt us to consider HEC as the cause of a unilocular cyst in approximately two-thirds of patients.
23158.8598432871998.12.16++Optimizing contrast enhancement during helical CT of the liver: a comparison of two bolus tracking techniques.AJR Am J Roentgenol
GD Schweiger, PJ Chang, BP Brown,
OBJECTIVE: The purpose of this study was to evaluate a recently developed hardware and software system for CT scanning that generates images in real time and switches to helical CT scanning by either a visual cue or a region of interest (ROI) amplitude threshold. SUBJECTS AND METHODS: We randomly and prospectively divided 120 abdominal CT examinations into three groups. Two groups received 75 ml of contrast agent at 1.5 ml/sec. Helical CT scanning began after visualization of the contrast bolus arrival in the hepatic veins (visual cue triggering) (39 patients) or after reaching an ROI threshold (automated ROI threshold triggering) (39 patients). A third group served as a control group (42 patients) and received 150 ml of contrast agent at 1 ml/sec. Quality of hepatic enhancement was assessed objectively and subjectively. Comparisons were made after stratifying each group into three weight classes. RESULTS: Errors occurred in 12 (31%) of 39 examinations in the group with automated ROI threshold triggering. In that group, we found a significantly (p < .04) lower mean hepatic enhancement in two of three weight categories, and a significantly (p < .04) lower mean subjective scan quality in one of three weight categories, than we found in the group with visual cue triggering. CONCLUSION: Optimizing portal venous phase helical CT of the liver after a low-volume bolus of contrast agent and an injection rate of 1.5 ml/sec is best achieved by initiating helical CT scanning after visualizing the contrast bolus arrival within the liver rather than after reaching a preset attenuation threshold.
23168.8439031991985.11.25++The role of ultrasonography in the detection of extrapulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).J Ultrasound Med
MM Abiri, M Kirpekar, S Abiri,
Three cases of extrapulmonary tuberculosis are presented. Retroperitoneal and periportal adenopathy were the major manifestation of the disease detected by ultrasonography in all three cases. All of the patients were subsequently diagnosed as having acquired immunodeficiency syndrome (AIDS). The lymphohematogenous dissemination of the disease and the diagnostic role of ultrasonography are discussed.
23178.8489662941996.12.16++Focal nodular hyperplasia of the liver: radiologic-pathologic correlation.Radiographics
PC Buetow, L Pantongrag-Brown, JL Buck, PR Ros, ZD Goodman,
Focal nodular hyperplasia (FNH) is a benign hepatic tumor that likely represents a local hyperplastic response of hepatocytes to a congenital vascular anomaly. It is most commonly seen in middle-aged women and is typically a solid mass measuring less than 5 cm in diameter. Most lesions have central scars that contain thick-walled vessels that provide excellent arterial blood supply; hemorrhage, necrosis, and infarction are, therefore, extremely unusual. Characteristic imaging features include a hypervascular homogeneous tumor with a central scar and with both hepatocellular and reticuloendothelial function. Ultrasonography, computed tomography, scintigraphy, and magnetic resonance imaging all offer different advantages in the detection and characterization of FNH. There is excellent correlation between the pathologic and imaging features of FNH. In many cases, it is possible to obtain a prospective imaging diagnosis of FNH; however, in some cases, the distinction between FNH and other primary hepatic neoplasms is not possible. In these latter cases, close imaging follow-up, needle biopsy, or even surgical resection may be necessary.
23188.84120349522002.07.10++Volumetric growth rate of stage I lung cancer prior to treatment: serial CT scanning.Radiology
HT Winer-Muram, SG Jennings, RD Tarver, AM Aisen, M Tann, DJ Conces, CA Meyer,
PURPOSE: To determine the range of growth rates of stage I lung cancers prior to treatment by using volumetric measurement at serial chest computed tomographic (CT) examinations. MATERIALS AND METHODS: The study population comprised 50 patients who underwent two CT examinations at 25-day or greater intervals. Tumor craniocaudal length and cross-sectional diameters and perimeters were used to volumetrically model each tumor in three ways (spherical, elliptical, perimeter). Volumes were compared by determining Pearson correlation coefficients. By using these volumes, tumor doubling time was determined for each patient. RESULTS: Volumes measured with all three methods were highly correlated. With the perimeter method, median doubling time was 181 days, with a very wide range. Eleven (22%) of 50 tumors had doubling times of 465 days or more. There was considerable overlap in doubling time between histologic subtypes. Assuming constant growth, only three (6%) of the 50 tumors would have been the size of a stage IA tumor for less than 1 year. CONCLUSION: Comparison of tumor volumes at serial CT examinations reveals a very wide range of growth rates. Some tumors grow so slowly that biopsy is required to prove they are malignant.
23198.8477540091995.06.20++MR imaging of the abdomen with a phased-array multicoil: prospective clinical evaluation.Radiology
NG Campeau, CD Johnson, JP Felmlee, JN Rydberg, RK Butts, RL Ehman, SJ Riederer,
PURPOSE: To prospectively compare use of a phased-array multicoil and a conventional body coil in abdominal MR imaging. MATERIALS AND METHODS: Thirteen patients (seven men, six women; mean age, 55 years) underwent imaging with a phased-array multicoil and with a conventional body coil. Four pulse sequences were used: T2-weighted spin echo (SE), magnetization-prepared gradient-recalled echo (GRE), breath-hold fast SE, and echo planar (EP). RESULTS: Lesion detection improved the most on fast SE, multicoil-acquired images. Signal-to-noise ratio (S/N) increased 64% with fast SE (P = .0005) and EP (P < .0109) sequences. Contrast-to-noise ratio (C/N) doubled (P < .05) with T2-weighted SE sequences. Lesion conspicuity improved on multicoil-acquired images with all fast sequences (magnetization-prepared GRE, P = .015; fast SE, P = .002; EP imaging, P = .013). There was little difference in respiratory and vascular artifact. Depiction of most abdominal structures improved (P < .01). CONCLUSION: Use of the phased-array multicoil provides better MR images of the abdomen than does use of a conventional body coil.
23208.8468563801983.07.08++Focal nodular hyperplasia of the liver imaging by differing modalities.Pediatr Radiol
VJ D'Souza, TE Sumner, NE Watson, AG Formanek,
The logistic approach in diagnosis of focal nodular hyperplasia (FNH) of the liver is discussed, based on the experience with three children. In only one child could the diagnosis be made without angiography. In that child the combination of hypervascularity on the radionuclide angiogram and uptake of the radiocolloid by Kupffer cells was sufficient for the diagnosis of FNH. If the radionuclide scintigraphy is inconclusive, angiography has to be done to show the typical features of FNH, seen in all three patients. Only if scintigraphy and angiography are not able to differentiate FNH from hepatic adenoma, biopsy or exploratory laparotomy is indicated as a final diagnostic procedure. Ultrasonography or computerized tomography is of value only in screening for hepatic mass lesions.
23218.83100632671999.03.22++Opportunistic hepatic infections in AIDS patients with fever of unknown origin.J Formos Med Assoc
YG Chang, PJ Chen, CC Hung, MY Chen, MY Lai, DS Chen,
The clinical features and histopathologic manifestations of hepatic opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS) in Taiwan remain unexplored. We report 28 AIDS patients (25 men, 3 women; mean age, 34 years) with fever of unknown origin who underwent 31 liver biopsies from December 1995 to May 1997. In most cases, the biochemical tests showed moderate to markedly elevated alkaline phosphatase concentrations, but normal or mildly elevated aminotransferase concentrations. The most common histopathologic finding was macrosteatosis, which was noted in 15 of the 28 patients. Another important histopathologic finding indicating the etiology of hepatic opportunistic infection was granuloma, which was found in 11 patients. Histochemical stain and culture of liver specimens yielded Mycobacterium avium complex (MAC) in eight patients, Mycobacterium tuberculosis in two patients, Histoplasma capsulatum in one patient, and cytomegalovirus in one patient with concomitant MAC infection. Therefore, a definitive diagnosis in AIDS patients with fever of unknown origin was made in 11 of the 28 cases with the assistance of liver biopsy. During follow-up, late extrahepatic involvement by the same infectious agents was found in six patients. Thus, hepatic manifestations could be a harbinger of disseminated opportunistic infections in AIDS patients.
23228.831100751979.08.29++Intraabdominal abscess: current concepts in radiologic evaluation.AJR Am J Roentgenol
MD Halber, RH Daffner, CL Morgan, WS Trought, WM Thompson, RP Rice, M Korobkin,
Forty patients with suspected abdominal abscess had computed tomography (CT) and plain film examinations; 15 also had ultrasound study. CT was found to be the most consistently accurate examination, both for the detection of abscess and evaluation of its extent. Ultrasound was positive in a high percentage of cases in which it was used. Although plain films correctly suggested the presence of an abscess in over half the proven cases, confirmatory evidence from CT or ultrasound was often required to persuade clinicians of the presence of an abscess and to provide detailed information regarding its extent and configuration.
23238.83128908242003.09.22+ Caution should be taken in using CD31 for distinguishing the vasculature of lymph nodes.J Clin Pathol
H Hattori,
23248.8233163231987.12.30++CT manifestations of Richter syndrome.J Comput Assist Tomogr
LM Cohen, MC Hill, RS Siegel, IM Lande,
Richter syndrome is an uncommon complication of chronic lymphocytic leukemia characterized by its transformation into diffuse histiocytic lymphoma. We present two documented cases of Richter syndrome and its radiographic manifestations, which have not previously been reported. These include hepatosplenomegaly, diffuse marked adenopathy, and involvement of the skeletal system. The diagnosis of Richter syndrome should be suggested when these radiographic findings occur with chronic lymphocytic leukemia.
23258.82151607552004.06.10++Specificity of SPIO particles for characterization of liver hemangiomas using MRI.Abdom Imaging
X Montet, F Lazeyras, N Howarth, G Mentha, L Rubbia-Brandt, CD Becker, JP Vallee, F Terrier,
We investigated the specificity of superparamagnetic iron oxide (SPIO)-enhanced T1-weighted spin-echo (SE) magnetic resonance (MR) images for the characterization of liver hemangiomas. When imaging liver hemangiomas, which are the most frequent benign liver tumors, a method with very high specificity is required, which will obviate other studies, follow-up, or invasive diagnostic procedures such as percutaneous biopsy. Eighty-three lesions were examined by MR imaging at 1.5 T before and after intravenous injection of SPIO particles. Lesions were categorized as follows according to the final diagnosis: 37 hemangiomas, nine focal nodular hyperplasias (FNHs), 19 hepatocellular carcinomas (HCCs), and 18 metastases. Their signal intensity values were normalized to muscle and compared. The only lesions showing a significant increase in signal intensity ratio (lesion to muscle) on postcontrast T1-weighted SE images were hemangiomas (p < 0.001). The signal intensity ratio of hemangiomas increased on average by 70%. Based on receiver operating characteristic analysis and using a cutoff level of 50% signal increase, the specificity and sensitivity of SPIO-enhanced MR imaging for the characterization of hemangiomas would be 100% and 70%, respectively. The T1 effect of SPIO particles can help differentiate hemangiomas from other focal liver lesions such as FNHs, HCCs, and metastases and may obviate biopsy. When using SPIO particles for liver imaging, it is useful to add a T1-weighted sequence to T2-weighted images, thereby providing additional information for lesion characterization.
23268.8290996511997.06.11++Inflammatory pseudotumor of the spleen in a young child.Pediatr Surg Int
GM Aru, CR Abramowsky, RR Ricketts,
We describe a case of an inflammatory pseudotumor of the spleen in a 5-year-old boy, found incidentally during a physical examination. The boy underwent a hemisplenectomy. The problems in differentiating this disease from lymphoma of the spleen before surgery and the advantages of hemisplenectomy are discussed. This rare disease has previously been described in the spleen in only 28 cases, the youngest being a 16-year-old patient.
23278.82162471592006.02.16++Posttransplantation lymphoproliferative disorder in pediatric recipients of solid organ transplants: timing and location of disease.AJR Am J Roentgenol
GE Wilde, DJ Moore, RD Bellah,
OBJECTIVE: The objective of our study was to correlate the location of radiologic presentation and time to onset of posttransplantation lymphoproliferative disorder (PTLD) with the allograft type received in a population of pediatric heart, lung, liver, kidney, and bone marrow transplant recipients. CONCLUSION: Symptomatic PTLD in children manifests earliest in lung recipients and can involve any organ system. However, PTLD in the thorax is most common after lung transplantation, and PTLD in the abdomen most commonly follows kidney transplantation.
23288.8118985521991.01.23+ CT of acute splenic torsion in children with wandering spleen.AJR Am J Roentgenol
TE Herman, MJ Siegel,
23298.80117567082002.02.21++Hepatocellular carcinoma: detection with gadolinium- and ferumoxides-enhanced MR imaging of the liver.Radiology
D Pauleit, J Textor, R Bachmann, R Conrad, S Flacke, G Layer, B Kreft, H Schild,
PURPOSE: To test the hypothesis that the accuracy of gadolinium- and ferumoxides-enhanced magnetic resonance (MR) imaging is different in small (< or =1.5-cm) and large (>1.5-cm) hepatocellular carcinomas (HCCs). MATERIALS AND METHODS: Forty-three consecutive patients with chronic liver disease were enrolled in this study. The imaging protocol included unenhanced breath-hold T1-weighted fast field-echo sequences, unenhanced respiratory-triggered T2-weighted turbo spin-echo (SE) sequences, dynamic gadolinium-enhanced T1-weighted three-dimensional turbo field-echo sequences, and ferumoxides-enhanced T2-weighted turbo SE sequences. Images of each sequence and two sets of sequences (ferumoxides set and gadolinium set) were reviewed by four observers. The ferumoxides set included unenhanced T1- and T2-weighted images and ferumoxides-enhanced T2-weighted turbo SE MR images. The gadolinium set included unenhanced T1- and T2-weighted images and dynamic gadolinium-enhanced three-dimensional turbo field-echo MR images. In receiver operating characteristic (ROC) curve analysis, the sensitivity and accuracy of the sequences were compared in regard to the detection of all, small, and large HCCs. RESULTS: Imaging performance was different with gadolinium- and ferumoxides-enhanced images in the detection of small and large HCCs. For detection of small HCCs, the sensitivity and accuracy with unenhanced and gadolinium-enhanced imaging (gadolinium set) were significantly (P =.017) superior to those with unenhanced and ferumoxides-enhanced imaging (ferumoxides set). The area under the composite ROC curves, or A(z), for the gadolinium set and the ferumoxides set was 0.97 and 0.81, respectively. For large HCC, the ferumoxides set was superior compared with the gadolinium set, but this difference was not statistically significant. Analysis of all HCCs demonstrated no significant differences for gadolinium- and ferumoxides-enhanced imaging. CONCLUSION: For the detection of early HCC, gadolinium-enhanced MR imaging is preferred to ferumoxides-enhanced MR imaging because the former demonstrated significantly greater accuracy in the detection of small HCCs.
23308.804247731979.05.23++The relationship of computed tomography, gray-scale ultrasonography and radionuclide imaging in the evaluation of hepatic masses.Semin Nucl Med
JP Petasnick, P Ram, DA Turner, EW Fordham,
Hepatic scintigraphy, gray-scale ultrasonography, and computed tomography have proven to be useful in the initial detection and evaluation of hepatic masses. These studies appear to be complimentary since each provides information not available from the others. Hepatic scintigraphy is currently the method of choice for the initial evaluation of the liver for mass lesions as it is easily performed, relatively inexpensive, and affords detectability of intrahepatic mass lesions at least as great as that of ultrasonography or computed tomography. When a definite or suspected abnormality is seen by hepatic scintigraphy, computed tomography or ultrasonography may be helpful in providing better anatomic definition or clarification of the nature of the abnormality. The choice between these latter two modalities depends on the type of scanning equipment available and the observer's experience with each method.
23318.8047199561973.09.26+ Cavernous hemangioma of the spleen; angiographic observations.Angiology
T Rosenthal, R Adar, I Wolfstein, V Deutsch,
23328.8083109321994.03.17++Gastrointestinal manifestations of AIDS in children.AJR Am J Roentgenol
JO Haller, HL Cohen,
The gastrointestinal manifestations of AIDS in children are related to opportunistic infections, lymphoproliferative disease, and cancer. The infections that affect the gastrointestinal tract at different sites also occur in patients without AIDS. However, in children with AIDS, the infections are more severe, often relapse, and are harder to eradicate. Candidiasis is the most common infection in the esophagus, but infections caused by herpes simplex virus and cytomegalovirus also are common. Radiologic findings include ulcerations, a cobblestone appearance, and disordered motility. Gastritis and enteritis are usually caused by cytomegalovirus. Lesions produced by this virus include ulcerations caused by ischemic necrosis as a result of vasculitis. Barium studies show increased nodularity and effacement of mucosa. Other organisms (typically found in all immunocompromised patients) include Mycobacterium avium-intracellulare, Mycobacterium tuberculosis, Campylobacter, Giardia, and Cryptosporidium. Colitis and proctitis are caused by many of the same enteric pathogens. Cytomegalovirus is the most virulent, causing necrosis, perforation, and often death. Lymphoma, smooth muscle tumors, and Kaposi's sarcoma are the most common neoplasms encountered in children with AIDS.
23338.79170057712006.11.30++Distribution of stage I lung cancer growth rates determined with serial volumetric CT measurements.Radiology
SG Jennings, HT Winer-Muram, M Tann, J Ying, I Dowdeswell,
PURPOSE: To retrospectively determine the distribution of stage I lung cancer growth rates with serial volumetric computed tomographic (CT) measurements. MATERIALS AND METHODS: This study was institutional review board approved and HIPAA compliant. The informed consent requirement was waived. Patients (n = 149) with stage I lung cancer who underwent two pretreatment CT examinations 25 or more days apart were identified. At the first and last examinations, tumor perimeters were manually inscribed by using software tools and the cross-sectional area was calculated. To calculate tumor volume, the summed areas were multiplied by the section increment and a formula was applied to reduce partial volume effects. Doubling time (DT) was calculated by using the volume and interscanning interval. The percentages of tumors that would surpass volume increase thresholds of 5%-25% for detectable growth at different time intervals were calculated. Age at diagnosis was compared with the reciprocal of DT, time interval between CT examinations, and initial tumor volume by using Pearson correlation. P < .05 denoted statistical significance. RESULTS: Lung cancer was stage IA in 99 patients and stage IB in 50. Median patient age was 72 years, and median interscanning interval was 130 days. Median tumor volumes were 3000 and 6213 mm3 at the first and last examinations, respectively. Median DT was 207 days; 21 tumors did not increase in volume between examinations. The interscanning interval required for 90% of growing tumors to surpass the growth threshold ranged from 8 weeks (5% threshold) to 37 weeks (25% threshold). Fifty-three percent of growing tumors would surpass the 25% threshold at 8 weeks, and 95% would surpass it at 1 year. Age at diagnosis was negatively correlated with growth rate (P = .047); there was no correlation between growth rate and either age at diagnosis or interscanning interval. CONCLUSION: At serial volumetric CT measurements, there was wide variability in growth rates. Some biopsy-proved cancers decreased in volume between examinations.
23348.7922257261990.12.14++CT in renal and perirenal lymphoma: a further look.Clin Radiol
RH Reznek, I Mootoosamy, JA Webb, MA Richards,
The CT appearances of renal and perirenal lymphoma detected in 26 patients are presented. Twenty-four patients had non-Hodgkin's lymphoma and two patients Hodgkin's disease. This represented 3% of all patients scanned for routine staging of known lymphoma. Eleven patients had involvement at the time of relapse only, having had no previous evidence of renal involvement. Forty-three per-cent of all patients with renal lymphoma had no retroperitoneal lymph node involvement. Most patients had other extranodal disease at the time of presentation, most commonly bone.
23358.7966306281983.12.17++CT detection of iatrogenic percutaneous splenic injury.J Comput Assist Tomogr
RF Rauch, M Korobkin, PM Silverman, AV Moore,
Although the potential for splenic injury during left sided thoracentesis or percutaneous renal biopsy is well known, its occurrence has been rarely reported. In a 1 year period we used computed tomography to detect acute splenic, perisplenic, and intraperitoneal hemorrhage in three patients after percutaneous diagnostic and therapeutic procedures in the lower chest and upper abdomen. One patient was asymptomatic, the second developed left upper quadrant pain, and the third required emergency splenectomy.
23368.7918715771991.09.13++[Blunt abdominal trauma: differential diagnosis of splenic lobulation and splenic rupture]Ultraschall Med
A el Mouaaouy, TT Zittel, HD Becker,
In a retrospective study, we analyzed the data of 232 patients with blunt abdominal trauma between January 1, 1984, and December 31, 1988. In emergency ultrasound, we detected 4 patients with a smooth disruption of the splenic outline combined with free peritoneal fluid around the spleen. Because of the blunt abdominal trauma, a rupture of the spleen had to be excluded. In two of these 4 cases, we decided for laparotomy. Intraoperatively, we found a splenic lobulation and no splenic injury in both cases. We conclude that an emergency sonographic examination of the spleen, it should be kept in mind that the anatomical variation of a splenic lobulation might mimic a rupture of the spleen.
23378.7882828781994.02.17++Enhancement of thoracic masses using nonionic MR contrast agents.J Comput Assist Tomogr
N Kanth, M Dulce, M O'Sullivan, A Duerinckx, G Gamsu, GR Caputo, CB Higgins,
OBJECTIVE: This study evaluated the effect of a new nonionic MR contrast medium, gadodiamide injection (Omniscan; Sanofi-Winthrop), on enhancement of thoracic masses on T1-weighted SE images. MATERIALS AND METHODS: Gadodiamide injection was administered intravenously at a dose of 0.2 mmol/kg to 26 patients with thoracic masses. The T1-weighted images with and without fat suppression and T2-weighted images obtained before contrast medium injection were compared with T1-weighted images obtained at 5, 30, and 45 min and a T1-weighted fat-suppressed image at 10 min after administration of the contrast medium. Enhancement of the thoracic masses and image quality were quantified by measuring signal intensity, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) using muscle and fat as reference tissues. RESULTS: The SNR of the masses increased significantly (p < 0.001) following contrast material injection both on standard T1-weighted sequences and on T1-weighted fat-suppressed images when compared with the precontrast T1-weighted images with and without fat suppression. The CNR (reference tissue muscle) improved significantly (p < 0.001) after contrast medium injection and persisted for 45 min on T1-weighted images compared with those prior to contrast medium. However, there was no significant difference in CNR between the T2-weighted images obtained before and the T1-weighted images obtained after contrast agent administration. On the other hand, the SNR of contrast-enhanced images was significantly better than that of the T2-weighted images. When fat was used as a reference tissue, CNR of the thoracic masses decreased significantly. CONCLUSION: This study shows that gadodiamide injection caused significant enhancement of thoracic masses on T1-weighted images, which rendered high signal intensity to the masses similar to the appearance on T2-weighted images. In comparison with the T2-weighted images, SNR was significantly improved.
23388.7866110471984.08.23++CT features of rounded atelectasis of the lung.AJR Am J Roentgenol
TC Doyle, GA Lawler,
Rounded atelectasis is an uncommon but increasingly recognized benign form of peripheral lung collapse. The three patients described here had pleural-based lung masses considered initially to represent carcinoma. On computed tomography, a characteristic appearance of eight major and five minor signs of rounded atelectasis of the lung were found. In conjunction with other radiologic evaluations, these allowed the patients to be confidently managed without exploratory thoracotomy.
23398.7871218681982.12.02+ [68 splenectomies of traumatic indication. Diagnostic considerations and operative technic]Minerva Chir
N Cortesi, M Malagoli, G Barberini, C Zanni, S Penazzi, G Ghidini, G Vaccari, M Scotti,
23408.7873846741980.08.25++Diagnostic and therapeutic aspirations of fluid containing masses: the role of ultrasound and computed tomography.Rev Interam Radiol
G Mendez, MB Isikoff, WN Sinner, JU Levi,
Twenty-eight patients have undergone diagnostic and/or therapeutic aspiration of fluid containing masses at Jackson Memorial Hospital over the last 8 months. The majority were diagnosed and aspirated under ultrasonic control while in a few cases CT was required. In 19 patients, a therapeutic aspiration was attempted. In 17, this was successful, none of these patients required surgical intervention. The role of ultrasound and CT in the diagnosis and treatment of fluid collection is emphasized. The technique for both diagnostic and therapeutic aspirations is stressed as well.
23418.7884301951993.03.11++Human immunodeficiency virus infection: musculoskeletal manifestations.Radiology
LS Steinbach, J Tehranzadeh, JL Fleckenstein, WJ Vanarthos, MJ Pais,
The authors retrospectively reviewed the charts, radiographs, and other accompanying imaging studies of 45 patients with musculoskeletal abnormalities associated with human immunodeficiency virus (HIV) infection. These included 19 patients with osseous infection, including eight with osteomyelitis, seven with bacillary angiomatosis (six of whom were described in a previous report), and four with septic arthritis; 10 with bacterial myositis (six of whom were described in a previous report); seven with non-Hodgkin lymphoma; five with hypointense marrow signal intensity at magnetic resonance imaging; two with Kaposi sarcoma; one with polymyositis; and one with psoriasis. The musculoskeletal system can be affected by a variety of abnormalities in association with HIV infection. Knowledge of their existence and characteristic appearance is valuable to radiologists for diagnosis and to clinicians for detection and appropriate treatment.
23428.7738806131985.01.15++Small, asymptomatic angiomyolipomas of the kidney.Radiology
PM Bret, M Bretagnolle, D Gaillard, H Plauchu, M Labadie, JF Lapray, Y Roullaud, P Cooperberg,
Ultrasound (US) detected 27 small, asymptomatic renal angiomyolipomas in 18 patients. Twenty-five lesions were diffusely hyperechoic and 2 were heterogeneous. Nephrotomography was positive in 8 out of 12 patients (67%), CT in 12/14 (86%), and angiography in 10/14 (71%). Percutaneous fine-needle biopsy confirmed the diagnosis in 8 out of 12 patients (67%). Nephrotomography and angiography were nonspecific, whereas CT and biopsy were most specific because of the presence of fatty tissue. Angiography helped clarify the degree of vascularity of the masses. If the diagnosis can be made preoperatively, more conservative management can be undertaken.
23438.7739160621987.01.14++Excision biopsy of the spleen by ultrasonic guidance.Br J Radiol
PG Lindgren, H Hagberg, B Eriksson, B Glimelius, A Magnusson, C Sundström,
Excision biopsy of the spleen was performed in 32 patients, using a recently invented instrument, which consists of a spring-trigger system for firing the two parts of a Tru-Cut needle. The biopsies were carried out under the guidance of an ultrasonic scanner. This technique yields sufficient material of high quality for a proper evaluation both of individual cells and the internal structure of the spleen. Eight patients had parenchymal abnormalities found by ultrasonic scanning: five had multiple abnormalities whereas three had a single abnormal area. Seven of these eight patients had a pathological spleen biopsy, consisting of Hodgkin's disease (four patients), "high-grade" malignant non-Hodgkin's lymphoma (two patients) or tuberculosis (one patient). In the other 24 patients with a normal ultrasonic picture of the splenic parenchyma five biopsies were pathological (3 cases of hairy-cell leukaemia, 1 of Gaucher's disease and 1 of Hodgkin's disease). Side-effects were: slight to moderate pain (16/32 patients) and bleeding requiring transfusion (4/32 patients). In one of these patients splenectomy was performed because of the bleeding. Two of the patients with bleeding complications suffered from hairy-cell leukaemia. It is concluded from this study that excision biopsy of the spleen is a diagnostic method which in some patients can replace splenectomy. The method seems to be valuable especially in patients with parenchymal abnormalities shown by ultrasonic scanning.
23448.7774298011981.01.26++"Delayed rupture of the spleen" or delayed diagnosis of the splenic injury?Isr J Med Sci
Y Berlatzky, E Shiloni, H Anner, Y Weiss,
Splenic rupture is the most frequent intraabdominal injury following blunt abdominal trauma. Massive hemorrhage commonly occurs from injuries to this friable vascular organ. The mortality rate from simple splenic rupture is 1%. Delayed diagnosis of a ruptured spleen increases the rate to 10%. During 1964-79, 293 patients underwent splenectomy for blunt splenic injury, of whom 278 were operated on within 24 h. All had typical signs of splenic lacerations with intraperitoneal bleeding from the time of injury. Fifteen patients were operated on more than 48 h after sustaining the injury. A detailed analysis of these 15 patients revealed that in only three did the evidence support delayed hemorrhage following traumatic rupture of the spleen. In the other 12 patients, there was a delay in recognition of the intraabdominal injury, almost entirely the result of "diagnostic error." Careful clinical inquiry and peritoneal lavage are the mainstays of early diagnosis and therapy and should help to eliminate any delay in the diagnosis of a ruptured spleen.
23458.7638958541985.08.30++Scintigraphic diagnosis of hepatic hemangioma: its role in the management of hepatic mass lesions.AJR Am J Roentgenol
M Moinuddin, JR Allison, JH Montgomery, JF Rockett, JM McMurray,
Hepatic cavernous hemangiomas are benign tumors of the liver that are often an incidental finding. They are usually asymptomatic but may cause symptoms when traumatized, may bleed spontaneously, or may produce pain by virtue of their large size and mass effect. A retrospective analysis of the clinical presentation, liver function tests, and diagnostic imaging procedures in 20 patients with hepatic hemangiomas is presented and the literature is reviewed. The 20 patients had 27 mass lesions as seen on liver scintigraphy, computed tomography, or sonography. Technetium-99m-labeled red blood cell flow studies and blood pool scintigrams showed delayed filling of the mass lesions, diagnostic of hemangiomas. This finding was not encountered in any other type of lesion. A new diagnostic algorithm is proposed in which blood-flow and blood-pool scintigraphy play a more prominent role in the diagnostic workup. According to this algorithm, if liver function tests in a patient with hepatic mass are either normal or abnormal and suggestive of hepatocellular dysfunction, the patient should undergo hepatic blood-flow and blood-pool studies.
23468.7623951271990.10.09++Rational approach to therapy in splenic abscess.J R Coll Surg Edinb
HS Walia, S Aman, HK Walia,
Intrasplenic abscess is an uncommon but potentially lethal condition. Seven cases of splenic abscess were seen between 1985 and 1988. There are no specific clinical findings; symptoms and signs of fever, abdominal pain and tenderness were present in all seven cases but were only helpful in diagnosing splenic abscess in three cases. Computed tomographic scanning probably at present offers the most direct way of evaluating the spleen and making an early diagnosis. Splenectomy was done in three cases and antibiotics were used in four cases with equally successful results. Contrary to the prevalent opinion, we believe that medical management is an important addition to the surgeon's armamentarium and offers a viable alternative in selected cases of splenic abscess. A successful outcome is dependent on a high degree of clinical alertness, an aggressive diagnostic approach and prompt effective treatment.
23478.7629285221989.04.28+ CT diagnosis of blunt hepatic and splenic injuries: a look to the future.Radiology
RB Jeffrey,
23488.7583521121993.09.15++Imaging of peritoneal pseudocysts: value of MR imaging compared with sonography and CT.AJR Am J Roentgenol
H Kurachi, T Murakami, H Nakamura, S Hori, A Miyake, T Kozuka, O Tanizawa,
OBJECTIVE. Peritoneal pseudocysts are created when fluid arising from the ovary is trapped by peritoneal adhesions. We studied the value of MR imaging, compared with sonography and CT, for detecting these abnormalities. SUBJECTS AND METHODS. Nine women, 27 to 49 years old, who had surgically proved peritoneal pseudocysts were included in the study. All nine patients were premenopausal, and eight had a history of pelvic surgery. All patients were examined with MR imaging and sonography, and five were also examined with CT. Imaging findings were analyzed and compared with the surgical findings. RESULTS. Sonograms in all nine patients showed a thick-walled cyst that contained focal echoes indicating nodules, making it difficult to differentiate these lesions from cystic ovarian tumors. In eight of the nine patients, the fluid in the pseudocysts had low signal intensity on T1-weighted MR images and high signal intensity on T2-weighted spin-echo MR images, suggesting that the fluid was serous. The pseudocyst had an irregular shape on MR images in seven patients and on CT scans in three patients. However, MR provided more information than CT did about the nature of the fluid within the pseudocyst. CONCLUSION. Our study suggests that MR imaging is more useful than sonography and CT for determining the characteristic findings of peritoneal pseudocysts.
23498.7535154181986.05.19++Mediastinal tumors: evaluation with suprasternal sonography.Radiology
K Wernecke, PE Peters, M Galanski,
Twelve patients with mediastinal masses evaluated by computed tomography (CT) and histologically verified were evaluated sonographically by means of the suprasternal approach. Eleven of 12 mediastinal tumors could be visualized sonographically, mainly as hypoechoic and perivascularly situated masses, and could be located topographically with a fair degree of certainty. Suprasternal sonography is particularly useful in the detection of small, perivascular lymphomas of the supraaortic branches. In patients with problematic CT findings, particularly children and patients with allergies to contrast media, suprasternal sonography can provide important additional information. Moreover, suprasternal sonography can be used to determine the consistency and to monitor the treatment of mediastinal tumors. Finally, the suprasternal approach is suitable for sonographically guided biopsies of mediastinal tumors.
23508.7593534721997.12.02++Imaging appearance of pachymeningeal tuberculosis.AJR Am J Roentgenol
M Goyal, A Sharma, NK Mishra, SB Gaikwad, MC Sharma,
OBJECTIVE: The purpose of our study was to examine imaging findings in patients with pachymeningeal tuberculosis. Imaging studies of seven patients with pachymeningeal tuberculosis were retrospectively reviewed. The diagnosis had been established on the basis of histopathology in three patients and response to antitubercular treatment in four patients. CONCLUSION: Tuberculosis can lead to localized or diffuse involvement of the pachymeninges. Most of the focal lesions were seen as en plaque, homogeneous, uniformly enhancing, dural-based masses. The lesions appeared hyperdense on plain CT scans, isointense to brain parenchyma on T1-weighted MR images, and isointense to hypointense on T2-weighted MR images. One patient had diffuse sheet-like thickening of the pachymeninges in the right hemicranium, involving both the supratentorial and infratentorial compartments.
23518.7566950691984.03.23++Hepatic tumors in children: ultrasonic differentiation of malignant from benign lesions.Radiology
F Brunelle, P Chaumont,
The authors studied 21 hepatic tumors in children using B-scan and real-time ultrasound as well as angiography. The final diagnosis was established surgically. Cystic tumors and hemangioendotheliomas were excluded. In all but one malignant tumor (15/16), ultrasound showed absence of one branch of the portal vein in the area of the tumor. Partial amputation of intrahepatic portal branches was confirmed angiographically in all cases. In all 6 benign tumors, ultrasound demonstrated a patent portal system despite compression by tumor. These findings were confirmed angiographically. No specific echo pattern allowing differentiation between benign and malignant tumors was found. The authors conclude that ultrasonic differentiation between malignant and benign hepatic tumors in children is possible, provided that special attention is given to the intrahepatic vessels.
23528.7535961351987.08.10++Splenobronchial fistula: interventional radiologic management.Gastrointest Radiol
CC Neff,
A 71-year-old man had a splenic abscess complicated by rupture into the left subphrenic space with formation of a splenobronchial fistula. One percutaneous catheter was placed into the splenic abscess and a second was placed in the subphrenic collection. The abscesses resolved and the bronchial fistula closed in 12 days.
23538.75161000852005.10.27++Imaging features of perivascular fatty infiltration of the liver: initial observations.Radiology
OW Hamer, DA Aguirre, G Casola, CB Sirlin,
PURPOSE: To retrospectively identify and describe the imaging features that represent perivascular fatty infiltration of the liver. MATERIALS AND METHODS: The institutional review board approved the study and waived informed consent. The study complied with the Health Insurance Portability and Accountability Act. Ten patients (seven women, three men; mean age, 78 years; range, 31-78 years) with fatty infiltration surrounding hepatic veins and/or portal tracts were retrospectively identified by searching the abdominal imaging teaching file of an academic hospital. The patients' medical records were reviewed by one author. Computed tomographic (CT), magnetic resonance (MR), and ultrasonographic (US) imaging studies were reviewed by three radiologists in consensus. Fatty infiltration of the liver on CT images was defined as absolute attenuation less than 40 HU without mass effect and, if unenhanced images were available, as relative attenuation at least 10 HU less than that of the spleen; on gradient-echo MR images, it was defined as signal loss on opposed-phase images compared with in-phase images; and on US images, it was defined as hyperechogenicity of liver relative to kidney, ultrasound beam attenuation, and poor visualization of intrahepatic structures. Perivascular fatty infiltration of the liver was defined as a clear predisposition to fat accumulation around hepatic veins and/or portal tracts. For multiphase CT images, the contrast-to-noise ratio was calculated for comparison of spared liver with fatty liver in each imaging phase. RESULTS: Fatty infiltration surrounded hepatic veins in three, portal tracts in five, and both hepatic veins and portal tracts in two patients. Six of the 10 patients had alcoholic cirrhosis, two reported regular alcohol consumption (one of whom had acquired immunodeficiency syndrome and hepatitis B), one was positive for human immunodeficiency virus, and one had no risk factors for fatty infiltration of the liver. In three of the 10 patients, fatty infiltration was misdiagnosed as vascular or neoplastic disease on initial CT images but was correctly diagnosed on MR images. CONCLUSION: Perivascular fatty infiltration of the liver has imaging features that allow its recognition.
23548.7466841291983.10.21++Hepatic angiosarcoma.J Comput Assist Tomogr
N Vasile, D Lardé, ES Zafrani, H Berard, D Mathieu,
The computed tomographic findings of a case of hepatic angiosarcoma are presented. Although many findings are similar to hemangioma, some features can suggest the diagnosis of angiosarcoma.
23558.7440145471985.07.30++Nonoperative management of adult splenic injury due to blunt trauma: a warning.Am J Surg
PA Mahon, JE Sutton,
An analysis of 11 patients with splenic injury initially receiving nonoperative treatment revealed that 73 percent subsequently required surgery for delayed hemorrhage. The influence of age and the anatomic differences between the adult's spleen and child's spleen may account for the increased incidence of delayed bleeding seen in this series. Which patients might avoid surgical intervention cannot be predicted with certainty from the mechanism of injury or the lack of early physical signs and symptoms. The corresponding medical problems that often exist with the older patient may make nonoperative management, with the inherent risk of hypotension and large transfusion requirements, inappropriate. Although not advocating immediate splenectomy, we encourage early operative intervention with splenorrhaphy. Although improved diagnostic techniques will uncover a greater incidence of splenic injury, the inability to identify the nonoperative patient remains a clinical dilemma. The true role of nonoperative management of splenic injuries in the adult and the criteria for selection need to be further defined with larger prospective series. Although this approach may be useful for some patients, its application cannot be universal, and one must be willing to accept the consequences of delayed hemorrhage.
23568.749482041976.10.01++Exploratory laparotomy and splenectomy in the diagnosis of Hodgkin's disease in children.J Surg Oncol
BA Kolygin, GA Fedoreev,
Thirty-three children with histologically proved Hodgkin's disease underwent exploratory laparotomy with splenectomy and biopsy of lumbar lymph nodes, liver, and bone marrow. In 13 patients (39%) the lesion of spleen and/or splenic hilar lymph nodes was diagnosed. The involvement of spleen was mostly found in patients with mixed cellularity type, in the presence of systemic symptoms ("B"), and in the biological stage "b." Involvement of the liver was found in 1 patient, of the hepatic hilar lymph nodes in 3 patients, and of the bone marrow in 4 patients. The lymphographic and histologic data as regards lumbar lymph nodes coincided in 65% of cases. After operation the stage of the disease was changed in 48% patients. The early and late complications were not numerous.
23578.7489954581997.02.11++Gadolinium-DTPA-enhanced MR imaging in asymptomatic knees.Acta Radiol
T Boegård, A Johansson, O Rudling, I Petersson, K Forslind, K Jonsson,
PURPOSE: To evaluate the occurrence and extent of Gd-DTPA-enhanced synovial structures in asymptomatic knee joints of middle-aged healthy individuals. MATERIAL AND METHODS: MR imaging of the knee joint was performed in 10 healthy subjects aged 40-61 years. The study included a sagittal T1-weighted SE sequence before and after i.v. injection of 0.1 mmol Gd-DTPA/kg b.w. RESULTS: Contrast-enhanced synovial structures were found in all knees. The extent of the synovial structures was usually not uniform within the examined joint. In the intercondylar fossa, the thickness of synovial structures was more often pronounced. In the suprapatellar recess, synovial thickness was constant and minimal. CONCLUSION: The presence and the varying extent and thickness of synovial structures in asymptomatic knees in middle-aged individuals must be considered in the evaluation of early and mild synovitis of the knee joint with Gd-enhanced MR imaging in this age group.
23588.74103905641999.09.14++Well-differentiated hepatocellular carcinoma: findings of US, CT, and MR imaging.Abdom Imaging
S Monzawa, K Omata, N Shimazu, A Yagawa, K Hosoda, T Araki,
BACKGROUND: To elucidate the imaging characteristics of well-differentiated hepatocellular carcinomas (HCCs) on ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. METHODS: Ultrasonograms, CTs, and MR images of 18 histopathologically proven well-differentiated HCCs in 15 patients were reviewed. The findings of these images were correlated with histopathologic findings. RESULTS: On US, seven tumors were depicted as a hyperechoic area and eight as a hypoechoic area. Three tumors were not visualized. On precontrast CT, four tumors were depicted as a low-density area, but 14 were not visualized. On conventional contrast-enhanced CT, 12 tumors were depicted as a low-density area but six were not visualized. On T1-weighted MR images, 10 tumors had high signal intensity and two had low signal intensity. Six tumors were not visualized. On T2-weighted MR images, five tumors had high signal intensity and two had low signal intensity. Eleven tumors were not visualized. Tumors with fatty change and/or clear cell formation were frequently hyperechoic on US and hyperintense on T1-weighted MR images. CONCLUSIONS: Well-differentiated HCCs show different findings on US, CT, and MR imaging. Therefore, reliable diagnosis of well-differentiated HCCs by these imaging techniques may be difficult.
23598.7438979031985.10.07+ [Role of percutaneous drainage in the treatment of hepatic abscesses]Minerva Chir
M Grosso, F Piemontesi, MC Cassinis, MA Scollo, S Gaia, G Gandini,
23608.73102074721999.05.06++US guidance for thoracic biopsy: a valuable alternative to CT.Radiology
S Sheth, UM Hamper, DB Stanley, JH Wheeler, PA Smith,
PURPOSE: To determine the role, accuracy, and selection criteria of ultrasonographic (US) guidance for biopsy for thoracic lesions. MATERIALS AND METHODS: Imaging-guided thoracic biopsies (n = 86) were performed in 84 consecutive patients. US guidance was used for lesions abutting the chest wall; computed tomographic (CT) guidance was used for all masses surrounded by aerated lung. Mass location and size, guidance modality, histologic results, procedure time, and complications were recorded. RESULTS: Thirty-four lesions (19 parenchymal, six pleural, six chest wall, three mediastinal) were amenable to US-guided biopsy. The mean mass diameter was 4.3 cm, the mean number of passes was 3.2, and the mean procedure time was 31.4 minutes. A histologic diagnosis was achieved in 31 (91%) patients, including all with small (< 2-cm) masses (n = 9). There was one case of pneumothorax. CT guidance was used in 52 (60%) of 86 cases. Lesions were parenchymal (n = 41), pleural (n = 1), and mediastinal and hilar (n = 10). The mean diameter was 2.9 cm, the mean number of passes was 2.3, and the mean procedure time was 45.2 minutes. A histologic diagnosis was achieved in 37 (71%) patients, including 18 of 27 with a small mass. Complications included pneumothorax (n = 21) and parenchymal hemorrhage (n = 2). CONCLUSION: US is an effective and safe alternative to CT for guidance at biopsy of masses abutting the chest wall. Real-time US visualization allows accurate needle placement, shorter procedure time, and performance in debilitated and less cooperative patients.
23618.7326626111989.08.09++[The place of echography in the clinical diagnosis of hepatic hemangioma]Vutr Boles
N Grigovrov, S Nikolova, I Glavincheva, L Tankova, N Krŭstev,
On the basis of 104 hemangiomas diagnosed in 81 patients an ultrasound classification of the disease is made which includes four basic variants. Echotomography detects the tumor most successfully in group I (well outlined homogenous hyperechogenisity) while in the other groups it shows a low percentage of correct diagnoses. The average sensitivity of the method is 60.6%. The possibilities of the other basic diagnostic methods are discussed and a scheme for clinical investigation is proposed. Scintigraphy is of no substantial help, computed tomography increases the percentage of the correct diagnoses, angiography and correctly indicated laparoscopy most often end the clinical investigation. The patients with hemangioma are subjected to a prolonged clinical follow up and ultrasound tomography is the best suitable method for this.
23628.73106529192000.02.11++Amyloidosis of the alimentary canal: radiologic-pathologic correlation of CT findings.Abdom Imaging
PA Araoz, KP Batts, RL MacCarty,
BACKGROUND: The purpose of the study was to describe the computed tomographic (CT) findings of the alimentary canal and mesentery in amyloid infiltration of the gastrointestinal (GI) tract and to correlate the CT findings with histologic extent and distribution and with amyloid subtype. METHODS: Abdominal CT scans performed between 1988 and 1997 on patients with pathologically proven amyloidosis of the alimentary canal and mesentery. Histology was graded for extent of mucosal, submucosal, and muscularis propria involvement and for degree of interstitial and vascular distribution. CT findings were correlated with histologic extent, histologic distribution, and amyloid histochemical type. RESULTS: Twenty-three patients were included. Four (17%) had bowel wall thickening, which was associated with a higher submucosal extent and interstitial distribution than in patients with normal bowel by CT. Four (17%) patients had bowel wall dilatation without thickening, which was not associated with statistically significantly different histology than in patients with normal bowel by CT. There was no statistically significant correlation between CT findings and histochemical subtype. Mesenteric soft tissue infiltration was seen in two patients, and mesenteric adenopathy was seen in one patient. CONCLUSIONS: Normal bowel is a common abdominal CT finding in amyloidosis of the alimentary canal. When findings are present, GI wall thickening and/or bowel wall dilatation without wall thickening may be seen. Bowel wall thickening on CT correlates with submucosal extent and interstitial distribution of disease. Soft tissue infiltration and adenopathy are also occasionally seen.
23638.7326985131990.05.04+ [Ultrasonic diagnosis of tumorous lesions of the liver]Sov Med
LM Portnoĭ, AL Roslov, MV Mokshantseva,
23648.7272370101981.08.10++Ultrasound guided percutaneous abdominal abscess drainage.Br J Radiol
DP MacErlean, AP Owens, JB Hourihane,
Traditional management of abdominal abscess is according to classical surgical methods. Catheter or needle drainage of these abscesses, using ultrasound both as an imaging modality and as a monitor of technique, offers a safe and rapid method of drainage of all types of abdominal abscess and eliminates surgery in many patients. Eleven abdominal and retroperitoneal abscesses were satisfactorily drained under ultrasound control in ten patients. No abscess recurred, but in three patients subsequent surgery was performed, in one because the abscess was multiloculated, and in the other two to exclude underlying malignancy.
23658.7230053801986.04.23++Lobar intensity differences of the liver on MR imaging.J Comput Assist Tomogr
Y Itai, K Ohtomo, S Furui, M Minami, K Yoshikawa, N Yashiro,
Differences in signal intensity involving lobes of the liver were noted in seven cases of liver tumor. The clinical significance and possible cause of these differences in lobar intensity are discussed.
23668.7276185451995.08.22++Hepatocellular adenoma: MR imaging features with pathologic correlation.AJR Am J Roentgenol
KY Chung, WW Mayo-Smith, S Saini, A Rahmouni, M Golli, D Mathieu,
OBJECTIVE. The purpose of this study was to describe the MR imaging characteristics of hepatic adenomas and to correlate these features with pathologic findings. MATERIALS AND METHODS. Sixteen patients from four institutions who had 31 hepatocellular adenomas underwent MR imaging with T1- and T2-weighted pulse sequences at 1.5 T. Dynamic gadolinium-chelate-enhanced gradient-recalled-echo (GRE) MR imaging was done in eight patients with 15 lesions. Twenty-three lesions in 15 patients were confirmed by surgical excision. MR images were retrospectively reviewed by three experienced radiologists for signal intensity of lesions relative to liver, heterogeneity, contrast enhancement, and presence of signs of histopathologic correlates. These imaging findings were then compared with histopathologic findings. RESULTS. Nearly all (29 of 31 lesions) hepatocellular adenomas showed heterogeneous signal intensity on MR images. Most (19/31) were predominantly hyperintense on proton density- or T2-weighted images; the predominant signal intensity on T1-weighted images varied. Thirteen of 15 lesions showed early arterial enhancement relative to liver on dynamic GRE MR images. MR imaging was most successful in showing intratumoral hemorrhage (10 of 12 histopathologically proven lesions), large intratumoral vessels (five of five), fatty change (three of six), and peliosis (three of three cases). In two lesions, capsules (one of five) and central scars (one of three) were detected. CONCLUSION. Hepatocellular adenomas have a highly variable appearance on MR images because of their varied histologic appearances. Although no definitive MR imaging signal or structural characteristics can be identified, tumor heterogeneity, particularly when related to hemorrhage, and early arterial enhancement can suggest a diagnosis of hepatocellular adenoma in the proper patient population.
23678.7223128491990.04.23++Gadolinium-DOTA enhanced fast imaging of liver tumors at 1.5 T.J Comput Assist Tomogr
G Marchal, P Demaerel, E Decrop, P Van Hecke, AL Baert,
Twenty patients [15 men, 5 women, 19-71 years old (mean 52 years)] highly suspected of having tumoral liver pathology were prospectively studied with motion compensated T2-weighted spin echo (SE) [repetition time (TR) 2,200 ms, echo time (TE) 90 ms] and Gd-DOTA enhanced gradient echo fast low angle shot [TR 60 ms, TE 10 ms, angle 30 degrees) sequences. The final diagnoses were hemangioma (five), hepatocellular carcinoma (four), focal nodular hyperplasia (one), adenoma (one), metastasis (two), abscess (two), echinococcal cyst (one), tumor of unknown origin (three), cirrhosis (one). Contrast enhanced images were obtained during the early vascular phases after intravenous bolus injection of Gd-DOTA at a dose of 0.1 mmol/kg (0.2 ml/kg). After Gd-DOTA, positive contrast enhancement was seen in 11 cases, negative enhancement in 4, and nonenhancement in 6. Contrast patterns were similar to contrast enhanced CT. In terms of visibility of lesions, the unenhanced motion-compensated T2 SE sequences were superior to the nonenhanced gradient echo sequences in 12 patients and equal in 8. After gadolinium enhancement, T2-weighted SE images were superior to the postcontrast gradient echo images in eight cases, equal in eight and inferior in four cases.
23688.7193695061998.01.21++Differentiation of hepatocellular adenoma and focal nodular hyperplasia of the liver: comparison of power Doppler imaging and conventional color Doppler sonography.Eur Radiol
C Bartolozzi, R Lencioni, A Paolicchi, M Moretti, N Armillotta, F Pinto,
The aim of our study was to compare the diagnostic efficacy of power Doppler imaging and conventional color Doppler sonography for differentiating between hepatocellular adenoma (HCA) and focal nodular hyperplasia (FNH) of the liver. Thirty-one focal liver lesions (in 29 patients) with histologic proof of HCA (n = 9) or FNH (n = 22) were studied with power and color Doppler sonography according to a standardized examination protocol. The size of the lesions ranged between 1.5 and 14.5 cm (HCA, 3.5-14.5 cm, mean +/- SD 7.3 +/- 3.3 cm; FNH, 1.5-9.1 cm, mean +/- SD 5.1 +/- 2.1 cm). Intratumoral vessels with a venous Doppler spectrum, associated with either pulsatile or continuous peripheral flow, were detected in HCA (eight of nine lesions by power Doppler imaging and six of nine by color Doppler imaging) but not in FNH. In contrast, color signals with an arterial Doppler spectrum, radiating from the center to the periphery of the lesion, were depicted in FNH (20 of 22 cases by power Doppler imaging and 15 of 22 by color Doppler sonography) but not in HCA. Differentiation of HCA and FNH was achieved in 28 of 31 cases (90 %) by power Doppler imaging and in 21 of 31 (68 %) by color Doppler sonography (p < 0.01). Power Doppler imaging is superior to conventional color Doppler sonography in the depiction of the intratumoral flow characteristics of HCA and FNH, and enables a more accurate differential diagnosis than color Doppler sonography.
23698.71167786052006.07.14++Liver tumor characterization: comparison between liver-specific gadoxetic acid disodium-enhanced MRI and biphasic CT--a multicenter trial.J Comput Assist Tomogr
J Halavaara, J Breuer, C Ayuso, T Balzer, MF Bellin, L Blomqvist, R Carter, L Grazioli, R Hammerstingl, A Huppertz, G Jung, D Krause, A Laghi, E Leen, L Lupatelli, L Marsili, J Martin, ES Pretorius, C Reinhold, M Stiskal, AH Stolpen,
OBJECTIVE: In our multi center trial we compared the potentials of biphasic contrast-enhanced computed tomography (CT) and a novel tissue-specific magnetic resonance imaging (MRI) contrast agent gadoxetic acid disodium in liver lesion characterization. METHODS: A total of 176 patients with 252 liver lesions were analyzed. There were 104 malignant and 148 benign lesions. High-field strength (1.0 T or 1.5 T) MR systems with T1-and T2-weighted sequences were used with and without fat suppression. After gadoxetic acid disodium injection, dynamic imaging and hepatocyte phase MR imaging were performed. Biphasic with 150 mg I/kg of body weight (100-200 mL) spiral CT was also performed. Image reading consisted of on-site (by study investigators) and fully blinded off-site (by E.S.P; C.R; and A.S) evaluations. The classification (benign or malignant) and characterization (lesion type) outcomes of both techniques were assessed. All imaging results were verified against a standard of reference. RESULTS: Both on-site and off-site evaluations demonstrated increases in the lesion classification accuracy with gadoxetic acid disodium-enhanced MRI when compared with spiral CT. This improvement was also shown for characterization. Gadoxetic acid disodium was well tolerated. CONCLUSIONS: Gadoxetic acid disodium offers a safe and diagnostically powerful tool for the evaluation of patients with focal liver lesions with a reliable assessment of lesion classification and characterization.
23708.71116050402001.12.07++Splenic metastasis of lung cancer.Oncol Rep
H Satoh, K Watanabe, H Ishikawa, YT Yamashita, M Ohtsuka, K Sekizawa,
Splenic metastasis from a lung cancer is infrequently noted, however, the pattern of the metastasis has not been studied, thus we conducted a retrospective study. Twelve of the consecutive 997 patients with lung cancer, who were admitted to our division, developed splenic metastasis. The pattern of splenic metastasis involved solitary nodule in 7 patients (58.3%); multiple nodules in 4, and microscopic metastasis in 1. All of the 12 patients had other abdominal organ metastasis. Splenic mass accompanying metastasis to other abdominal organs in a patient with a known lung cancer should be regarded as a metastasis.
23718.71162957512006.09.12++Vascular tumours disguising as solid organ injuries on computed tomography: a report of two cases.
KY Chan, CK Yoong, I Naqiyah, A Norlia,
We report two cases of uncommon vascular lesions (Littoral cell angioma and liver haemangioma) mimicking traumatic organ injuries. The patients' histories and clinical findings of trauma were well demonstrated. Both patients had interesting CT scan features that were suggestive of solid organ injuries. However, both conditions were subsequently found to be benign incidental lesions.
23728.71176209432007.11.07++Focal liver lesions: can SonoVue-enhanced ultrasound be used to differentiate malignant from benign lesions?Invest Radiol
Y Dai, MH Chen, SS Yin, K Yan, ZH Fan, W Wu, YB Wang, W Yang,
OBJECTIVE: To evaluate whether contrast-enhanced ultrasound (CEUS) with SonoVue could differentiate malignant focal liver lesions (FLLs) from benign lesions and provide lesion type diagnoses. MATERIALS AND METHODS: Four hundred fifty-six patients with 554 FLLs were examined by CEUS with SonoVue using low mechanical index, nonlinear imaging techniques. Each lesion was characterized by 2 independent off-site readers as malignant or benign and given specific lesion type diagnosis, if possible, both at baseline ultrasound (US) and after SonoVue administration (CEUS). The final diagnosis was achieved by histopathology obtained from biopsy or surgical specimens, or by typical manifestation on contrast-enhanced CT or MRI. RESULTS: The diagnostic accuracies of the 2 readers were 41.9% and 35.2% for baseline US, which improved significantly to 87.2% and 87.9% for CEUS (P < 0.05). Interreader agreement also increased with CEUS compared with baseline US (ê value changed from 0.49 to 0.77). The accuracy for lesion type diagnosis was 38.4% and 32.5% for baseline US, which increased to 77.6% and 78.0% for CEUS (P < 0.05). CONCLUSIONS: CEUS with SonoVue improves differentiation between malignant and benign FLLs, and also provides improved lesion type (differential) diagnosis.
23738.71170827052007.01.03++Magnetic resonance imaging characteristics with pathological correlation of cavernous malformation in cavernous sinus.J Comput Assist Tomogr
Z Yao, X Feng, X Chen, C Zee,
OBJECTIVE: To analyze extracerebral cavernous malformation located in the cavernous sinus and correlate their magnetic resonance imaging (MRI) features to pathological findings. MATERIALS AND METHODS: Nineteen patients (5 men and 14 women; mean age, 50.6 years; range, 32-71 years) with surgically verified cavernous malformations in the cavernous sinus were reviewed. MRI including T1-weighted, T2-weighted, and postcontrasted T1-weighted imaging was carried out in all instances with a 1.5-T superconductive system (Signa; General Electric Medical Systems, Milwaukee, WI). RESULTS: All these lesions measured from 2.5 cm to 6 cm (average, 4.3 cm) with 13 lesions located to the right side and 6 to the left side. Magnetic resonance images showed that 18 cases were hypointense to white matter on T1-weighted images with only one case showed mixed hypointensity and hyperintensity. On T2-weighted images, 17 cases showed marked homogeneous hyperintensity, 1 case showed marked hyperintensity with some signal void structures and 1 with mixed intensity. Marked homogeneous enhancement after contrast material administration was found in 7 cases, and the remaining 12 showed marked heterogeneous enhancement. Pathologically, these lesions can be classified as type A, type B, and type C. Type A was sponge-like with intact pseudocapsule; type B was mulberry-like with the pseudocapsule incomplete or absent; and type C was composed of both mulberry-like composition and sponge-like composition. Lesions with homogeneous contrast enhancement on MRI correlated with type A pathological findings, whereas those with heterogeneous enhancement correlated with type B and type C pathological findings. Asymmetrical dumbbell-shaped masses of 13 cases involving the sellar and round masses of 6 cases with 2 protruding into the sellar were found. All of the cavernous malformations displaced the adjacent temporal lobe without adjacent brain edema. The internal carotid arteries were displaced or encased in all cases. CONCLUSIONS: If a well-demarcated, homogeneous high signal intensity lesion on T2-weighted images with a dumbbell configuration involving both parasellar and sellar regions with marked heterogeneous or homogeneous enhancement is found, the diagnosis of cavernous sinus cavernous malformation should be entertained.
23748.7171118261982.10.12+ [Gigantic splenomegaly in sarcoidosis]Rev Esp Enferm Apar Dig
J Vilaseca, J Tor, M Puig Costa, JA Salva, A Sueiras, R Bacardi,
23758.71164055322006.03.07++Usefulness of contrast-enhanced endoscopic ultrasonography in the differentiation between malignant and benign lymphadenopathy.Am J Gastroenterol
A Kanamori, Y Hirooka, A Itoh, S Hashimoto, H Kawashima, K Hara, H Uchida, J Goto, N Ohmiya, Y Niwa, H Goto,
BACKGROUND/AIMS: Endoscopic ultrasonography (EUS) is considered the most useful diagnostic modality for regional staging; however, it is still difficult to diagnose lymph node metastasis by EUS images only. In this study, we report the usefulness of contrast-enhanced EUS (CE-EUS) in the evaluation of benign lymph nodes (BLN) or malignant lymph nodes (MLN) based on blood flow patterns. SUBJECTS AND METHODS: In the retrospective study, CE-EUS was performed in 46 patients in whom EUS revealed lymph node in the mediastinum or abdominal cavity. The subjects consisted of 22 patients with BLN and 24 patients with MLN. The lesions were examined by EUS, and the maximal and minimal diameters of lymph nodes were measured. Thereafter, the shape and internal echoes were investigated, and the findings were morphologically classified based on Catalano's report. Enhancement effects and the diagnostic capability of CE-EUS were evaluated. In the prospective study, BLNs were differentiated from MLN using the enhancement patterns on CE-EUS based on the results of the retrospective study, and the diagnostic capability was evaluated. RESULTS: In the retrospective study, there were no significant differences in the maximal diameter and maximal/minimal diameter ratio between MLN and BLN. The morphology was classified into four types. Based on the morphological classification, the sensitivity, specificity, and accuracy rate were 88.2%, 77.3%, and 82.1%, respectively. On CE-EUS, the enhancement pattern was classified into three types. The BLN lesions showed uniform enhancement (19/22). In all patients with MLN, a defect of enhancement was observed (24/24). The sensitivity, specificity, and accuracy rate of CE-EUS were 100%, 86.4%, and 92.3%, respectively. In the prospective study, the sensitivity, specificity, and accuracy rate of CE-EUS were 100%, 81.8%, and 92.0%, respectively. CONCLUSIONS: CE-EUS is useful for differentiating BLN from MLN.
23768.7127737251989.10.12++Serial assessment of myocardial infarction by using gated MR imaging and Gd-DTPA.AJR Am J Roentgenol
T Nishimura, H Kobayashi, Y Ohara, N Yamada, K Haze, M Takamiya, K Hiramori,
In order to assess the usefulness of Gd-DTPA in the evaluation of myocardial infarction, 17 patients were examined with gated MR imaging. Scans were made by using a spin-echo pulse sequence before and after IV administration of 0.15 mmol/kg of Gd-DTPA. The images were made at four intervals (average of 5, 12, 30, and 90 days) after the onset of the infarction. Gd-DTPA uptake at the infarcted area was graded as marked, moderate, or no increase in signal intensity by visual inspection. At these four time intervals, an area of increased signal intensity in the infarcted myocardium was detected on T1-weighted images after administration of Gd-DTPA in 14 (82%) of 17 cases, 16 (94%) of 17 cases, six (38%) of 16 cases, and three (21%) of 14 cases, respectively. Markedly increased signal intensity in infarcted areas was shown on T1-weighted images with Gd-DTPA at 5 and 12 days. The ratio of gadolinium uptake in the infarcted area to that in normal myocardium also was evaluated. At 5 and 12 days, the mean increase in signal intensity in the infarcted area was significantly higher than that in a normal area, but not at 30 and 90 days. Increased signal intensity also was apparent on T2-weighted images without Gd-DTPA at 5 and 12 days; however, the use of late echo reduced the signal-to-noise ratio, leading to image degradation. Uptake of Gd-DTPA was a positive marker in acute myocardial infarction, but no significant uptake of Gd-DTPA occurred in chronic myocardial infarction.
23778.70109319972000.10.18++Mesenteric Castleman's disease: case report.Abdom Imaging
G Demirpolat, A Pourbagher, M Hekimgil, N Elmas, O Kitis, M Korkut, A Memis,
An asymptomatic case of hyaline vascular-type Castleman's disease localized to the mesentery and detected incidentally by ultrasound is presented. Computed tomographic, angiographic, and histologic findings are reported. This type of Castleman's disease predominates in the thorax and is very rare in the mesentery.
23788.7023409931990.06.25++MRI of primary amyloidosis.Gastrointest Radiol
RB Rafal, R Jennis, PA Kosovsky, JA Markisz,
In a patient with primary amyloidosis, we compared T2 values and relative signal intensity ratios of involved organs to those of normal patients. T2 was significantly decreased in the spleen and adrenals, while significantly increased in the pancreas. T2 values were insignificantly changed in the liver, subcutaneous fat, bone marrow, or kidney. Ratios may facilitate detection of relative changes in T2 values.
23798.6916260021992.08.10++Peliosis lienis: uncommon cause of rupture of the spleen.Pathol Res Pract
S Gábor, F Back, D Csiffáry,
Rare anomaly: peliosis lienis, which was found in the spleen of a woman splenectomised for rupture, is presented. Speculations on the etio-pathogenesis of this peculiar disorder are discussed based on literary data. The awareness of this pathological curiosity may be of practical importance because of the hazard of life-threatening haemorrhagic consequences following rupture of the lesions.
23808.6975688591995.11.01++Hepatic spiral CT: reduction of dose of intravenous contrast material.Radiology
JA Brink, JP Heiken, HP Forman, SS Sagel, PL Molina, PC Brown,
PURPOSE: To assess the potential for reduction of contrast material dose in hepatic spiral computed tomography (CT). MATERIALS AND METHODS: Four hundred eighty-seven outpatients were randomized prospectively into nine biphasic and eight uniphasic injection protocols: 75, 100, or 125 mL of 240, 300, or 350 mg of iodine per milliliter of iohexol (18-44 grams of iodine). Protocols were compared according to the maximum hepatic enhancement (MAX) and the contrast enhancement index (CEI). RESULTS: Uniphasic injection was superior to biphasic injection for all protocols. No statistically significant difference in contrast enhancement was present for 38-44 grams of iodine with the uniphasic technique. Adequate enhancement thresholds (MAX > 50 HU, CEI at 30 HU > 300 HU x sec) were exceeded in more than 70% of heavy patients ( > 183 lb [83 kg]) with uniphasic injection of 38 g. For thin patients ( < 183 lb [83 kg]), uniphasic injection of 26 g produced adequate enhancement. CONCLUSION: Contrast material dose may be reduced by up to 40% in thin patients undergoing hepatic spiral CT after uniphasic injection of contrast material; this may result in substantial cost savings.
23818.6992167671997.07.31++Intrathoracic lymphadenopathy in patients with empyema.J Comput Assist Tomogr
LB Haramati, DD Alterman, CS White, AS Kerr,
PURPOSE: Our goal was to determine the prevalence of intrathoracic lymphadenopathy on chest CT in patients with empyema. METHOD: We retrospectively identified 27 patients (14 men, 13 women, mean age 43 years) with nontuberculous empyema examined with chest CT. All scans were reviewed by two of three board-certified radiologists for the presence of intrathoracic lymphadenopathy (> or = 1 cm, short axis) in an American Thoracic Society (ATS) nodal station or the internal mammary region. Differences were resolved by consensus. RESULTS: Thirteen (48%) patients with empyema had lymphadenopathy on chest CT. The mean number of enlarged lymph nodes for the patients with lymphadenopathy was 3.2 (SD +/-2.3, range 1-8). The mean size of the largest lymph node was 1.4 cm (range 1.0-2.5 cm). The lymphadenopathy was unilateral and ipsilateral to the empyema in seven (54%), bilateral in five (38%), and unilateral contralateral to the empyema in one. The distribution of lymphadenopathy according to ATS nodal stations was 4R (n = 8), 7 (n = 6), 10R (n = 5); n = 2 each 2R, 10L, 11L; and n = 1 each 11R, 2L, 4L, and 6. Four patients had internal mammary lymphadenopathy. Pleural fluid and smooth pleural thickening were present in each case. Four patients had follow-up CT after treatment. There was a decrease or resolution of the lymphadenopathy in each case. CONCLUSION: Intrathoracic lymphadenopathy is a common CT finding in patients with empyema and occurred in 48% of this series. In patients with smooth pleural thickening and pleural effusion, intrathoracic lymphadenopathy should not be used as a criterion to differentiate empyema from malignant or tuberculous pleural effusion.
23828.6867312491984.07.26+ Splenic trauma.Am Fam Physician
TA Frye, SA DeLuca,
23838.68128486092003.11.24+ [Splenic inflammatory pseudotumor: report of a case with thrombocytopenic manifestations and review of the literature]An Med Interna
RJ Bertolín Bernades, J Ferrando-Marco, MJ Arilla-Morell, A Pallas-Regueira,
23848.6722261941990.12.27++[Computed tomographic detection of liver hemangiomas]Dtsch Med Wochenschr
S Schorn, JC Bode, M Hübner, T Hupp, C Herfarth,
A 67-year old woman had noticed increasing growth of hair on the face and extremities for eight months. The testosterone level was raised at 2.6 micrograms/l and 24-hour urinary cortisol excretion was 160 micrograms. Ultrasound scanning showed a tumour measuring 14 x 10 x 10 cm in the left suprarenal, as well as several irregular space-occupying lesions in the liver, some of which were echo-rich. By computed tomography these structures were hypodense and did not concentrate any contrast medium. A provisional diagnosis of suprarenal carcinoma with hepatic metastases was accordingly made. After surgical removal of the suprarenal carcinoma the hormonal parameters unexpectedly returned to normal. Repetition of the computed tomography failed to elucidate the nature of the liver lesions. However, superselective hepatic angiography revealed the typical picture of haemangiomas of the liver. The existing computed tomograms were therefore reviewed. The diagnostic error was found to be due to incorrect timing of the interval between injection of contrast medium and performance of computed tomography.
23858.67106754622000.04.05++Hepatic and splenic involvement in cat-scratch disease: imaging features.Abdom Imaging
O Danon, M Duval-Arnould, Z Osman, B Boukobza, F Kazerouni, JF Cadranel, S Neuenschwander, F Nocton,
Hepatosplenic involvement in cat-scratch disease, probably underdiagnosed, is characterized by multinodular lesions throughout the liver and spleen. Radiologic features of ultrasound, computed tomography, and magnetic resonance imaging are not specific. The key of the diagnosis relies on a history of cat or kitten contact. A specific serological test can confirm the diagnosis without invasive procedures such as biopsy.
23868.6683166721993.07.26++From the archives of the AFIP. Infantile hemangioendothelioma of the liver revisited.Radiographics
PJ Keslar, JL Buck, DM Selby,
Infantile hemangioendothelioma is a benign tumor of the liver composed of anastomosing vascular channels lined by plump endothelial cells. At initial presentation, most patients are 6 months of age or younger and have hepatomegaly or an abdominal mass. Congestive heart failure, bleeding, anemia, jaundice, and cutaneous or visceral hemangiomas may also be present. Grossly, the lesions are usually well circumscribed and may be focal, multifocal, or diffuse. Large solitary lesions are often associated with central hemorrhage or necrosis. Radiography reveals a mass that is occasionally calcified. Angiography reveals hypervascular lesions, often with arteriovenous shunting. A solid lesion with variable echotexture is noted at ultrasound. Computed tomography typically shows a low-attenuation solid lesion with peripheral enhancement. Central enhancement is often lacking except in smaller lesions. At magnetic resonance imaging performed with T2-weighted pulse sequences, the lesions usually have high signal intensity. Spontaneous regression of the tumor occurs, although patients may die of associated conditions.
23878.665899221978.02.23++The lymphogram in abdominal tuberculosis.Clin Radiol
CA Beetlestone, W Wieland, EA Lewis, SO Itayemi,
Lymphograms of 11 patients with histologically proven abdominal tuberculosis have been assessed in an attempt to define a typical pattern of appearance in retroperitoneal lymph glands. Glandular enlargement, poor glandular filling and lymphovascular obstruction were present. A gradient of abnormality with more marked adenopathy in the upper para-aortic chain extending to a lesser involvement below in the iliac chain was demonstrated in keeping with a retrograde spread of the tuberculosis process from the abdominal lymphatics cauded along the retroperitoneal chain. Lymphography may be valuable in cases where data from clinical observations and routine radiological studies is inconclusive in cases of vague abdominal disease.
23888.665008381980.01.19++Malignant lymphoma with a high content of epithelioid histiocytes.J Clin Pathol
D Hayes, JH Robertson,
A series of 12 patients with a rare malignant lymphoma containing numerous epithelioid histiocytes (MLEH), originally believed to be an atypical variant of Hodgkin's disease, is described. Clinicopathological studies suggest MLEH is a distinct entity among the non-Hodgkin's lymphomas which is generally resistant to therapy and has an unfavourable prognosis. Differentiation of the disease from angioimmunoblastic lymphadenopathy and Hodgkin's disease is discussed. In the necropsy case MLEH had transformed into a malignant lymphoma of histiocytic type.
23898.6686236761996.06.19+ Clear cell tumor of the lung.AJR Am J Roentgenol
JB Seo, JG Im, JW Seo, KM Yeon,
23908.6549101271970.06.22+ Malignant lymphoma in the Saudi Arab.Cancer
AP Gelpi,
23918.6431708431988.11.02++Computed tomography of primary retroperitoneal malignancies.J Comput Assist Tomogr
RH Cohan, ME Baker, C Cooper, JO Moore, M Saeed, NR Dunnick,
The CT examinations and medical records of 33 patients with primary retroperitoneal malignancies were reviewed. Computed tomography findings were then compared with those from scans performed on 122 patients with non-Hodgkin lymphoma who presented during the same time interval. Primary retroperitoneal neoplasms had three distinct CT appearances. Twenty-one patients (64%) had large soft tissue masses. Seven patients (21%) had masses with fatty density components, and five patients (15%) had tumors that were primarily of water attenuation. With the exception of those liposarcomas that contained recognizable fat, CT could not distinguish among the different cell types. Seventeen patients with non-Hodgkin lymphoma had large dominant retroperitoneal soft tissue masses that resembled primary retroperitoneal malignancies. In most cases, however, CT was able to differentiate these tumor masses from primary retroperitoneal tumors. Although 19 of 20 sarcomas of soft tissue attenuation were heterogeneous, only six of the 17 lymphomas presenting as dominant masses had such an appearance. Computed tomography is extremely helpful in initially evaluating patients with primary retroperitoneal tumors and in assisting the surgeon in planning his or her approach by accurately defining tumor extent.
23928.64124834002003.04.22++CT fluoroscopy-guided abdominal interventions.Abdom Imaging
D Liermann, R Kickuth,
Computed tomographic fluoroscopy (CTF) is one of the most recent developments in helical computed tomography (CT), which is increasingly being used in interventional radiology. The method combines the advantages of CT with the real-time capabilities of ultrasonography. This article reviews the current clinical applications of CTF in the monitoring of abdominopelvic interventions with reference to published clinical studies.
23938.6483315121993.08.17++Management of splenic abscess in immunocompromised children.J Pediatr Surg
MD Smith, M Nio, JE Camel, JK Sato, JB Atkinson,
Splenic abscess is an infrequent complication in the immunocompromised patient. Six patients underwent splenectomy for presumed splenic abscess from 1987 to 1991. Chemotherapy altered the immune system of four patients; the human immunodeficiency virus (HIV) rendered the other two vulnerable to infection. Five presented with fever but none had leukocytosis; only one exhibited palpable splenomegaly; three had abdominal pain. Cultures documented systemic infection in all but one, an HIV-positive individual. Respiratory embarrassment was the indication for surgery in one patient. In five cases the decision for surgical intervention was made after computed tomography (CT) indicated the presence of multiple splenic lesions and systemic antibiotics failed to resolve the fevers. CT additionally showed hepatic and/or renal microabscesses in four patients. Signs and symptoms experienced preoperatively resolved with splenectomy in all six patients. No additional surgery was required for the patients with extrasplenic abscesses. Surgical pathology determined that three spleens had fungal and two had mycobacterial abscesses. The other was shown to be a spindle cell sarcoma; no abscess was present. This patient had preoperative blood cultures positive for mycobacteria, and the same organism was recovered from retroperitoneal nodes sampled at the time of splenectomy for the sarcoma. Follow-up indicates that no patients experienced surgical complications or sequelae related to their splenic pathology. Splenectomy is necessary and effective in treating splenic abscesses in immunocompromised patients and is appropriate for diagnosis as well as therapy.
23948.6485539831996.02.22+ Histoplasma prostatic abscess: rare cause in an immunocompromised patient.AJR Am J Roentgenol
RD Shah, PM Nardi, CC Han,
23958.63119269462002.04.19++Hepatic radiofrequency ablation.Arch Surg
DA Iannitti, DE Dupuy, WW Mayo-Smith, B Murphy,
HYPOTHESIS: Hepatic radiofrequency ablation (RFA) is effective in treating patients with unresectable hepatic malignancies. DESIGN: Case series of 123 patients with unresectable hepatic tumors or tumors with histological findings not traditionally treated by means of hepatic resection were considered for hepatic RFA. Median follow-up was 20 months. SETTING: Tertiary referral center. PATIENTS: The 123 patents underwent 168 RFA sessions from January 1, 1998, through September 30, 2001. Sixty-nine patients were male and 54, female; average age was 65 years (range, 1-89 years). Fifty-two patients had metastatic colorectal cancer; 30, hepatocellular carcinoma; and 41, cancers with other histological findings. INTERVENTIONS: A 200-W, cooled-tip RF probe system was used for all cases. Probe placement and ablation were monitored by means of real-time ultrasonography or fluoroscopic computed tomography. Final tissue temperature of greater than 50 degrees C was achieved in all cases. RESULTS: Initial treatment sessions were percutaneous in 87 patients, open operations in 33, and laparoscopic in 3. Repeated sessions were percutaneous in all but 2 patients. The mean number of lesions treated per session was 2.7 (range, 1-24). Mean tumor size was 5.2 cm (range, 0.5-15.0 cm). One death occurred within 30 days of a procedure. No hepatic bleeds, bile leaks, or adult respiratory distress syndrome occurred. Overall morbidity was 7.1%. Complications included hepatic abscesses in 4 patients, transient liver insufficiency in 3, segmental hepatic infarcts in 2, diaphragm paralysis in 1, hepatic artery-to-portal vein fistula in 1, and systemic hemolysis in 1. CONCLUSIONS: Hepatic RFA is an effective treatment option for patients with unresectable hepatic malignancies. Careful patient selection based on tumor size, location, and number and on patient clinical status should determine the choice of treatment. Further controlled trials are needed to determine the effect of hepatic RFA on long-term survival.
23968.6380506991994.09.08++[Splenic abscess, a diagnostic and therapeutic problem]G E N
A Marcos, AM Vegas, P del Médico, R Valera, R Piñero, S Piñate, V Marzullo, E Pifano,
Splenic abscess remains a rare entity, reserved for patients with predisposing factors or immunosuppressive conditions. In our 13 patients in which a splenic abscess was diagnosed pre- or intra-operatively, an average of 14 days past before the diagnosis was made. Main symptoms were fever, upper left abdominal pain, auscultatory left basal anomalies and splenomegaly. Culture from the spleen material included E. coli, Staphylococcus, Proteus, Salmonella and Streptococcus v. Although splenectomy has been considered the standard procedure for this pathology, we treated our last three patients by means of Computed Tomography Percutaneous Drainage (C.T.G.P.D.). There was no need for splenectomy after this procedure and there were no complications associated with the C. T. G. P. D.
23978.63154667962005.02.01++CT-guided transvenous or transcaval needle biopsy of pancreatic and peripancreatic lesions.J Vasc Interv Radiol
CT Sofocleous, J Schubert, KT Brown, LA Brody, AM Covey, GI Getrajdman,
PURPOSE: To evaluate the safety and efficacy of direct computed tomography (CT)-guided fine needle aspiration biopsy (FNAB) of pancreatic and peripancreatic masses via a posterior approach that traverses the inferior vena cava (IVC) or renal vein. MATERIALS AND METHODS: From January 2000 to July 2003, 55 patients underwent 58 biopsies of masses located within the pancreas (n = 28) or in a peripancreatic location (n = 30) with use of a posterior approach that crossed the IVC or renal vein. Biopsies were performed with needles ranging in size from 18 to 22. Cytology reports and medical records of all patients were retrospectively reviewed to evaluate diagnostic accuracy and complication rates. RESULTS: Masses were safely accessed with a direct (noncoaxial) pathway traversing the IVC (n = 54), renal vein (n = 4), or both (n = 3). Overall diagnostic accuracy was 86% (50 of 58). Cytologic examination was positive for malignancy in 39 of 58 biopsies (67%). Benign lesions were demonstrated in 12 of 58 biopsies. In seven cases (12%), the sample was deemed nondiagnostic. Of those, four were diagnosed later by endoscopy (n = 1), surgical biopsy (n = 2), or repeat FNAB (n = 1). A false-negative result was noted in one case, which was later diagnosed by repeat biopsy. A total of four inadvertent passes through the right renal artery were recorded. CT evidence of perilesional blood was seen in eight of 55 patients (eight of 58 cases). Three of these occurred after a passage via the right renal artery. All patients remained asymptomatic, and no transfusion or change in management was necessary. No other complications occurred. CONCLUSION: CT-guided noncoaxial FNAB with an approach that traverses the IVC or renal vein is safe and effective in obtaining diagnostic specimens from pancreatic and peripancreatic masses.
23988.63104212581999.08.17++Evaluation of chest computed tomography in the staging of patients with potentially resectable liver metastases from colorectal carcinoma.Cancer
U Kronawitter, NE Kemeny, R Heelan, F Fata, Y Fong,
BACKGROUND: Chest computed tomography (CT) often is used to rule out lung metastases in patients with potentially resectable liver metastases from colorectal carcinoma. In the current study the authors evaluated whether CT of the chest was necessary in patients with a negative chest radiograph. METHODS: The authors performed a retrospective analysis of 202 patients with negative initial chest X-rays who were undergoing evaluation for potentially resectable liver metastases from colorectal carcinoma. Patients with highly suspicious pulmonary lesions on the initial chest CT scan underwent a thoracoscopy and biopsy. All patients were monitored for the development of pulmonary metastases. RESULTS: Sixty patients (30%) had a positive initial chest CT scan. Two patients were found to have metastases by comparison with prior CT scans. Seventeen patients had highly suspicious lesions that were biopsied, but only 2 were found to have pulmonary metastases; the other lesions were benign. An additional 13 of these 60 patients developed lung metastases during follow-up, 6 of whom were diagnosed in retrospect. Of the 142 patients with a negative initial CT scan, 33 (23%) developed pulmonary metastases. The rate of pulmonary metastases in both groups was not significantly different, regardless of whether the CT scans were positive or negative. CONCLUSIONS: During routine preoperative workup for liver resection, the majority of lesions appearing on chest CT scans of patients with negative chest radiographs were not malignant. The positive yield of CT-guided workup was only 10 of 202 patients (5%). Based on this review the authors question the use of chest CT scans in this setting.
23998.6378455221995.03.03++[Magnetic resonance imaging of supratentorial and parafalcial empyema]No Shinkei Geka
Y Takamura, T Uede, K Igarashi, K Tatewaki,
The authors report the MR imaging of two patients with multiple subdural empyemas, including one in the interhemispheric fissure. MRI demonstrated convexity and interhemispheric collections which were mild hyperintense relative to CSF, hypointense relative to gray and white matter on T1W1, and marked hyperintense relative to CSF, and brain on T2W1. On the basis of signal intensity differences, MRI can distinguish subdural empyemas from most sterile effusions and chronic subdural hematomas with similar CT appearances. MRI was found to be clearly more sensitive to subdural empyemas than CT, though such lesions missed on CT were considered to be relevant. MR was superior to CT in demonstrating the nature, presence, and extent of these lesions. In both cases, the capsule of the lesions demonstrated enhancement, and connection between each lesion was obvious on contrast-enhanced MRI. It seems that contrast-enhanced MR image may detect encapsulation of an abscess which can not be detected from contrast-enhanced CT. We emphasized that the most significant factor in the successful surgical management of multiple subdural empyema, particularly including interhemispheric collections is the accurate location of pus. This can be reliably achieved with MR imaging.
24008.6286763061996.08.15+ [Diagnostic case: focal nodular hyperplasia]J Radiol
S Merran,
24018.6235321791986.10.30++Undifferentiated (embryonal) sarcoma of the liver: radiologic-pathologic correlation.Radiology
PR Ros, WW Olmsted, AH Dachman, ZD Goodman, KG Ishak, DS Hartman,
Undifferentiated (embryonal) sarcoma (UES) is an uncommon malignant mesenchymal hepatic tumor that occurs in older children and young adults. Fourteen cases are correlated with radiologic and pathologic findings. Radiologic findings reflect the spectrum of solid to cystic appearances observed in the gross specimens. Sonography typically demonstrates a large mass that may be predominantly solid with many small anechoic spaces or may be cystic. Computed tomography reveals a hypodense mass with hyperdense septa of variable thickness and a dense peripheral rim corresponding to the fibrous pseudocapsule of the tumor. Angiographically, UES is usually hypovascular with tumoral vessels, although hypervascular and avascular patterns occur. Prognosis of UES is poor, with a median survival of less than 1 year. Radiologists should be familiar with this malignant tumor since it may present as a large cystic hepatic mass, suggestive of a benign lesion.
24028.6282413001994.01.06++[Radiologic findings in renal metastases]Aktuelle Radiol
M Päivänalo, T Tikkakoski, J Merikanto, I Suramo,
US and CT findings in 41 cases of renal metastasis with known primary malignancy, mostly lymphoma and pulmonary carcinoma, are analysed retrospectively. All of them were examined with US and 22 with CT. The renal metastases were bilateral in 20 cases and multiple in 21. The echo structure was "infiltrative" in 20, non-infiltrative in 21, homogeneous in 11 and non-homogeneous in 30. 33 metastases were echo-poor, 5 were hyperechoic, two iso-echoic and one of mixed echogenicity. The lymphomas were usually homogeneous, infiltrative and echo-poor, whereas the metastases of pulmonary primaries were usually nonhomogeneous, non-infiltrative, echo-poor and some hyperechoic. None of hyperechoic metastases were lymphomas. One case out of 22 examined with CT indicated a false negative US finding, while 4 US examinations showed only some of the lesions detected with CT. The lesions were hypodense and non-homogeneous in plain CT and gave non-homogeneous enhancement in all cases except for 4 with homogeneous lesions. CT showed smaller and more numerous lesions than US.
24038.6196099011998.06.18++Intrapulmonary lesions: percutaneous automated biopsy with a detachable, 18-gauge, coaxial cutting needle.Radiology
O Lucidarme, N Howarth, JF Finet, PA Grenier,
PURPOSE: To evaluate a lung biopsy technique in which a detachable, 18-gauge, coaxial guide around a central notched stylet is used as a cutting needle. MATERIALS AND METHODS: The records of 89 consecutive patients (41 women, 48 men; aged 21-86 years) who underwent coaxial percutaneous core biopsy of 91 lung lesions that required needle passage through normal lung tissue (mean lesion size, 33.6 mm; range, 9-80 mm) were studied. Detachable, 18-gauge, coaxial automated cutting needles were used. RESULTS: The mean number of needle passes was 2.5 (range, 1-4). All biopsies yielded sufficient tissue for histopathologic (n = 91) and, if necessary, bacteriologic (n = 12) evaluation (mean core length, 5 mm; range, 1-15 mm). Eighty-nine lesions had definitive diagnoses. Seventy-five lesions were proved to be malignant; seventy (93%) could be accurately diagnosed with coaxial percutaneous core biopsy samples. Fourteen lesions were proved to be benign; 10 (71%) were specifically diagnosed with biopsy samples. Among the 91 biopsies, the overall diagnostic accuracy was 88% (80 of 91 lesions). A pneumothorax occurred in 31 cases (34%), three (3%) of which necessitated placement of a chest tube. Postbiopsy hemoptysis occurred and resolved spontaneously in nine cases (10%). CONCLUSION: This technique provides a core biopsy specimen without the need for an on-site cytopathologist during the procedure. It has a high diagnostic accuracy and an acceptable rate of complications.
24048.6183689061993.10.01++Inflammatory pseudotumor of the spleen. A clinicopathologic and immunophenotypic study of eight cases.Arch Pathol Lab Med
RM Thomas, ES Jaffe, A Zarate-Osorno, LJ Medeiros,
We report the clinical, pathologic, and immunophenotypic findings of inflammatory pseudotumors of the spleen in eight patients. The primary importance of recognizing these uncommonly found lesions is to distinguish them from malignant lymphoma, which splenic inflammatory pseudotumors may mimic clinically and radiologically. Grossly, the splenic inflammatory pseudotumors in this study ranged from 0.5 to 11.5 cm. One case was multinodular, and seven lesions were solitary. In general, the size of the lesion correlated with the presence of symptoms. The smaller lesions were usually incidental findings, discovered as part of the workup of idiopathic thrombocytopenic purpura (three cases), during staging for Hodgkin's disease (one case), or at autopsy (one case). Microscopically, the lesions were composed of a variable mixture of inflammatory cells admixed within a spindle cell proliferation. Small, cytologically normal lymphocytes and plasma cells were constant features, in a variable mixture, with neutrophilic and eosinophilic leukocytes present in some cases. Coagulative necrosis was located centrally in six lesions; neutrophilic leukocytes were correlated with the presence of necrosis. The presence of necrosis did not correlate with the presence of symptoms. Immunohistochemical studies revealed that the small lymphocytes present were predominantly T cells. Histiocytes and polytypic plasma cells were also numerous, whereas B cells were infrequent. Inflammatory pseudotumors of the spleen are benign lesions. The clinical follow-up for the seven patients in this study who underwent splenectomy showed no evidence of recurrence or subsequent development of a hematopoietic neoplasm, with a median follow-up of 18 months (range, 3 to 135 months).
24058.61151130622004.05.25+ Preoperative patient work-up: Resovist-enhanced MRI vs. multislice CT--preliminary results of an ongoing study.Eur Radiol
G Heinz-Peer,
24068.61103484421999.06.21++Comparison of high resolution CT findings of sarcoidosis, lymphoma, and lymphangitic carcinoma: is there any difference of involved interstitium?J Comput Assist Tomogr
O Honda, T Johkoh, K Ichikado, S Yoshida, N Mihara, M Higashi, N Tomiyama, M Maeda, S Hamada, H Naito, N Takeuchi, S Yamamoto, H Nakamura,
PURPOSE: The purpose of this study was to determine distinguishing features of three diseases that are distributed along the lymphatics. METHOD: CT scans of 40 patients with lymphangitic carcinomatosis, 41 with sarcoidosis, and 44 with malignant lymphoma were retrospectively reviewed. We evaluated the degree of involvement of the interlobular septa, bronchovascular structures, subpleural interstitium, and other CT findings. RESULTS: The number of thickened interlobular septa and the extent of involvement of the subpleural interstitium in lymphangitic carcinomatosis were higher than those in sarcoidosis and malignant lymphoma (p<0.0001). Nodules of >1 cm in diameter were more often seen in malignant lymphoma (41.0%) than in the other two diseases (p < 0.001). Bilateral distribution was more common in sarcoidosis (100%) than in the others (p<0.001). CONCLUSION: The major difference among lymphangitic carcinomatosis, sarcoidosis, and malignant lymphoma is the greater involvement of the interlobular septa and subpleural interstitium in lymphangitic carcinomatosis than in either sarcoidosis or malignant lymphoma.
24078.615108741980.02.26++Ultrasonographic-pathologic correlation of malignant hepatic masses.Gastrointest Radiol
BJ Hillman, EH Smith, J Gammelgaard, HH Holm,
Characterization of the source of hepatic malignancy would be useful in directing a patient's workup, saving time and expense. We attempted to correlate the echographic appearance of malignant hepatic masses with the pathologic (44 patients) or clinical (1 patient) diagnosis in 45 consecutive patients scanned to evaluate this problem. In 31 patients the lesions were hyperechoic (28) or predominantly hyperechoic with central lucency. Of these lesions, 25 represented metastases from adenocarcinoma of the colon (17), pancreas (6), or unknown origin (2). Six patients with metastatic adenocarcinoma had predominantly echolucent lesions. Of the 14 malignancies of other histologic types, 6 were largely hyperechoic and could not be distinguished from adenocarcinoma metastases. No correlations could be drawn between the ultrasound patterns and the tumor source in this diverse group fo malignancies. In eight patients receiving chemotherapy, sequential examinations failed to reveal any alteration in the echographic patterns of their lesions. These results indicate that the ultrasound appearance of hepatic malignancy lacks specificity in defining the organ of origin. Such factors as homogeneity, vascularity, or desmoplastic response may be more important than cell type in producing the echographic pattern.
24088.61152690192004.09.02++MRI of seemingly isolated greater trochanteric fractures.AJR Am J Roentgenol
F Feldman, RB Staron,
OBJECTIVE: The objective of this article is to show that greater trochanteric fractures commonly perceived on routine radiographs as isolated are often neither isolated nor minor and that MR images can serve as a basis for more informed treatment by revealing the actual extent of such fractures in acute posttraumatic settings. CONCLUSION: A pitfall in diagnosing seemingly isolated greater trochanteric fractures on routinely used imaging techniques lies in the fact that the injuries usually involve a large anatomic area. In our experience, MRI more accurately defines the true geographic extent of greater trochanteric fractures sustained through acute trauma than do radiography and bone scintigraphy and thus could provide a more reliable basis for anticipating complications and for planning appropriate treatment.
24098.6181808521994.06.16++Inflammatory pseudotumor of the liver: appearance on MRI.Clin Imaging
ME Flisak, DM Budris, MC Olson, EJ Zarling,
Inflammatory pseudotumor of the liver is a rare entity; fewer than 50 cases have been reported in the world literature. Its appearance on both computerized tomography (CT) and ultrasound have been previously described. To our knowledge, this is the first report of its appearance on magnetic resonance imaging (MRI). The lesion demonstrated increased signal intensity on T-1 and T-2 spin-echo and inversion recovery (STIR) sequences in relationship to normal liver. The signal characteristics, however, were nonspecific and diagnosis required biopsy confirmation. There was spontaneous resolution with conservative management, and this was documented on follow-up CT and MRI.
24108.6084305741993.03.11+ Severe adverse reaction to iv gadopentetate dimeglumine.AJR Am J Roentgenol
S Takebayashi, M Sugiyama, M Nagase, S Matsubara,
24118.6035222311986.07.25++Splenic abscess on ultrasonography.Eur J Radiol
BO Iko,
The characteristic sonographic features in 32 splenic abscesses (25 of which were retrieved from the world literature) were splenomegaly, associated with an-or hypoechoic masses of different sizes and shapes, demarcated by irregular walls, containing echogenic foci of variable intensity and demonstrating little or no sonic through-transmission. Although these splenic features are not pathognomonic for abscesses, they can be correlated with other incidental abdominal sonographic findings and the presenting clinical symptoms, can direct percutaneous needle punctures and can enable a prompt diagnosis. Immediate surgery is usually curative, and is necessary to improve the high mortality rate in untreated cases.
24128.6080577731994.09.09++Chemical shift misregistration artifact: increased conspicuity following intravenous administration of gadopentetate dimeglumine.Magn Reson Imaging
PL Apicella, SA Mirowitz, JA Borrello,
We have observed increased conspicuity of chemical shift misregistration artifact (CSMA) associated with enhancing structures on MR images after the intravenous administration of gadopentetate dimeglumine compared with corresponding unenhanced images. In this study, we investigate the influence of gadopentetate dimeglumine administration on the conspicuity of CSMA in MR imaging of the kidneys. Nine gadopentetate-enhanced and unenhanced T1-weighted images of the kidneys were evaluated in a side-by-side fashion for the conspicuity of both the high and low signal intensity (SI) components of CSMA. A phantom study of saline in a bath of oil and increasing concentrations of gadopentetate dimeglumine in a bath of oil was performed. There was increased conspicuity of both the high and low SI components of CSMA in gadopentetate-enhanced images compared with unenhanced images in all study cases and in the phantom samples containing gadopentetate compared with the saline control. In conclusion, the administration of gadopentetate dimeglumine results in increased conspicuity of CSMA on MR images of the kidneys.
24138.60112412662001.04.26++Fine-needle aspiration cytology of Hodgkin disease: a study of 89 cases with emphasis on false-negative cases.Cancer
DC Chhieng, JF Cangiarella, WF Symmans, JM Cohen,
INTRODUCTION. Although the cytologic features of Hodgkin disease (HD) has been well described, HD accounts for most of the false-negative fine-needle aspiration (FNA) biopsies of malignant lymphomas. In this study, the authors examined the factors contributing to a false-negative diagnosis of HD. METHODS: Eighty-nine cases from 72 patients (23 females and 49 males) with HD evaluated by FNA were identified between 1990 and 1999. The patients' ages ranged from 5 to 90 years (median, 38 years). Eighty-five FNAs were from lymph nodes, and 4 were from extranodal sites. Histologic correlation was available for all patients. RESULTS: Based on the original cytologic diagnosis, 43 (48.3%) cases had a positive diagnosis of HD, 20 (22.5%) suspicious or atypical diagnosis, 13 (14.6%) a benign diagnosis (false-negative cases), and 10 (11.2%) were nondiagnostic. Three (3.4%) additional cases had a malignant diagnosis other than HD. After review, three false-negative cases were reclassified as HD and seven as atypical lymphoid proliferation. Three of these 10 cases also showed conspicuous collections of histiocytes mimicking poorly formed granulomas. In those "atypical" cases, only rare Reed-Sternberg (R-S) cells variants were identified. No R-S cells or its variants were identified in the remaining three false-negative cases; subsequent excisional biopsy showed partial involvement of the lymph node by HD in two cases. Among the nondiagnostic cases, nine cases showed considerable fibrosis in the resected lymph node. In addition, six cases were performed without on-site assessment. CONCLUSIONS: The cytologic diagnosis of HD can be challenging when classic R-S cells are absent. Contributing factors for a false-negative diagnosis include obscuring reactive inflammatory cells, fibrosis of the involved lymph nodes, partial involvement of the lymph node by HD, sampling error, and misinterpretation. On-site assessment significantly minimizes the false-negative diagnostic rate. Furthermore, additional material can be obtained for ancillary studies. Cancer (Cancer Cytopathol) Copyright 2001 American Cancer Society.
24148.60159657762005.09.13++Comparison of contrast-enhanced power Doppler ultrasound (Levovist) and computed tomography in alveolar echinococcosis.Abdom Imaging
W Kratzer, S Reuter, K Hirschbuehl, AR Ehrhardt, RA Mason, MM Haenle, P Kern, A Gabelmann,
BACKGROUND: To date, no study has compared unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound with three-phase helical computed tomography (CT) for the analysis of the vascularization of hepatic lesions in patients who have alveolar echinococcosis. METHODS: Fifteen patients (11 female and four male; average age, 45.8 years) with confirmed Echinococcus multilocularis infection underwent unenhanced and contrast-enhanced (Levovist) power Doppler ultrasound (2- to 5-MHz transducer head) and three-phase helical CT. The largest identified lesion in each patient was studied. RESULTS: CT visualized vascularization peripheral or central to the largest echinococcal lesions in 11 of 15 patients. Vascularization in the area of the echinococcal lesions was not visualized by unenhanced or contrast-enhanced power Doppler ultrasound in any of the 15 patients studied. CONCLUSION: Three-phase helical CT visualizes the vascularization associated with Echinococcus multilocularis lesions in the liver. Neither unenhanced nor contrast-enhanced ultrasound in power mode is suitable for this application.
24158.59127199052003.08.21++Subphrenic bronchogenic cyst mimicking a juxtahepatic solid lesion.Abdom Imaging
YC Kim, JM Goo, JK Han, KH Lee, HS Lee, JG Im,
Most bronchogenic cysts occur in the mediastinum. However, they may be found near any organ derived from the embryonic foregut, even in the extrathoracic region. We report a case of subphrenic bronchogenic cyst that was initially confused with a solid lesion because of its unusual location and atypical appearance on ultrasonography, computed tomography, and magnetic resonance imaging.
24168.59164988092006.05.30++[Difficulties in diagnostics in recurrent abdominal pains in 71-years-old patient]Pol Merkur Lekarski
A Kuna, A Wojtacha, J Kostro, WL Nahorski,
Neoplasm of B-cell origin is the most frequent malignant disease of the lymphatic tissue. It is usually presented as enlargement of lymph nodes, hepatosplenomegaly, skeletal pains and gastrointestinal dysfunction. Splenic lymphoma can cause the difficulties in diagnostic procedures (ultrasound and computed tomography). It may be nearly anechoic and mimic a cyst, abscess or parasitic mass. We describe a course of the disease and diagnostic troubles noted in 71-years-old patient, in whom splenic cysts enlarging rapidly were observed. Splenectomy due to presented difficulties in diagnosis such as clinical disquiet about subsequent course of the disease was performed. It let us to recognize malignant lymphoma and initiate a correct treatment strategy.
24178.5976185561995.08.22++Percutaneous drainage of subphrenic fluid collections that occur after splenectomy: efficacy and safety of transpleural versus extrapleural approach.AJR Am J Roentgenol
MM McNicholas, PR Mueller, MJ Lee, J Echeverri, GS Gazelle, GW Boland, SL Dawson,
OBJECTIVE. The purpose of this study was to compare the safety and efficacy of transpleural and extrapleural approaches for draining left subphrenic abscesses in patients who have had splenectomy. MATERIALS AND METHODS. Twenty-five patients who had percutaneous catheter drainage (28 drainages) of postsplenectomy fluid collections were studied. Twenty drainages were transpleural and eight were extrapleural. In eight of the 20 transpleural drainages, it was elected to place the catheter transpleurally. In the remaining 12 patients, catheter drainage was judged to be transpleural on review, despite efforts to use an extrapleural approach. RESULTS. Sixteen of 18 patients who had transpleural percutaneous drainage and six of seven patients who had true extrapleural (subcostal) percutaneous drainage were cured by catheter drainage requiring no further intervention. The mean number of days of drainage was not significantly different (p > .05) for the group drained transpleurally (mean, 18 days; range, 1-90 days) versus the group drained extrapleurally (mean, 20 days; range, 6-43 days). Complications (pneumothorax) requiring treatment were seen in two patients in whom a transpleural approach was used and in none of the patients in whom an extrapleural approach was used. Complications that did not require treatment were seen in four further patients drained transpleurally. These were inadvertent placement of catheter into pleural space (two patients) and pneumothorax not requiring treatment (two patients). No patient had an empyema. CONCLUSION. Transpleural drainage of left subphrenic collections occurring after splenectomy is associated with a slightly increased complication rate but has a success rate similar to that of extrapleural drainage.
24188.5986062301996.05.21++Detection of renal ischemic lesions using Gd-DTPA enhanced turbo FLASH MRI: experimental and clinical results.J Comput Assist Tomogr
R Vosshenrich, M Kallerhoff, HJ Gröne, U Fischer, M Funke, L Kopka, G Siebert, RH Ringert, E Grabbe,
PURPOSE: Our goal was to investigate the role of Gd-DTPA-enhanced dynamic MRI in the evaluation of renal ischemic lesions. METHOD: With a turbo FLASH sequence before and after injection of Gd-DTPA, nine foxhound dogs after 60-120 min of renal ischemia underwent MR examination. In addition, five patients with a tumor in a solitary kidney were examined before and after nephron-sparing renal surgery to evaluate renal perfusion and function. The experimental and clinical findings were correlated with conventional measurements of kidney function and with histological findings. RESULTS: Complete renal ischemia leads to a poor corticomedullary differentiation in Gd-DTPA-enhanced turbo FLASH MRI. The signal-intensity-versus-time plots of kidneys with significant postischemic changes show a less steep increase of signal intensity in the cortex and a steeper increase of signal intensity in the medulla than those of normal kidneys. CONCLUSION: Dynamic MRI demonstrate renal morphology and reflect the functional status of renal vasculature.
24198.59103418021999.06.09+ [The wandering spleen--a rare differential diagnosis of acute abdomen]Rofo
A Fasse, S Walgenbach, HU Kauczor, M Thelen,
24208.5892075661997.09.18+ Re: Percutaneous transpulmonary CT-guided liver biopsy.AJR Am J Roentgenol
AR Padhani, WW Scott,
24218.5877905451995.07.21++CT evaluation of mediastinal lymphadenopathy: noncontrast 5 mm vs postcontrast 10 mm sections.J Comput Assist Tomogr
LB Haramati, AM Cartagena, JH Austin,
OBJECTIVE: Two CT techniques were compared in the assessment of mediastinal lymph nodes: 5 mm thick sections without intravenous contrast medium and 10 mm thick sections with intravenous contrast medium. MATERIALS AND METHODS: Seventy-nine adult patients were examined by chest CT. From the level of the aortic arch through the level of the right middle lobe bronchus 5 mm thick sections were performed without intravenous contrast medium, followed by 10 mm thick sections of the same region with intravenous contrast medium. Two chest radiologists separately reviewed each CT method for each patient. Mediastinal lymph nodes were localized according to the American Thoracic Society scheme. Lymph node diameter was measured on the short axis. RESULTS: The 5 mm thick noncontrast sections permitted identification of more mediastinal lymph nodes than the 10 mm thick contrast enhanced sections (p < 0.01, signed rank test). The 5 mm thick unenhanced sections tended to show slightly (1-2 mm) larger nodes than the 10 mm thick contrast enhanced sections (stations 7, 10R, both reviewers, p < 0.05, signed rank test). Nodes with a short axis diameter > or = 8 mm were identified comparably well using either CT technique. CONCLUSION: The present study indicates that CT of the mediastinum using 5 mm thick sections, without intravenous contrast medium, is an appropriate scanning technique for evaluation of mediastinal lymphadenopathy.
24228.5818871191991.10.10++Vascular rings: 10-year review of imaging.Radiographics
GM Lowe, JS Donaldson, CL Backer,
Radiologic studies of 47 children with surgically proved vascular rings were retrospectively reviewed. On radiographs, a right-sided or bilateral aortic arch and the presence of tracheal narrowing were signs indicative of vascular rings. On barium esophagograms, a double or right aortic arch appeared as deep persistent posterior indentation of the esophagus. On computed tomographic (CT) scans and magnetic resonance (MR) images, the diagnosis of vascular rings was based on vascular branching patterns, the side of the aortic arch or presence of two arches, and narrowing of the airway. Although the diagnosis of a complete vascular ring can usually be established with certainty by means of radiography and esophagography, CT and MR imaging add valuable anatomic detail about exact arch configuration, tracheobronchial compression, and brachiocephalic vessel branching.
24238.5794459701998.01.27++[Angiosarcoma of the spleen. Case report and review of the literature]Langenbecks Arch Chir
B Geissler, R Fleischmann, T Wagner, W Wohlgemuth, F Lindemann,
Angiosarcoma of the spleen is a very rare but highly malignant vascular neoplasm. So far only 140 cases have been reported. A 42-year-old patient is presented in which the radiologic imaging misled to the diagnosis of infiltrating echinococcosis. After splenectomy histological and immunohistochemical staining gave proof of metastatic angiosarcoma. The patient died three months later as a consequence of multiple organ dysfunction syndrome. The literature is reviewed in regard to clinical features, diagnosis and therapy.
24248.56166768672006.05.30++Lymphangiomatosis masquerading as metastatic melanoma.Am Surg
W Qutub, K Lewis, R Gonzalez, R Quaife, P Russ, M McCarter,
A patient undergoing evaluation for malignant melanoma was thought to have a metastatic process involving the anterior mediastinum, axilla, spleen, and possibly liver based on radiologic findings from positron emission tomography and computed tomography scans. The clinical picture did not corroborate this suspicion, and biopsies ultimately confirmed lymphangioma in the accessory spleen and subcutaneous tissues, leading to a diagnosis of lymphangiomatosis. Diagnosis and management of lymphangiomatosis is clinically challenging. This report reviews the literature on the pathology, diagnostic imaging, and management of lymphangiomatosis.
24258.5683276951993.08.12++Lymphoma: monitoring tumor size and signal intensity with MR imaging.Radiology
A Rahmouni, C Tempany, R Jones, R Mann, A Yang, E Zerhouni,
To assess the potential value of magnetic resonance (MR) imaging in monitoring disease status, 34 patients with residual masses underwent MR imaging at sequential intervals. Patterns of signal intensity suggestive of active and inactive residual disease were compared to changes in tumor size. The signal intensity pattern was suggestive of persistent disease in 18 patients, even though tumor size was stable or decreased. Three of these patterns, seen within 6 months of initiation of therapy, were due to necrosis or inflammation. The MR imaging assessment of inactive disease was confirmed in 15 of the remaining 16 patients. In no case was an increase in tumor size seen in conjunction with a decrease in signal intensity. Because tumor size and signal intensity changes are not parallel in many cases, MR imaging may have a role in monitoring masses in patients with lymphoma. Signal intensity patterns, however, reflect gross histologic characteristics and cannot be considered specific, especially in the first 6 months after initiation of therapy.
24268.5563501481983.10.28+ Pathology of the spleen in benign and malignant conditions.Histopathology
JJ Butler,
24278.55989811978.10.27++A reevaluation of intrathoracic lymphadenopathy in sarcoidosis.AJR Am J Roentgenol
ME Bein, CE Putman, TC McLoud, JH Mink,
Chest radiographs of 62 patients with sarcoidosis and intrathoracic lymphadenopathy were evaluated retrospectively for anatomic distribution of lymph nodes. All but two cases had bilateral hilar lymphadenopathy. Approximately 75% of the patients had nodal enlargement in the right paratracheal or aortopulmonic window regions and about 20% in the subcarinal or anterior mediastinal areas. The most frequent combination of lymphadenopathy, found in 37% of cases, included the aortopulmonic window, bilateral hilar, and right paratracheal regions. Right paratracheal and bilateral hilar lymph node enlargement was seen in only three patients. Aortopulmonic window nodes were almost always found with hilar or hilar and mediastinal lymphadenopathy. Anterior mediastinal or subcarinal involvement was never found without some combination of right paratracheal, bilateral hillar, and aortopulmonic window lymphadenopathy. We therefore conclude that aortopulmonic window, anterior mediastinal, or subcarinal lymph node enlargement often accompany the characteristic lymphadenopathy of sarcoidosis.
24288.55112247542001.04.19++Detection of intracranial metastases: a multicenter, intrapatient comparison of gadobenate dimeglumine-enhanced MRI with routinely used contrast agents at equal dosage.Invest Radiol
C Colosimo, J Ruscalleda, M Korves, R La Ferla, C Wool, P Pianezzola, MA Kirchin,
RATIONALE AND OBJECTIVES: To compare gadobenate dimeglumine (MultiHance) with other commercially available MRI contrast agents for the detection of intracranial metastases. METHODS: A retrospective assessment was performed on MR images from 22 patients enrolled in a prior phase II clinical trial of gadobenate dimeglumine. Each patient underwent two examinations: a first examination with one of three "comparator" agents (gadopentetate dimeglumine, gadodiamide, and gadoterate meglumine) at a dosage of either 0.1 or 0.2 mmol/kg, and then a similar examination with gadobenate dimeglumine at equal dosage. All images were evaluated randomly for lesion number and location in unpaired and then paired fashion by two independent, masked neuroradiologists. A third assessor performed quantitative assessments on the available complete sets of digitally recorded images (10 cases). RESULTS: The findings for the comparator agents were pooled. Sensitivity for lesion detection with gadobenate dimeglumine (93%-100%) was markedly superior to that of comparator-enhanced examinations (65%-73%). The increase of lesion-to-brain contrast of the main lesion was consistently greater with gadobenate dimeglumine than with comparator agents relative to unenhanced contrast (+43% vs. +27%). CONCLUSIONS: Gadobenate dimeglumine proved to be a more efficacious agent than comparator contrast agents for the detection of intracranial metastatic lesions: superior efficacy was noted by both reviewers for total lesion count as well as for sensitivity and positive predictive value for lesion detection. The higher relaxivity of gadobenate dimeglumine might explain the superior sensitivity of gadobenate dimeglumine-enhanced MRI for the detection of central nervous system metastases.
24298.5523530981990.07.19++Non-Hodgkin lymphoma: predicting prognostic grade with MR imaging.Radiology
SM Rehn, RS Nyman, BL Glimelius, HE Hagberg, JC Sundström,
Fifty patients with non-Hodgkin lymphoma (NHL) were examined with magnetic resonance (MR) imaging in order to analyze whether it is possible to distinguish in vivo between the two major prognostic groups, low-grade NHL and high-grade NHL. Most high-grade NHL nodes (15 of 24 [63%]) had an inhomogeneous appearance at MR imaging, in contrast to low-grade NHL nodes, which were homogeneous in almost all patients (18 of 20 [90%]) (P less than .001). A homogeneous image was also found in six patients who had previously received a diagnosis of low-grade NHL; at the time of examination their lesions had transformed into high-grade NHL. Necrosis, detectable in the histopathologic sections, was usually (five of six cases) associated with an inhomogeneous image. However, the images were also inhomogeneous [corrected] in 12 of 44 cases (27%) in which there were no signs of necrosis in the histopathologic sections. Patients with high-grade NHL and a homogeneous signal intensity pattern tended to have a better survival rate than those with an inhomogeneous pattern.
24308.5566581221984.02.14+ [Intra-abdominal cystic lymphangiomas. Review apropos of 10 cases]Rev Esp Enferm Apar Dig
JL Aguayo Albasini, J Illana Moreno, FJ Galera Peñaranda, F Sánchez Bueno, J Sola Pérez, MA Morcillo Rodenas, P Parrilla Paricio,
24318.5482843761994.02.17++MR imaging of prostate cancer with an endorectal surface coil technique: correlation with whole-mount specimens.Radiology
SF Quinn, DA Franzini, TA Demlow, DR Rosencrantz, J Kim, RM Hanna, J Szumowski,
PURPOSE: To evaluate the diagnostic accuracy of magnetic resonance (MR) imaging in staging prostate cancer with an endorectal surface coil technique. MATERIALS AND METHODS: The authors prospectively evaluated MR images obtained with an endorectal surface coil from 70 consecutive patients with known prostate cancer. Gadopentetate dimeglumine was administered to 40 patients. Multiple sequences were used, including conventional and fast spin echo, with and without fat suppression. The readers were blinded to the MR findings unless bone or nodal metastasis was present. MR images were compared with whole-mount sections. RESULTS: The prospective staging accuracy for MR imaging was 51% (36 of 70 patients). Stage B disease was present in 27 patients (38%), stage C in 42 (60%), and stage D in one (1%). The retrospective staging accuracy was 67% (47 of 70 patients). Of the 42 patients with stage C disease, positive surgical margins were present in 36 (85%). Gadopentetate dimeglumine did not help detect or stage tumors. CONCLUSION: Further studies must be performed to determine the role of endorectal coil MR imaging in the staging of prostate cancer.
24328.5483915291993.08.05++Large solitary non-parasitic cyst of the liver.J Belge Radiol
F Rypens, EF Avni, JJ Houben, J Struyven,
Non-parasitic solitary liver cysts are rare in children. Yet they should be included in the differential diagnosis of superior abdominal masses. We report one case in a 7-year-old boy that illustrates the difficulties of the diagnosis.
24338.5412898931993.03.23+ [Abdominal tuberculosis]Probl Tuberk
AA Sadovnikov,
24348.54120346122002.07.02++Multidetector CT of the spine in multiple myeloma: comparison with MR imaging and radiography.AJR Am J Roentgenol
AH Mahnken, JE Wildberger, G Gehbauer, T Schmitz-Rode, M Blaum, U Fabry, RW Günther,
OBJECTIVE: The purpose of this study was to compare multidetector CT (MDCT) of the thoracic and lumbar segments of the spine with MR imaging and conventional radiography for bone lesion detection and for evaluating the risk of vertebral fracture in multiple myeloma. SUBJECTS AND METHODS: Eighteen patients with multiple myeloma stage III (according to the criteria of Durie and Salmon) underwent MDCT, conventional radiography, and MR imaging of the lumbar and thoracic spine. MDCT was performed using a standard protocol with no contrast material. Source images were reconstructed using an effective slice thickness of 3 mm with an overlapping reconstruction increment (0.8 mm). Secondary coronal and sagittal multiplanar reformations were exclusively used for establishing the diagnosis. Findings were compared with those of MR imaging and conventional radiography. RESULTS: In all patients, coronal and sagittal multiplanar reformations depicted the extent of osseous destruction and provided detailed information about osseous infiltration and potential bone instability. Compared with conventional radiography, an additional 24 affected vertebrae, 15 additional vertebral fractures, and six vertebrae at further risk of fracture were detected on MDCT. Compared with MR imaging, three additional endangered vertebrae were detected on MDCT. MR imaging alone would have lead to an understaging of five (27.8%) of 18 patients. Using combined radiography and MR imaging, disease in three (16.7%) of 18 patients would have been understaged. CONCLUSION: MDCT seems to be preferable to conventional radiography in evaluating bone destruction in multiple myeloma. In combination with MR imaging, detailed information for staging these tumors is obtained. For the initial staging in patients with multiple myeloma, MDCT in combination with MR imaging seems to be the method of choice.
24358.5493084481997.10.16++Mediastinal mature teratoma: imaging features.AJR Am J Roentgenol
KH Moeller, ML Rosado-de-Christenson, PA Templeton,
OBJECTIVE: The purpose of this study was to characterize the cross-sectional imaging features of mediastinal mature teratomas. MATERIALS AND METHODS: Sixty-six cases of mediastinal mature teratoma were retrospectively reviewed, noting clinical, radiologic, surgical, and pathologic findings. The patient population consisted of 38 females and 28 males who were 1 week to 67 years old (mean age, 23 years 10 months). RESULTS: Forty-six patients presented with symptoms, predominantly chest pain, dyspnea, and cough. Twenty patients were asymptomatic. Fifty-four tumors were found in the anterior mediastinum, two in the posterior mediastinum, one in the middle mediastinum, and nine in multiple compartments. CT studies (n = 66) showed masses of heterogeneous attenuation with varying combinations of soft tissue, fluid, fat, and calcium. Soft-tissue attenuation was observed in 66 tumors (100%), fluid in 58 tumors (88%), fat in 50 tumors (76%), and calcification in 35 tumors (53%). The most frequent combination of attenuations was soft tissue, fluid, fat, and calcium, which was noted in 26 masses (39%). The combination of soft tissue, fluid, and fat was seen in 16 tumors (24%); and the combination of soft tissue and fluid was seen in 10 tumors (15%). Fat-fluid levels were seen in seven masses (11%). CONCLUSION: Mediastinal mature teratoma typically manifests on CT as a heterogeneous anterior mediastinal mass containing soft-tissue, fluid, fat, or calcium attenuation, or any combination of the four. Fluid-containing cystic areas, fat, and calcification occur frequently. Cystic lesions without fat or calcium were seen in 15% of tumors. Fat-fluid levels, considered highly specific for the diagnosis of mediastinal mature teratoma, are uncommon. CT is the imaging technique of choice in the evaluation of these lesions.
24368.5462922721983.01.07++Computed tomography of the brain, liver, and upper abdomen in the staging of small cell carcinoma of the lung.J Comput Assist Tomogr
PY Poon, R Feld, WK Evans, G Ege, JL Yeoh, ML McLoughlin,
Computed tomography (CT) examinations of the brain, liver, and upper abdomen were obtained in 60 previously untreated patients with histologically proven small cell carcinoma of the lung (SCCL). These results, together with clinical findings and laboratory investigations including radionuclide scans, determined the final staging of the patients. Computed tomography changed the stage from limited to extensive disease in three patients and from extensive to limited disease in seven patients. Overall, 10 of 60 patients (16%) had their final stage altered by CT. This study indicates that CT examinations may yield valuable information in some cases of small cell lung cancer but that it is of limited value in the routine staging of these patients.
24378.53128856112003.08.18++How we do a bloodless partial splenectomy.Am J Surg
NA Habib, D Spalding, G Navarra, J Nicholls,
Partial splenectomy and Tru-cut biopsy are not routinely practiced because of the lack of vascular control to arrest bleeding. Using radiofrequency energy to coagulate the resection margin and biopsy tract, a 74-year-old woman with a tumor in the lower pole of the spleen underwent partial splenectomy and Tru-Cut biopsy of the spleen. Hemostasis was excellent. Blood loss was minimal and the patient was discharged with a functioning spleen. This new technique may allow safe and bloodless partial splenic resection and Tru-cut biopsy of the spleen, which might reduce the number of splenectomies performed and the consequent difficulties for the patient that can arise.
24388.5326878441990.01.25+ [Isolated tuberculosis of the spleen]Probl Tuberk
DD Iablokov, VA Zykova,
24398.5226486141989.04.21++Current diagnostic imaging modalities of the liver.Surg Clin North Am
ME Clouse,
Although there are many complementary and supplementary types of diagnostic imaging of the liver, a logical sequence for most liver pathology begins with high-quality ultrasound. It is noninvasive and inexpensive but very operator dependent. In other settings, CT may be the preferable screening modality, as it gives an excellent picture of the global anatomy and is easily reproducible. Frequently, the two modalities are complementary and indicated; on other occasions, one method will suffice. Radionuclide evaluation of the liver is usually reserved for hepatobiliary imaging for biliary obstruction or the question of acute cholecystitis and tagged-red cell scanning for hemangioma. It is also frequently used for gallium scanning in hepatoma, but lymphoma and inflammatory diseases are also gallium avid. The invasive imaging tests of the liver--angiography and transhepatic and endoscopic retrograde cholangiography--are performed when insufficient information is obtained by the other methods (as in diagnostic transhepatic cholangiography) or when the procedure offers therapy (as for biliary drainage, percutaneous transhepatic removal of common bile duct stones, percutaneous cholecystosis with gallstone dissolution and liver embolization, or the angiographic evaluation for portal shunting or liver resection). The impact of magnetic resonance imaging and fourth-generation raid angiotomography CT scanning has yet to be felt. The use of intraoperative ultrasound is to be encouraged prior to liver resection because it can demonstrate lesions as small as 3 mm in diameter.
24408.52164989362006.03.23++Characterization of adrenal adenomas and metastases: correlation between unenhanced computed tomography and chemical shift magnetic resonance imaging.Acta Radiol
G Rescinito, F Zandrino, G Cittadini, E Santacroce, V Giasotto, CE Neumaier,
PURPOSE: To evaluate the correlation of absolute attenuation values of unenhanced computed tomography (CT) with signal intensity (SI) quantitative analysis on chemical shift (CS) magnetic resonance (MR) imaging in differentiating adrenal adenomas from metastases. MATERIAL AND METHODS: Forty-one adrenal masses (27 adenomas, 14 metastases) were studied with CS MR imaging and unenhanced CT. MR included T1-weighted breathhold gradient-echo in-phase (IP) and opposed-phase (OP) sequences. The SI index (SI-i) [(SIIP-SIOP/SIIP)] x 100% and chemical-shift ratio (CS-r) relative to the spleen [(SIlesion/ SIspleen)OP/(SIlesion/SIspleen)IP] were calculated for each lesion. CT absolute attenuation values were also determined. RESULTS: The mean attenuation value of metastases was significantly greater than that of adenomas (< 0.0001). On MR, the mean SI-i of adenomas was significantly greater than that of metastases (P < 0.0001) and no overlaps were evident. The CS-r of malignant and benign lesions overlapped considerably, and five adenomas (all with indeterminate Hounsfield Unit values at CT) were misclassified as potentially malignant. CT attenuation values were significantly correlated with both MR quantitative analyses. CONCLUSION: Since CS MR imaging and CT both depict the presence of lipids within adrenal lesions, absolute attenuation values are highly correlated with MR quantitative analysis. SI-i is the most reliable tool for differentiating adrenal adenomas from metastases, showing better accuracy than lesion-to-spleen CS-r, in particular for adenomas with indeterminate absolute attenuation values.
24418.5225449391989.08.03++[Space-occupying lesions in the pineal region--MRT using Gd-DTPA]Rofo
T Kahn, G Fürst, N Roosen, H Steinmetz, HG Lenard, U Göbel, U Mödder,
The results obtained from contrast-enhanced MRI in 21 patients with masses in the pineal region are reported. The use of gadolinium-DTPA results in intensive contrast uptake by the tumour; this produces better definition of the tumour and more exact delineation from neighbouring structures. This is of importance in judging resectability and in choosing the operative approach. During chemotherapy or radiotherapy, it provides reliable demonstration of the success of treatment and accurately demonstrates the size of the tumour and the presence of necrosis. On the other hand, histologic classification of pineal tumours is possible only occasionally.
24428.5281889011994.06.21++Cervical tuberculous lymphadenitis: CT findings.J Comput Assist Tomogr
Y Lee, KS Park, SY Chung,
OBJECTIVE: Cervical tuberculous lymphadenitis (CTBL) is still an important cause of neck mass in many countries. The purpose of this study is to analyze the CT findings of CTBL and compare them with those of malignant lymphadenopathies and pyogenic abscesses in the neck. MATERIALS AND METHODS: We retrospectively reviewed the CT scans of 32 CTBLs, 25 malignant lymphadenopathies, and 12 pyogenic abscesses in the neck. Attenuation value, enhancement pattern, and surrounding fat plane were evaluated. RESULTS: The CT findings of CTBL were classified into four types: type 1, homogeneous soft tissue density; type 2, central low density and peripheral rim enhancement with relative preservation of surrounding fat planes; type 3, multilocular central low densities and peripheral rim enhancement with obliteration of surrounding fat planes; and type 4, large confluent low density with peripheral rim enhancement and loss of lymph node architecture. Among the 32 cases of CTBL, type 3 was most frequently noted (59.4%) followed by type 2 (21.9%), type 4 (15.6%), and type 1 (12.5%). The enhancing rim of CTBL was usually thick and irregular in contrast to some malignant lymph nodes showing thin and regular rim enhancement. The degree of surrounding fat plane obliteration was less in type 4 CTBL than in pyogenic cervical abscess. CONCLUSION: Cervical tuberculous lymphadenitis usually shows a central low density and peripheral rim enhancement that tends to be thick and irregular compared with a malignant lymphadenopathy. Multilocular low densities with peripheral enhancement and a large confluent low density with less degree of fat plane obliteration than a pyogenic abscess are suggestive features of advanced CTBL.
24438.52116876852001.12.27++Lymphangioleiomyomatosis: CT of diurnal variation of lymphangioleiomyomas.Radiology
NA Avila, J Bechtle, AJ Dwyer, VJ Ferrans, J Moss,
PURPOSE: To evaluate the imaging and clinical features of lymphangioleiomyomas and to describe the phenomenon of diurnal variation in the size of lymphangioleiomyomas in patients with lymphangioleiomyomatosis. MATERIALS AND METHODS: One hundred twenty-eight patients with lymphangioleiomyomatosis underwent chest and abdominopelvic computed tomography (CT). Thirteen patients underwent CT in the morning and afternoon of the same day to assess diurnal variation in lymphangioleiomyoma size. RESULTS: Twenty-seven of 128 patients (21%) had 54 lymphangioleiomyomas. The vast majority (96%) of these masses contained material of low attenuation at CT. Associated CT findings included enlarged abdominal lymph nodes, pleural effusions, ascites, and dilatation of the thoracic duct. The prevalence of lymphangioleiomyomas was 15% in patients who had mild pulmonary disease, 19% in patients who had moderate disease, and 26% in patients who had severe disease. Diurnal variation in size of masses was demonstrated in 12 of 13 patients. Seven of the 27 patients who had masses underwent biopsy; all seven were confirmed to have lymphangioleiomyomas. The most common symptoms associated with lymphangioleiomyomas were bloating, abdominal pain, and edema of the lower extremities. The majority of the patients reported worsening of symptoms as the day progressed. CONCLUSION: Lymphangioleiomyomas are common in patients with lymphangioleiomyomatosis. Diurnal variation in size may explain worsening of symptoms during the day.
24448.5155518351971.05.30+ [Indications for splenectomy in splenomegaly]Pol Tyg Lek
Z Migdalska-Kornacka, M Szczecińska,
24458.5120893631991.05.28++[Sagittal MR images of normal pineal glands after Gd-DTPA injection]Nippon Igaku Hoshasen Gakkai Zasshi
S Saiwai, Y Inoue, H Fukuda, M Ishikawa, M Ohnishi, H Nakajima, T Miyamoto,
We evaluated normal pineal glands on Gd-DTPA enhanced MR images on a 1.5 Tesla superconducting unit. On enhanced sagittal MR images with a 3-mm slice thickness, pineal glands were identified as solid or cystic structures. The solid and cystic pineal glands were divided into two subgroups according to the degree of enhancement. The solid pineal glands showed diffuse or subtle enhancement and cystic ones showed peripheral enhancement either completely or incompletely. Of the 50 patients, 19 (38%) had solid pineal glands and 31 (62%) had cystic ones. In male, 7 out of 11 (63%) showed solid pineal glands and in female, 27 out of 39 (70%) showed cystic ones.
24468.5195853851998.06.11++Adrenal cystic lesions: report of 12 surgically treated cases and review of the literature.J Endocrinol Invest
R Bellantone, A Ferrante, M Raffaelli, M Boscherini, CP Lombardi, F Crucitti,
Adrenal cysts are rare (0,064%-0,18% in autopsy series) and less than 500 cases have been reported in the western literature. Incidental diagnosis of adrenal cysts, however, is reported with increasing rates. We observed 12 patients with adrenal cyst. Each of them had a careful laboratory and instrumental evaluation; all the patients were operated. In our series about 67% of the patients were symptomatic (6 patients with abdominal pain, 1 with palpable mass, 1 with hemorrhagic shock). No biochemical alteration was observed. Conversely we observed an unusual subclinically hyperfunctioning cystic adenoma, potentially progressive to a clinically recognizable endocrine syndrome. US, CT and MRI had a sensitivity of 66,7%, 80% and 100% respectively. Adrenalectomy was performed in all patients. The pathological findings were: 1 epithelial cyst (cystic adenoma), 2 endothelial cysts (vascular cystic ectasia with adenomatous adrenocortical hyperplasia and 1 vascular cyst) and 9 pseudocysts. On the basis of these results, we conclude that a careful hormonal, morpho-functional and instrumental evaluation is indicated in all adrenal cysts, even if the available diagnostic procedures, even when combined, cannot always define their nature. Surgical excision, when possible by laparoscopic approach, is indicated in presence of symptoms, endocrine abnormalities (even when subclinic), complications, suspicion of malignancy and/or large size (>5 cm). Adrenal gland must be excised en bloc, also because of the possible presence of other adrenal lesions.
24478.5086866041996.08.21+ Symptomatic vertebral hemangiomas: MR findings.AJR Am J Roentgenol
DP Friedman,
24488.5077856421995.07.20++Characterization of adrenal masses (< 5 cm) by use of chemical shift MR imaging: observer performance versus quantitative measures.AJR Am J Roentgenol
WW Mayo-Smith, MJ Lee, MM McNicholas, PF Hahn, GW Boland, S Saini,
OBJECTIVE. The purposes of this study were to evaluate the ability of chemical shift MR imaging to differentiate 1- to 5-cm adrenal adenomas from metastases and to compare subjective interpretation with several different quantitative measures. SUBJECTS AND METHODS. Forty-three patients with 46 proved adrenal lesions (28 adenomas and 18 metastases) had MR imaging with a gradient-echo breath-hold technique and echo time varied to obtain in-phase and out-of-phase images. Qualitative analysis of the MR images was done by three experienced observers, who reported their confidence in diagnosing the benignity versus the malignancy of the adrenal masses on the basis of signal loss on out-of-phase images. Quantitative analysis was performed by calculating the difference in signal intensity between in-phase and out-of-phase images by use of regions of interest (signal intensity index) and by use of adrenal-liver, adrenal-spleen, and adrenal-muscle signal intensity ratios. Results between quantitative and qualitative measures were compared by use of receiver operating characteristic (ROC) analysis. RESULTS. The mean signal intensity was significantly different between adenomas and metastases on out-of-phase images (64 versus 98) (p < .0005) but not in-phase images (130 versus 122) (p = .47). The adrenal-spleen ratio discriminated between adenomas and metastases better than did the adrenal-liver ratio, the adrenal-muscle ratio, or the signal intensity index. No significant difference in interpretation among the three observers was evident (areas under the ROC curves, 0.93, 0.95, and 0.96). The performance of the observers was comparable to the results obtained with the adrenal-spleen ratio measurement (area under the ROC curve, 0.97). CONCLUSION. Experienced observers were able to differentiate adrenal adenomas from metastases just as well as quantitative measures. The adrenal-spleen ratio is the best quantitative means of distinguishing benign from malignant adrenal masses. Chemical shift MR imaging is a good but imperfect discriminator of adrenal adenomas.
24498.5015645311992.05.15++MR imaging of transverse myelitis using Gd-DTPA.J Neuroradiol
K Pardatscher, DL Fiore, A Lavano,
A patient with subacute transverse myelitis (TM) had MRI studies, including scans after Gd-DTPA administration. The enhancement, with its intensity and persistence, seems to herald residual cord deficits. TM remains a clinical diagnosis of exclusion whereas MRI plays a valuable role in the assessment of the different abnormalities which may produce this syndrome and also defines accurately the location and extent of the intramedullary pathology.
24508.4976400961995.09.20++MR imaging of tubo-ovarian abscess.Acta Radiol
HK Ha, GY Lim, ES Cha, HG Lee, HJ Ro, HS Kim, HH Kim, SW Joo, MK Jee,
PURPOSE AND MATERIAL AND METHODS: MR findings of 9 surgically proven tubo-ovarian abscesses were analyzed in 8 patients. The images were evaluated for signal intensity characteristics and morphologic appearance of the mass, and presence of secondary changes in adjacent pelvic organs and structures. RESULTS: The signal intensity of the lesions on T1-weighted images was hypointense to the surrounding muscle and myometrium in 5 patients, isointense in 3 and hyperintense in 1. On T2-weighted images the signal intensity was hyperintense (n = 6) or heterogeneous (n = 3). A thin rim (1-3 mm) with hyperintensity on T1-weighted images was noted in the innermost aspect of the masses. Other findings were ill-defined margin, thickened wall, multiple internal septa, shading and gas collection. "Mesh-like" linear strands were noted in the pelvis in all patients, with involvement of adjacent pelvic organs in 7 and lymphadenopathy in 3. CONCLUSIONS: In this limited number of cases MR imaging showed great potential for demonstrating the extent of the disease, characterizing the lesions and making a specific diagnosis.
24518.4975736791995.10.20++Littoral cell angiosarcoma of the spleen. Case report with immunohistochemical and ultrastructural analysis.Am J Surg Pathol
R Rosso, M Paulli, U Gianelli, E Boveri, G Stella, U Magrini,
This report describes a case of a malignant vascular tumor of the spleen with the morphologic, immunologic, and ultrastructural features observed in splenic sinus-lining cells (littoral cells). Histological examination showed a well-differentiated neoplasm forming ectatic blood channels with intraluminal papillary fronds. Tumor cells displayed malignant nuclear features and hemophagocytosis. Solid neoplastic areas with mitotic figures were present. Ultrastructurally, the tumor cells showed the concomitant presence of lysosomes and Weibel-Palade bodies. Immunohistochemically, the tumor cells were positive for both endothelial (Factor VIII-AG, CD34) and histiocytic markers (cathepsin D, lysozyme, alpha-1-antichimotrypsin). Our results indicate that angiosarcoma may originate from all the vascular compartments of the spleen, including red-pulp sinuses, and may have morphologic and immunophenotypic similarities to littoral cell angioma, a recently described benign vascular tumor of the spleen.
24528.4983727681993.10.12++MR diagnosis of recurrent tears in the knee: value of intraarticular contrast material.AJR Am J Roentgenol
GR Applegate, BD Flannigan, BS Tolin, JM Fox, W Del Pizzo,
OBJECTIVE. After surgical resection or repair of a torn meniscus, the healed area may have areas of abnormal signal intensity on MR images. Consequently, routine MR imaging is not reliable for detecting recurrent meniscal tears. As a result, we studied the efficacy of MR imaging with intraarticular contrast material (MR arthrography) for detecting recurrent tears of the meniscus. SUBJECTS AND METHODS. Thirty-seven patients who previously had a meniscal tear treated by either meniscal resection or repair had conventional MR imaging and MR arthrography with 40-50 ml of a 1:100 solution of gadopentetate dimeglumine in saline. All patients had arthroscopy shortly after the MR studies. Follow-up arthroscopic surgery was performed within an average of 6.6 weeks after the MR arthrograms. The routine MR images and MR arthrograms were reviewed separately and randomly, and these results were compared with the arthroscopic findings. Meniscal morphology, signal intensity, and the presence of joint fluid tracking into recurrent tears were evaluated. RESULTS. The overall accuracy in diagnosing recurrent meniscal tears in the post-operative meniscus was 66% when conventional MR imaging was used and 88% when MR arthrography was used. In patients who had only minimal meniscal resection, both methods had an accuracy of 89%. In patients who had more extensive meniscal resection, accuracy was 65% with conventional MR imaging and 87% with MR arthrography. In four patients who had only a small meniscal remnant, the accuracy was 50% with routine MR imaging and 100% with MR arthrography. On conventional MR images, the presence of an effusion tracking into a meniscal tear had a sensitivity and positive predictive value of 90% for detection of recurrent meniscal tears; however, the sensitivity was only 41%. CONCLUSION. Our results show that the sensitivity of MR imaging in detecting meniscal tears after surgery varies with the extent of the resection. Sensitivity was considerably improved when intraarticular contrast material was used. MR arthrography should be considered as an alternative to arthroscopy in patients who have had resection or repair of the meniscus.
24538.4920236711991.06.06++[Diagnosis and surgical treatment of spinal hemangioblastoma]No Shinkei Geka
T Isu, H Abe, Y Iwasaki, M Akino, I Koyanagi, K Hida, K Miyasaka, H Saito,
Spinal hemangioblastoma is a rare tumor. Its incidence varies from 1.6 to 2.1% of primary spinal cord tumors. In this report, the authors described MRI (magnetic resonance imaging) of spinal hemangioblastoma and its surgical results. [MATERIALS AND METHODS] This series included 10 spinal hemangioblastomas studied with CT or MRI. There were 8 men and 2 women. The age ranged from 21 to 68 years, with a mean age of 45 years. 6 patients were preoperatively and postoperatively studied with a resistive 0.15 T system (Toshiba MRT 15A) or a superconductive 1.5 T system (GE Signa or Siemens Magnetom). The lesions were single in 8 out of 10 patients and multiple in 2. 10 spinal hemangioblastomas were located in intramedullary space and 2 in both intramedullary and extramedullary space. 8 out of 10 patients (80%) were associated with cyst. [RESULTS] (1) MRI In T1-weighted MR images after administration of Gd-DTPA, the solid component of the tumor enhanced brilliantly. The enhanced lesions contained serpiginous areas of signal void, reflecting vascular structures in 5 out of 6 cases. The intrinsic spinal cord signal was heterogenous with low intensity areas representing the associated cyst. The cyst appeared either isointensive to cerebrospinal fluid (CSF) or hyperintense relative to CSF and slightly hypointense relative to the spinal cord. The precise delineation of the tumor was impossible without enhancement. Noncontrast T1-weighted MR images displayed diffuse widening of the spinal cord. On T2-weighted MR images, all regions of the spinal cord enlargement increased in signal. (2) Postoperative results All 10 cases of spinal hemangioblastomas were totally removed with good postoperative results and the associated cysts were drained. The postoperative MRI showed the disappearance of the tumor and significant reduction in the size of the cyst. [CONCLUSION] (1) Gd-DTPA enhanced MRI was useful in defining and outlining the solid component of spinal hemangioblastoma. (2) The complete removal of the tumor with only drainage of the cyst was possible with good postoperative results.
24548.4939682781985.02.28++Retroperitoneal manifestations of sarcoidosis on computed tomography.J Comput Assist Tomogr
S Meranze, B Coleman, P Arger, M Mintz, L Markowitz,
Three patients with known or subsequently proven sarcoidosis had CT of the retroperitoneum because of clinical symptoms referable to this area. Gross splenomegaly was evident in all cases. The liver was massively enlarged in one patient and normal size in two patients. Lymphadenopathy was present in many nodal groups.
24558.4835856711987.07.17++Splenic lymphangiomatosis: a rare cause of splenomegaly.J Pediatr Surg
JV Marymont, PJ Knight,
A case of lymphangiomatosis of the spleen and adrenal in a 10-year-old girl is described. The patient had multiple recurrent lymphangiomata excised from her neck during the first 4 years of life. She presented with a recurrent cystic hygroma of the neck and was found to have an enlarged spleen. This increased in size during 5 months of observation, causing left upper quadrant discomfort, and was excised. The diagnosis, management, and prognosis of this rare disorder are discussed.
24568.4893946511997.12.30++Abdominal CT features and survival in acquired immunodeficiency.Acta Radiol
FD Knollmann, J Mäurer, T Grünewald, H Schedel, TJ Vogl, HD Pohle, R Felix,
PURPOSE: HIV-infected patients show a high incidence of abdominal disease. This investigation was made to determine whether abdominal CT provided prognostically relevant information in these patients. MATERIAL AND METHODS: Images from 533 abdominal CT examinations in 339 HIV-infected patients were retrospectively reviewed for signs of abdominal disease, and correlated with clinical data and survival rates. The Kaplan-Meier analysis and rank testing of survival, and proportional hazards regression were used to define prognostic clinical and imaging findings. RESULTS: Of the 339 patients, 278 (82%) showed abnormal abdominal findings on CT. Median survival was 29 months. Of the imaging findings, hepatic masses (n = 11), pathologically enlarged lymph nodes (n = 48), and ascites (n = 7) were associated with poor survival, giving a median survival of respectively 13 months, 15 months, and less than 1 month. These three features showed no association with CD4(+)-T-lymphocyte count or CDC category. Main determinants of survival were a low CD4(+)-T-lymphocyte count, and certain abnormal CT findings. Splenomegaly (n = 147), hepatomegaly (n = 144), and lymphadenopathy (n = 111) were the most common abdominal findings on CT but lacked prognostic relevance. CONCLUSION: Abdominal CT offered prognostic implications in HIV-infected patients and might serve in risk stratification in selected patients. CT features such as hepatic masses, grossly enlarged lymph nodes, or ascites indicate advanced immunosuppression.
24578.4789882101997.01.29++Thoracic aorta: comparison of gadolinium-enhanced three-dimensional MR angiography with conventional MR imaging.Radiology
GA Krinsky, NM Rofsky, DR DeCorato, JC Weinreb, JP Earls, MA Flyer, AC Galloway, SB Colvin,
PURPOSE: To evaluate gadolinium-enhanced three-dimensional magnetic resonance (MR) angiography for thoracic aortic disease and to compare this technique with conventional thoracic MR imaging. MATERIALS AND METHODS: One hundred eight consecutive patients underwent 122 thoracic MR examinations, including conventional MR imaging followed by enhanced three-dimensional MR angiography. A gradient-echo sequence was used at 1.5 T (116 examinations) and 1.0 T (6 examinations) during infusion of 0.2 mmol/kg gadopentetate dimeglumine. Two independent readers (A and B), with varied experience in thoracic MR angiography, retrospectively evaluated the images for presence of aortic dissection, aneurysm, arch vessel disease, and protruding atheroma. Correlation with findings of surgery or other imaging modalities was available in 98 cases. RESULTS: Enhanced MR angiography was sensitive (92%-96%) and specific (100%) for acute and chronic aortic dissection (n = 26) and was as useful as conventional MR imaging in the diagnosis of aneurysm (n = 43) and arch vessel disease (n = 7). One of two intramural hematomas were overlooked at MR angiography by reader A, and both were overlooked by reader B. CONCLUSION: Enhanced three-dimensional MR angiography is a rapid and accurate imaging modality in diagnosis of thoracic aortic disease but is insensitive to intramural hematoma.
24588.46122215672002.10.23++[Value of contrast-enhanced ultrasound vs. CT and MRI in palpable enlarged lymph nodes of the head and neck]Rofo
RJ Schröder, B Rost, N Hidajat, J Rademaker, R Felix, J Mäurer,
PURPOSE: To compare the value of B-mode-, plain and contrast enhanced color Doppler ultrasound, CT and MRI with respect to their diagnostic accuracy in palpable enlarged cervical lymph nodes. MATERIAL AND METHODS: Thirty patients (18 - 90 years old) with palpable enlarged lymph nodes of the head and neck underwent B-mode-ultrasound, plain and contrast enhanced color Doppler, CT and MRI (gold standard: histologic analysis in 22 and clinical follow up for at least six months in eight patients). The criteria of malignancy were maximal and minimal lymph node diameter, M/Q-ratio, various morphologic criteria (necrosis, hilus line, internal structure, contour, contrast enhancement), spectral Doppler indices, and vascular architecture in color Doppler. RESULTS: The highest sensitivity (= 1.00, specificity = 0.07 - 0.15) was obtained measuring the lymph node diameter independent on the used imaging modality (ultrasound, CT, MRI), the highest specificity (= 1.00, sensitivity = 0.71) analyzing the vascularity of the lymph node by plain color Doppler. The highest diagnostic (= 0.93) accuracy was delivered by contrast enhanced color Doppler analysis of the vascularity. Sensitivity (= 0.94) and specificity (= 0.92) of this imaging modality were only slightly inferior to the top values. Fisher's exact test revealed significant values in differentiating malignant from benign lymph nodes for B-mode- and MR-analysis of the M/Q-ratio (p < 0001/p < 0.05), B-mode morphology (p < 0.00005), plain and contrast enhanced color Doppler analysis of the vascularity (p < 0.0001/p < 0.000005), MR-morphology (p < 0.0001), and CT-morphology (p < 0.005). CONCLUSION: CT is inferior to MRI, B-mode-ultrasound and contrast-enhanced color Doppler in the differential diagnosis of selectively analyzed, palpably enlarged cervical lymph nodes using the criteria of our study. The analysis of the MR-morphology revealed a slightly inferior diagnostic accuracy to B-mode morphology and color Doppler analysis of the vascularity.
24598.468322491977.03.15++Spontaneous (pathologic) rupture of the spleen in previously undiagnosed Hodgkin's disease: report of a case with survival.Cancer
RB Dobrow,
Spontaneous (pathologic) rupture of the spleen in lymphoma is a rare event. A 38-year-old man with a 6-week history of fever, night sweats, and weight loss, and with known splenomegaly presented in shock as a result of a ruptured spleen. There was no known antecedent trauma. Hodgkin's disease was demonstrated in the spleen and liver. Review of the literature failed to reveal any previous report of spontaneous rupture of the spleen due to undiagnosed Hodgkin's disease. Only one survivor of spontaneous rupture of the lymphomatous spleen has been reported previously.
24608.4618538111991.08.16+ Acute torsion of a wandering spleen: diagnosis by CT and duplex Doppler and color flow sonography.AJR Am J Roentgenol
AA Nemcek, FH Miller, SW Fitzgerald,
24618.4571226401982.12.02++The surgical management of Gaucher's disease.Prog Clin Biol Res
AH Aufses, BM Salky,
The records of eleven patients who underwent splenectomy for Gaucher's disease at The Mount Sinai Hospital from 1967 to 1981 have been reviewed. The major indications for operation were hypersplenism, pain, and mechanical problems associated with a massively enlarged spleen. There were no operative mortalities and the hematologic picture returned to normal in all cases. Because of the danger of overwhelming sepsis following splenectomy, partial splenectomy should be considered as a therapeutic modality in these patients.
24628.4567781271981.02.19+ Association of left-sided pleural effusions and splenic hematomas.AJR Am J Roentgenol
PR Koehler, R Jones,
24638.4567388901984.08.17++Partial splenectomy for a splenic cyst.Neth J Surg
AJ Pull ter Gunne, JC Molenaar,
Partial splenectomy for a large splenic cyst was performed in a seven-year-old girl referred for splenomegaly. The increased risk of sepsis in splenectomized patients induced the successful attempt at partial splenectomy. The surgical procedure described involved removal of the cyst while preserving as much of the spleen as possible. In view of the planocellular epithelial lining, the pathological diagnosis was of a rare congenital, intrasplenic cyst.
24648.4522777641991.03.07++[Nontraumatic hemorrhage in abdomen and retroperitoneum--CT, sonographic and clinical findings]Nippon Igaku Hoshasen Gakkai Zasshi
S Takebayashi, K Matsui, H Hidai,
Sixteen patients with nontraumatic abdominal or retroperitoneal hemorrhage were examined with ultrasound (n = 16), and CT (n = 14). The lesions of the 10 patients with signs on the onset of hemorrhage were four rectus sheath hematomas, three renal subcapsular and perirenal hematomas, and subcapsular hematoma, pararenal hematoma, perirenal and parenal hematoma, on each. Fall in periphery blood hematocrit values within 24 hours after the onset was observed in only three patients. As the hematocrit value was increased, fluid area of hematoma was replaced by high density on CT and by hypoechoic area on ultrasound. The lesions of the remaining 6 patients were four renal subcapsular hematomas, one hepatic parenchymal and subcapsular hematoma, and one iliopsoas hematoma. CT is superior to ultrasound in evaluation of the nontraumatic hematomas. However, clinicians require to pay more attention to this disorder which occasionally mimick other disorders.
24658.4534893821986.10.15++Imaging the pediatric liver: MRI and CT.AJR Am J Roentgenol
JC Weinreb, JM Cohen, E Armstrong, T Smith,
The livers of 27 children, 2 weeks to 16 years old, were examined with MRI and CT. Fourteen children had normal livers, 9 had focal liver disease, and 4 had diffuse liver disease. Normal intrahepatic venous anatomy was visualized more frequently with MRI than with CT, regardless of presence of disease, type of disease, or age. Focal hepatic lesions were either iso- or hypointense on relatively T1-weighted images and were hyperintense on T2-weighted images regardless of the pathology. In three cases, lesions seen with MRI were not detected with CT. In two other cases, CT was interpreted as equivocal or abnormal, but the liver was normal on MRI. MRI was superior to CT for evaluation of patency of the intrahepatic portion of the inferior vena cava. Other than in cases of fatty infiltration, CT provided no information additional to MRI. MRI has the potential to replace CT as a technique for imaging the pediatric liver in many cases, especially for infants and young children.
24668.4484514061993.04.14++Anatomic features of reduced-size liver transplant: postsurgical imaging characteristics.Radiology
TE Ben-Ami, V Martich, DK Yousefzadeh, PF Whitington, JC Emond,
In this retrospective review, the authors evaluated the anatomic and imaging features of 140 reduced-size liver transplants in 120 boys and girls; 100 of these patients (83.3%) were 2 years old or younger. The authors reviewed the surgical reports, plain radiographs, contrast material-enhanced studies of the gastrointestinal tract, duplex Doppler and color Doppler ultrasound (US) scans, and computed tomographic (CT) scans. Understanding the anatomic features associated with transplantation was crucial to understanding the post-surgical imaging characteristics. Changes in visceral anatomic structure caused a variety of imaging appearances, some of them misleading: (a) Some patients had unusual bowel gas patterns on plain radiographs because of a shift in location by bowel loops; (b) gastrointestinal studies showed gastric compression by an oversized left lobe that mimicked mass effect; and (c) displacement or migration of the duodenum, jejunum, or cecum into the right hepatic fossa sometimes mimicked malrotation. Pitfalls were created by fluid and gas collections at the transected edge. US and CT were often used to further assess anatomic structures after surgery; color Doppler was especially helpful in vascular localization.
24678.4426897231990.01.30+ [Ultrasonography, x-ray computed tomography and magnetic resonance imaging of the lymph nodes]Rinsho Hoshasen
T Hamada, O Ishida,
24688.4414971191992.09.04++Epithelioid and spindle-cell hemangioendothelioma of the spleen. Report of a distinctive splenic vascular neoplasm of childhood.Am J Surg Pathol
S Suster,
A case of a distinctive vascular neoplasm of the spleen in a 3-year-old boy is described. The tumor was characterized histologically by a biphasic growth pattern, with discrete nodular areas composed of atypical round, epithelioid cells with large nuclei and prominent nucleoli, and areas showing an intricate proliferation of vascular channels lined by elongated spindle cells. Immunohistochemical studies showed cytoplasmic staining of the tumor cells with factor VIII-related antigen, Ulex europaeus lectin, and vimentin antibodies. Stains for keratin, actin, desmin, lysozyme, and S-100 protein were negative in the tumor cells. Electron microscopy revealed a fairly cohesive population of cells that contained mature and immature cell junctions, basal lamina material, and surface pinocytotic activity consistent with vascular endothelial cells. Five-year follow-up has shown the patient to be alive and free of disease. This case appears to represent a previously unreported primary vascular neoplasm of the spleen showing combined features of epithelioid and spindle-cell hemangioendothelioma. The lesion should be distinguished from other benign and malignant vascular proliferations of the spleen such as Kaposi's sarcoma, angiosarcoma, and the recently described littoral-cell angioma.
24698.44156740952005.07.12++Partial splenic embolization in patients with cirrhosis: efficacy, tolerance and long-term outcome in 32 patients.Eur J Gastroenterol Hepatol
G N'Kontchou, O Seror, V Bourcier, D Mohand, Y Ajavon, L Castera, V Grando-Lemaire, N Ganne-Carrie, N Sellier, JC Trinchet, M Beaugrand,
BACKGROUND: Although partial splenic embolization (PSE) has been proposed in patients with cirrhosis in cases when thrombocytopenia or neutropenia may cause clinical manifestations or if there are contra-indications to other therapeutic procedures, there are limited data on long-term outcome. We provide a retrospective review of results and the tolerance of all PSE procedures in patients with cirrhosis in our department. PATIENTS AND METHODS: Thirty-two consecutive patients with cirrhosis were included over a 6 year period. Indications for PSE were as follows: (1) severe cytopenia preventing necessary antiviral treatment (n=14), percutaneous destruction of hepatocellular carcinoma (n=8) or major surgery (n=3), severe purpura (n=3); (2) painful splenomegaly (n=4). After superselective catheterization, embolization was performed with up to 50% reduction of splenic blood flow. RESULTS: Thrombocyte and leucocyte counts increased markedly (185% and 51% at 1 month; 95% and 30% at 6 months). Thirty-one and 20 patients had platelet count >80,000/mm3 at months 1 and 6 vs only one before PSE. Overall, the aim of PSE was achieved in 27 patients (84%) (planned treatment: 20/25; disappearance of purpura and splenic pain: 7/7). Severe complications occurred in five patients (16%): transient ascites (n=2), splenic and/or portal vein thrombosis (n=2) that resolved after anticoagulation therapy, and splenic abscess (n=2) leading to death. These two patients had splenic necrosis >70%. CONCLUSION: In patients with cirrhosis, PSE may resolve cytopenia and the clinical complications related to hypersplenism or splenomegaly. However, due to a high risk of severe complications, particularly splenic abscess, the indications of PSE should be very limited and the extent of necrosis should be strictly controlled during the PSE procedure.
24708.4493084671997.10.16+ Abdominal and pelvic applications of opposed-phase MR imaging.AJR Am J Roentgenol
JP Earls, GA Krinsky,
24718.44166473502006.06.01++Management of splenic pseudocysts following trauma: a retrospective case series.Am J Surg
HM Wu, JB Kortbeek,
BACKGROUND: Post-traumatic splenic pseudocysts are uncommon. The optimal treatment is not well defined. METHODS: A retrospective chart review was conducted at the three adult hospitals in the Calgary Health Region. RESULTS: Six cases of splenic pseudocysts were found over a 6-year period. One splenic pseudocyst spontaneously resolved. A second splenic cyst was removed by open splenectomy. The remaining 4 patients were all first treated with percutaneous drainage. However, 3 of the 4 cysts recurred. Two of these 3 recurrent cysts were treated with laparoscopic fenestration, and all subsequently recurred; 1 of these patients later developed a splenic abscess. The third patient had a repeat percutaneous drain with subsequent recurrence. The last patient died of sepsis secondary to an iatrogenic punctured colon. CONCLUSIONS: Percutaneous drainage and laparoscopic fenestration have an unacceptably high rate of failure. Partial or complete splenectomy should be considered for young and otherwise healthy patients who have large symptomatic splenic pseudocysts.
24728.4386236231996.06.19++Gantry angulation in CT-guided percutaneous adrenal biopsy.AJR Am J Roentgenol
S Hussain,
OBJECTIVE: This study was performed to test a new method for CT-guided adrenal biopsy using angulation of the CT gantry. MATERIALS AND METHODS: In 23 patients, 26 biopsies were performed on patients in the prone position using CT gantry angulation and the introduction of the biopsy needles along the same angle, guided by the gantry locating light. The use of angulation ensured a safe needle path that avoided vital structures, such as the pleura, while monitoring of the needle course and its tip on one or two CT slices. RESULTS: Twenty-two of 23 adrenal masses (96%) were successfully biopsied without complications. Fifteen (65%) of the target masses were 1.5 cm or smaller. CONCLUSION: Using an angled gantry during percutaneous biopsy is a safe and preferred method over other techniques for biopsy of adrenal masses and can be used easily for small adrenal masses.
24738.42167786252006.07.14++Assessing the extent of breast cancer using multidetector row helical computed tomography.J Comput Assist Tomogr
K Takase, A Furuta, N Harada, T Takahashi, K Igarashi, Y Chiba, K Haga, S Takahashi,
OBJECTIVE: The aim of the study was to evaluate the usefulness of multidetector row helical computed tomography (MD-CT) in assessing the local extent of breast cancer. METHODS: Seventy-five breast cancer patients were examined using MD-CT with scanning performed in the supine position at 1-mm collimation. The extent of the breast tumors determined using CT was compared with that based on histopathologic mapping with continuous 5-mm slices. RESULTS: The CT evaluation of the maximum diameter of the extent of breast cancer was much better correlated with the histopathologic diagnosis (correlation coefficient=0.90) than the pre-CT diagnosis (correlation coefficient=0.46). Computed tomography correctly detected mammographically and clinically occult cancer other than the index lesion in 14 of 15 patients. The sensitivity, specificity, and accuracy in the diagnosis of the additional lesions were 93.3%, 98.3%, and 97.3%, respectively. Because the images were obtained in the supine position, they were useful for surgical planning. CONCLUSION: The extent of breast cancer can be determined accurately using MD-CT.
24748.42169341892006.10.04+ Splenic hamartoma: case report and review of literature.Chin Med J (Engl)
HB Jia, YP Li, DE Han, Y Liu, B Zhang, DQ Wu, X Chen, Y Jiang, LX Zheng, JR Du, XH Jiang,
24758.4216294171992.08.20++CT and MRI of siderotic regenerating nodules in hepatic cirrhosis.J Comput Assist Tomogr
T Murakami, H Nakamura, S Hori, K Nakanishi, T Mitani, K Tsuda, T Kozuka, K Wakasa, M Monden,
The demonstration by CT of siderotic regenerating liver nodules in cirrhosis was evaluated and compared with that of MR imaging retrospectively in 27 patients with histologically diagnosed hepatic cirrhosis. Only in one of the two patients with marked iron deposits in regenerating nodules did CT demonstrate multiple high density nodules. In the other patient with marked iron deposits and in seven of the nine patients with moderate iron deposits, the liver parenchyma on CT was demonstrated as heterogeneous and of slightly high density without focal nodules. In 8 patients with mild to moderate iron deposits and in the 10 with no iron deposits, the liver parenchyma was homogeneous on CT. Multiple low intensity nodules in the liver were seen on fast low-angle shot (FLASH) MR images in all 17 patients with iron deposits in regenerating nodules. No low intensity nodules were seen on FLASH MR images in the 10 patients with no iron deposits. If there are iron deposits above a certain level, siderotic regenerating nodules may appear as nodules of high density on CT or as heterogeneous regions of high density liver parenchyma. Magnetic resonance is more sensitive than CT in demonstrating siderotic regenerating nodules.
24768.41118610982002.04.24++A case with primary amyloidosis of the liver and spleen: radiologic findings.Eur J Radiol
S Monzawa, T Tsukamoto, K Omata, K Hosoda, T Araki, K Sugimura,
A case with primary amyloidosis of the liver and spleen is presented. In the liver, ultrasonography showed heterogeneous echogenicity. Portal phase CT showed heterogeneous enhancement, and delayed phase CT showed delayed enhancement with focal hypoattenuating areas. Bone scintigraphy showed diffuse accumulation. In the spleen, arterial phase CT showed the lack of parenchymal enhancement, and T2-weighted MR imaging showed decreased signal intensity. The combination of imaging findings of the liver and spleen was suggestive of amyloidosis.
24778.4185539801996.02.22+ Mucinous carcinoma of the liver mimicking cavernous hemangioma on pre- and postcontrast MR imaging.AJR Am J Roentgenol
K Ueda, O Matsui, K Nobata, T Takashima,
24788.4014304281992.12.16++Contrast enhanced area of posterior pituitary gland in early dynamic MRI exceeds hyperintense area on T1-weighted images.J Comput Assist Tomogr
Y Miki, R Asato, R Okumura, F Hua, J Konishi,
Seventeen normal pituitary glands were studied by midline sagittal (and in one case axial) dynamic MRI before and immediately after injection of Gd-DTPA, using spin-echo sequences with a short repetition time. Images were obtained at 1 min intervals for 6 min at 1.5 T. A well-defined focal area with marked enhancement was seen in the posterior portion of the pituitary gland on the first image after injection of Gd-DTPA. The size of the early enhancing area in the posterior pituitary (EEPP) was compared with the high signal of the posterior pituitary (HSPP) on the precontrast image. The EEPP was larger than the HSPP in 10 cases (59%). The two were equal in size in seven cases (41%). The EEPP was anteriorly convex in 11 cases (65%), whereas HSPP was anteriorly convex in 4 cases (24%). We believe that EEPP closely represents the real extent of the posterior lobe. Our results support the hypothesis that HSPP may involve only a portion of the posterior pituitary.
24798.4044260331975.01.25+ Mycosis fungoides with extracutaneous dissemination: a distinct clinicopathologic entity.Cancer
JC Long, MC Mihm,
24808.4079768811994.12.07++MR imaging of hepatic masses: diagnostic significance of wedge-shaped areas of increased signal intensity surrounding the lesion.AJR Am J Roentgenol
A Giovagnoni, F Terilli, P Ercolani, E Paci, A Piga,
OBJECTIVE. Wedge-shaped areas of increased signal intensity surrounding focal hepatic lesions on T2-weighted images have been described as an occasional finding in patients with hepatic metastases. We reviewed MR images of patients with benign and malignant focal hepatic lesions to determine the prevalence and diagnostic significance of this finding, and in particular to determine if these wedge-shaped areas are characteristic of cancer. MATERIALS AND METHODS. One hundred twenty-one patients with focal hepatic lesions (65 patients with metastases, 14 patients with hepatocellular carcinoma, and 42 patients with benign conditions) underwent MR imaging of the liver at 1.0 T. Axial spin-echo T1-weighted and spin-echo and turbo spin-echo T2-weighted MR images were obtained. The MR images were retrospectively evaluated: the number and size of the lesions and the presence of wedge-shaped areas surrounding the lesions were recorded; in patients with cancer, follow-up MR images and a clinical course were used to study the evolution of the lesions and the adjacent wedge-shaped areas. The final diagnosis in patients with cancer was proved by clinical course (54 patients) or fine-needle aspiration biopsy (25 patients); in patients with benign lesions, the findings on various other imaging techniques were accepted as conclusive. RESULTS. The wedge-shaped areas were noted on T2-weighted images in 16 (25%) of 65 patients with metastases, in 3 (21%) of 14 patients with hepatocellular carcinoma, and in 5 (12%) of 42 patients with benign lesions. In 11 of the 16 patients with metastases and wedge-shaped areas of increased signal intensity, a metastatic lesion within the wedge-shaped area was detectable; in the remaining five patients, a metastatic lesion appeared during the subsequent clinical course. In some instances, the wedge-shaped area obscured the lesion. In patients with benign conditions, the wedge-shaped area was frequently seen in association with hemangiomas (4 of 13, 31%). CONCLUSION. Our results show that wedge-shaped areas of increased signal intensity surrounding lesions on T2-weighted MR images are a common finding in patients with focal hepatic lesions. The wedge-shaped areas cannot be considered pathognomonic of malignant lesions because they are also seen in patients with benign conditions (hemangioma, abscess). However, the appearance of these wedge-shaped areas in a patient with cancer should suggest a metastasis. The possibility that hepatic lesions could be obscured by these wedge-shaped areas also should be considered when response to treatment is being evaluated.
24818.4033234901988.03.15++[Retroperitoneal cystic lymphangioma. Preoperative diagnosis. Apropos of a case]J Radiol
E Guérin, C Babin, P Moulle, F Barret,
Retroperitoneal cystic lymphangioma is an uncommon tumor. One case is reported, with surgical confirmation. Authors point out the diagnostic value of ultrasonography and computed tomography in the pre-operative diagnosis.
24828.3995743931998.06.03++[Selection criteria for conservative therapy of splenic trauma in adults]Langenbecks Arch Chir Suppl Kongressbd
D Böckler, M Klein, R Stangl, J Scheele,
The safety and effectiveness of nonoperative management of selected adults have been confirmed in those patients who meet selection criterias of isolated splenic injury and hemodynamic stability. The CT scan is a very precise and the most specific diagnostic procedure in splenic trauma. Nonoperative treatment is successful in 80% of adults in such selected group of patients.
24838.3994982531998.04.23+ [Unknown MRI finding of the spleen. Splenic involvement in systemic sarcoidosis]Radiologe
AS Robertson, H Hawighorst,
24848.3923993351990.10.18++Pituitary adenomas and normal pituitary tissue: enhancement patterns on gadopentetate-enhanced MR imaging.Radiology
Y Miki, M Matsuo, S Nishizawa, Y Kuroda, A Keyaki, Y Makita, J Kawamura,
A dynamic study of magnetic resonance (MR) imaging was used to obtain successive heavily T1-weighted coronal images (spin-echo [SE] 100/15 [repetition time msec/echo time msec]) of normal pituitary glands and pituitary adenoma immediately after patients were given an intravenous bolus injection of gadopentetate dimeglumine. The images were obtained every minute for 5-8 minutes at 1.5 T. Usual T1-weighted images (SE 600/15) were also obtained before and after the dynamic study was performed. The study group consisted of 18 patients, 10 with normal pituitary glands, and eight with pituitary adenoma. Normal pituitary glands showed maximum enhancement on the first or second image following the administration of gadopentetate dimeglumine, followed by gradual signal reduction through the later images, whereas pituitary adenomas reached a peak of enhancement later and showed slower signal reduction than normal pituitaries. The difference of enhancement patterns between the normal pituitary gland and the pituitary adenoma produced prominent image contrast on the first or second image after administration of gadopentetate dimeglumine, which improved the visualization of one microadenoma and four normal pituitary glands that had been displaced by large adenomas. Dynamic MR imaging is a useful diagnostic procedure not only for detection of microadenomas, but also for visualization of pituitary glands that have been displaced by large pituitary adenomas.
24858.3996091541998.06.16++Fast MR imaging and the detection of small-bowel obstruction.AJR Am J Roentgenol
F Regan, DP Beall, ME Bohlman, R Khazan, A Sufi, DC Schaefer,
OBJECTIVE: Our aim was to determine whether fast MR imaging using the half-Fourier acquisition single-shot turbo spin-echo (HASTE) MR sequence is accurate for diagnosis of small-bowel obstruction. MATERIALS AND METHODS: Forty-three nonconsecutive patients with suspected small-bowel obstruction were evaluated with HASTE MR imaging during a 12-month period. Images were retrospectively assessed for the presence, level, and cause of bowel obstruction. Data were compared with results of conventional radiography and findings at surgery when available. RESULTS: Of the 43 patients imaged, 29 patients had small-bowel obstruction revealed by unenhanced or contrast-enhanced radiography or by CT. Surgical confirmation was available in 21 patients. Small-bowel obstruction was shown by HASTE MR imaging in 26 (90%) of these 29 patients. HASTE MR images showed the correct level of obstruction in 19 (73%) of the 26 patients and showed the cause of obstruction in 13 (50%) of the 26 patients. CONCLUSION: With a high degree of accuracy, HASTE MR imaging can show the presence and level of small-bowel obstruction.
24868.3925610781990.05.15++Low field magnetic resonance imaging of focal hepatic masses at 0.02 T.Acta Radiol
L Ekelund, L Athlin,
The diagnostic utility of extremely low field magnetic resonance (MR) imaging was evaluated in 25 patients with focal hepatic masses, including 17 with primary (n = 7) or secondary (n = 10) malignant neoplasms and 8 with benign lesions (6 hemangiomas). The findings were compared with the results of computed tomography (CT). Out of 16 patients with malignant tumors demonstrated by both modalities, the diagnostic information from MR imaging was equal to or better than that from CT in 6 patients and inferior to CT in 10. Shortcomings of MR were mainly due to low signal-to-noise ratio and poor spatial resolution, resulting in an image quality inferior to that obtained at higher field strengths. Considering these facts, together with the long imaging times required, low field MR cannot be recommended for general use in the evaluation of hepatic masses. On the other hand, our results indicate that this technique may be useful in establishing the diagnosis of hepatic hemangioma.
24878.3882359061993.12.03+ [Magnetic resonance tomography of malignant peripheral soft tissue tumors]Rontgenpraxis
W Zaunbauer, B Lutz, C Fretz, M Haertel,
24888.38163668812006.06.23++Laparoscopic splenopexy of a pediatric wandering spleen by creation of a retroperitoneal pocket.J Laparoendosc Adv Surg Tech A
MH Hedeshian, MP Hirsh, PD Danielson,
Wandering spleen is a rare condition in which the spleen is attached by a long, vascular pedicle and lacks its usual peritoneal attachments and supporting ligaments. This condition predisposes the spleen to torsion and infarction. We report the case of a 2-year-old boy with a history of intermittent abdominal pain and early satiety who presented with abdominal pain and severe gastric distention. A work-up including computed tomographic and ultrasonographic imaging suggested a wandering spleen. The diagnosis was confirmed during laparoscopy, and splenopexy was performed by anchoring the spleen in a retroperitoneal pocket in the left upper quadrant at the level of the tenth rib. To our knowledge, this is the first reported case of minimally invasive splenopexy for wandering spleen that involves the creation of a retroperitoneal pocket without the use of mesh. The authors believe that this is a safe and effective method that takes advantage of laparoscopy and avoids the risk of infection and complications associated with the use of synthetic material.
24898.3866942511984.03.22++Determination of a splenic volumetric index by ultrasonic scanning.J Ultrasound Med
H Pietri, M Boscaini,
In a prospective study carried out to determine spleen size by a rapid and simple ultrasonic method, 45 normal subjects, 20 men and 25 women, average age 54 +/- 17 years (range 17-78) were studied. The three principal dimensions of the spleen, breadth, thickness, and height, were obtained with a compound scan technique; each dimension was measured at its largest point. The values obtained were multiplied by each other and the product arbitrarily divided by 27, which is the cube of the three values. This gave a splenic volumetric index (SVI), which, in 95 per cent of normal subjects, was between 8 and 34. There were no statistically significant differences related to age, sex, or morphotype when endomorphs, ectomorphs, and mesomorphs were examined. This SVI determination, based on standardized measurements, allows the distinction of normal from abnormal spleens in 10 minutes.
24908.3821307751991.10.29++[Radiological features of primary central nervous system lymphoma]Nippon Geka Hokan
T Nakazawa, M Matsuda, S Nakasu, J Hanada, T Koyama,
Radiological features of 12 cases of primary malignant lymphoma of the central nervous system with histological confirmation were reviewed. Ten patients had primary intracranial lymphoma, and two spinal. Angiography yielded no specific findings. CT appearances varied widely. Any positive relationships were not found between histologic types of tumors and patterns of contrast enhancement in the present cases as well as in those reported previously. Gd-DTPA was used in two patients. All lymphomas showed low to isointensity signals on T1-WI and high signal intensities on rho-WI and T2-WI. Although MRI gave no additional informations to those on CT with regard to the differential diagnosis, it proved to be a very accurate, non-invasive method of providing better delineation of tumor on multiplanar basis. Use of Gd-DTPA improved quality of T1-WI by markedly enhancing the tumor. It is generally difficult to distinguish primary from secondary spinal lymphoma, but two spinal epidural lymphomas in the present series were considered primary, as we could detect no other lesion elsewhere in the body. We expect that MR imaging would lead to an improvement in the detection of lesion in the paravertebral area.
24918.3875603161995.11.02++Three-dimensional fast spin echo T1-weighted imaging of the pediatric spine.J Comput Assist Tomogr
E Weinberger, JW Murakami, DW Shaw, KS White, MK Radvilas, C Yuan,
OBJECTIVE: We evaluated the feasibility of using a three-dimensional (3D) fast SE (FSE) pulse sequence to acquire T1-weighted (T1W) images of the pediatric spine. MATERIALS AND METHODS: The 3D FSE T1W images were acquired in nine pediatric patients undergoing spine MRI for different clinical indications. The 3D FSE images were compared with our standard 2D SE T1W images. RESULTS: Image contrast was comparable between the two sequences. The 3D FSE sequence produced contiguous thin sections that allowed multiplanar reformations not possible with the 2D SE sequence. CONCLUSION: 3D T1W spine imaging with conventional SE-like contrast is feasible with 3D FSE.
24928.3883166751993.07.26+ General case of the day. Angiosarcoma, stage III.Radiographics
MJ Flood, JA Hornback, GT Chua,
24938.3715445601992.04.16++MR imaging of malignant mesenchymal tumors of the liver.Gastrointest Radiol
K Ohtomo, T Araki, Y Itai, S Monzawa, H Ohba, Y Nogata, T Hihara, K Koizumi, G Uchiyama,
Magnetic resonance (MR) features of five primary malignant mesenchymal neoplasms (plasmocytoma, leiomyosarcoma, undifferentiated sarcoma, epithelioid hemangioendothelioma, and angiosarcoma) of the liver were reported. All tumors were hypointense on T1-weighted images and hyperintense on T2-weighted images. No halo and intravenous extension were noted. A target appearance was revealed in epithelioid hemangioendothelioma. MR findings of angiosarcoma were essentially the same as those of cavernous hemangiomas (markedly hyperintense with hypointense linear septa on T2-weighted images). MR findings of these rare hepatic malignancies were nonspecific, although they were quite different from those of typical hepatocellular carcinomas. This study suggested that MR differentiation of primary hepatic mesenchymal tumors from other common benign and malignant neoplasms was difficult; however, the number of studied cases was limited.
24948.379208691977.12.29++Angiographic and pathologic correlations of hepatic focal nodular hyperplasia.Am J Surg Pathol
RE Fechner, JO Roehm,
Focal nodular hyperplasia of the liver has a distinctive gross appearance which includes a central fibrous zone containing vessels with a variety of abnormalities. When focal nodular hyperplasia is visualized arteriographically, an artery enters the lesion, branches, and supplies the mass centrifugally. It is likely that the central fibrous zone is the area from which the these branches originate. Nodular hyperplasia is not a life-threatening lesion, except in women taking oral contraceptives who may have massive hemorrhage. If an asymptomatic lesion of the liver has the distinctive arteriographic centrifugal filling pattern of nodular hyperplasia, resection is not recommended as long as oral contraceptives are not used.
24958.3791426231997.06.25++Nonpalpable lymph nodes of the neck: assessment with US and US-guided fine-needle aspiration biopsy.J Clin Ultrasound
S Takashima, S Sone, N Nomura, N Tomiyama, T Kobayashi, H Nakamura,
Ultrasound (US) and US-guided fine-needle aspiration biopsy (FNA) were performed in 91 nonpalpable neck nodes of 70 patients, 98% of which had known malignancy. Various sonographic findings were evaluated for predicting malignancy. The accuracy of US-guided FNA for detecting malignancy was 88%, with 96% sensitivity and 94% specificity. The ratio of minimal to maximal axial diameters of a node was most valid for predicting malignancy with US. A ratio of more than 0.55 yielded the highest accuracy (80%) (92% sensitivity, 63% specificity). Addition of any other factors to this criterion did not improve its accuracy. US and US-guided FNA are accurate for the assessment of nonpalpable neck nodes. Lymph nodes with a round configuration should be biopsied in patients with known malignancy.
24968.37151638222004.06.24++Lung tumor growth: assessment with CT--comparison of diameter and cross-sectional area with volume measurements.Radiology
SG Jennings, HT Winer-Muram, RD Tarver, MO Farber,
PURPOSE: To compare diameter and cross-sectional area measurements with volume measurements in the assessment of lung tumor growth with serial computed tomography (CT). MATERIALS AND METHODS: Patients with lung cancer who underwent at least one pair of chest CT examinations 25 or more days apart before treatment and with a tumor size of T1 (< or =3-cm diameter) at the initial CT examination were identified. A total of 63 patients (62 men, one woman) who underwent 93 pairs of CT examinations were included. Images obtained at each examination were displayed, and the maximum diameter, cross-sectional area, and volume of the tumor were measured. For each measurement, the change between examinations was assessed to determine whether the change reached a detection threshold for growth, as determined in a prior study with simulated tumors. Results were then compared between measurement methods, with volume change serving as the reference standard, by calculating Spearman rank-order coefficients between examinations. Tumor size or section width were also evaluated with the two-tailed Fisher exact probability test to determine if they affected agreement about tumor growth between measurement methods. RESULTS: Thresholds were as follows: diameter, 2.1 mm with hand-held calipers and 0.68 mm with electronic calipers; area, 9.4%; volume, 16.5%. The median time between examinations was 92 days (range, 25-1,221 days). Median diameter increased from 19.3 mm to 23.0 mm (19.2%), median area from 207 mm(2) to 267 mm(2) (29.0%), and median volume from 1,652 mm(3) to 2,443 mm(3) (47.9%). Growth assessment with these diameter (as assessed with hand-held and electronic calipers) and area thresholds disagreed with those obtained with volume in 34 (37%), 26 (28%), and 25 (27%) of the 93 pairs of CT examinations, respectively. Of diameter assessments with the hand-held caliper threshold, 28 (30%) were false-negative; false-negative results occurred with this diameter threshold and area threshold with examination intervals as long as 1 year. CONCLUSION: Growth assessment of T1 lung tumors on serial CT scans with nonvolumetric measurements frequently disagrees with growth assessment with volumetric measurements.
24978.3663289621984.07.19++99mTc red blood cell scintigraphy in evaluating focal liver lesions.AJR Am J Roentgenol
SA Rabinowitz, KA McKusick, HW Strauss,
To determine the accuracy of blood-pool imaging in the diagnosis of hepatic hemangiomas, 39 patients with various focal hepatic lesions were studied. The diagnoses in these patients were made by biopsy, angiography, surgical exploration, or clinical stability for a minimum of 14 months. The diagnoses were: hemangiomas (13 patients), hepatoma (three), metastases (19), abscesses (two), and liver cysts (two). After modified in vivo labeling of red blood cells with 20 mCi (740 MBq) of 99mTc pertechnetate, an initial flow study and early (1-15 min) and delayed (1-2 hr) static images were obtained. Increased blood-pool activity with a discordant flow pattern was seen in 11 of 13 patients with hemangiomas. False-negative scans occurred in two hemangiomas with extensive fibrosis. Two of three hepatomas had increased blood-pool activity associated with increased flow in a pattern identical to the increased blood-pool activity. None of the metastatic, abscess, or cystic lesions had increased blood-pool activity at any time after injection. It is concluded that 99mTc red blood cell imaging can distinguish hemangiomas from other focal liver lesions.
24988.3689162621997.02.11++Cavernous hemangioma of the adrenal gland: MRI appearance.Radiat Med
K Hayasaka, Y Shimada, Y Okuhata, J Kawamori, S Soeda, Y Tanaka,
We describe a case of cavernous hemangioma of the adrenal gland in which MR imaging showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, and dynamic MR imaging using Gd-DTPA showed late and delayed enhancement, allowing definitive diagnosis.
24998.3689566131997.01.09+ Breast metastasis from non-Hodgkin's lymphoma: evaluation with color doppler sonography.AJR Am J Roentgenol
TT Kiziltepe, GA Erden, G Dingil, A Ince,
25008.3620471841991.07.18++[Accessory spleen in children with Hodgkin's disease according to ultrasonic studies]Pediatriia
OI Shcherbenko, SG Makarova,
Ultrasonography of the abdominal cavity and retroperitoneal space was carried out in 138 children suffering from Hodgkin's disease and in 98 children of the control group. The accessory spleen in the presence of the main spleen was revealed in 7.1% of the children. The regenerative spleen was identified in 8 (30.8%) out of 26 children with Hodgkin's disease, examined after splenectomy. That indicator was significantly higher in girls. The clinical follow-up points to a possibility of the regenerative growth of the dysontogenic accessory spleen following splenectomy. The ultrasonographic appearance and differential diagnostic signs of the accessory spleen are described.