Residents' corner. Answer to case of the month #36. Hepatic lipoma.
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Female↗
Biomedical subjects
C Reinhold
Publications and source records attributed to C Reinhold.
Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography.
PURPOSE: To evaluate the accuracy of magnetic resonance (MR) cholangiopancreatography in the diagnosis of bile duct obstruction. MATERIALS AND METHODS: One hundred twenty-six patients with clinically suspected bile duct obstruction underwent MR cholangiopancreatography with heavily T2-weighted fast spin-echo sequences. Reviewers were blinded to clinical and imaging findings. RESULTS: Seventy-nine patients had biliary obstruction that was diagnosed with MR cholangiopancreatography in 72 patients for a sensitivity of 91%, specificity of 100%, and overall accuracy of 94%. Thirty-two patients had choledocholithiasis that was diagnosed with MR cholangiopancreatography in 26 patients for an accuracy of 94%, sensitivity of 81%, specificity of 98%, positive predictive value of 93%, and negative predictive value of 94%. Fourteen patients had malignant obstruction that was diagnosed with MR cholangiopancreatography in 12 patients for a sensitivity and a positive predictive value of 86%, specificity and negative predictive value of 98%, and accuracy of 97%. CONCLUSION: MR cholangiopancreatography is a noninvasive technique with excellent accuracy in the diagnosis of bile duct obstruction and its causes.
Adolescent↗
Helical CT of the liver: value of an early hepatic arterial phase.
PURPOSE: To prospectively evaluate a dual-phase helical acquisition in computed tomography (CT) of the liver. MATERIALS AND METHODS: Two helical CT acquisitions were performed in 103 patients: hepatic arterial phase (HAP) 15 seconds after injection of 2 mL/kg contrast material at a rate of 6 mL/sec and the portal venous phase (PVP) 90 seconds after injection. Detection of focal liver lesions, vascular anatomic features, and perfusion abnormalities were assessed by two reviewers. Liver enhancement was also calculated on every section. RESULTS: Of 119 detected focal liver lesions, nine were seen during HAP only and 40 during PVP only. According to a 0-3 score, visualization of the arterial anatomic landmarks was better during HAP (P < .0001). Five right replaced and two left replaced hepatic arteries were visualized only during HAP. Parenchymal perfusion abnormalities were found in 32 patients during HAP and in four patients during PVP. CONCLUSION: A dual-phase acquisition depicted 8% additional focal liver lesions and outlined the entire vasculature of the liver.
Adult↗
Diffuse uterine adenomyosis: morphologic criteria and diagnostic accuracy of endovaginal sonography.
PURPOSE: To determine the accuracy of endovaginal ultrasound (US) in the diagnosis of uterine adenomyosis and to evaluate the frequency of observed sonographic criteria. MATERIALS AND METHODS: Endovaginal US was performed in 100 consecutive women undergoing hysterectomy for a variety of benign and malignant conditions. Adenomyosis was diagnosed when a poorly defined area of abnormal echotexture (decreased or increased echogenicity, heterogeneous echotexture, myometrial cysts) was present in the myometrium. All endovaginal US findings were correlated with those from histologic examination. RESULTS: Endovaginal US depicted 25 of 29 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 61 of 71 patients. Endovaginal US had a sensitivity of 86%, a specificity of 86%, and a positive and negative predictive value of 71% and 94%, respectively. Of the 25 patients with true-positive findings at US, the myometrium demonstrated heterogeneous and hypoechoic areas with or without the presence of cysts in 21 (84%) patients, hypoechoic areas with cysts in three (12%) patients, and heterogeneous areas within the myometrium in one (4%) patient. CONCLUSION: Adenomyosis of the uterus can be accurately diagnosed with endovaginal US with use of specific sonographic criteria.
Adult↗
Characterization of focal hepatic lesions with duplex sonography: findings in 198 patients.
OBJECTIVE: The purpose of this study was to determine the value of duplex Doppler sonography in the characterization of focal hepatic lesions. SUBJECTS AND METHODS: Duplex Doppler sonography with a 3-MHz transducer was performed prospectively on 198 patients with focal hepatic lesions. One hundred thirty-two patients had pathologically proved diagnoses, confirming 46 hepatomas and 86 metastatic lesions. Twenty-three hemangiomas were confirmed either with tissue, tagged RBC study, MR imaging, or hemangioma CT protocol. Forty-three patients with no history of cancer had benign lesions that were established on the basis of follow-up imaging and at least a 2-year clinical history with no evidence of cancer. RESULTS: Thirty-two hepatomas and four metastatic lesions had Doppler shifts of 4.5 kHz or more, giving a 70% sensitivity, 95% specificity, and 89% positive predictive value in distinguishing hepatomas from metastatic lesions. Forty-three hepatomas, 47 metastatic lesions, one hemangioma, and three benign lesions had Doppler shifts of 1.75 kHz or more, giving a 68% sensitivity, 94% specificity, and 96% positive predictive value in distinguishing malignant from benign lesions. Doppler shifts (mean +/- SD) were as follows: hepatomas, 4.72 +/- 1.72 kHz; metastases, 1.99 +/- 1.63 kHz; and hemangiomas, 0.53 +/- 0.75 kHz. These differences in mean Doppler shifts were statistically significant (p < .0001). CONCLUSION: Duplex Doppler sonography aids in distinguishing hepatomas from metastases and malignant from benign hepatic lesions with a high degree of specificity but low sensitivity.
Adult↗
Enterovesical fistula in a patient with B-cell lymphoma.
Enterovesical fistula is a known complication of several conditions involving the bowel or the genitourinary system. Its occurrence with primary small-bowel lymphoma is rare. The authors report a case of enterovesical fistula associated with secondary small-bowel non-Hodgkin's lymphoma. They review the criteria for classification of small-bowel lymphoma as primary or secondary and discuss the radiologic findings consistent with enterovesical fistula, with reference to the role of computed tomography as the initial radiologic study.
Aged↗
Comparison of helical and conventional computed tomography of the liver.
OBJECTIVE: To compare helical and conventional computed tomography (CT) of the liver in terms of enhancement (with different contrast media) and image quality, using optimal technique for each type of acquisition. PATIENTS AND METHODS: Of 218 consecutive patients referred to a tertiary-care hospital for CT of the liver, 166 were randomly assigned to undergo helical (79 patients) or conventional (87) CT. Fifty patients were excluded from the study because they were unable to hold their breath or were unable to cooperate or because they weighted more than 120 kg. Two other patients were excluded at the time of scanning because of a technical problem. Monophasic injections of contrast agent at 3 mL/second were given to patients undergoing helical CT and biphasic injections at 2 and 0.7 mL/second to patients undergoing conventional CT. The contrast media used were iothalamate meglumine, ioversol, iopamidol and iohexol. For each patient, liver enhancement over baseline attenuation was calculated for every slice, and time to peak enhancement was calculated. In addition, visualization of anatomic landmarks and image quality were scored by two independent reviewers. RESULTS: Minimum, maximum and mean liver enhancement were significantly greater in the group that underwent helical imaging (49, 62 and 55 Hounsfield units [HU] respectively) than in the group that underwent conventional imaging (36, 51 and 44 HU respectively) (Student's t-test, p < 0.0001). Similar differences were obtained when the results were analysed separately for each contrast medium. Image quality was not significantly different between the two acquisition modes. CONCLUSIONS: For computed tomography of the liver, monophasic injection of contrast medium at a high rate and helical acquisition (rather than biphasic injection and conventional acquisition) resulted in significantly better enhancement, without compromising image quality.
Adult↗
Heavy metal-induced cytotoxicity to cultured human epidermal keratinocytes and effects of antioxidants.
Human epidermal keratinocytes which have been cultured were treated with the heavy metal ions of cadmium, mercury, copper and zinc. Cytotoxicity was measured either by protein estimation or by using the neutral red assay. Antioxidants were added in order to find out whether heavy metal-induced cytotoxicity is related to oxidative stress. All metals used showed considerable cytotoxic effects within 24 h in moderate concentrations. None of the antioxidants vitamin E (alpha-tocopherol), pyrogallol, propyl gallate, BHT or ebselen showed any protective or preventive effect. This indicates that oxidative stress may not be involved in the cytotoxicity induced by heavy metals in human epidermal keratinocytes. The cells used are, however, a valuable tool to study mechanisms of cytotoxicity.
Antioxidants↗
Transvaginal US appearance of endometrial abnormalities.
A retrospective study was performed on a series of 44 patients who had undergone transvaginal ultrasound (US) before hysterectomy. The surgically proved endometrial abnormalities included cystic atrophy, cystic and adenomatous hyperplasia, polyps, and malignancy. The following endometrial findings were evaluated: endometrial thickness, echogenicity, smoothness or irregularity of the contour, definition of the contour, and the presence of cystic areas. Some overlapping features were present between the benign and malignant conditions. Although cystic changes were seen in 76% of benign conditions manifesting with endometrial thickening, cystic changes were also present in 24% of endometrial malignancies. In the majority of endometrial malignancies, the endometrial contour was poorly defined, but 40% of the cases manifested as well-defined endometrial thickening. Most endometrial carcinomas (88%) were either diffusely or partially echogenic, 12% were isoechoic, and there was no endometrial carcinoma that was purely hypoechoic. Although the presence of cystic changes favors a benign condition, malignancy cannot be reliably excluded. Malignancy should be considered in the presence of a poorly defined, irregular endometrium. Transvaginal US has a significant role in the assessment of the endometrium, and although it can help in the differentiation between some benign and malignant conditions, there remain some overlapping features.
Adult↗
Endovaginal sonographic appearance of benign ovarian masses.
This article illustrates the different appearances of benign ovarian and paraovarian masses at endovaginal sonography. A retrospective study was performed of the records for 118 patients with 140 surgically proved benign adnexal masses, including dermoid cysts (n = 27), endometriomas (n = 40), epithelial inclusion cysts (n = 14), serous cystadenomas (n = 11), mucinous cystadenomas (n = 14), fibromas (n = 11), cystadenofibromas (n = 12), paratubal cysts (n = 5), hydrosalpinges (n = 3), and tubo-ovarian abscesses (n = 3). Preoperative diagnosis was made in 96% of the dermoid cysts on the basis of a hyperechoic attenuating component or multiple small horizontal interfaces and in 100% of uncomplicated fibromas on the basis of a hypoechoic attenuating mass. There was an overlap among the endovaginal sonographic appearances of the other condition.
Abscess↗
Hypoechogenic embryologic ventral aspect of the head and uncinate process of the pancreas: in vitro correlation of US with histopathologic findings.
PURPOSE: To evaluate the hypothesis that hypoechogenicity of the embryologic ventral aspect of the head of the pancreas is due to diminished fat content. MATERIALS AND METHODS: Ultrasound and histopathologic findings in 13 pancreatic autopsy specimens were compared, and the prevalence of areas of hyperattenuation of the embryologic ventral aspect of the head of the pancreas at computed tomography (CT) was studied. RESULTS: In vitro examination of pancreatic autopsy specimens showed this variant in seven (54%) of the 13 specimens, and histopathologic correlation confirmed that there is diminished fat content corresponding to the hypoechoic portion of the head of the pancreas. This difference in attenuation was visible on 21 (22%) of 96 CT scans. There was a statistically significant (P < .05, r = .212) increase in the prevalence of this finding with increasing age. CONCLUSION: Hypoechogenicity of the embryologic ventral aspect of the head of the pancreas is due to diminished fat content. This difference in attenuation is also commonly seen on CT scans.
Adipose Tissue↗
Diagnosis of choledocholithiasis: value of MR cholangiography.
OBJECTIVE: T2-weighted fast spin-echo MR imaging (MR cholangiography) of the right upper quadrant of the abdomen depicts the biliary tree in considerable detail. We studied the value of this procedure for detecting stones in the common bile duct in a series of patients with proved calculi. MATERIALS AND METHODS: MR images of 10 consecutive patients with stones in the common bile duct were retrospectively reviewed. The diagnosis of choledocholithiasis was proved by stone extraction in all cases. Axial, coronal, and oblique images were obtained by using heavily T2-weighted fast spin-echo sequences, and the images were processed by using a maximum-intensity-projection (MIP) algorithm and a commercially available multiplanar reformatting software. Two reviewers who were not blinded to the diagnosis analyzed hard copy images and reformatted images at the MR console. The rate of stone detection was evaluated for each acquisition plane. The mean stone/bile signal-intensity ratio and the number and size of stones were recorded. RESULTS: In all patients, the entire length of the extrahepatic bile ducts was visualized, and the diagnosis of choledocholithiasis could be made on the basis of findings on MR images. Eight stones, including two that were impacted in the ampulla, were located in the distal part of the common bile duct. On the hard copy films, the stones were visible in eight of 10 coronal images, six of 10 axial images, and four of 10 oblique images. On the three-dimensional (3D) MIP reconstructions, the stones were seen in five of the coronal sets and in six of the axial sets. The best results were obtained when the multiplanar reconstruction software was used: nine of the 10 coronal sets and eight of the 10 axial sets showed stones in the bile ducts. By use of a combination of 3D MIP and multiplanar reconstruction, choledocholithiasis was detected in all 10 patients. The mean signal intensity of the stones was 58 (range, 18-87). The mean stone/bile signal-intensity ratio was 0.15 (range, 0.05-0.24). CONCLUSION: In this preliminary study, we showed that MR cholangiography, based on T2-weighted fast spin-echo sequences, could be an important imaging technique for patients with suspected bile duct obstruction and equivocal sonography and/or CT results. However, a large prospective clinical trial is needed to confirm these results.
Cholangiography↗
Panostotic fibrous dysplasia. A new craniotubular dysplasia.
The authors describe the radiographic-scintigraphic features of an unusual craniotubular dysplasia characterized by diffuse osteopenia with bone expansion and a "ground glass" appearance, markedly increased skeletal turnover, myelofibrosis, hypophosphatemia, and pigmented "coast-of-Maine" patches. This syndrome, termed panostotic fibrous dysplasia, is distinct from previously reported disorders.
Adolescent↗
Risks associated with intestinal perforation during experimental percutaneous drainage.
RATIONALE AND OBJECTIVES: The authors evaluated the complication rate of transgressing small or large bowel during intraperitoneal percutaneous catheter placement in an animal model. METHODS: Twenty-four 8-F catheters were percutaneously placed through the small and large bowel of 12 pigs. In six animals, the catheters were left in place until autopsy, whereas in the remaining six animals, the catheters were withdrawn 5 days after insertion. Computed tomographic (CT) scans were performed on days 1 and 8 after catheter placement in pigs in which catheters were in place at time of autopsy, and on days 1, 5, and 8 in pigs in which catheters were removed. RESULTS: CT results showed no abscess or peritoneal effusion, but a pneumoperitoneum was present in four animals whose signs resolved on subsequent studies. Autopsy was performed in all animals 9 days after catheter placement. No clinical complication occurred, and no significant biochemical changes were observed. At autopsy, no bowel leakage, peritonitis, or abscess was visible. Bowel and peritoneal adhesions were found around the catheter tract. There was no difference between the animals with catheters in place at the time of autopsy and the animals without catheters. There also was no difference between the group of animals with small or large bowel transgression. CONCLUSION: This study suggests that traversing the intestine during percutaneous placement of an intra-abdominal catheter should not be considered an absolute contraindication when no other approach is available.
Abdomen↗
Fast spin-echo MR imaging of the female pelvis. Part I. Use of a whole-volume coil.
In this prospective study, axial and sagittal magnetic resonance (MR) images were obtained with T2-weighted conventional spin-echo (CSE) and fast spin-echo (FSE) sequences in 34 consecutive female patients who underwent clinical pelvic MR examination at 1.5 T. The MR images from each patient were compared side by side, blindly and independently, by two radiologists experienced in MR imaging who used a standardized score sheet for anatomic and pathologic findings. The FSE sequences were rated superior significantly more often than the CSE sequences in most categories of findings (P less than .05), including overall image quality and reduction of motion artifact. The examination time for the FSE sequences was 1 minute 46 seconds versus an examination time of 9 minutes 14 seconds for the CSE sequences. (Both CSE and FSE sequences provided 18 sections.) It is concluded that the FSE sequence provides T2-weighted anatomic and pathologic information superior to that provided by the CSE sequence and requires substantially less imaging time.
Adolescent↗
Multicoil high-resolution fast spin-echo MR imaging of the female pelvis.
A fast spin-echo pulse sequence was combined with multiple surface coils used simultaneously in the form of a "multicoil" in magnetic resonance imaging studies of the female pelvis. This combination allowed maximal resolution with maintenance of the signal-to-noise ratio (S/N) at an acceptable level, and the S/N with the multicoil system was substantially better than that achieved with a body coil. Excellent image quality and demonstration of anatomic detail were afforded by use of this technique.
Adolescent↗
Inhibition of bleomycin-induced toxic effects by antioxidants in human malignant melanoma cells.
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Adult↗
Treatment of pleural effusions and pneumothorax with catheters placed percutaneously under imaging guidance.
We analyzed our experience with 42 consecutive patients who had pleural effusions (seven benign exudates, 12 malignant exudates, and 15 empyemas) or pneumothoraxes (eight patients) treated over a 3-year period by catheters placed percutaneously under imaging guidance. The catheters ranged in size from 8 French to 14 French. Although the overall success rate was 71% (30/42), the success rate during the first 2 years was 57% (12/21), compared with 86% (18/21) during the third year. The success rates according to collection type were 63% (12/19) for exudates, 80% (12/15) for empyemas, and 75% (6/8) for pneumothoraxes. There were two complications: a vasovagal reaction and a sterile collection converted to an empyema. After an initial learning period and with accumulated experience, radiologically placed catheters have proved to be an efficacious treatment of pleural effusions and pneumothoraxes that has a low complication rate.
Adult↗