Biomedical subjects

D M Panicek

Publications and source records attributed to D M Panicek.

At least 19 recordsLinked to original sources

PubMed2001

Breast cancer: assessing the use of routine pelvic CT in patient evaluation.

OBJECTIVE: The purpose of this study was to determine the benefit of routine pelvic CT in the evaluation of patients with primary breast cancer and to assess the frequency with which equivocal or abnormal findings on pelvic CT prompted the performance of additional studies or procedures that yielded results relevant to patient care. MATERIALS AND METHODS: The reports of 6628 body CT scans that included images of at least the pelvis in 2426 patients with breast cancer during a 9-year period were reviewed. The presence and sites of reported definite or probable metastases or pelvic tumors were recorded for each scan. Also, the types and results of diagnostic examinations and procedures prompted by equivocal or abnormal findings on pelvic CT were recorded. RESULTS: Pelvic metastases shown on CT were the only known site of metastasis in 13 (0.5%) of 2426 patients, and four other patients (0.2%) had new or enlarging pelvic metastases despite the presence of stable extrapelvic metastases. The pelvic metastases in these 17 patients were located in bone only in 11 patients, in adnexa only in five patients, and in adnexa, endometrium, and bone in one patient. In addition, pelvic CT led to the performance of 204 additional radiologic examinations, including 186 pelvic sonographic examinations, and 50 surgical procedures; 215 (84.6%) of these 254 additional examinations and procedures yielded normal, benign, or indeterminate results. CONCLUSION: The routine use of pelvic CT in the evaluation of patients with breast cancer has an extremely low yield and often prompts performance of pelvic sonographic or surgical procedures, the results of which were rarely relevant to cancer therapy.

Breast Neoplasms↗

PubMed2000

Evaluation of tumor measurements in oncology: use of film-based and electronic techniques.

PURPOSE: To evaluate the variability in bidimensional computed tomography (CT) measurements obtained of actual tumors and of tumor phantoms by use of three measurement techniques: hand-held calipers on film, electronic calipers on a workstation, and an autocontour technique on a workstation. MATERIALS AND METHODS: Three radiologists measured 45 actual tumors (in the lung, liver, and lymph nodes) on CT images, using each of the three techniques. Bidimensional measurements were recorded, and their cross-products calculated. The coefficient of variation was calculated to assess interobserver variability. CT images of 48 phantoms were measured by three radiologists with each of the techniques. In addition to the coefficient of variation, the differences between the cross-product measurements of tumor phantoms themselves and the measurements obtained with each of the techniques were calculated. RESULTS: The differences between the coefficients of variation were statistically significantly different for the autocontour technique, compared with the other techniques, both for actual tumors and for tumor phantoms. There was no statistically significant difference in the coefficient of variation between measurements obtained with hand-held calipers and electronic calipers. The cross-products for tumor phantoms were 12% less than the actual cross-product when calipers on film were used, 11% less using electronic calipers, and 1% greater using the autocontour technique. CONCLUSION: Tumor size is obtained more accurately and consistently between readers using an automated autocontour technique than between those using hand-held or electronic calipers. This finding has substantial implications for monitoring tumor therapy in an individual patient, as well as for evaluating the effectiveness of new therapies under development.

Humans↗

PubMed2000

Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT.

OBJECTIVE: We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS: We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS: Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION: Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.

Abdominal Neoplasms↗

PubMed2000

Solitary fibrous tumor of the liver: imaging findings.

OBJECTIVE: This study describes the imaging features of solitary fibrous tumor of the liver in three patients. CONCLUSION: A single large, well-circumscribed, heterogeneously enhancing hepatic mass was present in each patient. These imaging features are suggestive of, but not diagnostic for, solitary fibrous tumor of the liver. The two benign and one malignant solitary fibrous tumors of the liver in this series were indistinguishable from one another on imaging studies.

Female↗

PubMed1999

Prevalence and importance of small hepatic lesions found at CT in patients with cancer.

PURPOSE: To assess the prevalence of small hepatic lesions discovered at computed tomography (CT) in patients with cancer and to determine the frequency with which they represent clinically important findings. MATERIALS AND METHODS: The authors reviewed the CT reports obtained in 2,978 patients with cancer during a 24-month period. Small hepatic lesions (lesions 1 cm or less in diameter or deemed too small to characterize by the interpreting radiologist) noted on the initial scan were assessed at follow-up CT. The number and type of any other intrahepatic lesion, the histologic type of the primary tumor, and the presence of extrahepatic metastatic disease were also recorded. RESULTS: Small hepatic lesions were reported in 378 (12.7%) patients; 15 (4.0%) of these patients also reportedly had other larger hepatic lesions that were interpreted as metastases. Small hepatic lesions demonstrated interval growth in 44 (11.6%) patients and were therefore considered metastatic. Small hepatic lesions in 303 (80.2%) patients demonstrated no interval growth (mean follow-up, 25.6 months; range, 6-56 months) and were therefore presumed benign. Small hepatic lesions in 31 (8.2%) patients were stable at follow-up of less than 6 months and were considered indeterminate. Among the three most common tumors (lymphoma and colorectal and breast cancers), small hepatic lesions were metastatic in 4%, 14%, and 22%, respectively. CONCLUSION: Although small hepatic lesions in patients with cancer more frequently are benign than malignant, these lesions represent metastases in 11.6% of patients.

Humans↗

PubMed1999

Hepatocellular carcinoma: MR imaging findings in cirrhotic livers and noncirrhotic livers.

PURPOSE: To compare the magnetic resonance (MR) imaging findings of primary hepatocellular carcinoma (HCC) in cirrhotic versus noncirrhotic livers. MATERIALS AND METHODS: MR images in 36 patients with HCC (30 men and she women aged 42-84 years [mean age, 65 years]) were retrospectively reviewed. The number and size of hepatic lesions were assessed. Lesion margins were categorized as well circumscribed or ill defined. The presence of a capsule, intratumoral high signal intensity on T1-weighted MR images, and a stellate scar were determined. RESULTS: Eleven (31%) patients had MR imaging evidence of cirrhosis, and 25 (69%) did not: Lesions in cirrhotic livers differed significantly from those in noncirrhotic livers in terms of size (22 cm2 vs 99 cm2, P < .05), frequency of a solitary lesion (27% vs 72%, P < .05), and frequency of a central scar (6% vs 50%, P < .05). There was no difference between the cirrhotic and noncirrhotic livers with regard to tumor margin, intratumoral high signal intensity on T1-weighted images, or tumor capsule. CONCLUSION: Differences exist in the MR imaging appearance of HCC between patients with and those without cirrhosis, although there is overlap of imaging findings.

Adult↗

PubMed1999

Clinical importance of reinterpretation of body CT scans obtained elsewhere in patients referred for care at a tertiary cancer center.

PURPOSE: To determine the frequency and clinical importance of discordance between the initial interpretation of computed tomographic (CT) scans of the body and subsequent interpretations in patients with biopsy-proved cancer. MATERIALS AND METHODS: The initial and reinterpretation reports for 213 CT scans of the body submitted for official review were compared independently by two radiologists. Sixty-nine sets of reports were excluded because the reviewing radiologists and the outside radiologists had prior CT scans from differing dates to use for comparison. One set of reports was excluded because of lack of clinical follow-up. RESULTS: The interpretations were graded as "agree" in 90 patients (63%), "major disagreement" in 24 patients (17%), and "minor disagreement" in 29 patients (20%). A theoretic change in treatment could have occurred in nine of 53 cases of disagreement (17%). An actual change in treatment occurred in five of 53 cases of disagreement (9%). CONCLUSION: Discordant interpretations were frequent (53 of 143 cases [37%]), were often major (24 of 143 cases [17%]), and resulted in actual treatment changes in five of all 143 cases (3%). Reinterpretation of body CT scans can have a substantial effect on the clinical care of individual patients with proved malignancy.

Humans↗

PubMed1999

Recurrent gallbladder carcinoma along laparoscopic cholecystectomy port tracks: CT demonstration.

PURPOSE: To describe the computed tomographic (CT) appearance of recurrent gallbladder carcinoma along port tracks after laparoscopic cholecystectomy and to assess the effect of recurrence on patient care. MATERIALS AND METHODS: Seventeen abdominal CT scans in 16 of 19 consecutive patients who underwent hepatic resection for gallbladder carcinoma diagnosed at laparoscopic cholecystectomy were reviewed retrospectively. Medical records were reviewed to determine the clinical effect of tumor recurrence along a port track. RESULTS: CT revealed 12 tumor recurrences along laparoscopic port tracks in six (32%) patients (mean, two recurrences per patient; range, one to four per patient). Eight (67%) CT-depicted recurrences appeared homogeneous, and nine (75%) directly involved subjacent omental fat. The mass was the only site of recurrence at CT in two (33%) patients. The presence of an abdominal wall tumor recurrence affected patient care in four (67%) of six patients. Histopathologic examination results confirmed recurrent tumor in all five (100%) patients who underwent biopsy. CONCLUSION: Tumor recurrence along port tracks is a potential complication of laparoscopic cholecystectomy when gallbladder carcinoma is present, even after subsequent hepatic resection is performed for attempted cure. Recurrences appear as a new or enlarging abdominal wall mass, often involving subjacent omental fat, and may be the only site of recurrent disease at CT. Demonstration of abdominal wall tumor recurrence affects patient care.

Abdominal Muscles↗

PubMed1999

Pulmonary nodules resected at video-assisted thoracoscopic surgery: etiology in 426 patients.

PURPOSE: To determine the etiology of pulmonary nodules resected at video-assisted thoracoscopic surgery (VATS) and establish the probabilities that single or multiple nodules resected at VATS represent malignancy in patients with or patients without known cancer. MATERIALS AND METHODS: Pathology reports from VATS performed between January 1995 and July 1997 were searched for data on gross specimens revealing pulmonary nodules 3 cm or smaller. Findings were correlated with clinical and histologic data. RESULTS: In 254 patients with one nodule resected at VATS, the nodules were malignant in 108 patients with and in 32 patients without known cancer (P < .03). Among 172 patients with multiple nodules resected, at least one nodule was malignant in 85 patients with and in 20 patients without known cancer (P > .05). Nodules larger than 1 cm were more likely to be malignant than were smaller nodules (P < .002). In patients with known malignancy, nodules smaller than 0.5 cm were more likely to be benign, whereas nodules larger than 0.5 cm but smaller than 1 cm were more likely to be malignant (P < .001). CONCLUSION: A single pulmonary nodule resected at VATS was more likely to be malignant in patients with known cancer. Nodules larger than 1 cm but smaller than 3 cm resected at VATS were more likely to be malignant. Nodules smaller than 0.5 cm were more likely to be benign.

Humans↗

PubMed1999

Staging of malignant pleural mesothelioma: comparison of CT and MR imaging.

OBJECTIVE: This article compares the accuracy of CT with that of MR imaging in staging of malignant pleural mesothelioma. SUBJECTS AND METHODS: Ninety-five patients were enrolled in a prospective staging protocol based on the International Mesothelioma Interest Group staging system. Sixty-five patients underwent CT and MR imaging and a surgical procedure (excluding percutaneous needle biopsy) to stage and resect the tumor. Receiver operating characteristic analyses were performed. CT and MR scans were interpreted independently by observers who were unaware of the results of the other imaging study; these imaging findings were compared with the results of surgery and pathologic examination. RESULTS: The areas under the receiver operating characteristic curves for eight of 10 features revealed by imaging showed no statistically significant differences between CT and MR imaging. However, MR imaging was superior to CT in revealing invasion of the diaphragm (A(z) = .55 for CT versus .82 for MR imaging) and in revealing invasion of endothoracic fascia or solitary resectable foci of chest wall invasion (A(z) = .46 for CT; A(z) = .69 for MR imaging). Several anatomic regions could not be evaluated because positive findings at surgery were rare. CONCLUSION: CT and MR imaging are of nearly equivalent diagnostic accuracy in staging malignant pleural mesothelioma. MR imaging is superior to CT in revealing solitary foci of chest wall invasion and endothoracic fascia involvement and in showing diaphragmatic muscle invasion; however, this advantage does not affect surgical treatment. For cost reasons, CT should be considered the standard diagnostic study before therapy.

Adult↗

PubMed1998

MRI as an alternative to CT-guided biopsy of adrenal masses in patients with lung cancer.

BACKGROUND: This study was performed to assess chemical shift magnetic resonance imaging (CSMRI) for characterizing adrenal masses in patients with lung cancer, and to compare charges associated with two algorithms for assessing adrenal masses in these patients. METHODS: Forty-two patients with lung cancer underwent both CSMRI (using in-phase and opposed-phase gradient echo images) and computed tomography-guided percutaneous biopsy of adrenal masses. Adrenal-to-spleen signal intensity ratios on the opposed-phase images were correlated with histopathologic results. The normalized charges for two algorithms were compared. In algorithm A, computed tomography-guided biopsy is used first to evaluate an adrenal mass; in algorithm B, CSMRI is used first, followed by computed tomography-guided biopsy only if CSMRI findings are not diagnostic of adenoma. RESULTS: Biopsy showed 24 (57%) adrenal adenomas and 18 (43%) metastases. Chemical shift magnetic resonance imaging was 96% sensitive for adenoma and 100% specific. The average normalized charges associated with algorithm A were $1,905 per patient versus $1,890 with algorithm B. CONCLUSIONS: Initial use of CSMRI in evaluating an adrenal mass in lung cancer patients can obviate biopsy in 55% of patients, and its charges are similar to those for performing computed tomography-guided biopsy in all patients.

Adenocarcinoma↗

PubMed1998

Tumor involvement in hepatic veins: comparison of MR imaging and US for preoperative assessment.

PURPOSE: To compare use of magnetic resonance (MR) imaging and ultrasonography (US) for diagnosis of vascular involvement by tumor at the hepatic vein confluence. MATERIALS AND METHODS: Thirty-seven consecutive patients with tumors at the hepatic vein confluence were prospectively evaluated with spin-echo and gradient-echo MR imaging and gray-scale and Doppler US. Encasement, thrombosis, occlusion, and nonvisualization were considered to be evidence of vascular involvement. Imaging results were compared with surgical and pathologic examination findings in 27 patients who underwent resection. RESULTS: Sixteen hepatic veins (nine right, four middle, three left) were seen to be involved at surgery. Twelve of 16 involved veins were identified at MR imaging (75% sensitivity, 98% specificity, 92% positive predictive value, 94% negative predictive value). Thirteen of 16 involved veins were detected at US (81% sensitivity, 97% specificity, and 87% positive and 95% negative predictive values). There was one false-positive diagnosis of inferior vena cava involvement at both MR imaging and US. Ten patients had unresectable disease. One patient had motion artifact on MR images; in the remaining nine patients, MR imaging and US yielded identical findings at 26 of 27 hepatic vein sites. CONCLUSION: MR imaging and US provide comparable results for assessment of hepatic vein involvement by tumor.

Bile Duct Neoplasms↗

PubMed1998

Small cell and anaplastic prostate cancer: correlation between CT findings and prostate-specific antigen level.

PURPOSE: To evaluate the computed tomographic (CT) findings in patients with the anaplastic clinical variant of prostate cancer and to correlate these with prostate-specific antigen (PSA) levels. MATERIALS AND METHODS: Twenty-seven men with the anaplastic clinical variant of prostate cancer, including 12 patients with small cell cancer of the prostate, underwent CT before platinum-based chemotherapy. CT findings were retrospectively reviewed for the extent of disease in the abdominal and pelvic lymph nodes, liver, bone, and prostate. CT findings were correlated with baseline PSA levels. RESULTS: The overall mean PSA level was 59.9 ng/ml +/- 23.3 (range, 0-583 ng/ml; median, 4 ng/ml), with a mean PSA level in the small cell cancer subgroup of 12.3 ng/ml +/- 9.0 (range, 0-110 ng/mL; median, 1.7 ng/mL). Twenty-six patients (96%) had metastatic disease evident at CT, but only nine (33%) had PSA levels greater than 10 ng/mL. The mean PSA level in patients with pelvic lymphadenopathy was 12.8 ng/mL +/- 7.9 (median, 1.6 ng/mL); that in the small cell cancer subgroup was only 2.8 ng/ml +/- 1.4 (median, 1.6 ng/ml). Whereas 19 (70%) of all patients had osseous metastases and an average PSA level of 73 ng/ml +/- 32(median, 9.1 ng/mL), the seven (58%) with small cell cancer and bone metastases had an average PSA level of 18 ng/mL +/- 13 (median, 4 ng/mL). CONCLUSION: Unlike patients with advanced typical adenocarcinoma of the prostate, patients with the anaplastic clinical variant of prostate cancer often have extensive metastatic disease at CT despite relatively low PSA levels.

Adenocarcinoma↗

PubMed1998

Complex postcholecystectomy biliary disorders: preliminary experience with evaluation by means of breath-hold MR cholangiography.

PURPOSE: To assess preliminary experience with breath-hold single-shot fast spin-echo magnetic resonance (MR) cholangiography in complex postcholecystectomy biliary disorders. MATERIALS AND METHODS: MR cholangiography was performed in 17 consecutive patients referred for specialist surgical evaluation of suspected complex postcholecystectomy biliary disorders. Two readers, unaware of surgical, histopathologic, or other imaging findings, independently reviewed the MR cholangiographic images to assess the presence of biliary occlusion, peribiliary lesions, nonspecific biliary dilatation (biliary dilatation without an abrupt transition in caliber and without a visible underlying cause), bile duct stones, or biliary fistulas. Final diagnoses were established with surgery (n = 9), imaging other than MR (n = 6), and histopathologic review of the initial surgical specimen (n = 2). RESULTS: Final diagnoses were biliary occlusion (n = 8), peribiliary lesions (n = 3), nonspecific biliary dilatation (n = 3), bile duct stones (n = 2), and biliary-colonic fistula (n = 1). The two readers correctly categorized these diagnoses in 15 (88%) and 13 (76%) of the 17 cases, with excellent interobserver agreement (kappa = 0.82). CONCLUSION: Single-shot fast spin-echo MR cholangiography is an accurate, noninvasive modality for the assessment of complex postcholecystectomy biliary disorders.

Adult↗

PubMed1998

Misrepresentation of publications by applicants for radiology fellowships: is it a problem?

OBJECTIVE: We performed this study to determine whether applicants to the body and breast/body imaging fellowship programs at our institution misrepresented their publications in their applications or curricula vitae, as has been reported recently regarding applicants for gastroenterology fellowships. We also wanted to alert program directors to this issue. MATERIALS AND METHODS: For each applicant in 1992-1995, every article cited on an application form or curriculum vitae as published or in press was cross-referenced with computer databases or the actual journals. RESULTS: Of 201 applicants, 87 (43%) listed at least one article citation (total citations, 261; mean number of citations, 3.0; maximum number of citations, 20). Of 261 citations, 39 (15%) could not be verified. Seven articles (listed by six applicants) did not appear in print 16-30 months after being listed as in press; six citations (by six applicants) put the applicant's name higher on the authorship list than was actually true; two articles (by two applicants) were not in the location cited or elsewhere; and 24 articles (by 14 applicants) were listed as appearing in journals that could not be found. The first three categories were judged as misrepresentations of publications; the fourth category was judged indeterminate for misrepresentation. CONCLUSION: A minimum of 16% (14/87) of applicants to the body and breast/body imaging fellowship programs at our institution who cited publications, or 7% of all 201 applicants in the time studied, appear to have misrepresented their publication record. Program directors should be aware of the possible means for prevention of this problem.

Fellowships and Scholarships↗

PubMed1998

Patterns of neoplastic spread in colorectal cancer: implications for surveillance CT studies.

OBJECTIVE: This study was performed to assess patterns of metastatic disease shown on CT in colorectal cancer and to determine the diagnostic yield of routine pelvic CT in follow-up surveillance. MATERIALS AND METHODS: Pathology records and 3073 CT studies of 1119 patients with colorectal cancer were retrospectively reviewed. Primary tumor site, site of abdominal or pelvic metastases (liver, peritoneum, lymph nodes, local recurrence, or other), and incidental nonmetastatic pelvic disease were recorded. The superior iliac crests were considered the border between the abdomen (above) and the pelvis (below). RESULTS: Metastatic disease was present in 34% (1040/3073) of all CT studies: 33% (1007/3073) in the abdomen and 7% (227/3073) in the pelvis. Six percent (194/3073) of studies had metastases in both abdomen and pelvis. Forty-one percent (404/991) of studies showing abdominal primary colonic tumors showed metastatic disease: 40% (400/991) in the abdomen and 8% (78/991) in the pelvis. Four studies (0.4%; 4/991) in four different patients with abdominal primary colon tumors had isolated pelvic metastases; three of these were primary tumors of the cecum. Thirty-one percent (636/2082) of studies showing pelvic primary colonic tumors showed metastatic disease: 29% (607/2082) in the abdomen and 7% (149/2082) in the pelvis. Twenty-nine studies (1%; 29/2082) in 26 patients with pelvic primary colonic tumors revealed isolated pelvic metastases. CONCLUSION: In colorectal tumors arising within the abdomen, pelvic metastases are uncommon and isolated pelvic metastases are rare. Routine pelvic CT performed in the follow-up surveillance of patients with colorectal cancer with primary tumors arising in the abdominal portion of the colon has a low diagnostic yield.

Abdominal Neoplasms↗

PubMed1998

Neoplastic pancreaticobiliary duct obstruction: evaluation with breath-hold MR cholangiopancreatography.

OBJECTIVE: The purpose of this study was to investigate the use of breath-hold single-shot fast spin-echo MR cholangiopancreatography in neoplastic pancreaticobiliary duct obstruction. MATERIALS AND METHODS: Breath-hold MR cholangiopancreatography was performed for preoperative examination of 32 consecutive patients with pathologically confirmed neoplastic obstruction of the biliary tract or pancreatic duct using a single-shot fast spin-echo sequence. Two observers, unaware of clinical or pathologic findings, independently reviewed the MR cholangiopancreatograms to assess level of obstruction and site of underlying tumor. Pathologic diagnoses, based on surgical or CT-guided biopsy specimens, were pancreatic tumor (n = 12), gallbladder cancer (n = 9), intrahepatic cancer (n = 9), and ampullary cancer (n = 2). RESULTS: On the basis of conventional cholangiography, CT, and surgical findings, 20 patients had isolated bile duct obstruction, 11 patients had combined pancreatic and bile duct obstruction, and one patient had isolated pancreatic duct obstruction. Isolated bile duct obstruction was classified as lobar (n = 5), hilar (n = 12), or distal (n = 3). These levels of obstruction were correctly identified in 27 (84%) and 28 (88%) of the 32 cases by the two observers. The site of the underlying tumor was identified in 27 (84%) and 29 (91%) cases by the two observers. Good interobserver agreement was reached for both level of obstruction (kappa = .70) and identification of tumor site (kappa = .75). CONCLUSION: Breath-hold single-shot fast spin-echo MR cholangiopancreatography is accurate in identifying the level of obstruction and the site of underlying tumor in neoplastic pancreaticobiliary duct obstruction, with good interobserver agreement.

Adult↗

PubMed1997

Non-Hodgkin lymphoma in skeletal muscle manifesting as homogeneous masses with CT attenuation similar to muscle.

Two cases are presented of masses in muscle due to non-Hodgkin lymphoma (NHL) that were homogeneous and isoattenuating to normal muscle on CT. In each case, the mass was clinically suspected of representing soft tissue sarcoma. However, the masses were relatively inapparent on CT, being visible predominantly as mass effect--an appearance unlike that of soft tissue sarcomas. It is important to be aware that NHL in muscle can be difficult to detect at CT, even with intravenous contrast enhancement; therefore, a clinically apparent mass should not be dismissed on the basis of an apparently unremarkable CT scan of the region. Such findings should suggest the diagnosis of NHL rather than sarcoma.

Aged↗