Integrated imaging of adrenal disease.
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Adenoma↗
Biomedical subjects
L E Quint
Publications and source records attributed to L E Quint.
Duodenal neoplasms: predictive value of CT for determining malignancy and tumor resectability.
CT examinations of 25 patients with proved primary or metastatic duodenal neoplasms were retrospectively reviewed to determine if morphologic features seen on CT scans could be used to predict the benign or malignant nature of these neoplasms and to assess the effectiveness of using CT findings to predict tumor resectability. We studied 19 malignant and six benign tumors. Histologic proof was obtained by means of surgery in 20 patients and by endoscopic biopsy in five. CT features of tumor morphology were assessed in the 22 cases in which a duodenal tumor was seen on CT. These features included central necrosis, ulceration or excavation, and the location of the tumor with respect to the bowel wall. The specific morphologic features used to predict that a tumor was malignant included the presence of an exophytic or intramural mass, central necrosis, and ulceration. The only criterion used to predict that a tumor was benign was that the mass be entirely intraluminal. Whenever vascular encasement, invasion of contiguous organs other than the head of the pancreas, distant lymphadenopathy, or metastases were present, the tumor was predicted to be unresectable for cure. With the exception of three benign smooth muscle tumors, all tumors with one or more CT morphologic features indicative of a malignant neoplasm were malignant (n = 16). Three of four intraluminal masses were benign. In three cases of polypoid tumors smaller than 2 cm, a duodenal tumor was not seen on CT. Whenever extraduodenal disease was found (15 cases), the neoplasms were malignant. In the 22 cases in which a tumor was detected on CT, the sensitivity of using the presence of one or more morphologic features associated with a malignant neoplasm as a predictor was 94%; the specificity was 50%, and the accuracy was 82%. If the presence of any morphologic feature indicative of a malignant neoplasm was combined with the presence of any finding of extraduodenal disease, CT was 100% sensitive and 86% accurate for predicting that the tumor was malignant. CT appears to be reliable for predicting duodenal tumor resectability. On the basis of CT findings, 10 tumors were correctly predicted as being unresectable for cure, and 12 were predicted as being resectable; no surgery was performed in the remaining three cases. In conclusion, evaluation of the morphologic features of duodenal neoplasms is a sensitive, but nonspecific, method for predicting that a tumor is malignant.(ABSTRACT TRUNCATED AT 400 WORDS)
Adenocarcinoma↗
CT of the extraperitoneal space: normal anatomy and fluid collections.
Knowledge of the appearance and location of the normal fascial structures surrounding the kidneys and the bladder is the key to proper CT analysis of extraperitoneal fluid collections. Recent studies have shown that the renal fascia and the perirenal space are more complex than previously recognized. An extracapsular renal hematoma, confined against the kidney by the posterior renorenal septum within the perirenal space, can entirely simulate a subcapsular hematoma. Pancreatitis fluid can dissect between the discrete layers that constitute the posterior renal fascia, allowing fluid in the anterior pararenal space to extend posterior to the kidney without directly involving the posterior pararenal space. The umbilicovesical fascia separates the small perivesical space from the potential large reservoir of the prevesical space in the extraperitoneal portion of the pelvis. Fluid in the prevesical space can communicate directly with the retroperitoneal spaces surrounding the kidney. In addition to compartmental localization, CT features of the fluid itself or the presence of ancillary findings such as aortic aneurysm, enlarged pancreas, renal mass, or hydronephrosis will frequently indicate the cause and the extent of most extraperitoneal fluid collections.
Contrast Media↗
Prostate cancer: correlation of MR images with tissue optical density at pathologic examination.
To explain the variability in detection of prostate cancer with magnetic resonance (MR) imaging, the authors correlated preoperative MR findings in 28 patients with tissue optical density (TOD) measurements on whole-mount pathologic slides prepared from radical prostatectomy specimens. TOD was used as an indicator of the degree of tissue compactness or openness. TOD measurements from proved cancers and from pathologic regions corresponding to MR lesions (areas of low signal intensity seen at T2-weighted MR imaging) were compared with TOD measurements from adjacent, nonmalignant tissue. TOD measurements corresponding to MR lesions were higher than noncancerous tissue measurements in all cases (P less than .005). Although most of these lesions represented cancers (21 of 30), nine of 30 represented benign tissue that was composed mainly of densely packed fibromuscular stroma (30% false-positive results). Thus, signal intensity appeared to be related to TOD rather than to a specific histologic tissue type, and the finding of a peripheral zone lesion with low signal intensity did not necessarily indicate the presence of a cancer.
Densitometry↗
Carcinoma of the prostate: MR images obtained with body coils do not accurately reflect tumor volume.
MR imaging with a body coil is unreliable in directly demonstrating tumor spread through the prostatic capsule. However, the likelihood of extracapsular spread of prostatic cancer rises with increasing tumor volume. The aim of our study was to assess the accuracy of MR with a body coil in diagnosing capsular penetration indirectly via an estimation of prostatic tumor volumes. Twenty-six patients with proved prostatic cancer that was clinically confined to the gland underwent MR imaging before radical prostatectomy and whole-mount pathologic sectioning of the specimen. Twenty of 31 lesions prospectively outlined on the MR images corresponded to cancers outlined on the pathology slides, and tumor volumes were calculated by using a voxel summation technique. On MR, tumor volume was underestimated in 11 of 20 cases and overestimated in nine of 20 cases. Only two of 20 size estimates based on MR findings were within 10% of actual tumor volume. Overlap in MR tumor volumes was significant between lesions with and without capsular penetration at microscopy. Factors contributing to inaccuracies in measurements of tumor volume on MR images included the variable histologic make-up of the tumors. Our results show that, although knowledge of the size of a prostatic lesion is important in predicting the behavior of the tumor, MR imaging with a body coil is not reliable for accurate estimation of tumor volume.
Carcinoma↗
Traumatic rupture of the diaphragm without visceral herniation: CT diagnosis.
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Adult↗
Percutaneous biopsy of left adrenal masses: prevalence of pancreatitis after anterior approach.
Acute pancreatitis is an unusual but recognized complication of percutaneous aspiration biopsy of the pancreas. As the pancreatic tail is located anterior to the left adrenal gland, percutaneous biopsy of a left adrenal mass via the anterior approach may result in needle passage through the tail of the pancreas with subsequent potential development of pancreatitis. To evaluate this risk, we retrospectively reviewed 48 CT-directed percutaneous aspiration biopsies of left adrenal masses done between 1984 and 1989 at two institutions. Positioning of the patient, the course of the needle, the number of needle passes, and the size of the needle were analyzed. Thirty-three (69%) of 48 biopsies of a left adrenal mass were performed by using the anterior approach. The pancreas was traversed by one or more needles in 32 of 33 cases. Biopsies were performed with 20- to 22-gauge needles, and the number of needle passes varied widely. The medical records of the 33 patients in whom the anterior approach was used also were reviewed for complications. Acute pancreatitis, which required 11-13 days of hospitalization, developed in two patients (6%). None of the other 31 patients suffered a complication. We conclude that the pancreatic tail is routinely traversed by the biopsy needle when biopsy of a left adrenal mass is done via the anterior approach and that severe acute pancreatitis can occur as a result.
Acute Disease↗
Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer. Results of a multi-institutional cooperative trial.
BACKGROUND: In 1987, a cooperative study group consisting of five institutions was formed to determine the relative benefits of magnetic resonance imaging (MRI) and endorectal (transrectal) ultrasonography in evaluating patients with clinically localized prostate cancer (stage Ta or Tb). METHODS: Over a period of 15 months, 230 patients were entered into the study and evaluated with identical imaging techniques. We compared imaging results with information obtained at the time of surgery and on pathological analysis. RESULTS: MRI correctly staged 77 percent of cases of advanced disease and 57 percent of cases of localized disease; the corresponding figures for ultrasonography were 66 and 46 percent (P not significant). These figures did not vary significantly between readers; moreover, simultaneous interpretation of MRI and ultrasound scans did not improve accuracy. In terms of detecting and localizing lesions, MRI identified only 60 percent of all malignant tumors measuring more than 5 mm on pathological analysis and ultrasonography identified only 59 percent. CONCLUSIONS: The MRI and ultrasonography equipment that is currently available is not highly accurate in staging early prostate cancer, mainly because neither technique has the ability to identify microscopic spread of disease. Further evaluation with improved equipment may improve the accuracy of these techniques.
Adult↗
Proton-enhanced 13C imaging/spectroscopy by polarization transfer.
Carbon-13 magnetic resonance imaging/spectroscopy (CMRI/S) was performed using polarization transfer techniques where sensitivity of the carbon signal was enhanced by transferring the proton spin order to the carbon nuclei. The experimental feasibility of using polarization transfer techniques at 2.0 T was demonstrated with a phantom and an intact chicken egg. The potential clinical applications of CMRI/S with polarization transfer include the assessment of prostate cancer. Preliminary results using human prostate specimens are presented.
Animals↗
Hyperfunctioning and nonhyperfunctioning benign adrenal cortical lesions: characterization and comparison with MR imaging.
The authors evaluated the potential of magnetic resonance (MR) imaging at 0.35 T to permit differentiation of nine hyperfunctioning adrenal cortical lesions from 21 nonhyperfunctioning adrenal cortical adenomas. Both qualitative data (visual assessment) and quantitative data (signal intensity ratios, T1, and T2) were used for tissue characterization. With a 2,000/56-100 sequence (repetition time msec/echo time msec), the majority of lesions were visually isointense to liver. Of 34 quantitative measures, only lesion-liver and lesion-kidney intensity ratios at 2,000/150 showed statistically significant differences among nonhyperfunctioning adenomas, aldosterone-producing lesions, and corticosteroid-producing lesions; however, the authors question the significance of these differences because of the abundant noise associated with the 2,000/150 sequence. The results suggest that nonhyperfunctioning adrenal cortical adenomas cannot be distinguished from benign hyperfunctioning cortical lesions with use of MR imaging at 0.35 T.
Adenoma↗
Imaging of the adrenal glands.
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Addison Disease↗
Mediastinal lymph nodes: relaxation time/pathologic correlation and implications in staging of lung cancer with MR imaging.
The authors measured the T1 and T2 relaxation times of freshly excised human mediastinal lymph nodes to determine whether the times are clinically useful in distinguishing benign from malignant nodes. All measurements were performed at 20 MHz and 40 degrees C, within 45 minutes of lymph node excision. Mean T1 and T2 relaxation times of 99 benign nodes were 566 msec (standard deviation [SD], 117 msec) and 92 msec (SD, 29 msec), respectively. For the 16 malignant nodes, these times were 640 msec (SD, 138 msec) and 105 msec (SD, 26 msec), respectively (P less than .05 for difference in T1 times, P greater than .05 for difference in T2 times). Histograms showed considerable overlap in the relaxation times of benign and malignant nodes such that absolute measurement of these times will likely be of limited clinical value.
Humans↗
In vivo and in vitro MR imaging of renal tumors: histopathologic correlation and pulse sequence optimization.
Magnetic resonance (MR) imaging has given mixed results in the detection of renal masses. To identify the reasons for this and to determine the optimal pulse sequences for evaluating renal tumors, the authors imaged 12 primary renal tumors in vivo and 17 in vitro at 0.35 T. Histopathologic findings for each specimen were closely correlated with the MR images. Four of seven solid tumors imaged in vivo were isointense with surrounding normal renal parenchyma at all pulse sequences. The other three tumors were hyperintense in vivo at T2-weighted sequences. At heavily T2-weighted sequences eight solid tumors were hyperintense in vitro and four were hypointense. There was no correlation between signal intensity and specific tissue type or histologic pattern for solid tumors. The five cystic tumors were well seen both in vivo and in vitro on T2-weighted images. However, the signal intensity of the cyst fluid was an unreliable indicator of benignancy. SE MR imaging at 0.35 T has significant limitations in the detection of solid renal masses.
Carcinoma, Renal Cell↗
Distinction of hepatic cavernous hemangioma from hepatic metastases with MR imaging.
Twenty-four hepatic cavernous hemangiomas and 91 metastases from a variety of hypovascular and hypervascular primary neoplasms were prospectively studied with magnetic resonance (MR) imaging. In addition to qualitative analysis, quantitative analysis of signal intensity ratios of lesion to normal liver was performed with images obtained with 500/28-30 (repetition time msec/echo time msec) and 2,000/28-150 sequences. Quantitative data did not improve the ability to distinguish hemangiomas from metastases in our series compared with qualitative analysis. Hypovascular metastases, such as colon carcinoma, could be differentiated from hemangioma more frequently (97.5%) than hypervascular endocrine metastases, such as islet cell tumor, carcinoid, and pheochromocytoma (61%). These findings indicate that the utility of MR imaging in differentiating hemangiomas from metastases is dependent on the histologic type of the primary neoplasm.
Diagnosis, Differential↗
Radiologic evaluation of the subcarinal lymph nodes: a comparative study.
Subcarinal lymph nodes are commonly involved by metastases from cancers of both the right and left lungs. No data exist on the relative accuracy of radiologic methods for evaluating subcarinal nodes. We prospectively studied lung cancer patients who were surgical candidates with CT, MR imaging (0.35 T), esophagography, and anteroposterior tomography. Forty-six patients who subsequently underwent thoracotomy had excision or sampling of subcarinal nodes at mediastinoscopy. All 46 had CT scans, 27 had MR imaging, 23 had esophagography, and 21 had anteroposterior tomography. Receiver-operating characteristic curves were constructed for each technique, and the area under each curve was calculated. MR and CT were nearly identical in subcarinal evaluation, with areas under the receiver-operating characteristic curves of 0.90 and 0.86, respectively; both were superior to esophagography (0.55) and anteroposterior tomography (0.61). The size threshold at which subcarinal nodes were considered abnormally enlarged in this lung cancer population was 11 mm in short axis for CT, agreeing with the size threshold previously reported for a normal population. The size threshold for abnormal nodal enlargement with MR imaging was 18 mm in short axis. We conclude that CT and MR imaging are comparable in the detection of subcarinal lymphadenopathy and are superior to both tomography and esophagography. Different size thresholds for metastatic subcarinal nodes are needed for CT and MR imaging to be comparable in overall performance.
Carcinoma, Non-Small-Cell Lung↗
Pheochromocytoma and paraganglioma: comparison of MR imaging with CT and I-131 MIBG scintigraphy.
To ascertain the magnetic resonance (MR) imaging characteristics of pheochromocytomas and paragangliomas and to compare MR with computed tomography (CT) and iodine-131 metaiodobenzylguanidine (I-131 MIBG), 19 patients (18 with pheochromocytomas, one with a paraganglioma) were studied. The 18 patients with pheochromocytomas had had positive findings with I-131 MIBG scintigraphy. Abdominal pheochromocytomas were generally hypointense compared with normal liver on T1-weighted MR images and extremely hyperintense on T2-weighted MR images. MR imaging was preferable to CT in the evaluation of primary pheochromocytomas due to superior tissue characterization, particularly in the patient with hypertension and borderline catecholamine levels. For patients with recurrent or metastatic disease, the data suggest that I-131 MIBG scintigraphy is the examination of choice.
3-Iodobenzylguanidine↗
Central lung masses: prediction with CT of need for pneumonectomy versus lobectomy.
To assess the possible role of computed tomography (CT) in predicting the need for pneumonectomy rather than lobectomy, the authors retrospectively analyzed the CT scans of 26 patients requiring pneumonectomy (n = 21) or lobectomy (n = 5) for resection of central pulmonary abnormality. Twenty-three patients had primary lung cancer, two had metastatic carcinoma, and one had a massive granuloma. Scans were evaluated for tumor involvement of bronchi and pulmonary arteries and veins and for evidence of tumor extension across a fissure. Findings were compared with detailed surgical and pathologic data. Pneumonectomy was necessary most commonly because of proximal bronchial tumor invasion (13 patients). CT showed poor sensitivity (50%-54%) in depicting central bronchial and central pulmonary artery involvement as well as transfissural tumor extent. The results suggest that CT is not highly accurate in predicting the lobectomy/pneumonectomy decision in patients with central lung masses.
Carcinoma, Bronchogenic↗
MR imaging of hepatic focal nodular hyperplasia: characterization and distinction from primary malignant hepatic tumors.
Spin-echo MR imaging at 0.35 T was used to image hepatic focal nodular hyperplasia (FNH) and to attempt to distinguish it from primary malignant hepatic tumors. There were six FNH and 10 malignant tumors including seven hepatocellular carcinomas, two cholangiocarcinomas, and one hepatoblastoma. Our results show that FNH has a fairly consistent appearance, dissimilar from that of malignant primary hepatic tumors. Four of six FNH lesions were isointense (except for a central scar in three) and indistinguishable from normal hepatic parenchyma on all pulse sequences, whereas two of six were homogeneous but slightly hyperintense on T2-weighted sequences. Furthermore, a central hyperintense scar was seen in three of six lesions on T2-weighted sequences. In contrast, each of the malignant primary hepatic tumors was hyperintense on T2-weighted sequences and seven of 10 were hypointense on T1-weighted sequences; in nine of 10, heterogeneous areas of intensity were noted. In two fibrolamellar hepatocellular carcinomas a central scar was seen that was hypointense on all pulse sequences. By using quantitative data, the best characterization was obtained by using lesion/normal-liver intensity ratios from a T2-weighted sequence; all FNH had a ratio less than 1.33, while in nine of 10 primary malignant tumors it was greater than 1.41. We conclude that focal nodular hyperplasia may have a consistent appearance on spin-echo MR imaging and probably can be distinguished from primary malignant lesions in most instances.
Adenoma, Bile Duct↗