Quiz case of the month. Multiple hamartomas of the liver.
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Adult↗
Biomedical subjects
P R Ros
Publications and source records attributed to P R Ros.
High-density oral barium sulfate in abdominal MRI: efficacy and tolerance in a clinical setting.
Bowel and anatomic delineation were evaluated on abdominal magnetic resonance imaging scans in patients who received high-density barium sulfate orally (n = 16, BA+ group) or underwent magnetic resonance imaging without oral contrast (n = 14, BA- group). On T1-weighted images, the BA+ group had better delineation of gastric fundus, duodenum, jejunum, and ileum (p < .005) and pancreatic head (p < .02) than did the BA- group. On T2-weighted images, gastric fundus (p < .005), jejunum (p < .02), and ileum (p < .02) were better delineated in the BA+ group than in the BA- group. Analysis of patients' prior CT scans, used to control for selection bias, showed no differences in anatomic or bowel delineation between BA+ and BA- groups that would account for the differences seen in magnetic resonance imaging. One-fourth of patients could tolerate only 150 cc of contrast. High-density oral barium sulfate is recommended in patients undergoing magnetic resonance imaging for pancreatic or gastrointestinal tract disease, although patient intolerance may limit its widespread use in abdominal magnetic resonance imaging.
Abdomen↗
Xanthogranulomatous cholecystitis versus gallbladder carcinoma.
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Cholecystitis↗
Undifferentiated (embryonal) sarcoma of the liver: pathologic basis of imaging findings in 28 cases.
PURPOSE: To correlate the imaging and pathologic features of undifferentiated (embryonal) sarcoma (UES) and account for the discrepancy between the solid appearance at ultrasound (US) and the almost cystlike appearance at computed tomography (CT) and magnetic resonance (MR) imaging. MATERIALS AND METHODS: The clinical, pathologic, and imaging findings in 28 patients (age range, 3-49 years) with pathologically proved UES were retrospectively reviewed. All patients underwent at least one cross-sectional imaging study to include CT (27 patients), US (21 patients), and MR imaging (six patients). Tumor size, gross morphology (n = 27), histologic features, and proportion of solid and cystlike components were evaluated and correlated to the imaging findings. RESULTS: The mean transverse diameter of the tumors was 14 cm (range, 10-25 cm). At gross examination, the tumors were predominantly solid (mean, 83% of tumor volume), and pathologic and US findings were concordant. Conversely, CT scans showed low attenuation (approximately that of water) in 88% of the tumor volume and T2-weighted MR images showed high signal intensity (approximately equal to that of cerebrospinal fluid) in 89% of the tumor volume. CONCLUSION: UES shows a misleading cystlike appearance at CT and MR imaging compared with US and pathologic findings. In a child or young adult with a liver tumor, this finding is useful in making a prospective diagnosis and avoiding misguided attempts at drainage.
Adolescent↗
MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults.
OBJECTIVE: Our objective was to determine the accuracy, precision, and reliability of MR imaging as a technique for measurement of the femoral antetorsional angle. SUBJECTS AND METHODS: We used MR imaging to measure anteversion of the femoral neck in 44 patients: 19 children (range, 3-17 years old; mean, 11 years old) and 25 adults (range, 18-83 years old; mean, 29 years old). RESULTS: We found a high correlation between MR imaging and CT measurements (r = 77). On CT, the mean angle for children was 34 degrees and for adults it was 22.2 degrees. On MR imaging, the mean angle for children was 23.22 degrees and for adults it was 15.71 degrees. The mean anteversion angles obtained by CT exceeded those obtained by MR imaging. Mean interobserver and intraobserver agreements were high for MR imaging (r = .97 and r = .97, respectively) and for CT (r = .99 and r = .96, respectively). CONCLUSION: Compared with CT as the gold standard, MR imaging measurement of femoral anteversion allows precise anatomic measurements and produces reliable, reproducible results. MR imaging is recommended for preoperative planning in pediatric patients with femoral rotation osteotomies.
Adult↗
Retroperitoneal MR imaging.
Although CT is usually the first imaging study used to evaluate for retroperitoneal disease, MR imaging is increasingly chosen to further characterize lesions. In addition, MR imaging is the ideal modality for evaluating the extent of retroperitoneal tumors as well as their relationship to adjacent structures and organs. The multiplanar capabilities and soft-tissue contrast resolution are significant advantages of MR over CT. This article reviews the retroperitoneal anatomy and our current imaging techniques. Disease processes that commonly affect the retroperitoneum are discussed along with their MR imaging characteristics.
Diagnosis, Differential↗
MR imaging of inflammatory disease of the liver.
Although MR imaging has achieved a clear role in the assessment of focal benign and malignant hepatic lesions, its role in the evaluation of inflammatory processes in the liver is less well defined and studied. Many inflammatory diseases in the liver have no characteristic or specific imaging findings with MR imaging. Familiarization with these entities and their respective imaging findings is important, however, to aid in their identification and distinction from the more commonly studied neoplastic disease.
Amyloidosis↗
MR imaging of the liver--a practical approach.
Clinical information must be combined with radiologic features to evaluate focal or diffuse liver disease effectively, and MR examinations need to be tailored appropriately. If there are characteristic radiologic findings, in many cases a correct diagnosis is possible; however, radiologic methods may provide an exact description of disease extent, vascular supply, infiltration, metastases, and tumor changes like necrosis or hemorrhage, without providing a definitive diagnosis. In these situations interventional radiologic techniques (such as percutaneous biopsy) have a potential role in diagnosis.
Diagnostic Imaging↗
Superparamagnetic iron oxide (SPIO) as an oral contrast agent in gastrointestinal (GI) magnetic resonance imaging (MRI): comparison with state-of-the-art computed tomography (CT).
This study was conducted to compare the sensitivity and specificity of abdominal magnetic resonance imaging using oral superparamagnetic iron oxide with oral contrast-enhanced computed tomography in the detection of GI pathology. Overall sensitivity was calculated to be 83% for OECT compared to 67% by SPIO MRI. Specificity for OECT was 68% compared to 89% for SPIO MRI. The results from imaging with superparamagnetic iron oxide and imaging with oral contrast-enhanced computed tomography were in agreement in 14 subjects who had normal gastrointestinal tracts. In the remaining 16 patients, eight pathologic entities were detected by both modalities whereas 15 abnormalities were seen by only one modality. Superparamagnetic iron oxide magnetic resonance imaging was helpful in discriminating normal bowel from solid lesions and in detecting subtle gastrointestinal tract mass effect. In 30 consecutively studied patients suspected of having GI pathology, OECT was more sensitive than SPIO MRI in detecting abdominal pathology. Conversely, SPIO MRI was more specific than OECT.
Administration, Oral↗
Focal nodular hyperplasia of the liver: radiologic-pathologic correlation.
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.
Adult↗
Solid and papillary epithelial neoplasm of the pancreas: imaging-pathologic correlation on 56 cases.
PURPOSE: To evaluate the clinical, pathologic, and imaging findings of solid and papillary epithelial neoplasm (SPEN) of the pancreas and to correlate imaging and gross pathologic features. MATERIALS AND METHODS: A retrospective review was performed in 56 patients (53 female and three male patients aged 10-74 years [mean age at diagnosis, 25 years]) with pathologically proven SPEN of the pancreas. All patients underwent computed tomography (n = 49), ultrasonography (n = 31), or magnetic resonance (MR) imaging (n = 9). Tumor size, location, and imaging features were evaluated and correlated with gross pathologic and histologic features. RESULTS: Mean transverse diameter of these tumors was 9.0 cm (range, 2.5-17.0 cm). They were localized to the tail (n = 30), head (n = 18), and body (n = 8) of the pancreas. All tumors contained some degree of internal hemorrhage or cystic degeneration, and all were well encapsulated. Areas of hemorrhagic degeneration ranged from solid friable tumor to gelatinous or cystic cavities and therefore demonstrated variable imaging features. Calcification was noted in 16 patients. Fluid-debris levels were noted in 10 patients. CONCLUSION: Imaging studies of SPEN of the pancreas consistently demonstrate variable degrees of hemorrhagic degeneration. Calcification is common. Characteristic fluid-debris levels and signal intensities seen with MR imaging indicate blood products. In the appropriate clinical setting, these findings are useful in making a prospective diagnosis.
Adenocarcinoma↗
Ring enhancement in ultrasmall superparamagnetic iron oxide MR imaging: a potential new sign for characterization of liver lesions.
OBJECTIVE: We performed this study to evaluate the incidence and significance of ring enhancement after i.v. administration of an ultrasmall superparamagnetic iron oxide (USPIO) particle (Code 7227), a reticuloendothelial contrast agent with potential use as a blood-pool agent, for characterizing focal hepatic lesions. SUBJECTS AND METHODS: Conventional T1-weighed imaging, fat-suppressed T1-weighted imaging, conventional T2-weighted imaging, and fast T2-weighted imaging of the liver were obtained in 27 patients with 43 liver lesions before and after i.v. administration of a USPIO preparation. All lesions were larger than 1 cm; 29 were malignant and 14 were benign. Diagnosis was confirmed in all cases, either pathologically (19 patients) or by follow-up examination (eight patients). Two readers independently evaluated each pulse sequence for the presence of ring enhancement of hepatic lesions. RESULTS: Ring enhancement was noted only on T1-weighted images, with no ring enhancement evident on T2-weighted images. Twenty of 43 (47%) lesions showed ring enhancement, including 18 of 29 (62%) malignant lesions and two of 14 (14%) benign lesions (p < .011); Wilcoxon signed rank test). Fat-suppressed T1-weighted imaging showed ring enhancement better than or equal to conventional T1-weighted imaging in all cases, with ring enhancement of 15 of 18 (83%) malignant lesions and two of two benign lesions better demonstrated on fat-suppressed T1-weighted imaging sequences (p < or = .025). CONCLUSION: Ring enhancement after i.v. administration of Code 7227 is a frequent finding seen more often with malignant than benign lesions, potentially identifying a new MR imaging feature for the characterization of liver lesions. The identification of ring enhancement on T1-weighted images attests to the significant blood-pool effects of USPIO particles.
Contrast Media↗
The leaking esophagus: CT patterns of esophageal rupture, perforation, and fistulization.
Esophageal perforation can be a catastrophic event for a patient regardless of the etiology of the perforation. Contrast esophagrams can typically diagnose an esophageal perforation if the clinical symptoms or history suggest the diagnosis. Often, however, the clinical features are atypical and a CT scan is performed early in the patient's workup. It is, therefore, essential to recognize the CT features seen in esophageal perforation. The various etiologies and CT findings of esophageal perforation are reviewed in this article. The CT abnormalities include extraluminal air, periesophageal fluid, esophageal thickening, and extraluminal contrast. These CT findings may be the first clue to the correct diagnosis of esophageal perforation.
Esophageal Fistula↗
Iliopsoas compartment: normal anatomy and pathologic processes.
The iliopsoas compartment is an extraperitoneal space that contains the greater psoas, smaller psoas, and iliac muscles. Many pathologic processes may involve the iliopsoas compartment, including inflammatory, hemorrhagic, and neoplastic conditions. Psoas muscle infection is usually due to direct extension from contiguous structures. With the decreasing incidence of tuberculosis, the majority of psoas abscesses now encountered have a pyogenic origin. Hemorrhage into the psoas muscle can be spontaneous or secondary to various conditions. Neoplastic involvement of the psoas muscle is usually due to contiguous spread and is rarely primary. With the refinement of imaging modalities, there has been increased recognition of diseases that involve the iliopsoas compartment. Although these conditions may look similar radiologically, they can be correctly diagnosed by combining the radiologic findings with the clinical history. Biopsy is effective in diagnosis of such conditions; aspiration and drainage are effective in both diagnosis and therapy.
Abscess↗
Hepatic MR imaging with ferumoxides: a multicenter clinical trial of the safety and efficacy in the detection of focal hepatic lesions.
PURPOSE: To assess the safety and diagnostic efficacy of intravenous ferumoxides, a superparamagnetic iron oxide, for depiction of focal hepatic lesions on magnetic resonance (MR) images. MATERIALS AND METHODS: This open-label study included 208 patients with known or suspected focal hepatic lesions. MR images were obtained before and 45 minutes to 4 hours after intravenous infusion of ferumoxides (10 mumol/kg). The effect of ferumoxides on signal intensity of the liver was assessed with quantitative analysis. Safety was evaluated with patient monitoring and laboratory measurements. RESULTS: Mean lesion-to-liver contrast-to-noise ratio on T2-weighted images was 9.1 on unenhanced images and 12.7 on enhanced images. Signal intensity of normal liver on enhanced images decreased to 37% of that on unenhanced images. In blinded image evaluations, additional lesions were identified on 27% of enhanced images. No serious adverse events occurred. CONCLUSION: Ferumoxides is a safe and efficacious contrast agent for the detection of focal liver lesions on T2-weighted images.
Contrast Media↗
Biliary cystadenoma and cystadenocarcinoma: clinical-imaging-pathologic correlations with emphasis on the importance of ovarian stroma.
PURPOSE: To evaluate cross-sectional imaging in the distinction of biliary cystadenoma from cystadenocarcinoma and in the determination of the presence of ovarian stroma. MATERIALS AND METHODS: In 34 patients, radiologic studies and specimen photographs and descriptions were reviewed retrospectively without knowledge of the patient group. Histologic features were reviewed without knowledge of the radiologic findings and analyzed for epithelial and stromal components. Correlation was made between the radiologic findings, gross morphologic features, internal fluid characteristics, and histologic features. RESULTS: The 34 patients had 27 biliary cystadenomas, 22 with ovarian stroma, and seven cystadenocarcinomas, four with ovarian stroma. Gross morphologic and imaging features suggestive of biliary cystadenocarcinoma included internal septation and nodularity. Septation without nodularity was seen only in biliary cystadenoma. Nonbilious fluid was the only feature associated with the presence of ovarian stroma but was not distinguishable on images. CONCLUSION: Imaging studies accurately reflect the nodularity and septation seen grossly to distinguish biliary cystadenoma and cystadenocarcinoma but do not allow distinction of the presence or absence of ovarian stroma.
Adenoma, Bile Duct↗
Fluoxetine hydrochloride (Prozac)-induced pulmonary disease.
We describe a patient who developed progressive dyspnea, lung infiltrates, and restrictive lung disease in association with the antidepressant fluoxetine hydrochloride (Prozac). The pathologic findings were consistent with hypersensitivity pneumonitis. An associated pulmonary phospholipidosis was also noted.
Alveolitis, Extrinsic Allergic↗