Detection of extrapulmonary tuberculosis with gallium-67 scan and computed tomography

We evaluated 23 patients with extrapulmonary tuberculosis (TB) with 67Ga imaging to assess its usefulness in the diagnosis of this condition. We performed computed tomography (CT) in 17 patients to assess CT features of extrapulmonary TB in comparison with findings from 67Ga scans. Nineteen of 23 patients (83%) had positive findings on 67Ga scans. One of five patients with tuberculous mediastinal lymphadenopathy, two patients with cervical lymphadenitis and a patient with renal TB had negative 67Ga scans. It was observed that the detection of previously unrecognized primary foci of TB, without concomitant pulmonary TB, was possible using 67Ga imaging in five patients (22%). The 67Ga scan was relatively sensitive for the localization of extrapulmonary TB. It is suggested that the 67Ga scan could serve as a screening method, when followed by CT and ultrasonography, for the initial detection of occult tuberculous lesions, especially in patients with prolonged fever.

Calcified gastric carcinoma: CT findings

The computed tomographic (CT) findings of 13 cases of calcified gastric carcinoma were analyzed retrospectively. Eleven cases were confirmed as a mucinous adenocarcinoma by surgery (three cases), or endoscopic biopsy (eight cases). Two cases were diagnosed as adenocarcinoma by endoscopic biopsy. In all cases the calcifications were of the punctate or miliary shape and the size varied from 1-3 mm in diameter. The calcifications were located in the thickened gastric wall in all cases, and were seen in metastatic lesions such as lymph nodes and the liver in two cases. In 10 cases, some tumor portions showed lower attenuation number than that of the muscle on CT scans, and corresponded to mucin pool in tumor portions histologically. Twelve cases were in inoperable advanced stage.

Retroperitoneal neurilemoma: CT and MR findings

OBJECTIVE

Our objective was to characterize the CT and MR imaging findings of retroperitoneal neurilemomas.

MATERIALS AND METHODS

We reviewed the CT and MR imaging findings in six women with retroperitoneal neurilemomas.

RESULTS

Retroperitoneal neurilemomas were round, 5-13 cm in diameter, and located in the presacral pelvic retroperitoneum in four patients and adjacent to the kidney in two patients. CT findings of the tumors were well-demarcated round masses showing prominent cystic changes and oriented in a somewhat radial fashion. Medium and heavily T2-weighted MR images showed high-intensity necrotic areas and nonnecrotic areas of various signal intensity.

CONCLUSION

CT findings of a round mass with prominent cystic degeneration, along with certain MR imaging characteristics, may be helpful in the preoperative diagnosis of retroperitoneal neurilemomas.

Direct invasion of urinary bladder from sigmoid colon cancer: CT findings

Radiological findings in three cases of sigmoid colon carcinoma invading the urinary bladder are reported. An irregular spiculated margin or nodular indentations in region of bladder dome were seen on intravenous urography. A soft tissue mass contiguous with an irregularly thickened urinary bladder wall and a circumferentially thickened sigmoid colon wall were demonstrated on CT and sonography and led to the correct diagnosis.

Therapeutic effect of transcatheter oily chemoembolization therapy for encapsulated nodular hepatocellular carcinoma: CT and pathologic findings

An emulsion of iodized oil and doxorubicin hydrochloride was intraarterially injected in 27 patients with encapsulated single nodular hepatocellular carcinoma (HCC). Computed tomography (CT) was performed 1-3 weeks after injection, and the lesions were resected 1-4 weeks thereafter. The percentages of tumor necrosis were evaluated in cut surfaces of resected specimens and were compared with the findings at iodized-oil CT. Six tumors with complete intratumor retention of iodized oil had 98% necrosis, and 21 tumors with incomplete retention had 64% necrosis. Two tumors with complete retention of iodized oil in the surrounding liver had 100% necrosis, while 16 tumors with partial retention and nine tumors without retention of iodized oil in surrounding liver had 74% and 62% necrosis, respectively. Complete retention of iodized oil in the tumor and surrounding liver demonstrated the best therapeutic effects. Evaluation of the pattern and distribution of iodized oil in the tumor and surrounding liver with iodized-oil CT is useful in the assessment of the therapeutic effects of transcatheter arterial embolization in encapsulated nodular HCCs.

Duplex Doppler US in patients with medical renal disease: resistive index vs serum creatinine level

The relationship between resistive index of arterial Doppler waveform of the native kidney and serum creatinine level has been studied using duplex Doppler sonography in 40 patients with medical renal disease and 28 normal controls. The resistive index of the normal control group and the medical renal disease group was 0.627 +/- 0.042 and 0.823 +/- 0.237, respectively, with statistically significant difference. In the group with medical renal disease, there was a statistically significant correlation between the resistive index and the level of serum creatinine. The study suggests that duplex Doppler sonography may be helpful in evaluation of renal functional status in patients with medical renal disease.

Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter: review of 96 patients

Intrahepatic biliary stone disease is prevalent in East Asia and there is a high frequency of retained intrahepatic stones after surgical treatment. Percutaneous removal of retained intrahepatic stones with a pre-shaped angulated catheter and a Dormier basket was attempted in a group of 96 patients who had a T-tube. Seventy-six had multiple intrahepatic stones, confined to one hepatic lobe in 52 patients. Stones were exclusively intrahepatic in 68 cases. Biliary strictures were present in 92 cases (95.8%). A combination of techniques was used including pre-shaped angulated catheters, irrigation suction, balloon dilatation of strictures, crushing of large stones and extracorporeal shockwave lithotripsy. Retained stones were completely removed in 48 cases, and incompletely removed in 22 cases. The overall success rate was 72.9%. There were only minor complications. No mortality or significant morbidity requiring hospitalization occurred. Angular deformity, stricture of bile ducts and impacted stones were the most frequent factors responsible for failure or incomplete removal of retained stones. Fluoroscopically guided percutaneous interventional procedures with a pre-shaped angulated catheter are useful complementary procedures to surgery for patients with intrahepatic stones. The major benefits of an individually angulated catheter are safety and easy access to small peripheral bile ducts.

Intraoperative sonography of hepatocellular carcinoma: detection of lesions and validity in surgical resection

Eighty-six hepatocellular carcinomas (HCCs) in 67 patients were examined by intraoperative sonography. Sensitivity for detecting tumors with intraoperative sonography was compared with sonography, computed tomography (CT), hepatic angiography, and CT after intraarterial injection of iodized poppy-seed oil (Lipiodol-CT). The overall sensitivities were 76% with sonography, 86% with CT, 89% with angiography, 96% with Lipiodol-CT, and 98% with intraoperative sonography. The differences in sensitivity between intraoperative sonography and sonography (p less than 0.01), CT (p less than 0.01), and angiography (p less than 0.05) were significant. In 35 lesions smaller than 2 cm, the sensitivities of Lipiodol-CT and intraoperative sonography were high (91 and 94%, respectively). In operating field, tumors were invisible in 36 (42%) and nonpalpable in 31 of 86 cases (36%). In 35 tumors smaller than 2 cm, invisible tumors were 66% and nonpalpable tumors were 63%. However, 84 of 86 cases (98%) could be localized with intraoperative sonography. These results suggest that intraoperative sonography is the final diagnostic imaging procedure before surgical resection of tumors and in cases of invisible and nonpalpable tumors in the operating field, this procedure is mandatory to improve surgical results.

MR findings in liver adenomatosis

Liver adenomatosis is a rare entity in which multiple hepatic adenomas (more than 10) occur in patients with no prior history of oral contraceptives or androgenic steroid use. This report describes findings of this entity on magnetic resonance imaging (MRI) and discusses the differential diagnosis of this disease.

Membranous obstruction of the inferior vena cava with Budd-Chiari syndrome: MR imaging findings

Membranous obstruction of the inferior vena cava (IVC) is a curable cause of a primary type of Budd-Chiari syndrome. Magnetic resonance (MR) imaging and vena cavography were performed on nine patients with membranous obstruction of the IVC. The MR findings were retrospectively analyzed and compared with computed tomographic findings in seven patients. The morphologic features of membranous obstruction of the IVC on spin-echo MR images were a curvilinear soft-tissue membrane (five cases) or an obliterated lumen of a hepatic segment of the IVC (four cases) in transverse or sagittal views. The lumen below the obstruction revealed flow-related signal (seven cases), intraluminal thrombus (one case), and thrombotic occlusion (one case). The hepatic veins were narrow and disoriented without connection to the hepatic segment of the IVC just below the diaphragm. On T2-weighted images, inhomogeneity with high signal intensity was shown more prominently in the hepatic parenchyma in Simson type II or III membranous obstruction. Other findings were hepatosplenomegaly, enlarged caudate lobe, cirrhotic liver, associated hepatoma, and presence of various collaterals.

Retained intrahepatic stones: treatment with piezoelectric lithotripsy combined with stone extraction

Extracorporeal shock wave lithotripsy (ESWL) was performed in 11 patients with oriental cholangiohepatitis and intrahepatic stones associated with segmented strictures of intrahepatic ducts. All patients had previously undergone biliary surgery and basket extraction via a T-tube tract at the time of lithotripsy. The indication for ESWL was failure of, or anticipated difficulty with, basket extraction of the stones via a T-tube tract. A piezoelectric lithotriptor was used in all procedures. The average total number of shock waves administered was 29,756 (range, 10,000-61,395). The average number of treatment sessions was 3.1 (range, 1-6); the number of shock waves used in a single session ranged from 10,000 to 15,000 with a frequency of five shots per second and 30%-50% power. In six patients, the stones were successfully fragmented and completely removed; in three of the others of the stones were fragmented and removed. The overall success rate, including complete (54%) and incomplete (27%) success, was 82%. Difficulty in targeting stones, and severe strictures and deformities of intrahepatic ducts, were the factors responsible for failure. No significant complications were observed.

Diffuse intestinal arteriovenous malformation in a child

Mesenteric arteriovenous fistulas or arteriovenous malformations of the intestine are relatively rare, especially in the form of diffuse disease. We describe a case of diffuse intestinal arteriovenous malformation associated with congestive heart failure and cutaneous hemangioma.

Mosaic pattern of encapsulated hepatocellular carcinoma: correlation of magnetic resonance imaging and pathology

Internal architecture of an encapsulated hepatocellular carcinoma (HCC) was studied with magnetic resonance imaging and histologic correlation. The capsule of HCC showed low intensity relative to liver on both T1- and T2-weighted images. The T1-weighted images were superior to the T2-weighted images in delineating the capsule of HCC. The tumor showed a mosaic pattern, which was a configuration composed of multiple compartments of different intensities, reflecting viable tumor nodules and a necrotic portion. Viable tumor nodules, composed of trabeculae of polygonal cells resembling the normal liver cell with well-formed sinusoids, showed low intensity relative to liver on T1-weighted images and high intensity on T2-weighted images. The necrotic portion, composed of coagulation of amorphous, thick eosinophilic material without hemorrhage or inflammatory reaction, showed low intensity relative to liver on both T1- and T2-weighted images. The T2-weighted images were superior to the T1-weighted images in demonstrating the mosaic pattern of HCC.

Uterine metastasis from stomach cancer: radiological findings

The uterus is an unusual site for metastasis from an extrapelvic neoplasm. We report a case of uterine metastasis with extensive calcification. Plain radiography, ultrasonography and CT showed diffuse calcification within the uterine wall and T2-weighted MR images showed abnormally high signal intensity of the entire myometrium.

CT manifestations of peritoneal leiomyosarcomatosis

Peritoneal leiomyosarcomatosis causes multiple discrete tumor nodules in the peritoneum, mesentery, and omentum with or without evidence of a primary site. The CT and pathologic findings in seven patients with this disease were reviewed. All seven patients had CT evidence of multiple, discrete peritoneal masses, and five patients showed a central low-attenuation area. CT grade of malignancy in peritoneal tumors was categorized as low (four patients) and high (three patients) on the basis of the degree of central necrosis of the tumors. The CT results correlated with the histopathologic grade of malignancy, although all tumors were grade 2 or higher histopathologically. Ascites and lymphadenopathy were not present in any of the patients. Liver metastases were identified in five patients with central necrosis of the metastases evident in four. The presence of liver metastases and the degree of central necrosis in the liver metastases did not correlate with the size or histologic grade of the primary tumor. Although uncommon, peritoneal leiomyosarcomatosis should be considered when CT shows multiple, discrete peritoneal masses with central necrosis and liver metastases in the absence of ascites and lymphadenopathy.

Small hepatocellular carcinoma versus small cavernous hemangioma: differentiation with MR imaging at 2.0 T

Eighteen small hepatocellular carcinomas (HCCs) and 38 hemangiomas less than 5 cm in diameter were studied with magnetic resonance (MR) imaging at 2.0 T. Relatively T1-weighted spin-echo (SE) 500/30 (repetition time msec/echo time msec) images and proton-density 2,000/30 images showed nonspecific contrast-to-noise ratios (C/Ns) and intensity ratios in HCCs and hemangiomas. On T2-weighted 2,000/60, 90, 120, 150, and 180 images, hemangiomas had significantly greater C/N and intensity ratios than HCCs (P less than .05). The SE 2,000/180 sequence showed the greatest difference in tumor-liver intensity ratios between small HCCs and hemangiomas, followed by the SE 2,000/150 sequence, but there was no statistically significant difference between the two pulse sequences. However, the SE 2,000/180 sequence is limited in the number of sections obtainable for routine clinical liver imaging. The findings indicate that the SE 2,000/60 sequence is optimal for the detection of small HCCs and hemangiomas and that the SE 2,000/150 sequence is optimal for distinguishing small HCCs from hemangiomas at 2.0 T.

Papillary cystic tumor of the liver. A case report with ultrastructural observation

A case of primary tumor of the liver with pathologic features strikingly similar to those of the papillary cystic tumor of the pancreas in a 41-year-old woman is presented. Two large, well-demarcated, solid and cystic tumors with extensive hemorrhage and necrosis were located in the right and left lobes, measuring 30 x 27 x 7.5 cm and 5.5 x 4.0 x 2.5 cm, respectively. Microscopically, both tumor masses showed two basic patterns of cellular arrangement. One was a papillary pattern with fairly prominent fibrovascular stalks covered with one to three cell layers of tall to cuboidal cells. The other pattern was that of solid growth with microcystic degeneration. Ultrastructurally, the tumor cells were polyhedral and their oval shaped nuclei were occasionally indented. The cytoplasmic organelles varied in amount, and immature cell junctions and intercellular spaces were rarely present. A few cells contained zymogen-like secretory granules and annulate lamellae. The pancreas was free of tumor. To our knowledge, this tumor is a unique clinicopathologic entity of hepatic origin, and its similarity to the pancreatic papillary cystic tumor in clinical, gross, microscopic, and ultrastructural features together with their closely related organogenesis, suggests that this tumor derives from pluripotential cells transdifferentiating toward the pancreatic acinar cells and ductular cells, with the latter being indistinguishable from intrahepatic small bile ductular epithelial cells.

Papillary cystic tumor of the liver. A case report with ultrastructural observation

A case of primary tumor of the liver with pathologic features strikingly similar to those of the papillary cystic tumor of the pancreas in a 41-year-old woman is presented. Two large, well-demarcated, solid and cystic tumors with extensive hemorrhage and necrosis were located in the right and left lobes, measuring 30 x 27 x 7.5 cm and 5.5 x 4.0 x 2.5 cm, respectively. Microscopically, both tumor masses showed two basic patterns of cellular arrangement. One was a papillary pattern with fairly prominent fibrovascular stalks covered with one to three cell layers of tall to cuboidal cells. The other pattern was that of solid growth with microcystic degeneration. Ultrastructurally, the tumor cells were polyhedral and their oval shaped nuclei were occasionally indented. The cytoplasmic organelles varied in amount, and immature cell junctions and intercellular spaces were rarely present. A few cells contained zymogen-like secretory granules and annulate lamellae. The pancreas was free of tumor. To our knowledge, this tumor is a unique clinicopathologic entity of hepatic origin, and its similarity to the pancreatic papillary cystic tumor in clinical, gross, microscopic, and ultrastructural features together with their closely related organogenesis, suggests that this tumor derives from pluripotential cells transdifferentiating toward the pancreatic acinar cells and ductular cells, with the latter being indistinguishable from intrahepatic small bile ductular epithelial cells.

Hemorrhagic fever with renal syndrome: MR imaging of the kidney

Magnetic resonance (MR) imaging of the kidneys was performed in 14 patients with a severe form of hemorrhagic fever with renal syndrome (HFRS), a major public health problem in Far Eastern Asia. To the authors' knowledge, this is the first report of renal assessment with MR imaging in HFRS. Three MR imaging studies were done while patients were in the oliguric phase, 19 were done during the diuretic phase, and three were done during the convalescent phase. The authors differentiated the cortex and the medulla in all 21 T1-weighted examinations and all 25 T2-weighted examinations. Seven T1-weighted examinations (33%) and 20 T2-weighted examinations (80%) showed low signal intensity along the outer portion of the medulla, which thus enabled differentiation from the inner medulla. Low signal intensity along the medulla (especially the outer medulla) on T2-weighted images, possibly representing medullary hemorrhage, is fairly constant and characteristic on MR images of the kidneys in patients with HFRS.

Jejunal leiomyosarcoma detected by Tc-99m sulfur colloid gastrointestinal bleeding scan

Jejunal leiomyosarcoma was initially detected in a patient by a gastrointestinal bleeding scan with Tc-99m sulfur colloid (SC). The scan showed increased blood flow and delayed persistent accumulation of radiotracer in the tumor. The Tc-99m SC gastrointestinal bleeding scan provided useful information to help determine the differential diagnosis of gastrointestinal tumor with bleeding.

Uterine cervical carcinoma: comparison of CT and MR findings

Thirty patients with uterine cervical carcinoma underwent computed tomography (CT), magnetic resonance (MR) imaging, and surgical exploration. MR imaging was superior to CT in visualization of the tumor. MR imaging had an accuracy of 77% in the assessment of thickness of cervical stromal invasion. The accuracy rates of these modalities for parametrial evaluation were 78% for clinical evaluation, 70% for CT, and 92% for MR imaging. The overall accuracy rates for tumor staging were 70% for clinical evaluation, 63% for CT, and 83% for MR imaging. MR imaging is superior to clinical evaluation and CT in parametrial evaluation and the staging of uterine cervical carcinoma.

Caroli disease: central dot sign in CT

Two adults with communicating cavernous ectasia of the biliary tract (Caroli disease) are described. Both patients had the pure form of the disease, characterized by saccular dilatation of intrahepatic bile ducts, multiple intrahepatic calculi, absence of portal hypertension, and associated cystic renal disease. Computed tomographic (CT) scans of the liver showed tiny dots with strong contrast enhancement within dilated intrahepatic bile ducts (the central dot sign). These intraluminal dots on CT scans corresponded to intraluminal portal veins on sonograms, findings indicating portal radicles surrounded by dilated intrahepatic bile ducts.