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Abstract
A wide array of pathologic conditions can arise within the porta hepatis, which encompasses the portal triad (the main portal vein, common hepatic artery, and common bile ducts), lymphatics, nerves, and connective tissue. Major vascular diseases of the portal triad include thrombosis, stenosis, and aneurysm. Portal vein thrombosis can complicate liver cirrhosis and hepatocellular carcinoma and has important therapeutic implications. Hepatic artery thrombosis and stenosis require immediate attention to reduce graft loss in liver transplant recipients. Congenital (eg, choledochal cyst) and acquired (benign and malignant) diseases of the biliary system can manifest as mass lesions in the porta hepatis. Lymphadenopathy can arise from neoplastic and nonneoplastic entities. Uncommon causes of mass lesions arise from nerves (eg, neurofibroma, neurofibrosarcoma) and connective tissue (sarcomas) and are rare. The hepatoduodenal ligament is a peritoneal reflection at the porta hepatis and is an important route for the spread of pancreatic and gastrointestinal cancers. Imaging plays a major role in diagnosis and enables appropriate management. Ultrasonography accurately demonstrates anatomic variations and pathologic conditions and is the initial modality of choice for detection of vascular and biliary lesions. Multidetector computed tomography and magnetic resonance imaging allow characterization and differentiation of various masses in the porta hepatis. Imaging-guided interventions, including embolization and stent placement, also play a key role in disease management.
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Affiliation(s)
- Sree Harsha Tirumani
- From the Department of Imaging, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Mass (S.H.T.); Department of Radiology, University of Texas Health Sciences Center at San Antonio, San Antonio, Tex (A.K.P.S.); Department of Radiology, University of Texas M.D. Anderson Cancer Center, Houston, Tex (R.V., S.R.P.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.O.M.)
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Kotha VK, Khandelwal A, Saboo SS, Shanbhogue AKP, Virmani V, Marginean EC, Menias CO. Radiologist's perspective for the Meckel's diverticulum and its complications. Br J Radiol 2014; 87:20130743. [PMID: 24611767 PMCID: PMC4075535 DOI: 10.1259/bjr.20130743] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The Meckel's diverticulum is the commonest congenital anomaly of the gastrointestinal tract, often presenting with complications such as gastrointestinal bleeding, intussusception, bowel obstruction and diverticulitis, which are often misdiagnosed. Imaging plays an important role in the early diagnosis and characterization of these conditions and is very helpful in decision making. The Meckel's diverticulum and its complications have myriad presentations and appearances on various imaging modalities. Thus, sound knowledge of the anatomy, embryology, clinical presentation, imaging characteristics and complications is crucial to the practice of abdominal imaging. We present a review of the literature and current radiological practices in the diagnosis and management of the Meckel's diverticulum and its various complications with special emphasis on the imaging of various complications, mimickers and pathological correlation.
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Affiliation(s)
- V K Kotha
- Department of Medical Imaging, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Fasih N, Gulati A, Ryan J, Ramanathan S, Prasad Shanbhogue AK, McInnes M, Macdonald DB, Fraser-Hill MA, Walsh C, Kielar AZ, Bhagat K. The Mysterious Organ. Spectrum of Focal Lesions within the Splenic Parenchyma: Cross-Sectional Imaging with Emphasis on Magnetic Resonance Imaging. Can Assoc Radiol J 2014; 65:19-28. [DOI: 10.1016/j.carj.2012.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 02/12/2012] [Accepted: 03/07/2012] [Indexed: 12/19/2022] Open
Abstract
Incidental splenic lesions are frequently encountered at imaging performed for unrelated causes. Splenic cysts, hemangiomas, and lymphomatous involvement are the most frequently encountered entities. Computed tomography and sonography are commonly used for initial evaluation with magnetic resonance imaging reserved as a useful problem-solving tool for characterizing atypical and uncommon lesions. The value of magnetic resonance imaging lies in classifying these lesions as either benign or malignant by virtue of their signal-intensity characteristics on T1- and T2-weighted imaging and optimal depiction of internal hemorrhage. Dynamic contrast-enhanced sequences may improve the evaluation of focal splenic lesions and allow characterization of cysts, smaller hemangiomas, and hamartomas. Any atypical or unexplained imaging feature related to an incidental splenic lesion requires additional evaluation and/or follow-up. Occasionally, biopsy or splenectomy may be required for definitive assessment given that some of tumours may demonstrate uncertain biologic behavior.
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Affiliation(s)
- Najla Fasih
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Ajay Gulati
- PGIMER (Post Graduate Institute of Medical Education and Research), Chandigarh, India
| | - John Ryan
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - S. Ramanathan
- PGIMER (Post Graduate Institute of Medical Education and Research), Chandigarh, India
| | | | - Matthew McInnes
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - David B. Macdonald
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | | | - Cynthia Walsh
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Ania Z. Kielar
- Department of Diagnostic Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
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Abstract
Recent advances in genetics and pathology have improved our understanding of diagnosis and staging of uterine sarcomas. The major types of uterine sarcomas include leiomyosarcoma, low-grade endometrial stromal sarcoma, undifferentiated endometrial sarcoma, adenosarcoma and carcinosarcoma. The distinctive biological behavior and poor overall survival of uterine sarcoma create challenges in the management of these tumors. We herein present a comprehensive review of taxonomy, epidemiology, pathology, imaging findings and natural history of a wide spectrum of uterine sarcomas.
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Affiliation(s)
- Sree Harsha Tirumani
- Department of Diagnostic Radiology, Montreal General Hospital, McGill University Health Centre, 1650 Ave Cedar, Montreal, QC, H3G 1A4, Canada
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Tirumani SH, Ojili V, Gunabushanam G, Shanbhogue AKP, Nagar A, Fasih N, Chintapalli KN. Imaging of tuberculosis of the abdominal viscera: beyond the intestines. J Clin Imaging Sci 2013; 3:17. [PMID: 23814689 PMCID: PMC3690674 DOI: 10.4103/2156-7514.111234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 03/09/2013] [Indexed: 02/06/2023] Open
Abstract
There is an increasing incidence of both intra- and extra-thoracic manifestations of tuberculosis, in part due to the AIDS epidemic. Isolated tubercular involvement of the solid abdominal viscera is relatively unusual. Cross-sectional imaging with ultrasound, multidetector computed tomography (CT), and magnetic resonance imaging (MRI) plays an important role in the diagnosis and post treatment follow-up of tuberculosis. Specific imaging features of tuberculosis are frequently related to caseous necrosis, which is the hallmark of this disease. However, depending on the type of solid organ involvement, tubercular lesions can mimic a variety of neoplastic and nonneoplastic conditions. Often, cross-sectional imaging alone is insufficient in reaching a conclusive diagnosis, and image-guided tissue sampling is needed. In this article, we review the pathology and cross-sectional imaging features of tubercular involvement of solid abdominopelvic organs with a special emphasis on appropriate differential diagnoses.
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Affiliation(s)
- Sree Harsha Tirumani
- Department of Imaging, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Abstract
Pancreatic endocrine neoplasms are rare pancreatic tumours that may occur sporadically or as part of inherited syndromes such as multiple endocrine neoplasia-1 syndrome, von Recklinghausen disease, von Hippel-Lindau syndrome and tuberous sclerosis complex. Recent advances in the genetics and pathology of hereditary syndromes have provided valuable insights into the pathophysiology and biology of sporadic pancreatic endocrine neoplasms. Evolving molecular data on the biology of these neoplasms have the potential for diagnostic, therapeutic and prognostic use.
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Affiliation(s)
- S Philips
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Prakash M, Vyas S, Shanbhogue AKP, Kang M, Dey P, Khandelwal N. Case report: Fat-containing liver metastases from retroperitoneal liposarcoma. Indian J Radiol Imaging 2011; 18:230-1. [PMID: 19774164 PMCID: PMC2747442 DOI: 10.4103/0971-3026.41834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Fasih N, Virmani V, Walsh C, McInnes M, MacDonald B, Kielar A, Prasad Shanbhogue AK. Double-contrast Magnetic Resonance Imaging in Preoperative Evaluation of Rectal Cancer: Use of Aqueous Jelly as Luminal Contrast. Can Assoc Radiol J 2011; 62:122-4. [DOI: 10.1016/j.carj.2010.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 03/01/2010] [Accepted: 03/01/2010] [Indexed: 11/29/2022] Open
Affiliation(s)
- Najla Fasih
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Vivek Virmani
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Cynthia Walsh
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Mattew McInnes
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Blair MacDonald
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Ania Kielar
- Department of Diagnostic Radiology, Ottawa Hospital, University of Ottawa, Ottawa, Canada
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Fasih N, Shanbhogue AKP, Thipphavong S, Surabhi VR, Papadatos D, Marginean C. Gamut of focal fatty lesions in the liver: imaging manifestations with emphasis on magnetic resonance imaging. Curr Probl Diagn Radiol 2010; 39:137-51. [PMID: 20510752 DOI: 10.1067/j.cpradiol.2009.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A wide variety of hepatic lesions contain fat within them in a proportion good enough to be demonstrable on imaging. With the biological behaviors quite different from each other, they form a clinico-radio-pathologic spectrum worth remembering. We present a review of common and uncommon focal hepatic lesions containing fat (micro- and macroscopic) within them and emphasize the role of imaging in their diagnosis.
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Affiliation(s)
- Najla Fasih
- Department of Diagnostic Imaging, The Ottawa Hospital, Ottawa, ON, Canada.
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Prasad Shanbhogue AK, Prasad SR, Jagirdar J, Takahashi N, Sandrasegaran K, Fazzio RT, Fidler JL. Comprehensive Update on Select Immune-Mediated Gastroenterocolitis Syndromes: Implications for Diagnosis and Management. Radiographics 2010; 30:1465-87. [DOI: 10.1148/rg.306105520] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Shanbhogue AKP, Shanbhogue DKP, Prasad SR, Surabhi VR, Fasih N, Menias CO. Clinical Syndromes Associated with Ovarian Neoplasms: A Comprehensive Review. Radiographics 2010; 30:903-19. [DOI: 10.1148/rg.304095745] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Shanbhogue AKP, Fasih N, Surabhi VR, Doherty GP, Shanbhogue DKP, Sethi SK. A clinical and radiologic review of uncommon types and causes of pancreatitis. Radiographics 2009; 29:1003-26. [PMID: 19605653 DOI: 10.1148/rg.294085748] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Acute pancreatitis is one of the most common conditions for which emergent imaging is indicated. Alcohol consumption and cholelithiasis are the most common causes of acute pancreatitis in adults, whereas the majority of cases in children are idiopathic or secondary to trauma. A wide variety of structural and biochemical abnormalities may also cause pancreatitis. Although in some cases it is difficult to identify the specific cause of the disease radiologically, certain uncommon types of acute or chronic pancreatitis may have unique imaging features that can help the radiologist make an accurate diagnosis. These unusual types include autoimmune pancreatitis, groove pancreatitis, tropical pancreatitis, hereditary pancreatitis, and pancreatitis in ectopic or heterotopic pancreatic tissue. Pancreatitis may occasionally be seen in association with cystic fibrosis or pancreas divisum, or secondary to worm infestation of the pancreaticobiliary tree (eg, by Ascaris lumbricoides). In addition, primary pancreatic and duodenal masses may occasionally manifest as acute or recurrent acute pancreatitis. Knowledge of the classic imaging findings of these entities allows prompt recognition of the relevant pathologic condition, thereby preventing misdiagnosis and subsequent inappropriate or delayed management.
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Shanbhogue AKP, Sandhu MS, Singh P, Ojili V, Khandelwal N, Sen R. Real time spatial compound ultrasound in the evaluation of meniscal injuries: a comparison study with conventional ultrasound and MRI. Knee 2009; 16:191-5. [PMID: 19059782 DOI: 10.1016/j.knee.2008.10.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 10/24/2008] [Accepted: 10/30/2008] [Indexed: 02/02/2023]
Abstract
The aim of this study was to compare real time spatial compound ultrasound (RTCS) and conventional ultrasound with MRI in the evaluation of meniscal injuries. Thirty five patients with clinical suspicion of meniscal injury underwent ultrasound of knee alternating between conventional and compound sonography followed by MRI of the knee on a 1.5 T MR system. The images were compared for their quality and ability to detect meniscal tear. Compound ultrasound significantly improved definition of soft tissue planes, reduced speckle and other noise, improved contrast resolution (p value<0.05) with improved confidence in detection of tears in doubtful cases. Interobserver variability was seen only for conventional ultrasound and the sensitivity, specificity, accuracy were 83.3%, 87.5% and 85.7% for the first observer and 80%, 87.5% and 84.3% for second observer. For compound ultrasound it was same for both the observers with sensitivity, specificity and accuracy being 90% each. Although compound ultrasound improves image quality in the evaluation of meniscal injuries the benefit with respect to detection of tears is only marginal. It is a valuable tool for screening the patients before MRI and we recommend that instead of conventional ultrasound, compound ultrasound should be routinely used for sonographic evaluation of meniscal injuries.
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Bapuraj JR, Ojili V, Khandelwal N, Shanbhogue AKP, Gupta SK. Basilar artery aneurysm treated with coil embolization via persistent primitive hypoglossal artery. ACTA ACUST UNITED AC 2008; 51 Suppl:B340-3. [PMID: 17991102 DOI: 10.1111/j.1440-1673.2007.01759.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A saccular aneurysm at the basilar artery bifurcation associated with a persistent primitive hypoglossal artery (PPHA) was successfully treated by endovascular occlusion with Guglielmi detachable coils. As both vertebral arteries were aplasitc, a microcatheter was advanced via PPHA. To the best of our knowledge, this is the first case report describing the treatment of a basilar top aneurysm through the PPHA.
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Affiliation(s)
- J R Bapuraj
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Bapuraj JR, Ojili V, Khandelwal N, Kaza RK, Shanbhogue AKP, Chabbra R. Case series: Saccular aneurysm of the azygos anterior cerebral artery: Report of 2 cases and review of literature. Indian J Radiol Imaging 2007. [DOI: 10.4103/0971-3026.34719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Jayapalli Rajiv Bapuraj
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vijayanadh Ojili
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ravi Kiran Kaza
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Rajesh Chabbra
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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