Stromal fibrosis: imaging features with diagnostic contribution of diffusion-weighted MRI

OBJECTIVE

To describe magnetic resonance imaging (MRI) and ultrasonography findings of breast stromal fibrosis (SF) and compare apparent diffusion coefficient (ADC) stromal fibrosis values with breast cancer and normal parenchyma.

METHODS

45 patients (ages 22‒74) with histopathologically proven SF who underwent MRI were included in this study. Their MRI and ultrasonography features were examined and categorized. The mean ADC values for SF, contralateral normal parenchyma, and breast malignancy of the control group values were calculated and compared among each other.

RESULTS

The vast majority of SF on sonography showed features suggestive of malignancy: (1) irregular in shape 25/45 (55%); (2) indistinct in margin 27/45 (60%); and (3) hypoechoic 39/45 (87%) with posterior acoustic shadowing 11/45 (24%). An SF MRI showed a mass in 12/45 (26%) and non-mass enhancement in 33/45 (74%), mostly with irregular (8/12; 67%) shape. Non-mass lesions showed heterogeneous (12/33), clumped (9/33), and homogenous (9/33) enhancement. The initial SF contrast uptake rate varied between slow (57%), rapid (22%), and medium (21%). Delayed SF enhancement may be persistent (66%) or plateau (34%). Small cysts were located around/near 21 (47%) of lesions. Ductal ectasia was found in 14 (31%) of all patients. Mean ADCs of parenchyma, SF, and malignancy were 1.32 ± 0.32, 1.23 ± 0.25, and 0.99 ± 0.24 × 10^-3 mm² sec^-1, respectively.

CONCLUSION

SF often mimics breast carcinoma on imaging and leads the radiology‒pathology disagreement. In terms of distinguishing SF from malignancy, ADC could be a significant and promising value in diffusion-weighted MRI along with conventional sequences. Slow initial uptake with delayed persistent contrast enhancement in a non-mass lesion with relatively higher ADC values are very helpful for differentiating SF from malignancy. The presence of small cysts and ductal ectasia were common findings around/near the SF. Advances in knowledge: A quantitative analysis for measuring ADC values along with additional MRI features can be very helpful in distinguishing SF from malignant lesions.

Sonographic and Magnetic Resonance Imaging Characteristics of Juvenile Papillomatosis: Three Cases With Different Manifestations

Juvenile papillomatosis (JP) is an infrequently seen benign proliferative lesion in women younger than 30 years. Herein, we present different clinical manifestations of histopathologically proven JP of the breast, in addition to magnetic resonance and sonographic imaging features of these cases. Patient 1 exhibited nipple discharge and papillary carcinoma accompanied after the operation. Patient 2 presented with a giant mass with cystic and numerous solid nodular components that filled the entire right breast. Patient 3 exhibited cystic areas in a well-circumscribed hypoechoic solid mass besides ahypoechoic mass with indistinct borders, which was evaluated as multifocal JP.

Fibroadenomatosis involving bilateral breasts and axillary accessory breast tissues in a renal transplant recipient given cyclosporin A

We present the mammographic and sonographic findings in a case of fibroadenomatosis involving both breasts and axillae in a renal transplant patient after 16 years of treatment with cyclosporin A. Awareness of the fact that cyclosporin A may induce the formation of fibroadenomas, including in accessory breast tissue, is important for correct diagnosis and preventing unnecessary intervention.

Effect of using endorectal coil in preoperative staging of rectal carcinomas by pelvic MR imaging

PURPOSE

To assess the accuracy of magnetic resonance imaging with pelvic phased-array and endorectal coils prospectively, and evaluate if endorectal coil provides any additional information to high resolution pelvic MR imaging in rectal carcinoma staging.

MATERIALS AND METHODS

Preoperative MRI of 25 patients with rectal carcinoma was performed with pelvic phased-array coil alone, and with both phased-array coil and endorectal coil placed. Staging was made by evaluating images obtained by using both coils prospectively, and correlated with histopathologic staging. The images were then assessed separately, and compared to each other retrospectively.

RESULTS

Two and 3 of the 5 histopathologically proved T1 tumors were staged correctly on MRI with pelvic phased-array coil alone and after the endorectal coil placement, respectively. Histopathologically identified five T2 tumors were staged correctly as T2 in 4 of the cases, 1 was understaged and 10 of 14 patients who had T3 tumor were staged as T3, 4 of them were understaged as T2 on both techniques. Specificity, sensitivity and accuracy rates for staging of T3 tumors were found as 71%, 100% and 84%, respectively, for each technique. Sensitivity and positive predictive value of N staging were both 88% on both techniques.

CONCLUSION

Pelvic MR imaging after the placement of endorectal coil in addition to the phase-array coil was not superior to the imaging with phased-array coil alone in T staging of rectal carcinomas and the latter achieved better visualization of the lymph nodes by means of larger field of view.

Frequency of sternal variations and anomalies evaluated by MDCT

OBJECTIVE

Our objective was to reveal the frequency and MDCT appearances of sternal variations and anomalies in subjects without sternal deformities.

SUBJECTS AND METHODS

One thousand consecutive patients who underwent thoracic MDCT examination were enrolled in the study. All MDCT data, including multiplanar and curved-planar reconstructed images, were evaluated for detection of sternal variations and anomalies. Various kinds of sternal variations and anomalies, such as suprasternal bones and tubercles, manubriosternal and sternoxiphoidal fusions, sternal clefts and foramina, and sternal sclerotic bands were documented.

RESULTS

In 1,000 subjects, the frequencies of main sternal variations and anomalies were as follows: suprasternal bone in 4.1%, suprasternal tubercle in 4%, complete manubriosternal fusion in 19.6%, complete sternoxiphoidal fusion in 30.3%, sternal foramen in 4.5%, and sternal sclerotic band in 37.1%. Xiphoidal foramen was seen in 27.4%, and the most common type was single foramen. Xiphoid process mostly ended as a single process (71%). Double-ended xiphoid process was also frequent (27.2%). Pseudocleft and pseudoforamen at the sternoxiphoidal junction were detected in 3.3% and in 3.6% of subjects, respectively.

CONCLUSION

MDCT exhibited various sternal variations and anomalies. Sternal foramen is a frequent minor anomaly and generally associated with sternal sclerotic bands. Early manubriosternal and sternoxiphoidal fusions can be seen in early adulthood without osteodegeneration. Double-ended xiphoid process and single xiphoidal foramen are frequent sternal variations. Awareness of MDCT appearances of sternal variations and anomalies provides a better differential diagnosis with pathologic conditions.

Contrast-enhanced 3D MR voiding urethrography: preliminary results

Contrast-enhanced 3D MR voiding urethrography (CE 3D MRVU) was performed on 5 healthy volunteers and 18 patients with urethral disease. After intravenous injection of 0.3 ml/kg gadolinium, the images of the three consecutive acquisitions of the 3D MRVU technique were obtained during voiding. The raw data were reconstructed on all patients for visual analysis. The image quality of the volunteers was technically sufficient to demonstrate normal urethral anatomy. Contrast-enhanced 3D MR voiding urethrography of the urethral strictures was compared with conventional retrograde urethrography (n = 10) and urethroscopy (n = 12). The urethral pathologies including strictures and other obstructive causes of impaired urethral flow were correctly identified on CE 3D MRVU.

Weismann-Netter-Stuhl syndrome in two siblings

Cases of Weismann-Netter-Stuhl syndrome involving the upper extremities and affecting siblings have rarely been reported. We present the radiological findings of Weismann-Netter-Stuhl syndrome in two siblings, with upper extremity involvement in one of them.

Sialoblastoma: MRI findings

Sialoblastoma is a rare, aggressive and potentially malignant salivary gland tumour diagnosed in the neonatal period. A total of 28 cases have been reported in the literature, but reports of the imaging findings are limited. We describe a neonate with a right parotid sialoblastoma. MRI showed a large facial mass, which was mostly hypointense to the brain on T1-weighted images and mildly hyperintense on T2-weighted images. There were foci of haemorrhage and necrosis. Heterogeneous and weak contrast enhancement was detected on contrast-enhanced images. The tumour invaded the maxilla and adjacent muscles.

Congenital bilateral perisylvian syndrome with pituitary hypoplasia and ectopic neurohypophysis

Congenital bilateral perisylvian syndrome (CBPS) is a congenital neurological syndrome characterized by pseudobulbar palsy, cognitive deficits and bilateral perisylvian abnormalities observed on imaging. The described abnormality in CBPS is polymicrogyria located in the frontal, parietal, and/or occipital lobes. A few syndromes or abnormalities associated with this syndrome have been documented. Pituitary abnormalities are rare disorders. Association of CBPS with pituitary abnormalities has not been reported previously. In this case, a combination of bilateral perisylvian polymicrogyria with pituitary hypoplasia and ectopic neurohypophysis, caused by a possible single common insult, is presented.

Analysis of the thymus in 151 healthy infants from 0 to 2 years of age

OBJECTIVE

A prospective sonographic study of the normal thymus was performed to determine the size changes with age and to compare the results according to some clinical conditions, such as sex, breast versus formula feeding, and term or preterm status.

METHODS

One hundred fifty-one healthy infants underwent thymic sonography. Maximal transverse and longitudinal dimensions and anteroposterior dimensions of the right and left lobes were measured, and thymic indices were calculated. Mean values of thymic measurements for each group (sex, age, breast or formula feeding, and term or preterm status) were determined. The results were statistically evaluated.

RESULTS

Thymic dimensions showed the maximal values at about 4 to 6 months and gradually decreased after 6 to 8 months. No significant differences were found between mean values of thymic dimensions according to the sex and formula- versus breast-fed groups. As expected, the term group had greater thymic size values than the preterm group, probably because of positive correlations between thymus size, birth weight, and height.

CONCLUSIONS

The thymus is clearly and easily visualized on sonography in the 0- to 2-year age period. This may be useful for evaluating qualitative and quantitative properties of the thymus and determining size changes according to age in various clinical conditions.

Acute torsion of a wandering spleen: imaging findings

Wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. It can migrate to the lower abdomen or pelvis and can be congenital or acquired. We report a case of torsion of a wandering spleen for which there was correlative imaging by ultrasonography, Doppler ultrasonography, computed tomography, magnetic resonance imaging, and angiography. To our knowledge, this is the first reported case in which all these modalities were used in the diagnostic evaluation.

Purely cystic hydatid disease of the liver: treatment with percutaneous aspiration and injection of hypertonic saline

Percutaneous aspiration of purely cystic liver lesions was performed in 15 patients aged 11-56 years. After aspiration under guidance with computed tomography (CT) in 12 patients, a membrane that is diagnostic for hydatid disease was visible in the lumen of the cyst on CT scans. Hypertonic saline was injected in the cystic cavities of these patients as a scolecidal agent. No major complications occurred during or after the procedures. In the follow-up period of 6-16 months, control CT and ultrasound scans revealed a progressive decrease in the size of the lesions and no evidence of peritoneal seeding. It is concluded that percutaneous aspiration and hypertonic saline injection for purely cystic hydatid disease of the liver seem to be an effective form of treatment and may eventually prove to be an alternative to surgical intervention.

Balloon dilatation of iatrogenic urethral strictures

Balloon dilatation of the urethra was performed in five patients with iatrogenic urethral strictures. The urethral strictures were successfully negotiated and dilated in all patients. Redilatation became necessary in a period ranging from 3 to 10 months. The authors believe that balloon dilatation of the urethra can be safely and successfully performed; the procedure produces minimal trauma and immediate relief of symptoms.