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Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings
446
Abstracts / Journal of Clinical Imaging 29 (2005) 444 – 447
Intra-abdominal desmoplastic small round cell tumors: CT findings and clinicopathological correlations in 13 cases Chouli M, Viala J, Dromain C, Fizazi K, Duvillard P, Vanel D (D.V.: Department of Radiology, Institute Gustave-Roussy, 39 Rue Camille Desmoulines, F-94805 Villejuif Cedex, France). Eur J Radiol 2005;54:438–442. Purpose: We report computed tomography (CT) findings in 13 patients with a primary abdominal desmoplastic small round cell tumor. Materials and methods: Thirteen cases (12 men, 1 woman, mean age = 24.8 years) were found in our hospital database between 1991 and 2003. Clinical, CT, and histopathological features were studied retrospectively. Results: Peritoneal involvement was the most common feature. In 10 cases, several lobulated peritoneal soft tissue masses (with a mean of four masses per patient) were seen. Two patients had diffused irregular peritoneal carcinomatosis without any distinct peritoneal masses. One patient had a solitary mass in the pelvic space. The main sites of peritoneal involvement were the pelvic space (n = 7), omentum (n = 5), retroperitoneal space (n = 4), small bowel mesentery (n = 3), paracolic gutter (n = 2 on the right and n = 1 on the left), transverse colon mesentery (n = 1), perisplenic space (n = 1), and perihepatic space (n = 1). The soft tissue masses were often bulky (mean = 6 cm, range = 1 – 28 cm), lobulated, and heterogeneous with hypodense areas (in 73% of cases). In six cases, moderate ascites was seen. In one case of pelvic involvement, unilateral hydronephrosis was seen. Adenopathies were present in seven cases at the time of the diagnosis (at intraperitoneal, retroperitoneal, and pelvic sites in six patients and in the groin in one patient). Five patients had liver metastases (four lesions per case excepted one patient with 30 metastases). Associated thoracic metastases were seen in three patients. The diagnosis was confirmed with four CT-guided percutaneous biopsies. Conclusion: Although CT features are nonspecific, the diagnosis of desmoplastic small round cell tumor may be suspected in young men with multiple bulky heterogeneous peritoneal soft tissue masses. Imaging is useful for staging and also to guide biopsies.
Role of computed tomography in the follow-up of hepatic and peritoneal metastases of GIST under imatinib mesylate treatment: a prospective study of 54 patients Vanel D, Albiter M, Sapeero L, Le Cesne A, Bonvalot S, Le Pechoux C, Terrier P, Petrow P, Caillet H, Dromain C (Department of Radiology, Institute Gustave-Roussy, Rue Camille Desmoulines, F-94800 Villejuif Cedex, France). Eur J Radiol 2005;54:118–123. Purpose: The aim of this sturdy was to prospectively analyze the evolution of hepatic and peritoneal unresectable metastases from gastrointestinal stromal tumors (GIST) under imatinib mesylate, a new targeted treatment, which induces changes in lesion structure. Materials and methods: Fifty-four patients with metastases from GIST underwent an abdominal and pelvic computed tomography examination without and with contrast enhancement, before and during treatment with imatinib mesylate. The number and size of lesions and contrast enhancement were noted before treatment and every 2 weeks for the first 2 months, then every 2 months for the first year of treatment and every 3 months thereafter. Results: Twenty-seven patients presented with both hepatic and peritoneal metastases: 14 had only peritoneal and 13, only hepatic disease. On baseline imaging, all metastases were hypodense heterogeneous lesions with progressive, concentric enhancement. After treatment (mean duration of follow-up: 23 months), metastases decreased in size number and enhancement in 35/54 patients, remained stable in 2 patients, and increased in 14 patients. In 13/39 patients with hepatic metastases, a cyst-like appearance was noted. Reactivation after a partial response appeared first
as a focal, peripheral, solid nodule in the wall of a cystic lesion, or an increase in lesion density, before size regrew. Conclusion: Besides the classic size criterion, a decrease in density and in contrast enhancement with stable bnear cysticQ lesions signifies a good response. A more aggressive approach (surgery or radiofrequency ablation) may be indicated for initially focal recurrences with a stable size.
Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT Phongkitkarun S, Kobayashi S, Varavithya V, Huang X, Curley SA, Charnsangavej C (Department of Radiology, Ramathibodi Hospital, Rama VI Rd., Rajchathewi, Bangkok 10400, Thailand). Clin Radiol 2005;60: 700-709.1 Aim: The aim of this study were to describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data. Methods: Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms, and laboratory data. Results: Bile duct abnormalities developed in 34 (57%) of cases, either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade. Conclusion: Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes, and guide appropriate treatment. 1
D 2005 The Royal College of Radiologists. Reprinted with permission.
Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings Koseoglu K, Ozsunar Y, Taskin F, Karaman C (Department of Radiology, Faculty of Medicine, Adnan Menderes University, Aydin 09100 Turkey). Eur J Radiol 2005;54:388–392. Objective: Localized low attenuated areas (pseudolesions) in the medial segment of left liver lobe are not rarely seen in the screening of abdomen using helical CT. The purpose of this study was to determine the prevalence of pseudolesions in the routine helical CT of the abdomen and to evaluate the morphologic and enhancement features of pseudolesions in the unenhanced and enhanced CT examinations. Materials and methods: We retrospectively evaluated 333 contrastenhanced abdominal CT examination of 328 patients with no known liver disease, to detect the presence of pseudolesion of liver. In the presence of unenhanced and arterial phase examinations, these images were also analyzed. The imaging criteria for pseudolesion of the liver was localized low attenuated area with geometric, ovoid, or nodular shaped and with no mass effect adjacent to the falciform ligament, gallbladder, or porta hepatis. Previous CT, CTAP, and MR examinations were also reviewed to understand the evolution of pseudolesion in patients in whom a pseudolesion was detected in the portal phase of helical CT examination.
Abstracts / Journal of Clinical Imaging 29 (2005) 444 – 447 Results: We identified a pseudolesion in the 65 (19.8%) of 328 patients in portal phase of helical CT examinations. Pseudolesions were identified in the medial segment of left liver lobe adjacent to falciform ligament in the 92.8% of patients, both sides of falciform ligament in 1.5% of the patients, adjacent to porta hepatis in 3% of the patients and adjacent to gallbladder in 3% of the patients. These lesions had triangular shape in the 66.1% of patients, ovoid shape in 18.6% of patients, and nodular shape in the 15.3% of patients. Unenhanced, arterial, and portal phase images existed in 50.7% of 65 patients. The pseudolesions were not identified on the unenhanced images in 75.7% of the patients and on the arterial phase images in 55.6% of the patients. Conclusion: Pseudolesions around the falciform ligament are not rarely seen in the routine helical CT examination of liver and abdomen. The pseudolesions are more encountered in the portal phase of helical CT examination. These lesions seem to be likely focal fatty infiltration or perfusion defect due to venous supply variation or both. Nodular-shaped pseudolesions may be interpreted as true tumors and further study may require for differential diagnosis.
Sonographic features of gestational choriocarcinoma [in French] Diouf A, Cisse´ ML, Laı¨co A, Ndiaye D, Moreau JC, Diadhiou F (Service de Gyne´cologie Obste´trique, Hoˆpital Aristide Le Dantec, Ave. Pasteur, BP 3001, Dakar, Se´ne´gal). J Radiol 2005;86:469 – 473. Purpose: The aim of this study is to describe the sonographic morphological features of gestational choriocarcinoma. Materials and methods: A retrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in eight cases was conducted. Results: The tumor presented multiple features (nodular, submucosal, macrocystic multicystic, compact, and microcystic), often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal, with small corpus luteum cysts noted in only five cases. In two cases, ultrasound modified the clinical staging. Conclusion: Sonographic features of gestational choriocarcinoma are variable and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.
MRI of vaginal conditions —pictorial review Lo´pez C, Balogun M, Ganesan R, Olliff JF (Department of Radiology, Birmingham Women’s Hospital, Edgbaston, Birmingham B15 2TG, UK). Clin Radiol 2005;60:648 – 662.1
Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review 1
D 2005 The Royal College of Radiologists. Reprinted with permission.
447
demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, and transverse vaginal septum), benign (Bartholin’s cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, and postsurgical appearances with the formation of a neovagina and adhesions), or malignant, usually due to the extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies.
Magnetic resonance imaging of atherosclerosis Leiner T, Gerretsen S, Botnar R, Lutgens E, Cappendijk V, Kooi E, van Engelshoven J (Department of Radiology, Maastricht University Hospital, Peter Debijelaan 25, Maastricht 6229 HX, The Netherlands). Eur Radiol 2005;15:1087–1099. Abundant data now link composition of the vascular wall, rather than the degree of luminal narrowing, with the risk for acute ischemic syndromes in the coronary, central nervous system, and peripheral arterial beds. Over the past few years, magnetic resonance angiography has evolved as a well-established method to determine the location and severity of advanced, lumen-encroaching atherosclerotic lesions. In addition, more recent studies have shown that high-spatial resolution, multisequence MRI is also a promising tool for noninvasive, serial imaging of the aortic and carotid vessel wall, which potentially can be applied in the clinical setting. Because of the limited spatial resolution of current MRI techniques, the characterization of coronary vessel wall atherosclerosis, however, is not yet possible and remains the holy grail of plaque imaging. Recent technical developments in MRI technology such as dedicated surface coils, the introduction of 3.0-T high-field systems, and parallel imaging, as well as developments in the field of molecular imaging such as contrast agents targeted to specific plaque constituents, are likely to lead to the necessary improvements in signal to noise ratio, imaging speed, and specificity. These improvements will ultimately lead to more widespread application of this technology in clinical practice. In the present review, the current status and future role of MRI for plaque detection and characterization are summarized.
Abstracts / Journal of Clinical Imaging 29 (2005) 444 – 447
Intra-abdominal desmoplastic small round cell tumors: CT findings and clinicopathological correlations in 13 cases Chouli M, Viala J, Dromain C, Fizazi K, Duvillard P, Vanel D (D.V.: Department of Radiology, Institute Gustave-Roussy, 39 Rue Camille Desmoulines, F-94805 Villejuif Cedex, France). Eur J Radiol 2005;54:438–442. Purpose: We report computed tomography (CT) findings in 13 patients with a primary abdominal desmoplastic small round cell tumor. Materials and methods: Thirteen cases (12 men, 1 woman, mean age = 24.8 years) were found in our hospital database between 1991 and 2003. Clinical, CT, and histopathological features were studied retrospectively. Results: Peritoneal involvement was the most common feature. In 10 cases, several lobulated peritoneal soft tissue masses (with a mean of four masses per patient) were seen. Two patients had diffused irregular peritoneal carcinomatosis without any distinct peritoneal masses. One patient had a solitary mass in the pelvic space. The main sites of peritoneal involvement were the pelvic space (n = 7), omentum (n = 5), retroperitoneal space (n = 4), small bowel mesentery (n = 3), paracolic gutter (n = 2 on the right and n = 1 on the left), transverse colon mesentery (n = 1), perisplenic space (n = 1), and perihepatic space (n = 1). The soft tissue masses were often bulky (mean = 6 cm, range = 1 – 28 cm), lobulated, and heterogeneous with hypodense areas (in 73% of cases). In six cases, moderate ascites was seen. In one case of pelvic involvement, unilateral hydronephrosis was seen. Adenopathies were present in seven cases at the time of the diagnosis (at intraperitoneal, retroperitoneal, and pelvic sites in six patients and in the groin in one patient). Five patients had liver metastases (four lesions per case excepted one patient with 30 metastases). Associated thoracic metastases were seen in three patients. The diagnosis was confirmed with four CT-guided percutaneous biopsies. Conclusion: Although CT features are nonspecific, the diagnosis of desmoplastic small round cell tumor may be suspected in young men with multiple bulky heterogeneous peritoneal soft tissue masses. Imaging is useful for staging and also to guide biopsies.
Role of computed tomography in the follow-up of hepatic and peritoneal metastases of GIST under imatinib mesylate treatment: a prospective study of 54 patients Vanel D, Albiter M, Sapeero L, Le Cesne A, Bonvalot S, Le Pechoux C, Terrier P, Petrow P, Caillet H, Dromain C (Department of Radiology, Institute Gustave-Roussy, Rue Camille Desmoulines, F-94800 Villejuif Cedex, France). Eur J Radiol 2005;54:118–123. Purpose: The aim of this sturdy was to prospectively analyze the evolution of hepatic and peritoneal unresectable metastases from gastrointestinal stromal tumors (GIST) under imatinib mesylate, a new targeted treatment, which induces changes in lesion structure. Materials and methods: Fifty-four patients with metastases from GIST underwent an abdominal and pelvic computed tomography examination without and with contrast enhancement, before and during treatment with imatinib mesylate. The number and size of lesions and contrast enhancement were noted before treatment and every 2 weeks for the first 2 months, then every 2 months for the first year of treatment and every 3 months thereafter. Results: Twenty-seven patients presented with both hepatic and peritoneal metastases: 14 had only peritoneal and 13, only hepatic disease. On baseline imaging, all metastases were hypodense heterogeneous lesions with progressive, concentric enhancement. After treatment (mean duration of follow-up: 23 months), metastases decreased in size number and enhancement in 35/54 patients, remained stable in 2 patients, and increased in 14 patients. In 13/39 patients with hepatic metastases, a cyst-like appearance was noted. Reactivation after a partial response appeared first
as a focal, peripheral, solid nodule in the wall of a cystic lesion, or an increase in lesion density, before size regrew. Conclusion: Besides the classic size criterion, a decrease in density and in contrast enhancement with stable bnear cysticQ lesions signifies a good response. A more aggressive approach (surgery or radiofrequency ablation) may be indicated for initially focal recurrences with a stable size.
Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT Phongkitkarun S, Kobayashi S, Varavithya V, Huang X, Curley SA, Charnsangavej C (Department of Radiology, Ramathibodi Hospital, Rama VI Rd., Rajchathewi, Bangkok 10400, Thailand). Clin Radiol 2005;60: 700-709.1 Aim: The aim of this study were to describe the imaging findings of bile duct complications of hepatic arterial infusion chemotherapy (HAIC) using helical CT, to set diagnostic criteria, to develop a CT grading system, and to correlate these with clinical findings and laboratory data. Methods: Follow-up helical CT of the abdomen was performed every 3 months for 60 patients receiving HAIC. Three radiologists reviewed all CT studies before and after treatment, using either the picture archiving and communication system or hard copies. The findings of bile duct abnormalities were correlated with findings from other imaging techniques, clinical symptoms, and laboratory data. Results: Bile duct abnormalities developed in 34 (57%) of cases, either during HAIC or 1 to 12 months after treatment. In 14 (41%) of these 34 patients, enhancement of the hepatic parenchyma along the dilated bile duct or in the segmental or lobar distribution was observed. In 43 cases (72%), normal or abnormal alkaline phosphatase levels were consistent with normal or abnormal CT findings, respectively. Increasing alkaline phosphatase and bilirubin levels were related to CT grade. Conclusion: Imaging findings of bile duct complications of HAIC are similar to those of primary sclerosing cholangitis and correlate well with abnormal clinical and laboratory data. In the presence of such clinical abnormalities, thin-section helical CT with careful review of the imaging studies helps to determine the correct diagnosis, monitor the changes, and guide appropriate treatment. 1
D 2005 The Royal College of Radiologists. Reprinted with permission.
Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings Koseoglu K, Ozsunar Y, Taskin F, Karaman C (Department of Radiology, Faculty of Medicine, Adnan Menderes University, Aydin 09100 Turkey). Eur J Radiol 2005;54:388–392. Objective: Localized low attenuated areas (pseudolesions) in the medial segment of left liver lobe are not rarely seen in the screening of abdomen using helical CT. The purpose of this study was to determine the prevalence of pseudolesions in the routine helical CT of the abdomen and to evaluate the morphologic and enhancement features of pseudolesions in the unenhanced and enhanced CT examinations. Materials and methods: We retrospectively evaluated 333 contrastenhanced abdominal CT examination of 328 patients with no known liver disease, to detect the presence of pseudolesion of liver. In the presence of unenhanced and arterial phase examinations, these images were also analyzed. The imaging criteria for pseudolesion of the liver was localized low attenuated area with geometric, ovoid, or nodular shaped and with no mass effect adjacent to the falciform ligament, gallbladder, or porta hepatis. Previous CT, CTAP, and MR examinations were also reviewed to understand the evolution of pseudolesion in patients in whom a pseudolesion was detected in the portal phase of helical CT examination.
Abstracts / Journal of Clinical Imaging 29 (2005) 444 – 447 Results: We identified a pseudolesion in the 65 (19.8%) of 328 patients in portal phase of helical CT examinations. Pseudolesions were identified in the medial segment of left liver lobe adjacent to falciform ligament in the 92.8% of patients, both sides of falciform ligament in 1.5% of the patients, adjacent to porta hepatis in 3% of the patients and adjacent to gallbladder in 3% of the patients. These lesions had triangular shape in the 66.1% of patients, ovoid shape in 18.6% of patients, and nodular shape in the 15.3% of patients. Unenhanced, arterial, and portal phase images existed in 50.7% of 65 patients. The pseudolesions were not identified on the unenhanced images in 75.7% of the patients and on the arterial phase images in 55.6% of the patients. Conclusion: Pseudolesions around the falciform ligament are not rarely seen in the routine helical CT examination of liver and abdomen. The pseudolesions are more encountered in the portal phase of helical CT examination. These lesions seem to be likely focal fatty infiltration or perfusion defect due to venous supply variation or both. Nodular-shaped pseudolesions may be interpreted as true tumors and further study may require for differential diagnosis.
Sonographic features of gestational choriocarcinoma [in French] Diouf A, Cisse´ ML, Laı¨co A, Ndiaye D, Moreau JC, Diadhiou F (Service de Gyne´cologie Obste´trique, Hoˆpital Aristide Le Dantec, Ave. Pasteur, BP 3001, Dakar, Se´ne´gal). J Radiol 2005;86:469 – 473. Purpose: The aim of this study is to describe the sonographic morphological features of gestational choriocarcinoma. Materials and methods: A retrospective evaluation of 13 cases of gestational choriocarcinoma diagnosed by clinical and laboratory (BHCG) criteria in all cases and confirmed by histological data in eight cases was conducted. Results: The tumor presented multiple features (nodular, submucosal, macrocystic multicystic, compact, and microcystic), often with involvement of surrounding tissues. All cases showed myometrial involvement. The size of the ovaries was normal, with small corpus luteum cysts noted in only five cases. In two cases, ultrasound modified the clinical staging. Conclusion: Sonographic features of gestational choriocarcinoma are variable and may mimic other diseases of the endometrium or myometrium. The involvement of multiple layers of the uterus suggests a malignant disease.
MRI of vaginal conditions —pictorial review Lo´pez C, Balogun M, Ganesan R, Olliff JF (Department of Radiology, Birmingham Women’s Hospital, Edgbaston, Birmingham B15 2TG, UK). Clin Radiol 2005;60:648 – 662.1
Magnetic resonance imaging (MRI) has become an important part of the assessment of suspected vaginal pathology. This pictorial review 1
D 2005 The Royal College of Radiologists. Reprinted with permission.
447
demonstrates the MRI features and some of the histopathological findings of a variety of vaginal conditions. These may be congenital (total vaginal agenesis, partial vaginal agenesis, longitudinal vaginal septum, and transverse vaginal septum), benign (Bartholin’s cyst, diffuse vaginal inflammation, invasive endometriosis, ureterovaginal fistula, and postsurgical appearances with the formation of a neovagina and adhesions), or malignant, usually due to the extension or recurrence from another pelvic malignancy. In this paper, examples of the above are described and illustrated together with examples of the much rarer primary vaginal malignancies.
Magnetic resonance imaging of atherosclerosis Leiner T, Gerretsen S, Botnar R, Lutgens E, Cappendijk V, Kooi E, van Engelshoven J (Department of Radiology, Maastricht University Hospital, Peter Debijelaan 25, Maastricht 6229 HX, The Netherlands). Eur Radiol 2005;15:1087–1099. Abundant data now link composition of the vascular wall, rather than the degree of luminal narrowing, with the risk for acute ischemic syndromes in the coronary, central nervous system, and peripheral arterial beds. Over the past few years, magnetic resonance angiography has evolved as a well-established method to determine the location and severity of advanced, lumen-encroaching atherosclerotic lesions. In addition, more recent studies have shown that high-spatial resolution, multisequence MRI is also a promising tool for noninvasive, serial imaging of the aortic and carotid vessel wall, which potentially can be applied in the clinical setting. Because of the limited spatial resolution of current MRI techniques, the characterization of coronary vessel wall atherosclerosis, however, is not yet possible and remains the holy grail of plaque imaging. Recent technical developments in MRI technology such as dedicated surface coils, the introduction of 3.0-T high-field systems, and parallel imaging, as well as developments in the field of molecular imaging such as contrast agents targeted to specific plaque constituents, are likely to lead to the necessary improvements in signal to noise ratio, imaging speed, and specificity. These improvements will ultimately lead to more widespread application of this technology in clinical practice. In the present review, the current status and future role of MRI for plaque detection and characterization are summarized.