Abdom Imaging

Topographic evaluation of lateral hypopharyngeal pouches using electron beam tomography.

Lindbichler F. Raith J. Groll R. Kern R. Uggowitzer M. Wuttge-Hannig A.
Department of Radiology, University Hospital Graz, Auenbruggerplatz 9, A-8036 Graz, Austria.
BACKGROUND: To evaluate the exact topography of lateral hypopharyngeal pouches using electron beam tomography. METHODS: Seventeen patients, nine female, eight male, aged 28-72 years, who showed lateral hypopharyngeal pouches in the videofluorographic swallowing examination were studied using electron beam tomography. Upon swallowing a 20-ml bolus of water, the region of the thyrohyoid membrane was scanned 20 times per level. Scan parameters: single slice cine mode (exposure time 100 ms, slice thickness 3 mm, 620 mA, 130 KV). RESULTS: The lateral hypopharyngeal pouches appeared air-filled in the posterior aspect of the thyrohyoid membrane closely attached to the upper horn of the thyroid cartilage, just below the hyoid bone. CONCLUSIONS: With electron beam tomography it was possible to define the topographic location of the pouches more accurately, compared with the prior assumption of position.

Demonstration of intraluminal duodenal diverticulum by computed tomography.

Fidler JL. Saigh JA. Thompson JS. Habbe TG.
Department of Radiology, University of Nebraska Medical Center, 600 South 42nd Street, Omaha, NE 68198-1045, USA.
Intraluminal duodenal diverticulum is a rare congenital anomaly consisting of a saclike projection within the duodenum. Small diverticula may be asymptomatic; however, when these enlarge, patients may develop recurrent episodes of pain, obstruction, or pancreatitis. Normally, the diagnosis is made by barium luminal examination. We report a case where the findings were seen on computed tomography and confirmed by upper gastrointestinal series.

Cystic lymphangioma of the pancreas: CT and pathologic findings.

Gray G. Fried K. Iraci J.
Department of Radiology, Lenox Hill Hospital, 100 East 77th Street, New York, NY 10021, USA.
A case of pancreatic cystic lymphangioma is presented with CT and pathologic findings. CT demonstrated a large septated cystic mass in the left abdomen in an otherwise healthy young female. A diagnosis of lymphangioma was made after excision and pathologic examination.

Portal vein opacification during ERCP in patients with pancreatitis.

Lum C. Cho KC. Scholl DG. Sundaram NK.
Department of Radiology, University Hospital C320, 150 Bergen Street, UMDNJ-New Jersey Medical School, Newark, NJ 07103, USA.
We report two cases of portal vein visualization during ERCP in patients with pancreatitis, one from inadvertent cannulation of the superior mesenteric vein, and in the other, through a preexisting fistula. Prompt recognition of this potentially significant event will obviate confusion and unnecessary prolongation of the procedure.

Diagnosis of arteriovenous malformation of the pancreas by color Doppler ultrasonography.

Koito K. Namieno T. Nagakawa T. Morita K.
Department of Radiology, Sapporo Medical University, S1, W17, Chuo-ku, Sapporo 060, Japan.
Arteriovenous malformation (AVM) of the pancreas is a rare disease, and once this silent disease develops portal hypertension it is too difficult for the physician to successfully control the disease. AVM is usually diagnosed by invasive diagnostic modalities, and noninvasive modalities should be developed for its diagnosis. We have experienced two cases of AVM of the pancreas, which were located at the pancreatic head and diagnosed by color Doppler ultrasonography (Doppler US). The two AVM lesions were detected as a mosaic pattern, and the lesions were connected to the main portal vein on Doppler US; the pulsatile waves were also observed in the mosaic lesions by the analysis of the Doppler spectrum. We determined the two patients suffered from congenital AVM of the pancreas, since they had no abnormal findings on past and physical histories, laboratory data, and other images. One patient refused surgery, and another underwent pancreatoduodenectomy. Histology of the resected specimen demonstrated the lesion was AVM of the pancreas. These cases support that the present modality is useful for the diagnosis of the pancreatic AVM as a noninvasive procedure, and we discuss the usefulness of noninvasive Doppler US which shows not only static but also hemodynamic informations.

Narrowing of the upper abdominal inferior vena cava in patients with elevated intraabdominal pressure.

Wachsberg RH. Sebastiano LL. Levine CD.
Department of Radiology, University Hospital and New Jersey Medical School, 150 Bergen Street, Room C-320, Newark, NJ 07103, USA.
BACKGROUND: Previous investigators have suggested that narrowing of the suprahepatic inferior vena cava (IVC) occurs in patients with increased intraabdominal pressure (IAP). SUBJECTS AND METHODS: We retrospectively reviewed 59 contrast-enhanced computed tomographic (CT) scans performed over a 2-year period in patients with evidence of increased IAP. We also reviewed CT scans performed in a control group of 30 normal patients. The intrahepatic and suprahepatic IVC segments were assessed for narrowing. RESULTS: Narrowing of the suprahepatic IVC was never observed in the patients with elevated IAP. Slit-like narrowing of the upper intrahepatic IVC was noted in 11 (44%) of 25 patients; the intrahepatic IVC was not evaluated in 34 other patients with liver abnormalities or unsatisfactory opacification of the intrahepatic IVC. In control subjects, narrowing was not observed in either the intrahepatic or suprahepatic IVC. CONCLUSION: Narrowing of the upper intrahepatic IVC can be seen in some patients with increased IAP. The cause and significance of this phenomenon remain to be determined.

Peritoneal metastases from transitional cell carcinoma of the urinary tract: CT and MR imaging.

Chrysikopoulos H. Maniatis V. Roussakis A. Pappas J. Andreou J.
Department of Radiology, Hygeia Hospital, 4 E. Stavrou and Kifisias Avenue, Marousi 15123, Athens, Greece.
We present three patients with peritoneal metastases from transitional cell carcinoma of the urinary tract. CT scan in one patient showed massive ascites with subtle peritoneal thickening and infiltration of omental fat. We had the opportunity to study the other patients with both CT and MR. Both examinations showed numerous large and small peritoneal implants in the abdomen and pelvis, mostly in the greater omentum.

Peritoneal lymphomatosis: CT findings.

Kim Y. Cho O. Song S. Lee H. Rhim H. Koh B.
Department of Diagnostic Radiology, College of Medicine, Hanyang University, #17, Haengdang-Dong, Sungdong-Ku, Seoul 133-792, South Korea.
BACKGROUND: Diffuse peritoneal tumor infiltration is well recognized on computed tomography (CT) and is usually associated with carcinomatosis. The purpose of this investigation was to analyze the CT findings of peritoneal spread from primary gastrointestinal lymphomas. METHODS: Abdominal CT scans in eight patients with peritoneal lymphomatosis were retrospectively reviewed. Patients were 12-75 years old (mean = 48 years); with six patients were male and two were female. Pathologic evidence of primary lymphoma was available by colonoscopic biopsy of the terminal ileum in seven cases and by gastroscopic biopsy of the stomach in one case. All patients had non-Hodgkin's lymphoma. We analyzed CT findings in view of presence or loculation of ascites, abnormal patterns of mesentery and omentum, presence of peritoneal enhancement, presence of low attenuation and location of lymph nodes, and primary gastrointestinal lymphoma. RESULTS: Although ascites was present in all patients, there was no loculation. The involvement of mesentery was present in seven patients, and the stellate pattern was the common type (4/7). The involvement of omentum was present in seven patients, and the common type was omental cake (3/7). Peritoneal enhancement was present in six patients. Enlarged lymph nodes were present in six patients, mainly at the retroperitoneum and mesentery, and showed centrally low attenuation in half the patients. CONCLUSION: Patterns of tumor involvement of mesentery, omentum, and peritoneum seen in peritoneal lymphomatosis are indistinguishable from those seen in peritoneal carcinomatosis or tuberculous peritonitis. However, ascites without any loculation or septation and diffuse distribution of enlarged lymph nodes were helpful signs of peritoneal lymphomatosis.

NSAID injury to the small intestine.

Zalev AH. Gardiner GW. Warren RE.
Department of Radiology, University of Toronto and St. Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada.
PURPOSE: To identify the clinical and radiologic findings in patients with diaphragm-like strictures in the small bowel. PATIENTS AND METHODS: We reviewed the histories, radiologic findings, and pathologic findings in two men and two women, all in their sixties, with a history of long-term nonsteroidal antiinflammatory drug (NSAID) or aspirin (ASA) usage and one or more radiologically demonstrated diaphragm-like strictures in the small bowel. RESULTS: Two patients had long histories of NSAID usage, and two of ASA usage. One NSAID user had a long segment of jejunal involvement, and the other three had short segments of duodenal involvement. The ASA users presented with symptoms of esophageal disease, the small bowel lesions were unexpected, and ASA usage was not initially elicited. In one NSAID user and one ASA user, broader strictures with humps rather than diaphragms were also seen producing a lifesaver-like or bagel-like configuration. CONCLUSIONS: Multiple diaphragm-like strictures can occur in NSAID injury and are pathognomonic except in the rare patient with ulcerative enteritis complicating celiac disease. Single or few diaphragm-like strictures can occur in NSAID injury and peptic ulceration. ASA should be considered an NSAID with regard to small-bowel toxicity. A careful medication history is required when an unexplained small bowel abnormality is seen radiologically, and a dedicated small bowel examination is required when NSAID injury is suspected.

Color Doppler findings of gastrointestinal varices.

Komatsuda T. Ishida H. Konno K. Hamashima Y. Ohnami Y. Naganuma H. Asanuma Y. Masamune O.
First Department of Internal Medicine, Akita University School of Medicine, 1-1-1 Hondo, Akita, Japan.
BACKGROUND: Compared with esophageal varices, gastrointestinal varices are relatively rare, but they are clinically important because they tend to bleed massively. Color Doppler sonography is now widely used to diagnose the collaterals, but few color Doppler findings of gastric or intestinal varices have been reported. The aim of this study was to investigate the sonographic and color Doppler findings of gastrointestinal varices and to determine the role of color Doppler sonography in the diagnosis of these varices. METHODS: We studied 30 patients who were diagnosed by endoscopy as having gastrointestinal varices (24 gastric, four duodenal, two intestinal) with color Doppler sonography and compared the results with the clinical data. The causes of gastric varices included liver cirrhosis (16/24, 66.7%), idiopathic portal hypertension (3/24, 12. 5%), chronic pancreatitis with splenic vein thrombosis (2/24, 8.3%), congenital biliary atresia (1/24, 4.2%), congenital hepatic fibrosis (1/24, 4.2%), and unknown (1/24, 4.2%). The causes of duodenal varices included idiopathic portal hypertension with portal thrombosis (3/4, 75%) and liver cirrhosis (1/4, 25%). RESULTS: The gastric wall at the fundus was thickened in 17 of 24 cases (70.8%) with gastric varices, and the duodenal wall was thickened in four of four cases (100%) with duodenal varices. Sonography revealed thrombosis in the splenic vein in two of two cases with gastric varices secondary to chronic pancreatitis and in the confluence of the superior mesenteric vein and the splenic vein in three of four cases with duodenal varices. Color Doppler sonography demonstrated multiple, slow constant blood flows in the thickened wall in 15 of 24 cases (62.5%) with gastric varices and in four of four cases (100%) with duodenal varices. It demonstrated accumulated slow constant blood flows in the cecum in the case with cecal varices. Color Doppler showed also the communication between the varices and the neighboring vascular system (superior mesenteric vein and inferior vena cava) in the case with cecal varices, but it did not directly reveal such a communication in the other 29 cases (96.7%). Color Doppler showed a hepatofugal flow in the left gastric vein in all the hemorrhagic gastric varicose patients with esophageal varices, but it showed a hepatopetal flow in the left gastric vein in the isolated nonhemorrhagic gastric varicose patients. CONCLUSION: Color Doppler sonography was very useful for the diagnosis of gastric and duodenal varices and for visualizing fine venous flows in the thickened gastric or duodenal wall. When it shows portal thrombosis in the confluence of the splenic vein and the superior mesenteric vein, duodenal varices should be suspected. The flow direction of the left gastric vein helps to differentiate hemorrhagic gastric varices from nonhemorrhagic ones.

Homogeneous enhancement of hepatic parenchyma: MR imaging during arterial portography versus CT during arterial portography.

Fujita T. Honjo K. Ito K. Matsumoto T. Matsunaga N.
Department of Radiology, Yamaguchi University School of Medicine, 1144, Kogushi, Ube, Yamaguchi 755, Japan.
BACKGROUND: The goal of this study was to investigate the frequency of inhomogeneous parenchymal enhancement of the liver in magnetic resonance imaging during arterial portography (MRAP) versus computed tomography during arterial portography (CTAP). METHODS: CTAP and MRAP were performed in 29 and in 21 patients, respectively, who had suspected primary or secondary liver tumors on clinical or biological grounds. We evaluated the frequency of inhomogeneous hepatic parenchymal enhancement not related to a decrease of portal blood supply due to compression or obstruction by the tumor and physiologic variation in portal perfusion. Inhomogeneous parenchymal enhancement of the liver was classified as segmental or subsegmental and as nonsegmental. RESULTS: Segmental or subsegmental inhomogeneous parenchymal enhancement was seen in six of 29 patients (20.1%) on CTAP and in one of 21 patients (4.8%) on MRAP. Nonsegmental inhomogeneous parenchymal enhancement was seen in five of 29 patients (17.2%) on CTAP images and in none of the patients (0%) on MRAP images. The incidence of nonsegmental inhomogeneous parenchymal enhancement was significantly lower on MRAP than on CTAP. CONCLUSION: MRAP was superior to CTAP in achieving homogeneous parenchymal enhancement of the liver.

Unusual liver MR findings of Wilson''s disease in an asymptomatic 2-year-old girl.

Ko S. Lee T. Ng S. Lin J. Cheng Y.
Department of Radiology, Chang Gung Memorial Hospital at Kaohsiung, Chang Gung College of Medicine and Technology, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien 833, Taiwan.
We describe the unusual magnetic resonance (MR) findings of a case of Wilson's disease (WD) in an asymptomatic 2-year-old girl. Preenhanced computed tomography revealed multiple hyperdense areas in the liver. These lesions were hyperintense on T1-weighted and hypointense on T2-weighted MR images, results that might be ascribed to the paramagnetism of copper deposited in liver at a relatively early stage of the disease before severe liver cirrhosis had evolved.

Ultrasound appearances of intra- and extrahepatic biliary ascariasis.

Schulman A.
Department of Radiology, University of Stellenbosch and Tygerberg Hospital, Tygerberg, 7505, South Africa.
BACKGROUND: To determine the range of ultrasonographic (US) appearances of Ascaris lumbricoides roundworms in the biliary system, their distribution in the intra- and extrahepatic parts of the system, and associated features. METHODS: All cases of biliary ascariasis during a 10-year period were reviewed. There were 42 cases in which diagnosis was based on established US criteria, and 2 cases diagnosed surgically in which US had been negative. These 44 cases occurred in 36 patients. RESULTS: In the US-diagnosed cases, worms were present in intrahepatic ducts in 32 cases, in the main duct in 37, and in the gallbladder in eight. In six cases, the liver was lifted off the main portal vein by a bundle of worms obliterating the lumen of the main bile duct. Worms packing and dilating intrahepatic ducts produced pseudotumorous appearances in the liver in four cases and bundlelike appearances in three. Worms were also seen in the pancreatic duct in two cases. Stones in intrahepatic ducts were present in 12 patients. CONCLUSION: Biliary ascariasis should be searched for inside and outside the liver. The appearances of bundles and boluses are different from those of single worms. Intra- and extrahepatic biliary stones may be present.

Sonographic findings of anomalous position of the gallbladder.

Naganuma S. Ishida H. Konno K. Hamashima Y. Hoshino T. Naganuma H. Komatsuda T. Ohyama Y. Yamada N. Ishida J. Masamune O.
First Department of Internal Medicine, Akita University School of Medicine, 1-1-1 Hondo, Akita, Japan.
Anomalous position of the gallbladder is relatively rare and has been reported only in isolated case reports. We tried to determine its ultrasound (US) findings on the basis of 18 such patients. In the left-side gallbladder group (nine patients), the gallbladder was imaged as an oval cystic mass in front of the pancreas. In all patients, the narrow neck of the gallbladder was clearly detected by US in the usual location before the main portal vein. Four of nine patients had small gallbladder stones. The retrohepatic gallbladder group (four patients) showed marked atrophy of the right lobe of the liver. Two patients had multiple gallstones in the bile ducts of the right lobe. All patients in the suprahepatic retrohepatic gallbladder group (four patients) were cirrhotic, and the anterior segment of the right lobe was markedly atrophied. In the intercostal scan, the gallbladder mimicked a perihepatic fluid. In the floating gallbladder group (one patient), the gallbladder was imaged as a cystic mass in the anterior abdominal wall. Surgical intervention showed a severely inflamed gallbladder, with small stones adhered into the anterior abdominal wall and partially ruptured. Knowledge of the wide range of US findings of malposition of the gallbladder helps in avoiding misdiagnosis.

Radiologic and pathologic correlation of adenomyomatosis of the gallbladder.

Hwang JI. Chou YH. Tsay SH. Chiang JH. Chang CY. Boland GW. Mueller PR.
Department of Radiology, Veterans General Hospital-Taipei and National Yang-Ming University, 201, Shih-Pai Road, Section 2, Taipei, Taiwan 11217, Republic of China.
BACKGROUND: To demonstrate the radiologic-pathologic correlation of adenomyomatosis of gallbladder (GBA) and emphasize the role of high-resolution real-time ultrasound (RTUS) in the diagnosis of GBA. METHODS: Ten (four male and six female, mean age = 49 years) patients with proven GBA (three diffuse, three segmental, and four fundal) diagnosed by histopathology or confirmed by oral cholecystography (OCG) were reviewed. Radiologic studies included OCG (n = 8), RTUS (n = 8), and computed tomography (CT; n = 4). Six patients subsequently underwent cholecystectomy. RESULTS: Histopathologic correlation between pathologic specimens and OCG, RTUS, and CT was possible in six patients. The diagnostic criteria with ultrasound included numerous tiny intramural cysts containing echogenic foci with reverberation artifacts and associated segmental or diffuse gallbladder wall thickening. OCG with fatty meal demonstrated intramural diverticula. Localized fundal GBA was better visualized on RTUS and CT scan than on OCG. CONCLUSION: Accurate diagnosis of GBA may be made by either OCG or high-resolution RTUS preoperatively. CT scan may used as an alternative method to help make the diagnosis in equivocal cases.

Retroperitoneal edema: sonographic mimic of retroperitoneal fluid collection.

Wachsberg RH. Singh-Panghaal S.
Department of Radiology, University Hospital and New Jersey Medical School, 150 Bergen Street, Room C-320, Newark, NJ 07103, USA.
BACKGROUND: The sonographic finding of an anechoic retroperitoneal abnormality suggests a fluid collection (e.g., abscess, urinoma, hematoma). Our study was performed to evaluate cases in which this sonographic finding appeared to be a manifestation of systemic edema. SUBJECTS AND METHODS: Inpatient sonograms performed over a 40-month period were reviewed for the presence of anechoic areas suggestive of fluid collection in the retroperitoneum of the flank. Records of patients with such findings were reviewed for evidence of retroperitoneal abscess, urinoma, or hemorrhage, as well as for the presence and cause(s) of peripheral edema. RESULTS: Of the 29 patients identified with sonographic findings suspicious for retroperitoneal fluid collection, 13 (45%) had no cause for and no clinical evidence of focal retroperitoneal collection. All 13 patients had peripheral edema attributable to hypoalbuminemia, congestive heart failure, overhydration, cirrhosis, and/or the systemic inflammatory response (multiple organ failure) syndrome. Resolution of the retroperitoneal abnormality following therapy for congestive heart failure was documented in one case, and CT scan confirmed retroperitoneal edema in another. CONCLUSION: Anechoic regions that represent edema can be seen on sonograms of the retroperitoneum in patients with conditions that cause edema in other regions. The possibility of edema mimicking a fluid collection should be particularly considered prior to invasive procedures in the retroperitoneum.

Adult Crohn disease: can ileoscopy replace small bowel radiology?

Year 1998
Halligan S. Saunders B. Williams C. Bartram C.
Intestinal Imaging Centre, St. Mark's Hospital, Harrow, Middlesex, UK.
BACKGROUND: This study aimed to document the radiological features and distribution of small bowel Crohn disease (CD) in adults by using a barium follow-through (BaFT) technique and to determine whether disease would be missed or its distribution underestimated if only colonoscopy with ileoscopy were performed. METHODS: The BaFT examinations of 121 adults with proven CD were reviewed retrospectively with respect to the stage and distribution of disease. Colonoscopy with attempted ileoscopy was performed in 37 of these subjects, and the results were compared with radiological findings. RESULTS: A normal villous pattern was visualized in 89 studies (74%). BaFT showed small bowel CD in 71 (59%) of 121 patients studied. The terminal ileum (TI) was the most common site of disease, affecting 62 (87%) of patients with small bowel CD. Forty-six patients (65%) had more proximal small bowel disease, including nine (13%) with a normal TI. BaFT showed early mucosal changes of CD in 52 subjects (73%), which was the sole manifestation in 15 (21%). Ileoscopy was possible in the majority of patients colonoscoped but was not achieved in 14 (38%), nine of whom had CD on BaFT. Of the 23 patients in whom ileoscopy was performed, findings agreed with BaFT assessment of the TI in 22. CONCLUSION: BaFT adequately demonstrates the stage and extent of small bowel CD. The majority of patients with small bowel CD have disease proximal to the TI, which cannot be diagnosed by ileoscopy.

Jejunal arteriovenous malformation, diagnosed by angiography and treated by embolization and catheter-guided surgery: case report and review of literature.

Year 1998
Defreyne L. Verstraeten V. De Potter C. Pattyn P. De Vos M. Kunnen M.
Department of Radiology and Medical Imaging, University Hospital of Gent, Belgium.
A case of chronic gastrointestinal hemorrhage caused by a small jejunal arteriovenous malformation (AVM) is reported. Treatment by endovascular embolization was temporarily successful. Subsequently, the patient underwent laparoscopic resection, guided by intraoperative catheter localization with methylene blue. Histopathology confirmed a true AVM. Eighteen months after treatment, the patient is free of symptoms. Literature of jejunal AVMs is reviewed.

CT of large small-bowel diverticulum.

Year 1998
Chou CK. Mak CW. Hou CC. Chang JM.
Department of Radiology, Chi Mei Foundation Hospital, Tainan, Taiwan, Republic of China.
The previous reports concerning the computed tomographic (CT) appearances of small bowel diverticulum are usually limited to those of diverticulitis. We present the CT findings of uncomplicated, large small bowel diverticulum in five patients. An interesting coexistence of large small bowel diverticulum and small bowel volvulus will be mentioned. Four patients had recurrent abdominal pain in the past 2 years.

Adenocarcinoma arising in colonic duplication cysts with calcification: CT findings of two cases.

Year 1998
Inoue Y. Nakamura H.
Department of Radiology, Minoo City Hospital, Osaka, Japan.
We report the computed tomographic findings of mucinous adenocarcinoma with calcification arising from duplication cyst of the colon in two adult cases. In both cases, serum levels of carcinoembryonic antigen (CEA) were high. Differential diagnosis of intraperitoneal or retroperitoneal cystic tumors with mucinous density includes duplication cyst, and its malignant change should be considered when serum level of CEA is high.

Utility of flexible sigmoidoscopy as an adjunct to double-contrast barium enema examination.

Year 1998
Cheong Y. Farrow R. Frank CS. Stevenson GW.
Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada.
BACKGROUND: There is controversy regarding the most appropriate investigation for suspected colorectal carcinoma. We offered these patients same-day flexible sigmoidoscopy (FS) and double-contrast barium enema (DCBE). METHODS: We reviewed the results of 117 consecutive adult patients. All patients underwent FS followed by DCBE on the same day. The radiographs were reviewed by two of the authors who were blinded to the clinical information, flexible sigmoidoscopy reports, and the original DCBE report. RESULTS: One hundred seventeen patients made up the study population. Thirty-four of the 117 patients had polyps and/or carcinoma. Three malignant tumours were detected by DCBE; one of these was also seen on FS, and the other two cancers were out of FS range. Fifty-three polyps were found by FS; nine were removed by biopsy prior to the enema examination. Of the 44 remaining polyps, DCBE failed to detect 87% of the 0-9-mm group and 67% of the >9-mm group. Ten polyps were seen only on DCBE; seven of these 10 were beyond the range of the sigmoidoscope, and the three remaining polyps were less than 5 mm. CONCLUSION: DCBE is insensitive in the detection of rectosigmoid polyps. FS should continue to be used as a complementary examination to DCBE in the investigation of suspected colorectal carcinoma.

Prospective evaluation of colonic obstruction with computed tomography.

Year 1998
Frager D. Rovno HD. Baer JW. Bashist B. Friedman M.
Columbia University College of Physicians and Surgeons, St. Luke's/Roosevelt Hospital Center, Department of Radiology, New York, NY 10019, USA.
BACKGROUND: To determine whether computed tomography (CT) can satisfactorily diagnose and evaluate patients with suspected colonic obstruction. METHODS: Seventy-five patients with suspected colonic obstruction were evaluated prospectively by CT and compared with the gold standards of surgery and/or endoscopy in 65 patients, clinical course in nine, and contrast enema (CE) in one. A limited comparison between CT and CE (26) patients was also made in those patients who had both studies. RESULTS: CT successfully diagnosed colonic obstruction in 45 of 47 patients (96% sensitivity). Pseudo-obstruction was correctly diagnosed in 26 of 28 patients (93% specificity). CT correctly localized the point of obstruction in 44 of 47 patients (94%). CE successfully diagnosed obstruction in only 20 of 25 patients (80% sensitivity). CONCLUSION: In this study, CT proved to be a satisfactory modality in evaluating patients with suspected colonic obstruction. CT may in certain circumstances be preferable to the traditional CE in evaluating these patients.

Abdominal CT in familial Mediterranean fever: a case report.

Year 1998
Wikstrom M. Wolf A. Birk D. Brambs HJ.
Department of Diagnostic Radiology, University Hospital of Ulm, Germany.
In order to clarify abnormal findings at abdominal ultrasound (suspicion of late abscess subsequent to appendectomy) in a young male patient with known familial Mediterranean fever (FMF), a helical CT examination of the abdomen was performed. At CT, extensive serositis of the lower abdomen was detected. Findings at CT were verified 2 weeks later at laparoscopy.

Hepatic involvement in hypereosinophilic syndrome: value of portal venous phase imaging.

Year 1998
Cha SH. Park CM. Cha IH. Kim HJ. Lee DH. Baek SY. Kim PN. Ha HK.
Department of Radiology, An San Hospital, Korea University College of Medicine, An San City, Kyung Ki Do.
US, portal venous phase CT, and MRI-CSE (MRI with conventional spin-echo sequence) findings in three cases of hepatic involvement in hypereosinophilic syndrome are presented. These showed varied imaging findings, but portal venous phase CT showed multiple, poorly marginated, and hypodense hepatic lesions in all three cases. The result suggested that portal venous phase CT is the optimal method for depicting hepatic involvement.

Magnetic resonance imaging of an angiomyolipoma of the liver.

Year 1998
Sakamoto Y. Inoue K. Ohtomo K. Mori M. Makuuchi M.
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
A case of hepatic angiomyolipoma and its imaging features are presented. Computed tomography of the liver showed a low-density mass without obvious fat. T1-weighted magnetic resonance images revealed a low-signal-intensity mass containing some tiny high-signal-intensity foci. One of the high-signal-intensity foci was found by histology to represent the fat component of the tumor.

Fluid-fluid levels within focal hepatic lesions: imaging appearance and etiology.

Year 1998
Soyer P. Bluemke DA. Fishman EK. Rymer R.
Department of Body and Vascular Imaging, Hopital Lariboisiere AP-HP, Paris, France.
PURPOSE: To report our experience with fluid-fluid levels within focal hepatic lesions and determine if this finding indicates a specific diagnosis. MATERIALS AND METHODS: We reviewed our experience with eight patients with focal hepatic lesions that showed fluid-fluid level on cross-sectional imaging. Seven CT scans, four MR examinations, and four sonograms were reviewed. The hepatic lesions included metastases (four patients), biliary cystadenoma (two patients), cavernous hemangioma (one patient), and hematoma (one patient). A histologic diagnosis was made in all cases. RESULTS: Fluid-fluid levels were found in both malignant and benign focal hepatic lesions. Fluid-fluid levels were seen on six CT scans, four MR examinations and on none of the four sonograms. Radiologic-pathologic correlation showed that fluid-fluid levels corresponded to internal hemorrhage in all but one case. In the case of cavernous hemangioma, a fluid-fluid level was found to correspond to a sedimentation effect within a large vascular space. CONCLUSION: Fluid-fluid levels in focal hepatic lesions do not indicate a specific diagnosis but can be seen in both malignant and benign conditions affecting the liver.

Intrahepatic venous collaterals.

Year 1998
Naganuma H. Ishida H. Konno K. Komatsuda T. Hamashima Y. Ishida J. Masamune O.
First Department of Internal Medicine, Akita University School of Medicine, Hondo, Japan.
BACKGROUND: The aim of this study was to reevaluate the causes and sites of intrahepatic venous collaterals and to determine the role of color Doppler sonography in the diagnosis of this relatively rare vascular abnormality. METHODS: Real-time color Doppler sonography was used to study 21 patients with intrahepatic venous collaterals. The cause, distribution, and clinical manifestations of collaterals were determined, and Doppler waveforms obtained from the collaterals were also analyzed. RESULTS: First, the causes of intrahepatic venous collaterals were divided roughly into two groups according to the presence or absence of veno-occlusions. The former group included liver tumors (six cases), primary Budd-Chiari syndrome (five cases), and metastatic adrenal tumors invading the inferior vena cava (two cases). The latter group consisted of diaphragmatic hernia (three cases), Osler-Weber-Rendu disease (two cases), and congestive liver (one case). The cause was not determined in two cases. Second, venous collaterals were distributed throughout the entire liver in primary Budd-Chiari syndrome but localized in the other cases. Third, Doppler waveforms of the collaterals were divided into two patterns: flat flow and multiphasic flow. Flat flow pattern was seen in patients with veno-occlusive diseases, and multiphasic flow pattern was seen in patients without veno-occlusive disease. CONCLUSION: The relationship between intrahepatic venous collaterals and veno-occlusive diseases has been emphasized in the literature, but the results of our series showed that they occurred under a wide variety of conditions, even without veno-occlusive diseases, including diaphragmatic hernia and Osler-Weber-Rendu disease. The analysis of the Doppler waveforms of the collaterals was useful in differentiating those due to veno-occlusive diseases and those not.

CT imaging of biliary enteric fistula.

Year 1998
Shimono T. Nishimura K. Hayakawa K.
Department of Radiology, Kyoto City Hospital, Kyoto, Japan.
BACKGROUND: To define the signs useful for differentiating between gallbladder-enteric fistula (GB-EF) and common bile duct-enteric fistula (CBD-EF) on computed tomography (CT) because the prognosis and management of the two are different. METHODS: CT scans in 13 patients with pneumobilia, who had not had surgical biliary-enteric anastomosis and endoscopic sphincterotomy, were reviewed. The presence of fistula itself, the location of air in the biliary system, and the appearance of the gallbladder were assessed. RESULTS: The causes of pneumobilia were GB-EF in seven patients, CBD-EF in three patients, emphysematous cholecystitis (EC) in one patient, gallbladder cancer (GBC) in one patient, and incompetent sphincter of Oddi in one patient. In three of seven GB-EF patients (43%) and in none of the three CBD-EF patients (0%), the fistula itself was detected. Air was detected in the common bile duct in four of seven GB-EF (57%) and in all three CBD-EF (100%) patients, and GBC. In six of seven GB-EF (86%) and in one of three CBD-EF (33%) patients, the gallbladder was contracted. Thus, the location of air and the contraction of gallbladder were useful signs to differentiate GB-EF from CBD-EF. CONCLUSION: CT can distinguish between GB-EF and CBD-EF.

Obstructive jaundice caused by lymphangitis carcinomatosa of bile duct wall from gastric carcinoma.

Year 1998
Gabata T. Matsui O. Kadoya M. Yoshikawa J. Ueda K. Kawamori Y. Takashima T. Nagakawa T. Kayahara M.
Department of Radiology, Kanazawa University, School of Medicine, Kanazawa City, Japan.
We report a case of advanced gastric carcinoma presenting with obstructive jaundice. Computed tomography showed marked lymphadenopathy in the hepatoduodenal ligament and concentric bile duct wall thickening. Histologically, extrahepatic bile duct wall was thickened due to submucosal lymphangitic spread of gastric carcinoma (lymphangitis carcinomatosa). Lymphangitis carcinomatosa may be considered when extrahepatic bile duct wall thickening is seen in patients with obstructive jaundice.

Portal vein calcification and associated biliary stricture in idiopathic portal hypertension (Bantis syndrome).

Year 1998
Pickhardt PJ. Balfe DM.
Mallinckrodt Institute of Radiology, Washington University Medical Center, St. Louis, MO 63110, USA.
We present a case of dense portal vein calcification with secondary extrahepatic biliary stricture and cholangitis in an adult patient diagnosed with idiopathic portal hypertension at age three. Biliary ductal dilation proximal to echogenic shadowing foci near the porta hepatis mimicked choledocholithiasis on sonographic examination. Portal vein calcification and biliary stricture from portal venopathy each represent rare findings. The obstruction was successfully managed with biliary stenting.

CT diagnosis of perihepatic endometriosis complicated by malignant transformation.

Year 1998
Weinfeld RM. Johnson SC. Lucas CE. Saksouk FA.
Department of Radiology, Wayne State University School of Medicine, Hutzel Hospital, Detroit, MI 48201, USA.
Endometriosis is a condition in which endometrial tissue becomes implanted on extrauterine sites, most commonly within the pelvis. Malignant transformation of endometriotic foci is rare, but has been frequently reported. We describe a patient with a CT scan demonstrating pathologically proven perihepatic endometriosis, including malignant transformation. Endometrioses should be considered in the differential diagnosis of perihepatic masses.

Lymphoepithelial cysts of the pancreas: CT and sonographic findings.

Year 1998
Kim YH. Auh YH. Kim KW. Lee MG. Kim KS. Park SY.
Department of Diagnostic Radiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
Two cases of rare lymphoepithelial cyst (LEC) of the pancreas are presented. Although the histogenesis of this lesion is not known, it can be histologically differentiated from other pancreatic and retropancreatic cysts. The importance of its recognition is in the distinction from cystic neoplasm of the pancreas.

Primary carcinoid tumor of the pancreas.

Year 1998
Hiller N. Berlowitz D. Fisher D. Blinder G. Hadas-Halpern I.
Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel.
Serotonin-secreting (carcinoid) tumors of the pancreas are very rare. There are only 13 cases reported since 1963. Liver metastases have not previously been described. We present two patients with primary carcinoid tumor of the pancreas, which metastasized to the liver. These patients differ in their clinical and radiological appearance. Carcinoid tumor should be considered in the differential diagnosis of a pancreatic mass in a patient with carcinoid syndrome, but lack of this syndrome does not exclude the diagnosis.

Peliosis of the spleen: splenic rupture with intraperitoneal hemorrhage.

Year 1998
Shimono T. Yamaoka T. Nishimura K. Naya M. Hojo M. Yamamoto E. Mukaihara S. Hayakawa K.
Department of Radiology, Kyoto City Hospital, Japan.
Peliosis is a rare disease that is characterized by multiple blood-filled cystic spaces. We report the computed tomographic findings of splenic rupture secondary to splenic peliosis in a patient receiving anabolic steroids for aplastic anemia.

Ultrasonographic evaluation of the cervical lymph nodes in preoperative staging of esophageal neoplasms.

Year 1998
Doldi SB. Lattuada E. Zappa MA. Cioffi U. Pieri G. Massari M. De Simone M. Peracchia A.
Department of General and Oncologic Surgery, Padiglione Monteggia, Ospedale Maggiore Policlinico, Milan, Italy.
Background: The detection of cervical lymph node metastases plays an important role in staging of patients affected by esophageal cancer to perform the best therapeutic approach.Methods: We report our experience concerning the ultrasound evaluation of the cervical area in 174 patients with esophageal cancer. Ultrasonographic evaluation of the neck can be done with a 7.5- or 10 MHz transducer in all cases, with selective scanning of the lymph node chains of the internal jugular veins and supraclavicular regions. The short-to-long axis ratio (S/L) was a useful way to detect lymph node metastasis. Histopathologic diagnoses were obtained by sonographically guided fine-needle aspiration biopsy.Results: At ultrasound examination, we found 18 (10.3%) patients with metastatic cervical nodes. Of these, 17 (94.4%) had metastatic cervical lymph nodes confirmed by cytology from fine-needle biopsy. Lymph node exceeding 5 mm in long axis and with an S/L over 0.5 showed a higher incidence of metastasis than those with an S/L under 0.5. Our experience shows a high incidence of lymph node metastases in patients with esophageal cancer localized to the thoracic supracarinal tract and in patients with cervical and lower esophageal cancer.Conclusion: In the ultrasound evaluation of nodes, the most useful parameters are size of nodes, heterogeneity of internal echoes, morphology of the margins, and the deformation caused by compressive instrumental manipulation. These criteria, indicated by the Japanese Society for Esophageal Diseases, yield a high sensitivity and diagnostic specificity when the ultrasonographic studies are performed.

Bilateral paraduodenal hernias: computed tomography and magnetic resonance imaging appearance.

Year 1998
Oriuchi T. Kinouchi Y. Hiwatashi N. Maekawa H. Watanabe H. Katsurashima Y. Toyota T.
Third Department of Internal Medicine, Tohoku University School of Medicine, Sendai, Japan.
Paraduodenal hernias are rare congenital malformations. We report an unusual case of bilateral paraduodenal hernias diagnosed preoperatively by small bowel series, computed tomography (CT), and magnetic resonance imaging (MRI). Both CT and MRI are useful in the noninvasive diagnosis of paraduodenal hernias.

Use of methylcellulose in small bowel follow-through examination: comparison with conventional series in normal subjects.

Year 1998
Ha HK. Park KB. Kim PN. Lee M. Hong WS. Yang S. Lee SK. Kim MH. Suh DJ. Min YI. Auh YH.
Department of Radiology, Asan Medical Center, University of Ulsan Medical College of Medicine, Seoul, Korea.
Background: To evaluate and optimize a modified small bowel follow-through examination (SBFT) by using an oral administration of a large amount (600 mL) of methylcellulose after taking a small amount of barium.Methods: Ninety-nine normal subjects underwent modified SBFT with an oral administration of 600 mL of 0.5% methylcellulose after taking 100 mL of 120% or 100, 150, or 200 mL of 70% w/v barium. The transradiancy and distensibility of the bowel and the transit time were compared with those of 39 other normal subjects who underwent conventional SBFT with 500 mL of 70% w/v barium.Results: Except for two subjects who developed diarrhea immediately after examination, no patients complained of acute symptoms, such as abdominal pain or vomiting. Modified SBFT was much superior to conventional series for obtaining good bowel transradiancy and rapid transit time (range = 37-49 min), but bowel distention was not significantly improved. The use of 150 mL of 70% w/v barium was better than the other three modified techniques for achieving good bowel transradiancy, rapid transit time, and less occurrence of flocculation.Conclusion: Modified SBFT is a simple method for easily improving the image quality in terms of bowel transradiancy and transit time.

Eosinophilic gastroenteritis: percutaneous biopsy under ultrasound guidance.

Year 1998
Marco-Domenech SF. Gil-Sanchez S. Jornet-Fayos J. Ambit-Capdevila S. Gonzalez-Anon M.
Servicio de Radiologia, Hospital General de Castello, Spain.
Eosinophilic gastroenteritis (EG) is an unusual disorder that is characterized by diffuse or scattered eosinophilic infiltration of the digestive tract. The diagnosis is based on histology obtained by capsule, endoscopic, laparoscopic, or laparotomy biopsy. The eosinophilic infiltration produces thickening of the small bowel wall that can be observed by using sonography. The appearance produces the pseudokidney sign that can be used to guide biopsy. We report the first case of EG diagnosed by percutaneous biopsy under ultrasound guidance.

Mucocele of the appendix: ultrasonographic and CT findings.

Year 1998
Kim SH. Lim HK. Lee WJ. Lim JH. Byun JY.
Department of Radiology, Samsung Medical Center, College of Medicine, Sung Kyun Kwan University, Seoul, Korea.
Background: Mucocele of the appendix is a rare disease entity, but preoperative diagnosis is very important. With the advent of ultrasonography (US) and computed tomography (CT), it has been possible to preoperatively diagnose mucocele of the appendix. We describe the spectrum of US and CT findings of mucocele of the appendix and the differential points from mimicking diseases. Methods: We evaluated 17 patients with pathologically proven mucocele of the appendix by using US and CT. Pathologic diagnoses of 17 patients were mucinous cystadenoma in 11 patients, mucinous cystadenocarcinoma in two, and mucosal hyperplasia in four. We analyzed morphologic characteristics of mucocele of the appendix at US and CT.Results: The typical US finding were a cystic mass with variable internal echogenicity, layered wall, and calcification in the wall. The CT finding was a well-encapsulated cystic mass with a wall of variable thickness. Both cases with focal nodular solid enhancing portion in the wall on CT were pathologically proven as mucinous cystadenocarcinoma.Conclusion: US and CT were useful methods in diagnosing mucocele of the appendix and differentiating this condition from mimicking diseases. Nodular enhancing lesion in the wall of the mucocele may be a finding suggestive of malignant cause of mucocele.

Urinary excretion of orally ingested gastrografin on CT.

Year 1998
Apter S. Gayer G. Amitai M. Hertz M.
Department of Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel
Renal excretion of orally ingested gastrografin has rarely been reported on computed tomography (CT). We studied the unenhanced scans of 82 patients with bowel disorders or perforation to assess the prevalence of urinary contrast material (CM) in various bowel diseases. We also assessed the clinical significance of this sign. In addition, we reviewed the unenhanced CT scans of 100 randomly selected patients without bowel diseases as a control group. Twenty-nine of the 58 patients with bowel diseases, six of nine with free perforation, and one of 15 with covered perforation had CM in the urinary tract. None of the 100 without bowel disease showed urinary CM. Statistical analysis was done by using the Fisher's exact test. The prevalence of urinary CM was highest in inflammatory bowel disease, radiation enteritis, and free perforation (p < 0. 0001). This study shows that the CT finding of orally ingested gastrografin in the urinary tract differentiates patients with bowel disease from those without.

Examination techniques for endosonography of the anal canal.

Year 1998
Frudinger A. Bartram CI. Halligan S. Kamm M.
Intestinal Imaging, St Mark's Hospital, Northwick Park, United Kingdom.
Background: To determine whether patient position or sphincter contraction influences sphincter thickness or defect assessment. Methods: Anal endosonography was performed on 35 consecutive patients (30 women, five men). Twenty-five were scanned in the left lateral and prone positions, and the internal sphincter thickness was measured. In 10 patients, the internal sphincter, longitudinal muscle, external sphincter, and length of any defect were measured at rest and during anal squeeze.Results: There was no significant difference in internal sphincter thickness measured in the prone and left lateral positions (95% limits of agreement, -0.12 to 0.06). The thickness of the internal sphincter, longitudinal muscle, and external sphincter at rest did not change significantly during straining (95% limits of agreement, -0.44 to 0.3, -0.28 to 0.24, and 0.33 to 0.71, respectively). The squeeze maneuver did not influence defect appearance or length (95% limits of agreement, -2.845 to 2. 379). Greater symmetry of the anterior part of the external sphincter and improved visualization of perineum was achieved in the prone position.Conclusion: Examination in the prone position is preferred. Squeeze maneuvers are of no diagnostic benefit.

CTAP in budd-chiari syndrome: evaluation of intrahepatic portal flow.

Year 1998
Ueda K. Matsui O. Kadoya M. Yoshikawa J. Gabata T. Kawamori Y. Takashima T.
Department of Radiology, Kanazawa University School of Medicine, Kanazawa, Japan.
Background: To assess the intrahepatic portal flow in patients with Budd-Chiari syndrome (BCS) by computed tomography (CT) during arterial portography (CTAP).Methods: Five patients with BCS [with (n = 3) and without (n = 2) inferior vena cava (IVC) obstruction] underwent both CTAP and postcontrast CT following CTAP. CTAP and postcontrast CT after angioplasty were also performed in one patient. Findings on CTAP and postcontrast CT were analyzed retrospectively. Results: Patients with IVC obstruction and a patent large hepatic vein showed homogeneous hepatic enhancement on CTAP. Patients without IVC obstruction and with no patent large hepatic veins showed heterogeneous hepatic enhancement, which consisted of patchy enhancement and more definite enhancement in the central part of the liver. On postcontrast CT, the patchy enhancement was enlarged compared with that on CTAP in these patients. The heterogeneous hepatic enhancement became homogeneous in the patient who underwent angioplasty.Conclusion: We suggest that the more marked the blood congestion, the more heterogeneous the hepatic enhancement becomes on CTAP. Heterogeneous hepatic enhancement on CTAP is seen in such cases without any patent hepatic veins.

Delayed MR imaging of the liver: correlation of delayed enhancement of hepatic tumors and pathologic appearance.

Year 1998
Gabata T. Matsui O. Kadoya M. Yoshikawa J. Ueda K. Kawamori Y. Takashima T. Nonomura A.
Department of Radiology, Kanazawa University, School of Medicine, Kanazawa City, Japan.
Background: The value of delayed magnetic resonance (MR) imaging (6 min) and ultradelayed MR imaging (1-4 h) for differentiating of hepatic tumors was studied.Methods: Postcontrast delayed and ultradelayed MR images were obtained after administration of 0.1 mmol/kg of Gd-DTPA in 30 patients with various malignant hepatic tumors.Results: Delayed enhancement in the center of the tumors was seen in 13 patients on the delayed MR images and in 22 patients on the ultradelayed MR images. On the ultradelayed images, peripheral hypointense rim was seen in 12 patients and central focal hypointense area was seen in eight patients. Pathologically, the portion showing delayed enhancement corresponded to abundant fibrous stroma, the hypointense rim to rich proliferation of tumor cells, and the central hypointense areas to coagulative necrosis. Conclusion: Ultradelayed MR imaging can characterize different tissue components within various hepatic tumors.

Cryotherapy of metastatic carcinoid tumors.

Year 1998
Shapiro RS. Shafir M. Sung M. Warner R. Glajchen N.
Department of Radiology, Mount Sinai School of Medicine of the City University of New York, NY 10029-6574, USA.
Background: To describe the use of hepatic cryotherapy to treat patients with symptomatic carcinoid metastates.Methods: Hepatic cryotherapy was performed on five patients with carcinoid syndrome resulting from metastatic carcinoid tumors. Intraoperative ultrasound was used to guide the cryotherapy and to assess the adequacy of freezing.Results: All five patients had relief of the carcinoid syndrome after treatment. In four of the five patients, the relief was prolonged (>3 months); in one patient, the relief of symptoms was transient (2 months). Four of five patients had a transient reduction in hormonal tumor markers (the fifth patient did not have hormonal-level follow-up). During a follow-up period of 2.5 years, four of the five patients died. The 6-month survival rate was 80%, the 1-year survival rate was 60%, the 2-year survival rate was 40%, and the 2.5-year survival was 20%. One patient is alive 30 months after treatment.Conclusion: Hepatic cryotherapy can provide symptomatic relief for patients with hepatic metastates producing the carcinoid syndrome.

Pseudoaneurysm secondary to pancreatitis presenting as GI bleeding.

Year 1998
Waslen T. Wallace K. Burbridge B. Kwauk S.
Department of Medical Imaging, Saskatoon, Canada.
Pseudoaneurysm formation is a rare but potentially dev approximately astating complication of pancreatitis. It can be diag approximately nosed by using various imaging modalities including computer tomography, ultrasound, and angiography and should be entertained in any patient with a history of pancreatitis. We present the imaging findings in three patients with pseudoaneurysm formation secondary to pancreatitis who initially presented with gastrointestinal bleeding.

Modified intra-arterial calcium stimulation with venous sampling test for preoperative localization of insulinomas.

Year 1998
Defreyne L. Konig K. Lerch MM. Hesse UJ. Rottiers R. Feifel G. de Hemptinne B. Kramann B. Kunnen M.
Radiologie en Medische Beeldvorming, Vasculaire en Interventionele Radiologie, Universitair Ziekenhuis Gent, Belgium.
Background: To determine the accuracy and safety of a modified intra-arterial calcium stimulation with the venous sampling test (ASVS) for preoperative localization of insulinomas. Modification included stimulation with a fixed low dose of calcium gluconate, additional stimulation in the distal splenic artery, and no insulin sampling in the left hepatic vein.Methods: In 10 patients showing biochemical evidence of organic hyperinsulinemia, 0.45 mmol of Ca2+ was injected into the gastroduodenal, superior mesenteric, proper hepatic, proximal, and distal splenic arteries during angiography. Insulin levels were measured in samples taken from the right hepatic vein before and 30, 60, 90, 120, 180, and 300 s after Ca2+ injection. Results: Insulin gradients with an increase of more than fourfold indicated direct tumor supply, two- to fourfold correlated with collateral supply, and less than twofold correlated with normal tissue vascularization. ASVS localized all the adenomas of the pancreatic head (n = 3) and body (n = 2) and two of four adenomas of the tail correctly, as confirmed by surgery. Two adenomas of the proximal pancreatic tail were erroneously localized to the body segment, but the fault was rectified by angiography. In one patient with a negative ASVS and without exploration, the diagnosis of an insulinoma was revised.Conclusion: ASVS with a fixed low dose of calcium gluconate is a highly accurate and safe method for preoperative localization of insulinomas. Sampling in the left hepatic vein can be routinely omitted. Additional stimulation in the distal splenic artery seems helpful in surgical decision making, but additional experience is needed.

CT appearance of ectopic pancreas: a case report.

Year 1998
Wang C. Kuo Y. Yeung K. Wu C. Liu G.
Department of Radiology, Kaohsiung Medical College, Taiwan, Republic of China.
The appearance of ectopic pancreas on computed tomography (CT) is described in a 47-year-old man with bowel obstruction. The enhancement pattern of ectopic pancreas after intravenous iodine contrast administration is the same as that of leiomyoma or carcinoid. This CT finding has not been reported previously to our knowledge.