Localized fibrous tumor of the liver: imaging findings.
Lecesne R. Drouillard J. Le Bail B. Saric J. Balabaud C. Laurent F.
Service d'Imagerie Medicale-Radiologie Diagnostique et Therapeutique, Hopital du Haut-Leveque, CHU Bordeaux, Avenue de Magellan, F-33604 Pessac, France.
We report the imaging of a localized fibrous tumor of the liver, focusing on color Doppler US, CT, MR imaging, and angiographic findings. We discuss the differential diagnosis of such a rare, benign lesion of the liver. Detailed imaging of this tumor has not been reported in the literature previously.
Evaluation of the vascular pattern of hepatocellular carcinoma with dynamic computed tomography and its use in identifying optimal temporal windows for helical computed tomography.
Pacella CM. Bizzarri G. Anelli V. Valle D. Fabbrini R. Bianchini A. Fenderico P. Rossi Z.
Department of Radiology and Diagnostic Imaging, Regina Apostolorum Hospital, Via San Francesco, 50, I-00041 Albano L., Rome, Italy.
The aim of this work was to study the vascularization of hepatocellular carcinoma (HCC) by means of dynamic CT and to demonstrate the existence of optimal temporal windows for visualization of HCC in order to develop new protocols for helical CT of the liver. We studied, by means of dynamic CT, 42 histologically proved HCCs in 30 patients after injecting contrast medium (100 ml, 3 ml/s). We performed a time-density analysis of the aorta, liver, portal vein, spleen and lesion. We identified three temporal curves of attenuation of the neoplastic tissue. Curve 1 was three-phasic: hyperattenuation, isoattenuation and hypoattenuation; curve 2 was two-phasic: hyperattenuation and isoattenuation; curve 3 was two-phasic: isoattenuation and hypoattenuation. Thirty-two lesions were homogeneous (curve 1 in 22 cases, 68.7 %; curve 2 in 7 cases, 21.8 %; curve 3 in 3 cases, 9.4 %), whereas 10 lesions were non-homogeneous. Two optimal temporal windows were identified: the first, with predominantly hyperattenuating lesions (range 29-65 s, 90.4 % sensitivity); the second, with predominantly hypoattenuating lesions (range 132.1-360 s, 76.1 %). There is an interposed time range of reduced visualization (range 62-127 s, 54.7 %) in which lesions are isoattenuating. Combined CT study during the first and second temporal windows improves the detection of HCCs especially for homogeneous and small lesions. The intermediate isoattenuation time range does not increase lesion detection rate.
Assessment of resectability of pancreatic cancer with dynamic contrast-enhanced MR imaging: technique, surgical correlation and patient outcome.
Spencer JA. Ward J. Guthrie JA. Guillou PJ. Robinson PJ.
Department of Radiology, St. James's University Hospital, Leeds LS9 7TF, UK.
The aim of our work was to investigate the use of a dynamic contrast-enhanced MR (DCEMR) technique for staging apparently localised pancreatic cancer, and to determine the patterns of tumour and vascular enhancement with this technique. Thirty-five consecutive patients were examined. The MR findings were correlated with surgical findings in 13 patients and with clinical outcome in 22 patients. Breath-hold gradient-echo fast low angle shot (TR = 100, TE = 4, flip angle 80 degrees ) acquisitions were obtained at 10 and 40 s (right anterior coronal oblique plane) and at 90 s (axial plane) following intravenous gadolinium. Mean contrast-to-noise ratio was higher on the first than the second acquisition (p < 0. 001) and higher on the second acquisition than the third (p < 0.005). Tumour conspicuity was greatest and arterial anatomy was best demonstrated on the first acquisition and the portal venous anatomy on the second. Small tumours were isointense by the third acquisition. Maximal intensity projections were helpful. The MR findings correctly predicted the surgical findings in 11 of 13 cases (85 %) and the clinical course in the other 22 patients. The DCEMR imaging technique is valuable in the staging of patients with pancreatic cancer. Capillary and portal venous phase images are both required for complete local staging.
Radiological intervention in pancreatic cancer.
Martin DF. England RE. Tweedle DE.
Department of Radiology, South Manchester University Hospitals NHS Trust, Withington Hospital, West Didsbury, Manchester M20 2LR, England.
Pancreatic carcinoma is increasing in its incidence, and despite advances in surgical treatment and chemotherapy, its prognosis remains extremely poor. Realistic therapy is targeted primarily at the relief of obstruction of the biliary tract and the duodenum, as well as the relief of pain. This paper discusses the indications and techniques for palliation and illustrates the critical team approach between radiologist, endoscopist and surgeon.
Magnetic resonance cholangiopancreatography: interest of IV secretin administration in the evaluation of pancreatic ducts.
Nicaise N. Pellet O. Metens T. Deviere J. Braude P. Struyven J. Matos C.
Department of Radiology, Hopital Erasme, Route de Lennik 808, B-1070 Brussels, Belgium.
The aim of this study was to investigate whether IV secretin administration is useful to enhance the delineation of the main pancreatic duct (MPD) and its side branches, and if it provides additional information concerning signal voids and strictures. Twenty-seven patients referred for abdominal pain or laboratory abnormalities (group 1, n = 13) or for the follow-up of chronic pancreatitis (CP; group 2, n = 14) were studied. Magnetic resonance cholangiopancreatography was acquired at 1.5 T before and after IV secretin by a coronal 3D TSE T2-weighted sequence with maximum intensity projection postprocessing. In group 1 secretin provided a better visualization of MPD in 9 patients. In a patient with pancreas divisum, it allowed suggestion of stenosis of the accessory papilla, confirmed at endoscopic retrograde cholangiopancreatography (ERCP). In group 2 secretin provided a better visualization of MPD only in the 3 patients with mild disease. A mild dilation upstream a stricture occurred in 2 cases and a marked dilation appeared upstream a wallstent which was non-patent at ERCP. Few changes were noticed concerning side branches. These preliminary results indicate that in patients without CP, secretin improves MPD delineation avoiding invasive diagnostic ERCP. In patients with mild CP secretin does not improve the characterization of signal voids, but it may be useful to appreciate their significance and to follow-up stenosis.
MRI of the rectum: non-neoplastic disease.
Paley MR. Ros PR.
Department of Radiology, Division of Body Imaging and MRI, University of Florida College of Medicine, P. O. Box 100374, Gainesville, FL 32610, USA.
The rectum has become the most successful area of the gastrointestinal tract to be studied with MRI. Its anatomical location, fixed in the pelvic fat, and its lack of peristalsis, make it an ideal organ to be scanned with MRI. In addition, MRI allows a direct sagittal and coronal display, of key importance to colorectal surgeons whose terminology and approach are based on the coronal plane. The sagittal plane allows the depiction of the relation of the rectum to the sacrum, uterus and prostate, with detail not available by other imaging techniques, and the use of endorectal coils allows excellent demonstration of the rectal wall. Although MRI has been used primarily to study rectal carcinoma, other diseases, congenital, inflammatory and vascular in origin, can be studied using the correct technique.
Renal colic: comparison of spiral CT, US and IVU in the detection of ureteral calculi.
Yilmaz S. Sindel T. Arslan G. Ozkaynak C. Karaali K. Kabaalioglu A. Luleci E.
Department of Radiology, Akdeniz University Medical Faculty, Arapsuyu, TR-07 070 Antalya, Turkey.
The aim of our study was to compare non-contrast spiral CT, US and intravenous urography (IVU) in the evaluation of patients with renal colic for the diagnosis of ureteral calculi. During a period of 17 months, 112 patients with renal colic were examined with spiral CT, US and IVU. Fifteen patients were lost to follow-up and excluded. The remaining 97 patients were defined to be either true positive or negative for ureterolithiasis based on the follow-up data. Sensitivity, specificity, positive and negative predictive value and accuracy of spiral CT, US and IVU were determined, and secondary signs of ureteral stones and other pathologies causing renal colic detected with these modalities were noted. Of 97 patients, 64 were confirmed to have ureteral calculi based on stone recovery or urological interventions. Thirty-three patients were proved not to have ureteral calculi based on failure to recover a stone and diagnoses unrelated to ureterolithiasis. Spiral CT was found to be the best modality for depicting ureteral stones with a sensitivity of 94 % and a specificity of 97 %. For US and IVU, these figures were 19, 97, 52, and 94 %, respectively. Spiral CT is superior to US and IVU in the demonstration of ureteral calculi in patients with renal colic, but because of its high cost, higher radiation dose and high workload, it should be reserved for cases where US and IVU do not show the cause of symptoms.
Imaging of constipation in infants and children.
Division of Pediatric Radiology, Department of Radiology, University Hospital Graz, A-8036 Graz, Austria.
The aims of this review article are to present epidemiology, important definitions, clinical considerations, and etiologic and pathogenetic aspects of constipation in infants and children. Anatomy, physiology, and pathophysiology of the the anorectum are described. Special attention is given to the indications for diagnostic imaging, imaging techniques, and imaging findings with different causes of constipation. Other diagnostic modalities, such as anorectal manometry, electromyography, and biopsy techniques are briefly discussed. The central question as to whether diagnostic imaging is needed for the diagnostic workup of infants and children suffering from constipation can be answered affirmatively. Especially the combination of barium enema or defecography and anorectal manometry allows definition of those infants and children who do not need biopsy and surgery for Hirschsprung's disease. The special role of defecography in this context is underlined.
Giant esophageal polyp: a clinical and radiological entity with variable histology.
Ginai AZ. Halfhide BC. Dees J. Zondervan PE. Klooswijk AI. Knegt PP.
Department of Radiology, University Hospital Dijkzigt and Erasmus University, Dr. Molewaterplein 40, NL-3015 GD Rotterdam, The Netherlands.
Giant pedunculated esophageal polyps are very rare. They may stay asymptomatic for a long time, and first come to the attention of the patient and the clinician after regurgitation into the mouth. Regurgitation, however, can be dangerous and has been known to lead to asphyxia and death due to closure of the larynx by the polyp mass. For this reason resection of the giant polyp is essential when it is discovered. We have seen four cases of giant esophageal polyps (GEP) at our institution. All four patients have undergone removal of the giant polyps. The histological diagnoses were fibrovascular polyp, liposarcoma, hamartoma and multiple lipomas. The mode of clinical presentation, radiological appearances, variable histological diagnoses, and therapy options in these four patients are presented along with a review of the literature.
Groin hernia: can dynamic magnetic resonance imaging be of help?
van den Berg JC. de Valois JC. Go PM. Rosenbusch G.
Department of Diagnostic Radiology, St. Antonius Hospital, Koekoekslaan 1, NL-3435 CM Nieuwegein, The Netherlands.
This technical note describes the use of dynamic MRI in the diagnosis of groin herniations. A review of the anatomy of the groin is presented and 4 representative cases are described. This paper indicates that dynamic MRI can be used to confirm the diagnosis in patients with clinically evident groin herniations.
Murakami R. Tajima H. Kobayashi Y. Sugizaki K. Ogura J. Yamamoto K. Kumazaki T. Egami K. Maeda S.
Department of Radiology, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1, Nagayama, Tama-city, Tokyo, 206, Japan.
Schwannoma is a benign neurogenic tumor arising from the sheath of peripheral nerves. It occurs very rarely in the mesentery, where it is difficult to diagnose. Herein we describe a case in which contrast-enhanced CT and gadolinium-DTPA-enhanced MR showed a locally enhanced well-defined tumor with a cystic component just anterior to the duodenum. These findings corresponded well to the resected specimen.
Pancreatic adenocarcinoma: combination of MR imaging, MR angiography and MR cholangiopancreatography for the diagnosis and assessment of resectability.
Catalano C. Pavone P. Laghi A. Panebianco V. Scipioni A. Fanelli F. Brillo R. Passariello R.
Department of Radiology, II Chair, University of Rome "La Sapienza", V.le Regina Elena, 324, I-00 161 Rome, Italy.
The purpose of this study was to determine the possibility of integrating MR cholangiopancreatography (MRCP) and MR angiography (MRA) to conventional MR images in the diagnosis and assessment of resectability of pancreatic adenocarcinoma. Twenty-three patients with pancreatic adenocarcinoma were prospectively examined with MR. Conventional MR images were acquired in all patients. Three-dimensional MRCP and MRA images were acquired in all patients with suspected biliary and vascular involvement. Acquisition time was less than 45 min in all cases. Images were independently evaluated by two radiologists, with final reading decided by consensus among readers. Diagnosis was confirmed with surgery in 16 patients and with percutaneous biopsy in 7. Concordance among readers was high with a kappa value of 0.83. Pancreatic adenocarcinoma was observed in all patients. Correct assessment of unresectability due to vascular involvement was found in 22 of 23 patients. Biliary obstruction was evident in 13 patients, involving the biliary and pancreatic ducts in 9 and the biliary ducts only in 4. Technical advances permit extensive use of MRI in the evaluation of abdominal pathologies. The combination of MR imaging, MRCP, and MRA can provide sufficient information for the diagnosis and assessment of resectability of pancreatic adenocarcinoma, which otherwise would require three different exams.
Primary epiploic appendagitis: US and CT findings.
Molla E. Ripolles T. Martinez MJ. Morote V. Rosello-Sastre E.
Department of Radiology, Hospital Dr. Peset, C/ Gaspar Aguilar, 90, E-46017 Valencia, Spain.
A retrospective review is presented of seven cases of epiploic appendagitis, with surgical confirmation in one case. The main clinico-analytical data and the US and CT findings are described, as well as the histopathologic features in the sole case that underwent surgical resection. We also calculated the frequency of this entity in patients undergoing emergency abdominal US on clinical suspicion of diverticulitis. In all seven cases the clinico-analytical evidence was nonspecific (localized acute abdominal pain and slight leukocytosis), mimicking in six cases the clinical presentation of sigmoid diverticulitis and in one case that of acute appendicitis. US imaging findings were characteristic: a hyperechoic mass localized under the point of maximum pain, adjacent to the anterior peritoneal wall and fixed during deep breathing. In none of the cases did color Doppler US show flow. CT findings were also typical and showed a mass with a peripheral hyperattenuated rim surrounding an area of fatty attenuation. Overall 7.1 % of patients investigated to exclude sigmoid diverticulitis finally showed findings of primary epiploic appendagitis. Primary epiploic appendagitis thus shows characteristic US and CT findings that allow its diagnosis and follow-up. This entity is much more frequent than previously reported, especially in patients referred for US to exclude sigmoid diverticulitis.
Combined transcatheter arterial chemoembolization and percutaneous ethanol injection for the treatment of large hepatocellular carcinoma: local therapeutic effect and long-term survival rate.
Lencioni R. Paolicchi A. Moretti M. Pinto F. Armillotta N. Di Giulio M. Cicorelli A. Donati F. Cioni D. Bartolozzi C.
Division of Diagnostic and Interventional Radiology, Department of Oncology, University of Pisa, Via Roma 67, I-56 125 Pisa, Italy.
The aim of our study was to investigate local therapeutic effects and long-term results of combined transcatheter arterial chemoembolization (TACE) and percutaneous ethanol injection (PEI) in the treatment of large hepatocellular carcinoma (HCC). Eight-six patients (67 males and 19 females, age range 48-75 years, mean age 65.1 years) with Child-Pugh class A (n = 48) or B (n = 38) liver cirrhosis and a large HCC (main tumor 3.1-8 cm in diameter with no more than two daughter nodules) were enrolled in a prospective study. All patients underwent a single TACE session followed by PEI. Follow-up ranged from 4 to 65 months (mean 27.8 months, median 26 months). No major complication occurred. The local therapeutic effect, as assessed on the basis of findings at CT and MR imaging, was complete response in 71 of 86 patients (82 %) and partial response in 15 of 86. Overall survival rates by the Kaplan-Meier method were 92 % at 1 year, 83 % at 2 years, 69 % at 3 years, 58 % at 4 years, and 47 % at 5 years. Survival of Child-Pugh A patients (75 % at 3 years and 59 % at 5 years) was significantly longer (p < 0.01) than that of Child-Pugh B patients (61 % at 3 years and 35 % at 5 years). Combined TACE and PEI is an effective treatment for large HCC.
Percutaneous catheter drainage of external fistulas of the pancreatic ducts.
Cabay JE. Boverie JH. Dondelinger RF.
Department of Medical Imaging, University Hospital Sart Tilman, B35, B-4000 Liege, Belgium.
The aim of this study was to describe catheterization techniques and report the results of percutaneous drainage of external pancreatic fistulas. Twenty patients with external pancreatic fistulas in whom medical therapy had failed, were referred for radiologically guided treatment. Fifteen patients had postoperative and five primary fistulas. Sixteen were high-output fistulas (H-OF) and four were low-output fistulas (L-OF). All patients were treated percutaneously. Percutaneous catheter drainage was successful in 16 of 20 patients (80 %). The fistula healed in 13 of 15 postoperative cases (86.6 %) and in three of five primary fistulas (60 %). Treatment was successful in 14 of 16 patients (87.5 %) with H-OF and in two of four patients with L-OF. Percutaneous catheterization of the pancreatic ducts was successful in eight of 20 patients (40 %); seven of these patients were cured. Catheterization was not achieved in 12 patients and treatment failed in three (25 %). Conservative treatment of external pancreatic fistulas with percutaneous catheter-directed drainage is thus a reasonable alternative to surgery, particularly in patients with H-OF.
Intraluminal duodenal diverticulum causing pancreatitis in a patient with a polysplenia syndrome.
Lundstedt C. Lyttkens K. Andren-Sandberg.
Department of Radiology, University Hospital, S-221 85 Lund, Sweden.
A 19-year-old female had recurrent bouts of pancreatitis. At endoscopy a mucosa-covered mass lesion was seen in the duodenum. A double-contrast examination of the stomach and duodenum showed an intraluminal duodenal diverticulum (IDD). Also an inversed abdominal situs and a midgut malrotation were noted. Computed tomography revealed evidence of a polysplenia syndrome. Although this syndrome is associated with various gastrointestinal abnormalities, its combination with an IDD does not seem to have been reported previously. After surgical removal of the IDD the patient has not had any further attacks of pancreatitis.
Gastrointestinal autonomic nerve tumors (plexosarcomas). is A radiological diagnosis possible?
Rueda O. Escribano J. Vicente JM. Garcia F. Villeta R.
Department of Radiology, Hospital Universitario Principe de Asturias Carretera Alcala-Meco s/n, Alcala de Henares, E-28 805 Madrid, Spain.
The gastrointestinal autonomic nerve (GAN) tumor, or plexosarcoma, is a very uncommon stromal tumor of the gastrointestinal tract and retroperitoneum. Distinction of GAN tumors from other stromal tumors is not possible based on imaging studies, and needs specific ultrastructural and inmunohistochemical techniques. There are some morphologic characteristics that the radiologist should know, so as to include these rare tumors in the differential diagnosis of an abdominal mass. We report two new cases: small bowel (jejunum-ileum) and stomach GAN tumors.
A case of spontaneous hemorrhage of the abdominal wall caused by rupture of a deep iliac circumflex artery treated by transcatheter arterial embolization.
Katsumori T. Nakajima K.
Department of Radiology, Saiseikai Shiga Hospital, Ohashi 2-4-1, Ritto-chou, Kurita-gun, Shiga 520-30, Japan.
We report an uncommon case of spontaneous massive hemorrhage of the abdominal wall caused by rupture of a deep iliac circumflex (DIC) artery. Enhanced computed tomography (CT) demonstrated a marked extravasation in a huge hematoma of the abdominal wall. Although a pelvic arteriogram demonstrated no extravasation, a superselective DIC arteriogram subsequently revealed an extravasation of the artery. We successfully performed transcatheter arterial embolization for the artery. There have been few reports in the literature of spontaneous hemorrhage in the abdominal wall resulting from rupture of DIC artery, which were defined by diagnostic imaging and successfully treated by transcatheter arterial embolization.
Blunt abdominal trauma in adults: role of CT in the diagnosis and management of visceral injuries. Part 1: liver and spleen.
Becker CD. Mentha G. Terrier F.
Department of Radiology, Division of Diagnostic and Interventional Radiology, Geneva University Hospital, 24, Rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland.
Computed tomography is now widely used in the initial diagnostic workup of adult trauma victims with suspected intra-abdominal injuries. We review the role of CT in the detection and management of blunt visceral injuries in two parts. In the first part we discuss general aspects of performing CT in the setting of abdominal trauma and the diagnostic findings of intra-abdominal hemorrhage and blunt hepatic and splenic injuries. Hepatic and splenic injuries can be detected by means of CT with a high accuracy. The vast majority of hepatic injuries can be successfully managed conservatively, even when CT demonstrates parenchymal damage of more than three segments and major hemoperitoneum. Delayed complications, e. g., formation of biloma or a false aneurysm, can be readily detected on repeat CT studies, although they are quite uncommon. The outcome of conservative treatment of splenic injuries remains unpredictable because delayed splenic rupture may occur even when initial CT shows only minor parenchymal lesions and little or no intraperitoneal hemorrhage.
Virtual endoscopy of the small bowel: phantom study and preliminary clinical results.
Rogalla P. Werner-Rustner M. Huitema A. van Est A. Meiri N. Hamm B.
Department of Radiology, Charite Hospital, Humboldt-Universitat zu Berlin, Schumannstrasse 20/21, D-10098 Berlin, Germany.
The purpose of this study was to determine the optimal scanning technique for lesion detection in a small bowel phantom and to evaluate the virtual endoscopy (VE) technique in patients. A small bowel phantom with a fold thickness of 7 mm and length of 115 cm was prepared with nine round lesions (3 x 1 mm, 2 x 2 mm, 2 x 3 mm, 2 x 4 mm). Spiral CT parameters were 7/7/4, 3/5/2, 3/5/1, 1.5/3/1 (slice thickness/table feed/reconstruction interval). VE was done using volume rendering technique with 1 cm distance between images and 120 degrees viewing angle. Two masked readers were asked to determine the number and location of the lesions. Seven patients underwent an abdominal CT during one breathhold after placement of a duodenal tube and filling of the small bowel with methyl cellulose contrast solution. VE images were compared with the axial slices with respect to detectability of pathology. With the 7/7/4 protocol only the 4-mm lesions were visualised with fuzzy contours. The 3/5/2 protocol showed both 4-mm lesions, one 3-mm lesion and one false positive lesion. The 3/5/1 protocol showed both 4-mm and both 3-mm (one uncertain) lesions with improved sharpness, and no false positive lesions. One 2-mm and one 1-mm lesion were additionally seen with the 1.5/3/1 protocol. Path definition was difficult in sharp turns or kinks in the lumen. In all patients, no difference was found between VE and axial slices for bowel pathology; however, axial slices showed 'outside' information that was not included in VE. We conclude that the 3/5/2 protocol may be regarded as an optimal compromise between lesion detection, coverage during one breathhold, and number of reconstructed images in patients; round lesions of 4 mm in diameter can be detected with high certainty.
Umbilical hernia of stomach.
Sampaio R. Ferreira M.
Department of Radiology, Coimbra University Hospital, P-3000 Coimbra, Portugal.
Herniation of the stomach through the umbilicus is exceedingly rare with only one case reported in the international literature in the past 40 years. One case of a reducible gastric umbilical hernia, not diagnosed by endoscopy, is reported. Diagnosis was made by double-contrast barium examination after 5 years of symptoms and ineffective treatment. Herniation of the stomach is difficult to diagnose by endoscopy and radiological studies can be more sensitive and allow a more specific diagnosis.
An unusual localization of massive portasystemic collaterals: CT angiographic demonstration.
Kilicoglu G. Eren N. Celik L. Tasel B.
Department of Radiology, Haydarpasa Numune Hospital, TR-81324 Istanbul, Turkey.
This article presents a patient with portal hypertension in whom an unusual localization for portosystemic collaterals have incidentally been found. Upper abdominal sonography revealed tubular structures filling the whole perirenal and partially the perihepatic area, and their venous nature was demonstrated with duplex Doppler sonography. Spiral CT angiography identified the right-sided retroperitoneal location and mesenteric-lumbar route of the collaterals. Upper gastrointestinal endoscopy with antral biopsy and percutaneous liver biopsy were performed. Laboratory results and specimen evaluation revealed chronic active hepatitis due to hepatitis-B infection. Attention is drawn to the abnormal location of these vessels, together with the noninvasive nature and competence of CT angiography in demonstrating vascular pathologies.
MR imaging of anorectal malformations and associated anomalies.
Nievelstein RA. Vos A. Valk J.
Department of Diagnostic Radiology, Free University Hospital, Amsterdam, P. O. Box 7057, 1007 MB Amsterdam, The Netherlands.
Congenital anorectal malformations are found in many forms, and are frequently associated with other anomalies, especially of the spinal cord, spine, and urogenital system. Decisions concerning initial management of children with anorectal malformations can be made only after accurate determination of (a) the level and type of malformation, (b) the type of fistula, (c) the developmental state of the sphincter muscle complex, and (d) the presence of associated anomalies. Magnetic resonance imaging has proven to be the only modality to answer all these crucial questions, and has contributed to a better insight in the morphology and pathogenesis of such complex congenital malformations.
Granulomatous hepatitis in pasteurella multocida infection.
Chateil JF. Brun M. Perel Y. Sananes JC. Castell JF. Diard F.
Service de Radiologie A, Hopital Pellegrin, Place A Raba Leon, F-33076, Bordeaux Cedex, France.
Numerous diseases can lead to multilocular lesions of the liver. The authors report a rare pediatric case of hepatic granulomas due to Pasteurella multocida: a 7-year-old girl with chronic fever was investigated by sonography and CT scan, demonstrating mesenteric lymph node enlargement and numerous small hepatic lesions. After surgical biopsy, histopathology of the liver specimens showed pyogenic granuloma, with serologic testing positive for Pasteurella multocida. Treatment with a tetracycline and corticosteroids was successful. Pasteurella multocida infection, despite its habitual benign course, should be suspected among differential diagnoses of lymphogranulomatous affections with hepatic involvement. No case of liver and lymph node foci in a child has been previously described.
The pelvis after surgery and radio-chemotherapy for rectal cancer studied with Gd-DTPA-enhanced fast dynamic MR imaging.
Blomqvist L. Fransson P. Hindmarsh T.
Department of Diagnostic Radiology, Karolinska Hospital, Karolinska Institute, S-171 76 Stockholm, Sweden.
The aim of this work was to study the gadolinium-enhancement of malignant and benign pathology in the pelvis after surgery for rectal cancer. Thirty patients with either local recurrence (n = 17) or benign changes related to treatment for rectal cancer (n = 13) were studied with pelvic MR imaging. T2-weighted fast spin-echo as well as T1-weighted spin- or gradient-echo imaging before and after intravenous contrast was performed and referred to as contrast-enhanced MRI (CEMRI). In addition, between the pre- and postcontrast images, dynamic contrast-enhanced MRI (DCEMRI) was performed using a single-slice, multi-phase, contrast-enhanced T1-weighted fast spoiled gradient-echo sequence. The time between the start of contrast injection to the beginning of enhancement, the duration and rate of enhancement as well as enhancement amplitude were recorded. The data were compared with the clinical diagnosis according to biopsy in 8 patients and surgery in 6 patients. In the remaining 16 patients, the clinical diagnosis was obtained by clinical or radiological follow-up. DCEMRI did not improve the diagnostic information compared with CEMRI. None of the examined parameters were found to help discriminating malignant from benign changes. Characterisation of lesions in the pelvis after rectal cancer surgery was not improved by a dynamic gadolinium-enhanced sequence.
Biliary ascariasis associated with cholangiocarcinoma: ultrasonographic and percutaneous transhepatic cholangiographic findings.
Dinc H. Arslan MK. Sayil. Gumele HR.
Department of Radiology, KTU Farabi Hospital, TR-61 080 Trabzon, Turkey.
The combination of biliary ascariasis and cholangiocarcinoma is rare. A 56-year-old female presented with progressive jaundice. Ultrasonography revealed a curvilinear structure with anechoic center consistent with ascariasis within the dilated common bile duct. Ultrasonography also demonstrated that a slightly echogenic soft tissue mass projecting into the mid segment of the common bile duct proved to be coexistent cholangiocarcinoma. Percutaneous transhepatic cholangiography did not confirm the presence of worm. In this report ultrasonographic and percutaneous transhepatic cholangiographic findings of the case are described and the relative merits of these two techniques are discussed.