Medical Magazine

The objective of this study was to evaluate the concordance of US and contrast-enhanced US (CEUS) with CT in the assessment of solid organ injury following blunt trauma. Patients underwent complete US examination, including free fluid search and solid organ analysis. CEUS followed, using low-mechanical index techniques and SonoVue. CT was performed within 1 h. Among 156 enrolled patients, 91 had one or more abnormalities (n = 107) at CT: 26 renal, 38 liver, 43 spleen. Sensitivity, specificity, and accuracy for renal trauma at baseline US were 36%, 98%, and 88%, respectively, after CEUS values increased to 69%, 99%, and 94%. For liver baseline US values were 68%, 97%, and 90%; after CEUS were 84%, 99%, and 96%. For spleen, results were 77%, 96%, and 91% at baseline US and 93%, 99%, and 97% after CEUS. Per patient evaluation gave the following results in terms of sensitivity, specificity and accuracy: 79%, 82%, 80% at baseline US; 94%, 89%, and 92% following CEUS. CEUS is more sensitive than US in the detection of solid organ injury, potentially reducing the need for further imaging. False negatives from CEUS are due to minor injuries, without relevant consequences for patient management and prognosis.

Orlando Catalano1,2　Luca Aiani3　Libero Barozzi4　Daniela Bokor5　Armanda De Marchi6　Carlo Faletti6　Fabio Maggioni5　Nicola Montanari7　Paolo Emilio Orlandi7　Alfredo Siani1　Paul S. Sidhu8　Peter K. Thompson9　Massimo Valentino4　Angelo Ziosi4　Alberto Martegani3
[1] Department of Radiology, I.N.T. Pascale, via Semmola, 80131 Naples, Italy;[2] via Crispi 92, 80121 Naples, Italy;[3] Department of Radiology, Valduce Hospital, Como, Italy;[4] Department of Emergency Radiology, S.Orsola-Malpighi Hospital, via Massarenti 9, 40138, Bologna, Italy;[5] Imaging Guided & Integrated Technology Department, Bracco Imaging SpA, Milan, Italy;[6] Department of Radiology, C.T.O., Turin, Italy;[7] Department of Radiology, Maggiore Hospital, Bologna, Italy;[8] Department of Radiology, King’s College Hospital, Denmark Hill, London, SE5 9RS, UK;[9] Department of Accident and Emergency, College Hospital, Denmark Hill, London, SE5 9RS, UK

Background The plicae palmatae is a developmental remnant of the Müllerian ductal fusion, which is demonstrated as a ridge of low intensity in the cervical canal on axial T2-weighted MR images. The identification of the plicae palmatae on MR imaging is beneficial for avoiding misinterpretation of this finding as anomalous uterine septum. The current study is performed to investigate the frequency of this finding and its variation among different age groups. Methods Axial T2-weighted images in 433 subjects were evaluated regarding the presence of the plicae palmatae and uterine anomaly. Results The frequency of the plicae palmatae was 47.5–53.2% in the third to fifth decade groups, but it was significantly lower in the sixth decade group (24.8%) than in the fifth decade group (53.2%). In three subjects with uterine anomalies, the plicae palmatae was recognized in a bicornuate uterus with single cervix, whereas it was not identified in unicornuate uterus and bicornuate uterus with duplicated cervices. Conclusion The plicae palmatae is commonly encountered in routine MR images of normal uterus, especially in reproductive-aged women.

Akiko Takahata1　Takashi Koyama2　Aki Kido3　Masako Kataoka4　Shigeaki Umeoka5　Sadahiko Nishizawa6　Tsunehiko Nishimura1　Kaori Togashi7
[1] Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan;[2] Department of Radiology, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan;[3] Department of Radiology, Kyoto Katsura Hospital, Kyoto, Japan;[4] Department of Radiology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK;[5] Department of Radiology, Wakayama Red Cross Hospital, Wakayama, Japan;[6] Department of Radiology, Hamamatsu Medical Photonics Foundation, Shizuoka, Japan;[7] Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

Prostatic atrophy which represents a form of adaptive response to injury most commonly to inflammation and/or chronic ischemia is a histological abnormality frequently found in prostate biopsies and autopsies. Although commonly found, this lesion is rarely reported in the prostatic biopsy reports. It is well known that histologically focal prostatic atrophy (FPA) is one of the most frequent mimics of prostatic adenocarcinoma. On conventional and color Doppler transrectal ultrasound and on magnetic resonance spectroscopic imaging studies (MRSI), FPA may also simulate prostate cancer. Thus, this entity should be considered together with prostatitis as an important cause of false-positive results in MRSI of the prostate. It has been shown that there is a positive and significant association between extent of FPA in biopsies and serum total or free PSA elevation. For this reason, pathologists should include the presence of FPA in the pathology report of a prostatic biopsy, particularly in those patients with absence of cancer. When extensive FPA is the only finding in patients with several negative prostatic biopsies, this lesion may be the source for PSA elevation.

Adilson Prando1　Athanase Billis2
[1] Radiology, Hospital Vera Cruz, Campinas, SP, Brazil;[2] Anatomic Pathology, School of Medicine, Campinas, SP, Brazil

Background To evaluate the imaging findings in patients with renal involvement of Polyarteritis nodosa (PN) to diagnose as early as possible. Materials and methods Four patients diagnosed as having PN participated in the present study. Two patients underwent abdominal dynamic CT, one underwent only pre- and post-contrast CT, and the remaining patient underwent only noncontrast CT and MR imaging, including dynamic contrast study. Results The common findings of CT and MR imaging were diffuse enlargement, multiple small wedge-shaped less-enhanced areas on dynamic contrast study, and indistinctness of the margin between the cortex and medulla on equilibrium-phase CT. Renal arteriogram showed multiple microaneurysms on arterial phase image in all four cases, and PN was diagnosed. The common CT and MR findings of renal involvement of PN mimicked those of pyelonephritis, when microaneurysms were not demonstrated. Conclusion The differentiation between PN and pyelonephritis on CT and MR imaging is difficult. Therefore, the radiologist should be familiar with the imaging findings of renal involvement of PN. When PN is suspected, angiography should be performed as early as possible to make a definite diagnosis.

Kumi Ozaki1　Shiro Miyayama2　Yasuyuki Ushiogi3　Osamu Matsui1
[1] Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takara-machi, Kanazawa 920-8641, Japan;[2] Department of Diagnostic Radiology, Fukuiken Saiseikai Hospital, Fukui, Japan;[3] Department of Internal Medicine, Fukuiken Saiseikai Hospital, Fukui, Japan

Objective The purpose of this retrospective study was to evaluate the accuracy of MRI using pelvic-phased-array and endocavitary coils in detecting intestinal wall invasion by an endometriotic nodule. Materials and methods Forty-seven patients (32.1 ± 4.2 years) who were planned for a surgical cure of deep endometriosis underwent MRI with conventional sequences using both coils. A thin bright layer on T2-w with enhancement on post-Gd T1-w defined our MR pattern for muscular layer involvement. MR results were correlated with surgical and pathological findings of the removed nodule. Results MR results for Group 1 (both coils) achieved a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100–63%, 96–92%, 90–70%, 100–85%, and 97–83% for endovaginal coil and phased-array coil, respectively. Group 2 (phased-array coil) had a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 73%, 93%, 84%, 88%, and 87% for this coil, respectively. Conclusion Combined pelvic-phased-array and endovaginal coils are better than phased array alone in the detection of intestinal wall invasion. Easy to perform, it has to be considered as a preoperative staging for deep posterior endometriosis to orientate the surgical management.

Catherine Roy1　Céline Balzan1　Véronique Thoma2　Benoit Sauer1　Arnaud Wattiez2　Joel Leroy3
[1] Department of Radiology B, Universitary Hospital of Strasbourg – Civil Hospital, 1, place de l’hopital BP 426, 67091 Strasbourg Cedex, France;[2] Department of Gynecology, Universitary Hospital of Strasbourg – Civil Hospital, 1, place de l’hopital BP 426, 67091 Strasbourg Cedex, France;[3] Department of Digestive Surgery, Universitary Hospital of Strasbourg – Civil Hospital, 1, place de l’hopital BP 426, 67091 Strasbourg Cedex, France

Purpose To retrospectively assess the performance of MR imaging in the evaluation and triage of pregnant patients presenting with acute abdominal or pelvic pain. Method and materials MRI studies of pregnant patients who were referred for acute abdominal pain between 2001 and 2007 were included. MR images were retrospectively reviewed and compared with surgical and pathologic findings and clinical follow-up data. Analysis of imaging findings included evaluation of the visceral organs, bowel and mesentery, appendix (for presence of appendicitis), ovaries (detection and adnexal masses were evaluated), focal inflammation, presence of abscesses, and any other abnormal findings. Results A total of 118 pregnant patients were included. MR findings were inconclusive in 2 patients and were positive for acute appendicitis in 11 patients (n = 9 confirmed by surgery, n = 2 improved without surgery). One patient with inconclusive MR had surgically confirmed appendicitis; the other patient with inconclusive MR had surgically confirmed adnexal torsion. Other surgical/interventional diagnoses suggested by MR imaging were adnexal torsion (n = 4), abscess (n = 4), acute cholecystitis (n = 1), and gastric volvulus (n = 1). Two patients with MR diagnosis of torsion improved without surgery. One patient with MR diagnosis of abscess had biliary cystadenoma at surgery. The rest of the MR diagnoses above were confirmed surgically or interventionally. MR imaging was normal in 67 patients and demonstrated medically treatable etiology in 28 patients: adnexal lesions (n = 9), urinary pathology (n = 6), cholelithiasis (n = 4), degenerating fibroid (n = 3), DVT (n = 2), hernia (n = 1), colitis (n = 1), thick terminal ileum (n = 1), rectus hematoma (n = 1). Three of these patients had negative surgical exploration and one had adnexal mass excision during pregnancy. Other patients were discharged with medical treatment. The sensitivity, specificity, accuracy, positive predictive values (ppv), and negative predictive values (npv) of MR imaging for acute appendicitis, and surgical/ interventional diagnoses were 90.0% vs. 88.9%, 98.1% vs. 95.0%, 97.5% vs. 94.1%, 81.8% vs. 76.2%, 99.1% vs. 97.9%, respectively. Conclusion MR imaging is an excellent modality for diagnosis of acute appendicitis and exclusion of diseases requiring surgical/interventional treatment. Therefore MR imaging is useful for triage of pregnant patients with acute abdominal and pelvic pain.

Aytekin Oto1　Randy D. Ernst2　Labib M. Ghulmiyyah3　Thomas K. Nishino4　Douglas Hughes4　Gregory Chaljub4　George Saade3
[1] Department of Radiology, The University of Chicago, 5841 S Maryland Avenue, MC 2026, Chicago, IL 60637, USA;[2] Department of Radiology, M.D. Anderson Cancer Center, Houston, TX, USA;[3] Department of Obstetrics and Gynecology, University of Texas Medical Branch at Galveston, Galveston, TX, USA;[4] Department of Radiology, University of Texas Medical Branch at Galveston, Galveston, TX, USA

Fewer than 140 cases of aortic sarcoma have been reported with only 34 classified as angiosarcoma. These rare malignancies most often mimic aortoiliac occlusive or aneurysmal arteriosclerotic disease both clinically and on imaging studies, and the large majority are unexpected and diagnosed pathologically on a surgical specimen or at autopsy [1–5]. A 42-year-old woman who presented with low back pain and claudication was shown by CT and angiography to have infrarenal aortic occlusion. Angiosarcoma was an unexpected pathologic diagnosis based on tissue removed during aortobifemoral bypass surgery. Pre and postoperative CT and angiography are presented along with a review of the literature.

Douglas Brylka1　Terrence C. Demos1　Kenneth Pierce1
[1] Department of Radiology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA

We present a case of leiomyomatosis peritonealis disseminata (LPD) after laparoscopic myomectomy with imaging features corroborating laparoscopic tract dissemination of the tumor. This would suggest a subset cases of LPD may be secondary to transcoelomic dissemination of a primary uterine leiomyoma rather than de novo peritoneal metaplasia. To our knowledge, this is the first case report of LPD and subcutaneous leiomyoma complicating laparoscopic surgery. The imaging features of LPD are reviewed. Radiologists as well as clinicians should consider LPD as a potential complication of laparoscopic myomectomy.

Yee Liang Thian1　Kok Hian Tan2　Jin Wei Kwek1　Junjie Wang2　Bernard Chern2　Kwai Lam Yam2
[1] Department of Diagnostic Radiology, KK Women’s and Children Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore;[2] Divison of Obstetrics and Gynaecology, KK Women’s and Children Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore

Background To retrospectively analyze computed tomography (CT) features of adenosquamous carcinoma (ASC) of the extrahepatic bile duct and to correlate them with pathologic findings. Methods Six patients who underwent radical surgical resection for ASC of extrahepatic bile duct were included. CT and pathologic findings were analyzed and correlated with each other. Results Five ASCs were periductal infiltrative type and the remaining one was intraductal polypoid type. Histologically, ASC was composed of squamous and glandular components which mixed in an intermingled pattern and was characterized by a high local aggressiveness mainly due to the squamous component. The most common CT findings were a segmental wall thickening with delayed enhancement. Overall, CT features were well correlated with pathologic findings. However, CT tended to underestimate radial extent of the tumor compared with histologic findings. Conclusions Histopathologically, ASC of the extrahepatic bile duct is characterized by greater local aggressiveness. However, their CT findings are not quite different from those of usual adenocarcinoma due to the unique geographic characteristic of being located at a very limited space.

Kyung Won Kim1　Se Hyung Kim1　Min A. Kim2　Jeong Min Lee1　Hee Sun Park1　Ji Young Kim1　Jae Young Lee1　Joon Koo Han1　Byung Ihn Choi1
[1] Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, 28 Yeongon-dong, Jongno-gu, Seoul, 110-744, Korea;[2] Department of Pathology, Seoul National University Hospital, 28 Yeongon-dong, Jongno-gu, Seoul, 110-744, Korea

Background In order to retrospectively determine the frequency of dilated cisterna chyli (CC) on MR images in patients with cirrhosis, and to assess its value as a simple diagnostic imaging sign of uncompensated cirrhosis. Methods Study population included 257 patients (149 with pathologically proved cirrhosis and 108 control subjects without the history of chronic liver diseases) who had 1.5 T MR imaging. Cirrhosis patients were divided into compensated and uncompensated groups. Three independent observers qualitatively evaluated the visibility of CC 2 mm or greater in transverse diameter, identified as a tubular structure with fluid signal intensity. CC diameters greater than 6 mm were defined as dilated. Statistical analysis was performed by Student t-test and interobserver agreement via intraclass correlation coefficient. Results CCs with diameter 2 mm or more were recorded in 113 of 149 (76%) cirrhotic patients and 15 of 108 (14%) control subjects (P < 0.001). Dilated CCs were significantly more frequent in uncompensated than compensated cirrhotic patients (54% vs 5%, P < 0.001). The sensitivity, specificity, accuracy, and positive predictive value of dilated CC for uncompensated cirrhosis were 54%, 98%, 80%, and 96%, respectively. Conclusions Dilated CC can be used as a simple and specific sign complimentary to other findings of uncompensated cirrhosis.

Sachit K. Verma1　Donald G. Mitchell1　Diane Bergin1　Yulia Lakhman1　Amy Austin1　Manisha Verma2　David Assis2　Stevene K. Herrine2　Laurence Parker1
[1] Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA;[2] Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA