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This study evaluated the usefulness of T2-weighted and gadolinium-enhanced T1-weighted magnetic resonance (MR) images correlated with patients' menopausal status in assessing the depth of myometrial invasion in stage I endometrial carcinoma. MR images of 46 patients with stage I endometrial carcinoma were retrospectively reviewed. Twenty-five patients were premenopausal, and 21 were postmenopausal. The staging accuracy without regard to menopausal status was 59% for T2-weighted images and 61% for gadolinium-enhanced T1-weighted images. However, when staging accuracy was evaluated separately in the premenopausal and postmenopausal patient groups, T2-weighted imaging had an accuracy of 80% in the premenopausal group and gadolinium-enhanced T1-weighted imaging had an accuracy of 81% in the postmenopausal group. Therefore, T2-weighted imaging was more accurate in premenopausal patients and gadolinium-enhanced T1-weighted imaging was more accurate in postmenopausal patients. The overall accuracy of staging with MR imaging improved to 80% when patients' menopausal status was considered. Therefore, menopausal status should be considered when T2-weighted and gadolinium-enhanced T1-weighted MR images are used to stage early endometrial carcinoma.

To evaluate the computed tomographic (CT) features of systemic lupus erythematosus (SLE) in patients with acute abdominal pain. Special emphasis was placed on the analysis of ischemic bowel disease.The authors retrospectively reviewed the images from 39 abdominal CT examinations performed in 33 patients with SLE and acute abdominal pain. Images were evaluated for bowel wall changes, mesenteric changes, fluid collection, retroperitoneal lymphadenopathy, peritoneal enhancement, and hepatomegaly as well as for changes in other abdominal organs. Ischemic bowel disease was diagnosed if at least three of the following signs were seen: bowel wall thickening, target sign, dilatation of intestinal segments, engorgement of mesenteric vessels, and increased attenuation of mesenteric fat.Thirty-one (79%) of the 39 examinations had CT findings diagnostic of ischemic bowel disease, including symmetric bowel wall thickening (n = 29), target sign (n = 26), and mesenteric vascular engorgement and haziness (n = 31). In 24 cases, bowel wall thickening was multifocal, with variable length, and did not appear to be confined to a single vascular territory.The most common CT finding in patients with SLE and acute abdominal pain is ischemic bowel disease. CT is useful for detecting the primary cause of gastrointestinal symptoms, planning treatment, and monitoring for infarction or perforation.

PURPOSE: To correlate the findings of nonossifying fibroma at magnetic resonance (MR) imaging with those at pathologic examination. MATERIALS AND METHODS: In 19 patients (age range, 8-25 years; mean age, 14 years) with pathologically proved nonossifying fibroma, MR images were analyzed for signal intensity and patterns of contrast enhancement. Findings at MR imaging and biopsy were correlated. RESULTS: On T1-weighted images, all nonossifying fibromas had low signal intensity compared with that of skeletal muscle. On T2-weighted images, 15 lesions (79%) were hypointense and four (21%) were hyperintense. On gadolinium-enhanced images, intense contrast enhancement was seen throughout 15 lesions (heterogeneous pattern in 12 and homogeneous in three) and in the margins and septa in four. Extensive hypercellular fibrous tissue and hemosiderin seen at pathologic examination were depicted with low signal intensity on T2-weighted MR images. CONCLUSION: The distinguishing features of nonossifying fibroma included hypointensity and septation on T2-weighted images. Signal intensity on T1- and T2-weighted MR images and the patterns of contrast enhancement were dependent on the amounts of hypercellular fibrous tissue, hemosiderin, hemorrhage, collagen, foamy histiocytes, and bone trabeculae.

Purpose: To determine the impact of stereotactic radiosurgery (SRS) on the clinical course, hormonal status, and follow-up CT/MRI scan of pituitary macroadenomas. Methods and Materials: From July 1988 to March 1996, 24 pituitary macroadenomas had been treated using 6 MV linear accelerator based SRS. They consisted of 11 (45.8%) prolactinomas, 2 (8.3%) growth hormone (GH)-secreting tumors, 1 (4.2%) Cushing’s disease, 8 (33.3%) nonsecreting (nonfunctioning: NF) tumors, and 2 (8.3%) mixed prolactin-growth hormone (PRL-GH)-secreting tumors (M:F = 12:12; aged 21–61 years). Postoperative irradiation was performed in all cases except for the instance of Cushing’s disease. The prescribed dose to tumor center varied from 10 to 27 Gy (mean 21.1 Gy) using a collimator size of 0.5 to 2.5 cm. The follow-up duration ranged from 13 to 89 months (mean 49.2 months). Results from these patients were compared to our results using conventional radiation. Results: Visual acuity and field defect were improved or became normal in 19 (79.2%) cases. Four (16.7%) remained unchanged after the treatment. One (4.1%) progressed 6 years after SRS and subsequently had repeat surgery with conventional boost irradiation. Of the 13 (46.4%) prolactinomas, including two mixed PRL-GH secreting tumors, 11 (84.1%) revealed normal hormonal levels within 1 year after SRS. In contrast, it took 2 years to become normal after conventional radiation therapy. In four GH-secreting tumors including two mixed PRL-GH secreting tumors, SRS and conventional methods showed similar responses. On follow-up imagings of the 21 patients, the mass was completely resolved in 4 (16.7%), including 3 PRLs and one NF, decreased in 11 (45.8%), and unchanged in 5 (16.7%) with central necrosis or cysts. One (4.2%) progressed and was reoperated 6 years after treatment. The complications related to SRS were comparable to those from conventional method. Conclusion: Radiosurgery can be used effectively in patients with pituitary adenoma. In this study, a more rapid hormonal and clinical response was achieved with radiosurgery than with conventional pituitary irradiation treatment.

Purpose: to investigate the utility of the resistive indices (RIs) of the epididymal and intratesticular arteries, and to establish diagnostic criteria for scrotal inflammatory disease on the basis of quantitative color Doppler sonography Material and Methods: We prospectively examined 29 consecutive patients with scrotal pain, and 15 normal control subjects. the RIs of the intratesticular and epididymal arteries were obtained from color Doppler sonographs Results: the RIs of the testicular artery in epididymoorchitis were significantly lower than those in normal control subjects and in epididymitis (p0.5). with a cut-off value of RI=0.5, sensitivity, specificity, accuracy, and positive and negative predictive values were 91%, 94%, 94%, 83%, and 77% respectively. the mean RI of the epididymal arteries in epididymitis and epididymoorchitis was 0.49±0.11. A high level of diagnostic accuracy in scrotal inflammatory disease was achieved when the RIs of the intratesticular and epididymal arteries were less than 0.5 and 0.7 respectively Conclusion: the RI of the intrascrotal artery would give a more objective evaluation than subjective assessment and could provide diagnostic criteria for scrotal inflammatory disease

The purpose of this study was to describe the findings of MR imaging of fibrous dysplasia and to evaluate the correlation between radiologic and pathologic findings.MR images of 13 proven cases of fibrous dysplasia were analyzed for signal intensity, hypointense rind, internal septations, cystic changes, soft-tissue extension, and patterns of contrast enhancement.All cases of fibrous dysplasia showed low signal intensity on T1-weighted MR images. Five cases (38%) were hypointense on T2-weighted MR images, and the other eight cases (62%) were hyperintense. Hypointense rind was seen in 10 cases (77%); internal septations were seen in three cases (23%); and cystic changes was seen in two cases (15%). Soft-tissue extension was observed in four cases (31%), including one case (8%) with a pathologic fracture. After gadolinium infusion, central contrast enhancement was noted in eight cases (73%), and peripheral rim enhancement was noted in three cases (27%). Numerous bony trabeculae, confirmed pathologically, caused a hypointense signal intensity on T2-weighted images.Patients with fibrous dysplasia showed a correlation between radiologic and pathologic findings. Our results showed that T1-weighted images reveal fibrous dysplasia as hypointense, and T2-weighted images reveal fibrous dysplasia as either hyperintense or hypointense. Signal intensity on T1- and T2-weighted images and the degree of contrast enhancement on T1-weighted images depended on the amount and degree of bony trabeculae, cellularity, collagen, and cystic and hemorrhagic changes.

We reviewed CT of four patients with surgically proved bowel infarction secondary to superior mesenteric vein (SMV) thrombosis. Pathologic correlation was available in all patients. Three patients had thrombus in both portal vein and proximal SMV and the remaining patient had thrombus that was seen only in the peripheral branches of the SMV. Contrast-enhanced CT showed a segmental distribution of marked concentric bowel wall thickening in all four patients. Two patients also showed zones of different attenuation in the bowel wall, which were caused by varying degrees of edema and hemorrhage in the submucosa. Dense peripheral enhancement of the bowel wall was present in one patient. Other CT findings included ascites and mesenteric changes such as edema and vascular engorgement. The combination of thrombus in the SMV with bowel wall thickening strongly suggests bowel infarction and, therefore, warrants initiation of appropriate therapy.

The authors investigate whether there is a lateral effect of 1H-magnetic resonance spectroscopy (MRS) observable metabolite ratios between the symptomatic and the asymptomatic side in Parkinson's disease with unilateral symptoms.Localized in vivo 1H MRS was used to measure the metabolite levels in the symptomatic and the asymptomatic sides of the substantia nigra (SN) and putamen-globus pallidus (PG) in Parkinson's disease with unilateral symptom (n = 15). The metabolite ratios of N-acetylasparatate (NAA)/creatine (Cr), and choline-containing compounds (Cho)/Cr in the symptomatic side were compared with those in the asymptomatic side. According to the symptomatic duration, the authors evaluated whether there was a specific correlation between laterality and the clinical stage.Significant metabolic lateral effect of NAA/Cr ratio was established between the symptomatic and the asymptomatic sides of SN and PG in Parkinson's disease with unilateral symptoms (P = 0.03). The decreased NAA/Cr ratio was calculated in at least one of the selected regions in SN and PG, indicating neuronal loss. The main observations were that NAA/Cr ratios were reduced in the left symptomatic side (n = 7; P = 0.001) and reduced to a lesser degree in the right symptomatic side (n = 8; P = 0.03 [PG], P = 0.21 [SN]) and that there was no significant laterality of other metabolite ratios.On the basis of NAA/Cr ratios between the symptomatic and the asymptomatic sides, the present 1H MRS study shows a significant neuronal laterality in Parkinson's disease with unilateral symptoms. In vivo 1H MRS may provide a diagnostic marker for neuronal dysfunction in Parkinson's disease with unilateral symptoms.

Fifteen patients underwent computed tomography (CT)-guided contrast material localization of pulmonary nodules, with barium and indigo carmine stain used in five patients, iodized oil and indigo carmine stain in five, and water-soluble contrast material and indigo carmine stain in five before fluoroscopy-assisted thoracoscopic resection. Contrast material localization was successful in all cases, and the surgeon confirmed accurate localization, CT-guided contrast material localization is simple and useful for thoracoscopic resection.

Purpose: Our goal was to evaluate CT efficacy in differentiating gastrointestinal leiomyoma and leiomyosarcoma. Method: We retrospectively reviewed CT scans of 45 patients (21 men, 24 women, mean age 55 years) with surgically proven gastrointestinal leiomyomas (n = 21) and leiomyosarcomas (n = 24) with respect to size, contour, enhancing pattern, mesenteric fat infiltration, calcification, ulceration, regional lymphadenopathy, direct invasion, distant metastasis, and growth pattern after visual inspection by two radiologists in agreement. On the basis of these CT features, subjective diagnosis was also categorized into three groups (Group I: probably benign, Group II: probably malignant, Group III: diagnostic malignant). The results were compared with the final histopathologic diagnosis. Results: In addition to the features of direct invasion and distant metastasis suggesting diagnostic malignancy, the CT features favoring malignancy with statistical significance included larger size (>5 cm), lobulated contour, heterogeneous enhancement, mesenteric fat infiltration, ulceration, regional lymphadenopathy, and exophytic growth pattern (p < 0.005). However, calcification was not significant in differentiating the two entities (p = 0.25163). A subjective analysis revealed 89% sensitivity, 85% specificity, and 87% accuracy for diagnosis of leiomyosarcoma. Conclusion: CT features are useful in differentiating leiomyoma and leiomyosarcoma in gastrointestinal tract.

To evaluate the computed tomographic (CT) features of xanthogranulomatous cholecystitis (XGC) and to distinguish it from gallbladder carcinoma.Retrospective analysis was performed in 11 patients with XGC and 17 patients with gallbladder carcinoma in which the wall was thickened. The following CT features were analyzed: maximum wall thickness, intramural hypoattenuated nodules, mucosal line, patterns of wall thickening and enhancement, and the presence of stones. The changes outside the gallbladder were also compared.The mean thickness of the gallbladder wall was 1.8 cm in patients with XGC and 2.1 cm in patients with gallbladder carcinoma. Intramural hypoattenuated nodules were seen in all patients with XGC but in only seven patients with gallbladder carcinoma (P = .008). The mucosal line was observed in nine patients with XGC and in six with gallbladder carcinoma (P = .02). The gallbladder wall was more diffusely thickened in patients with XGC (10 of 11 patients) than in patients with gallbladder carcinoma (seven of 17 patients) (P = .01). The occurrence of changes outside the gallbladder did not differ statistically significantly.Because of a statistically significant overlap of CT features, only when intramural hypoattenuated nodules occupy a large area of the thickened gallbladder wall can the diagnosis of XGC be highly suggestive. The diagnosis of XGC at CT may indicate a less aggressive surgical approach.

The authors investigate: (1) whether there is a lateral effect of hydrogen (1H) magnetic resonance (MR) spectroscopy observable metabolite ratios between the right and the left prefrontal lobe in chronic schizophrenia; (2) whether there is a change of proton metabolite ratios in chronic schizophrenia after neuroleptic treatment; (3) whether there is a relation between changes in 1H MR spectra and the clinical assessment of Brief Psychiatric Rating Scale (BPRS); and (4) to investigate a hypofrontality hypothesis in schizophrenia in terms of neurochemical aspects.Localized in vivo 1H MR spectroscopy was used to measure the metabolite levels in the prefrontal lobes of control persons (n = 20) and of chronic patients before and after neuroleptic treatment (n = 34). The MR spectra of 8 cm3 voxels were compared with clinical assessment of BPRS in each subject.No significant metabolic lateral effect was established in both schizophrenia and control groups (P0.05). After neuroleptic treatment, chronic schizophrenic patients generally demonstrated a decrease of the complex of gamma-aminobutyric acid (GABA) and glutamate (Glu) containing (GABA + Glu)/creatine (Cr) ratio.The current follow-up 1H MR spectroscopy study shows a significant correlation between alterations of (GABA + Glu)/Cr ratio and BPRS, and supports a hypofrontality hypothesis in chronic schizophrenia. The reduction of (GABA + Glu)/Cr ratio after neuroleptic treatment may implicate the recovery of normal neuronal function in neurotransmitters. In vivo 1H MR spectroscopy may be a useful modality in follow-up evaluation of neuroleptic treatment in chronic schizophrenia.

Rationale and Objectives. We in vestigated the proton metabolism of right prefrontal white matter in drug-naive, chronic schizophrenic patients (n=23), compared with healthy normal control subjects (n=10), by using localized, water-suppressed in vivo 1H magnetic resonance (MR) spectroscopy. Methods. All 1H MR spectroscopy examinations were performed on a 1.5-T MR imaging/MR spectroscopy system by using a point-resolved spectroscopy pulse sequence for localizd volumes of 2×2×2 cm3. Proton metabolite ratios relative to creatine (Cr) were obtained using a Marquart algorithm. Results. Drun-naive, chronic schizophrenic patients demonstrated a decrease in the N-acetylaspartate (NAA):Cr and choline (Cho):Cr ratios and an increase of the complex of γ-aminobutyric acid (GABA) and glutamate (Glu) containing ratio [(GABA+Glu):Cr] as compared with normal control subjects. Conclusion. Results suggest that the reduction of NAA and Cho may indicate neuronal dysfunction and that the elevation of GABA and Glu may play a role in chronic schizophrenia. 1H MR spectroscopy may be a useful modality in research and in the clinical evaluation of chronic schizophrenic patients.

Local recurrence of gastric carcinoma after surgery is defined as histologic evidence of a tumor in the surrounding tissues of the resected stomach. Compared with the large number of articles describing tumor recurrence after colectomy for colonic carcinoma, few reports have been published on the CT findings after gastrectomy. We illustrate the CT features of local tumor recurrence after gastrectomy in 36 patients in whom recurrence was confirmed pathologically or by definitive findings on CT scans.

The purpose of this study was to analyze the CT findings in 10 patients with abdominal actinomycosis to determine the appearance of lesions and the pattern of spread of the disease.We retrospectively reviewed the CT findings in 10 patients with pathologically proved actinomycosis. Involved areas were the pelvis (n = 4), greater omentum (n = 3), liver (n = 2), and kidney (n = 1). Contrast-enhanced (oral and IV) CT scans were available in all patients. Unenhanced CT scans were also available in six patients.CT scans showed mostly solid masses with focal areas of diminished attenuation in seven patients and mostly cystic masses with thickened walls in three. CT findings confirmed the infiltrative nature of the disease, showing its tendency to invade across tissue planes and boundaries. Dense inhomogeneous contrast enhancement in the walls or solid components of masses was seen in eight patients. Minimal lymphadenopathy was seen in only two patients.Although nonspecific, actinomycosis should be included in the differential diagnosis when CT scans show an infiltrative mass with unusual aggressiveness and dense inhomogeneous contrast enhancement, especially in patients with fever, leukocytosis, or long-term use of intrauterine contraceptive devices.

We evaluated the CT of intestinal obstruction due to adhesions in 20 postoperative patients, with emphasis on early detection of strangulation. Ten patients with surgically proven strangulated obstruction (strangulation group) were compared with another ten patients (nonstrangulation group) in whom seven improved with conservative management and three had confirmed simple obstruction on surgical exploration. Beak-like luminal narrowing ("beak") was the most common CT finding at the obstructed site in both groups. The CT findings that suggested strangulated obstruction were serrated beaks, mesenteric edema or vascular engorgement, and moderate to severe bowel wall thickening. In contrast, simple obstruction could be assumed when the beak was smooth, there were no mesenteric changes, and the bowel wall was normal or mildly thickened. Computed tomography is a useful tool for detecting strangulation in patients with postoperative adhesive intestinal obstruction.

The air meniscus sign occurs in a number of lung conditions, including infection, benign and malignant tumors, and hematoma. Sclerosing hemangioma does not appear to have been implicated previously in this connection. Two such cases are described. Possible mechanisms of air meniscus formation and its diagnostic value in sclerosing hemangioma are discussed.