Search

Contains fulltext : 71386.pdf (Publisher’s version ) (Closed access) PURPOSE: The purpose of our study was to evaluate the image quality and diagnostic performance of two-dimensional (D) turbo spin echo (TSE) and 3D T2-weighted TSE MR imaging in local staging of rectal cancer at 3T. MATERIALS AND METHODS: 3T phased-array MR imaging was performed in 36 consecutive patients with biopsy-proven rectal cancer. High-resolution 2D TSE images in three planes and 3D TSE images of the rectum were obtained. Two independent observers performed an image quality assessment using eight image quality characteristics. All 2D and 3D datasets were evaluated separately. MR images were prospectively evaluated by two experienced radiologists in consensus with regard to local disease. Total mesorectal excision was used as the standard of reference. The sensitivity, specificity, positive and negative predictive value, and overall accuracy were calculated. Areas under the receiver operating characteristic (ROC) curve (AUC) were determined. RESULTS: Twenty-two patients who underwent a total mesorectal excision were enrolled in this study. Significantly more motion artifacts were present with 3D TSE imaging (P=0.04). The overall sensitivity, specificity, and accuracy of muscularis propria invasion in rectal cancer using 2D T2-weighted images were 100%, 66%, and 95%, respectively. There was a statistical significant greater AUC using 2D T2-weighted images compared to 3D T2-weighted MR images (P=0.04). The ROC curves describing the results of the interpretation of 2D and 3D T2-weighted datasets regarding perirectal tissue invasion showed no statistical significant difference (P=0.41). CONCLUSIONS: In this study, high local staging accuracies with 3T 2D T2-weighted MR imaging were demonstrated. 3D T2-weighted MR imaging cannot replace 2D MR imaging for local staging of rectal cancer. However, 3D MR imaging can be used for visualization of the complex pelvic anatomy for treatment planning purposes.

PURPOSE: To evaluate the comparative accuracy of magnetic resonance (MR) imaging relative to mammography and ultrasonography (US) for assessing the extent of breast tumors. MATERIALS AND METHODS: Histologic results and preoperative imaging findings (mammography, US, MR imaging) were analyzed regarding tumor size and multifocality of 61 tumors in 60 women undergoing mastectomy for carcinoma. RESULTS: In 10% of cases, the index tumor was not seen at mammography. With US, 15% of the index tumors were not recognized, while MR imaging missed 2% of the index tumors. On mammographic and US images, tumor size was underestimated significantly (P < .005), by 14% and 18%, respectively, while MR imaging showed no significant difference in size compared with that found in a pathologic evaluation. Mammography showed 31% of the additional invasive lesions, while US showed 38% and MR imaging showed 100%. CONCLUSION: MR imaging was the most accurate of the three preoperative imaging modalities in assessing the size and nu...

Contains fulltext : 98363.pdf (Publisher’s version ) (Closed access) Retroperitoneal cystic tumours are rarely found, and of these, the most common lesion is a cystic lymphangioma. We present two postpartum patients with a cystic retroperitoneal tumour which showed spontaneous regression and a review of the literature.

To determine the value of herniography (also known as peritoneography) in the detection of groin hernias, herniographs obtained in 70 consecutive patients with clinically suspected hernias (but with a normal or inconclusive physical examination) were retrospectively evaluated. The radiologic features, complications, and final clinical outcome were reviewed. A total of 30 hernias were found. Sixteen patients underwent surgery; there were no false-positive herniographic diagnoses. No procedure-related complications occurred. These results indicate that herniography is a simple and valuable diagnostic tool in patients with unexplained groin pain or pain in the anterior abdominal wall, with an acceptably low complication rate.

Contains fulltext : 49598.pdf (Publisher’s version ) (Closed access) OBJECTIVES: The 1992 Atlanta classification is a clinically based classification system that defines the severity and complications of acute pancreatitis. A study was undertaken to assess the interobserver agreement of categorizing peripancreatic collections on computed tomography (CT) using the Atlanta classification. METHODS: Preoperative contrast-enhanced CTs from 70 consecutive patients (49 men; median age, 59 years; range, 29-79 years) operated for acute necrotizing pancreatitis (2000-2003) in 11 hospitals were reviewed. Five abdominal radiologists independently categorized the peripancreatic collections according to the Atlanta classification. Radiologists were aware of the timing of the CT and the clinical condition of the patient. Interobserver agreement was determined. RESULTS: Interobserver agreement among the radiologists was poor (kappa, 0.144; SD, 0.095). In 3 (4%) of 70 cases, the same Atlanta definition was chosen. In 13 (19%) of 70 cases, 4 radiologists agreed, and in 42 (60%) of 70 cases, 3 radiologists agreed on the definition. In 21 cases (30%), 1 or more of the radiologists classified a collection as "pancreatic abscess," whereas 1 or more radiologist used another Atlanta definition. CONCLUSION: The interobserver agreement of the Atlanta classification for categorizing peripancreatic collections in acute pancreatitis on CT is poor. The Atlanta classification should not be used to describe complications of acute pancreatitis on CT.

Contains fulltext : 57921.pdf (Publisher’s version ) (Closed access) We describe a 35-year-old man who was initially treated with standard inguinal orchiectomy and prophylactic radiotherapy for Stage I seminomatous germ cell tumor of the testis. We report the case because of the unique nature of the later disease recurrence, which was a solitary cranial bony recurrence that extended both intracranially and extracranially. The patient had complete remission after combined cisplatin-based chemotherapy.

A 21-year-old man was admitted because of upper abdominal pain and cholestasis. Endoscopic retrograde cholangiopancreatography was suggestive of primary sclerosing cholangitis. During follow-up the patient developed symptoms which were not compatible with primary sclerosing cholangitis, i.e. icterus and weight loss. Finally the patient died, almost three years after presentation, because of a metastatic adenocarcinoma which had arisen from biliary papillomatosis. Biliary papillomatosis is characterised by papillary adenomatous proliferation of the bile duct epithelium. It has a high chance of malignant degeneration. The only curative option would have been transplantation of the liver and biliary system, but this ought to have happened at an early stage before malignant degeneration had occurred.

Spontaneous fracture of central venous catheters (CVC) has been reported. It results from repeated compression of the extravasal part of the CVC between the clavicle and the first rib. The so called pinch-off sign (POS) of the CVC as visible on a chest radiograph has been described as a warning for this complication. Fracture of CVC in patients receiving chemotherapy results in extravasation of the drug which may have serious consequences. We describe the spontaneous fracture of a CVC in two cancer patients. Subsequently we retrospectively analyzed chest radiographs for the POS of 77 cancer patients who received chemotherapy through a CVC and correlated these results with the occurence of complications related to CVC compression. In 77 patients a total of 97 CVC were implanted for a median duration of 7 months. Four CVC (4%) showed a grade 2 POS (change in course of CVC)CVC with luminal narrowing) on a chest radiograph. In three of these (75%) a compression-related complication occurred versus no compression-related complications in 93 CVC showing a POS of grade 1 (change in course of CVC without narrowing) or 0 (no change in course of CVC). The grade of POS on a chest radiograph may vary with the position of the patient, but all grade 2 POS were visible in the upright position. We recommend a chest radiograph in the upright position after placement of a CVC for grading of the POS. CVC showing a grade 2 POS should be removed or at least checked by a chest radiograph before the start of each chemotherapy infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of herniography in patients with unexplained pain in the groin or anterior abdominal wall is discussed and referred to that of other imaging modalities. The technique of herniography, its indications and contraindications, and anatomical aspects are dealt with. A series of 81 patients who underwent herniography is presented and the results are correlated with findings at surgery.

To assess the prognostic significance of histological classification, grade and stage with regard to overall survival in patients with non-Hodgkin's lymphoma (NHL).Retrospective analysis.University Hospital St Radboud, Nijmegen.All consecutive 346 patients with NHL diagnosed in the period January 1978-December 1990 were included in this one-centre study. Recorded data included histological type according to the Kiel classification, histological grading according to the International Working Formulation (IWF), Ann Arbor stage, age, sex, tumour mass, number of extranodal sites, serum LDH and ESR. Grading according to the IWF was assessed retrospectively for those patients whose primary disease had been diagnosed before 1982. The observation period ended September 1st, 1991. Overall survival was calculated according to Kaplan-Meier. The significance of the prognostic parameters was studied using both univariate and multivariate stepwise regression analysis.There were 209 men and 137 women with a median age of 56 years (range 15-85). No initial treatment was given to 8% of the patients. After a median follow-up of 52 months, 179 patients (52%) had died; the calculated median survival time was 49 months. Patients with low-grade NHL had a significantly better short-term prognosis than the remaining patients. Related to clinical stage, only patients with stage I disease had distinctly longer survival times than those with more advanced disease. Multivariate analysis revealed serum LDH, age, stage and histological classification to be the most important independent prognostic variables.Even in multivariate analysis, histological classification and Ann Arbor stage have prognostic significance with regard to overall survival in patients with NHL. However, serum LDH levels proved to be the most important prognostic parameter.

Fab' fragments of the monoclonal antibody OV-TL 3, that recognizes an ovarian carcinoma-associated antigen (OA3), were labelled with 99Tcm using D-glucarate as a ligand. Twenty patients suspected of having primary or recurrent ovarian cancer received intravenously 1 mg of the Fab' labelled with 740 MBq 99Tcm. Both planar and single photon emission computed tomographic (SPECT) scintigraphy were performed up to 30 h after intravenous infusion. In 19 out of 20 patients surgical and histopathological evaluation was performed between 2 and 6 days postinfusion. Imaging results were compared with X-ray computed tomography (CT), ultrasonography (US) and CA 125 serum level. Blood clearance was fast with median t1/2 beta of 9.5 h. Thirty-seven per cent of the injected dose (% ID) was excreted in the urine within the first 24 h, whereas 7% ID was excreted in the 24 h faeces. In one patient with an OA3 negative ovarian carcinoma, radioimmunoscintigraphy (RIS) did not visualize the tumour. In two other patients a benign ovarian cyst was found, also showing no elevated uptake. In 13 out of 17 patients ovarian cancer lesions were detected with RIS, whereas CT and US detected lesions in, respectively, 15 and 12 patients. Of 36 surgically defined tumour deposits larger than 1 cm in diameter, 53% were detected and localized with RIS, whereas CT and US detected 61 and 40%, respectively. Radioimmunoscintigraphy with 99Tcm-OV-TL 3 Fab' is less distressing for the patients but the overall imaging performance is not improved when compared with 111In-OV-TL 3 F(ab')2.

The safety and diagnostic accuracy of immunoscintigraphy with the indium-111-labeled monoclonal antibody OV-TL 3 F(ab')2(111In-OV-TL 3 F(ab')2) for diagnosis and follow-up of ovarian cancer was prospectively studied in 31 patients. Planar and SPECT scintigraphy were performed up to 4 days after i.v. injection of 140 MBq 111In-OV-TL 3 F(ab')2. Surgical evaluation was possible in 22 out of 31 patients. Imaging results were compared with X-ray computed tomography, ultrasound, and CA 125 serum level using the histologically confirmed surgical findings as a "gold standard." Apart from a transient rash observed in two patients, no other immediate or delayed adverse reactions were observed. Within the surgically evaluated group, ovarian cancer lesions were detected in 16 out of 17 patients (94%). Of 45 distinct tumor deposits found at operation, 67% were detected and localized with immunoscintigraphy while X-ray computed tomography and ultrasound visualized 53% and 23%, respectively.

The case history of a young female patient is described, in whom a typical subacute thyroiditis of De Quervain was complicated by the occurrence of bilateral thrombosis of the subclavian and axillary veins. This unusual coincidence seemed to be suggestive of an association of these features with previous treatment, as 8 yr earlier she had been treated with mantle field irradiation and polychemotherapy for Hodgkin's disease. She recovered fully and at the time of the events described no relapse of Hodgkin's disease could be established.

Two cases of renal cell carcinoma, metastatic to the pancreas, are presented. The lesions were hypoechoic with ultrasound examination, and were mixed iso- and hypodense with computed tomography. Angiography was performed in one case, and showed a typical hypervascular pattern of the metastatic tumor.

A qualitative comparison of two contrast media for cerebral angiography with regard to contrast should, preferably, be based on a comparison made in two different hemispheres of one patient. Two problems then arise which made evaluation difficult. Vasodilation occurs after the first contrast injection as a result of which the second contrast medium to be compared flows into a dilated vascular tree. In addition, in the case of a comparison in two different hemispheres, variations of image geometry occur, resulting in differences of sharpness and contrast. The method of solving these problems is discussed and is illustrated by a comparison of two contrast media which might be expected to produce differences in contrast because of their physical properties. The results of this clinical comparison show that the expected differences can be partly demonstrated.

A total of 19 patients (7 men, 12 women) with locally advanced pancreatic adenocarcinoma were treated with six cycles of FAP (5-fluorouracil, 300 mg/m2 i.v. on days 1-5; Adriamycin, 50 mg/m2 i.v. on day 1; cisplatin, 20 mg/m2 i.v. on days 1-5). Each course was repeated every 28 days. After six cycles, the treatment was followed by irradiation amounting to 4,000 cGy (split course) in combination with 5-FU (500 mg/m2) on days 1-3 of the two irradiation periods. The median age of our patients was 55 years (range, 40-64 years). The median WHO performance status was 1, with a range of 0-2. Three (16%) complete (CR) and six (31%) partial responses (PR) were observed, as were six cases of stable disease (SD) and four of progressive disease (PD). The median duration of response was 11 months, with a range of 4-24 months, and the median survival was 14 months (range, 5-27 + months). FAP toxicity was tolerated fairly poorly. The dose-limiting toxic effect was myelosuppression, with a mean WBC nadir of WHO grade 1.6 (range, 0-3) and a mean platelet count of WHO grade 1.1 (range, 0-4). Nausea and vomiting were not dose-limiting. Complete alopecia was seen in 14/19 patients. Neuropathy was mild (WHO grade 1) in seven and moderate (grade 2) in four. Irradiation in combination with 5-FU was generally well tolerated. Due to several reasons, only ten patients could be treated with all six cycles of FAP. We conclude that in future combined modality studies, irradiation should be given after three cycles of chemotherapy, and that combined modality treatment for locally advanced pancreatic cancer is feasible and warrants further testing.

SummaryThe case history of a 34-year-old patient with precirrhotic idiopathic haemochromatosis and severe chronic steatorrhoea is presented. The pancreas had a normal appearance on ultrasonography and endoscopic retrograde pancreaticography. However, pancreatic function tests revealed significant abnormalities. The pancreatic output of trypsin, amylase, lipase and bicarbonate was deficient and basal and stimulated serum pancreatic polypeptide levels were subnormal. In contrast, the oral glucose tolerance test was unimpaired. The pancreatic insufficiency had started suddenly during a summer vacation and may have had a viral aetiology. The hypothesis is advanced that in haemochromatosis the iron-laden pancreatic acinar and PP-producing cells are more susceptible to damage by viruses than normal pancreatic cells.

A double-contrast examination of the colon was performed during diarrheal illness in 5 patients with Campylobacter infection. The findings in these 5 patients were aphthoid ulcers and stippled appearance. In 1 patient with stool culture positive for Campylobacter, double-contrast study of the colon 9 days later showed no abnormalities. In a 12-year-old boy lymphoid hyperplasia could be observed as well as the aphthoid ulcers. All the abnormalities were segmental, more often localized in the rectosigmoid. No changes were found in the ascending colon. Histopathologic studies of the biopsy specimens taken endoscopically in 3 patients showed a nonspecific inflammatory reaction.

Findings of CT of the spleen were compared with those of histologic examination in 35 patients who had Hodgkin disease. CT provides a simple way to calculate splenic size. This index is also of value in the assessment of the histologic state of the spleen. An accuracy rate of 91%, specificity of 94%, and a sensitivity of 89% in diagnosing splenic localization of lymphoma was found in this study.

Of 59 patients undergoing lymphography as part of staging for urologic tumor (bladder carcinoma, prostate carcinoma, seminomatous and nonseminomatous testicular tumors), histological material was obtained in 38. Lymphography was shown to have a specificity of 95%, a sensitivity of 81%, and an overall accuracy of 89%. When lymph node regions were considered, the specificity was 99.2%, sensitivity 59%, and overall accuracy 91%. Causes of discrepancies between radiography and histology are evaluated and receiver operating characteristic curves are demonstrated.

Ninety-one patients with non-Hodgkin lymphoma (NHL) were subjected to computed tomography (CT) and lymphography. Both examinations agreed in 74 patients (81%) with regard to the infradiaphragmatic lymph nodes. In patients undergoing CT prior to lymphography, the concordance amounted to 75 per cent. When lymphography was the initial examination, the concordance amounted to 86 per cent. Lymphography was abnormal in 30 per cent of the patients with a normal CT scan and in 93 per cent of those with an abnormal CT scan as the first examination. CT was abnormal in 4 per cent of patients with a normal lymphogram and in 84 per cent of those with an abnormal lymphogram as the first examination. CT did not detect mesenteric or retrocrural lymph node enlargement in the absence of retroperitoneal lymph node involvement. Eleven patients had extranodal manifestations of the disease (excluding liver and spleen), and 3 were detected primarily with CT. Lymphography is the most complete examination for the infradiaphragmatic lymph nodes for staging purposes. Although CT outlined the disease better, it changed the lymphographic diagnosis in only 2 per cent of the patients. Lymphography modified the CT stage in 15 per cent of the patients. When abdominal CT is performed first, in staging patients with NHL, lymphography will only yield additional information when CT is normal or equivocal.

Computed tomography of the spleen was correlated with histologic examination or clinical data in 53 selected patients with non-Hodgkin lymphoma. Calculation of the splenic index with CT by multiplying spleen length, width and thickness is a simple and rapid procedure for defining splenic size in vivo. A good correlation was found between size of the spleen, as estimated by splenic index calculation, and the proven or probable histologic state of the spleen.

The accuracy in the diagnosis of gastric cancer was investigated in 188 histologically proven cases, including 12 cases of early gastric cancer. One hundred and sixty-five of 167 patients (99%) were recorded radiologically as having a gastric lesion. The initial diagnosis was carcinoma in 144 patients (86%), and benign lesion in 21 cases (13%). In 2 cases (1%) no abnormalities were seen. In 3 out of 9 patients with a partial gastrectomy (33%) an incorrect diagnosis was made. In 11 of 12 patients with early gastric cancer the radiologic examination revealed abnormal findings, but 7 of these were incorrectly interpreted as benign. A retrospective analysis of the radiologic examination in which no malignancies were reported showed that inadequacy of the examination technique and misinterpretation of radiologic signs of malignancy were the main causes of failure in diagnosing of malignancy. The rate of misinterpretation of malignancy as a benign lesion (13%) justifies the endoscopic control of every radiologically detected abnormality. The high sensitivity in detecting a lesion indicates, however, that a biphasic radiologic examination is a safe screening method in gastric cancer. Endoscopy with biopsy showed a lesion in 156 out of 160 patients (98 %), but in 11 of these (7%) the initial examination did not yield histologic proof of malignancy. In 4 patients (2%) no abnormalities were observed by endoscopists. One hundred and forty-nine patients were examined with both radiology and endoscopy with biopsy. A malignant lesion with recognition of its malignant character was defined in 144 cases (97%).

Thirty-two patients with proven progressive metastatic renal cell carcinoma were treated with the combination of 0.1 mg/m2 (2 X 10(6) IU/m2) r-interferon (r-IFN)-gamma and 6 micrograms/m2 (2 X 10(6) IU/m2) r-IFN-alpha. In case of progressive disease (PD) or stable disease (SD), after 8 weeks, the dose of r-IFN-alpha was escalated by 6 micrograms/m2 every 2 weeks until the maximum tolerable dose was reached, while r-IFN-gamma was maintained at the low dose. The rationale for this study is provided by the dose-related efficacy of IFN-alpha as a monotherapy, the potent immunostimulatory activity of IFN-gamma, and the alleged synergistic effect of the combination. Fourteen patients are evaluable for 8 weeks of low-dose combination treatment (7 X SD, 5 X PD, 2 X early progression), while so far 6 of 24 patients (25%) who started dose escalation of IFN-alpha have reached a partial response. These data indicate better efficacy with higher doses of IFN-alpha. Because of the infrequent administration and the relative low doses, compared to other trials, the treatment regimen was well tolerated. Although preliminary results are promising, definite efficacy remains to be proven.

Lymphography and abdominal CT were performed in 78 patients staged for Hodgkin's disease. In 82% of all patients, both examinations agreed on the presence or absence of lymph node involvement. In the group of 39 patients undergoing lymphography prior to CT, the agreement was 90%. In the group of 39 patients with lymphography following CT, the agreement was 74%. In 50% of the patients with discrepant findings, lymphography revealed abnormal nodes compared with CT. Lymphography was abnormal in 26% of patients with a normal CT scan as the first examination, and in 9% of patients with a normal CT scan as the second examination. It is concluded that lymphography is more reliable than CT in the examination of the abdomen. CT performed after a normal or an abnormal lymphogram adds little additional information. When CT is preferred as the initial investigation in staging Hodgkin's disease, lymphography only adds significant information if the CT scan is normal or equivocal.

Lymph node calcification in malignant lymphoma is an uncommon radiologic finding. Eight cases are added to the 61 cases of lymph node calcification following radiation therapy for Hodgkin's disease, assembled from the literature. The typical radiographic appearance of punctate calcifications, usually found in the upper mediastinum, at times together with egg-shell type calcification, is confirmed. The mean time before appearance of calcification was 3 years after initial treatment. The calcification seems to be associated with a good prognosis and long-term survival. In addition, the radiologic and clinical findings in a patient with non-Hodgkin's lymphoma who developed calcifications in the involved area after treatment are presented.

Floating stones were noted in the nonopacified gallbladder at ultrasound examination. Gas-containing fissures in these stones could be demonstrated pre- and postoperatively (Mercedes Benz sign).

17 of 400 patients with a total of 537 renal transplantations developed a malignant tumour (4,2%). 3 patients had a tumour of the skin or lips, 5 a solid lymphoma, 2 a hepatocellular carcinoma and 7 each another tumour. The radiologic findings of the patients are described. The problems around the diagnostics of malignant tumours in patients with renal transplantations are discussed.