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Hepatocellular adenoma (HCA) is a rare benign tumor of the liver with low risk of malignant transformation. It is associated with oral contraceptives/anabolic steroid use, metabolic disease, and rarely, vascular abnormalities. We report an interesting case of HCA arising in a background of diffuse hepatic nodular regenerative hyperplasia (NRH) in a 40-year-old female patient with systemic lupus erythematosus (SLE). She presented with sudden-onset refractory ascites, elevated liver enzymes, diffuse hepatic nodularity and mass lesions on imaging concerning for malignancy. Targeted biopsies of the mass lesion were performed with inconclusive diagnoses. The patient ultimately underwent resection of the mass, which was confirmed as HCA, inflammatory type, arising in a background of NRH. It is not uncommon for SLE patients to have liver manifestations such as NRH, but HCA arising in NRH has not been previously reported. Our case reveals an unusual relationship between HCA and hepatic vasculopathy in the clinical context of a systemic inflammatory condition, the mechanism by which is not fully understood.

Computed tomographic (CT) scans of 11 patients with perforations of the stomach or duodenum were reviewed to determine the variety and relative conspicuity of findings. Five patients had de novo presentation due to perforation of peptic ulcers, two had perforations at ulcer repair sites, and the remaining four patients had ulcer perforations following unrelated surgery. CT allowed recognition of at least one component of bowel perforation, such as extra-gastrointestinal gas and/or contrast, in most patients. In only three patients (27%), however, could these findings be specifically related to a perforation of the stomach or duodenum from the CT scans alone.

We reviewed various imaging approaches in 22 patients with gallbladder cancer. Nineteen had had ultrasonography and nine computed tomography performed. A gallbladder mass or diffuse wall thickening was seen by ultrasonography in 42% and computed tomography in 33% of patients. A significant number of patients had no gallbladder wall abnormality detected by ultrasonography (37%) or computed tomography (56%). Performing both ultrasonography and computed tomography improved the diagnostic rate; in this subgroup the detection rate was 51%. Cholelithiasis, dilated biliary ducts, the liver metastases were associated findings. Percutaneous cholangiography in jaundiced patients revealed the level of bile duct occlusion and often suggested the diagnosis. Radionuclide hepatobiliary imaging simply revealed non-visualization of the gallbladder.

The chopper fat suppression (CFS) pulse sequence, which is a phase sensitive implementation of the Dixon fat suppression method and the spin echo (SE) pulse sequence, was used in the evaluation of anatomic structures of the normal knee using 48 sets of imaging sequences in six volunteers using a repetition time/echo time combination of 1,500/30, 60 ms. A demonstration of the CFS technique in 10 patients with suspected knee pathology is also presented. A semiquantitative grading scale was established to rate anatomic visualization and used to compare CFS and SE pulse sequence techniques. The results in normal subjects demonstrate that hyaline cartilage is significantly better visualized by fat suppression pulse sequence than by conventional SE pulse sequence in the coronal and sagittal planes of imaging (p less than 0.001). The preliminary results from patients studies suggest that CFS imaging may be useful in the evaluation of meniscal tears, in the differentiation of hyaline cartilage from joint fluid, and in the detection of both soft tissue and bone injuries.

In patients with stage IB cervical carcinoma (carcinoma confined to the cervix), accurate staging is essential in order to determine the best treatment strategy--that is, whether to use surgery alone or surgery in combination with pre- or postsurgical radiation therapy. Currently, decisions regarding the management of patients are made on the basis of clinical staging that has an error rate of 34-39% (when surgical staging is used as the standard). To investigate the value of MR in staging patients with IB cervical cancer, we performed prospective MR examinations in 27 patients who had cervical carcinoma. Of these, 10 were clinically staged as having IB cervical carcinoma and underwent radical hysterectomy, providing specimens for pathologic correlation. In six of these 10 patients, the extent of disease had been underestimated during clinical examination under anesthesia. These six patients would have received radiation therapy before surgery had the MR information been used at the treatment-planning stage. MR imaging correlated better with surgical pathology than did clinical examination under anesthesia in determining the location and extent of tumor. MR imaging should be used in conjunction with clinical staging to determine appropriate therapy in patients with stage IB cervical carcinoma.

Ultrasonographic evaluation of the abdominal aorta is most often done with the patient in the supine position. The right lateral decubitus position, which views the aorta through the left flank has, until now, been considered unsatisfactory for aortic evaluation. One hundred consecutive patients were prospectively examined for visualization of the aorta both through the left flank and the anterior abdomen. Twenty-one patients were then comparatively examined from the right coronal and left coronal approach. These studies showed that the aorta was clearly visualized using the left flank approach in the majority of patients (96 per cent). The combined approach yielded 99 per cent satisfactory visualization, and in a few select cases (13 per cent) the left flank was actually superior. The left flank approach was superior when directly compared with the right flank in 42 per cent of patients and comparable in 48 per cent. The right flank approach was superior in only 10 per cent.