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PURPOSE: To develop a quantitative DCE MRI technique enabling entire-abdomen coverage, free-breathing acquisition, 1-second temporal resolution, and T(1)-based quantification of contrast agent concentration and kinetic modeling for the characterization of pancreatic ductal adenocarcinoma (PDAC). METHODS: Segmented FLASH readouts following saturation-recovery preparation with randomized 3D Cartesian undersampling was used for incoherent data acquisition. MR Multitasking was used to reconstruct 6-dimensional images with 3 spatial dimensions, 1 T(1) recovery dimension for dynamic T(1) quantification, 1 respiratory dimension to resolve respiratory motion, and 1 DCE time dimension to capture the contrast kinetics. Sixteen healthy subjects and 14 patients with pathologically confirmed PDAC were recruited for the in vivo studies, and kinetic parameters v(p), K(trans), v(e), and K(ep) were evaluated for each subject. Intersession repeatability of Multitasking DCE was assessed in 8 repeat healthy subjects. One-way unbalanced analysis of variance (ANOVA) was performed between control and patient groups. RESULTS: In vivo studies demonstrated that v(p), K(trans), and K(ep) of PDAC were significantly lower compared with nontumoral regions in the patient group (P = .002,.003, .004, respectively) and normal pancreas in the control group (P = .011

Intraoperative grid pattern markings have been used in the performance of liposuction. Grid pattern markings include series of longitudinal and transverse lines to delineate various anatomical boundaries and landmarks, including the midline, lateral line, and medial line. The markings are superimposed on the customary preoperative markings and divide broad or circumferential body surfaces into smaller subunits for liposuction. Grid pattern markings are applied to areas such as the anterior thighs, medial thighs, entire abdomen, flanks, back, arms, buttocks, calves, and ankles; they are not applied to smaller, less curved areas. Eighty-two consecutive patients underwent lipoplasty in 562 areas of the body. The revision rate for postliposuction contour irregularities was 4.0 percent (nine of 224 areas) where grid pattern markings were used; one area had an indentation type of contour irregularity and required autologous fat grafting. The revision rate was 1.5 percent (five of 328 areas) where grid pattern markings were not used; two areas in one patient had indentation-type contour irregularities and required autologous fat grafting. All remaining areas requiring revision had protuberant-type contour irregularities and responded to additional liposuction only. The use of grid pattern markings is associated with a low incidence of serious contour-related complications.

A two-point Dixon technique using a novel phase-correction algorithm and commercially available dual-echo fast gradient-echo pulse sequence is presented. The phase-correction algorithm determines the directional rather than phase distribution of signals due to field inhomogeneities. Specifically, a region-growing scheme uses precalculated spatial gradients of the signal phase to guide the growth sequence, so there is no need to manually select the seeds or use an empirical angular threshold. Further, the determination of the signal direction of a given pixel is based on both the amplitude and phase of the surrounding pixels, the direction of which has already been determined. The advantages of this algorithm include its easy implementation, computational efficiency, and robustness in the presence of pixels with large phase uncertainty. The feasibility and usefulness of the technique are demonstrated in vivo with artifact-free water and fat images of an entire abdomen in a single breath-hold.

We report a method of fast adipose tissue (FAT) assessment to characterize the quantity, and distribution of abdominal adipose tissue. Whole-volume coverage of the abdomen was obtained using 31 contiguous transverse T(1)-weighted images from 16 obese females. A radiologist manually traced all adipose tissue volumes in the images, while a physiologist used an automated method to measure adipose tissue in a single image at the level of the umbilicus. Automated analysis of the umbilicus-level image was significantly correlated with values obtained by manual analysis of the entire abdomen (p < 0. 001). There was good agreement between the automated umbilicus-level image method and the manual whole abdomen method for subcutaneous adipose tissue (r(2) = 0.958), visceral adipose tissue (r(2) = 0. 753), and total adipose tissue (r(2) = 0.941). The automated method required 6 min vs 2 h for the manual method.

We present the case of an 8-year-old child with diffuse lipomatosis simultaneously involving the intra-peritoneum, retro-peritoneum and abdominal wall. To the best of our knowledge, this is the first case of diffuse lipomatosis with simultaneous multi-focal involvement of the entire abdomen.

This is the first clinical case report of a thoracic invasive thymoma metastatic to the ovary with disease noted in the entire abdomen including the pelvis 5 1/2 years after initial diagnosis. The involved areas of metastases include the distal ileum, peritoneal and serosal surfaces (including the surface of the distal colon, bladder, and pelvis), and the surface of the right ovary. The patient survived 13 years after her initial diagnosis and 7 1/2 years after discovery of her metastases. Thymomas are rare tumors but comprise the most common primary tumor of the anterior mediastinum. Extrathoracic metastases of malignant thymomas are also rare, and the literature reports that the most common sites for metastases are the liver, lung, lymph nodes, and bone. Extrathoracic disease is associated with a poor prognosis. The average time of survival after the diagnosis of metastases is 1.5 years.

Giant solitary nonparasitic cysts of the liver are rarely encountered in children, and establishing a preoperative diagnosis is usually difficult, especially when the cyst occupies the entire abdomen. We report herein the case of an 8-year-old girl found to have a giant congenital solitary cyst of the liver masquerading as an ovarian cyst.

Computed tomography (CT) represents the preferred imaging modality for imaging the large bowel when virtual endoscopic reconstructions are desired. Using the spiral acquisition technique, it has become possible to scan the entire abdomen within a single breathhold, however, slice thicknesses of 5 mm or more are necessary should the breathhold not last longer than 30-40 s. With the advent of multislice CT, contiguous 1-mm slices can be obtained through the entire abdomen while even shortening the breathhold to 25-30 s. The improved speed and spatial resolution of multislice CT results in remarkably sharp virtual reconstructions allowing detection of polyps with sizes less than 3 mm. The disadvantages must still be considered including a dataset consisting of up to 800 images representing a new challenge for postprocessing hard- and software.

Although the majority of impalpable undescended testes lie in an intracanalicular location, a significant number are also found to be intraabdominal. The expected location of intraabdominal testes is a line joining the renal hilum and the internal inguinal ring. We describe a case of an adult patient in whom impalpable undescended testes were located in a retrovesical location. This case highlights the importance of performing a thorough inspection of the entire abdomen and pelvis if the impalpable testis is not found in an expected location.

The authors report a giant hepatocellular carcinoma (HCC) with a diameter over 30 cm and weight over 10 kg that was resected completely. A 62-year-old man was admitted because of continuous abdominal uplift. A computed tomography scan demonstrated that the entire abdomen was filled with a giant tumor containing both cystic and solid components with a size of 29 cm x 22 cm. The huge tumor was successfully resected without any complication, such as massive hemorrhage or visceral injuries. The size and weight of the tumor were 35 cm x 30 cm x 15 cm and 10 050 g, respectively. Pathological examination showed that the tumor was a well-differentiated HCC, and alpha-fetoprotein was positive. Postoperative syndrome, characterized by hypovolemic shock, diarrhea and urine retention, was observed and induced by abdominal decompression. This syndrome was resolved with expectant treatment. The patient was still alive without recurrence after a 27-mo follow-up.

The use of laparoscopy in general surgery has expanded to aid in the diagnosis of various intraabdominal conditions. A new application of the laparoscope is described to explore the abdominal cavity for potential gangrenous bowel after reduction of an incarcerated inguinal hernia. Hernioscopy allows for a good view of the entire abdomen including inspection of the colon for serosal changes of carcinoma. Exploration via this technique is accomplished without additional skin incisions or fascial disruptions and with no increased morbidity, when performed during the inguinal herniorrhaphy.

During the past five years, 21 patients with Stage III nodular malignant lymphoreticular tumors (MLT) have undergone total central lymphatic (TCL) irradiation. The irradiation must include the entire abdomen and Waldeyer's ring in addition to the usual regions encompassed by total nodal irradiation. A threshold dose of 2500–3000 rad in 20–45 days is received m each target volume. Every patient has been rendered free of all evidence of disease. One patient developed local recurrence and three had marginal recurrences; they are now free of disease 6–56 months after additional irradiation. Five patients have developed visceral dissemination and are receiving chemotherapy. All patients are alive (6–60 months, median 24 months). A prospective randomized trial has been established to compare TCL irradiation to the most favorable combination chemotherapy for patients with Stage III nodular MLT.

To identify patients at high risk for the development of enteric injury, an analysis was made of 212 women who received extensive pelvic and abdominal radiotherapy at the University of Minnesota from 1970 through 1981. One hundred one patients with cervical carcinomas received 8,000 to 8,500 rads to point A, 6,000 rads to point B, and 4,500 to 5,075 rads to the periaortic lymph nodes. One hundred eleven women with ovarian cancers received 2,000 rads to the entire abdomen, followed by an additional 2,975 to 3,000 rads to the pelvis. The overall complication rate was 6.6% (14/212). The only patients who sustained chronic radiation morbidity had thin physiques. The maximum likelihood multiple logistic model was utilized to predict the probability of enteric injury as a function of thin physique, previous operations, and hypertension for individual patients. The usefulness of predictive models is discussed, and possible reasons for the susceptibility of thin women to ionizing radiation are explored.

Total central lymphatic irradiation (2500-3000 rads in 3 to 6 weeks) including the entire abdomen, the supradiaphragmatic nodal areas, and Waldeyer's ring is being investigated as a potentially curative approach to patients with Stage III disease. Twenty-two patients have been treated (24-month minimum observation). All evidence of disease has disappeared in every patient. Three patients have developed local recurrence; 2 of them received 2000 rads or less. Three patients had marginal recurrences, and 5 developed generalized disease involving viscera. Fourteen patients (64%) are alive and free of any evidence of disease from 24-90 months (median, 54 months). Absolute survival is 82% (18/22).

Unsuspected abnormalities are occasionally detected during real-time ultrasound examinations. To determine the frequency of these findings during standard, routine real-time abdominal survey, the records of 500 consecutive examinations were reviewed. We found that a significant number of important occult abnormalities were detected. The influence of the abdominal survey on clinical management and improved radiologic consultation is discussed.

Two models of antishock trousers were studied for the effect of their inflation on the pulmonary function of 20 healthy men. Vital capacity was measured for each model at pressures at 0, 30, 60, and 100 mm Hg. The antishock suit with the abdominal compartment extending over the entire abdomen decreased the vital capacity 13.8% with inflation to a pressure of 100 mm Hg. The antishock suit with a smaller abdominal compartment, considered the standard model, decreased vital capacity only 5% at the same pressure.

A huge pancreatic pseudocyst which nearly filled the entire abdomen ruptured into the sigmoid colon, and caused perplexing clinical and radiographic findings. Because of the thickness of its wall, the pseudocyst did not collapse but became filled with intestinal gas. The more common features of pseudocysts that rupture are discussed.

The gastrointestinal radiologist no longer has to rely on indirect signs of extraluminal and solid organ pathology. With the use of the newer imaging modalities, including computed tomography, magnetic resonance imaging, and isotopic techniques, the entire abdomen and its contents can be directly visualized. Pathology, its extent and its effect on adjacent structures, can be readily appreciated.

Irradiation of the entire abdomen is the logical therapy for ovarian carcinomas spread throughout the abdominal cavity, seminomas with massive periaortic lymph node involvement, and abdominal manifestations of the lymphomas. When irradiation is done either with kilovoltage or megavoltage, through large portals, marked systemic reactions can only be avoided by long protraction; it is likely that the dose administered will not be lethal to a high fraction of tumors.A moving strip technique using megavoltage is better tolerated. In this paper it is shown that a dose of 2,800 rads can be delivered to each segment of the abdomen in 12 days with local systemic reactions kept within safe limits during the treatment.A minimum period of 3 years has now[See table in the PDF file]elapsed in the study of the original patients, which makes an assessment of the late complications possible. No kidney or spinal cord sequelae have been observed.The original patients now have a minimum of 3 years follow-up, so that one can...

Summary A supernumerary, hugely dilated ectopic urefer filled practically the entire abdomen. The significant roentgenologic features seen were very similar to those present in children with distal ureteral atresia and marked dilatation of the blind distal segment.

To the Editor:— I read with interest the communication, "Podophyllum Resin Poisoning With Complete Recovery" ( JAMA 189: 639 [Aug 24] 1964), by Balucani and Zellers. Their case being only the fifth case of podophyllum resin poisoning in the literature, I would like to report a short history of another, this one a legal matter for which all records were sent to me by the Turkish health authorities. The patient was a 45-year-old woman with a Krukenberg tumor of the ovary. The entire abdomen was infiltrated by metastases and the tumor was considered inoperable. To test the antitumoral effect of podophyllum resin, the physician in charge injected intravenously 6 ml of a podophyllum resin solution (1.5 gm of podophyllum resin in 100 ml of alcohol). The patient died a short time later. She had received 90 mg of podophyllum resin, and chemical analysis showed that this amount of the resin contains

A case report in which a silver surgical clip was mistaken for the identifying metallic bar affixed to an Antigon intrauterine device (IUD) is presented. The tail of the device was found to be missing during a routine examination. Radiographic examination revealed a metallic clip outside the uterine cavity. Laparotomy however failed to locate the IUD outside of the uterine cavity. In patients wearing an IUD containing a bar metallic marker suspicion of uterine perforation must be carefully evaluated with regard to previous operations and X-rays of the entire abdomen are mandatory.

Renal cell carcinoma is not an uncommon finding in our population. Since the symptoms of renal cell carcinoma may mimic those of other abdominal disease, we strongly advocate ultrasonic evaluation of the entire abdomen when screening patients with pain. Whether our three patients' symptoms were due to gallbladder disease or the incidentally detected renal cell carcinoma is relatively inconsequential, as long as detection of the potentially life-threatening lesion is achieved.

• From a review of 266 cases reported in the literature and data on 15 other patients operated on at the Mayo Clinic for symptomatic, annular pancreas, the following three conclusions can be made. First, annular pancreas is an uncommon congenital anomaly, often not becoming symptomatic until late in life. Second, complicating congenital and acquired disorders must be recognized if patients are to be properly prepared for surgery. Sometimes associated problems may be recognized, whereas the annular pancreas may be overlooked. The chance of this happening is decreased by methodical inspection of the entire abdomen, especially all segments of the duodenum, because annuli can occur in any segment and can be partially or completely circumferential. Third, while there is no single operative procedure of choice, published experience militates against any direct attack on the offending annulus. (Arch Surg115:46-50, 1980)