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This pilot study compared the utility of immediate postprocedural contrast-enhanced sonography with that of delayed enhanced sonography and CT or MRI in assessing the success of radiofrequency ablation of hepatocellular carcinoma.Twenty-two lesions (1.5-3.7 cm) were studied in 19 patients. Enhanced sonography was performed before and within 1 hr after radiofrequency ablation. At routine 2-week follow-up CT or MRI, additional enhanced sonography was performed. The findings of preablation CT or MRI and enhanced sonography were compared with those of postprocedural and follow-up enhanced sonography by three radiologists experienced in these techniques. The reviewers were unaware of the follow-up CT or MRI results (reference standard). Technical adequacy, ablation zone targeting, and identification of residual disease were assessed by each reviewer, and the results were analyzed by consensus.One postprocedural sonographic study was considered technically inadequate. Postprocedural sonography predicted the follow-up CT or MRI results in 76% (16/21) of subjects (sensitivity, 88%; specificity, 40%; positive predictive value [PPV], 82%; negative predictive value, [NPV] 50%). Follow-up CT or MRI identified accurate targeting in 17 of 22 subjects. Follow-up sonography agreed with CT or MRI in 82% (18/22) of subjects (sensitivity, 88%; specificity, 67%; PPV, 88%; NPV, 67%). Postprocedural sonography predicted the follow-up CT or MRI results in 81% (17/21) of subjects (sensitivity, 40%; specificity, 94%; PPV, 66%; NPV, 83%). Follow-up CT or MRI detected residual disease in six subjects. Follow-up sonography agreed with CT or MRI in 91% (20/22) of subjects (sensitivity, 83%; specificity, 94%; PPV, 83%; NPV, 94%).Postprocedural enhanced sonography has the potential to guide completion of radiofrequency ablation at the time of initial therapy when residual disease is detected. The procedure is less accurate in detection of residual disease than is either delayed enhanced sonography or CT or MRI.

OBJECTIVE. Extraosseous multiple myeloma is rare (< 5%) and has not been systematically documented in the abdomen. Our aim is to catalogue and describe the manifestations of multiple myeloma affecting abdominal organs.CONCLUSION. Extraosseous myeloma may involve multiple abdominal organs and may mimic other malignancies. Clinicians and radiologists should be aware of the potential for myeloma to involve extraosseous sites to avoid unnecessary interventions when this occurs.

To evaluate the role of SH U 508A-enhanced ultrasonography (US) in the differentiation of focal hepatic masses.Contrast material-enhanced pulse inversion US was performed on 58 unknown hepatic lesions: 23 hepatocellular carcinomas, 10 focal nodular hyperplasias, 16 hemangiomas, and nine metastases. Selected images were sequentially reviewed by readers blinded to the final diagnosis. On a baseline image, they determined lesion echogenicity, and on a vascular image, the presence or absence of distinct vascularity. On an arterial phase interval-delay flash image and a postvascular image, they assessed enhancement of the lesion and liver. Responses were compared with confirmed diagnoses.Focal nodular hyperplasia was characterized by detectable vascularity and positive enhancement on interval-delay and postvascular scans (sensitivity, 83% [eight of 10 lesions]; specificity, 98% [40 of 41 lesions]). Hepatocellular carcinoma also showed detectable vascularity and positive enhancement on interval-delay images but no postvascular enhancement (sensitivity, 68% [14 of 20 lesions]; specificity, 74% [23 of 31 lesions]). Vascular imaging with SH U 508A did not contribute to the diagnosis of metastasis or hemangioma. However, no or weak enhancement during the arterial phase flash without postvascular enhancement produced a sensitivity of 83% (seven of eight lesions) and sensitivity of 77% (33 of 43 lesions) for metastasis. Peripheral nodular enhancement on arterial phase flash images was highly specific (98% [37 of 38 lesions]) but not sensitive (44% [six of 13 lesions]) for hemangioma.SH U 508A-enhanced pulse-inversion interval-delay flash and postvascular phase imaging are helpful in differential diagnosis of focal hepatic lesions.

The magnetic resonance imaging (MRI) features of 11 biopsy-proven lesions of focal nodular hyperplasia (FNH) of the liver were reviewed retrospectively. Only three lesions showed atypical features. It is believed MRI can reliably differentiate FNH from other liver tumours when strict criteria are fulfilled.

Purpose To compare the value of diffusion-weighted MRI (DWI), dynamic contrast-enhanced (DCE) MRI, and microbubble contrast-enhanced ultrasound (CEUS) for assessment of the thermal lesion created by interstitial microwave heating of the normal canine prostate. Materials and Methods A microwave antenna was inserted into each lobe of the prostate in seven dogs to induce coagulation necrosis. Immediately after therapy the lesion was assessed using CEUS, DCE-MRI, and DWI. The prostates were excised, photographed, and prepared for hematoxylin and eosin staining. Results from posttreatment MRI and ultrasound were compared to histology. Results The apparent diffusion coefficient (ADC) was slightly lowered within the thermal lesion but was drastically reduced in a ring-like region that corresponds to a grossly appearing red thermal damage zone immediately peripheral to the central coagulum. Both DCE-MRI and CEUS delineated a smaller area of vascular damage, for which the borders lie within the red zone. Conclusion The red zone encompasses a range of vascular responses, including hyperemia and hemostasis, and is known to progress to necrosis and tissue nonviability. DWI clearly depicts this zone as a region of sharply reduced ADC, and may be better than contrast-enhanced imaging for accurate assessment of the eventual full extent of thermal damage. J. Magn. Reson. Imaging 2008;28:136–143. © 2008 Wiley-Liss, Inc.

OBJECTIVE. We performed this pilot study to investigate the utility of contrast-enhanced sonography for the detection of endoleaks in patients with abdominal aortic endografts.CONCLUSION. Contrast-enhanced sonography evaluation of abdominal aortic endografts is a technically feasible alternative to our current practice standard.

Evaluation of aortic endografts is an exciting new application for contrast enhanced ultrasound. Detection of endoleaks is critical as they may lead to progressive enlargement of a treated aneurysm with a risk of aneurysm rupture. In this article, contrast enhanced ultrasound is presented as a potentially accurate, safe and economical alternative to CTA, the current practice standard, for endoleak detection.

Survivors of Hodgkin's disease are at increased risk of developing a second malignant neoplasm, including breast carcinoma and sarcoma. We report the first case of synchronous development of chest wall fibrosarcoma and breast carcinoma after mantle radiotherapy for Hodgkin's disease. Mammographic, sonographic and MR features are demonstrated.

A 23-year-old male involved in a high-speed collision acquired, among other injuries, a wide fracture distraction at C2/C3. Reduction was delayed by an enlarging vertebral artery pseudo-aneurysm at the site of injury which was successfully treated by proximal endovascular occlusion with a detachable polymer-filled balloon. A traumatic arachnoid cyst or pseudomeningocele was also demonstrated at the injury site but intervention was not required. The treatment and outcome of these three uncommon injuries in the literature is reviewed and discussed. Given the severity of the injury, the absence of severe long-term neurological disability is notable.

SUMMARY A 60-year-old man presented with sudden onset of left shoulder pain followed 2 weeks later by the development of left shoulder girdle weakness. A clinical and electrophysiological diagnosis of subacute idiopathic brachial neuritis was made. The MRI features of subacute muscular denervation in this patient are discussed and the relevant literature reviewed.

avernous hemangioma is the most common benign tumor of the liver. The imaging appearances and characteristic enhancement patterns identifying these lesions are well described on sonography, CT, and MRI. The presence of a fluid-fluid level within a hemangioma is an unusual variant that has been rarely described [1–3]. Extremely slow flow has been postulated as the cause of this phenomenon. We present a case of fluid-fluid levels in multiple liver hemangiomas and offer an explanation for their appearance, with an analogy observed in the penis on MRI.