Differentiating between Adenomyomatosis and Gallbladder Cancer: Revisiting a Comparative Study of High-Resolution Ultrasound,Multidetector CT,and MR Imaging

Objective

To compare the diagnostic performance of high-resolution ultrasound (HRUS) with contrast-enhanced CT and contrast-enhanced magnetic resonance imaging (MRI) with MR cholangiopancreatography (MRCP) to differentiate between adenomyomatosis (ADM) and gallbladder cancer (GBCA).

Materials and Methods

Forty patients with surgically proven ADM (n = 13) or GBCA at stage T2 or lower (n = 27) who previously underwent preoperative HRUS, contrast-enhanced CT, and contrast-enhanced MRI with MRCP were retrospectively included in this study. According to the well-known diagnostic criteria, two reviewers independently analyzed the images from each modality separately with a five-point confidence scale. The interobserver agreement was calculated using weighted κ statistics. A receiver operating characteristic curve analysis was performed and the sensitivity, specificity, and accuracy were calculated for each modality when scores of 1 or 2 indicated ADM.

Results

The interobserver agreement between the two reviewers was good to excellent. The mean Az values for HRUS, multidetector CT (MDCT), and MRI were 0.959, 0.898, and 0.935, respectively, without any statistically significant differences between any of the modalities (p > 0.05). The mean sensitivity of MRI with MRCP (80.8%) was significantly higher than that of MDCT (50.0%) (p = 0.0215). However, the mean sensitivity of MRI with MRCP (80.8%) was not significantly different from that of HRUS (73.1%) (p > 0.05). The mean specificities and accuracies among the three modalities were not significantly different (p > 0.05).

Conclusion

High-resolution ultrasound and MRI with MRCP have comparable sensitivity and accuracy and MDCT has the lowest sensitivity and accuracy for the differentiation of ADM and GBCA.     

~(18)F-FDG PET显像诊断胆囊癌

目的：探讨^18F-FDG PET显像在胆囊癌诊断中的应用价值。方法：7例临床怀疑的胆囊癌患者均行^18F—FDG PET显像，对显像结果进行目测法及半定量分析，并与CT、手术、腹腔镜取病理等进行对比研究。结果：病理检查确诊4例胆囊癌，3例胆囊良性病变。^18F-FDG PET显像均正确定性。CT对6例作出正确定性。2例PET显像发现了CT未发现的转移灶3处，并对1例胆囊癌患者进行了正确疗效评价。结论：^18F-FDG PET显像对胆囊癌的诊断及临床分期具有较好的临床应用价值，并可准确地评价治疗效果。     

MR cholangiography in the diagnosis of sclerosing cholangitis in Langerhans' cell histiocytosis

Langerhans' cell histiocytosis (LCH) is a disorder of histiocytic proliferation that primarily affects infants. Imaging findings of a rare case of lung and liver involvement in an adult are presented. High-resolution computed tomography (HRCT) of the lungs showed confluent thin-walled cystic air spaces compatible with advanced LCH. Liver CT and MRI revealed unspecific signs of fatty infiltration. Irregular widening of peripheral bile ducts was displayed in breath-hold MR cholangiography. This pattern is considered characteristic for sclerosing cholangitis and should support the diagnosis of LCH in case of concomitant cystic pulmonary disease, even in adult patients.     

Sclerosing Cholangitis: Clinicopathologic Features,Imaging Spectrum,and Systemic Approach to Differential Diagnosis

Sclerosing cholangitis is a spectrum of chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts, which can be classified as primary and secondary sclerosing cholangitis. Primary sclerosing cholangitis is a chronic progressive liver disease of unknown cause. On the other hand, secondary sclerosing cholangitis has identifiable causes that include immunoglobulin G4-related sclerosing disease, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndrome-related cholangitis, and eosinophilic cholangitis. In this review, we suggest a systemic approach to the differential diagnosis of sclerosing cholangitis based on the clinical and laboratory findings, as well as the typical imaging features on computed tomography and magnetic resonance (MR) imaging with MR cholangiography. Familiarity with various etiologies of sclerosing cholangitis and awareness of their typical clinical and imaging findings are essential for an accurate diagnosis and appropriate management.     

Multidisciplinary Functional MR Imaging for Prostate Cancer

Various functional magnetic resonance (MR) imaging techniques are used for evaluating prostate cancer including diffusion-weighted imaging, dynamic contrast-enhanced MR imaging, and MR spectroscopy. These techniques provide unique information that is helpful to differentiate prostate cancer from non-cancerous tissue and have been proven to improve the diagnostic performance of MRI not only for cancer detection, but also for staging, post-treatment monitoring, and guiding prostate biopsies. However, each functional MR imaging technique also has inherent challenges. Therefore, in order to make accurate diagnoses, it is important to comprehensively understand their advantages and limitations, histologic background related with image findings, and their clinical relevance for evaluating prostate cancer. This article will review the basic principles and clinical significance of functional MR imaging for evaluating prostate cancer.     

硬化性胆管炎与胆总管癌的影像鉴别诊断

目的探讨CT和胆道造影对硬化性胆管炎和胆总管浸润癌的影像特征并评价其诊断区别。方法对18例经手术病理证实的胆总管癌与4例临床诊断的硬化性胆管炎的CT和PTC、ERCP、MRCP的影像学表现进行分析。结果4例硬化性胆管炎表现胆总管壁较薄,边界更加光整,管壁向心性增厚,狭窄近段胆管轻度扩张;CT增强扫描呈明显强化,胆道造影表现管腔渐进性、均匀的狭窄,与胆管癌比较表现多灶性狭窄并有沙漏样改变。结论CT和胆道造影能有效区分硬化性胆管炎和胆总管浸润癌病变,密切结合临床综合分析,对于两种疾病的鉴别诊断有重要的价值。     

Imaging of acute pancreatitis

Acute pancreatitis is defined as an acute inflammatory process of the pancreas with variable involvement of peripancreatic tissues or remote organ systems. This article reports the current classification, definition and terminology, epidemiology and etiology, pathogenesis and pathological findings, clinical and laboratory findings, and finally imaging findings of acute pancreatitis with emphasis on cross-sectional imaging modalities such as ultrasound, computed tomography, and magnetic resonance imaging.     

Imaging of Anal Fistulas: Comparison of Computed Tomographic Fistulography and Magnetic Resonance Imaging

The primary importance of magnetic resonance (MR) imaging in evaluating anal fistulas lies in its ability to demonstrate hidden areas of sepsis and secondary extensions in patients with fistula in ano. MR imaging is relatively expensive, so there are many healthcare systems worldwide where access to MR imaging remains restricted. Until recently, computed tomography (CT) has played a limited role in imaging fistula in ano, largely owing to its poor resolution of soft tissue. In this article, the different imaging features of the CT and MRI are compared to demonstrate the relative accuracy of CT fistulography for the preoperative assessment of fistula in ano. CT fistulography and MR imaging have their own advantages for preoperative evaluation of perianal fistula, and can be applied to complement one another when necessary.