Hepatic hemangioma: correlation of enhancement types with diffusion-weighted MR findings and apparent diffusion coefficients

Purpose

To correlate hepatic hemangioma enhancement types in gadolinium-enhanced magnetic resonance (MR) images with diffusion-weighted MR findings and apparent diffusion coefficients (ADCs).

Materials and methods

Respiratory-triggered diffusion-weighted MR images (TR/TE, 2422/46 ms; parallel imaging factor, 2; b factor, 500 s/mm²; number of averaging, 6) obtained in 35 patients with 44 hepatic hemangiomas diagnosed by gadolinium-enhanced MR and by follow-up imaging were retrospectively evaluated. Hemangiomas were classified into three enhancement types based on gadolinium-enhanced MR imaging findings: type I, early-enhancement type; type II, peripheral nodular enhancement type; type III, delayed enhancement type. Two blinded readers qualitatively assessed lesion sizes and signal intensities on T2-weighted turbo spin-echo and diffusion-weighted images. The ADCs of hemangiomas were also measured.

Results

No significant difference was observed between the three enhancement types in terms of signal intensities on T2-weighted images. Signal intensities on diffusion-weighted images were lower in the order type I to III (P < .01), and mean ADCs were 2.18 × 10⁻³, 1.86 × 10⁻³, and 1.71 × 10⁻³ mm²/s for types I, II, and III, respectively (P < .01). No correlation was found between lesion sizes and ADCs.

Conclusion

Hepatic hemangiomas were found to have enhancement type dependent signal intensities and ADCs on diffusion-weighted MR images. Further studies will have to substantiate that these diffusion patterns might reflect intratumoral blood flow or perfusion.     

Hand-foot syndrome induced changes of the palmar epidermal ridge configurations during and after treatment with capecitabine

Palmar plantar erythrodysesthesia (hand-foot syndrome, HFS) is a common adverse event of treatment with cytostatic chemotherapeutics such as capecitabine. Histopathological findings are nonspecific and may even include generalized epidermal necrolysis.A total of 50 patients were examined before and after the intake of capecitabine to assess if HFS may result in relevant changes of the palmar epidermal ridge configurations with possible consequences for the patients who want to travel abroad.In total, 14 of the 50 patients developed HFS (28%) with HFS grades 1–3 observed. HFS grade 4 was not observed.HFS of grade 2 and 3 was associated with a temporary macroscopic loss of the epidermal ridges. No dactyloscopic changes that might have led to a false identification were seen in those cases.Patients with a risk of HFS development who want to travel abroad should carry a medical pass of the chemotherapeutic treatment to prevent them from difficulties in identification controls.     

Atypical hemangioma mimicking hepatocellular carcinoma with a special note on radiological and pathological findings

We report a case of hemangioma with an atypical vascular enhancement pattern. The hemangioma showed peripheral rim enhancement at the arterial phase during dynamic magnetic resonance imaging, and the peripheral enhanced zone was still apparent during the delayed phase, as shown on double-phase computed tomography hepatic arteriography. The rim enhancement pattern of this case, mimicking that of hepatocellular carcinoma, may be due to the surrounding liver parenchymal fibrotic change caused by an active hepatitis C viral infection.     

Renal artery aneurysm: diagnosis and surveillance with multidetector-row computed tomography

Purpose: To investigate the prevalence of renal artery aneurysms, and to assess the value of multidetector-row computed tomography (MDCT) in diagnosing renal artery aneurysms.

Material and Methods: Altogether, 862 patients underwent arterial-phase contrast-enhanced CT scan of the abdomen in the period November 2003 to October 2005. A search for renal artery aneurysms was performed in our reporting system and revealed six patients with renal artery aneurysm (RAA).

Results: The incidence of RAA was 0.7%. All renal artery aneurysms were solitary, located in the main trunk or the first branch of the renal artery, with sizes from 1.5 cm to 3.4 cm. Five aneurysms were saccular, one fusiform. No underlying thrombosis was seen. Extensive calcification was found in one aneurysm. Three aneurysms were diagnosed using axial images, while three aneurysms were only displayed by volume rendering and maximum-intensity projection images.

Conclusion: This study demonstrates a 0.7% incidence of renal artery aneurysms in a total of 862 patients. MDCT has an important role in detecting and assessing renal artery aneurysms. Some aneurysms can only be displayed by post-processing techniques such as volume rendering and maximum-intensity projection.     

Primary thyroid hemangioma,a rare diagnosis in a patient with a painless neck mass

The aim of this case report is to demonstrate a case of primary thyroid hemangioma in a 62-year-old female who presented with a painless neck mass, treated with right hemithyroidectomy and diagnosed by surgical biopsy. Thyroid hemangiomas are rare, benign lesions which present a diagnostic challenge given the lack of specific imaging findings and clinical manifestations associated with them. However, accurate recognition of these lesions is important and can facilitate conservative, rather than surgical, management strategies. In this report, we discuss a case in a patient whose laboratory assessment raised concern for a thyroid paraganglioma, leading to surgical resection of what was ultimately a benign thyroid hemangioma. We also review the pathophysiology, clinical manifestations, differential diagnostic considerations, and imaging characteristics of thyroid hemangiomas across multiple modalities and discuss strategies for accurately diagnosing these lesions.     

Embolization of a subclavian artery aneurysm with steel coils and thrombin

Subclavian artery aneurysms are rare lesions usually treated by surgical excision or ligation. Steel coils were used successfully to treat a rapidly enlarging subclavian aneurysm in a patient deemed unsuitable for surgery. Because of a profound, uncorrectable coagulopath, thrombin was required to obtain effective thrombosis.     

A case of neurofibromatosis associated with a coronary artery aneurysm and myocardial infarction

A case of myocardial infarction secondary to thrombosis of a coronary artery aneurysm in a patient with neurofibromatosis is presented. The vascular manifestations of neurofibromatosis, and the associated clinical sequelae, are reviewed.     

肝海绵状血管瘤合并动静脉短路的介入治疗

目的 :评价平阳霉素碘化油乳剂合用PVA微粒肝动脉双重栓塞治疗合并有门静脉短路的肝海绵状血管瘤的可行性和临床疗效。方法 :对 6例肝海绵状血管瘤合并门静脉短路 ,应用微导管行肝动脉超选择插管 ,局部平阳霉素碘化油乳剂合用PVA微粒双重栓塞 ,观察动静脉短路闭塞情况肿瘤染色变化情况、术后患者临床症状的缓解和并发症及随访瘤体缩小程度。结果 :6例肝血管瘤患者行平阳霉素碘化油合用PVA微粒肝动脉超选择双重栓塞后 ,动静脉短路均闭塞 ,肿瘤染色消失 ,术后随访瘤体直径明显缩小 (P <0 .0 5 ) ,临床症状基本缓解 ,无严重并发症出现。结论 :平阳霉素碘化油乳剂合用PVA微粒肝动脉双重栓塞治疗 ,合并门静脉短路的肝海绵状血管瘤疗效及安全性良好。     

Mediastinal mass and tracheal compression due to an aneurysm of a systemic-to-pulmonary collateral artery in a patient with pseudotruncus arteriosus

A patient with pseudotruncus arteriosus who presented with a large mediastinal mass due to a systemic to pulmonary collateral artery aneurysm is reported. This aneurysm caused tracheal compression with resulting dyspnea and postobstructive pneumonitis, which are unusual presenting features in these patients. The differential diagnosis for a mediastinal mass arising in a patient with pseudotruncus arteriosus, or any other patient with possible systemic-to-pulmonary collateral arteries, should include aneurysm.     

Intrarenal aneurysm associated with “Ask-Upmark kidney”: Imaging pitfalls and limitations

The imaging of a case of intrarenal aneurysm with associated “Ask-Upmark kidney” is presented. Pitfalls and limitations encountered with imaging in this case are discussed. Magnetic resonance imaging (MRI) proved to be the best imaging modality for visualization and characterization of the mass lesions present.     

Anatomic differences of the distal aorta with dilatation or aneurysm between patients from Asia and Europe as seen on CT imaging

Aim

The hypothesis of this research is that there are differences in morphology of dilated and aneurysm changed infrarenal aorta between the patients from Europe and Asia that are important for endovascular treatment. Authors analyzed the morphologic differences of the infra-renal segment of abdominal aorta (a.a.) and the iliac arteries, common iliac artery (c.i.a.) between the Asians and Europeans examined by computed tomography (64 MD CT) from the point of the clinical use of the endovascular stent-graft.

Materials and methods

The research was conducted simultaneously in Europe and in Asia and 60 patients with distal aorta aneurysm were included (30 of each ethnic origin). The examinations were conducted at the identical types of 64 MD CT equipment, and under same conditions of examination technique and post-processing.

Results

There were statistically significant differences in regard to important morphology criteria for a.a. and c.i.a. between patients with the aneurysm from Asia and the Europe.Analysis was preformed referring to the gender, age, body weight (BW), height, body mass index (BMI), body surface (SA index), and various diameters of a.a. and c.i.a. at several linear and transversal levels, angle and volume of the aneurysm. The biggest differences relate to the width of the central part of aneurysm of a.a. and the length and volume of c.i.a.

Conclusion

There were statistically significant differences in regard to important morphology criteria for a.a. and c.i.a. between patients with the aneurysm from Asia and the Europe.     

Persistent primitive trigeminal artery associated with aneurysm: report of two cases and review of the literature

We present two cases of persistent primitive trigeminal artery (PPTA) associated with a giant aneurysm originating at the opening of the PPTA on the internal carotid artery (ICA). In one case, opening of the PPTA occurred 4 months after balloon occlusion of the ICA, when a giant aneurysm located at the cavernous segment of the ICA was being treated. The PPTA was occluded successfully using a Guglielmi detachable coil (GDC). A vertebral artery approach was taken. This is the first report of the opening of a PPTA associated with contrast filling of the aneurysm after balloon occlusion of the parent artery. The possibility of contrast filling of the aneurysm via potential PPTA should therefore be considered in the event of an ICA aneurysm with parent artery occlusion.     

Artefact on MRA following aneurysm clipping: an in vitro study and prospective comparison with conventional angiography

Using both an experimental model and clinical cases, we looked at the artefact produced by Aesculap titanium-alloy aneurysm clips on MRA. Experimentally, the volume affected by artefact was 50 % less when the clip was imaged lying parallel to the main ferromagnetic field than when lying perpendicular to it. Clinically, MRA was prospectively compared with digital subtraction angiography (DSA) in nine patients who had undergone aneurysm clipping. One patient with a non-diagnostic MRA due to movement artefact was excluded. In all other cases there was an area of signal loss surrounding the clips, obscuring the immediately adjacent vessel segments. There was good demonstration of the adjacent bifurcations in five cases and the contralateral circulation was seen well in all patients. In three cases in which the adjacent bifurcations were not seen, considerable vasospasm was suggested by MRA and confirmed with DSA. In one patient an unclipped contralateral ophthalmic artery aneurysm was identified using both modalities. In this series there were no adverse events relating to clips in either static or time-varying magnetic fields. Received: 29 November 1998 Accepted: 24 December 1998     

封堵器联合覆膜支架和弹簧圈治疗胸腔内锁骨下动脉瘤

目的探讨用封堵器联合覆膜支架和弹簧圈治疗临近主动脉弓的锁骨下假性动脉瘤的价值。方法经左侧肱动脉通路将室间隔封堵器植于锁骨下动脉起始段,封堵动脉瘤入口;经股动脉通路植入覆膜支架加强封堵效果;再经左侧肱动脉通路以弹簧钢圈封闭假性动脉瘤出口。结果左锁骨下动脉假性动脉瘤入口、开口完全封闭,无内漏,无脑部症状,上肢无明显缺血表现。结论封堵器联合覆膜支架和钢圈的"三介入法"治疗临近主动脉弓的左锁骨下动脉假性动脉瘤,具有微创操作、封闭彻底、机械结构稳定、手术安全性高等优点。     

Aneurysmal sizing after endovascular repair in patients with abdominal aortic aneurysm: interobserver variability of various measurement protocols and its clinical relevance

The aim of this study was to determine the variability of various measurement protocols for measurement of abdominal aortic aneurysm (AAA) and the clinical relevance of variability. Three radiologists performed computed tomographic angiography measurements of both the aorta and the largest portion of the aneurysm on selected axial slices. Then measurements of the largest portion of the aneurysm were performed on unselected axial slices, sagittal and coronal reformatted. Finally, aortic volume was calculated. Measurements and volume calculation were performed before and after endovascular repair and assessed: Part 1: interobserver variability for maximum anteroposterior (MAP) and maximum transverse (MTR) diameters on selected slices; part 2: interobserver variability for unselected slices considering MAP and MTR; part 3: interobserver variability considering maximum diameter in any direction (MAD); part 4: interobserver variability for sagittal (SAG) and coronal (COR) free curved multiplanar reformation (MPR); and part 5: volume calculations. We then determined which technique of measurement was the most clinically relevant for detecting changes in aneurysm size or aortic volume. Parts 1 and 2: interobserver variability was 4.1 mm for both MAP and MTR; part 3: interobserver variability was 7 mm for MAD; part 4: interobserver variability was 5.5 mm (COR) and 4.9 mm (SAG); part 5: interobserver variability for volume was 5.5 ml. A combination of MAP and MTR was the most useful for detecting aortic modification. Volume calculation was needed in only a few cases. We recommend avoiding MAD and MPR measurements and suggest instead measuring both maximum anteroposterior and maximum transverse diameters. If aneurysm size remains stable after endovascular repair, aneurysm volume should be measured.     

Right coronary artery aneurysm with aneurysmal dilation and thrombosis of the sinoatrial nodal branch mimicking a right atrial mass

Aneurysms of the branches of the coronary arteries are rare. We report a case of a right coronary artery aneurysm with aneurysmal dilation and thrombosis of the sinoatrial nodal branch presenting as a right atrial mass. The patient underwent multiple imaging evaluations before coronary CT angiography diagnosed aneurysm and thrombosis of the sinoatrial nodal branch.