Multifocal nodular fatty infiltration of the liver mimicking metastatic disease on CT: imaging findings and diagnosis using MR imaging

The aim of this study was to describe the MR appearance of multifocal nodular fatty infiltration of the liver (MNFIL) using T1-weighted in-phase (IP) and opposed-phase (OP) gradient-echo as well as T2-weighted turbo-spin-echo sequences with fat suppression (FSTSE) and without (HASTE). Magnetic resonance imaging examinations at 1.5 T using T1-weighted IP and OP-GRE with fast low angle shot (FLASH) technique, and T2-weighted FSTSE, T2-weighted HASTE of 137 patients undergoing evaluation for focal liver lesions were reviewed. Five patients were identified in whom CT indicated metastatic disease; however, no liver malignancy was finally proven. Diagnosis was confirmed by biopsy (n = 3), additional wedge resection (n = 1) or follow-up MRI 6–12 months later (n = 5). Regarding the identified five patients, the number of focal liver lesions was 2 (n = 2) and more than 20 (n = 3). The MR imaging characteristics were as follows: OP-image: markedly hypointense (n = 5); IP image: isointense (n = 2) or slightly hyperintense (n = 3); T2-weighted FSTSE-image: isointense (n = 5); T2-weighted HASTE image isointense (n = 1); slightly hyperintense (n = 4). On OP images all lesions were sharply demarcated and of almost spherical configuration (n = 5). Further evaluation by histology or follow-up MR imaging did not give evidence of malignancy in any case. Histology revealed fatty infiltration of the liver parenchyma in three patients. Magnetic resonance follow-up showed complete resolution in two patients and no change in three patients. Multifocal nodular fatty infiltration can simulate metastatic disease on both CT and MR imaging. The combination of in-phase (IP) and opposed-phase (OP) gradient-echo imaging can reliably differentiate MNFIL from metastatic disease. Received: 15 September 1999 Revised: 3 February 2000; Accepted: 7 February 2000     

Functional significance of air trapping detected in moderate asthma

The aim of this study was to evaluate bronchial and lung abnormalities in patients suffering from moderate asthma as defined by international guidelines, with special attention to air trapping on CT in comparison with that detected in smoking and non-smoking normal subjects. Twenty-two patients classified as moderate asthma and control subjects including healthy volunteers, smokers (n = 10) or non-smokers (n = 12) were prospectively explored by high-resolution CT (HRCT) performed at suspended full inspiration and expiration. The same expiratory protocol was performed 15 min after inhalation of 200 μg of salbutamol. Patients underwent pulmonary function tests within the same week and bronchodilator response was assessed following inhalation of salbutamol. Abnormalities of bronchi and lung parenchyma on inspiratory CT and air trapping on expiratory CT, in dependent and non-dependent areas, were assessed and scored semi-quantitatively by two independent observers. Comparison of score mean values between the different groups was performed using Mann-Whitney test and Spearman correlation between CT findings and pulmonary function tests were calculated. Mosaic perfusion was observed in 23 % of asthmatics. Air-trapping scores were significantly higher in asthmatic patients than in non-smoking control subjects (p = 0.003), but not than in smokers. This difference was ascribed to non-dependent zones of the lung for which air-trapping scores were also higher in asthmatic patients (p = 0.003) and in smoking subjects (p = 0.004) than in normal controls. In the asthmatic group, a significant positive correlation was found between airways resistance and bronchial dilatation score (p = 0.01), and between small airways obstruction index and mosaic perfusion score (p = 0.05). In addition, both FEV1 and reversibility of small airways obstruction values correlated with air-trapping score (p = 0.03 and p = 0.007, respectively). No change could be detected in air-trapping score following salbutamol inhalation. Patients suffering from moderate asthma present mosaic perfusion and larger areas of air trapping than normal subjects, particularly in non-dependent areas of the lung. These lung abnormalities are related to small airways obstruction. Received: 28 December 1999; Revised: 27 April 2000; Accepted: 2 May 2000     

Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features

This study was conducted to determine characteristic CT findings following the Whipple procedure and to evaluate the usefulness of CT in predicting tumor recurrence. Eighty-four postoperative abdominal CT scans and medical records of 43 patients were retrospectively reviewed. Perioperative histopathologic examinations revealed malignancy in 32 patients (74.4 %). Time interval between surgery and CT varied from 13 days to 6 years and 7 months. Common postoperative findings were unopacified anastomotic bowel loops in the porta hepatis (n = 69 scans), perivascular cuffing (n = 42 scans), pneumobilia (n = 40 scans), dilated intrahepatic bile ducts (n = 22 scans), reactive lymphadenopathy (n = 21 scans), and transient fluid collections (n = 20 scans). Postoperative complications were detected on 17 CT scans (20.2 %): generalized ascites (n = 8 patients), deep abscesses (n = 3 patients), wound abscess (n = 1 patient), pancreatitis (n = 1 patient), and pseudomembranous colitis (n = 1 patient). Tumor recurrence appeared in 15 patients (46.8 %) after a mean postoperative period of 11 months (1 month to 3 years): local (9 of 15), regional lymph nodes (9 of 15), and liver metastasis (8 of 15). Detection of generalized ascites more than 30 days after surgery was associated with tumor recurrence in 6 of 6 patients (100 %). Diffuse ascites (> 30 days after surgery) behaved as an early predictive sign of tumor recurrence. In our series CT accuracy for detecting recurrent tumor with CT was 93.5 %. No predilection site for disease recurrence could be determined. Received: 1 February 1999; Revised: 15 April 1999; Accepted: 19 April 1999     

Pulmonary MALT lymphoma: imaging findings in 24 cases

The aim of this study was to describe the imaging features of pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma. The chest radiographs (n = 18) and CT scans (n = 17) of 24 patients (18 men and 6 women) aged 27–78 years (mean = 56 years), with a known diagnosis of pulmonary MALT lymphoma, were retrospectively reviewed by two radiologists and the imaging findings are described. Six of the 24 patients had a history of an autoimmune disorder and 1 patient had acquired immune deficiency syndrome. Multiple pulmonary lesions were identified in 19 of 24 patients (79 %) and solitary lesions in 4 of 24 patients (17 %). Diffuse pulmonary infiltration was present in 1 patient. Lesions included masses or mass-like areas of consolidation (n = 21) and pulmonary nodules (n = 18). Associated findings were air bronchograms, airway dilatation, a positive angiogram sign and a halo of ground-glass shadowing at lesion margins. Peribronchovascular thickening was also observed, as were hilar or mediastinal lymph node enlargement and pleural effusions or thickening. Although rare, the diagnosis of pulmonary MALT lymphoma should be considered in patients with the imaging features described, particularly when in association with an indolent clinical course or a history of autoimmune disease. Received: 4 October 1999; Revised: 24 February 2000; Accepted: 18 April 2000     

Tracheal rupture caused by blunt chest trauma: radiological and clinical features

The aim of this study was to assess radiomorphologic and clinical features of tracheal rupture due to blunt chest trauma. From 1992 until 1998 the radiomorphologic and clinical key findings of all consecutive tracheal ruptures were retrospectively analyzed. The study included ten patients (7 men and 3 women; mean age 35 years); all had pneumothoraces which were persistent despite suction drainage. Seven patients developed a pneumomediastinum as well as a subcutaneous emphysema on conventional chest X-rays. In five patients, one major hint leading to the diagnosis was a cervical emphysema, discovered on the lateral cervical spine view. Contrast-media-enhanced thoracic CT was obtained in all ten cases and showed additional injuries (atelectasis n = 5; lung contusion n = 4; lung laceration n = 2; hematothorax n = 2 and hematomediastinum n = 4). The definite diagnosis of tracheal rupture was made by bronchoscopy, which was obtained in all patients. Tracheal rupture due to blunt chest trauma occurs rarely. Key findings were all provided by conventional chest X-ray. Tracheal rupture is suspected in front of a pneumothorax, a pneumomediastinum, or a subcutaneous emphysema on lateral cervical spine and chest films. Routine thoracic CT could also demonstrate these findings but could not confirm the definite diagnosis of an tracheal rupture except in one case; in the other 9 cases this was done by bronchoscopy. Thus, bronchoscopy should be mandatory in all suspicious cases of tracheal rupture and remains the gold standard. Received: 22 February 1999; Revision received: 29 June 1999; Accepted: 1 July 1999     

Value of MR cholangiography in the evaluation of postoperative biliary complications following orthotopic liver transplantation

The aim of this study was to describe the spectrum of abnormal biliary findings as seen with magnetic resonance cholangiography (MRC) in symptomatic patients after orthotopic liver transplantation (OLT). In our study we included 12 consecutive patients post-OLT who presented with clinical and/or biochemical suspicion of biliary complications. In all patients MRC was performed on a 1.0-T whole-body magnet and breathhold half-Fourier acquired single-shot turbo spin echo and rapid acquisition with relaxation enhancement sequences were used. Diagnostic confirmation was obtained with percutaneous transhepatic cholangiography (PTC; n = 3 patients), endoscopic retrograde cholangiography (ERC; n = 3 patients), or clinical follow-up. A vast array of biliary abnormalities were detected in 11 of 12 patients: high-grade, obstructive, anastomotic stricture was the most common unique abnormality. Findings consistent with bile duct necrosis, the second most common abnormality, were accompanied by arterial abnormalities in 2 of 5 patients on subsequent MR- and digital subtraction angiography. Compared with the findings obtained with direct cholangiography (n = 5 patients), MRC was highly accurate for the detection and characterization of postoperative biliary complications. Compared with the final diagnosis, which was based on PTC-ERC findings and/or all available clinical data, MRC imaging alone was able to provide a specific diagnosis in 9 of 12 patients. Magnetic resonance cholangiography is an accurate, time-saving, and non-invasive imaging modality in the evaluation of post-OLT patients in whom suspicion of biliary complications exists. Although the precise value of MRA in this patient group requires larger dedicated studies, single session “all-in-one” MR evaluation of both biliary and arterial system in our series proved to be a substantial benefit in obtaining an accurate and complete diagnosis. Received: 2 December 1999; Revised: 24 February 2000; Accepted: 24 February 2000     

Cervical spine injury: accuracy of helical CT used as a screening technique

Objective: The study objective was to determine the sensitivity and specificity of a helical CT technique to screen for cervical spine injury in a high-risk trauma population. Materials and methods: The helical CT reports for a consecutive series of 601 high-risk adult blunt trauma victims were reviewed. Findings were confirmed using an independent reference standard, which consisted of additional cervical spine imaging (CT, MRI, or radiography), operative findings, autopsy results or clinical outcome. Results: Sensitivity and specificity of helical CT for injury were 77/81 (95 %; 95 % confidence limits: 90–100 %) and 484/520 (93 %; 95 % confidence limits 91–95 %) respectively. Four false negative cases were comprised of three missed ligamentous injuries and one missed fracture. False positive cases (n = 36) were mostly attributed to possible facet fracture (n = 6), possible ligamentous injury (n = 8) or technically inadequate scan (n = 6).The overall accuracy of the helical CT protocol for cervical spine injury in this population was 561/601 (93 %; 95 % confidence limits 91–95 %). Conclusion: Helical CT has high accuracy for cervical spine injury. We believe that helical CT should be the preferred imaging strategy in high-risk blunt trauma patients.     

Vetting requests for body computed tomography

The aim of this study was to assess the process and outcome of hospitalised patients (inpatients) for whom whole-body CT was requested but not performed. For 6 months the reasons why CT was not performed were recorded, together with relevant discussions with clinicians. Subsequent referrals for alternative investigations were noted. The eventual outcome of the patients was monitored via the patients' records. Eighty-three (8 %) of 1001 inpatient requests were identified for which body CT was not performed after an electronically generated request. Fifty-five requests were not accepted by the radiology department during the vetting process for a variety of reasons (often more than one): criteria used for rejection often overlapped and included referrals outside national guidelines (n = 20), better alternative investigations (n = 29), time constraints (n = 19), over-zealous requests (n = 17) and clinicians' erroneous interpretation of preceding imaging investigations (n = 9). Sixteen CT exams were cancelled by a clinician. An additional 12 exams were not performed for miscellaneous non-medical reasons. In no case could a patient's death be ascribed to CT not being performed. Most (981 of 1001, 98 %) CT requests comply with current guidelines, disproving a perception that many radiological referrals are inappropriate. In our health care system radiologists have to turn down some appropriate CT referrals due to a lack of CT capacity. Although lack of CT contributed to delay in diagnosis, no patient died as a direct result of not having CT. Received: 15 June 1999; Revised: 4 October 1999; Accepted: 5 October 1999     

New method for fast spiral CT of trauma patients: RUSH CT

Aim: The purpose of this study was to develop a fast scanning protocol for spiral CT of emergency trauma patients (RUSH-CT) in order to accelerate the diagnostic work-up. Method: In a consecutive series 446 trauma patients underwent spiral CT; of these, 51 emergency patients underwent a modified protocol (RUSH-CT) on a recent technology scanner (Somatom Plus 4). Scanning time was compared between the RUSH-CT and the regular protocols. Results: The average time for RUSH-CT, comprising one pilot scan and three spiral scans, including preparation time and monitor reading was 15 min (range 12–18 min; n = 51). Using regular organ protocols comprising two pilot scans and four spiral scans, the control group had an average scanning time of 35 min. In comparison to the conventional organ protocols, total scanning time could be reduced by the RUSH-CT by 57 % (P < 0.01). Conclusion: Fast spiral CT (RUSH-CT) significantly reduces the time needed for diagnostic work-up and allows early therapeutic intervention. CT diagnosis can be completed within the first 30 min after the patient's admission.     

Sonography in acute appendicitis: diagnostic utility and influence upon management and outcome

A study is made of the diagnostic utility of echography in clinically suspected appendicitis, and its influence upon patient management and outcome. A total of 374 consecutive patients with possible appendicitis were prospectively evaluated by ultrasound. Two groups were established: group A (high clinical probability, ≥ 0.70) and group B (moderate clinical probability, 0.20–0.60). In group-A patients (n = 105, 28 %), prevalence of appendicitis = 0.90) underwent surgery regardless of the echographic findings. In group B (n = 269, 72 %), prevalence of appendicitis = 0.28) surgery was performed in the event of positive echography, whereas negative echographic findings did not definitively discard appendicitis. The diagnostic utility of echography was evaluated by applying the Pauker-Kasirer threshold approach to clinical decision making. The influence of ultrasound upon outcome was in turn evaluated by contrasting the total appendectomized patients (190 of 374) with a series of 181 individuals subjected to appendectomy prior to the introduction of echography. The probability of appendicitis in the presence of positive echography was 0.95 in group A (sensitivity = 0.92) and 0.89 in group B (sensitivity = 0.91). The probability of appendicitis in the event of negative ultrasound was 0.58 in group A (specificity = 0.55) and 0.03 in group B (specificity = 0.95) . In 46 % of cases the echographic findings led to a change in therapeutic regimen. In addition, the incidence of negative appendectomies was significantly reduced (19.3 vs 11.6 % with echography; p = 0.03), as was the delay in establishing a diagnosis (under 6 h in 68.5 vs 84.2 % with echography; p = 0.002) and the number of medical acts required (three in 71.3 vs 84.1 % with echography; p = 0.001). There was no significant reduction in the incidence of perforated appendicitis (17.1 vs 17.9 % with echography), in the number of postoperative complications (13.8 vs 7.6 % with echography), or in the days of hospital stay (4.44 vs 4.80 with echography). Echography proved useful in group B, and was generally of little utility in group A. The technique had a positive influence on treatment, with management reorientation in a considerable number of patients, and on outcome, since ultrasound contributed to establishing an earlier diagnosis, with a reduction of unnecessary appendectomies. Received: 4 October 1999, Revised: 11 February 2000, Accepted: 17 May 2000     

Helical CT: a useful technique in the evaluation of aortic intramural hematoma

Purpose: To investigate the diagnostic role of helical CT in aortic intramural hematoma. Material and methods: We retrospectively evaluated CT images obtained during a 6-year period, between 1994 and 2000, in 427 patients who underwent helical CT. Only 21 patients had typical findings of aortic intramural hematoma. All studies were performed with helical technique before and after a power injection of nonionic contrast material. Results: Twenty-one patients had aortic wall thickening (9 type A and 12 type B in Stanford's classification). Wall thickening was more than 4 mm in all cases, it was irregular in shape in 16/21 patients (76 %) and had a regular concentric shape in the remaining 5/21 patients (24 %). One patient with type A hematoma died soon after CT diagnosis because of arrhythmia caused by hemopericardium. Five patients (4 type B and one type A) underwent pharmacological therapy and radiological follow-up. Fifteen patients (7 type A and 8 type B) underwent prosthetic surgery and six of these died of postoperative complications. Conclusion: Helical CT represents the first step in the early diagnosis of aortic intramural hematoma before complications develop. In our experience, which agrees with the reports of other authors, helical CT is an accurate and valuable investigation for identifying the location and extent of an aortic intramural hematoma.     

Evaluation of CT findings for diagnosis of pleural effusions

Computed tomography studies are usually used to assess patients with pleural effusions, and radiologists should be aware of the significance of different CT findings for the diagnosis of the effusion. The purpose of this study was to evaluate CT findings for etiological diagnosis of pleural effusions. Contrast-enhanced CT of the chest of 211 patients with pleural effusion of definite diagnosis were evaluated. The CT images were evaluated for the presence and extent of pleural effusion, thickening or nodules, extrapleural fat and other changes in the mediastinum or lung. The CT scans were read by two independent observers and correlation between them was evaluated. Comparison of CT findings between benign and malignant effusions, between exudates and transudates, and between empyemas and the other parapneumonic effusions were carried out. Kappa values for most CT findings were > 0.85. Loculation, pleural thickening, pleural nodules, and extrapleural fat of increased density were only present in exudative effusions. Multiple pleural nodules and nodular pleural thickening were the only pleural findings limited to malignant pleural effusions. The signs were also more frequently seen in empyemas than in other parapneumonic effusions. Computed tomography findings can help to distinguish between transudates and exudates. Although there is some overlap between benign and malignant pleural effusions, pleural nodules and nodular pleural thickening were present almost exclusively in the latter. Although differences between CT findings of empyemas and the other parapneumonic effusions exist, there is no finding which can definitely differentiate between them. Received: 27 January 1999; Revised: 24 June 1999; Accepted: 24 August 1999     

Feasibility of synchrotron radiation computed tomography on rats bearing glioma after iodine or gadolinium injection

The purpose of this work was to demonstrate the feasibility of a new imaging technique called synchrotron radiation computed tomography (SRCT). This technique leads to a direct assessment of the in vivo concentration of an iodine- or gadolinium-labeled compound. Rats bearing C6 glioma were imaged by MRI prior to the SRCT experiment. The SRCT experiments were performed after a 1.3 g I/kg (n = 5) or a 0.4 g Gd/kg (n = 5) injection. Finally, brains were sampled for histology. The SRCT images exhibited contrast enhancement at the tumor location. Ten minutes after injection, iodine and gadolinium tissular concentrations were equal to 0.80 ( ± 0.40) mg/cm³ and 0.50 ( ± 0.10) mg/cm³, respectively in the peripheral area of the tumor (respective background value: 0.20 ± 0.02 to 0.10 ± 0.01). Correlation to MRI and histology revealed that the contrast uptake occurred in the most vascularized area of the tumor. The present study summarizes the feasibility of in vivo SRCT to obtain quantitative information about iodine and gadolinium-labeled compounds. Beyond brain tumor pathology, the SRCT appears as a complementary approach to MRI and CT, for studying iodine- and gadolinium-labeled compounds by the direct achievement of the tissular concentration value in the tissue. Received: 8 September 1999; Revised: 3 May 2000; Accepted: 4 May 2000     

Focal airtrapping at expiratory high-resolution CT: comparison with pulmonary function tests

This study was undertaken to determine prevalence, extent, and severity of focal airtrapping at expiratory high-resolution CT, and to compare focal airtrapping with age, gender, pulmonary function tests, and blood gas analysis. Two-hundred seventeen patients with and without pulmonary disease underwent paired inspiratory/expiratory high-resolution CT. Six scan pairs with corresponding scan levels were visually assessed for focal – not diffuse – airtrapping using a four-point scale. Pulmonary function tests and blood gas analysis were available for correlation in all patients (mean interval 5 days). Focal airtrapping with lower lung predominance was observed in 80 % of patients. Twenty-six of 26 patients with restrictive lung function impairment exhibited focal airtrapping (mean score 2.4), whereas only 72 of 98 (74 %) patients with obstruction did (mean score 1.5; p < 0.05). Fifty-eight of 70 (83 %) patients with normal lung function (mean score 1.8) and 19 of 23 (83 %) patients with mixed impairment (mean score 1.8) had focal airtrapping. Focal airtrapping showed negative correlations with static lung volumes (–0.27 to –0.37; p < 0.001) in all patients and moderate positive correlations with dynamic parameters (0.3–0.4; p < 0.001) in patients with obstruction. No significant correlations were found with age, gender, and blood gas analysis. Visual assessment of focal – not diffuse – airtrapping at expiratory high-resolution CT does not correlate with physiological evidence of obstruction as derived from pulmonary function tests since the perception of focal airtrapping requires an adequate expiratory increase in lung density. Received: 11 February 2000; Revised: 8 June 2000; Accepted: 9 June 2000     

Accuracy of enteroclysis in Crohn's disease of the small bowel: a retrospective study

The aim of this study was to evaluate the accuracy of enteroclysis in the diagnosis of Crohn's disease of the small bowel in a group of consecutive patients. From January 1992 to December 1995, 165 patients with suspected Crohn's disease of the small bowel presented to our institution for enteroclysis. In 14 patients up to three enteroclysis exams were performed. Most patients (78 %) underwent colonoscopy and retrograde ileoscopy. In the remaining patients clinical follow-up was used as gold standard. In 79 patients no radiographic abnormalities were found. Sixty-one patients (40 men and 21 women; mean age 34.2 years) had a radiological diagnosis of Crohn's disease. This involved the terminal ileum in 39 patients (64 %) either alone (n = 25) or in association with the pelvic ileum (n = 14). In 12 of these patients retrograde ileoscopy was not feasible. Twenty-one patients underwent surgery. In 4 patients pathology revealed diseases other than Crohn's. These patients had all ileocecal diseases (tuberculosis = 2; non-Hodgkin's lymphoma = 1; adenocarcinoma = 1). One false-negative result was observed. Overall, enteroclysis showed a sensitivity of 98.2 % and a positive predictive value of 93.4 %. Enteroclysis is a sensitive technique in evaluating both the extent and the severity of small bowel involvement in Crohn's disease, although the overlap of radiographic findings may hamper its accuracy when the disease is confined to the ileocecal area. Received: 25 November 1999; Revised: 4 April 2000; Accepted: 6 April 2000     

Indium-111 labelled platelet scintigraphy can predict the immunological origin of fever in patients on dialysis carrying a non-functioning renal allograft

The purpose of this study was to evaluate the usefulness of labelled platelet scintigraphy in the differential diagnosis of a prolonged febrile syndrome (PFS) in patients on dialysis carrying a non-functioning renal allograft. We prospectively performed an indium-111 mercaptopyridine-labelled platelet scan on 91 patients (54 men, 37 women; mean age 39.6±12 years). The mean duration of PFS was 35 days (range 7–122). Forty-six of the 91 patients underwent steroid therapy (2– 10 mg/day). Platelet labelling was carried out following Thakur’s method. Platelet scans were performed 48 h after reinjection of labelled platelets. The platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft ROI by cpm/pixel in a mirror background ROI. The final diagnosis of PFS was established depending on the outcome after treatment. In 61/91 patients the fever had an immunological origin because it disappeared after graft embolisation or transplantectomy. In 30/91 patients the PFS disappeared after antibiotic therapy (non-immunological origin). The PUI in patients with immunological PFS was 1.80±0.7, while in patients with non-immunological PFS it was 1.12±0.1 (P<0.05). When a PUI of ≥1.5 was considered as the threshold to establish PFS of immunological origin, the sensitivity of platelet scan was 76%, the specificity 100%, and the negative and positive predictive values 69% and 100%, respectively. In patients classified with immunological PFS who underwent steroid therapy, the PUI was significantly lower than in patients without steroids (P<0.05). These results suggest that ¹¹¹In-labelled platelet scintigraphy can accurately predict an immunological PFS in patients on dialysis carrying a non-functioning renal allograft. Therapy with steroids could reduce the sensitivity of ¹¹¹In-labelled platelet scintigraphy in detecting immunological PFS. Received 23 September and in revised form 3 November 1999     

Congenital infiltrating lipomatosis of the face with cerebral abnormalities

The aim of this study was to describe a possible variant of encephalo-craniocutaneous lipomatosis syndrome. Three cases of congenital infiltrating lipomatosis of the face, associated with cutaneous, subcutaneous, and cerebral abnormalities, are presented. This neurocutaneous syndrome appears very similar to encephalo-craniocutaneous lipomatosis syndrome but lacks the typical eye lesions. Received: 23 August 1999; Revised: 18 February 2000; Accepted: 29 February 2000     

Paraspinal lipomatosis: a benign mass

Paraspinal lipomatosis usually occurs in patients with steroid excess. In two patients a paraspinal mass was detected on conventional radiographs and was subsequently shown to represent benign fat deposition on computed tomography, thereby obviating further studies. Neither patient had been receiving steroids. Paraspinal lipomatosis may be the cause of a benign mass and may be considered in the differential diagnosis of this finding.     

Imaging in ureteral complications of renal transplantation: value of static fluid MR urography

Ureteral obstruction is an infrequent complication after renal transplantation that may cause rapid loss of transplant function. We tested static fluid MR urography for determining the cause of graft hydronephrosis. Magnetic resonance urography was performed in nine transplants with dilated collecting systems on ultrasound. A heavily T2-weighted 3D turbo spin-echo sequence on a 1.5-T scanner was used and maximum intensity projections were obtained. The patients also underwent excretory urography (n = 1), renal scintigraphy (n = 1), antegrade pyelography (n = 3), voiding cystourethrography (n = 4), and non-enhanced CT (n = 2). Six patients had pathologic conditions including ureteral stricture, compression by lymphoceles, implantation stenosis, vesicoureteral reflux, and late-occurring transitional cell carcinoma at the implantation site. Static MRU was able to diagnose or exclude a dilation of the graft collecting system. It visualized the course of the ureters and localized the obstruction site in four of five obstructed transplants. In one case the ureter was obscured by lymphoceles, which were demonstrated by hydrographic MRU as well. The definite cause for obstruction was provided in only 2 of 5 cases. Dilation due to vesicoureteral reflux could not be differentiated. The current multimodality approach to renal transplant imaging already provides comprehensive assessment of graft hydronephrosis. Static MRU may be useful in some cases since complications associated with intravenous iodinated contrast or antegrade pyelography can be avoided. Its main drawback, the lack of functional information, may be overcome by combining it with contrast-enhanced MRU. Received: 18 February 1999; Revised: 23 July 1999; Accepted: 18 November 1999     

Screening for cervical spine trauma with helical CT: experience with 676 cases

Purpose: CT scanners with helical capability are commonplace. Evaluation of multiple trauma patients using this technique is fast, and easily performed as part of the radiological evaluation. Our purpose was to ascertain the clinical effectiveness of cervical spine screening with helical CT in a large sample population of multitrauma patients. Materials and methods: A retrospective review was carried out using screening helical CT scans from multitrauma patients referred to the Massachusetts General Hospital emergency department. The radiographic diagnosis was evaluated and tallied along with the clinical diagnosis and outcome for each patient included in the study. Results: Six hundred seventy-six patients conformed to the inclusion criteria. In this series, 59 true-positive, 616 true-negative, 1 false-negative, and no false-positive findings were encountered. These data result in a sensitivity of 98.3 %, a specificity of 100 %, and an accuracy of 99.9 %. Conclusions: Screening helical CT in the evaluation of trauma patients has a high diagnostic accuracy, and is sensitive and specific in diagnosing clinically relevant fractures of the cervical spine.