Radiologic diagnosis of the recurrence of soft tissue sarcomas]

We report about the diagnosis of recurrent soft tissue tumors in more than 350 patients using magnetic resonance tomography (MRT) and computed tomography (CT) during the last 5-6 years. MRT turned out to be the method of choice having a sensitivity of about 85% and a specificity of 60-70%, provided that a high resolution technique is used and a paramagnetic contrast agent (gadolinium-DTPA (Gd)) is applied. By performing "dynamic Gd-sequences" a quantification and of the perfusion of a recurrent tumor is possible. Even MRT does not produce a definite tumor-specificity. The alterations of imaging concerning surgical treatment or therapeutic irradiation are extensively discussed. Practical suggestions for the daily routine diagnostic in case of uncertain clinic or symptoms are given.     

Computed tomography of the paranasal sinuses, nasopharynx, and soft tissues of the neck.

A number of cases are presented illustrating the value of computed tomography in the investigation of mass lesions involving the paranasal sinuses, nasopharynx, and soft tissues of the neck. Rapid advances in CT technology now underway will alter our approach to the investigation of certain diseases in these locations.     

CT of thyroglossal duct cysts

A retrospective analysis of surgically proved cases of thyroglossal duct cysts was performed in an attempt to determine the characteristics of these lesions using computed tomography (CT). We evaluated 12 preoperative cases and two cases with postoperative complications. Ten patients with lesions that could be confused either clinically or radiographically with these cysts were also evaluated to develop a systemized radiologic differential diagnostic approach for the evaluation of anterior triangle neck lesions. CT enables the differentiation of thyroglossal duct cysts from other anterior triangle lesions based on location, CT values, and alterations in the adjacent soft tissues.     

Hydatid disease of the soft tissues of the lower limb: findings in three cases

Three cases of hydatid disease are reported, all presenting as soft tissue lesions in the lower extremities. All three cases were studied with ultrasound (US), two with computed tomography (CT), and two with magnetic resonance (MR) imaging techniques. Two patients presented with multivesicular lesions which were considered diagnostic of hydatid disease. The third patient showed a lesion with a predominantly solid pattern, closely mimicking a soft-tissue neoplasm. US was not diagnostic, but MR outlined vesicular structures and a fibrous pericyst. Hydatid disease presenting in the soft tissues can therefore be diagnosed with confidence when it shows multi-vesicular lesions but MR may be the most useful imaging technique when a complex or solid pattern is present.     

Radiologic diagnosis of bone metastases

The diagnostic relevance of the various radiological examination methods - skeleton scintigraphy, conventional x-ray film, computed tomography, sonography and magnetic resonance - was analysed on the basis of an examination of 4765 clinically or scintigraphically suspect skeleton segments in order to arrive at an effective but also economically justifiable diagnostic approach. Conventional skeleton scintigraphy should be employed as the first method of choice, since it has a sensitivity of 93% and is hence very suitable as a searching tool. To differentiate benign and malignant lesions it is absolutely imperative to conduct at the same time a x-ray control of any abnormal accumulation of nuclides, or of parts of the skeleton that display signs or symptoms. Conventional x-ray film diagnosis enabled correct diagnosis of the type of disease in 95% of the cases. In its capacity as a complementary examination method, computed tomography enabled correct diagnosis in 52% of the cases that had remained roentgenologically unclear. A pathological bone scintigram without any x-ray or CT correlate must be considered as being suspect of metastases if trauma is absent. Magnetic resonance proved to be the most sensitive method in identifying malignant infiltrations of the medullary space in two patients suffering from a clearly delineated pain syndrome with normal x-ray and CT findings. Sonography proved superior in detecting extraosseous tumour portions. The value of angiography is the preoperative vascular imaging of metastases of the possibility of performing therapeutic embolisation or intraarterial drug therapy.     

CT and MRI findings in calvarial non-infectious lesions

Differential diagnosis of the calvarial lesions is important in order to decide whether biopsy, surgical intervention, or follow-up is required for further management. In this pictorial essay on calvarial lesions, lytic or sclerotic patterns, contours of the lesions, calcifications, soft tissue components, inner and outer table localizations were evaluated with computed tomography (CT). On magnetic resonance imaging (MRI) signal characteristics and contrast enhancement of the lesion, relation to brain parenchyma and soft tissue were evaluated. CT scan is considered to be the best examination to characterize bone alterations whereas MRI depicts bone marrow abnormalities and invasion of adjacent tissues.     

Integrated imaging of head and neck tumors in children]

Examinations of 28 children with various tumors of the visceral cranium and neck have shown that both ultrasound and magnetic resonance tomography should be used primarily for diagnosis and follow-up. These tomographic methods are especially suitable for use in children. Ultrasound is better suited to visualization of localized, superficial masses and MRT to examination of deeper lying tumors within the complex structures of the visceral cranium and neck. X-rays in different planes should be regarded as supplementary examinations. The use of CT, preferably as high-resolution CT, provides more precise visualization of fine bone structures. Conventional tomography has been almost completely replaced by CT. Angiography is applied mainly in subsequent, interventional measures; videofluoroscopy should be used to examine lesions of the upper airways and digestive tract.     

High-dose computed tomography in the evaluation of low attenuation lesions in the neck

Recent reports have established the clinical utility of computed tomography (CT) in the evaluation of jugular vein thrombosis. Other abnormalities of the soft tissues in the neck can mimic this condition. This study reviews the pertinent normal soft tissue and vascular anatomy of the neck and describes the use of high-dose CT in the evaluation of low attenuation lesions in this area. Various abnormalities are compared and contrasted, including cystic hygroma, neoplasm, abscess, and venous thrombosis.     

Radiology and pathology of malignant fibrous histiocytomas of the soft tissues: A report of ten cases

Malignant fibrous histiocytomas (MFH) are believed to originate from histiocytes and are composed of malignant cells with spindle or round shapes. We evaluated ten MFH of the soft tissues by plain roentgenograms, computed tomography (CT), and angiography and subdivided them into four grades of anaplasia and five predominant histologic variants. The variants of MFH demonstrated different vascular patterns. The extension of the lesions could be determined by CT and angiography. CT is the method of choice in the assessment of size and extent of MFH of the soft tissues. When intra-arterial chemotherapy is indicated the angiograms obtained at each catheter placement may substitute CT in follow-up studies obviating additional diagnostic procedures.     

Lesions of skull base observed on high resolution computed tomography. A comparison with magnetic resonance imaging

Forty patients with tumors involving the skull base were selected on the basis of findings at high resolution computed tomography (CT). The reliability of demonstrating bony lesions with magnetic resonance imaging (MRI) and CT were compared. CT showed osseous lesions of the skull base better than MRI but was less sensitive in evaluating an associated inflammatory reaction or in defining intracerebral infiltration. Small cortical lesions were only demonstrable with CT. MRI was superior in defining the full extent of soft tissue infiltration. Arterial encasement was observed at MRI. The special advantage of Gd-DTPA lies in the additional possibility to differentiate vessels from tumor-like lesions and in en plaque tumors.     

Gd-DTPA administered MR imaging of intracranial mass lesions: a comparison with CT and precontrast MR

Magnetic resonance (MR) images of 13 intracranial mass lesions taken with the intravenous administration of gadolinium-DTPA were evaluated in comparison with precontrast computed tomography (CT), postcontrast CT, and precontrast MR. In the MR images taken with Gd-DTPA, tumor delineation improved in eight of 13 cases (62%) in comparison with precontrast MR images, and in seven of 13 cases (54%) in comparison with the overall evaluation of precontrast CT, postcontrast CT, and precontrast MR images. Tumor demarcation was unchanged in the remaining cases; no deterioration was observed with Gd-DTPA administration. MR imaging with Gd-DTPA should be performed to better evaluate the extent of intracranial mass lesions and to provide additional information.     

Spiral CT in evaluation of head and neck lesions: work in progress.

Spiral computed tomography (CT) was used in the evaluation of 21 patients with head and neck lesions. Scanning time ranged from 24 to 36 seconds, and high-quality diagnostic scans with excellent anatomic resolution and minimal motion artifact were produced. Vascular opacification was optimized with substantially less contrast medium than used in conventional studies. These preliminary results show spiral CT to be at least comparable with conventional CT in the evaluation of the head and neck.     

MRI of facial skeleton and parapharyngeal space

The diagnostic value of magnetic resonance imaging is examined in relation to computed tomography on the basis of 66 patients, who had pathological processes in the midfacial and nasopharyngeal space. The high power of contrast resolution in imaging soft tissue masses and the direct multiplanar capability of magnetic resonance offer advantages over computed tomography in respect of space occupying lesions in the median and lower parts of the craniofacial skull. Lymph nodes of more than 1 cm. in diameter were detected by both modalities. A disadvantage is the poorer detectability of tumour conditioned bone destruction at the base of the skull. In such cases, computed tomography remains the method of choice.     

Comparison of sonography of the soft tissues of the neck with computerized tomography and magnetic resonance

Ultrasound B-scan, computed tomography and magnetic resonance imaging are currently used in the diagnosis of head and neck tumours. Screening of head and neck tumours should be performed by high resolution B-scan. Its high diagnostic sensitivity, minimal imaging artifacts, real-time recording and its minimal costs are outstanding features. CT is superior in imaging of bony structures; on the other hand, MR is superior in demonstrating site, border and topography of tumours and lymph nodes. Postoperative and/or post-irradiation follow-up of head and neck tumours should be done by sonography which allows differentiation of oedema, scars and tumour recurrence. The parapharyngoscopic sonography, echography, CT and MR can deliver different aspects in planning of neck surgery. An adequate diagnostic schedule is presented.     

Contrast enhanced magnetic resonance imaging of the brain using gadolinium-DTPA

This report concerns a clinical trial with gadolinium-DTPA (Gd-DTPA) as an intravenous contrast medium for magnetic resonance imaging (MRI) in patients with disorders of the central nervous system. Fifty patients, 30 females and 20 males, were examined without and with Gd-DTPA. The contrast medium was well tolerated by all patients. The results of MRI scanning without and with Gd-DTPA and those obtained with computed tomography (CT) using intravenous contrast enhancement were compared. This investigation comprised mainly patients with intracranial tumors, multiple sclerosis, and nasopharyngeal tumors. The results may be summarized as follows: 1) MRI with Gd-DTPA (MRI+) gave better results than MRI without Gd as regards delineation of the lesion, blood vessels and edema in cerebral tumors, pituitary adenomas and acute forms of multiple sclerosis (MS). 2) MRI+ was better than CT in 32 of the 50 cases examined; with intracerebral tumors it was better in 15 out of 18 cases. 3) MRI+ was always better than CT in patients with MS. In 3 out of 7 cases MRI demonstrated the acute MS lesions. 4) MRI+ seemed to have advantages also in nasopharyngeal tumors as ascertained from this limited experience.     

Neoplasms of the temporomandibular joint (TMJ). Diagnosis, differential diagnosis and intervention

Purpose. To evaluate the effectiveness of diagnostic and interventional radiological techniques for neoplastic lesions of the temporomandibular joint (TMJ). Material and methods. Modern diagnosis of the TMJ is based on the clinical use of conventional X-ray techniques, computed tomography (CT), magnetic resonance imaging (MRI) and interventional techniques like biopsies, vascular occlusion and ablation. Results. Conventional X-ray still forms the basic diagnostic procedure applied in open and closed mouth position. CT improves the diagnostic information and serves as the standard diagnostical instrument for cartaliganeous or osseous neoplastic lesions. MRI evaluates soft tissue infiltration in multiplanar techniques and high spatial resolution. Interventional vascular and ablative techniques improve the treatment of neoplastic disorders. Conclusion. Radiological diagnostic procedures are essentials for the diagnosis and intervention of neoplastic lesions of the temporomandibular joint.     

MR imaging of intraocular lesions--a comparison with CT]

Thirty-two intraocular lesions were studied with magnetic resonance (MR) imaging and computed tomography (CT). These lesions included retinoblastoma (n = 11), uveal melanoma (n = 6), metastatic choroidal tumor (n = 3), choroidal hemangioma (n = 2), retinochoroiditis (n = 6) and Coats' disease (n = 4). MR imaging was superior to CT in the depiction of intraocular masses and retinal detachment. Gd-DTPA enhanced MR imaging was more useful than contrast enhanced CT in evaluating the contrast enhancement of intraocular tumors. Differential diagnosis of intraocular tumors was difficult with both MR imaging and CT. Intratumoral calcification was noticed on CT in nine cases of retinoblastoma. It was concluded that MR imaging, including contrast enhancement study, is more useful than CT in the evaluation of intraocular lesions, except for calcification, and contrast enhanced CT may be unnecessary in the diagnosis of intraocular lesions.     

不同影像技术导引纵膈病变穿刺活检术评价

纵膈病变是临床常见病变之一,其仅凭影像学诊断很难定性,临床难以确诊,患者得到最佳治疗的可能性降低。影像导引经皮纵膈肿块定位更精确,提高了穿刺诊断技术,有效地减少了损伤和并发症。尽管X线透视引导穿刺方便可行并且得到了广泛的认可,但是利用超声(US)、计算机断层成像(CT)及磁共振成像(MRI)这样的影像导引手段可以明显提高疾病的诊断率,尤其是用于高危患者。磁共振成像的卓越软组织分辨率对人体的深部组织结构行经皮手术非常有用,比如纵膈病变穿刺诊疗技术的开展。     

Magnetic resonance imaging for diagnosis and follow-up of genitourinary, pelvic, and perineal rhabdomyosarcoma.

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.     

Magnetic resonance imaging for diagnosis and follow-up of genitourinary,pelvic, and perineal rhabdomyosarcoma

Magnetic resonance (MR) imaging, ultrasound, and computed tomography (CT) were performed for diagnosis and follow-up of rhabdomyosarcoma (RMS) arising from the genitourinary tract in five children, pelvic musculature in one, and the perineum in three others. MR imaging performed at 1.0 T included the following: spin-density-, T1-, and T2-weighted images in all nine patients; gadopentatate dimeglumine (Gd-DTPA)-enhanced T1-weighted images in five; and short TI inversion recovery (STIR) images in two children. Longitudinal T1-weighted images were of additional help in localizing the primary tumor at diagnosis and detecting local spread. Residual or recurrent disease within the bladder was best detected by spin-density images. Gd-DTPA enhancement improved contrast in two studies, but paramagnetic artifacts obscured intravesical lesions in three other studies. STIR images disclosed pelvic and retroperitoneal lymphadenopathy. MR imaging is recommended as the key method of diagnosis and follow-up of pelvic RMS.