Hepatic Cavernous Hemangioma in Cirrhotic Liver: Imaging Findings

Objective

To document the imaging findings of hepatic cavernous hemangioma detected in cirrhotic liver.

Materials and Methods

The imaging findings of 14 hepatic cavernous hemangiomas in ten patients with liver cirrhosis were retrospectively analyzed. A diagnosis of hepatic cavernous hemangioma was based on the findings of two or more of the following imaging studies: MR, including contrast-enhanced dynamic imaging (n = 10), dynamic CT (n = 4), hepatic arteriography (n = 9), and US (n = 10).

Results

The mean size of the 14 hepatic hemangiomas was 0.9 (range, 0.5-1.5) cm in the longest dimension. In 11 of these (79%), contrast-enhanced dynamic CT and MR imaging showed rapid contrast enhancement of the entire lesion during the early phase, and hepatic arteriography revealed globular enhancement and rapid filling-in. On contrast-enhanced MR images, three lesions (21%) showed partial enhancement until the 5-min delayed phases. US indicated that while three slowly enhancing lesions were homogeneously hyperechoic, 9 (82%) of 11 showing rapid enhancement were not delineated.

Conclusion

The majority of hepatic cavernous hemangiomas detected in cirrhotic liver are small in size, and in many, hepatic arteriography and/or contrast-enhanced dynamic CT and MR imaging demonstrates rapid enhancement. US, however, fails to distinguish a lesion of this kind from its cirrhotic background.     

Focal Hepatic Lesions: Contrast-Enhancement Patterns at Pulse-Inversion Harmonic US using a Microbubble Contrast Agent

Objective

To analyze the contrast-enhancement patterns obtained at pulse-inversion harmonic imaging (PIHI) of focal hepatic lesions, and to thus determine tumor vascularity and the acoustic emission effect.

Materials and Methods

We reviewed pulse-inversion images in 90 consecutive patients with focal hepatic lesions, namely hepatocellular carcinoma (HCC) (n=43), metastases (n=30), and hemangioma (n=17). Vascular and delayed phase images were obtained immediately and five minutes following the injection of a microbubble contrast agent. Tumoral vascularity at vascular phase imaging and the acoustic emission effect at delayed phase imaging were each classified as one of four patterns.

Results

Vascular phase images depicted internal vessels in 93% of HCCs, marginal vessels in 83% of metastases, and peripheral nodular enhancement in 71% of hemangiomas. Delayed phase images showed inhomogeneous enhancement in 86% of HCCs; hypoechoic, decreased enhancement in 93% of metastases; and hypoechoic and reversed echogenicity in 65% of hemangiomas. Vascular and delayed phase enhancement patterns were associated with a specificity of 91% or greater, and 92% or greater, respectively, and with positive predictive values of 71% or greater, and 85% or greater, respectively.

Conclusion

Contrast-enhancement patterns depicting tumoral vascularity and the acoustic emission effect at PIHI can help differentiate focal hepatic lesions.     

颅内海绵状血管瘤的CT和MRI诊断

目的 探讨CT和MRI对颅内海绵状血管瘤的表现和诊断价值。资料与方法 经手术病理证实的颅内海绵状血管瘤22例,其中脑内型海绵状血管瘤21例,脑外型海绵状血管瘤1例。10例行CT检查,16例行MRI检查,13例行MRA检查。结果 脑内型海绵状血管瘤可位于脑内任何部位,单发病灶多见,周围无或轻度水肿,无明显占位效应。CT平扫为稍高密度影,钙化占72．7％,增强扫描大都无强化;MR T1WI表现为桑葚状混杂高信号．周围有云絮状低信号环,增强后病灶大都无强化;MRA检查未见异常血管。脑外型病灶位于中颅窝、鞍旁,MRI呈类似哑铃形较均匀的稍长T1、长T2信号,增强扫描见明显均匀强化．MRA检查未见异常血管。结论 脑内型海绵状血管瘤的MRI表现较有特异性,结合CT和MRA可明确诊断;脑外型者易误诊,对CT和MRI表现类似的中颅窝脑膜瘤,应考虑到本病的可能。     

眼眶血管瘤CT动态增强诊断探讨

目的 分析眼眶血管性肿瘤的动态增强CT表现,提高对其诊断和鉴别诊断的能力。资料与方法 对24例眼眶血管瘤(海绵状血管瘤13例,静脉性血管瘤11例)行CT动态增强扫描,分析其表现,测定各时间段的CT值。结果 两种肿瘤均有显著强化,多数病例表现为早期局部强化,延迟扫描均匀强化填充,少数病例呈均匀强化;部分静脉性血管瘤填充不完全;两种肿瘤的密度在增强后10min内无下降,20min后才开始降低,它们的CT值在平扫和增强后20min内均无差异,30min时有差异,静脉性血管瘤CT值下降较多(P<0.05)。结论 眼眶海绵状血管瘤和静脉性血管瘤的CT动态增强表现具有特征性,可与其他肿瘤进行鉴别,两者表现较相似,但也有所不同。     

Hepatic Sinusoidal Obstruction Syndrome Caused by Herbal Medicine: CT and MRI Features

Objective

To describe the CT and MRI features of hepatic sinusoidal obstruction syndrome (HSOS) caused by herbal medicine Gynura segetum.

Materials and Methods

The CT and MRI features of 16 consecutive Gynura segetum induced HSOS cases (12 men, 4 women) were analyzed. Eight patients had CT; three patients had MRI, and the remaining five patients had both CT and MRI examinations. Based on their clinical presentations and outcomes, the patients were classified into three categories: mild, moderate, and severe. The severity of the disease was also evaluated radiologically based on the abnormal hepatic patchy enhancement in post-contrast CT or MRI images.

Results

Ascites, patchy liver enhancement, and main right hepatic vein narrowing or occlusion were present in all 16 cases. Hepatomegaly and gallbladder wall thickening were present in 14 cases (87.5%, 14/16). Periportal high intensity on T2-weighted images was present in 6 cases (75%, 6/8). Normal liver parenchymal enhancement surrounding the main hepatic vein forming a clover-like sign was observed in 4 cases (25%, 4/16). The extent of patchy liver enhancement was statistically associated with clinical severity classification (kappa = 0.565).

Conclusion

Ascites, patchy liver enhancement, and the main hepatic veins narrowing were the most frequent signs of herbal medicine induced HSOS. The grade of abnormal patchy liver enhancement was associated with the clinical severity.     

MRI-Guided Intervention for Breast Lesions Using the Freehand Technique in a 3.0-T Closed-Bore MRI Scanner: Feasibility and Initial Results

Objective

To report the feasibility of magnetic resonance imaging (MRI)-guided intervention for diagnosing suspicious breast lesions detectable by MRI only, using the freehand technique with a 3.0-T closed-bore MRI scanner.

Materials and Methods

Five women with 5 consecutive MRI-only breast lesions underwent MRI-guided intervention: 3 underwent MRI-guided needle localization and 2, MRI-guided vacuum-assisted biopsy. The interventions were performed in a 3.0-T closed-bore MRI system using a dedicated phased-array breast coil with the patients in the prone position; the freehand technique was used. Technical success and histopathologic outcome were analyzed.

Results

MRI showed that four lesions were masses (mean size, 11.5 mm; range, 7-18 mm); and 1, a nonmass-like enhancement (maximum diameter, 21 mm). The locations of the lesions with respect to the breast with index cancer were as follows: different quadrant, same breast - 3 cases; same quadrant, same breast - 1 case; and contralateral breast - 1 case. Histopathologic evaluation of the lesions treated with needle localization disclosed perilobular hemangioma, fibrocystic change, and fibroadenomatous change. The lesions treated with vacuum-assisted biopsy demonstrated a radial scar and atypical apocrine hyperplasia. Follow-up MRI after 2-7 months (mean, 4.6 months) confirmed complete lesion removal in all cases.

Conclusion

MRI-guided intervention for breast lesions using the freehand technique with a 3.0-T closed-bore MRI scanner is feasible and accurate for diagnosing MRI-only lesions.     

椎管内硬膜外海绵状血管瘤的MRI诊断及鉴别诊断

目的探讨椎管内硬膜外海绵状血管瘤的MRI诊断及鉴别诊断价值。资料与方法回顾性分析5例经病理证实的椎管内硬膜外海绵状血管瘤的MRI表现,并与硬膜外其他病变进行鉴别。结果5例中,4例位于胸段,1例位于胸腰段,均沿脊椎纵轴生长,呈梭形或长椭圆形;病变平面脊髓明显受压,3例肿块呈"钳"状包绕脊髓;5例均表现为T2WI高信号,T1WI等或稍高信号,增强扫描均匀一致明显强化;2例肿瘤沿相邻的椎间孔呈"哑铃"状生长,并使椎间孔扩大。结论椎管内硬膜外海绵状血管瘤的MRI表现具有一定特征性,但需与硬膜外其他病变相鉴别。     

Atypical hemangioma and malignant lesions of spine: Can diffusion weighted Magnetic Resonance Imaging help to differentiate?

Objective

The aim of the work was directed to evaluate the value of diffusion weighted Magnetic Resonance Imaging in diagnosis, characterization and differentiation of atypical hemangioma and malignant lesions of spine.

Materials and methods

This study included three groups: group (A) 8 (33%) patients with metastatic bony lesions of spine, group (B) 6 (25%) patients with atypical hemangioma and group (C) 10 (42%) patients with typical hemangioma.All patients were presented with different degrees of back pain. MRI was done for all patients (including T1, T2, T2 fat suppression and DWI with IV contrast administration when needed). Complementary non contrast CT was also done.

Results

Atypical hemangioma and malignant lesions were low in T1 and high in T2 WI. Restricted diffusion and low ADC values were seen in metastasis compared with atypical hemangioma. Complementary CT revealed the lytic nature of malignant lesions while in hemangiomas, it showed their characteristic striated appearance.

Conclusion

Diffusion weighted Magnetic Resonance Imaging is a useful tool in diagnosis, characterization and differentiation of atypical hemangioma and metastasis of spine.     

Measurement of Intra-Fraction Displacement of the Mediastinal Metastatic Lymph Nodes Using Four-Dimensional CT in Non-Small Cell Lung Cancer

Objective

To measure the intra-fraction displacements of the mediastinal metastatic lymph nodes by using four-dimensional CT (4D-CT) in non-small cell lung cancer (NSCLC).

Materials and Methods

Twenty-four patients with NSCLC, who were to be treated by using three dimensional conformal radiation therapy (3D-CRT), underwent a 4D-CT simulation during free breathing. The mediastinal metastatic lymph nodes were delineated on the CT images of 10 phases of the breath cycle. The lymph nodes were grouped as the upper, middle and lower mediastinal groups depending on the mediastinal regions. The displacements of the center of the lymph node in the left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions were measured.

Results

The mean displacements of the center of the mediastinal lymph node in the LR, AP, and SI directions were 2.24 mm, 1.87 mm, and 3.28 mm, respectively. There were statistically significant differences between the displacements in the SI and LR, and the SI and AP directions (p < 0.05). For the middle and lower mediastinal lymph nodes, the displacement difference between the AP and SI was statistically significant (p = 0.005; p = 0.015), while there was no significant difference between the LR and AP directions (p < 0.05).

Conclusion

The metastatic mediastinal lymph node movements are different in the LR, AP, and SI directions in patients with NSCLC, particularly for the middle and lower mediastinal lymph nodes. The spatial non-uniform margins should be considered for the metastatic mediastinal lymph nodes in involved-field radiotherapy.     

Nodular Ground-Glass Opacities on Thin-section CT: Size Change during Follow-up and Pathological Results

Objective

To evaluate the inter-group differences in growth and the pathological results of nodular ground-glass opacities (GGOs) according to their size and focal solid portions.

Materials and Methods

Ninety-six nodular GGOs in 55 individuals followed by CT for at least one month from an initial chest CT were included. Forty nodular GGOs in 30 individuals were pathologically confirmed to be: adenocarcinoma (n = 15), bronchioloalveolar carcinoma (BAC) (n = 11), atypical adenomatous hyperplasia (AAH) (n = 8), focal interstitial fibrosis (n = 5) and aspergillosis (n = 1). Lesions were categorized based on high-resolution CT findings: pure nodular GGO (PNGGO) ≤ 10 mm, PNGGO > 10 mm, mixed nodular GGO (MNGGO)≤ 10 mm, and MNGGO > 10 mm. In each group, the change in size during the follow-up period, the pathological results and the rate of malignancy were evaluated.

Results

Three MNGGO lesions, and none of the PNGGO, grew during the follow-up period. Resected PNGGOs ≤ 10 mm were AAH (n = 6), BAC (n = 5), and focal interstitial fibrosis (n = 1). Resected PNGGOs > 10 mm were focal interstitial fibrosis (n = 4), AAH (n = 2), BAC (n = 2), and adenocarcinoma (n = 2). Resected MNGGOs ≤ 10 mm were adenocarcinoma (n = 2), and BAC (n = 1). Resected MNGGOs > 10 mm were adenocarcinoma (n = 11), BAC (n = 3), and aspergillosis (n = 1).

Conclusion

Mixed nodular GGOs (MNGGOs) had the potential for growth; most were pathologically adenocarcinoma or BAC. By contrast, PNGGOs were stable for several months to years; most were AAH, BAC, or focal interstitial fibrosis.     

Are bilateral cavernous hemangiomas of the orbit rare entities? The role of MRI in a retrospective study

Cavernous hemangioma is a benign orbital extraocular vascular lesion consisting of large dilated venous channels with fibrous, well-delineated capsule and hemosiderin deposition. Cavernous hemangioma is considered to be almost always unilateral and bilateral cases have been rarely described.

The aim of our study is to evaluate imaging characteristics of cavernous hemangioma and evaluate the prevalence of bilateral cases.

We studied 14 patients with cavernous hemangioma of the orbit with surgical confirmation. MRI was performed on a 1.5-T unit before and after contrast agent administration. Each MR examination had been retrospectively evaluated in order to define signal patterns, dimensions, location and other main imaging characteristics. In 3 out of the 14 cases studied (21.4%) bilateral cavernous hemangiomas were found. Thirteen masses appeared isointense on T1, two were hypointense, and two heterogeneous. On T2, 12 were hyperintense, 3 were heterogeneous, 1 isointense, and 1 hypointense. Contrast enhancement was inhomogeneous in 5, homogeneous and intense in 12 cases. The size ranged from 3 mm up to 21 mm (average 14.57). In four patients also CT scan without contrast administration of the orbits was performed.

Bilateral cavernous hemangioma appears to be more frequent than as predicted by the literature. In our opinion the main reason of this incongruence is related to technological advances. Our results could also be related to carelessness of radiologists to inspect the other orbit for possible concomitant lesions, and thus invites to major attention in exploring both orbits for eventual bilateral lesions.     

Unruptured Aneurysms with Cranial Nerve Symptoms: Efficacy of Endosaccular Guglielmi Detachable Coil Treatment

Objective

To evaluate the efficacy of endosaccular Guglielmi detachable coil (GDC) treatment of unruptured aneurysms causing cranial nerve (CN) symptoms.

Materials and Methods

Among a database of 218 patients whose aneurysms were treated using GDC, seven patients met the criteria for unruptured aneurysms presenting with symptoms and signs of CN palsy. Changes in CN symptoms before and after GDC treatment were reviewed.

Results

Aneurysms were located in the internal carotid-posterior communicating artery (n=3), the basilar bifurcation (n=1) and the cavernous internal carotid artery (n=3). CN symptoms included ptosis (n=6), mydriasis (n=2), and extraocular muscle (EOM) disorder (CN III: n=4; CN VI: n=3). Overall, improvement or resolution of CN symptoms after treatment was noted in five patients. CN symptoms in cases involving small (≤ 10 mm) and intradural aneurysms tended to respond better to GDC treatment. Ptosis was the initial symptom to show improvement, while EOM dysfunction responded least favourably.

Conclusion

GDC coil packing appears to be an appropriate treatment method for the relief of CN symptoms associated with intracranial aneurysms.     

Repaired Supraspinatus Tendons in Clinically Improving Patients: Early Postoperative Findings and Interval Changes on MRI

Objective

To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs.

Materials and Methods

Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated.

Results

The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050).

Conclusion

Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.     

CT Findings of Gallbladder Metastases: Emphasis on Differences According to Primary Tumors

Objective

To describe computed tomography (CT) features of metastatic gallbladder (GB) tumors (MGTs) from various primary tumors and to determine whether there are differential imaging features of MGTs according to different primary tumors.

Materials and Methods

Twenty-one patients who had pathologically confirmed MGTs and underwent CT were retrospectively enrolled. Clinical findings including presenting symptoms, type of surgery, and interval between primary and metastatic tumors were recorded. Histologic features of primary tumor and MGTs including depth of invasion were also reviewed. Imaging findings were analyzed for the location and morphology of MGTs, pattern and degree of enhancement, depth of invasion, presence of intact overlying mucosa, and concordance between imaging features of primary and metastatic tumors. Significant differences between the histologies of MGTs and imaging features were determined.

Results

The most common primary tumor metastasized to the GB was gastric cancer (n = 8), followed by renal cell carcinoma (n = 4) and hepatocellular carcinoma (n = 3). All MGTs (n = 21) manifested as infiltrative wall thickenings (n = 15) or as polypoid lesions (n = 6) on CT, similar to the features of primary GB cancers. There were significant differences in the morphology of MGTs, enhancement pattern, enhancement degree, and depth of invasion according to the histology of primary tumors (p < 0.05). Metastatic adenocarcinomas of the GB manifested as infiltrative and persistently enhancing wall thickenings, while non-adenocarcinomatous metastases usually manifested as polypoid lesions with early wash-in and wash-out.

Conclusion

Although CT findings of MGTs are similar to those of primary GB cancer, they are significantly different between the various histologies of primary tumors.     

Esophageal Leiomyoma: Radiologic Findings in 12 Patients

Objective

The aim of our study was to describe and compare the radiologic findings of esophageal leiomyomas.

Materials and Methods

The chest radiographic (n = 12), esophagographic (n = 12), CT (n = 12), and MR (n = 1) findings of surgically proven esophageal leiomyomas in 12 consecutive patients [ten men and two women aged 34 - 47 (mean, 39) years] were retrospectively reviewed.

Results

The tumors, surgical specimens of which ranged from 9 to 90 mm in diameter, were located in the upper (n = 1), middle (n = 5), or lower esophagus (n = 6). In ten of the 12 patients, chest radiography revealed the tumors as mediastinal masses. Esophagography showed them as eccentric, smoothly elevated filling defects in 11 patients and a multilobulated encircling filling defect in one. In 11 of the 12 patients, enhanced CT scans revealed a smooth (n = 9) or lobulated (n = 2) tumor margin, and attenuation was homogeneously low (n = 7) or iso (n = 4). In one patient, the tumor signal seen on T2-weighted MR images was slightly high.

Conclusion

Esophageal leiomyomas, located mainly in the middle or distal esophagus, are consistently shown by esophagography to be mainly eccentrically elevated filling defects and at CT, lesions showing homogeneous low or isoattenuation are demonstrated.     

Gallbladder Tuberculosis: CT Findings with Histopathologic Correlation

Objective

We wanted to describe the computed tomography (CT) findings of gallbladder tuberculosis (TB) and to correlate them with pathologic findings.

Materials and Methods

There were seven patients (M:F = 3:4; mean age, 46.3 years; age range, 32 to 78 years) in whom gallbladder TB was eventually diagnosed. All of them underwent cross-sectional imaging with CT, a pathologic examination and a retrospective review. CT imaging evaluation was done in each case, including the findings of a mass versus nodule, wall thickening (uniform or irregular) and the enhancement patterns (homogeneous or heterogeneous).

Results

All the cases of gallbladder TB revealed the following three different CT findings: micronodular lesion of the gallbladder wall (n = 1), a thickened wall (n = 4) and a gallbladder mass (n = 2). There were three cases of homogeneous enhancement of the lesions, including homogeneous enhancement with nodular lesion, homogeneous uniform thickness enhancement and homogeneous thickness enhancement in one case each, and these cases pathology showed tuberculous granuloma with a little caseating necrosis in one case and tuberculous granuloma with rich fibrous tissue, but little or no evident caseating necrosis in two cases. Four cases of heterogeneous enhancement of the lesions, including heterogeneous uniform-thickness enhancement in two cases, heterogeneous enhancement with a local mass lesion in one case and heterogeneous enhancement with a mass that replaced the gallbladder in one case; in these cases, pathology showed tuberculous granuloma with marked caseation or liquefaction necrosis in three cases and tuberculous granuloma by fibrous and calcifications accompanied by caseating necrosis in one case. Among the seven cases of gallbladder TB, six cases were accompanied by abdominal extra-gallbladder TB, including abdominal lymph node TB in five cases and hepatic TB in four cases.

Conclusion

Gallbladder TB has various CT manifestations, and the enhanced CT findings are well matched with pathological features. An irregularly thickened gallbladder wall or a gallbladder wall mass with multiple-focus necrosis or calcifications accompanied by the typical CT findings of abdominal extra-gallbladder TB should suggest the diagnosis of gallbladder TB.     

海绵窦内海绵状血管瘤的影像学诊断(附4例报告)

目的:探讨海绵窦海绵状血管瘤影像学特点,以提高其诊断水平。方法:回顾性分析经手术后病理证实的4例海绵窦海绵状血管瘤,均有CT和MRI检查资料,1例行DSA检查。结果:4例海绵窦海绵状血管瘤均位于左侧,CT表现为均匀的稍高密度影,伴蝶骨轻度骨质侵蚀,未见钙化。MRI检查见T1WI呈较脑灰质低的均匀信号,T2WI呈较脑灰质高的均匀信号,静脉注射钆喷酸葡甲胺后T1WI显示明显强化的均匀高信号,形态特点呈内小外大的哑铃状结构,边缘清晰。1例DSA检查见颈内动脉受压移位明显,但无管腔狭窄征象,于毛细血管期和窦期有浅淡的肿瘤染色。结论:MRI是术前诊断海绵窦海绵状血管瘤最具价值的检查手段,而CT、DSA可作为鉴别诊断工具。     

The CT Evaluation of Neoarytenoid Soft Tissue after an Arytenoidectomy during a Supracricoid Partial Laryngectomy

Objective

To evaluate the postoperative laryngeal CT findings of neoarytenoid soft tissue at an arytenoidectomy site during a supracricoid partial laryngectomy, and to compare its thickness to the mucosa over the spared arytenoid cartilage.

Materials and Methods

Thirty-one patients underwent a supracricoid partial laryngectomy with (n = 14) or without (n = 17) an arytenoidectomy. A postoperative laryngeal CT examination was performed to statistically compare the thickness of the neoarytenoid soft tissue to the mucosa over the spared arytenoids.

Results

The neoarytenoid soft tissue revealed an eccentric prominence in all 14 arytenoidectomy sites. Further, the neoarytenoid soft tissue was consistently thicker than the mucosa over spared arytenoids cartilage (p < 0.01), however did not exceed 11 mm.

Conclusion

The eccentric prominence of neoarytenoid soft tissue at the arytenoidectomy site during a supracricoid partial laryngectomy should be identified and distinguished from a recurrent mass when compared to spared arytenoid cartilage on a postoperative laryngeal CT.     

Differentiating Pancreatic Ductal Adenocarcinoma from Pancreatic Serous Cystadenoma, Mucinous Cystadenoma, and a Pseudocyst with Detailed Analysis of Cystic Features on CT Scans: a Preliminary Study

Objective

To determine whether or not detailed cystic feature analysis on CT scans can assist in the differential diagnosis of pancreatic ductal adenocarcinoma (PDAC) from serous cystadenoma (SCN), mucinous cystadenoma (MCN), and a pseudocyst.

Materials and Methods

This study received Institutional Review Board approval and informed patient consent was waived. Electronic radiology and pathology databases were searched to identify patients with PDAC (n = 19), SCN (n = 26), MCN (n = 20) and a pseudocyst (n = 23) who underwent pancreatic CT imaging. The number, size, location, and contents of cysts, and the contour of the lesions were reviewed, in addition to the wall thickness, enhancement patterns, and other signs of pancreatic and peripancreatic involvement. Diagnosis was based on lesion resection (n = 82) or on a combination of cytological findings, biochemical markers, and tumor markers (n = 6). Fisher''s exact test was used to analyze the results.

Results

A combination of the CT findings including irregular contour, multiple cysts, mural nodes, and localized thickening, had a relatively high sensitivity (74%) and specificity (75%) for differentiating PDAC from SCN, MCN, and pseudocysts (p < 0.05). Other CT findings such as location, greatest dimension, or the presence of calcification were not significantly different.

Conclusion

The CT findings for PDAC are non-specific, but perhaps helpful for differentiation. PDAC should be included in the general differential diagnosis of pancreatic cystic neoplasms.     

Comparison of ultrasonography with computed tomography in the diagnosis of nasal bone fractures

Objectives

The aim of this study is to compare ultrasonography with CT in the diagnosis of nasal bone fractures.

Methods

40 patients (9 female and 31 male) with mid-facial fractures, which were suspected nasal bone fractures, were included. All of the patients had mid-facial CT images. Ultrasonography with a 7.5 MHz transducer (Aloka 3500, Tokyo, Japan) was used to evaluate the nasal bone fractures. All of the sonograms were compared with CT findings for sensitivity, specificity and predictive values. A χ² test was applied to the data to assess statistical significance.

Results

CT diagnosed nasal bone fractures in 24 of the 40 patients (9 unilateral fractures and 15 bilateral fractures) while ultrasonography diagnosed the fractured bones in 23 patients (9 unilateral fractures and 14 bilateral fractures). Ultrasonography missed one fractured bone in a bilateral fractured case and a unilateral fracture was also missed (two false-negative results). The sensitivity and specificity of ultrasonography in assessing nasal bone fracture in comparison with CT were 94.9% and 100%, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) of ultrasonographic evaluation of the nasal bone fractures were 100% and 95.3%, respectively. The χ² test did not show any significant difference between CT and ultrasonography in diagnosis of nasal bone fractures (P = 0.819).

Conclusion

Ultrasonography can be used as a first line of diagnostic imaging for evaluating nasal bone fractures, especially in children and pregnant women.