活动性克罗恩病肠系膜淋巴结的CT 影像学研究

目的：探讨活动性克罗恩病(CD)肠系膜淋巴结的 CT 影像学特征。方法回顾性分析经内镜、病理证实的54例活动性 CD 患者的64排螺旋 CT 影像表现,重点观察肠系膜淋巴结的分布、大小、数目、形态及强化情况。结果38例(70.4%)CD 患者出现肠系膜淋巴结增大,总数为242个,其中83.5%(202/242)的淋巴结位于病变邻近肠系膜根部,16.5%(40/242)的淋巴结位于肠系膜周边部;肠系膜根部的淋巴结较周边部的淋巴结稍大,平均最大短径分别为(8.57±2.26)mm、(5.38±0.19)mm;73.6%(178/242)的淋巴结呈卵圆形;增强后淋巴结出现均匀明显强化,强化率为0.53±0.09。结论活动性 CD 常引起肠系膜淋巴结增大,以肠系膜根部淋巴结受累较为明显。     

胰腺癌胰周淋巴结转移分布特征的螺旋CT表现

目的:胰腺癌胰周淋巴结转移的分布特征及螺旋CT影像表现。方法:搜集经手术病理诊断为原发性胰腺癌45例,所有病例均经手术病理或影像标准诊断有胰周淋巴结转移。根据本组45例病例CT所反映的肿大淋巴结的分布情况,将胰周淋巴结分为8组。设定淋巴结的短径≥1.0cm为淋巴结转移阳性的影像表现。统计阳性淋巴结的出现率,重点观察淋巴结转移的部位、大小、数目、形态、密度、强化情况。结果:本组45例胰腺癌中,共计89个部位观察到淋巴结转移胰周转移淋巴结以腹腔动脉干组46.7%(21例),肠系膜根部组46.7%(21例),腹主动脉周围组35.6%(16例)为最多,胃周11.1%(5例)及脾动脉-脾门组13.3%(6例)最少。结论:胰腺癌转移所致肿大淋巴结主要分布在腹腔干、肠系膜根部以及腹主动脉周围。螺旋CT扫描检查可以较准确显示胰腺癌胰周淋巴结的转移情况。     

Mesenteric lymph nodes: detection and significance on MDCT

OBJECTIVE: Unsuspected mesenteric lymph nodes are frequently found on abdominal CT scans in everyday clinical practice. What to do with these findings has not been well established. The purpose of this study is to document the incidence of mesenteric lymph nodes in a previously healthy population and to provide guidelines for further management. MATERIALS AND METHODS: We examined the CT scans of 132 consecutive patients (84 men and 36 women; age range, 12-90 years; mean age, 43 years) who presented to the emergency department after experiencing blunt abdominal trauma. Twelve patients were excluded because they had disease processes known to be associated with lymphadenopathy. All imaging was performed using 3.2-mm collimation on MDCT scanners with IV contrast material. Two radiologists evaluated the images by consensus and recorded the presence of mesenteric lymph nodes greater than 3 mm in the short axis. Lymph node size, number, and location (central, peripheral, or right lower quadrant) were documented. All studies were reviewed on a PACS workstation. RESULTS: Of the 120 patients with otherwise normal CT scans, 47 had mesenteric lymph nodes greater than 3 mm. Of these 47 patients, 22 (47%) had five or more lymph nodes detected. Twenty-five (53%) of the 47 patients had four or fewer nodes. The mean size of the largest nodes was 4.8 mm (range, 3-9 mm), and the mean size of the nodes found per patient was 3.6 mm (range, 3-6 mm). These nodes were identified only at the mesenteric root in 32 patients (68%), only in the mesenteric periphery in eight patients (17%), and only in the right lower quadrant in five patients (11%). Nodes were identified in more than one location in two patients (4%). CONCLUSION: Incidental finding of mesenteric lymph nodes is common, reflecting more widespread use of thin-collimation MDCT and PACS workstations. In general, these nodes are small, measuring less than 5 mm. Such nodes when found in an otherwise healthy population are clinically insignificant and require no further imaging.     

Identification of inguinal lymph node metastases from vulval carcinoma by magnetic resonance imaging: an initial report

AIM: Magnetic Resonance Imaging (MRI) has the potential to assess inguinal lymph nodes more accurately than palpation and less invasively than surgical exploration. The objective of this study was to measure the accuracy of MRI in identifying inguinal metastases by demonstrating abnormal lymph node morphology. MATERIALS AND METHODS: 10 women with vulval malignancy underwent T1- and fat-suppressed T2-weighted surface coil MRI of both groins before surgery. Each groin was prospectively categorised as normal or as having metastatic lymphadenopathy using criteria established in normal volunteers. Histopathological findings in patients undergoing groin dissection for invasive vulval carcinoma were used as validation. RESULTS: MRI had a positive predictive value of 89%, negative predictive value of 91%, sensitivity of 89%, specificity of 91% and accuracy of 90%. The most useful observations on MRI to identify metastatic lymphadenopathy were those of lymph node contour irregularity, cystic change in a lymph node, short axis diameter exceeding 10mm and abnormal long: short axis diameter ratio. CONCLUSION: High resolution MRI of the inguinal regions has potential to screen for lymph node metastases in patients with vulval cancer, with the aim of reducing the number of women who have to undergo groin dissection.     

Size of normal hilar lymph nodes measured in autopsy specimens

The normal size of lymph nodes for each region of the hilum was determined by direct measurement of the short and long diameters of each node in the transverse plane of the node and the longitudinal diameter in the vertical plane of the node in 30 adult cadavers. The mean short transverse diameters ranged from 3.2 to 6.4 mm, the mean long transverse diameters ranged from 4.9 to 10.0 mm, and the mean longitudinal diameters ranged from 5.7 to 11.3 mm. The largest mean transverse diameters were found in the anterior upper lobe (AUL) and the inferior interlobar (IIL) regions. We noted a different maximum normal size for lymph nodes in each region of the hilum and determined the standard maximum normal short transverse diameters to be as follows: 12 mm for nodes in the right AUL and IIL regions, 10 mm for nodes in the right superior interlobar region and the left AUL and IIL regions, and 8 mm for nodes in other regions. Both the maximum normal long transverse diameters and the longitudinal diameters showed a wider variation, ranging from 18 to 10 mm and from 20 to 12 mm, respectively.     

Magnetic resonance appearance of normal inguinal nodes

AIM: To identify adult inguinal lymph node anatomical subgroups using magnetic resonance imaging (MRI), to derive a normal range for nodal number and size and to describe their morphology. MATERIALS AND METHODS: Eighty-three oncology patients with low stage pelvic tumours had inguinal lymph node assessment by MRI. Nodes were divided into proximal superficial (PS), distal superficial (DS) and deep inguinal (DI) subgroups, their number counted in two planes, and their transaxial short axis diameter recorded. Consistency of the largest node was recorded for each anatomical subgroup and two vertical distances measured, between the skin surface and the ipsilateral pubis, and between the skin surface and the deepest node. RESULTS: Transaxial plane maximum nodal number at the three sites was: PS 5, DS 8, DI 3; and in the coronal plane: PS 7, DS 5, DI 3. Nodal size ranges were: PS 3-10 mm (mean 4 mm), DS 3-15 mm (mean 6 mm) and DI3-10 mm (mean 6 mm). There was no correlation between nodal size or number and age or gender. Nodes were usually uniformly solid (PS 44%; DS 37%, DI 45%), or fatty (PS 39%; DS 33%; DI 25%). The range of distances between the skin and deepest lymph node was 2.5-16 cm depending on patient fatness. CONCLUSION: The mean number of nodes counted in the axial plane was six and in the coronal plane five. A maximum short axis diameter of 15 mm was recorded for inguinal lymph nodes.     

Cardiac MRI of elite junior Olympic weight lifters

Cardiac magnetic resonance imaging was performed on 14 junior elite Olympic weight lifters and 14 controls (means +/- Se, age = 18.4 +/- 0.5 and 17.8 +/- 0.4 years, weight = 76.5 +/- 3.6 and 78.8 +/- 3.3 kg, % fat = 6.5% +/- 0.8% and 11.5% +/- 1.7%, respectively). Controls were individually matched to the lifters to within 2 years of age and 2.5 kg of body weight. Systolic (S) and diastolic (D) left posterior wall thickness (LPW), left ventricular short axis (LSA), left ventricular transverse long axis (LLA), spetal wall thickness (SW), right ventricular wall thickness (RWT), and right ventricular short axis (RSA) were determined. Variables were examined in absolute (mm), relative to body surface area (BSA, mm/m2), total body weight (BW, mm/kg), and lean body mass (LBM, mm/kg) terms. In absolute terms S LPW (21.1 +/- 1.7 vs 13.3 +/- 0.5 mm), S SW (15.3 +/- 1.3 vs 11.7 +/- 0.6 mm), and D LLA (75.2 +/- 1.6 vs 69.1 +/- 2.4 mm) were significantly greater and S LSA (23.4 +/- 2.4 vs 36.7 +/- 2.3 mm) and S LLA (46.5 +/- 3.7 vs 58.2 +/- 3.8 mm) were significantly less in the lifters vs the controls. S LPW/BW, S LPW/BSA, S LPW/LBM, S SW/BW, S SW/BSA, S SW/LBM, D LSA/BSA, and D LLA/BSA were significantly greater and S LSA/BW, B LSA/BSA, S LSA/LBM, S LLA/BSA, S LLA/LBM, and D SW/LBM were significantly less in the lifters than the controls.(ABSTRACT TRUNCATED AT 250 WORDS)     

中上腹正常淋巴结的多排螺旋CT观察

目的 建立成年国人中上腹淋巴结大小正常CT观察标准;探讨影响中上腹正常淋巴结多层螺旋CT观察的因素。资料与方法 排除可能引起腹部淋巴结增大的因素,120例行16层螺旋CT腹部增强扫描的成年人纳入本研究。使用工作站,分别采用两种窗技术对中上腹淋巴结的大小、数目及出现率等进行观察测量。结果 采用窗宽350HU,窗位30HU观察,上腹部9个部位淋巴结最大短径上限分别为：肝胃韧带6．1mm,门腔间隙8．2mm。胃结肠韧带3．8mm,脾胃韧带2．4mm,腹腔动脉周围6．3mm,肠系膜血管周围6．5mm,膈脚后6．3mm,腹主动脉周围上部6．9mm,腹主动脉周围下部9．8mm。不同窗技术条件对腹部淋巴结的观察有影响,窗a（窗宽350HU,窗位30HU）淋巴结显示率及其最大短轴上限值大于窗b（窗宽200HU,窗位60HU）。腹部脂肪量对淋巴结的显示率有影响,但当腹部脂肪量达到一定量后,显示率并不随脂肪量的增加而升高。结论 上腹部淋巴结最大短径上限按部位有所不同,腹膜后淋巴结有从上到下逐渐增大的趋势。观察时采用的窗条件对淋巴结正常上限值测量及显示率有影响。观察个体腹部脂肪量对腹部淋巴结在CT观察时显示率有影响。     

Abdominal lymphadenopathy: spectrum of CT findings

Many malignant processes cause abdominal lymphadenopathy, and computed tomography (CT) has become the primary modality for its detection. Diagnosis of lymphadenopathy is facilitated by optimal imaging techniques and a knowledge of the various nodal chains, their complex interconnections, and preferential pathways of spread. Optimal techniques include imaging after oral administration of adequate amounts of barium suspension and dynamic scanning after intravenous administration of contrast material with an infusion pump. Although such techniques help prevent misdiagnoses due to normal and anomalous vascular structures, other benign diseases can mimic the CT appearance of malignant lymphadenopathy. The authors emphasize a regional approach for the diagnosis of lymphadenopathy, according to the groupings of retrocrural, retroperitoneal, gastrohepatic ligament, porta hepatis, celiac and superior mesenteric artery, pancreaticoduodenal, perisplenic, mesenteric, and pelvic lymph nodes. Lymphadenopathy is defined as retrocrural nodes greater than 6 mm in short axis, upper abdominal nodes greater than 10 mm, and pelvic nodes greater than 15 mm.     

Mediastinal lymphadenopathy in pulmonary fibrosis: correlation with disease severity

OBJECTIVE: To evaluate the relationship between mediastinal lymph node enlargement and disease severity score in patients with pulmonary fibrosis. MATERIALS AND METHODS: A retrospective study included 30 patients with pulmonary fibrosis: idiopathic pulmonary fibrosis (n = 25), usual interstitial pneumonia (UIP) associated with collagen vascular disease (n = 4), and UIP associated with hepatitis C (n = 1). Disease severity was determined by a computed tomography (CT) scoring system. Each patient's lobe was scored by two radiologists on a scale of 0-5 for both ground glass opacity (GGO) and fibrosis. The presence, number, and sites of enlarged nodes (short axis > or = 10 mm) were assessed. CT severity scores were compared with total number of enlarged lymph nodes (L/Ns) and short axis diameter of the largest L/N (LLN). According to each severity score, patients were divided into two groups: the GGO-predominant group (n = 10) and the fibrosis-predominant group (n = 20). Total numbers of enlarged L/Ns and short axis diameter of LLN were compared in each group. RESULTS: Enlarged mediastinal L/Ns were present in 86%. Total severity score, GGO score, and fibrosis score strongly correlated with total number of enlarged L/Ns (p<0.05). Total severity score and GGO score correlated well with short axis diameter of LLN; however, the fibrosis score did not correlate with the short axis diameter of LLN. In respect to total number of enlarged L/Ns, the difference between the GGO group and fibrosis group was not apparent. In respect to the short axis diameter of LLN, the GGO group LLN was larger in diameter than the fibrosis group LLN (p<0.05). CONCLUSION: The greater the severity score of pulmonary fibrosis, the larger the total number of enlarged L/Ns. Those patients with more GGO had larger lymph nodes.     

Preoperative evaluation of local invasion and metastatic lymph nodes of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography before laparoscopic surgery

OBJECTIVE: To evaluate local invasion and lymph nodes metastasis of colorectal cancer and mesenteric vascular variations using multidetector-row computed tomography (MDCT) before laparoscopic colorectal surgery. METHODS: Fifty-one patients with colorectal cancer underwent MDCT. The evaluation items were as follows: (1) local invasion; (2) detected lymph nodes evaluated by short-axis diameter, long-axis diameter, short/long axis diameter ratio, and computed tomography (CT) attenuation; and (3) visualization of mesenteric artery and vein by 3-dimensional-CT angiography. RESULTS: First, in the evaluation of local invasion, overall accuracy was 94.1%. Second, the point of 0.8 or greater in short/long-axis diameter ratio was best index for the diagnosis of metastatic lymph nodes. Using this index, the accuracy of the diagnosis per node was 80.5%. Third, 3-dimensional-CT angiography correctly demonstrated variations of the mesenteric artery and vein. CONCLUSIONS: The MDCT was effective for evaluation of local invasion and lymph nodes metastasis of colorectal cancer and mesenteric vascular variations before laparoscopic surgery.     

The number and size of normal mediastinal lymph nodes: a postmortem study

For the CT diagnosis of pathologically enlarged nodes, information concerning the size of normal nodes is required. We studied 40 adult cadavers and determined the number and size of normal lymph nodes for each region of the mediastinum, counting all nodes and directly measuring the short and long diameters of each in the transverse plane of the node. The location of each node was classified according to the American Thoracic Society system, and the range and standard maximum sizes of normal lymph nodes in each location were determined. Nodes were found in 90-100% of cadavers in regions 4, 7, and 10; and in 68-85% of cadavers in regions 2 and 6. The average number of lymph nodes found was 3.5-4.8 in regions 4, 6, and 10R; 2.1-2.9 in regions 2, 7, and 10L; and 0.1-1.2 in all other regions. The mean short transverse diameters ranged from 2.4 to 5.6 mm, and the mean long transverse diameters ranged from 3.9 to 10.0 mm. The largest mean short and long transverse diameters were found in region 7, the next largest were in region 10R, followed by regions 4, 5, and 10L. We noted a different maximum normal size of lymph nodes in each region of the mediastinum. The short transverse diameter, which showed a smaller variation, appeared to be a more useful parameter than the long transverse diameter. We propose a standard for maximum normal short transverse diameters for nodes in each region of the mediastinum as follows: 12 mm for nodes in region 7; 10 mm for nodes in regions 4 and 10R; and 8 mm for nodes in other regions. The maximum long transverse diameters showed a wider variation, ranging from 25 to 10 mm.     

MR IVIM-DWI 及 DCE-MRI 对直肠癌系膜淋巴结良恶性的诊断价值

目的：探讨 MR 体素内不相干运动扩散加权成像(IVIM-DWI)及动态增强磁共振成像(DCE-MRI)在鉴别直肠癌直肠系膜淋巴结转移的应用价值。方法38例经病理确诊为直肠癌的患者,术前行 IVIM-DWI 及 DCE-MRI 检查。比较转移性淋巴结(n=28)与非转移性淋巴结(n=27)的短径、短径-长径比、IVIM-DWI 参数值[表观扩散系数(ADC)、单纯扩散系数(D)、伪扩散系数(D?)和灌注分数(f)]及 DCE-MRI 半定量参数值[曲线上升斜率(Slope)、最大上升斜率(Maxslope)、对比增强比(CER)、对比剂清除率(Washout)、达峰时间(TTP)、前90 s 增强曲线下面积(iAUC90)和前180 s 增强曲线下面积(iAUC180)]。结果转移性与非转移性淋巴结在平均短径(8.87 mm±2.829 mm vs 6.83 mm±1.075 mm)、D 值[(0.824±0.113)×10-3 mm2/s vs (1.033±0.244)×10-3 mm2/s)]、CER(1.588±0.664 vs 1.054±0.419)、iAUC90(22.89±9.83 vs 13.59±5.34)和 iAUC180(49.38±20.19 vs 30.31±11.67)上差异有统计学意义(P ≤0.001);在短径-长径比、ADC 值、D?值、f 值及 Slope、Maxslope、Washout、TTP 上无统计学差异(P >0.05)。鉴别转移性及非转移性淋巴结的最佳阈值(各自的曲线下面积、敏感性、特异性)分别为：短径=7.1 mm(0.744、64.2%、85.1%)、D=0.906×10-3 mm2/s (0.821、81.5%、75.0%)、CER=1.05(0.749、85.7%、62.9%)、iAUC90=13.42(0.780、85.7%、62.9%)及 iAUC180=49.65(0.770、50.0%、100%)。结论IVIM-DWI 及 DCE-MRI 在鉴别直肠癌直肠系膜转移性及非转移性淋巴结的诊断中具有一定的意义。     

DWI评估宫颈癌盆腔淋巴结转移的应用价值

目的探讨扩散加权成像(DWI)对于鉴别宫颈癌转移与非转移淋巴结的诊断价值。资料与方法 36例宫颈癌初诊患者于治疗前行常规MRI及DWI检查,观察并比较宫颈癌转移淋巴结与非转移淋巴结常规MRI及表观扩散系数(ADC)图表现,测量各淋巴结的长径(L)、短径(S)、T2信号强度、平均ADC值和最小ADC值,利用受试者工作特征(ROC)曲线下面积(Az)评价上述各项指标鉴别宫颈癌转移与非转移淋巴结的诊断效能。结果转移淋巴结短径和长径的平均秩次均大于非转移淋巴结,且两者差异具有统计学意义(均为P=0.000),而转移淋巴结与非转移淋巴结的L/S、S/L以及T2信号强度差异均无统计学意义(P=0.261;P=0.157;P=0.166);转移淋巴结的平均ADC值和最小ADC值均低于非转移淋巴结,且差异均具有统计学意义(均为P=0.000);短径、长径、平均ADC值和最小ADC值对鉴别宫颈癌转移与非转移淋巴结均有诊断意义(Az>0.5),其中最小ADC值的诊断效能最高,选取最小ADC阈值为0.983×10-3mm2/s时,其敏感性和特异性分别为94.6%和91.8%。结论 DWI有助于宫颈癌转移和非转移淋巴结的检出,最小A...     

Computed tomography and ultrasonography of metastatic cervical lymph nodes in oral squamous cell carcinoma

OBJECTIVES: To define criteria for CT and US in differentiating cervical lymph node metastases in oral squamous cell carcinoma (SCC). MATERIALS AND METHODS: CT and/or US of 230 metastatic lymph nodes and 228 benign lymph nodes in 147 patients with oral SCC were retrospectively evaluated. The CT and US findings of each lymph node were compared with the histopathological findings. A metastasis was defined on CT as a lymph node with rim or heterogeneous enhancement, or measuring 10 mm or more in the short axis, regardless of enhancement pattern, and on US as having definite internal echoes, regardless of size, or without definite internal or hilar echoes, but measuring 10 mm or more in the short axis. A lymph node with hilar echoes or a ratio of the long to short axis (L/S ratio) of 3.5 or more was considered benign. A lymph node failing to comform to any of these categories was termed questionable. RESULTS: The positive predictive value (PPV) for CT was 90.8% and the negative predictive value (NPV) was 70.4%. However, 65.7% of all lymph nodes could not be classified as either metastastic or benign. PPV for US was 96.5% and NPV was 88.1%. 25.5% of all lymph nodes could not be classified as either metastatic or benign. CONCLUSIONS: Despite limitations in detecting metastases, by including a third category 'questionable' our criteria appear clinically more useful than other current methods based on two groups only.     

Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients

OBJECTIVE: Our objective was to determine the clinical significance of mesenteric adentitis when detected on CT. MATERIALS AND METHODS: Mesenteric adenitis was considered present if a cluster of three or more lymph nodes measuring 5 mm or greater each was present in the right lower quadrant mesentery. If no other abnormality was detected on CT, then mesenteric adenitis was considered primary. If a specific inflammatory process was detected in addition to the lymphadenopathy, then mesenteric adenitis was considered secondary. Patients with a known neoplasm or HIV infection were excluded. Three separate groups of patients were examined for the presence and cause of mesenteric adenitis. Group 1 consisted of 60 consecutive patients prospectively identified with mesenteric adenitis on CT examinations. Group 2 consisted of 60 consecutive patients undergoing abdominal and pelvic CT for evaluation of blunt or penetrating abdominal trauma. Group 3 consisted of 60 consecutive patients undergoing abdominal and pelvic CT with acute abdominal symptoms. In all patients, the indication for imaging was documented, and the size of the largest lymph node, when present, was measured. In patients with mesenteric adenitis, the CT findings, clinical history, and clinical or surgical follow-up were subsequently evaluated to determine the cause of mesenteric adenitis. RESULTS: In the 60 patients prospectively identified with CT findings of mesenteric adenitis (group 1), 18 (30%) of 60 had primary mesenteric adenitis. The remaining 42 patients (70%) had an associated inflammatory condition that was established on CT as the likely cause of mesenteric adenitis. Mesenteric adenitis was present in none (0%) of the 60 patients in group 2 and in five (8.3%) of 60 patients in group 3. CONCLUSION: The incidence of mesenteric adenitis in patients with and those without abdominal pain is low. When evidence of mesenteric adenitis is present on CT examinations, usually a specific diagnosis can be established as its cause.     

Microwave coagulation therapy with interruption of hepatic blood in- or outflow: an experimental study

PURPOSE: To determine how interruption of hepatic blood in- or outflow affects the coagulation diameter of microwave coagulation therapy (MCT) in the liver. MATERIALS AND METHODS: Laparotomic MCT at 60 W for 1 minute was performed in 11 Landrace pigs. MCT was performed under six different conditions: without occlusion (Group N; in seven lobes of seven pigs); with occlusion of the hepatic artery (Group A; in five lobes of five pigs); with occlusion of the portal vein (Group P; in five lobes of five pigs); with occlusion of the hepatic artery and portal vein (Group AP; in six lobes of six pigs); with occlusion of the hepatic vein (Group V; in five lobes of four pigs); and with occlusion of the hepatic artery and vein (Group AV; in seven lobes of seven pigs). The maximum diameters for each group were compared. RESULTS: The coagulation diameters (mean +/- SD) were 8.5 mm +/- 2.0, 10.0 mm +/- 1.6, 14.3 mm +/- 2.5, 14.4 mm +/- 2.4, 13.0 mm +/- 0.8, and 14.4 mm +/- 1.5 for Groups N, A, P, AP, V, and AV, respectively. The coagulation diameters for groups P, AP, V, and AV were statistically larger than those for groups N and A (P < .05). There was no significant difference between the coagulation diameters of Groups P, AP, V, and AV. CONCLUSION: The coagulation diameter depends mainly on the portal venous flow. In addition of direct interruption of the portal vein, interruption of the hepatic vein can also result in a substantial increase in the coagulation diameter.     

Intra- and interstudy reproducibility of coronary artery diameter measurements in magnetic resonance coronary angiography

PURPOSE: To determine the intra- and interstudy reproducibility of right coronary artery diameter assessment using serial magnetic resonance (MR) coronary angiography. MATERIALS AND METHODS: Two-dimensional (2D) navigator-gated segmented fast low angle shot (FLASH) images of the proximal right coronary artery were acquired three times in 11 healthy volunteers, the first two times in the same study session and the third time after repositioning the subject in the scanner. Coronary artery diameters were determined using automated segmentation software and intra- and interstudy reproducibility calculated as the standard deviation (SD) of the signed differences between measurements within and between study sessions, respectively. The reproducibility of the segmentation software was determined by repeated analysis of each individual scan. RESULTS: One subject was excluded from the study due to poor-quality images. In the remaining 10 subjects, the mean (+/- SD) intrastudy difference in coronary artery diameters was -0.05 +/- 0.12 mm, a value that is very similar to between-frame (same-film) differences reported in quantitative coronary angiography (QCA). The mean (+/- SD) interstudy difference in coronary artery diameters was 0.16 +/- 0.43 mm, although this was greatly skewed by one subject with poor image plane repositioning. Excluding that subject resulted in a mean (+/- SD) interstudy difference of 0.04 +/- 0.20 mm. The reproducibility of the segmentation software was excellent, with the mean difference between repeat analyses of the images being 0.00 +/- 0.03 mm. CONCLUSION: The intrastudy variability of coronary artery diameter measurements is low, potentially allowing MR coronary angiography to be used as a tool for the noninvasive assessment of serial changes following pharmacological intervention. A major contributing factor to this is the high reproducibility of the segmentation software. Interstudy variability is approximately three times the intrastudy variability.     

The presence and significance of lymphadenopathy detected by CT in primary sclerosing cholangitis.

Patients with primary sclerosing cholangitis (PSC) are at increased risk of developing cholangiocarcinoma, which adversely affects their survival especially after orthotopic liver transplantation. All CT scans of patients with PSC referred to the Liver Unit at the Queen Elizabeth Hospital since 1992 were reviewed. The location of any lymph node with a short axis diameter greater than normal was documented. The incidence of lymphadenopathy and cholangiocarcinoma was also documented. 36 scans are reviewed, including eight with cholangiocarcinoma as well as PSC. Abdominal lymphadenopathy was present in 26 cases (66%) and 45 separate lymph node groups were involved in these patients. There were eight cases of cholangiocarcinoma; five were detectable on CT, but only four had significant lymphadenopathy. The remaining three cases of cholangiocarcinoma were not detectable on CT and only one of these had lymphadenopathy. Follow-up of the remaining patients has not demonstrated the development of cholangiocarcinoma. Lymphadenopathy is commonly demonstrated by CT in PSC patients, but does not imply malignancy and should not exclude a patient from undergoing liver transplantation. Conversely cholangiocarcinoma may develop without significant lymphadenopathy.     

Quantitative evaluation of vascularity within cervical lymph nodes using Doppler ultrasound in patients with oral cancer: relation to lymph node size

Objectives

The aim of this study was to quantitatively evaluate the relationship between vascularity within lymph nodes and lymph node size on Doppler ultrasound images of patients with oral cancer.

Methods

A total of 310 lymph nodes (86 metastatic, 224 benign) from 63 patients with oral cancer were classified into 4 groups according to their short axis diameters: Group 1, short axis diameters of 4–5 mm; Group 2, 6–7 mm; Group 3, 8–9 mm; and Group 4, ≥10 mm. Vascular and scattering indices of lymph nodes on Doppler ultrasound images were analysed quantitatively. The vascular index was defined as the ratio of blood flow area to the whole lymph node area and the scattering index was defined as the number of isolated blood flow signal units.

Results

For metastatic lymph nodes, the vascular index was highest in Group 1 and decreased as lymph node size increased. The vascular index of benign lymph nodes did not differ significantly among the four groups. The vascular index of metastatic lymph nodes was significantly higher than that of benign lymph nodes in Group 1. For metastatic lymph nodes, the scattering index increased as lymph node size increased and was significantly higher than that of benign lymph nodes in Groups 2–4.

Conclusions

An increase in vascularity is a characteristic of Doppler ultrasound findings in small metastatic lymph nodes. As the metastatic lymph node size increases, blood flow signals become scattered, and the scattering index increases.