Alterations in the CT image following retroperitoneal lymphadenectomy in early stage non-seminomatous testicular tumor

CT was performed before and after lymphadenectomy in 105 patients with early stage non-seminomatous testicular tumor. Retroperitoneal blurring and retracted bowel were the most common findings and might cause interpretation problems. A reference CT making future comparison possible should be routinely performed two months after the operation.     

Radiologic, clinical and biochemical features of non-seminomatous testicular tumors.

Current therapy for metastatic non-seminomatous testis tumors is effective but toxic. Careful investigation is needed to select those who need treatment and yet avoid needless toxicity in patients who have no disease. Current radiographic investigations and measurement of two biochemical tumor markers (AFP & BHCG) provided accurate monitoring in 19 patients. Preoperative urography and lymphography correctly predicted the presence or absence of retroperitoneal metastases in 9 of 12 patients but did not show microsocpic metastases in 3. There was good correlation between the clinical, readiographic and biochemical evidence of disease progression and regression.Serial ultrasonography and tumor marker determinations were particularly useful in following asymptomatic abdominal metastases. Radiography and tumor marker determinations each have specific advantages which make them complementary.     

Computed tomography and conventional radiography in intrathoracic metastases from non-seminomatous testicular tumor

Conventional chest radiographs and CT scans were studied retrospectively in 283 patients with untreated non-seminomatous testicular tumor. Intrathoracic metastases were found in 47 patients, and CT was the only positive examination in 20 of them. Lung metastases were seen in 39 patients and mediastinal lymph nodes were involved in 13. The additional yield of CT in detecting only at CT in 9 out of 13 cases as compared with 14 out of 39 for the lung parenchyma). Posterior mediastinal and retrocrural lymph nodes were most often enlarged, and involvement of these was most difficult to detect at conventional radiography.     

Evaluation of retroperitoneum with computerized tomography and ultrasonography in patients with testicular tumors.

Results of CT and US examinations in 24 patients with testicular tumors yielded similar sensitivity and specificity in the diagnosis of enlarged retroperitoneal lymph nodes found at laparatomy. Therefore, the choice of either imaging modality may be influenced by other factors such as presence of abundant bowel gas, post-operative wounds, surgical clips in the abdomen, cachexia or obesity.     

Computed tomography in primary non-seminomatous germ cell tumors of the mediastinum

Germ cell tumor exists as a primary entity in the anterior mediastinum. In a CT study of two males and one female with primary non-seminomatous germ cell tumors all masses were large and lobulated with a mixed density. The fat planes were for the most part obliterated. A high attenuating border was present around parts of the tumor in all three cases, and the pleura-lung interfaces were irregular. One patient had pericardial and left pleural effusions as well as tumor invasion of the anterior chest wall. An extragonadal germ cell tumor should be considered when CT of the thorax reveals a large mass in the anterior mediastinum of a young adult.     

Influence of different criteria for abnormal lymph node size on reliability of computed tomography in patients with non-seminomatous testicular tumor

The reliability of computed tomography (CT) using different criteria for abnormal size of retroperitoneal lymph nodes (5, 10, 15 mm in largest diameter) was evaluated prospectively in 90 consecutive patients with a non-seminomatous testicular tumor and lymph nodes less than 20 mm at CT. Correlation was made with histologic findings following retroperitoneal lymphadenectomy. Histologic examination revealed metastases in 38 patients (42%). Using a strict criterion of 15 mm for abnormal node size, sensitivity was 37%, specificity 98%, positive predictive value 93% and negative predictive value 68%. A relaxed criterion of 5 mm led to a sensitivity of 71%, specificity 67%, positive predictive value 61% and negative predictive value 76%. Overall accuracy was approximately 70% with the 5, 10 and 15 mm criteria for abnormal size. The inability of a normal scan to exclude metastases was the main limitation of CT.     

Shape of retroperitoneal lymph nodes at computed tomography does not correlate to metastatic disease in early stage non-seminomatous testicular tumors

Variety Range (difference between the maximum and minimum transverse diameters in percentage of the minimum diameter) was calculated for 86 lumbar lymph nodes with maximum diameter ranging between 5 mm and 19 mm at CT. The nodes were located within a group (pre- and paracaval, interaortico-caval, pre- and paraaortic) which was removed during primary lymphadenectomy for non-seminomatous testicular tumor. Most nodes were fairly rounded with a Variety Range less than 20%. There was no difference between the largest node in a metastasis group (Variety Range less than 20% in 29 out of 36) and tumor free nodes (Variety Range less than 20% in 39 out of 50). A rounded shape of lymph nodes measuring less than 20 mm on transverse CT sections was not a reliable sign of metastasis in patients with non-seminomatous testicular tumor.     

Computed tomography and magnetic resonance imaging findings of solitary fibrous tumors in the pelvis: Correlation with histopathological findings

Objective

We aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of pelvic solitary fibrous tumors (SFTs) and to improve the diagnostic efficacy for such tumors.

Methods

Six cases of pelvic SFTs confirmed by histopathology were analyzed retrospectively. Of the 6 patients, 4 had undergone CT scanning, and 2 had undergone magnetic resonance imaging. All the patients had undergone unenhanced and contrast-enhanced examinations, and 2 had also undergone dynamic CT enhancement examination. Image characteristics such as shape, size, number, edge, attenuation or intensity for each lesion before and after contrast enhancement were analyzed and compared with the pathomorphology of the tumors.

Results

All the 6 cases showed oval or rounded and well-defined masses. Unenhanced CT images showed heterogeneous masses with patchy, necrotic foci in 3 cases and homogeneous mass in 1 case. None of the tumors showed calcification. Contrast-enhanced CT images showed marked, heterogeneous enhancement in the first and second cases. Dynamic enhancement scan demonstrated mild homogeneous enhancement in the third case and mild prolonged, delayed enhancement and washout in the fourth case. T1-weighted MR images showed heterogeneous mild hypointense lesion with linear hyperintensity in 1 case, and homogeneous isointensity in the other. T2-weighted images showed heterogeneous mixed intensity in 1 case and mostly hyperintensive lesion with hypointense foci in another case. A case showed marked heterogeneous enhancement and another showed marked homogeneous enhancement on contrast-enhanced T1-weighted images.

Conclusion

Radiological findings of pelvic SFTs are variable and nonspecific. However, a well-defined, ovoid or rounded mass with hypointense on MR T2-weighted images and variable enhancement on CT and MR images may suggest the diagnosis of SFTs. Pelvic SFTs should be included in the differential diagnosis of regional tumors.     

胃间质瘤CT征象与肿瘤危险度分级的关系

目的 探讨胃间质瘤(GST)的CT征象与肿瘤危险度分级的关系.方法 回顾性分析106例经CT及病理证实的GST的CT征象,探讨其与肿瘤危险度分级的关系.结果 106例GST病例中,低危组46例,中危组27例,高危组33例.采用单因素分析,各组GST在肿瘤大小、形态、生长方式、边界、密度、实性部分强化程度、远处转移方面有统计学差异(P＜0.05),而在年龄、性别、瘤体部位方面无统计学差异(P＞0.05);采用多分类Logistic回归分析,肿瘤大小、形态和生长方式在预测GST恶性风险方面有统计学差异(P＜0.05).结论 GST的CT征象有助于评估GST的危险度分级,肿瘤大小、形态和生长方式可预测GST的恶性风险.     

The role of magnetic resonance imaging and computed tomography in the treatment evaluation of retroperitoneal lymph-node metastases of non-seminomatous testicular tumors.

The role of Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) in the treatment evaluation of retroperitoneal lymph-node metastases of non-seminomatous testicular tumors (NSTT) was prospectively studied in 10 consecutive patients before, during and after chemotherapy. The results thus obtained were compared with laparotomy findings before and after chemotherapy, the histology of the primary testicular tumor, and that of retroperitoneal residual lesions after chemotherapy. MRI and CT proved to be equivalent in detection and in determining the anatomical localization and size of the retroperitoneal lymph node metastases. Unlike CT, MRI revealed unmistakable changes in the structure of the retroperitoneal lymph-node metastases during chemotherapy, for which no histological cause was found except in mature teratoma. In mature teratoma a high T2 signal was found within the metastases, corresponding with a high water content. On the basis of tumor consistency and signal intensity in the T1- and T2-weighted images, MRI cannot yet warrant any conclusion about the ultimate effect of chemotherapy.     

Influence of section spacing on reliability of abdominal computed tomography in early stage non-seminomatous testicular tumor

Comparison of reliability of CT with contiguous and non-contiguous scan reading was performed in 100 consecutive patients with a non-seminomatous testicular tumor and lymph nodes less than 20 mm at CT. The patients underwent primary lymphadenectomy and histologic examination of removed nodes. Ten mm thick slices at adjacent 10 mm intervals were used and non-contiguous reading was based on sections with uneven numbers. Reading of non-contiguous scans led to drop in sensitivity from 71% to 66% compared with contiguous scans when 5 mm was used as criterion for abnormal node size. Corresponding decrease was from 47% to 39% with the 10 mm criterion and from 37% to 26% with the 15 mm criterion. Other parameters were only slightly influenced by the scan reading technique. The benefit of contiguous as opposed to non-contiguous scanning was small in the present series.     

Imaging of cecal tumors using computer tomography

Although contrast enema of the colon and endoscopy remain the preferential diagnostic methods in tumour of the caecum, computed tomography can accurately determine the extent of extraluminar tumour growth and hence help to arrive preoperatively at the appropriate therapeutic concept. Adenocarcinomas are morphologically distinctly different, due to focal thickenings of the colon wall, from the diffuse wall thickenings associated with malignant lymphomas, or from inflammatory conglomerate tumours. Computed tomography of the caecal region is a noninvasive examination method that can speed up diagnosis especially in elderly patients with elongated colon and stool incontinence.     

Intramammary incidental findings on staging computer tomography

Purpose

Incidental findings are a common feature in computer tomographic examinations of the chest. Breast incidentalomas, however, were described only sporadically. The purpose of this study was to evaluate retrospectively incidental breast findings and to compare radiological features of benign and malignant breast lesions.

Materials and methods

From January 2006 to December 2010 a total of 8105 computer tomographic examinations were performed at our institution. In 89 patients incidental breast lesions were diagnosed. 64 of the identified patients were referred for further clinical, radiological, and hystopathological examination. All patients were female with a median age of 62 years, range 39–82 years.

Results

A total of 98 breast lesions were identified in the 64 patients. The mean size was 12.0 ± 8.0 mm. Primary breast carcinoma was identified in 9, breast metastases in 27, and benign findings in 28 patients.Malignant lesions demonstrated more often marked enhancement and showed a higher density compared with benign lesions. Benign findings were more often lobular in shape and had spiculated margins.Most of the breast metastases were round or oval in shape with circumscribed margins and marked homogenous enhancement. There was no significant difference between the breast cancer and benign findings groups in the characteristics of the lesions.

Conclusion

The breast is a very important region and should be carefully evaluate on chest CT. There are no certain radiological criteria to differentiate between malignant and benign breast lesions on CT. Therefore all breast incidentalomas should be evaluated by further radiological/histological investigations.     

Computerized tomography findings in hormonally inactive adrenal gland tumors

CT examinations of 6 years served as basis for the incidence of hormonally inactive space-occupying masses at the adrenal. Of a total of 25,000 patients, 313 (1.3%) suffered from disease of the adrenals, and of these 261 patients had a hormonally inactive adrenal tumour. Adenomas were the most frequent space-occupying growths (101 patients), followed by metastases of the adrenals (77 patients), whereas adrenal carcinomas (4 patients), myelolipomas (3 patients), ganglioneuromas (3 patients) adrenal cysts (3 patients) and adrenal haemorrhages (2 patients) were rare findings.     

CT-evaluation in patients with testicular tumors (author's transl)]

Fifty CT examinations of 31 patients with testicular tumours were evaluated. In 13 patients, the CT findings were compared with results of histological-surgical or autoptic findings. Comparative evaluation of CT, lymphography and other methods of diagnosis is demonstrated. The high incidence (80 %) of correct CT results is emphasised, in staging patients and in the work up of patients with long treatment time and history of tumor recurrence. The advantages of CT are: 1) possibility of exact localisation and determination of tumor-size, as well as discovery and assessment of their patho-anatomic relations to the adjacent organs, 2) utilisation of these data in the planning of radiotherapy, 3) the possibility to document exactly any treatment sucess (reduction of tumor size). In more than 30 % of the patients, CT scanning revealed, despite radiological preliminary examinations, clinically and radiologically unexpected pathologic findings, such as osseous metastases (17%), non functioning kidneys, metastases in the liver and pleura.     

Late relapse of metastatic non-seminomatous testicular germ cell tumours

Although the majority of men presenting with non-seminomatous germ cell tumours (NSGCT) are cured, late relapse (occurring more than 2 years after obtaining a complete response to treatment) is increasingly recognized. The typical patterns of disease spread have been well-documented, but the findings at late relapse are more variable and less well-described. We discuss the phenomenon of late relapse, the characteristics of teratoma differentiated (TD), and the issue of long-term imaging surveillance of patients with NSGCT. The potential sites of late relapse of NSGCT and the associated spectrum of imaging appearances are illustrated.     

High-resolution computed tomography findings in elderly patients with asthma

OBJECTIVE: Based on the hypothesis that airway remodelling is related to the duration of asthma, HRCT scanning should show greater abnormalities in the early-onset than the late-onset asthmatics. It was, therefore, intended to assess the presence and the frequency of airway and parenchymal abnormalities with high-resolution computed tomography (HRCT) in elderly asthmatic patients, and to determine whether these abnormalities are related to the duration of asthma. PATIENTS AND METHODS: Sixty-eight clinically stable asthmatic patients aged > or =60 yr were included in this prospective study. The patients were separated into two groups according to the duration of symptoms as late-onset asthma (n=31) with disease duration of <5 yr, and early-onset asthma (n=37) with disease duration of > or =5 yr. All patients were lifelong non-smoker and had been using inhaled beta agonists and inhaled steroids. HRCT-scanning and histamine inhalation test were performed on all patients. RESULTS: In comparison with late-onset asthmatic patients, those with early-onset asthma had significantly higher frequency of emphysema (21.6% versus 0.0%, p=0.006), bronchial dilatation (13.9% versus 0.0%, p=0.03) and bronchial wall thickness (41.7% versus 12.9%, p=0.01). Multiple logistic regression analysis identified that early-onset of disease was an independent risk factor for the presence of irreversible HRCT-scan abnormalities in elderly asthmatics [odds ratio (OR): 9.4 (2.7-32.7), p=0.00001]. CONCLUSION: Present data suggest that HRCT abnormalities in early-onset elderly asthmatics reflect parenchymal and airway changes that become irreversible throughout the long course of the disease.