Renal transplant evaluation: multimodality imaging of post-transplant complications

With advancements in surgical techniques and immuno-suppression, renal transplantation is established as the most effective treatment option in patients with end-stage renal disease. Early detection of renal allograft complications is important for long-term graft survival. Late clinical presentation often causes diagnostic delays till the time allograft failure is advanced and irreversible. Imaging plays a key role in routine surveillance and in management of acute or chronic transplant dysfunction. Multimodality imaging approach is important with ultrasound-Doppler as the first-line imaging study in immediate, early and late post-transplant periods. Additional imaging studies are often required depending on clinical settings and initial ultrasound. Renal functional MRI is a rapidly growing field that has huge potential for early diagnosis of transplant dysfunction. Multiparametric MRI may be integrated in clinical practice as a noninvasive and comprehensive “one-stop” modality for early diagnosis and longitudinal monitoring of renal allograft dysfunctions, which is essential for guiding appropriate interventions to delay or prevent irreversible renal damage. With rapidly increasing numbers of renal transplantation along with improved patient survival, it is necessary for radiologists in all practice settings to be familiar with the normal appearances and imaging spectrum of anatomical and functional complications in a transplant kidney. Radiologist”s role as an integral part of multidisciplinary transplantation team continues to grow with increasing numbers of successful renal transplantation programs across the globe.     

Gallbladder carcinoma update: multimodality imaging evaluation, staging, and treatment options

OBJECTIVE: The purpose of this article is to review the epidemiology, multimodality imaging findings, differential diagnosis, pathologic staging, and current treatment options of gallbladder carcinoma. CONCLUSION: Understanding the characteristic appearances of primary gallbladder carcinoma at multiple imaging modalities can facilitate diagnosis and enable more accurate staging for triage to extended resection or an alternate therapy.     

Congenital thoracic vascular anomalies: evaluation with state-of-the-art MR imaging and MDCT

Congenital thoracic vascular anomalies include embryologic developmental disorders of the thoracic aorta, aortic arch branch arteries, pulmonary arteries, thoracic systemic veins, and pulmonary veins. Diagnostic evaluation of these anomalies in pediatric patients has evolved with innovations in diagnostic imaging technology. State-of-the-art magnetic resonance (MR) imaging, MR angiography multidetector-row computed tomographic (MDCT) angiography, and advanced postprocessing visualization techniques offer accurate and reliable high-resolution two-dimensional and three-dimensional noninvasive anatomic displays for interpretation and clinical management of congenital thoracic vascular anomalies. This article reviews vascular MR imaging, MR angiography, MDCT angiography, and advanced visualization techniques and applications for the assessment of congenital thoracic vascular anomalies, emphasizing clinical embryology and the characteristic imaging findings.     

Gastroenteropancreatic neuroendocrine tumors: multimodality imaging features with pathological correlation

Neuroendocrine tumors of the gastrointestinal tract are rare entities. Functioning neuroendocrine tumors tend to present early because of hormoneinduced clinical symptoms, but detection of the primary lesion may be difficult owing to their small size. Neuroendocrine tumors are typically hypervascular and show enhancement after contrast administration on computed tomography (CT) or magnetic resonance imaging (MRI). Large nonfunctioning tumors may be found in asymptomatic patients. In such cases, the synchronous presence of hypervascular hepatic metastases should be explored. This pictorial review illustrates imaging features of functioning and nonfunctioning neuroendocrine tumors arising in the gastrointestinal tract and the pancreas. Modalities included are CT, MRI, ultrasonography, and nuclear medicine. Characteristic histological specimens of these lesions are presented.     

Foreign esophageal body impaction: multimodality imaging diagnosis

We report a case of a portion of bran bread impacted in the cervical esophagus in an 88-year-old woman. A complete radiologic study including ultrasonography, computed tomography, and barium swallow was performed. These techniques confirmed and localized the foreign body, which was endoscopically removed. A complete radiologic assessment can guarantee the usefulness of esophagoscopy to avoid significant morbidity from unnecessary procedures in a patient in poor clinical condition. Ultrasonography and computed tomography are attractive and profitable options in these cases.     

Ossified intramuscular hemangioma: multimodality imaging findings.

Whereas calcification of hemangiomas is common, ossification is unusual. Multimodality imaging findings of a rare case of an ossified intramuscular hemangioma in the calf of a 24-year-old woman are presented. Radiographic, computed tomographic, magnetic resonance (MR), scintigraphic, and histologic features of this case are reported. The radiologic differential diagnosis of an ossified mass in soft tissue is also discussed.     

Pitfalls in multimodality imaging in a patient undergoing evaluation for bone marrow transplantation

Autologous bone marrow transplantation is being offered with increasing frequency as a therapeutic alternative to patients who have failed conventional chemotherapy. Presently, these patients are being evaluated with a variety of imaging modalities, including planar radiographs, nuclear bone and bone marrow scans, and CT and magnetic resonance imaging. A case is presented here that demonstrates potential pitfalls encountered in this multimodality approach. Correlation of imaging findings with patients history and clinical findings is essential for optimal interpretation of functional imaging modalities.     

Intraductal papillary mucinous tumors of the pancreas: features with multimodality imaging

The radiologic diagnosis of intraductal papillary mucinous tumor (IPMT) of the pancreas is important to establish because of its malignant potential and in order to determine the site of tumor origin and its extent. These pancreatic tumors are recognized more often now than previously because of the increasing use of imaging modalities such as computed tomography and magnetic resonance cholangiopancreatography. The main features of IPMT are given in this pictorial essay, with illustrations provided from a series of 50 patients with a surgically proven diagnosis of IPMT.     

多模式分子影像PET-MRI的研究进展

PET-CT已成为当今恶性肿瘤诊断、分期及疗效评价必不可少的工具,但是,MRI具有比CT更好的软组织分辨力,还可提供多种生理功能、多序列和多参数成像,且无放射性损伤,其与PET提供的分子信息互补、融合,有望成为新的双模式显像工具,在基础和临床研究中将起着至关重要的作用.然而PET与MRI结合在技术上具有很多挑战,近几年...     

Pleural diseases: multimodality imaging and clinical management.

The parietal and visceral pleura are specialized membranes which are highly efficient in keeping the pleural space essentially dry and free of protein and particulate matter. Radiology has played a pivotal role in the understanding of pleural diseases because radiography and, more recently, computed tomography (CT), sonography, and magnetic resonance imaging (MRI) have allowed in vivo visualization of abnormalities. In addition, these newer modalities have been invaluable in guiding diagnostic and therapeutic measures. Cross-sectional imaging techniques, particularly CT, are frequently of assistance in determining whether tube thoracostomy or other surgical measures are indicated, and when these procedures should be performed. The application of newer imaging modalities in expediting the management of pleural diseases is emphasized. The anatomy, histology, and physiology of the pleura, in both normal and disease states, are also reviewed.     

Comprehensive review on cardio-oncology: Role of multimodality imaging

Journal of Nuclear Cardiology - Cancer and cardiovascular disease are the two leading causes of mortality worldwide. Evolving oncologic therapy, including the use of newer targeted agents, has led...     

Molecular imaging of small animals with fluorescent proteins: from projection to multimodality

Fluorescent proteins (FPs) have been widely adopted in cell research for protein trafficking and reporter gene expression studies, as well as to study other biological processes. However, biological tissue has high light scattering and high absorption coefficients of visible light; hence, using FPs in small animal imaging remains a challenge, especially when the FPs are located deep in the tissue. In small animals, fluorescence molecular imaging could potentially address this difficulty. We constructed fluorescence molecular imaging systems that have two modes: a planner mode (projection imaging) and a multimodality mode (fluorescence molecular tomography and micro-CT). The planner mode can provide projection images of a fluorophore in the whole body of a small animal, whereas three-dimensional information can be offered by multimodality mode. The planner imaging system works in the reflection mode and is designed to provide fast imaging. The multimodality imaging system is designed to allow quantification and three-dimensional localization of fluorophores. A nude mouse with a tumour targeted with a far-red FP, which is appropriate for in vivo imaging, was adopted to validate the two systems. The results indicate that the planner imaging system is probably suitable for high throughput molecular imaging, whereas the multimodality imaging system is fit for quantitative research.     

Pseudotumoral ganglion cyst of a finger with unexpected remote origin: multimodality imaging

The case of a ganglion cyst in the pulp of a fifth finger in an elderly woman initially mimicking a soft tissue tumor is described. Most typical sites of ganglion cysts are well documented at the wrist and in the vicinity of inter-phalangeal and metacarpo-phalangeal joints. In this case, ultrasonography (US) and magnetic resonance imaging (MRI) demonstrated a cystic lesion within the pulp of the fifth finger and indicated carpal osteoarthritis as the distant—and unexpected—origin of the lesion. The suggested diagnosis of ganglion cyst was confirmed by computed tomography arthrography (CT arthrography) of the wrist, which showed opacification of the cyst on delayed acquisitions after intra-articular injection into the mid-carpal joint, through the fifth flexor digitorum tendon sheath. The communications between the degenerative carpal joint, the radio-ulnar bursa, the fifth flexor digitorum tendon sheath and the pedicle of the cyst were well demonstrated.     

Atlantoaxial instability associated with an orthotopic os odontoideum: a multimodality imaging assessment

Radiography, computed tomography (CT), and magnetic resonance imaging exams of the cervical spine were performed in a 29-year-old man who was ultimately diagnosed with an orthotopic os odontoideum during admission for injuries sustained in a motor vehicle collision. Initial radiography suggested either os odontoideum or an acute fracture of the dens. Further imaging with CT and flexion and extension radiographs confirmed os odontoideum and excluded a dens fracture. Although rare, os odontoideum is an important cervical spine anomaly to consider and to distinguish from an acute fracture of the dens.     

Adnexal torsion -- a multimodality imaging review

Adnexal torsion is a gynaecological surgical emergency as prompt restoration of ovarian blood flow may prevent permanent irreversible damage. Patients frequently present with non-specific symptoms and signs and therefore adnexal torsion is often an unexpected radiological diagnosis. Although ultrasound is the initial imaging technique of choice in suspected adnexal torsion, many patients undergo computed tomography (CT) or magnetic resonance imaging (MRI) either as a first-line test following non-specific presentation, or as a confirmatory test following equivocal ultrasound findings. Using multiple techniques, this review illustrates the wide variety of imaging features observed in adnexal torsion enabling a confident diagnosis that may result in a more favourable surgical outcome.