Sclerosing stromal tumor of the ovary: MRI.

The MR and pathologic findings of a case of sclerosing stromal tumor (SST) are presented. MR findings reflecting pathological features of SST include pseudolobulation, which consists of low-intensity nodules set against high-intensity stroma on T2-weighted images, and striking enhancement on postcontrast images.     

Breast ultrasonography: diagnostic efficacy of a computer-aided diagnostic system using fuzzy inference.

We have developed a computer-aided diagnostic (CAD) system using fuzzy inference for breast sonography and have evaluated the performance of the system. Our CAD system is not an automated image processing method, but requires the observer's subjective "scoring." Seven radiologists interpreted 54 breast mass lesions (24 malignant, 30 benign). Six criteria (shape, border, halo, internal echoes, posterior echoes, and edge shadows) were scored using a five-point rating scale. The output was described as a real number from 0.0 to 1.0. For cancer diagnosis, the sensitivity of the radiologists, a six-criteria CAD version, and a four-criteria version (excluding posterior echoes and edge shadows) were 63.1%, 82.1%, and 78.0%, respectively. Specificity was 71.0%, 42.9%, and 51.0%, respectively, while accuracy was 67.5%, 60.3%, and 63.0%, respectively. No significant differences in the areas under ROC curve (Az) were found between the observers and CAD system. Several cases assessed as false-negative by observers were correctly diagnosed by the CAD system, and diagnostic efficacy could be improved, especially among novice sonographers. Although the system's high false-positive rate needs to be reduced, it will assist radiologists in generating a level of suspicion for malignancy.     

Primary leiomyoma of the ovary: a case report

The imaging features of primary ovarian leiomyoma have seldom been described because of the very low prevalence of the tumor. Herein we present a case report on its magnetic resonance imaging features. Both T1- and T2-weighted images revealed a low-signal-intensity mass, which was well circumscribed and sharply demarcated from the uterus. Magnetic resonance imaging was useful in distinguishing it from a malignant ovarian tumor and uterine leiomyoma. Received 10 October 1997; Revision received 2 February 1998; Accepted 4 February 1998     

Massive edema of the ovary.

Ovarian edema is a newly recognized clinicopathologic entity. A case of massive ovarian edema is presented in which a huge abdominal mass was considered to be an ovarian cyst roentgenographically and clinically. However, ultrasound revealed the mass to be solid. Five previously reported cases in which ovarian edema simulated a fibroma are reviewed.     

Dysgerminoma of the ovary: a report on 29 patients

Twenty nine patients with pure dysgerminoma of the ovary were referred to the Institute of Radiology of the University of Florence between 1960 and 1983. Twenty six patients received radiation therapy after surgery; three cases, classified as Stage IA, were not submitted to postoperative radiation therapy. Five patients relapsed 2 to 16 months after initial surgery, and three of them died because of their tumours. Sites of relapse were found to be outside the treated volume in four out of these five patients. The overall survival rate for this series is 90%. The survival rate seems to depend not only on the stage of the disease, but also on initial accurate staging and appropriate therapy. Criteria for selecting patients from whom post-operative radiotherapy may be withheld are discussed.     

Carcinoma of the male breast: report of a series of 88 cases.

A series of 88 cases of male breast cancer was compared with 241 cases of female breast cancer randomly selected from Departmental records. Cases of male breast cancer differed significantly from control female cases with regard to stage of the disease, age of onset and liability to the development of a second carcinoma. In 11 of the 88 cases (12.5%) of male breast cancer another primary malignant tumour developed. In seven instances the large bowel or rectum was the site of the other carcinoma. When correction was made for age and for the stage of the disease the prognosis of breast cancer in men and women was found to be similar. Only minor histological differences were found between male and female cases. Two of 54 cases examined for X-chromatin proved to be Barr-positive.     

Neurofibromatosis type 1: a diagnostic mimicker at CT.

Neurofibromatosis type 1 (NF1) is the most common of the phakomatoses and has a variety of localized or, more frequently, systemic manifestations throughout the thorax, abdomen, pelvis, and extremities. Classic computed tomographic (CT) findings in NF1 with thoracic involvement include small, well-defined subcutaneous neurofibromas, focal thoracic scoliosis, posterior vertebral scalloping, enlarged neural foramina, and characteristic rib abnormalities due to bone dysplasia or erosion from adjacent neurofibromas. However, more atypical manifestations are occasionally seen, and magnetic resonance (MR) imaging can be useful in equivocal cases. NF1 with abdominopelvic involvement tends to arise in the retroperitoneal, mesenteric, and paraspinal regions; it may be quite extensive and therefore difficult to distinguish from adenopathy at CT. The multiplanar capabilities of MR imaging, particularly with T2 weighting, make this modality helpful in evaluating affected patients and making the diagnosis. The classic peripheral manifestations of NF1 include limb hemihypertrophy, pseudarthrosis, peripheral nerve neurofibromas, and subcutaneous common and plexiform neurofibromas. In some cases of NF1, imaging findings are inconclusive, and biopsy and subsequent pathologic analysis are required. Familiarity with the various manifestations of NF1 in different anatomic locations is important in making the diagnosis and optimizing postdiagnostic treatment.     

Contrast enhancement: diagnostic significance from a statistical viewpoint.

Contrast enhancement attenuation units were calculated from 13 tissues and organs of 20 rats at five different times after bolus 125I-diatrizoate administration. Percent distribution volume of diatrizoate was calculated from these results. The statistical significance of differences in contrast enhancement between each of 72 tissue pairs was determined at each of the five times. A similar treatment of percent distribution volume for 60 tissue pairs was determined. The time elapsed after contrast medium injection appears to be of pivotal importance in contrast enhancement diagnosis. Calculation of percent contrast distribution volume is of potential diagnostic importance, since it reveals contrast medium behavior not evident from a visual perusal of scans. The above methods can be readily adapted to computed tomography scanning.     

卵巢肝样癌一例

患者女,34岁.因尿频4个月,腹胀、经期短、经量少2个月入院.妇科体检:下腹部膨隆,脐下3 cm可触及一较大质硬肿块,如孕5个月大小,不活动,无压痛.     

Carcinoma of the cervix: dynamic MR imaging.

Dynamic magnetic resonance (MR) imaging was performed to evaluate eight normal uteri and 29 cervical carcinomas. After rapid injection of gadopentetate dimeglumine, dynamic images were obtained every 30 seconds with the spin-echo (SE) technique in the sagittal plane or the fast low-angle shot (FLASH) technique in the axial plane. In the normal uterus, initial slight enhancement of the junction between endometrium and myometrium was followed by enhancement of the uterine myometrium. Cervical carcinoma was readily distinguished from the cervical stroma and myometrium in the early dynamic phase (30-60 seconds). Tumor-cervix contrast in the early dynamic phase was significantly more marked with the dynamic SE technique than with T2-weighted or contrast material-enhanced T1-weighted imaging (P less than .01). For the evaluation of parametrial invasion, the dynamic FLASH study showed better contrast than did T2-weighted images. Among 18 patients who underwent surgery, accurate assessment of the degree of stromal invasion and tumor size was possible with dynamic MR images in 14 patients (78%), T2-weighted images in 11 (61%), and postcontrast T1-weighted images in seven (39%).     

Carcinoma of the vulva.

The results of treatment of carcinoma of the vulva in patients referred to the Rotterdamsch Radio-Therapeutisch Instituut in the years 1965-1969 are reported. Electron beam therapy seems not to be the method of choice; surgery is to be preferred. Radiation therapy requires high doses (greater than or equal to 6 krad) and is frequently followed by severe induration with recurrent ulcerations.     

Carcinoma of the urachus.

Characteristic roentgenographic and anatomical features of a mucinous adenocarcinoma of the urachus were observed in two patients. Both presented with a midline anterior abdominal mass in the supravesicular area. The tumor contained fine stippled calcification in one case. The cystogram demonstrated an irregular filling defect in the bladder dome in the other case. Ultrasonographic examination in one case was helpful in delineating the nature, size, and location of the mass in detail.     

Analysis of diagnostic confidence and diagnostic accuracy: a unified framework

Diagnostic confidence has been used as a measure of diagnostic efficacy, but this measure in isolation fails to take into account incorrect diagnoses. Conventional analytical approaches of diagnostic confidence ignore associated diagnostic accuracy. To address this limitation, we introduce a unifying framework which incorporates diagnostic confidence, changes in diagnoses and ultimate accuracy. The framework is illustrated using data from a study in which 62 patients with acute abdominal pain prospectively underwent CT. Admitting surgeons documented their diagnoses and graded their diagnostic confidences (on a 5-point scale) on admission and again after CT. Our approach, unlike conventional analyses, incorporates knowledge of final diagnoses, obtained from surgery or 6 months follow up, in assessing the impact of the test (on a 9-point scale). Changes in pre- and post-CT confidence scores were assessed by the one-sample t-test comparing against zero change, with the test statistic acting as a standardized quantity allowing comparison between our and conventional methodological approaches. Overall, 52% (32/62) of patients were misdiagnosed on admission and 19% (12/62) had incorrect post-CT diagnoses. Diagnostic confidence following CT increased significantly compared with pre-CT confidence on applying both analytical methods, although the level of statistical significance was less marked using our approach. Mean (95% confidence interval) increase in confidence under conventional analysis was 1.32 (1.03, 1.62), with standardized score t = 8.90 [p<0.0001], whereas our method yielded 0.69 (0.25, 1.13), with standardized score t = 3.12 [p = 0.003]. Although both analytical methods led to the same inference regarding the efficacy of CT in the illustrative case study presented, they differed somewhat in degree. It is conceivable that disparate conclusions may emerge in other studies and circumstances. Failure to take adequate account of incorrect diagnoses is potentially misleading. We suggest that a comprehensive analysis of diagnostic confidence requires the incorporation of diagnostic accuracy.     

Odontogenic keratocyst of the maxilla: a diagnostic problem

A case is reported of an 11-year-old boy with a space-occupying lesion in the left maxilla: the radiographic appearances were consistent with either fibrous dysplasia or an adenomatoid odontogenic tumour but the histology proved it to be an odontogenic keratocyst.