CT findings in patients with familial Mediterranean fever during an acute abdominal attack

The aim of this study is to present the abdominal CT findings of patients with familial Mediterranean fever (FMF) examined during an acute abdominal attack. CT scans of 17 patients (10 women and 7 men; age range 11-45 years) were retrospectively reviewed. Attention was directed to mesenteric or peritoneal abnormalities and to the presence of appendiceal pathology. Patients were divided into two groups; group A (n=14) consisted of patients with an acute abdominal attack caused by FMF, and group B (n=3) consisted of patients whose attack proved to be owing to a separate pathology requiring surgery. Characteristic CT findings of acute abdomen in FMF included mesenteric pathology (n=12), mainly of engorged vessels with thickened mesenteric folds, mesenteric lymphadenopathy (n=6) and ascites (n=6). Signs of focal peritonitis were found in four patients. Radiologists should be familiar with such CT findings of peritoneal irritation in patients with FMF during an acute attack, and may suggest this clinical diagnosis in the proper clinical setting in a patient who has not been previously diagnosed. Alternatively, the radiologist should be aware of the possibility of a concurrent acute appendicitis or other acute abdominal pathology in patients with known FMF and should search for it.     

Peritoneal carcinomatosis: role of (18)F-FDG PET.

Peritoneal carcinomatosis can be difficult to diagnose, as CT is insensitive, with peritoneal biopsy and lavage often subject to problems of sampling error. The aim of our study was to evaluate the role of (18)F-FDG PET in detecting peritoneal carcinomatosis in patients with stomach, ovarian, and adrenal cancer and mesothelioma and to compare the results with CT scans in the same patient group. Our secondary aim was to identify characteristic patterns of abdominal (18)F-FDG uptake in biopsy-proven peritoneal disease and to correlate these patterns with available histologic and anatomic findings after surgery and structural imaging. METHODS: The medical records of 88 patients with stomach (n = 48), ovarian (n = 13), and adrenal cancer (n = 6) and mesothelioma (n = 21) were reviewed for the presence of peritoneal tumor on (18)F-FDG PET and CT scans. The results were correlated with either contemporaneous peritoneal biopsy or ascitic aspirate or with radiographic or clinical follow-up if histology was negative or unavailable. Of 24 patients with suspected peritoneal tumor, 17 had biopsy-proven findings of peritoneal disease. RESULTS: Of the 24 patients with suspected peritoneal tumor, (18)F-FDG PET was positive in 14 patients, with 1 of these scans being false-positive, CT was positive in 10 patients, and either PET or CT was positive in 18 patients. This yielded sensitivities of 57% (13/23), 42% (10/23), and 78% (18/23), with uniformly high positive predictive values of 93% (13/14), 100% (10/10), and 95% (18/19), respectively. We identified 2 distinctly abnormal scintigraphic patterns of focal and uniform (18)F-FDG uptake corresponding to nodular and diffuse peritoneal disease on pathologic examination. CONCLUSION: (18)F-FDG PET adds to conventional imaging in the staging of peritoneal carcinomatosis. It is also a useful diagnostic tool when peritoneal biopsy is either unavailable or inappropriate. We have identified 2 distinct scintigraphic patterns that appear to predict the presence of either nodular or diffuse peritoneal pathology.     

Malignant peritoneal mesothelioma presenting with respiratory symptoms

Malignant peritoneal mesothelioma is a rare disease associated with mild, nonspecific abdominal symptoms and a wide spectrum of imaging findings, with thickened mesentery and peritoneum being the most common ones. A case of a malignant peritoneal mesothelioma presenting with manifestations of pulmonary disease is reported. Imaging evaluation revealed pleural, lung and pericardial involvement together with retroperitoneal lymphadenopathy, little ascites and extensive omental, but only subtle, mesenteric thickening. Received: 1 February 1999; Revised: 14 June 1999; Accepted: 22 September 1999     

Granulocytic sarcoma of bowel: CT findings

PURPOSE: To evaluate retrospectively the computed tomographic (CT) findings of granulocytic sarcoma of the bowel. MATERIALS AND METHODS: The institutional review boards of all participating institutions approved this study and waived the requirement for informed consent. CT scans were retrospectively reviewed in eight patients (seven men, one woman; age range, 23-71 years; mean age, 46 years) with pathologically proved granulocytic sarcoma of the small and/or large bowel. CT findings were evaluated with regard to the sites, morphologic characteristics, and contrast material enhancement patterns of the lesions, along with other ancillary findings (ie, peritoneal and mesenteric infiltration, ascites, lymphadenopathy, bowel perforation, and obstruction). RESULTS: Eight patients had a total of 13 lesions in the bowel (of which eight were pathologically proved), involving the duodenum (n=1), jejunum (n=2), ileum (n=5), sigmoid colon (n=1), and rectum (n=4); multifocal bowel lesions were noted in four patients. The lesion varied in shape, with wall thickening alone in three of 13 lesions, an intraluminal polypoid mass in four, an exophytic mass in one, and a combination of findings in five. Contrast material enhancement, relative to the back musculature, showed isoattenuation in seven lesions, hyperattenuation in four, and hypoattenuation in two. Five of eight patients had multiple peritoneal masses with diffuse mesenteric or peritoneal infiltration. Ascites was present in six of eight patients; lymphadenopathy (especially in the mesentery), in five; bowel perforation, in two; and bowel obstruction, in one. CONCLUSION: Granulocytic sarcoma of the bowel is characterized by variability in shape and contrast enhancement and has a high predilection for mesenteric and peritoneal spread.     

腹膜间皮瘤的CT表现

作者总结１６例腹膜间皮瘤ＣＴ表现，并与大体病理检查进行对照研究。主要ＣＴ表现包括：腹水（１６／１６，１００％），腹膜不规则增厚粘连（１３／１６，８１％）和腹膜结节（５／１６，３１％），大网膜（１０／１６，６３％）和肠系膜受累（１１／１６，６９％），盆腔肿块（９／１６，５６％），胸膜受累（７／１６，４４％）。早期腹膜病变ＣＴ检查不易发现；当腹膜、大网膜和肠系膜广泛增厚粘连时，ＣＴ所见可提示此病的诊断     

MRI evaluation of cranial bone marrow signal intensity and thickness in chronic anemia

Background and purpose: The aim is to assess the magnetic resonance imaging (MRI) findings for cranial bone marrow (CBM) signal intensity and thickness in patients with chronic anemia and compared these with findings in healthy subjects. We also investigated the relationships between CBM changes and age, type of anemia (hemolytic versus non-hemolytic), and severity of anemia. Methods: We quantitatively evaluated CBM signal intensity and thickness on images from 40 patients with chronic anemia (20 with congenital hemolytic anemia (HA) and 20 with acquired anemia) and compared these to findings in 28 healthy subjects. The intensity of CBM relative to scalp, white matter (WM), gray matter (GM), and muscle intensity was also investigated in patients and subjects in the control group. The sensitivity and specificity of CBM hypointense to GM and CBM hypointense to WM as markers of anemia were evaluated. Relationships between age and CBM thickness/intensity, and between anemia severity (hemoglobin (Hb) level) and CBM thickness/intensity were evaluated. Results: Cranial bone marrow signal intensity was lower in the chronic anemia patients than in the controls (P<0.001). In the control group, CBM intensity was higher than GM intensity, whereas the opposite was true in the patient group. The finding of CBM hypointense to GM was 85% sensitive and 67% specific as a marker of anemia. The corresponding statistics for CBM hypointense to WM were 90 and 46%. The patients had thicker CBM than the controls (temporal, P<0.05; parietal, P<0.005). The subgroup with hemolytic anemia had thicker parietal CBM than the subgroup with non-hemolytic anemia (NHA) (P<0.05) and exhibited thicker temporal and parietal CBM than the controls (temporal, P<0.05; parietal, P<0.001). The CBM thicknesses in the non-hemolytic anemia subgroup were similar to control values (P>0.05 for both). There were no correlations between age and CBM intensity or thickness, or between anemia severity and CBM intensity or thickness. Conclusion: Patients with chronic anemia exhibit lower CBM signal intensity on MRI than healthy subjects. Patients with hemolytic anemia have thicker CBM than patients with non-hemolytic anemia or healthy individuals. Decreased CBM intensity may indicate that the patient has anemia, and increased CBM thickness may specifically point to hemolytic anemia. These MRI findings may signal the need for further evaluation for the clinician.     

Imaging of musculoskeletal complications of hemophilia

In patients with hemophilia, hemarthrosis often occurs in one or several joints and may progress to a destructive, disabling arthropathy. Treatment includes continuous or on-demand clotting factor replacement and radionuclide or open synovectomy. The radiographic findings of hemophilic arthropathy depend on the stage of disease, the age of the patient at onset, and the joint involved. These findings include joint effusion, soft tissue swelling, epiphyseal overgrowth, subchondral cysts, osseous erosion, and secondary degenerative changes. Magnetic resonance imaging (MRI) is the most accurate imaging modality for assessing hemophilic arthropathy and may have a significant impact on patient management. MRI is anticipated to be useful in documenting early joint changes when treatment may be most effective. Hemophilic pseudotumor is a chronic, encapsulated, hemorrhagic fluid collection that usually destroys bone and may become quite large. Both computed tomography and MRI are useful in determining the extent of this lesion.     

Analysis of mesenteric thickening on computed tomography

Computed Tomography (CT) provides a noninvasive information in the evaluation of abnormalities of the gastrointestinal tract by direct imaging of the bowel wall and adjacent mesentery. Several prior studies have discussed the variable CT appearances of mesenteric abnormalities, such as lymphoma, metastasis, inflammatory disease and edema. Although mesenteric thickening was mentioned in these studies, no study has provided a detailed analysis of the CT appearance of the thickened mesentery. Two characteristic types of mesenteric thickening were identified in 47 patients. Type I is "Intra-mesenteric thickening", which was noted in 25 patients with vascular obstruction, inflammatory disease and edema. Type II is "Mesenteric surface thickening", which was noted in 22 patients with peritonitis carcinomatosa, peritoneal mesothelioma, tuberculous peritonitis and pseudomyxoma peritoneal. An understanding of these two types of mesenteric disease is important in the identification of mesenteric pathology.     

Hip arthropathy in a patient with primary hemochromatosis: MR imaging findings with pathologic correlation

Arthropathy is a major clinical manifestation in primary hemochromatosis, typically affecting the metacarpophalangeal joints. Hip arthropathy is not uncommon, with radiologic features resembling osteoarthritis or calcium pyrophosphate dihydrate (CPPD) crystal deposition disease. We describe the MR imaging findings of the hip in a patient with severe hip arthropathy and primary hemochromatosis and correlate them with the histopathologic findings. MR imaging showed severe degenerative changes, with large subchondral cysts and subchondral sclerosis in the femoral head and acetabulum. There was conspicuous correlation between MR imaging and pathologic findings of the resected femoral head. However, MR imaging failed to reveal intra-articular iron.     

强直性脊柱炎骶髂关节的CT诊断价值

目的探讨强直性脊柱炎（AS）患者骶髂关节病变的CT表现,并评价其对早期诊断的意义。方法对46例经临床证实AS患者骶髂天节病变的CT表现进行了回顾性分析,并参照修订的AS纽约标准（5级分类法）对全部患者的骶髂关节病变进行了分级。结果研究证实,本组46例均有异常CT表现。其中,Ⅱ级（早期,7例）CT表现为骶髂关节受累,关节面轻度硬化、毛糙,皮质白线消失,关节面细小囊变,但关节间隙仍正常;Ⅲ级（进展期,35例）CT表现为骶髂关节面呈虫蚀状侵蚀,软骨钙化,关节面骨质增生硬化,关节间隙略增宽或不均匀变窄;Ⅳ级（晚期,4例）CT表现为关节骨性强直,关节间隙消失。结论CT能清晰显示骶髂关节的微细结构及其病理改变,极有利于诊断AS患者早期骶髂关节病变。     

CT features of serous surface papillary carcinoma of the ovary

OBJECTIVE: The purpose of this study was to determine the CT appearance of serous surface papillary carcinoma of the ovary. MATERIALS AND METHODS: CT scans of 17 patients with histologically proven serous surface papillary carcinoma of the ovary were retrospectively reviewed. We evaluated the ovary size, omental or mesenteric involvement (none, mild, or severe), ascites (none, small, moderate, or large), and peritoneal thickening (none, smooth, or nodular).We also noted the presence of a cul-de-sac mass, lymphadenopathy, and calcification within the peritoneal mass. The preoperative serum level of cancer antigen (CA)-125 was assessed in all patients. RESULTS: The diameter of ovaries was 3 cm or smaller in 14 patients (82%). All patients had omental or mesenteric involvement by the tumor (mild, n = 2; severe, n = 15) and ascites (small, n = 1; moderate, n = 3; large, n = 13). Peritoneal thickening (smooth, n = 5; nodular, n = 10) was noted in 15 patients (88%) and a cul-de-sac mass in 10 (59%). Lymphadenopathy was noted in five patients (29%) and calcification within the peritoneal mass in one (6%). Serum CA-125 level was elevated in all patients (168-63,300 U/mL). CONCLUSION: Serous surface papillary carcinoma of the ovary should be suggested as a diagnosis in patients who have peritoneal carcinomatosis, relatively normal-sized ovaries, and a highly elevated serum CA-125 level.     

Primary hepatic angiosarcoma: findings at CT and MR imaging

PURPOSE: To evaluate and describe cross-sectional imaging findings in patients with pathologically confirmed primary hepatic angiosarcoma. MATERIALS AND METHODS: Findings from imaging examinations in 13 patients with pathologically confirmed primary hepatic angiosarcoma were retrospectively reviewed (computed tomographic [CT] images obtained in 10 patients and magnetic resonance [MR] images obtained in five patients were available for review). Two gastrointestinal radiologists evaluated lesion number, size, attenuation and signal intensity characteristics, and the pattern and degree of contrast material enhancement. Medical records were reviewed for clinical features associated with angiosarcoma. RESULTS: Angiosarcoma appeared as multiple nodules (n = 6), as dominant masses (n = 6), or as a diffusely infiltrating lesion (n = 1). Multiple nodules were hypoattenuating at unenhanced and contrast material--enhanced CT (six of six patients). When dominant masses were encountered at MR imaging, T2-weighted MR imaging demonstrated heterogeneous internal architecture (four of four patients) similar to that of hepatocellular carcinoma. Multiphase contrast-enhanced CT and MR images showed dominant masses to have heterogeneous and progressive enhancement (three of three patients). Clinical features associated with angiosarcoma included splenic metastases (six of 13 patients), thrombocytopenia (seven of 13 patients), disseminated intravascular coagulation (four of 13 patients), and hemolytic anemia (three of 13 patients). CONCLUSION: Primary hepatic angiosarcoma exhibits a spectrum of appearances that reflect its varied pathologic features.     

Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience

PURPOSE: To determine if radiographic, computed tomographic (CT), and magnetic resonance (MR) imaging findings can help differentiate spinal neuropathic arthropathy from disk space infection. MATERIALS AND METHODS: Imaging studies in 33 patients were evaluated, including 14 patients with spinal neuropathic arthropathy (12 radiographic, seven CT, and six MR studies) and 19 with disk space infection (13 radiographic, nine CT, and 12 MR studies). Potential imaging discriminators, including endplate sclerosis or erosions, osteophytes, spondylolisthesis, facet involvement (narrowing or erosions), vacuum disk, paraspinal soft-tissue mass, joint disorganization, and osseous joint debris, were recorded, as were MR imaging signal intensity and gadolinium-enhancement characteristics. RESULTS: The most helpful findings for diagnosis of spinal neuropathic arthropathy were vacuum disk on radiographs and CT images, debris on radiographs and CT and MR images, disorganization on radiographs and CT and MR images, facet involvement on radiographs and CT and MR images, spondylolisthesis on CT and MR images, diffuse signal intensity patterns in vertebral bodies on MR images, and rim enhancement of disks on gadolinium-enhanced MR images. Findings that were not helpful included endplate sclerosis and erosions, osteophytes, paraspinal soft-tissue mass, and decreased disk height. CONCLUSION: Vacuum disk, facet involvement, vertebral body spondylolisthesis, joint disorganization and debris, and gadolinium-enhancement patterns of vertebral bodies and disks may help differentiate spinal neuropathic arthropathy from infection.     

Blunt abdominal trauma: performance of CT without oral contrast material

PURPOSE: To retrospectively evaluate multi-detector row computed tomography (CT) without oral contrast material for depiction of bowel and mesenteric injuries that require surgical repair in patients with blunt abdominal trauma. MATERIALS AND METHODS: The investigational review board approved the study. Informed consent was waived. CT reports for October 2001 to September 2003 were reviewed and 1082 patients were identified who had undergone abdominopelvic CT with a multi-detector row scanner and without oral contrast material. Findings were divided into four categories: negative, solid organ injury with or without hemoperitoneum, free fluid only, and suspected bowel or mesenteric injury. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated by comparing CT findings with laparotomy reports and hospital course. RESULTS: CT findings were no intraabdominal injury (n = 932), solid organ injury only (n = 102), free fluid only (n = 34), and suspected bowel or mesenteric injury (n = 14). CT findings in patients suspected of having bowel or mesenteric injury were pneumoperitoneum with other secondary findings (n = 4), mesenteric hematoma and bowel wall abnormality (n = 2), mesenteric hematoma only (n = 4), and bowel wall thickening only (n = 4). In 11 patients, bowel or mesenteric injury was proved surgically. Thus, the study included 1066 true-negative, nine true-positive, two false-negative, and five false-positive results. Based on these data, sensitivity was 82% (95% confidence interval [CI]: 52%, 95%), specificity was 99% (95% CI: 98%, 99%), positive predictive value was 64% (95% CI: 39%, 83%), and negative predictive value was 99% (95% CI: 98%, 99%) for depiction of bowel and mesenteric injuries. CONCLUSION: Multi-detector row CT without oral contrast material is adequate for depiction of bowel and mesenteric injuries that require surgical repair. Results are comparable with previously reported data for single-detector row helical CT with oral contrast material.     

Medical-type peritoneal mesothelioma leading to death two months after onset of fever of unknown origin

In malignant mesotheliomas, cases involving the peritoneum as the primary site are rare, accounting for approximately 10% of all mesothelioma cases. We report a case of medical-type peritoneal mesothelioma leading to death 2 months after the onset of fever of unknown origin, along with a review of the literature. A 76-year-old man presented with a fever of unknown origin over 4 weeks. Thoracoabdominal computed tomography (CT) scan showed increased mesenteric adipose tissue density. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scan showed diffuse hyperaccumulation in the mesentery and hyperaccumulation in the intraperitoneal and parasternal lymph nodes. A thoracoscopic biopsy of the parasternal lymph nodes revealed metastatic peritoneal mesothelioma. The treatment plan was discussed with him and his family, and the best supportive care was provided. 2 months later, he died from multiple organ failure. Underlying malignant tumors cause 38% of mesenteric panniculitis cases. Symptoms accompanied by lymphadenopathy within the area of mesenteric panniculitis are highly suggestive of malignancy. Peritoneal mesothelioma can be classified as (1) classical, which is accompanied by abdominal pain, ascites, and abdominal masses; (2) surgical, which is accompanied by hernia incarceration and intestinal occlusion; and (3) medical, wherein systemic symptoms, such as fever and weight loss, are primarily observed. The medical-type peritoneal mesothelioma, wherein systemic symptoms are primarily observed, has a poorer prognosis than the other types. FDG-PET/CT is an effective diagnostic modality for peritoneal mesothelioma and typically shows diffuse hyperaccumulation along the peritoneal surface.     

Bowel and mesenteric injury following blunt abdominal trauma: evaluation with CT

Computed tomography (CT) used in cases of blunt abdominal trauma has been found sensitive in detection of bowel and mesenteric injuries and discrimination of operable from nonoperable candidates. In 51 patients with suspected bowel or mesenteric injury following blunt abdominal trauma, CT correctly depicted bowel hematoma or mesenteric injury in 17 of 19 nonoperable patients (89%) and severe injuries in one patient who died preoperatively. In 26 of 28 patients who underwent therapeutic laparotomy (93%), initial CT enabled identification of surgically confirmed injuries. In two cases, initial scan misinterpretation delayed diagnosis of serious bowel injuries. The correct interpretation was rendered preoperatively and at blind retrospective review. CT findings that correlated with bowel or mesenteric injury requiring surgery were free peritoneal fluid (27 of 28, 96%), mesenteric infiltration (24 of 28, 86%), thick-walled bowel (17 of 28, 61%), associated abdominal injuries (12 of 28, 43%), and free air (nine of 28, 32%). In nonoperable cases, CT scans demonstrated bowel thickening (84%) but less frequently peritoneal fluid (21%), mesenteric infiltration (26%), or associated injuries (5%). In three of four patients who underwent nontherapeutic laparotomy, preoperative CT correctly imaged the limited abdominal injuries.     

Biliary sequelae following radioembolization with Yttrium-90 microspheres

PURPOSE: Yttrium-90 (90Y) radioembolization has emerged as a promising and safe therapeutic modality for patients with hepatocellular carcinoma (HCC) or metastatic liver cancer. The present report describes biliary sequelae following intraarterial 90Y therapy in patients with HCC or liver metastases. MATERIALS AND METHODS: All patients were treated with 90Y therapy according to standard lobar treatment protocol. Pre- and posttreatment imaging, liver function tests, and serum total bilirubin measurements were performed. Three to 6 months after treatment, biliary sequelae were evaluated with computed tomography and magnetic resonance imaging, and any liver-related laboratory adverse events were noted. RESULTS: A total of 327 patients (HCC, n=190; liver metastases, n=137) received 569 infusions of 90Y. At follow-up imaging, 33 patients (10.1%; liver metastases, n=26; HCC, n=7) had 40 imaging findings related to the biliary tree, including biliary necrosis (n=17), biloma (n=3), cholecystitis (n=2), gallbladder wall enhancement (n=6), gallbladder wall rent (n=3), abscess (n=1), and stricture (n=8). A total of 31 patients exhibited grade 3/4 bilirubin toxicities (13 [6.8%] with HCC, 18 [13.1%] with liver metastases). Unplanned interventions prompted by biliary sequelae were necessary in six of 327 patients (1.8%). CONCLUSIONS: 90Y therapy in patients with HCC or metastatic disease to the liver is associated with an acceptable rate of biliary toxicities. Further studies assessing long-term biliary sequelae are warranted.     

Subchondral insufficiency fracture of the femoral head in a patient with alkaptonuria

We report a patient with alkaptonuria accompanied by bilateral rapidly destructive arthrosis of the hip. The destruction of the left hip joint with its severe functional impairment necessitated total hip arthroplasty (THA). The outcome was satisfactory. Both magnetic resonance imaging (MRI) and pathologic findings were compatible with a subchondral insufficiency fracture. A year and half later, during a follow-up visit, the patient complained of right coxalgia. Radiography showed that the right femoral head had already disappeared, requiring THA of the right hip. Although there have been a few reports of rapid destructive hip osteoarthritis associated with ochronotic arthropathy, the pathogenesis of the destructive change is not clear. Subchondral insufficiency fracture was diagnosed on MR imaging and pathologically confirmed in our patient with alkaptonuria, suggesting that subchondral insufficiency fracture is one of the causes of ochronotic hip destruction.     

Intra-abdominal desmoplastic small round cell tumors: CT findings and clinicopathological correlations in 13 cases

PURPOSE: We report computed tomography (CT) findings in 13 patients with a primary abdominal desmoplastic small round cell tumor. MATERIALS AND METHODS: 13 cases (12 men, 1 woman, mean age=24.8 years) were found in our hospital database between 1991 and 2003. Clinical, CT and histopathological features were studied retrospectively. RESULTS: Peritoneal involvement was the most common feature. In 10 cases, several lobulated peritoneal soft tissue masses (with a mean of four masses per patient) were seen. Two patients had diffused irregular peritoneal carcinomatosis without any distinct peritoneal masses. One patient had a solitary mass in the pelvic space. The main sites of peritoneal involvement were the pelvic space (n=7), omentum (n=5), retroperitoneal space (n=4), small bowel mesentery (n=3), paracolic gutter (n=2 on the right and n=1 on the left), transverse colon mesentery (n=1), peri-splenic space (n=1), peri-hepatic space (n=1). The soft tissue masses were often bulky (mean 6cm, range 1-28cm), lobulated and heterogeneous with hypodense areas (in 73% of cases). In six cases, moderate ascites was seen. In one case of pelvic involvement, unilateral hydronephrosis was seen. Adenopathies were present in seven cases at the time of the diagnosis (at intraperitoneal, retroperitoneal and pelvic sites in six patients and in the groin in one patient). Five patients had liver metastases (four lesions per case excepted one patient with 30 metastases). Associated thoracic metastases were seen in three patients. The diagnosis was confirmed with four CT-guided percutaneous biopsies. CONCLUSION: Although CT features are nonspecific, the diagnosis of desmoplastic small round cell tumor may be suspected in young men with multiple bulky heterogeneous peritoneal soft tissue masses. Imaging is useful for staging and also to guide biopsies.     

Acute disseminated encephalomyelitis and multiple sclerosis: magnetic resonance imaging differentiation

The study was undertaken to compare the MR imaging features of acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in a country with a high prevalence of ADEM. Magnetic resonance scans from 33 patients diagnosed clinically with MS (14 patients) or ADEM (19 patients) were reviewed concurrently by two radiologists blinded to the clinical diagnosis. The size, site, morphology and pattern of brain and spinal cord involvement were recorded and the MR imaging diagnosis was compared with the clinical diagnosis. The MR imaging findings matched with the clinical diagnosis in 11 of 14 patients with MS (sensitivity = 78.6%), and with the clinical diagnosis in 15 of 18 patients with ADEM (sensitivity = 78.9%). Three patients had non-specific findings and in a further three patients discordant imaging features were present. One patient with imaging features typical of Balo's concentric sclerosis was diagnosed clinically as suffering from ADEM. In a country with a high prevalence of ADEM, the majority of patients with ADEM and MS can be differentiated on MR imaging.