Extrahepatic recurrence and second malignancies after treatment of hepatocellular carcinoma: spectrum of imaging findings

PURPOSE: To describe diagnostic imaging features (with a focus on CT findings) of extrahepatic relapses of treated hepatocellular carcinoma and to propose a post-treatment follow-up protocol. MATERIAL AND METHODS: During a six-year span, 226 patients (aged 32-88 years) with chronic hepatitis/cirrhosis were diagnosed as having hepatocellular carcinoma confined to the liver and treated percutaneously with radiofrequency (RF) ablation. A total of 313 treatment sessions were performed. Post-therapeutic follow-up is based upon clinical evaluation, laboratory and imaging (with CT holding the key role) studies. RESULTS: Mean duration of follow-up was 17 months. After successful treatment, actuarial probability of neoplastic relapse is 30.7% after 1 year and 58.5% after 2 years. Eighty-eight patients had recurrence of hepatocellular carcinoma after a variable time interval (mean 7.3 months). Extrahepatic neoplastic relapse was observed in 14 patients, half of these without active hepatic disease. Distribution of extrahepatic sites of recurrence was as follows: abdominal lymph nodes (6 cases), bone (3), peritoneum (2), adrenal (2), lung (1). Five patients (2.2%) had a second primary neoplasm. CONCLUSIONS: Extrahepatic hepatocellular carcinoma is uncommon and occurs in advanced stages, but may represent a pattern of post-treatment relapse. The distinctive hypervascularity of this tumour histology may be observed in adenopathies and adrenal metastases. Second primary neoplasms should be considered in the differential diagnosis of lesions observed during follow-up.     

Budd-Chiari syndrome: spectrum of imaging findings

OBJECTIVE: The objective of our study was to illustrate the imaging findings of Budd-Chiari syndrome, including CT, MRI, sonographic, and angiographic findings. CONCLUSION: The key imaging findings in Budd-Chiari syndrome are occlusion of the hepatic veins, inferior vena cava, or both; caudate lobe enlargement; inhomogeneous liver enhancement; and the presence of intrahepatic collateral vessels and hypervascular nodules. Awareness of these findings is important for early diagnosis and appropriate treatment.     

Extraskeletal osteosarcoma: spectrum of imaging findings

OBJECTIVE: The purpose of this article is to present the spectrum of imaging findings of primary and metastatic extraskeletal osteosarcoma and highlight the differences from primary osteogenic osteosarcoma in bone. CONCLUSION: Extraskeletal osteosarcoma is a rare mesenchymal malignancy of soft tissue, histologically indistinguishable from primary osteosarcoma of bone. However, there are distinct differences in demographics, imaging features, prognosis, and management compared with osteogenic osteosarcoma. Imaging characteristics reflect tumor morphology, with only 50% of primary tumors showing mineralization. Metastases may or may not show mineralization, even if present in the primary tumor. The overall prognosis is poor.     

Peliosis hepatis: spectrum of imaging findings

OBJECTIVE: It is important to recognize the imaging characteristics of peliosis hepatis because peliotic lesions may mimic several different types of focal hepatic lesions CONCLUSION: We illustrate the spectrum of imaging findings of peliosis hepatis, including sonography, CT, MR, and angiography.     

Amebic meningoencephalitis: spectrum of imaging findings

Primary amebic meningoencephalitis and granulomatous amebic meningoencephalitis are central nervous system infections caused by free-living amebae. We describe the neuroimaging findings in 5 such cases on CT and MR imaging. A spectrum of findings was seen in the form of multifocal parenchymal lesions, pseudotumoral lesions, meningeal exudates, hemorrhagic infarcts, and necrosis in the brain. Familiarity with the imaging findings is important for the diagnosis and management of this nearly universally fatal disease.     

Abdominal complications of chemotherapy in pediatric malignancies: imaging findings

ObjectiveTo describe the imaging findings of abdominal complications caused by chemotherapy in pediatric cancer patients.Subjects and MethodsRadiology studies of 243 patients treated in our Children Cancer Center were reviewed, 164 of whom had abdominal studies. Medical records of 54 patients with abnormal imaging findings were studied.ResultsUltrasound and/or CT findings showed the following complications: (1) gallbladder sludge/crystals (n=13), gallstones (n=8), cholecystitis (n=3); (2) liver steatosis (n=23), siderosis (n=1), veno-occlusive disease (n=2); (3) pancreatitis (n=7); (4) typhlitis (n=12), esophagitis (n=2).ConclusionAwareness of these complications is essential for appropriate management, decreasing their mortality and morbidity.     

Pseudomembranous colitis revisited: spectrum of imaging findings

In recent years there has been a marked increase in the incidence of pseudomembranous colitis (PMC). PMC is more common in patients over 65 years of age and can cause significant morbidity. The purpose of this article is to review the imaging features of PMC on plain radiography, sonography, computed tomography (CT), scintigraphy and magnetic resonance imaging (MRI). It is important to recognize the imaging findings of PMC using different imaging methods and encourage urgent confirmation of the diagnosis serologically, as the differential includes other fulminant colitides for which colectomy may be the required. Awareness of the spectrum of imaging findings of PMC can help radiologists make the primary or incidental diagnosis of PMC.     

Recurrent ovarian cancer: spectrum of imaging findings

OBJECTIVE: The purpose of this article is to show the appearance of atypical sites of metastasis in patients with recurrent ovarian cancer. CONCLUSION: Metastatic disease from ovarian cancer outside of the peritoneal cavity is generally rare at presentation but is increasingly seen in patients who have recurrent disease, despite multiple therapies. It is important for radiologists to recognize atypical sites of metastasis in patients with recurrent ovarian cancer to facilitate earlier diagnosis and treatment.     

Synovial osteochondromatosis: the spectrum of imaging findings

Imaging plays a vital role in the diagnosis and management of synovial osteochondromatosis, a proliferative disorder of the synovium with associated loose body formation. The aim of this pictorial review is to illustrate the radiographic, computed tomographic and magnetic resonance appearances of various stages of the disease.     

Nonketotic hyperglycinemia: spectrum of imaging findings with emphasis on diffusion-weighted imaging

Purpose

The purpose of this study was to explore brain abnormalities in nonketotic hyperglycinemia (NKH) using diffusion-weighted imaging (DWI) and when feasible, diffusion tensor imaging (DTI) and tractography.

Methods

Seven patients with confirmed diagnosis of NKH (8 days–2 years) underwent brain MRI. Conventional T1 and T2WI were acquired in all patients, DWI in six and DTI and tractography in two (4 months and 2 years). Measurements of fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and Trace from eight white matter regions were compared between the two patients and age-matched controls. Tractography of corpus callosum, superior longitudinal fasciculus and corticospinal tracts was performed with extraction of their FA and diffusivity indices.

Results

MRI showed nonspecific brain atrophy in three children. Corpus callosum atrophy was found as a part of these atrophic changes. Cerebellar vermian hypoplasia and supratentorial hydrocephalus were seen in one patient. The topographic distribution of diffusion restriction was different among patients. The affected white matter regions were not predominantly following the expected areas of myelination according to patients’ age. Deep grey matter nuclei were affected in one patient. DTI revealed lower FA with higher RD in most of the measured white matter regions and tracts. These changes were more appreciated in the 2-year-old patient. However, Trace was higher in the 2-year-old patient and lower in the 4-month-old one. The extracted tracts were decreased in volume.

Conclusion

DWI, DTI and tractography with FA and diffusivity measurements can give insights into white matter microstructural alterations that can occur in NKH.

     

Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings

OBJECTIVE: The purpose of this article is to illustrate the spectrum of appearances of extranodal lymphoma in the abdomen using cross-sectional imaging techniques. CONCLUSION: Extranodal lymphoma in the abdomen can mimic other neoplastic or inflammatory conditions. Although a definitive diagnosis is possible only with biopsy, it is important to consider extranodal lymphoma in the presence of certain imaging appearances in the appropriate clinical setting for the correct diagnosis, accurate staging, and optimal management.     

Extrahepatic spread of hepatocellular carcinoma: spectrum of imaging findings

OBJECTIVE: The purpose of this article is to describe the imaging findings of extrahepatic spread of hepatocellular carcinoma (HCC). CONCLUSION: Detecting extrahepatic metastases in HCC is critical in determining the optimal treatment plan for patients. Identifying the presence of extrahepatic metastases in patients with advanced disease may eliminate unnecessary surgery, such as liver transplantation or partial hepatic resection, and help direct the appropriate therapy.     

Traumatic neuropathies: spectrum of imaging findings and postoperative assessment

Traumatic injury to peripheral nerves is a significant cause of morbidity and disability. Until reinnervation occurs, electrodiagnostic studies cannot differentiate severe axonotmetic lesions (Sunderland class 4) from complete nerve transection or neurotmesis (Sunderland class 5). This limitation is relevant clinically because in cases of neurotmesis an improved outcome may be achieved with an early surgical repair (within 1 week after trauma). High-resolution ultrasound (US) is an efficient modality to visualize injured nerves and is becoming increasingly important among radiologists and surgeons. Magnetic resonance (MR) imaging is complementary to high-resolution US, especially in evaluating deep-seated and proximal nerve segments. This article describes the imaging features of traumatic peripheral nerve lesions. The role of diagnostic imaging in stretching injuries, contusion trauma, penetrating wounds, and after surgery is discussed. A multimodality diagnostic approach including physical examination, electrophysiology, and US and MR imaging allows an accurate evaluation of most peripheral nerves. Imaging assessment of peripheral nerves trauma is useful for the diagnosis, follow-up, and postoperative evaluation.     

Left-lobe hepatic transplants: spectrum of normal imaging findings.

The limited availability of suitable size-matched donor whole organs has been a major cause of morbidity and mortality in infants and children requiring liver transplantation. Techniques for transplanting segments of the liver have successfully addressed this problem. The surgical anatomy of the left hepatic lobe transplant is unique in three primary respects: the cut edge, the presence of an enteric Roux loop for biliary drainage, and the alteration in the position and number of hepatic vessels. The spectrum of normal imaging findings in 17 left-lobe allografts is illustrated.     

恶性血液病骨髓动态增强磁共振成像特征的初步研究

目的探讨利用动态增强MR成像技术检测恶性血液病患者骨髓构成的变化，判定其骨髓浸润程度，以减少血液病患者治疗随访过程中穿刺活检的次数。方法25例恶性血液病患者经动态增强MPJ（DCE-MR）及髂嵴穿刺活检，测定骨髓灌注的最大强化率（PER），最大强化斜率值（Slopemax），峰值时间（TTP），平均时间（MT），以及骨髓活检分析细胞构成、肿瘤分数（TF）。结果25例恶性血液病患者骨髓的PER、Slopemax、TTP、MT的中位值分别为0．27、0．21s^-1。、79．08s、84．43s。不同细胞构成（低、正常、高）骨髓的灌注特征性变量的中位数值分别为PER（0．29、0．24、1．15）、Slopemax（0．20s^-1、0．21s^-1、1．28s^-1）、TTP（96．67s、83．49s、25．52s）、MT（77．52s，86．25s，84．34s）。肿瘤浸润组首次灌注值（PER0．32，Slopemax0．28s。）高于肿瘤缓解组，（PER0．20，Slopemax0．20s^-1），而对比剂到达峰值时间（TTP68．66s）低于缓解组（TTP85．85s）。肿瘤浸润组与缓解组骨髓的PER差异有统计学意义（P=0．02），而Slopewmax、TTP、MT差异无统计学意义（P值均＞0．05）。PER（r=0．564，P=0．003）、Slopemax（r=0．478，P=0．016）、MT（r=0．186，P＞0．05）与骨髓细胞构成状态（低、正常、高）呈正相关，而TTP（r=-0．222）与骨髓细胞构成状态呈负相关。PER（r=0．561，P=0．004）、Slopemax（r=0．318，P=0．121）、MT（r=0．207，P＞0．05）与TF呈正相关，而TTP（r=-0．305，P＞O．05）与TF呈负相关。结论动态增强MR成像能够监测恶性血液病骨髓肿瘤细胞浸润和细胞构成的变化。     

Dedifferentiated liposarcoma of retroperitoneum: spectrum of imaging findings in 15 patients

BackgroundDedifferentiated liposarcoma is a high-grade nonlipogenic sarcoma that arises in the background of a preexisting well-differentiated liposarcoma. The purpose of this work is to evaluate the spectrum of radiologic appearance of retroperitoneal dedifferentiated liposarcoma with clinicopathologic features.MethodsRadiologic images and clinical histories of 15 patients with histologically verified retroperitoneal dedifferentiated liposarcoma were retrospectively studied. Patients included 11 men and 4 women, with mean age of 55.8 years (range, 36–74 years), and they underwent computed tomography (CT) (n=15) and magnetic resonance imaging (MRI) (n=5).ResultsThe mean size of the tumor was 22.6 cm with a range of 9.5–38 cm. Both CT and MRI showed well-circumscribed, large round, or lobulated retroperitoneal mass. The appearance of the tumor was classified as follows: Category I, nonfatty component within predominant fatty mass (n=5); Category II, focal fatty component within large nonfatty mass (n=6); Category III, well-defined fatty mass and well-defined nonfatty mass (n=1); Category IV, two masses with predominantly nonfatty component (n=3).ConclusionRetroperitoneal dedifferentiated liposarcomas present various spectra of imaging findings. While Categories I and III may suggest dedifferentiated liposarcoma, Categories II and IV may appear as other types of liposarcoma or other malignant retroperitoneal tumor.     

Lipomatous tumors of the pelvis in women: spectrum of imaging findings

Pelvic tumors that contain fat are common findings in women. Although the majority of these lipomatous tumors are benign cystic ovarian teratomas, other diseases should be considered in the differential diagnosis: malignant degeneration of a benign cystic ovarian teratoma, nonteratomatous lipomatous ovarian tumors, lipomatous uterine tumors, benign pelvic lipomas, and pelvic liposarcomas. Although these diseases are rare, their differentiation can be clinically significant. While most of these tumors are treated by surgical excision, asymptomatic lipomatous uterine tumors and benign pelvic lipomas may require no therapy. Additionally, correct identification of a malignant lipomatous tumor will affect both prognosis and surgical planning. The purpose of this essay is to illustrate the imaging findings of these conditions.     

Cerebrotendinous xanthomatosis: the spectrum of imaging findings and the correlation with neuropathologic findings

PURPOSE: To describe imaging findings and their neuropathologic correlate in patients with cerebrotendinous xanthomatosis (CTX). MATERIALS AND METHODS: Computed tomographic (CT) and magnetic resonance (MR) images in 24 patients with symptoms (mean age at time of imaging, 37 years; mean disease duration, 18 years) were reviewed for site and frequency of brain, spinal cord, and Achilles tendon involvement. Two patients died, and imaging findings were compared with postmortem neuropathologic findings. RESULTS: Apart from nonspecific supratentorial atrophy and deep white matter changes, more typical hyperintense lesions were seen on T2-weighted images in the dentate nucleus (in 79% of patients), globus pallidus, substantia nigra, and inferior olive and extended into adjacent white matter as disease progressed. In these locations, lipid crystal clefts and perivascular macrophages, neuronal loss, demyelination, fibrosis, and reactive astrocytosis were found at microscopic examination. Hypointensity was sometimes found on T2-weighted images in the dentate nucleus and was related to deposition of hemosiderin and calcifications. CT depicted fewer lesions; all had low attenuation, except for the calcifications. Spinal cord MR imaging revealed increased signal intensity in the lateral and dorsal columns on T2-weighted images. Achilles tendon xanthomas displayed intermediate signal intensity on T1- and T2-weighted images. CONCLUSION: The typical pattern of MR imaging findings reflects the classic histopathologic findings and should prompt the diagnosis of CTX.