MR evaluation of chest wall involvement in malignant lymphoma

Chest CT and magnetic resonance (MR) examinations of 28 patients with newly diagnosed or recurrent lymphoma involving the mediastinum were retrospectively evaluated for evidence of chest wall involvement. Computed tomography demonstrated seven sites of chest wall involvement in four patients; whereas MR demonstrated 14 sites in seven patients, including all sites shown by CT. Eight chest wall lesions were located in the extranodal soft tissues (three sites were contiguous with anterior mediastinal lymphadenopathy; three sites were contiguous with pleural/parenchymal disease; and one each involved the breast and multiple vertebral bodies). Six sites involved lymph nodes in the interpectoral (n = 4), submammary (n = 1), and infraspinatus (n = 1) areas. Lesion conspicuity in the chest wall was better on T2- than T1-weighted sequences and was best on short inversion time inversion recovery. Detection of chest wall lymphoma may alter staging; when present in this group of patients, it influenced management in two of the seven patients.     

Computed tomography following endoscopic sclerotherapy of esophageal varices

Computed tomography of the chest following endoscopic injection sclerotherapy for esophageal varices was performed in 17 procedures in 13 patients. CT scans were obtained before and within 48 hours after the procedure. CT findings included: esophageal wall thickening; a low-attenuating lesion within the wall of the esophagus with varying appearances, either laminated, localized, or inhomogeneous; a mediastinal lesion; pleural effusion; and various types of pulmonary changes such as atelectasis, pleural-based lesions, dilatation of peripheral pulmonary vessels, and nodular lesions. However, on follow-up CT they had regressed or disappeared. The changes in the mediastinum and pleural space might be caused by direct extension of inflammation from the esophagus, but those in the lungs, especially dilatation of peripheral vessels, may be caused by the sclerosing agent passing to the pulmonary vessels.     

Computed tomography and ultrasound findings in Klippel-Trenaunay syndrome

Computed tomography (CT) and ultrasound were used to evaluate two patients with Klippel-Trenaunay (K-T) syndrome. Bowel and bladder hemangiomas were demonstrated in these cases. Computed tomography demonstrated multiple low attenuation areas in the liver and spleen in one case. Computed tomography is capable of noninvasively demonstrating bowel and bladder wall hemangiomas in K-T syndrome. Both CT and ultrasound may reveal silent lesions in the upper abdominal viscera, such as liver and spleen.     

CT observation of rib abnormalities: spectrum of findings

The CT studies in 63 patients in which rib abnormality was identified or excluded were retrospectively analyzed. The CT features were detailed and correlated with other available radiographic findings as well as clinical data. Contiguous spread of tumor to rib or metastasis to rib characteristically showed subtle or complete segmental lytic rib destruction. An accompanying extrapleural soft tissue mass was frequently seen with metastatic disease and myeloma. In nine patients CT showed rib destruction that had been obscured on chest radiography by heart, diaphragm, mass, or pleural effusion. Other imaging studies prompted consideration of neoplasm in seven patients in whom CT clearly showed benign post-traumatic or developmental lesions. Six patients had a clinically suspected chest wall mass excluded, leading to the diagnosis of Tietze syndrome. The ribs should be carefully inspected on all CT studies of the thorax and upper abdomen. Computed tomography is helpful when other imaging techniques, such as rib films or isotopic bone scans, have not resolved the question of clinically or radiographically suspected rib abnormality.     

Practical techniques for pediatric chest computed tomography

Chest computed tomography (CT) is an excellent modality for evaluation of the chest wall, mediastinum, and pulmonary parenchyma in infants and children. Computed tomography of infants and children requires meticulous technique as well as a knowledge of pediatric disease. The potential indications, practical techniques, unique problems, and radiation considerations for pediatric chest CT are discussed and illustrated.     

Solitary pulmonary metastases in high-risk melanoma patients: a prospective comparison of conventional and computed tomography

A prospective comparison of chest radiography, conventional tomography, and computed tomography (CT) in the detection or confirmation of solitary pulmonary nodules was made in 42 patients with high propensity for pulmonary metastases due to advanced local (Clark level IV or V) or regional malignant melanoma. Unequivocal nodules were revealed by chest radiography in 11 patients, conventional tomography in 16, and computed tomography in 20 patients. Both plain films and tomography in three of these 20 were normal, but follow-up verified pulmonary metastases. Computed tomography detected more pulmonary nodules than conventional tomography in 11 patients in addition to identifying lesions in extrapulmonary sites. Therefore, chest CT is recommended before institution of immunotherapy or surgical removal of a solitary pulmonary melanoma metastasis. Once chemotherapy had been instituted for bulky regional or cutaneous involvement, however, the findings of either conventional or computed tomography were comparable in this study.     

Computed tomography of breast lesions: comparison with x-ray mammography

Thirty-three patients with breast lesions demonstrated by mammography were examined with computed tomography (CT) using a standard whole body scanner. Although the CT images were of good diagnostic quality, the amount of new information gained was limited. The diagnostic accuracy of mammography in the hands of an experienced reader was higher than that with CT. We conclude that, although technically a whole body scanner is capable of producing good images of the breast, the number of patients in whom CT should be used instead of or in addition to mammography is limited. The indication for its use was primarily for patients in whom quality mammograms could not be produced because either the breast was unusually dense or extensive breast disease caused technical difficulties in performing mammograms. Computed tomography was also useful if the interpretation of the mammogram was equivocal, regional lymph node enlargement was questioned, invasion of the chest wall by tumor was suspected, and for planning radiotherapy treatment.     

The value of CT in rectal villous tumors

Computed tomography of 13 patients with villous rectal tumors was reviewed. Five tumors were benign, eight were malignant. All five benign lesions demonstrated homogeneous focal colonic wall thickening of less than 2 cm. Seven of the eight malignant lesions demonstrated focal colonic wall thickening greater than 2 cm. "Fronds," characterized by contrast within the interstices of the lesion, were seen in three malignant lesions. In the remaining five malignant lesions, three had a polypoid appearance, one had low attenuation regions, and one had focal rectal wall thickening. Computed tomography upstaged two carcinomas, downstaged two carcinomas, and accurately staged four carcinomas. Our experience shows (a) CT can demonstrate the classic fronds of villous tumors; (b) benign villous tumors tend to be less than 2 cm and are nonspecific in appearance; (c) biopsy is necessary to differentiate small malignant lesions from benign lesions; and (d) CT is inaccurate in staging local invasion of malignant villous tumors.     

Computed tomography of the pulmonary parenchyma and chest wall

Computed tomography has evolved into a unique diagnostic modality that is slowly gaining acceptance for use in the chest. The overall impact of this relatively new technique will be tempered by the inexpensive and universally available conventional diagnostic studies. More refined and sophisticated CT devices will certainly become available in the future. The use of ultrashort scan time will further improve the images obtained in the chest by minimizing the effects of cardiovascular and respiratory motion. The ultimate acceptance of CT will no doubt be hastened by the search for otherwise undetectable pulmonary nodules and an appreciation of its usefulness in the evaluation of lesions of the chest wall.     

Role of CT in the study of recurrences of Hodgkin's disease on the chest wall. Report on 12 cases

Twelve cases of recurrences of Hodgkin's disease on the chest wall, associated with three breast lesions and three diaphragmatic lesions, were studied by computed tomography (CT). Although the chest radiographs of all the patients were abnormal, CT was more accurate than clinical and other radiological examinations in delineating the lesions of the chest wall and in studying the extension of the relapse. Muscle enlargement was present in all cases. In seven cases osseous lesions and in seven cases pleural effusion or subpleural plaques were found. Chest wall recurrences were associated with other thoracic or abdominal lesions in 75% of the cases. Recurrences to the chest wall occur late (mean 6.3 years) in the evolution of Hodgkin's disease. They developed during the first relapse in 67% of the cases and during the second to the fourth relapse in 33% of the cases. CT is useful for the screening of lesions for which the outcome is bad. Only in four cases patients were without any evidence of disease after treatment.     

CT demonstration of pulmonary effects of tangential beam radiation

Breast cancer is sometimes treated with an excisional biopsy and a radiation portal limited to the breast and the adjacent chest wall, especially in patients with negative lymph node dissections. The beam passes through this portion of the chest wall tangentially. Such radiation can result in changes in the included lung parenchyma that are pleural-based and sharply demarcated from the normal lung on CT lung windows. In our experience CT lung windows were more sensitive than chest radiography in showing these changes. Such changes must be recognized and differentiated from pleural metastases. Computed tomography also resulted in a more specific diagnosis than chest radiography because it better localized the abnormality to the radiation portal.     

Computed tomography of the thorax and standard radiographic evaluation of the chest: a comparative study.

Comparison of standard radiographic evaluation of the chest with computed tomography (CT) was carried out in 109 patients who were examined on a prototype EMI CT5000 scanner. Forty-eight patients had lung problems, and 61 were evaluated because of a mediastinal mass or widening, or for the detection of an occult thymoma in myasthenia gravis. Computed tomography was of value in the staging of bronchogenic carcinoma, particularly in the detection of direct mediastinal and pleural extension, and in evaluating patients with solitary or multiple nodules by detecting additional lesions and calcification. Thymomas not detected on conventional imaging modalities were visualized in 4 of 33 patients with myasthenia gravis or red cell aplasia. One of these was a false positive. In 28 patients with a mediastinal mass or widening on the chest roentgenogram, incremental information was noted on CT in 22. These included a definitive diagnosis of lesions composed of fat, evaluation of the isolated esophagus after colon by bypass surgery,and identification of the cause of paraspinal widening.     

Malignant pleural disease

The vast majority of pleural neoplasms invade the pleura secondarily and can be seen in patients with bronchogenic carcinoma, breast cancer, lymphoma, and ovarian or gastric carcinoma. Primary pleural neoplasms are less common, although they have developed notoriety since the up-surge of malignant mesothelioma and the knowledge of its connection to asbestos exposure. Other malignant primary tumors include localized fibrous tumor and pleural liposarcoma. In most patients with diffuse malignant pleural disease the chest radiograph shows pleural effusion with or without pleural thickening. Computed tomography (CT) usually provides precise localization and extent of the disease and may be of value in assessing chest wall and mediastinal involvement. In specific situations, magnetic resonance (MR) may be useful as a problem-solving tool when CT findings of chest wall or diaphragmatic invasion are equivocal or in patients with contraindication to intravenous administration of ionic contrast material.     

PET-CT in the diagnosis of localized malignant pleural mesothelioma

A 67-year-old man presented with right-sided chest and shoulder pain. Chest roentgenogram demonstrated a right upper zone shadow. Computed tomography (CT) revealed a pleural mass and adjacent chest wall disease. Image-guided percutaneous biopsy suggested malignant mesothelioma. We describe the use of 18-fluorodeoxyglucose-positron emission tomography (PET-CT) in the diagnosis and management of localized malignant mesothelioma.     

Chest CT in infants and children

Computed tomography (CT) is a powerful and irreplaceable imaging technique in the evaluation of thoracic disease in infants and children. Recent advances in CT technology, with multi-detector equipment now widely available in most institutions, allowing a highly detailed evaluation of the chest in a short time period has resulted in expanding indications of chest CT in paediatric patients. Its improved diagnostic yield along with a widespread availability has also resulted in an increased number of CT examinations in children, not always with beneficial impact on patient management and outcome. Accordingly with the ALARA concept, a judicious and correct use of CT is strongly advisable in order to reduce unnecessary high dose radiation exposure. The objective of this paper is to review the use of chest CT in paediatric patients focused mainly on basic technical aspects and clinical applications in the evaluation of the lungs, mediastinum and chest wall.     

The value of thoracic computed tomography in the detection of recurrent Hodgkin's disease

Fifty chest radiographs and concurrent thoracic computed tomography (CT) scans obtained in a total of 44 patients with 50 separate episodes of suspected recurrent Hodgkin's disease were reviewed. Recurrent disease was present in 18 episodes, involving the mediastinum in 12, the lung parenchyma in five and both mediastinum and lung parenchyma in one. In four episodes, mediastinal recurrence was demonstrated on both the chest radiograph and CT scan. In a further two cases, the chest radiograph appeared normal but CT detected recurrence in the mediastinum. In 20 cases, the mediastinal appearances on chest radiography were suspicious but not diagnostic of recurrence, usually because of previous radiotherapy resulting in residual mediastinal widening. Computed tomography diagnosed recurrent disease which was subsequently proven in seven of these cases. Recurrent disease was suggested by CT in a further case, subsequently shown to be radiation fibrosis. Of the 12 remaining chest radiographs in which the mediastinal assessment was indeterminate, CT was true negative for recurrent disease in 10 cases and was also indeterminate in two. Recurrent disease in the lung parenchyma was demonstrated on the chest radiograph and CT scan on five occasions. There was one incident in which the chest radiograph was normal but CT detected recurrent parenchymal disease. The appearances of the lung parenchyma were indeterminate for recurrent disease on three chest radiographs but CT was helpful in only one case in which radiation change alone was diagnosed. In eight cases the diagnosis of recurrent disease by CT resulted in a decision to initiate treatment. Computed tomography is of value in detecting relapse in patients with suspected recurrent Hodgkin's disease when the chest radiograph is inconclusive, and may enable differentiation of radiation change from recurrent disease in the mediastinum.     

Radiographic,CT and MRI spectrum of hydatid disease of the chest: a pictorial essay

Thirty patients with thoracic hydatidosis (Echinococcus granulosus) were studied. The hydatid cysts were located in the lung parenchyma (70%), mediastinum (6.7%), inside the heart (10%), the pleurae (10%) and the chest wall (3.3%). complications of thoracic hydatid cysts, such as rupture, infection, pleural involvement, spread and calcifications are presented. Computed tomography (CT) without and/or with contrast enhancement was performed in all patients (30). Findings from conventional chest radiographs were compared with CT and confirmed by pathology (30). In 10 cases (33.3%), magnetic resonance imaging was also performed. The diagnostic spectrum of hydatid cysts, including variations and developmental stages, is presented in this pictorial essay.     

Computed tomography of hepatic fascioliasis

In seven patients with active fascioliasis of the liver, CT revealed nodular intrahepatic lesions of diminished attenuation, as well as peripheral branching formations. Computed tomography was negative in a single patient with quiescent disease. Computed tomography can be a useful tool for the diagnosis of this disease during the invasive period and also to evaluate response of patients to medical treatment.     

肾上腺囊性病变的影像学诊断和鉴别

目的 分析肾上腺囊性病变的影像学表现,以提高其诊断准确性. 资料与方法 经手术病理证实的肾上腺囊性病变16例,术前14例经螺旋CT和多排螺旋CT平扫增强扫描.2例经MR检查.然后与手术病理对照,回顾性分析CT和MR表现. 结果 16例病理证实的肾上腺囊性病变中,肾上腺上皮性囊肿8例,陈旧出血形成假囊肿3例,嗜铬细胞瘤囊变3例,原发性肾上腺癌囊变2例.肾上腺上皮性囊肿和肿瘤坏死囊变CT多表现为低密度,出血为等密度或高密度; T1WI为低信号或高信号,T2WI为显著高信号或低信号.囊内壁光整11例,毛糙5例.囊外壁光整13例,不规则3例.囊壁钙化2例.增强扫描显示壁强化11例,不强化5例. 结论 肾上腺囊性病变特征不同,有助于明确诊断.     

Computed tomography of pleural lesions with special reference to the mediastinal pleura

Computed tomography (CT) and conventional chest radiography were reviewed in retrospect in 84 patients in whom pleural pathology was suggested clinically. The importance of administration of contrast medium in distinguishing between malignant lesions and other pleural diseases was given special attention. CT was found to be of value in diagnosing and establishing the extent of pleural lesions, especially in the mediastinal region. All malignancies exhibited high contrast enhancement following intravenous bolus injection of contrast medium. There were no features specific for mesotheliomas distinguishing these from other pleural malignancies. Some benign infectious lesions also showed high contrast enhancement. High contrast enhancement thus indicated malignancy only if an infectious lesion could be excluded. If contrast enhancement was absent or slight, the lesion was likely to be benign. Clinical follow-up may be regarded as justified in such cases. Indirect signs were not helpful in distinguishing between malignant and benign lesions.