Hydatid disease of the spleen: imaging findings in nine patients

Splenic involvement is uncommon in patients with hydatid disease. The radiologic and clinical findings in nine patients with splenic hydatidosis are described. The three men and six women were 41-76 years old (mean, 58 years). Their histories and physical findings, the results of serologic tests for hydatidosis, and imaging procedures were evaluated. Plain abdominal radiographs were obtained in all nine patients, sonograms in six, and CT scans in seven. Plain films showed calcification of the cyst wall in four of the nine patients. On sonograms, five lesions were anechoic and one was echogenic. On CT scans, all lesions except one were of lower attenuation than the surrounding spleen. None of the lesions enhanced after administration of IV contrast material. Although rare, splenic hydatidosis should be included in the differential diagnosis when a cystic splenic lesion is identified with sonography or CT.     

Cervical spondylolysis: imaging findings in 12 patients

Cervical spondylolysis is defined as a corticated cleft between the superior and inferior articular facets of the articular pilar, the cervical equivalent of the pars interarticularis in the lumbar spine. Associated dysplastic changes and spina bifida suggest that the lesion is congenital. It is a rare condition; only 70 cases have been previously reported in the world literature. Recognition of this disorder and differentiation from traumatic articular pilar fracture or dislocation is of paramount importance in patients who have had cervical spine trauma. The present study details radiologic features in 12 patients 20-80 years old with cervical spondylolysis. Plain film radiologic findings were correlated with hypocycloidal high-resolution tomography (nine patients), CT (six patients), and MR imaging (one patient). Seven patients had spondylolysis at C6 (three bilateral) and five had the abnormality at C4 (all unilateral). Nine of 12 patients were initially misdiagnosed. Characteristic radiologic features include (1) a well-marginated cleft between the facets, (2) a triangular configuration of the pilar fragments on either side of the spondylolytic defect, (3) posterior displacement of the dorsal triangular pillar fragment, (4) hypoplasia of the ipsilateral pedicle, (5) spina bifida at the involved level, and (6) compensatory hyper- or hypoplasia of the ipsilateral articular pillars at the level above and/or below the defect. A multistudy approach was often necessary to demonstrate these findings. Heightened awareness of the radiologic features of cervical spondylolysis should allow one to differentiate it from articular pillar fracture or dislocation.     

Ossification of the Achilles tendon: imaging abnormalities in 12 patients

Ossification of the Achilles tendon is a rare clinical entity that is characterized by the presence of an ossific mass contained within the fibrocartilaginous substance of the tendon. Because the radiographic features of this condition have not been documented entirely and the magnetic resonance (MR) imaging findings have not been determined, a review of 16 affected tendons in 12 patients was performed in an attempt to characterize the imaging abnormalities associated with this process. MR imaging was performed in three Achilles tendons which demonstrated thickening of the tendons at the level of the ossifications and a lack of intratendinous signal abnormalities compatible with acute tendinitis. Signal intensity similar to that of bone marrow was present in the ossifications.     

Hemolymphangiomatosis of the spleen: imaging features

Hemolymphangiomatosis is an extremely rare entity that has never been described in the diffuse form. Its main pathologic feature is proliferation of lymphatic and vascular cells inducing interstitial and hematic lakes and then splenomegaly. We report a complete imaging study, including magnetic resonance (MR) imaging, after administration of a superparamagnetic contrast agent. Ultrasonography (US), basal MR imaging, and late computed tomography (CT) contrastographic features are quite similar to those of other diffuse benign vascular neoplasms, without real hemangioma-like enhancement during the vascular phase. Its late contrastographic pattern could be considered specific if CT and iron oxide-enhanced MR imaging are applied as complementary diagnostic tools, however.     

Siderotic nodules in the spleen: MR imaging of portal hypertension

The authors retrospectively evaluated magnetic resonance (MR) images obtained at 1.5 T in 233 patients with portal hypertension and 91 subjects without it and pathologic findings in four resected spleens (one normal). Multiple, tiny (3-8 mm in diameter), low-intensity spots in the spleen were observed in 21 of 233 patients. Among the imaging studies performed in these 21 patients, the spots were seen on five of 14 T1-weighted images, 11 of 20 proton density images, and 12 of 20 T2-weighted images obtained with spin-echo techniques and on 14 of 14 fast-scan images obtained with gradient-echo rephasing. MR images in the 91 subjects did not show such lesions. MR images of the three spleens resected from patients with portal hypertension showed the low-intensity spots, which corresponded to siderotic nodules found at pathologic analysis. Despite limited pathologic confirmation, siderotic nodules (so-called Gamna-Gandy nodules) are considered the most likely cause of multiple low-intensity spots in the spleen.     

Intra-articular gouty tophi of the knee: CT and MR imaging in 12 patients

Objective. To define the imaging characteristics of intra-articular tophi of the knee. Design and patients. Twelve patients with intra-articular tophi in the knee were studied with routine MR imaging, gadolinium (Gd)-enhanced MR imaging, and CT over a 4-year period. There were 11 men and one woman, 25–82 years of age (mean age 48 years). Four patients did not have a documented history of gout at the time of the MR examination. The diagnosis of intra-articular tophi was provided by arthroscopy and histological examination (5 patients), by microscopic study of joint fluid (5 patients), or by characteristic clinical, laboratory and imaging findings (2 patients). Results. In 15 MR examinations the tophi were located purely intra-articularly in 10 knees. In the remaining five MR studies, periarticular soft tissues or bone, or both, were involved. All the intra-articular tophi manifested low to intermediate signal intensity on both T1- and T2-weighted images. All five Gd-enhanced MR examinations demonstrated a heterogeneous peripheral enhancement. All 10 CT scans showed varying degrees of stippled calcifications within the tophi. The nature of the calcifications was confirmed on histological examination in three patients. Conclusion. Presenting clinical manifestations of gout may relate to intra-articular tophaceous deposits. Such deposits present as masses on MR images with low to intermediate signal intensity on both T1- and T2-weighted images and a characteristic enhancement pattern following intravenous Gd administration. These features relate primarily to internal calcifications, which are most evident on CT images. MR evaluation (including Gd administration) supplemented, in some cases, with CT scanning allows accurate diagnosis of intra-articular tophaceous deposits. Received: 24 August 1998; Revision requested: 1 October 1998; Revision received: 19 October 1998; Accepted: 23 October 1998     

Angiosarcoma associated with chronic lymphedema (Stewart-Treves syndrome) of the leg: MR imaging

Magnetic resonance (MR) imaging findings of two patients with Stewart-Treves syndrome are presented. MR imaging showed edematous changes in the subcutaneous fat and skin masses that proved to be angiosarcomas. MR signal intensity of the tumor was low compared with fat on T1-weighted images and intermediate and heterogeneous on T2-weighted images. In one patient, administration of intravenous Gd-DTPA showed marked enhancement in the early phase, which persisted until the delayed phase. These finding on dynamic MR imaging may reflect the abundant vascular spaces seen in these tumors. Received: 20 August 1999 Revision requested: 28 October 2000 Revision received: 31 January 2000 Accepted: 8 February 2000     

Gamna-Gandy bodies of the spleen: evaluation with MR imaging

The authors retrospectively evaluated magnetic resonance (MR) images obtained in 64 patients with portal hypertension. Multiple low-intensity nodules were noted within the spleen in eight patients. In all eight cases, these nodules were most apparent on images obtained with the GRASS (gradient-recalled acquisition in the steady state) technique, which is known to be more sensitive to heterogeneity of the magnetic susceptibility, usually caused by hemosiderin deposition. In one of these cases, ultrasonography demonstrated diffuse hyperechoic spots that had been reported to represent Gamna-Gandy bodies of the spleen (ie, organized hemorrhage caused by portal hypertension). Although there was no pathologic proof in their series, the authors believe these low-intensity nodules seen on MR images may represent the hemosiderin deposits of Gamna-Gandy bodies.     

Dual radionuclide subtraction imaging of the spleen

Dual radionuclide subtraction imaging of the spleen using 67Ga citrate and 99mTc is useful in further delineating lesions that are identified on either a routine radiogallium survey or on a conventional sulfur colloid liver-spleen image. Better anatomic localization of left subphrenic abscesses may be obtained. Differentiation of tumors and abscesses from less serious lesions such as cysts, infarcts, and hematomas is possible. We have found this technique to be generally applicable to any organ that can be selectively imaged using a technetium radiopharmaceutical, including the liver, bones, and kidneys. In addition, we are currently evaluating thallium-pertechnetate subtraction imaging in the evaluation of parathyroid adenomata.     

Anterior dynamic imaging of the liver and spleen

Anterior dynamic imaging of the abdomen was performed in 870 patients using a large field-of-view (LFOV) gamma camera. Sequential images were obtained immediately after the injection of Tc-99m sulfur colloid (Tc-99m SC) in an antecubital vein for liver-spleen imaging and was followed by standard planar images. This provided additional information in 172 cases (20%), including such findings as determination of the lesion's vascularity in 76 (9%), visualization of abnormal portal blood flow in 53 (6%), and detection of abnormalities in the aorta, inferior vena cava, iliac vessels, or kidneys in 43 (5%) of these patients. This procedure is recommended in all patients undergoing liver-spleen imaging.     

核素脾显像观察7例严重脾外伤自体腹膜后带蒂移植脾功能

目的应用放射性核素脾显像评价严重脾外伤自体腹膜后脾移植的脾功能。方法对严重脾外伤患者行自体腹膜后带蒂脾移植术,应用99mTc-植酸钠胶体法和99mTc-热变性红细胞法观察自体脾移植后患者脾功能。结果术后2周、3个月及6个月分别观察到7例自体脾移植均成活,移植脾显像较清晰。结论99mTc-植酸钠和99mTc-热变性红细胞脾显像是直接观察严重脾外伤自体脾移植术后脾成活、功能和形态的有效方法。     

脾脏淋巴管囊肿1例

患者 女,49岁。因发现“肝硬化1年,身软乏力3 d”入院。查体：精神欠佳,面色青黑,颈部可见少许蜘蛛痣,可见肝掌。脾脏剑突下4 cm 处可扪及,质硬,光滑。实验室检查：PLT 40×109/L;PA 122 mg/L,TBA 28.6μmol/L。     

Angiosarcoma of the breast

OBJECTIVE: This article describes the imaging findings, pathologic correlation, and clinical presentation of rare primary and secondary angiosarcomas of the breast. CONCLUSION: With the increasing use of breast conservation therapy for breast cancer, reports of postirradiation angiosarcoma have increased. Both primary and secondary angiosarcomas may present with bruiselike skin discoloration, which may delay the diagnosis. Imaging findings are nonspecific. MRI may be used to determine lesion extent by showing rapid enhancement and washout in high-grade tumors.