Initial experience on utility of gadobenate dimeglumine (Gd‐BOPTA) enhanced T1‐weighted MR cholangiography in diagnosis of acute cholecystitis

Purpose

To investigate the feasibility of the use of gadobenate dimeglumine (also known as Gd‐BOPTA) ‐enhanced T1‐weighted MR cholangiography in diagnosis of acute cholecystitis.

Materials and Methods

This prospectively designed institutional review board‐approved HIPAA‐compliant study was done between January and November 2007. We included 11 consecutive patients (7 male, mean age 59 years) who presented to the emergency room with acute right upper quadrant pain and with equivocal physical examination and/or ultrasound findings. The control group included 15 patients who underwent liver MRI with Gd‐BOPTA. All patients underwent contrast‐enhanced (CE) MR cholangiography examinations. CE‐MR cholangiography was performed on a 1.5 Tesla magnet using 3D T1‐weighted high resolution isotrophic volume examination (THRIVE) obtained at the 90th min after intravenous injection of Gd‐BOPTA. Imaging features detected on CE‐MR cholangiography were correlated with operative and histopathologic findings.

Results

In the control group, GD‐BOPTA was visualized within the gallbladder in all subjects. For the study group, gallstones were present in nine patients (n = 7 both in gallbladder and cystic duct, n = 1 only in gallbladder, n = 1 only in cystic duct) on MRCP. Hydropic gallbladder was detected in seven patients, significant wall thickening in seven patients, and pericholecystic free fluid in 6 patients. On delayed phase CE cholangiography, significant enhancement of gallbladder wall was seen in 10 patients, and contrast agent excretion into gallbladder was absent in all patients. Surgery was performed in 10 patients, and cholecystostomy was done in 1 patient. Surgery and histopathology findings were consistent with cholecystitis in all patients.

Conclusion

In addition to anatomical assessment, Gd‐BOPTA‐enhanced MR cholangiography can provide functional evaluation similar to HIDA scintigraphy in diagnosing acute cholecystitis in patients with acute right upper quadrant pain and equivocal findings. J. Magn. Reson. Imaging 2009;30:578–585. © 2009 Wiley‐Liss, Inc.     

CT findings of lymphoma with peritoneal, omental and mesenteric involvement: peritoneal lymphomatosis

Purpose

We aimed to describe computed tomography (CT) findings in patients with peritoneal, omental and mesenteric lymphoma involvement.

Materials and methods

We searched our archive retrospectively to find out patients with peritoneal, omental and mesenteric lymphoma involvement. We found 16 patients with non-hodgkin lymphoma meeting these criteria. CT studies of these patients were reevaluated for the presence of peritoneal involvement, ascites, omental mass, organomegaly, retroperitoneal lymphadenopathy, bowel wall thickening and other associated findings.

Results

There were 14 males and 2 females with peritoneal and/or mesenteric and omental lymphoma involvement. Mean age was 39 (range 4-76). Subgroups of non-hodgkin lymphoma were diffuse large B-cell lymphoma (n = 11), small cell lymphocytic lymphoma (n = 2), small cleaved cell lymphoma (n = 1), T-cell lymphoma (n = 1) and Burkitt's lymphoma (n = 1). Peritoneal involvement was seen in 15 patients (93.8%) in the form of linear (n = 12) and nodular (n = 3) thickening. Ascites was seen in 12 (75%) patients. Omental and mesenteric masses were present in 10 (66.6%) and 10 (66.6%) patients, respectively. Bowel wall thickening, retroperitoneal lymphadenopathy and hepatosplenomegaly were also common and observed in 10, 10 and 11 patients, respectively. Solid organ involvement in the form of liver and splenic lesions was seen in 9 (56%) patients.

Conclusion

Peritoneal involvement can be seen in many subtypes of lymphoma and most frequently in diffuse large B-cell lymphoma. Peritoneal lymphomatosis can mimic peritoneal carcinomatosis and should be included in the differential diagnosis list in patients with ascites, hepatosplenic lesions and unidentified cause of peritoneal thickening on CT in a male patient.     

Long-term results of single-session percutaneous drainage and ethanol sclerotherapy in simple renal cysts

PURPOSE: To demonstrate the efficacy and long-term results of the single-session ethanol sclerotherapy in simple renal cysts. MATERIALS AND METHODS: Ninety-eight cysts in 97 patients (range: 18-76 years; mean age, 54 years) were included in the study. Indications were determined as flank pain in 74, hydronephrosis in 12, hypertension in 8, patient reassurance due to increasing cyst size in three patients. Mean follow-up period was 24.4 months. Procedures were performed with the guidance of fluoroscopy and ultrasonography at all times using 5-7 Fr pigtail catheters. After the cystogram that was obtained in all cases, 95% ethanol with a volume of 30-40% of the cyst volume was used as a sclerosing agent on an outpatient basis. Maximum volume of the injected ethanol was 200 ml. Follow-up examinations were performed 1, 3, 6 and 12 months after the procedure and once every year thereafter. RESULTS: Average cyst volume reduction was 93% at the end of the first year. The cysts disappeared completely in 17 (17.5%) patients. After the procedure, in 67 (90%) patients improvement in flank pain was noted. Sixty-one (82%) patients were free of pain and in 6 (8%) of them the pain decreased. Normotension was obtained in 7 (87.5%) of the 8 hypertensive patients and no hydronephrosis was detected in 10 (83.3%) of the 12 patients after the procedure. Second intervention was required in 2 (2%) patients due to recurrence of cysts and related symptoms. One (1%) patient had small retroperitoneal hematoma that resolved spontaneously and in another (1%) patient spontaneous hemorrhage was detected into the cyst 1 year after the procedure. No other complication was detected during the procedure and follow-up. CONCLUSION: Percutaneous treatment of simple renal cysts with single-session sclerotherapy is a safe, effective and minimally invasive procedure and can be used as an alternative to multiple-session sclerotherapy with comparable results. High volume, up to 200 ml ethanol can be used without adverse effects for large renal cysts.     

Imaging features of non-traumatic vascular liver emergencies

Acute non-traumatic liver disorders can originate from abnormalities of the hepatic artery, portal vein and hepatic veins. Ultrasonography and computed tomography can be used in non-traumatic acute vascular liver disorders according to patient status, indication and appropriateness of imaging modality. Awareness of the imaging findings, in the appropriate clinical context, is crucial for prompt and correct diagnosis, as delay may cause severe consequences with significant morbidity and mortality. This review article will discuss imaging algorithms, and multimodality imaging findings for suspected acute vascular disorders of the liver.     

Unusual causes of left renal vein compression along its course: MDCT findings in patients with nutcracker and pelvic congestion syndrome

Purpose  

The aim of this study was to describe the multidetector computed tomography (MDCT) findings of unusual locations of left renal vein compression in patients with nutcracker and pelvic congestion syndrome.     

采用双源CT进行双能量仿真CT结肠镜成像的初步经验

目的：探讨双源CT行双能量仿真CT结肠镜技术的可行性和临床价值。方法：8例患者采用双源CT的双能量采集和剂量调节软件进行扫描,采用专用双能量软件分析结果。前期平扫图像和给予对比剂后的双能量仰卧位图像一同分析。结果：7例患者均顺利完成成像．其中1例患者未能在视野内涵盖所有结肠,扫描成功率为87．5％。2例患者在盆腔区域出现条形伪影。     

Imaging of bladder cancer: update on current approaches for diagnosis

Imaging plays a mainstay role in evaluation of patients with bladder cancer, especially for diagnosis, local and distant staging and treatment follow up. In this article, we aim to review and to update conventional and functional imaging methods used in clinical management of bladder cancer.