Evaluation of adrenal masses in oncologic patients: dynamic contrast-enhanced MR vs CT

The CT examinations, precontrast gradient echo MR images, and fast contrast enhanced dynamic MR studies were evaluated in 44 patients with 52 adrenal masses and known malignant disease of different origin. Morphologic features (size, shape, attenuation, contour, and enhancement) on CT scans, signal intensity on T2-weighted MR images, and patterns of enhancement on Gd-DTPA enhanced dynamic MR studies were analyzed in all patients. With dynamic contrast enhanced studies with prolonged imaging up to 15 min after Gd-DTPA, masses with moderate enhancement and complete washout after 10 min were considered as adenomas. Computed tomography and plain MR had a sensitivity of 0.71 and 0.96, a specificity of 0.75 and 0.88, and overall accuracy of 0.56 and 0.71, respectively. Simultaneous use of precontrast MR and dynamic contrast enhanced studies led to an accurate diagnosis in 88% (sensitivity = 1.0, specificity = 0.91) and thus should be considered in oncologic patients with undetermined adrenal masses.     

Semiautomated ROI analysis in dynamic MR studies. Part II: Application to renal function examination

Fast MR techniques and the application of water-soluble contrast agents allow the simultaneous examination of renal morphology and the functional aspects of glomerular filtration using bolus injections of Gd-DTPA. Spatial resolution is sufficient to resolve individual renal pyramids, but the quantitative examination of regions of interest (ROIs) is severely impeded by organ movements due to variations of the end-inspiratory position. A new image-processing scheme has been used and tested in 23 normal volunteers and patients. This scheme replaces a tedious frame-by-frame ROI analysis by positional correction of renal regions of all frames of the sequence such that the definition of the regions has to be performed only once. The signal intensities (SIs) of the local regions in each frame are used to compute statistics and to generate curves representing local temporal SI changes due to contrast agent excretion. The success rate of the procedure depends largely on the image quality and on the adherence to a proved acquisition protocol. The present article shows that the combination of MR and robust and reliable image-processing methods can be important for the highly automated analysis of a large number of images acquired as dynamic studies.     

COMPARING THE EFFICACY OF CISAPRIDE AND RANITIDINE IN OESOPHAGITIS: A DOUBLE-BLIND,PARALLEL GROUP STUDY IN GENERAL PRACTICE

SUMMARY Patients with endoscopically confirmed oesophagitis (n=49) were treated for 8 weeks with either cisapride (10 mg four times a day) or ranitidine (150 mg twice a day) in a double-blind study in general practice. Mean overall symptom scores fell from 10.8 to 4.5 in the cisapride group and from 9.9 to 4.4 in the ranitidine group over the course of the study. The proportion of patients reporting improvements in individual symptoms in the two treatment groups (cisapride and ranitidine respectively) were: heartburn, 66% and 55%; acid regurgitation, 53% and 47%; epigastric pain, 60% and 52%; satiety, 57% and 47%; bloating, 69% and 71%; belching, 65% and 72%; nausea, 62% and 85%; vomiting, 77% and 66%; poor appetite, 50% and 75%. Improvement in the endoscopic grade of oesophagitis was observed in 66% of patients receiving cisapride and 63% of those receiving ranitidine. It was concluded that cisapride is as effective as ranitidine in relieving the symptoms of oesophagitis and in healing oesophageal erosions.     

Functional dynamic MRI,pharmacokinetics and safety of Gd-DTPA in patients with impaired renal function

Renal elimination of the paramagnetic contrast agent Gadolinium-DTPA (Gd-DTPA) was analyzed in 24 patients with impaired renal function and 3 normal controls. Dynamic magnetic resonance studies were performed using fast gradient-echo sequences with single images during suspended respiration and a temporal resolution of 10s per image. The time between appearance of the contrast agent in the renal cortex and signal intensity drop mL/min the medulla, due to a high concentration of Gd-DTPA and predominant T2-shortening, was an indicator of glomerular filtration rate and correlated well with creatinine clearance values (r=0.81). Fractionate urine collections and serum analysis up to 120h following administration showed a prolonged but complete elimination of Gd-DTPA mL/min patients with creatinine clearance above 20 mL/min. Renal functional parameters did not change after administration of Gd-DTPA and no nephrotoxic effects were observed.     

Reply to the article 'Hepatitis C virus (HCV) infection and MALT-type ocular adnexal lymphoma (OAL)' by P. Arnaud, M.-C. Escande, M. Lecuit et al. (Ann Oncol doi:10.1093/annonc/mdl369)

According to the interesting letter from Arnaud et al. [1],the prevalence of hepatitis C virus (HCV) infection in ocularadnexal lymphoma (OAL) patients diagnosed at the Institut Curieis 2%, which is significantly lower compared with the 13% observedin our series [2]. Intriguingly, the single French patient withOAL and HCV infection displayed a disseminated lymphoma andwas the sole patient who died of lymphoma progression, whichis in line with the negative prognostic     

Computed tomography and magnetic resonance tomography of rectal and sigmoid tumors

CT and MR imaging are of minor importance for the preoperative diagnosis of rectosigmoid carcinoma. A synchronous colon tumor can be excluded with a barium enema, while an accurate diagnosis of liver metastases is possible using real-time ultrasonography. However, post-operative management requires the use of tomographic methods: MR imaging has proved to be more accurate than CT for differentiation between local recurrence and post-operative scars. Therefore MRI should be the method of choice after surgery for rectosigmoid carcinoma in all patients without postoperative baseline examinations.     

The value of computed tomography for the staging of esophageal carcinoma

64 patients were operated on for carcinoma of the oesophagus during a five-year period (1/83 to 1/88) at the Department of Surgery of the University of Cologne; 95.3% of these suffered from squamous cell carcinoma. A preoperative CT of the thorax was performed in 38 patients, 13 of whom underwent abdominothoracic surgery and 25 blunt oesophagus dissections. The CT and plain diagnostic results were compared retrospectively and postoperatively with the intraoperative or histological findings. Three of seven oesophageal carcinomas of up to 2 cm size were not identified by CT. Infiltration of adjacent mediastinal structures by T3 carcinomas was detected in 16 of 22 cases with 3 false positive findings. In blunt oesophagus dissection the preoperatively diagnosed lymph node status agreed with the histological findings in more than 80% of the cases; a limitation, however, was the fact that only those lymph nodes could be assessed that clung to the resectate. In contrast, agreement was seen in only 7 of 13 cases (with 6 false negative findings) after abdominothoracic resection of oesophageal carcinomas. On the whole, there was agreement between preoperative and histological staging according to the TNM classification (UICC = in 50% of the cases, whereas in almost 40% (n = 15) the size or extension of the tumour growth had been underestimated preoperatively. Hence, the value of CT for the preoperative staging of oesophageal carcinoma is restricted.