Adrenal Hemangioma: Findings at Multidetector CT with Short Review of the Literature

We present the computed tomography (CT) imaging findings of a 44-year-old male with incidentally discovered right adrenal hemangioma displaying imaging pattern of nonadenomatous pattern, associated with multiple hepatic hemangiomata using 64-slice multidetector scanner with reviewing published CT imaging findings with short review of the literature

Diffusion weighted MRI in evaluation of transplanted kidney: Preliminary clinical experience

Purpose: To evaluate the diagnostic performance ofDiffusion Weighted (DW) magnetic resonance(MR) imaging in evaluation of transplantedkidneys.Patients and methods: One hundred twelve patientswith transplanted kidney from live kidney donorswere evaluated with coronal T2w and DW MRI ofthe kidney. There was 86 males and 26 females andthe mean age was 26.911.5ys (range 10-55).Apparent diffusion coefficient (ADC) wascalculated and the kidneys studied for any areasdiffusion restriction. Our patients classified into 2groups: Group 1 included 81 patients with stablekidney function and normal serum creatinine andthe second group included 31 patients with alteredkidney function, it includes 18 patients with chronicnephropathies and 13 patients with acute cellularrejection.Results: The mean ADC values for group 1 was2.70.26 x 10-3 mm2 /sec (range 1.93-3.6). In casesof chronic nephropathies, the mean ADC valueswas 2.30.22mm2/sec (range 2.05-2.77) while incases of acute cellular rejection it was1.80.2mm2/sec (range 1.7-2.2). When we use the2.4mm2/sec as a low cutoff ADC value fordiagnosis of normal kidney function, the sensitivity,specificity and overall accuracy for DWI MRI was80%, 96% and 93.5% respectively.When we used the ADC value of 2mm2/sec as acutoff value between acute cellular rejection andchronic nephropathies, the sensitivity, specificityand overall accuracy of DWI MRI was 90%, 98%and 90% respectively.Conclusion: In this relatively large study includingstable and abnormal function in transplantedkidneys, we can conclude that DW MRI isrelatively a new technique that allows diagnosis oftransplanted kidney with normal and alteredfunction

Avascular bone necrosis of the femoral head after renal transplantation: Is it avoidable?

Background: Avascular osteonecrosis (AVN) is a seriousosseous complication after renal transplantation (RT). Itsprevalence clearly decreased from 20% to 4% possiblydue to the use of calcinurin inhibitors (CNI), reduction ofsteroid doses and use of steroid free regimens. The aimof our study was to evaluate the frequency of AVNamong our kidney transplant recipients and to determinethe risk factors for its occurrence.Patients and methods: Among 1785 kidney transplantrecipients who received renal allografts between March1976 and December 2005, 40 patients (2.24%) developedAVN with a mean age of 31.3 10.2 years. Eightykidney transplant recipients without AVN were selectedto be a matched control group. The localization of AVNwas the femoral head in all cases.Results: AVN was diagnosed at a mean of 20.4 monthsafter transplantation. The following risk factors werestatistically significant; sirolimus-based regimen,hypercholesterolemia, overweight with body mass index(BMI)>26 and those with HLA A9, HLA B35 and DRB15.Conclusions: We concluded that the proper managementof hypercholesterolemia, maintenance of ideal bodyweight as well as avoidance of sirolimus-basedimmunosuppressive regimen in genetically predisposedpatients may be an effective preventive strategy to avoidAVN

Role of CT in Assessment of Unresectable Wilms' Tumor Response after Preoperative Chemotherapy in Pediatrics

The purpose of this study was to define the structural response of unresectable Wilms' tumor following preoperative chemotherapy by computed tomography (CT). We also compared CT changes in relation to histopathological nature. The study included 36 patients with 41 nephroblastomas. All were examined by CT before preoperative chemotherapy using multiphasic CT protocol study. The unresectability was diagnosed by CT imaging. All patients were subjected to fine-needle biopsy (FNB) to confirm the diagnosis and to define the histopathological type before preoperative chemotherapy. Five patients had unfavorable pathology and 31 patients with 36 nephroblastomas had favorable pathology. All patients received first line of treatment. Follow-up of these patients by CT at the 6th week was reviewed. All of our patients were diagnosed as unresectable Wilms' tumor by CT. Preoperative chemotherapy was started. Among our patients, 28 (77.8%) gave good response in the form of significant reduction in tumor size, disappearance of one tumor in two cases with bilateral WT and inferior vena cava (IVC) thrombus, and increased nonenhancing necrotizing content. Two patients with unfavorable pathology did not show any response. The remaining six patients gave partial response. CT can be used to evaluate tumor response and resectability after preoperative chemotherapy with high accuracy. The response to preoperative chemotherapy is not related to the histopathological classifications

Dynamic perfusion CT parameters and delayed contrast washout CT in characterization of adrenal tumors: A comparative study

Purpose: The study aims to compare the accuracy of washout and perfusion CT techniques in diagnosis of adrenal tumors. Patients and methods: A prospective study included 38 patients with incidentally detected adrenal masses on conventional abdominal CT studies performed for unrelated reasons were subjected to full medical history, physical examinations, serum creatinine assessment, dynamic perfusion CT using 64 MDCT scanner with Absolute washout (APW), Relative washout (RPW) assessment and CT perfusion parameters calculation [perfusion, Peak enhancement intensity (PEI), Time to peak (TTP) & Blood volume (BV)]. Time density curves (TDCs) for all adrenal masses were done. The gold standard was either follow up or histopathological examination after fine needle biopsy or surgical resection. Results: Washout CT differentiated between adenomas and non-adenomas using APW (â¥55%) with sensitivity 73.3%, specificity 90% and accuracy 82.8%, and using RPW (â¥36%) with sensitivity 53.3%, specificity 85% and accuracy 81.8%. Perfusion CT differentiated between adenomas and nonadenomas using BV (â¥15 ml/100 g) with sensitivity 80%, specificity 75% and accuracy 77.1%. TDC curves of adenomas show slow-rise platform pattern. Conclusion: Perfusion CT can distinguish between adrenal adenomas and non-adenomas using the BV, however washout CT was more accurate than perfusion CT in characterization of adrenal masses using the APW and RPW. Keywords: Perfusion CT, Washout CT, Adrenal adenoma, ARW, RPW, TD

Radiation dose associated with common computed tomography examination

Objective: To survey computed tomography (CT) radiation dose associated with non-contrast spiral Multislice CT examination in our institute. Methods: Detailed parameters for 362 consecutive examinations, including the patient weight, height, volume CT dose index (CTDIvol), scan length, and dose length product (DLP) were recorded from the dose report. Effective dose (E) was estimated for each patient. The differences between E doses were statistically analyzed using SSPS. Results: Patients body mass index (BMI) was 13.4 to 51.42 (average BMI 29.5 kg/m). Patients dose data (1 scan phase for each patient) from dose information: the median value of DLP was 586.45 mGy cm (83.30â1179.70 mGy cm), median value of CTDIvol was 12.07 (2.20â23.9 mGy), median value of mAs used was 186.50 (34â334 mAs). Effective dose range was (1.1â16.5 mSv) according to international commission of radiological protection (ICRP) 103 and according to ICRP60 the range was (1.3â18.93 mSv). Median value of frequent CT examinations for the same patient was 2 (min 1 scan/year & max 11 scan/year). CT dose variation was highly significant (p value <0.01) depending on high variation on mAs with (r = 0.98). CT dose was moderate depending on BMI (r = 0.55). Conclusion: There was statistically highly significant variation in effective radiation doses associated with non-contrast CT scan of abdomen and pelvis. The reason for this variation must be avoided. Keywords: Computed tomography (CT), CT dose, volume CT dose index, dose length product (DLP), Effective dose (E), International commission of radiological protection (ICRP) 10