Diagnostic efficiency of multislice computed tomography colonography in the detection of colorectal tumors: Comparison with conventional colonography

AMAÇ Konvansiyonel kolonoskopi yapılan kolorektal kanser riski yüksek hastalarda, çok kesitli BT kolonografi tetkikinin kolorektal patolojilerin saptanmasındaki tanısal etkinliğini konvansiyonel kolonoskopi ile karşılaştırarak değerlendirmek. GEREÇ VE YÖNTEM Kolon kanseri şüphesiyle konvansiyonel kolonoskopi yapılan 37 hastaya 4 dedektörlü bir çok kesitli BT cihazı ile 4x1 mm’lik dedektör kolimasyonu, 120 kV, 0.5 sn’lik gantri rotasyonu ve 120 mAs’lik parametreler ile çekimler gerçekleştirildi. Her hastada yapılan multiplanar reformat imajlar, sanal kolonografi ve sanal kolonoskopi imajları konvansiyonel kolonoskopi ile karşılaştırıldış Sonuçlar %95 güvenilirlik alanı tekniği ile konvansiyonel kolonoskopi bulguları referans standart alınarak hesaplandı. BULGULAR Konvansiyonel kolonoskopide izlenen 23 polipin 17’si çok kesitli BT kolonografide doğru olarak saptandı. 10 mm ve daha büyük boyuttaki 11 lezyondan dokuz tanesi (%81), 6-9 mm boyutları arasındaki dört lezyondan üç tanesi (%75), 1-5 mm boyutları arasındaki sekiz lezyondan beş tanesi (%62)çok kesitli BT kolonografide doğru olarak saptandı. SONUÇ Sonuçlar çok kesitli BT kolonografi tetkikinin 10 mm’nin üzerindeki poliplerde duyarlılığının yüksek olması, rölatif olarak güvenilir ve minimal invazif olması nedeni ile varolan diğer kolorektal kanser tarama testlerine iyi bir alternatif olabileceğini göstermektedir.PURPOSE: To evaluate the diagnostic efficiency of multislice CT colonography in the detection of colorectal tumors by comparing it with conventional colonography in patients with high risk of colorectal cancer MATERIALS AND METHODS: Thirty-seven patients who had undergone conventional colonoscopy because of a suspicion of colorectal cancer were scanned with a fourdetector multislice CT scanner with 4x1 mm detector collimation, 120 kV, 0.5 sec gantry rotation and 120 mAs scan parameters. Multiplanar reformatted images, virtual colonography and virtual colonoscopy images were compared with conventional colonoscopy. With conventional colonoscopy taken as the reference standard, the results were calculated with 95% confidence interval technique. RESULTS: Seventeen of the 23 polyps detected in conventional colonoscopy were identified correctly with multislice CT. Nine of 11 lesions with a diameter of 10 mm or greater (81%), three of four lesions with a diameter of 6-9 mm (75%), and five of eight lesions with a diameter of 1-5 mm (62%) were correctly identified with multislice CT. CONCLUSION: Multislice CT colonography is a good alternative to other colorectal screening tests because it has high sensitivity for polyps 10 mm or larger in diameter, is relatively safe and minimally invasive

Diffuse pulmonary lymphangiomatosis: imaging findings

Diffuse pulmonary lymphangiomatosis is a rare pulmonary disorder affecting the lymphatic channels from the mediastinum to the pleura. The disease usually occurs in children and young adults and frequently ends with death due to progressive course. Imaging findings of the disease are based on lymphatic involvement which appear as mediastinal soft tissue infiltration and thickening of pulmonary peribroncovascular bundles and interlobular septae. In this report, spiral and high-resolution computed tomography, and ultrasonography findings of severe form of this rare disease are presented. Furthermore, some lymphatic disorders, which are called with similar name but different appearances on imaging, are discussed

MR-arthrography comparedto MRI in glenohumeral joint instability

Klinik olarak anterior, posterior ve çok yönlü tekrarlayan omuz instabilités! ön tanısı alan 47 olgu Magnetik Rezonans (MR) ve Magnetik Rezonans Artrografi (MRA) ile incelendi. Olgularda hem MR, hem de MRA inceleme ile humérus başı, eklem kapsülü, glenohumeral ligamanlar, glenoid lab-rum ve komşu kemik yapılar değerlendirildi. Olgulardan 15'inde yapılan artroskopik inceleme, 1 olguda uygulanan açık cerrahi sonuçları MR ve MRA sonuçları ile karşılaştırıldı. 10 olguda MRA ile Artroskopi bulguları ve 1 olguda MRA ve açık cerrahi sonuçlan uyumlu idi. MRA ile Bankart lezyon tanısı alan 20 olgunun 16'smda MR ile aynı tanı konabildi. MRA ile 17 olguda labral lezyon saptanabilirken MR ile ancak lezyonların 7'si tanınabildi. MRA ile rahatlıkla değerlendirilebilen kapsül tipleri MR ile değerlendirilemedi Hill-Sachs lezyon ve rotator cuf tendon patolojileri her iki yöntem ile de eşit oranda tanındı. Sonuç olarak MRA'nın gleno-humeral instabilité olgularında artroskopi ve açık cerrahi öncesi uygulanması gereken primer tanı yöntemi olduğu sonucuna varılmıştır.47 patients, who were suffering from anterior, posterior or multidirectional shoulder joint instability, were evaluated by MR and MR-Arthography. In all patients, humeral head, joint capsule, glenohumeral ligaments, glenoid labrum and neigboring bony structures were assessed. Fifteen subjects underwent arthroscopic and one .patient underwent surgical exploration. All the surgical and arthros-copical data were corraleted with MRI and MRA findings. In 10 subjects examined by arthroscopy and in the case operated surgically, all the findings were compatible with the data obtained by MRA. In 16 of the 20 cases with Bankard lesions proved by MRA, the same diagnosis could also be made by conventional MRI. MRA could detect labral lesions in 17 cases. But the same diagnosis could be made by MRI in only 7 patients. The joint capsule types, which can be easily evaluated by MRA, could not be visualised by MRI. The sensitivity of MRI and MRA for Hill-Sachs lesions and rotator cuff pathologies were the same. It is concluded that MRA is the primary imaging modality of choice in cases of glenohumeral joint instability before undergoing shoulder joint arthroscopy or open surgical exploration

Sternal metastasis from uterine leiomyosarcoma

Uterus leiomyosarkomları zayıf metastaz eğilimi olan nadir yumuşak doku tümörleridir. En sık, akciğerler, karaciğer ve beyine metastaz yaparlar. Bu olgu sunumunda sternuma metastaz yapan nüks uterus leiomyosarkomunun manyetik rezonans görüntüleme bulguları sunulmakatadır.Uterine leiomyosarcoma is a rare soft tissue neoplasm having a tendency to the distant metastasis, most commonly to the lung, liver and brain. In this case, magnetic resonance imaging findings of recurrent uterine leiomyosarcoma metastasing to the sternum, which is unusual metastatic site for uterine leiomyosarcoma, are presented

Diagnosis of Nipple Discharge: Value of Magnetic Resonance Imaging and Ultrasonography in Comparison with Ductoscopy

Background: Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found. Aims: To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies. Study Design: Diagnostic accuracy study. Methods: Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery. Results: Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis. Conclusion: Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesion

Two cases of infantile myofibromatosis: Multiple visceral involvement and a solitary soft tissue mass

Infantile myofibromatosis is a rare myofibroblastic tumor in which soft tissue, bone and rarily visceral involvement can be seen. It is usually a solitary tumor, however, multicentric involvement may also be present. The cases with solitary or multiple lesions but no visceral involvement have good prognosis and spontaneous regression can often be seen. Nevertheless, multicentric visceral tumors are associated with high mortality. In this report, imaging findings of a case of infantile myofibromatosis with liver and both adrenal glands involvement; and another case with involvement of posterior thoracal and servical region muscles are presented

Comparison of fdg-pet/ct and mr with diffusion- weighted ımaging for assessing peritoneal ımplants in patients with gynecologic neoplasms

Amaç: Jinekolojik maligniteli hastalarda peritoneal imp- lant saptamada rutin abdominal MRG, diffüzyon ağırlıklı görüntüler (DAG) ve PET-BT tetkiklerinin duyarlılıklarını saptamak ve birbirleri ile karşılaştırmaktır. Gereç ve Yöntemler: Jinekolojik tümör nedeniyle takip edi- len 21 hasta çalışmamıza dâhil edildi. Hastalara PET-BT, tüm batın MRG ve b 0-500-1000 s/mm2 değeri kullanılarak batına yönelik diffüzyon ağırlıklı (DAG) çekimler yapıldı. PET-BT incelemesi nükleer tıp uzmanı tarafından, MRG ve DAG ise radyoloji uzmanı tarafından değerlendirildi. Batın içi implantlar, lezyon sayılarına göre standart referansla karşılaştırılıp değerlendirildi. Bulgular: PET-BT incelemesinde toplam 40 lezyon izle- nirken, MRG’de 49, MRG ve DAG birlikte değerlendiril- diğinde 65 lezyon raporlandı. Tüm görüntüleme metodla- rı ile toplam 8 hastada lezyon izlenmedi. İki hastamızda MRG+DAG’te lezyon izlenirken, MRG ve PET-BT’de iz- lenmedi. Bir hastada ise MRG ve MRG+DAG’de lezyon izlenirken PET-BT’de lezyon izlenmedi. MRG+DAG’de iz- lenen lezyon sayısı, PET-BT ile karşılaştırıldığında anlamlı derecede fark izlendi. Sonuç: Biz bu çalışmada kontrastlı MRG ve MRG+DAG ile PET-BT’ye göre daha fazla lezyon bulduk. PET-BT’ye alternatif olabilecek diffüzyon ağırlıklı görüntüleme, kon- vansiyonel MRG’e eklenerek peritoneal implant taramada daha duyarlı sonuçlar elde edilebilir.Objective: Our aim was to determine the sensitivity and comparison of abdominal MRI, diffusion weighted MRI (DWI), PET-CT in detecting peritoneal implants in patients with gynecologic neoplasms. Material and Methods: Twenty-one patients with gyneco- logical malignant tumors were enrolled in this retrospective study. Twenty-one oncology patients underwent abdominal and pelvic MRI, diffusion weighted MRI with a b value of 0-500-1000 s/mm2 and whole body PET-CT for follow-up. All MRI images were evaluated by a radiologists and PET- CT images were reviewed by a nuclear medicine physici- an. The results were compared with surgery or laparotomy exploratis, follow-up MRI or CT at a varying time between 2 and 12 months from the initial MRI, and moreover they were also evaluated with laboratory values and clinical outcomes at the 12 to 36th month from the initial MRI. Results: Forty lesions were identified with PET-CT, forty- nine lesions with MRI and 65 lesions with MRI+DWI. In 8 patients there were no implants with all imaging modalities. Although PET-CT and MRI were negative for two patients, MRI+DWI was positive for them. And also PET-CT was negative for one patient whereas MRI and MRI+DWI was positive. On a lesion-based analysis, overall lesion num- bers for PET-CT and MRI+DWI were significantly different (p<0,05). Conclusion: In our study we found with MRI and MRI+DWI more implants than PET-CT. DWI which may be an alter- native to PET-CT with conventional MRI can improve the sensitivity in depicting peritoneal implants

Feasibility of surgical management in patients with granulomatous mastitis

Granulomatous mastitis (GM) is a rare inflammatory breast disease of unknown etiology. Although it usually presents with sinus formation and abscesses, it may mimic the clinical characteristics of breast cancer. The aim of this study was to identify the clinical, radiologic, and pathologic characteristics of patients with GM and to show the results of surgical treatment in these patients. A chart review was performed for patients that were treated with a diagnosis of GM at the Breast Unit, Department of Surgery, Istanbul Medical Faculty, University of Istanbul, between September 1998 and January 2003. Eighteen patients were eligible for this study. The median age was 41.5 years (range 16-80 years). Seventeen patients were evaluated by both ultrasonography and mammography; whereas one young patient only had ultrasonography. Three patients were further examined with color Doppler ultrasonography and magnetic resonance imaging (MRI). Fourteen patients (78%) presented with a mass as the chief symptom, with a median size of 3.9 cm (range 1-8 cm), whereas four patients presented with fistula in their breasts. None of the radiologic techniques distinguished benign disease from cancer in any of the 14 patients that presented with a mass except one patient with normal mammography findings. Ultrasonography was only helpful to localize the abscess associated with a fistula tract in one patient. Therefore fine-needle aspiration biopsy (FNAB) was performed in six patients, followed by surgical excisional biopsy. The remaining eight patients with a clinical suspicion of malignancy underwent wide surgical excision with frozen section analysis under general anesthesia. All of the FNAB and frozen section evaluations revealed benign findings. All of the 18 patients underwent a wide excisional biopsy and had a definitive histopathologic diagnosis of GM. The median follow-up was 36 months (range 6-60 months). Only one patient had a recurrent disease, which was diagnosed at 12 months. GM is a rare breast disease that mimics cancer in terms of clinical findings. Preoperative radiologic diagnosis might be difficult. Complete surgical excision is the treatment of choice