Radiology

Scheidler, Juergen; Hricak, Hedvig; Vigneron, Daniel B.; Yu, Kyle K.; Sokolov, Dahlia L.; Huang, L. Royal; Zaloudek, Charles J.; Nelson, Sarah J.; Carroll, Peter R.; Kurhanewicz, John

doi: N/Apmid: 10551229

PURPOSE: To assess the efficacy of combined magnetic resonance (MR) imaging and three-dimensional (3D) proton MR spectroscopic imaging in the detection and localization of prostate cancer. MATERIALS AND METHODS: MR imaging and 3D MR spectroscopic imaging examinations were performed in 53 patients with biopsy-proved prostate cancer and subsequent radical prostatectomy with step-section histopathologic examination. The prostate was divided into sextants. At MR imaging, the presence or absence of cancer in the peripheral zone of each sextant was assessed independently by two readers (readers 1 and 2) unaware of the findings at 3D MR spectroscopic imaging and histopathologic examination. At 3D MR spectroscopic imaging, cancer was diagnosed as possible if the ratio of choline plus creatine to citrate exceeded 2 SD above population norms or as definite if that ratio exceeded 3 SDs above the norm. RESULTS: On the basis of sextants, sensitivity and specificity, respectively, for MR imaging were 77% and 61% (reader 1) and 81% and 46% (reader 2) with moderate interreader agreement (κ = 0.43). The 3D MR spectroscopic imaging diagnosis of definite cancer had significantly higher specificity (75%, P < .05) but lower sensitivity (63%, P < .05). Receiver operating characteristic analysis showed significantly ( P < .001) improved tumor localization for both readers when 3D MR spectroscopic imaging was added to MR imaging. High specificity (up to 91%) was obtained when combined MR imaging and 3D MR spectroscopic imaging indicated cancer, whereas high sensitivity (up to 95%) was obtained when either test alone indicated a positive result. CONCLUSION: The addition of 3D MR spectroscopic imaging to MR imaging provides better detection and localization of prostate cancer in a sextant of the prostate than does use of MR imaging alone. Magnetic resonance (MR), spectroscopy, 844.12145 Magnetic resonance (MR), three-dimensional, 844.12149 Prostate, hyperplasia, 844.316 Prostate, MR, 844.12141, 844.12145 Prostate, neoplasms, 844.32

Boijsen, Erik; Pettersson, Holger; Redman, Helen C.

doi: N/Apmid: N/A

Partap, Vince A.

doi: N/Apmid: 10551240

Nakai, Akihito; Asakura, Hirobumi; Oya, Atsuko; Yokota, Akishige; Koshino, Tatsuo; Araki, Tsutomu

doi: N/Apmid: 10551222

PURPOSE: To evaluate whether Doppler ultrasonographic (US) velocimetry in renal interlobar arteries is altered in women with pregnancy-induced hypertension (PIH) compared with that in healthy pregnant and nonpregnant women. MATERIALS AND METHODS: Flow waveform measurements in renal interlobar arteries were obtained in 39 nonpregnant women, 77 healthy pregnant women at 16–40 weeks gestation, and 15 women with PIH at 28–39 weeks gestation by using color and pulsed Doppler US. RESULTS: In the nonpregnant group, the mean (± SD) peak systolic velocity, end-diastolic blood flow velocity, resistive index, and acceleration time were 0.34 m/sec ± 0.08, 0.14 m/sec ± 0.03, 0.62 m/sec ± 0.07, and 52.3 m/sec ± 13.7, respectively. In the healthy pregnant group, the peak systolic and end-diastolic blood flow velocities at 16 weeks gestation had decreased greatly by 40 weeks gestation. However, the values of other indexes in this group did not change with gestational age. In the PIH group, the acceleration time values were greatly prolonged compared with those in the other groups. CONCLUSION: Acceleration time is one of the hemodynamic parameters of substantial upstream stenosis. These findings suggest that severe stenosis or continuous vasospasm in the proximal arteries, such as the main renal artery and segmental artery, might be implicated in the pathogenesis of PIH. Hypertension, 961.723 Pregnancy, complications, 961.723 Renal arteries, US, 961.12981, 961.12983, 961.12984 Ultrasound (US), Doppler studies, 961.12981, 961.12983, 961.12984

Shimono, Taro; Hatabu, Hiroto; Kasagi, Kanji; Miki, Yukio; Nishizawa, Sadahiko; Misaki, Takashi; Hiraga, Akira; Konishi, Junji

doi: N/Apmid: 10551216

PURPOSE: To use magnetic resonance (MR) imaging to evaluate the morphologic changes of the pituitary gland during the development of hypothyroidism. MATERIALS AND METHODS: Fourteen patients who had undergone thyroidectomy were evaluated before radioactive iodine 131 therapy. In each patient, MR imaging and measurement of serum hormone levels were performed twice: 5 weeks before 131 I treatment as the “euthyroid state” with thyroid hormone supplementation and on the day of 131 I treatment as the “hypothyroid state” after a 3-week depletion of thyroid hormone supplements. Nine healthy volunteers also underwent MR imaging twice at an interval of 5 weeks. Pituitary volume and the relative signal intensity ratio of the anterior pituitary to the pons were measured. The shape and signal intensity of the pituitary gland were also visually assessed. The paired Student t test was used to evaluate the significance of the data. A P value less than .05 indicated a statistically significant difference. RESULTS: The patients had significantly larger pituitary volume in the hypothyroid state than in the euthyroid state both quantitatively ( P < .001) and visually. No significant differences were found in the relative signal intensity ratios of the anterior pituitary to the pons. In healthy volunteers, no significant differences in pituitary volumes or signal intensity were found between the two MR images. CONCLUSION: Rapid progression of hyperplasia of the anterior pituitary may occur with acute development of hypothyroidism. Pituitary, abnormalities, 145.144, 145.458, 145.521 Thyroid, hypothyroidism, 273.458, 273.521 Pituitary, MR, 145.12141

Dwamena, Ben A.; Sonnad, Seema S.; Angobaldo, Jeff O.; Wahl, Richard L.

doi: N/Apmid: 10551237

PURPOSE: To meta-analytically compare 2-fluorine 18fluoro-2-deoxy- d -glucose positron emission tomography (PET) and computed tomography (CT) for the demonstration of mediastinal nodal metastases in patients with non–small cell lung cancer. MATERIALS AND METHODS: English-language reports on the diagnostic performance of PET (14 studies, 514 patients) and/or CT (29 studies, 2,226 patients) for demonstration of mediastinal nodal metastases from NSCLC were selected by using the M edline database. In eligible studies, an objective diagnostic standard was used, data were presented to allow recalculation of contingency tables, and established diagnostic criteria were used for abnormal test results. Summary receiver operating characteristic (ROC) curves were calculated. RESULTS: Pooled point estimates of diagnostic performance and summary ROC curves indicated that PET was significantly more accurate than CT for demonstration of nodal metastases ( P < .001). Mean sensitivity and specificity (± 95% CI) were 0.79 ± 0.03 and 0.91 ± 0.02, respectively, for PET and 0.60 ± 0.02 and 0.77 ± 0.02, respectively, for CT. The log odds ratios were 1.79 (95% CI: 1.49, 2.09) for CT and 3.77 (95% CI: 2.77, 4.77) for PET ( P < .001). Subgroup analyses did not alter findings. CONCLUSION: PET is superior to CT for mediastinal staging of non–small cell lung cancer, independent of performance index or clinical context of PET imaging. Computed tomography (CT), comparative studies, 996.1291 Positron emission tomography (PET), comparative studies, 996.12963 Lung neoplasms, metastases, 60.321, 67.33 Lymphatic system, neoplasms, 996.33 Lymphatic system, CT, 996.1291 Lymphatic system, radionuclide studies, 996.12963 Mediastinum, neoplasms, 67.33

Gupta, Sanjay; Sood, Bimal; Gulati, Madhu; Takhtani, Deepak; Bapuraj, Rajiv; Khandelwal, Niranjan; Singh, Usha; Rajwanshi, Arvind; Gupta, Subhash; Suri, Sudha

doi: N/Apmid: 10551243

PURPOSE: To evaluate the safety and effectiveness of using ultrasonographic (US) guidance for performing fine-needle aspiration biopsies of orbital mass lesions. MATERIALS AND METHODS: Thirty-seven patients with mass lesions in the orbit underwent US-guided fine-needle aspiration biopsy. Computed tomographic scans were available in all patients. In 19 patients, the lesions were located in the posterior orbit, whereas in 18 patients the lesions were located in ( n = 3) or extended up to ( n = 15) the anterior compartment. Fine-needle aspiration biopsy was performed with 22–25-gauge needles and use of the freehand technique. RESULTS: Needle biopsies were performed safely and easily, and real-time US monitoring of the needle position was used to avoid injury to the eyeball. No major complications were encountered. Diagnostic specimens were obtained in 29 (78%) of the 37 patients, and 19 benign and 10 malignant disease processes were diagnosed. In eight patients (22%), an appropriate diagnosis could not be made, as aspiration samples yielded insufficient tissue. CONCLUSION: US provides safe and effective guidance for performing fine-needle aspiration biopsy in orbital mass lesions and is especially useful in deep-seated nonpalpable retrobulbar lesions. Biopsies, 22.126, 22.12985 Orbit, CT, 22.12112 Orbit, neoplasms, 22.343, 22.362, 22.363, 22.365 Orbit, US, 22.12981, 22.12985 Ultrasound (US), guidance, 22.12985

Shinde, Tejas S.; Lee, Vivian S.; Rofsky, Neil M.; Krinsky, Glenn A.; Weinreb, Jeffrey C.

doi: N/Apmid: 10551241

PURPOSE: To assess the usefulness of three-dimensional (3D) gadolinium-enhanced magnetic resonance (MR) venography for evaluation of thoracic central veins. MATERIALS AND METHODS: A retrospective study included 15 patients who underwent 3D gadolinium-enhanced subtraction MR venography with a spoiled gradient-echo sequence before and at multiple times after intravenous administration of 30-40 mL of contrast material. Maximum intensity projection and multiplanar reconstruction images were used to categorize central veins as patent, occluded, or narrowed. Results were compared with findings (in 12 patients) at conventional venography ( n = 3), attempted central venous catheter placement ( n = 3), or surgery ( n = 6). Medical records were retrospectively reviewed to determine if patient care was affected by MR venographic findings. RESULTS: By using MR venograms, an appropriate vessel could be identified for successful placement of a catheter, indwelling venous access device, or arteriovenous hemodialysis graft in all nine patients in whom placement was attempted. MR venography also was predictive of unsuccessful hemodialysis catheter placement in one patient. Conventional venographic findings confirmed MR venographic findings in three patients; in a fourth patient, conventional venography was unsuccessful due to inadequate access. MR venographic findings influenced treatment in 14 patients. CONCLUSION: On the basis of these initial results, 3D gadolinium-enhanced MR venography may facilitate comprehensive evaluation of abnormalities of the central veins in the thorax, particularly with regard to selection of venous access sites. Gadolinium Magnetic resonance (MR), vascular studies, 94.129412, 94.12942, 94.12943 Veins, access, 94.1269 Veins, MR, 94.129412, 94.12942, 94.12943 Veins, stenosis or obstruction, 94.75 Veins, thrombosis, 94.75

Fotoohi, Mehran; D'Agostino, Horacio B.; Wollman, Bruce; Chon, Kenneth; Shahrokni, Seyed; vanSonnenberg, Eric

doi: N/Apmid: 10551244

PURPOSE: To assess the relationship between the cause and severity of pancreatitis and the development of persistent pancreatocutaneous fistula (PPCF) after percutaneous drainage of pancreatic fluid collections. MATERIALS AND METHODS: Sixty patients (44 male, 16 female; age range, 10–74 years) were included in the study. The cause of pancreatitis was postoperative in 29 patients, alcoholism in 20 patients, biliary in six patients, hyperlipidemia in two patients, unknown in two patients, and trauma in one patient. Patients requiring intensive care unit treatment for their condition at the time of drainage were considered to have severe pancreatitis. Thirty-seven patients had mild pancreatitis, and 23 had severe pancreatitis. PPCF was defined as catheter drainage of pancreatic fluid of more than 10 mL/d for more than 4 weeks after catheter placement. RESULTS: PPCF developed in 27 of the 60 patients. It occurred in five of the six patients with biliary pancreatitis, 10 of the 20 with alcohol-related pancreatitis, and 10 of the 29 with postoperative pancreatitis ( P > .2). The prevalence of PPCF was higher in patients with severe pancreatitis ( n = 16 70%) than in those with mild pancreatitis ( n = 11 30%). This difference was statistically significant ( P < .002). CONCLUSION: Development of PPCF correlated with severity of pancreatitis, regardless of the cause of pancreatitis. Fistula, gastrointestinal tract, 77.289 Pancreas, CT, 77.12111, 77.12112, 77.12115 Pancreas, interventional procedures, 77.1263 Pancreatitis, 77.291

Liang, Huei-Lung; Pan, Huay-Ban; Lee, Ying-Huei; Huang, Jer-Shyung; Wu, Tony D. L.; Chang, Cheng-Tsung; Liang, Hsin-Lee; Yang, Tsung-Lung; Yang, Chien-Fang

doi: N/Apmid: 10551251

Two patients with Conn syndrome and one patient with Cushing syndrome underwent computed tomography (CT)-guided tumor ablation with a total of 5–11 mL of 50% acetic acid injected into their adrenal nodule (1.3–3.3 cm in diameter). No major complications were encountered during or after the procedure. All patients were symptom free with normal laboratory test results for at least 1-year follow-up. CT images showed complete cystic change with tumor size regression. Our preliminary results suggest that percutaneous acetic acid injection is a safe and effective alternative for treatment of small functional adrenal cortical adenoma. Acetic acid Adrenal gland, neoplasms, 86.31 Interventional procedures, 86.1266