Diagnosis of intravenous leiomyomatosis extending to heart with emphasis on magnetic resonance imaging / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intravenous leiomyomatosis is a rare neoplasm, and its cardiac extension is often overlooked or misdiagnosed. The purpose of this study was to explore the imaging features of intravenous leiomyomatosis with cardiac extension, especially the value of magnetic resonance imaging in differential diagnosis.</p><p><b>METHODS</b>Between July 2005 and August 2008, 4 cases of intravenous leiomyomatosis with cardiac extension were resected in Cangzhou Central Hospital. Three cases had echocardiography performed, two had post contrast scans of CT performed, and two had MRI performed. Between July 2005 and May 2010, 25 cases of histopathologically proven other kinds of tumors involving the inferior vena cava and right atrium were compared for discussion of differential diagnosis.</p><p><b>RESULTS</b>Intravenous leiomyomatosis with cardiac extension demonstrated a hyperechoic elongated mobile mass extending from the inferior vena cava to the right atrium with or without evidence of protruding into the right ventricle on echocardiography. The lesion was enhanced heterogeneously on post contrast scans of CT and was of relatively lower density compared to the enhanced blood in the inferior vena cava and right atrium, with common iliac vein and the ipsilateral internal iliac and ovarian veins involved in some cases. The untreated uterus myoma demonstrated enlargement of the uterus with heterogeneous contrast enhancement. On MRI, the lesion looked like a luffa vegetable sponge on FIESTA coronal images and a sieve pore on T2-weighted axial images. All four tumors were removed successfully, and follow up of one to four years revealed no recurrence. The 25 cases of histopathologically proven other kinds of tumors involving inferior vena cava and right atrium had their own imaging features different from those seen on intravenous leiomyomatosis with cardiac extension. With reference to their medical history, differential diagnosis can often be made.</p><p><b>CONCLUSION</b>The imaging appearance of intravenous leiomyomatosis has some unique features, and the luffa vegetable sponge and sieve pore like appearance on MRI may be helpful for differential diagnosis.</p>

Preliminary study on CT perfusion imaging in guiding biopsy of pulmonary lumps / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>CT perfusion imaging (CTP) has been proved to be a powerful functional imaging technique. This study aimed to evaluate the value of CTP in guiding biopsy of pulmonary lumps.</p><p><b>METHODS</b>A total of 147 patients with pulmonary lumps who had CT guided biopsies were enrolled in this study from February 2005 to June 2007. The patients were assigned to 3 groups: 33 cases guided by CTP as group I, 45 cases guided by contrast-enhanced scan of CT as group II, and 69 cases guided by plain scan of CT as group III. Each group was subdivided into central and peripheral types according to the location of the lumps. The achievement ratio of biopsy, the accuracy in grouping, and grading of lung cancer, and the incidence of complication were compared.</p><p><b>RESULTS</b>The total achievement ratios of biopsy from group I to III were 100% (33/33), 91% (41/45), and 80% (55/69) respectively, and the difference was statistically significant between group I and III (P < 0.05). For the central type, they were 100% (18/18), 88% (15/17), and 79% (11/14) respectively, and the difference was also statistically significant between group I and III (P < 0.05). For the peripheral type, they were 100% (15/15), 93% (26/28), and 80% (44/55) respectivelies, and the difference was not statistically significant among the three groups. The total accuracies in grouping and grading of lung cancer from group I to III were 100% (27/27), 91% (31/34), and 72% (33/46) respectively, and the difference was statistically significant between group I and III and between group II and III (P < 0.05). For the central type, they were 100% (16/16), 94% (16/17), and 70% (8/12) respectively, and the difference was statistically significant between group I and III (P < 0.05). For the peripheral type, they were 100% (11/11), 88% (15/17), and 72% (26/36) respectively, and the difference was statistically significant between group I and III (P < 0.05). The total incidence of complication from group I to III were 15% (5/33), 27% (12/45), and 43% (30/69) respectively, and the difference was statistically significant between group I and III (P < 0.01). For the central type, they were 11% (2/18), 24% (4/17), and 57% (8/14) respectively, and the difference was statistically significant between group I and III (P < 0.01). For the peripheral type, they were 20% (3/15), 29% (8/28), and 40% (22/55) respectively, and no statistically significant difference was found among the three groups.</p><p><b>CONCLUSIONS</b>CTP guided biopsy of pulmonary lumps using multi-detector row CT has the potential to improve the accuracy of histopathological diagnosis with a lower risk and higher achievement ratio. More research and technical improvements are needed before it is widely used.</p>