ABSTRACT
The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.
ABSTRACT
The gallbladder (GB) is a rare site of renal cell carcinoma (RCC) metastasis. To the best of our knowledge, only a few reports of CT findings of GB metastasis exist in the literature. Herein, we report a case of histologically proven GB metastasis of RCC in a 55-year-old male who underwent CT for an intraluminal polypoid mass simulating a primary GB lesion.
ABSTRACT
Purpose@#To retrospectively determine whether specialized magnetic resonance imaging (MRI) reading performed by an experienced radiologist affected the successful assessment of extraprostatic extension (EPE) in the presence of biopsyrelated hemorrhage after prostate biopsy. @*Materials and Methods@#Two hundred consecutive patients with biopsy-proven prostate cancer underwent MRI. General radiologist and subspecialized radiologist readings were unpaired and reviewed in random order by a radiologist who was blinded to patients’ clinical details and histopathologic data. The extent of hemorrhage was assessed on T1-weighted (T1W) MRI using a 1-4 scale, and the likelihood of EPE was assessed for each of the four categories. Histopathologic specimens served as the reference standard. The area under the curve (AUC) of the standard reading was compared to that of the specialized reading. @*Results@#Post-biopsy hemorrhage was subjectively graded as ≥ 3 in 101 patients (50.5%) by standard reading, and in 100 patients (50.0%) by specialized reading.The standard and specialized readings disagreed for 40 (20.7%) of the patients (kappa [κ] = 0.35; 95% CI, 0.14-0.48). Of these, specialized reading was the correct interpretation for 21 patients (52.5%). The sensitivity (75% vs. 44%; P = 0.002) and area under the receiver operating characteristics (AUROC) (0.83 vs. 0.67; P = 0.008) of the specialized readings were significantly higher than those of the standard readings, while there was no significant difference in specificity (84% vs. 87%; P = 0.434). @*Conclusion@#The reinterpretation of MRI by experienced radiologists significantly improves the diagnosis of EPE in prostate cancer in the presence of post-biopsy hemorrhage.
ABSTRACT
Purpose@#The goal of this study was to retrospectively compare systematic ultrasound-guided prostate biopsy (US-PB) and multiparametric magnetic resonance imaging-ultrasound fusion prostate biopsy (MRI-PB) in men undergoing primary or repeated biopsies. @*Methods@#A population of 2,200 patients with a prostate-specific antigen (PSA) level >4.0 ng/ dL and/or an abnormal rectal examination was divided into two groups. All patients underwent US-PB (n=1,021) or MRI-PB (n=1,179) between April 2015 and April 2019. Population demographics, including age, PSA level, digital rectal examination results, prostate volume, number of previous negative biopsies, Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) score, and biopsy results, were acquired and compared with respect to these variables. Univariate regression analysis of the risk factors for a higher Gleason score (GS) was performed. @*Results@#The cancer detection rate (CDR) was 23.8% (243 of 1,021) in the US-PB group and 31.3% (399 of 1,179) in the MRI-PB group. Of those, 225 patients (22.0%) in the US-PB group and 374 patients (31.7%) in the MRI-PB group had clinically significant prostate cancer (csPCa). The patients with csPCa in the MRI-PB group included 10 (40%), 50 (62.5%), 184 (94.8%), and 32 (94.1%) patients with PI-RADS V2 scores of 2, 3, 4, and 5, respectively. Of the patients with csPCa, 155 (91.7%) in the US-PB group were diagnosed on the basis of the primary biopsy, compared to 308 (94.4%) in the MRI-PB group. We found the PI-RADS V2 score to be the best predictor of a higher GS. @*Conclusion@#MRI-PB showed a high CDR for csPCa. MRI-PB could be a reasonable approach in patients with high PI-RADS V2 scores at primary biopsy.
ABSTRACT
BACKGROUND@#We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas.@*METHODS@#Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), K(trans) (vessel permeability), and V(e) (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences.@*RESULTS@#There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, K(trans), and V(e) values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively.@*CONCLUSION@#Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.
ABSTRACT
Collision tumor is a synchronous neoplasm wherein two histologically distinct tumors co-exist within the same anastomosis site. Collision tumor can occur in any organ, but the incidence is markedly rare. Additionally, preoperative diagnosis can be challenging to the radiologist. Herein, we report an age 60 male with collision tumor of rectal adenocarcinoma and diffuse large B-cell lymphoma, presented as a semi-annular wall thickening and bulky exophytic mass on MR imaging.
Subject(s)
Humans , Male , Adenocarcinoma , B-Lymphocytes , Diagnosis , Incidence , Lymphoma , Lymphoma, B-Cell , Magnetic Resonance Imaging , Neoplasms, Multiple Primary , RectumABSTRACT
BACKGROUND: We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas.METHODS: Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), K(trans) (vessel permeability), and V(e) (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences.RESULTS: There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, K(trans), and V(e) values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively.CONCLUSION: Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.
Subject(s)
Humans , Area Under Curve , Diagnosis , Diffusion , Logistic Models , Magnetic Resonance Imaging , ROC CurveABSTRACT
Small cell carcinoma of the ovary, hypercalcemic type is a rare ovarian tumor. This tumor has three distinctive clinical features: i) an occurrence in young women, ii) the presence of hypercalcemia in 62% of cases, and iii) a high degree of malignancy. The radiologic findings of the tumors are usually large and a predominantly solid mass with internal necrosis, hemorrhage and cystic degeneration. We report on the CT and MRI findings of an ovarian small cell carcinoma, hypercalcemic type in a 17-year-old female who presented 1 month abdominal discomfort with weight loss.
ABSTRACT
PURPOSE@#To prospectively assess the diagnostic potential of computed tomography urography (CTU) as a prior examination in the detection of bladder cancer.@*MATERIALS AND METHODS@#A total of 3280 CTU examinations were assessed in 3050 consecutive patients. Patients who were over 35 years of age, with gross hematuria, persistent microhematuria, or a history of urothelial tumor, were included in our study. Our study investigated the diagnostic capability of CTU over the course of two prior examinations. After the first examination, patients with a definite lesion observed by CTU were referred directly for rigid cystoscopy (RC) and patients with negative or probable lesion were referred for flexible cystoscopy (FC). After the second examination, patients with a definite lesion observed by CTU were referred directly for RC, patients with probable lesion were referred for FC, and patients with negative lesion were referred for clinical follow-up. Performance characteristics for the two prior examinations were determined by using pathologic findings or clinical follow-up as the reference standard.@*RESULTS@#The overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value for detecting bladder cancer were 95.2%, 95.4%, 95.4%, 69.1%, and 99.2%, respectively, for the first prior examination, and 93.4%, 93.3%, 93.3%, 61.1%, and 98.4%, respectively, for the second prior examination.@*CONCLUSION@#CTU as a prior examination is accurate for the early detection of bladder cancer. Notably, when used as a second prior examination, CTU could help to avoid the unnecessary use of FC in patients with negative lesions.
ABSTRACT
Parovarian cyst is usually simple cyst, and accounts for 10%–20% of adnexal masses. Borderline or malignant parovarian tumor is rare, and it contains papillary projection at the smooth inner wall. We report the ultrasonography, CT and MRI findings of a parovarian serous borderline tumor in 19-year-old female presenting left lower quadrant abdominal discomfort for 2 days.
ABSTRACT
OBJECTIVE: We wanted to assess the long-term results of cyst ablation with using N-butyl cyanoacrylate (NBCA) and iodized oil in patients with autosomal dominant polycystic kidney disease (ADPKD) and symptomatic cysts. MATERIALS AND METHODS:Cyst ablation using a mixture of NBCA and iodized oil was performed in 99 cysts from 21 patients who had such symptoms as abdominal distension and pain. The collapse or reaccumulation of the ablated cysts after the procedure was assessed during the follow-up period of 36 to 90 months. The treatment effects, including symptom relief, and the clinical data such as the blood pressure and serum creatinine levels were also assessed, together with the complications. RESULTS: The procedure was technically successful in all 99 cysts from the 21 patients. Any procedure-related significant complications were not detected. Seventy-seven of 99 cysts (78%) were successfully collapsed on the follow-up CT. Twenty-two cysts showed reaccumulation during long-term follow-up period. The clinical symptoms were relieved in 17 of the 21 patients (76%). Four of 12 patients (33%) with hypertension and two of six patients (33%) with azotemia were improved. End stage renal disease (ESRD) occurred in six of the 21 patients (28%) during the follow-up period. The mean age of ESRD in our patients was 57 years. The mean time interval for the development of ESRD was 19 months. CONCLUSION: Ablation using a mixture of NBCA and iodized oil may be an effective, safe method for obtaining symptom relief in patients with ADPKD.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Enbucrilate/administration & dosage , Follow-Up Studies , Iodized Oil/administration & dosage , Polycystic Kidney, Autosomal Dominant/surgery , Sclerosing Solutions/administration & dosageABSTRACT
The perforation of the superior vena cava during the placement of a tunneled hemodialysis catheter, via the subclavian vein, is a rare complication, and is manifested by hemothorax or hemopericardium. The treatment of this complication requires an early diagnosis and open thoracic surgery. Herein, we report a patient with hemothorax due to the perforation of the superior vena cava during the placement of a tunneled hemodialysis catheter via the right subclavian vein which was successfully treated by embolization by way of a coil and histoacryl.
Subject(s)
Humans , Catheterization , Catheters , Early Diagnosis , Embolization, Therapeutic , Enbucrilate , Hemothorax , Pericardial Effusion , Renal Dialysis , Subclavian Vein , Thoracic Surgery , Vena Cava, SuperiorABSTRACT
PURPOSE: To describe efficacy of percutaneous lithotripsy for removing difficult bile duct stones using endoscopy. MATERIALS AND METHODS: A total of 88 patients with difficulties for the removal of bile duct stones using endoscopy (an impacted stone, stone size >15 mm, intrahepatic duct (IHD) stone, stone size to bile duct diameter ratio >1.0), were enrolled in this study. A 12 Fr sheath was inserted through the percutaneous transhepatic biliary drainage (PTBD) tract, and then nitrol stone baskets and a 0.035" snare wire were used to capture, fragment and remove the stones. The technical and clinical success rates were analyzed, together with an analysis of any complications. RESULTS: The overall technical success rate of stone removal was achieved in 79 of 88 patients (89.8%). In five of nine patients with failed stone removal, small residual IHD stones were noted on a cholangiogram. Even if stone removal failed in these cases, cholangitic symptoms were improved and the drainage catheter was successfully removed. Therefore, clinical success was achieved in 84 of 88 patients (95.5%). There were no significant procedure-related complications, except for sepsis in one case. CONCLUSION: Billiary stone removal using the stone basket and guide-wire snare technique through the PTBD tract is a safe and effective procedure that can be used as a primary method in patients with difficulties for the removal of bile duct stones using endoscopy.
Subject(s)
Humans , Bile , Bile Ducts , Catheters , Dioxolanes , Drainage , Endoscopy , Fluorocarbons , Lithotripsy , Nitroglycerin , Sepsis , SNARE ProteinsABSTRACT
We report a case of dural-based intracranial primary mesenchymal chondrosarcoma, initially thought to be a meningioma. This rare tumor should be included in the differential diagnosis of an aggresive dural-based lesion occurring in a young adult. A 27-year-old man presented with headache, nausea and vomiting, first experienced months earlier. Pre-enhanced CT revealed the presence of a well-marginated isodense mass with dense calcifications in the frontoparietal convexity, while MR images depicted a lobulated extra-axial mass with peritumoral edema. At T1-weighted imaging, the signal intensity of the mass was slightly low or than that of gray matter, while T2-weighted imaging demonstrated heterogeneous high signal intensity. Some portions of the tumor showed low signal intesnity at all sequences, suggesting the presence of calcification. After the injection of contrast medium, heterogeneous enhancement was observed. We report the radiologic findings of an intracranial primary mesenchymal chondrosarcoma, confirmed pathologically.
Subject(s)
Adult , Humans , Young Adult , Chondrosarcoma , Chondrosarcoma, Mesenchymal , Diagnosis, Differential , Edema , Headache , Meningioma , Nausea , VomitingABSTRACT
Primitive neuroectodermal tumor (PNET) is relatively uncommon, arising outside the central nervous system. Very rarely, it occurs within the urinary system. A 55-year-old woman presented with gross hematuria and right flank pain which had begun two months earlier. A well-marginated, low-density mass containing high-density portions representing hemorrhage was seen in the right kidney at pre-enhanced CT; contrast enhancement was not prominent. At both T1- and T2- weighted MR imaging, a multilocular cystic mass with high signal intensity portions representing hemorrhage was observed. Contrast enhancement was absent. We report the radiologic findings in this case of renal PNET.
Subject(s)
Female , Humans , Middle Aged , Central Nervous System , Flank Pain , Hematuria , Hemorrhage , Kidney , Magnetic Resonance Imaging , Neuroectodermal Tumors, PrimitiveABSTRACT
BACKGROUND: In patients with endometrial carcinoma, preoperative evaluation of exact staging has important prognostic and therapeutic implications. The incidence of pelvic and aortic lymph node involvement in endometrial carcinoma depends on grade of tumor differentiation and depth of myometrial invasion. MATERIAL AND METHOD: To evaluate whether MRI provides a preoperative assessment for staging of endometrial carcinoma, MRI was undertaken in 28 patients, a few weeks before operation. Myometrial invasion was devided in three categories, and involvement of cervix, adnexa, and pelvic cavity were classified. RESULTS: The results of MR imaging were compared with these of pathology. The preoperative MRI staging of endometrial carcinoma was correct in 22 out of 28 patients. In the evaluation of myometrial invasion, the MR imaging underestimated in 4 cases and overestimated in 1 case. CONCLUSION: In patients with endometrial carcinoma, MR imaging is very useful in the assessment of the depth of myometrial invasion, stromal invasion of cevix, lymphatic & pelvic metastases and extent of the lesion.
Subject(s)
Female , Humans , Cervix Uteri , Endometrial Neoplasms , Incidence , Lymph Nodes , Magnetic Resonance Imaging , Neoplasm Metastasis , PathologyABSTRACT
Primary serous papillary carcinoma of the peritoneum is a rare neoplasm arising from the mesothelium. Histologically it is indistinguisable from ovarian serous papillary carcinoma, but it should be free of tumor or involved only superficially with the ovary. Radiologically its common findings are peritoneal and omental masses with ascites, and it is indistinguisable from peritoneal carcinomatosis or malignant mesothelioma. We report a case of surgically proven primary serous papillary carcinoma of the peritoneum in a 63-year-old woman.