MR Images of Infarction of Wandering Spleen Associated with Intestinal Non-rotation

Wandering spleen is a rare clinical condition caused by lax splenic suspensory ligaments. The laxity of ligaments causes torsion of splenic vascular pedicle. CT scan of a 7-year-old girl with abdominal pain showed a non-enhancing lobular mass in lower abdomen. Small bowel loops were located at the right-sided abdomen and colonic loops at the left-sided abdomen. MRI scan showed non-enhancing heterogeneous mass with twisted vascular pedicle. To our knowledge, only a few cases have been reported about wandering spleen diagnosed on MRI.

Perilesional Steatosis in Ectopic Pancreas Mimicking Exogastric Mass : A Case Report

We report an unusual case of ectopic pancreas that appeared on radiologic images as a lobulated, submucosal mass enclosed by fat component in the gastric lower body. Although, ectopic pancreas including fat component is extremely rare, in the setting of gastric submucosal mass with containing perilesional fat, these findings should be considered in ectopic pancreas as part of the differential diagnosis.

H1 Magnetic Resonance Spectroscopy of Cystic Ovarian Lesions

On H1 MRS (magnetic resonance spectroscopy), malignant tumors show higher concentration of metabolite than benign lesions. Lactate double peak was detected in malignant tumor and endometriosis, and more prominent high concentration was demonstrated in endometriosis. Tuboovarian abscesses and salpingitis do not show prominent peak. Dermoid cysts show high levels of lipid peak. Paratubal cyst and follicular cyst can be showed the lipid peak, however, the concentration of lipid is lower than that of dermoid cyst. H1 MRS of ovarian cystic lesions can give valuable information about the presence of metabolites of ovarian cystic lesions.

Image Findings of Primary Squamous Cell Carcinoma of the Pancreas in Patient with Chronic Pancreatitis: A Case Report

Squamous cell carcinoma of the pancreas is a rare, uncommon tumor that is characterized by squamous metaplasia of the ductal columnar cells. We report the image findings of a rare case of the pancreatic squamous cell carcinoma associated with chronic pancreatitis.

MR Images and 1H MR Spectroscopy of Enteric Duplication Cyst of the Pancreas in an Adult

Enteric duplications associated with the pancreas are especially uncommon, and the differential diagnosis of pancreatic duplication cysts is often difficult, and may be confused with various cystic lesions of the pancreas. We report a case of pancreatic duplication cyst; present the images and laboratory findings including cyst fluid tumor markers. MR and MRS findings enabled the detection of the location, contour, characteristics of cystic fluid and definition of tissue planes between the lesion and adjacent structures, providing useful information for an accurate surgical approach.

Langerhans Cell Histiocytosis in the Skull: Comparison of MR Image and Other Images

PURPOSE: To evaluate the characteristic MR imaging findings of Langerhans cell histiocytosis (LCH) in the skull and to compare them with those of plain radiography and computed tomography. MATERIALS AND METHODS: A total of 10 lesions in 9 patients (Age range; 5-42 years, Mean age; 18, all women) with Langerhans cell histiocytosis in the skull were included in our study. Nine lesions in nine patients were histologically confirmed by surgery or fine needle aspiration biopsy. All patients performed with MRI, and plain radiography and CT scan were done in 7 patients (8 lesions). Two experienced neuroradiologists reviewed the radiological examinations independently with attention to location, size, shape and nature of the lesions in the skull and compared the extent and extension of the lesions to adjacent structures. RESULTS: The lesions were distributed in all of the skulls without predilection site. On MRI, the masses were shown as well-enhancing soft tissue masses (10/10) mainly in diploic spaces (8/10) with extension to scalp (9/10) and dura mater (7/10). Dural enhancement (7/10) and thickening (4/10) were seen. The largest diameter of the soft tissue masses ranged 1.1 cm to 6.8 cm, shaped as round (5/10) or oval (5/10). On CT scans, the lesions were presented as soft tissue masses involving diploic space (6/8) and scalp extension (7/8) were also well visualized. Although bony erosion or destruction was more clearly seen on CT rather than those of MRI, enhancement of soft tissue masses and dura were not well visualized on CT. In contrast, all of the lesions in LCH were seen as punched out (4/8), beveled-edge appearance (4/8) osteolytic masses in plain radiography, but scalp and dural extension could not be seen. CONCLUSION: Characteristic MR findings in patients with LCH are soft tissue mass in diploic space with extension to dura and scalp, and MRI would be better imaging modality than plain radiography or CT .

MR Images of Primary Localized Amyloidosis of the Ureter and Bladder: A Case Report

Primary localized amyloidosis of the ureter and bladder is a very rare condition. CT and cystoscopic findings are indistinguishable from malignant neoplasm or inflammatory lesions. We report a case of unilateral distal ureteral thickening caused by primary localized amyloidosis. MR image features of hypointensity on T2-weighted images and mural enhancing pattern on contrast enhanced T1-weighted images can be helpful for diagnosis of ureteral amyloidosis.

MR Imaging in a Child with Scurvy: a Case Report

Scurvy is very rare disease in industrialized societies. Nevertheless, it still exists in higher risk groups including economically disadvantaged populations with poor nutrition, such as the elderly and chronic alcoholics. The incidence of scurvy in the pediatric population is very low. This study reports a case of scurvy in a 5-year-old girl with cerebral palsy and developmental delay based on MRI findings.

The Usefulness of the 3-D Overlapped Reconstruction MR Angiographic Technique in Patients with Hemifacial Spasm - A Preliminary Study

PURPOSE: To investigate the applicability of the new three-dimensional overlapped reconstruction MR angiography (3-D ORMRA) technique in patients with hemifacial spasm and to compare the new 3-D reconstruction images with conventional MRA source images. MATERIALS AND METHODS: The study group comprised 27 patients with surgically proven hemifacial spasm. In all patients, conventional MRA source images and 3-D fast imaging employing steady-state acquisition (FIESTA) images were obtained prospectively. After 3-D MR angiographic images were obtained, the 3-D MRA and FIESTA images were overlapped at the workstation by using GE A/W 4.2 add/sub software. We analyzed the relationship between the offending vessels and root exit zone of the facial nerve using both 3-D ORMRA images and conventional MRA source images. RESULTS: In 25 of 27 patients, the offending vessel at the REZ of the facial nerve could be correctly identified on conventional MRA source images. In all patients, the presumed offending vessels depicted by the overlapped 3-D reconstruction MRA image corresponded well with the intraoperative findings. The 3-D reconstruction image showed more clear visualization of the spatial relationship between the offending vessels and the root exit zone of the facial nerve. CONCLUSION: The overlapped 3-D reconstruction MR angiography technique is very useful and informative in patients with hemifacial spasm, as compared with conventional MRA angiography technique.

Assessment of the Viable Fraction of Hepatocytes by Mangafodipir Trisodium Enhanced Functional MR Imaging: Preliminary Report in Animal Models

PURPOSE: We designed this study to evaluate the feasibility of using mangafodipir trisodium enhanced functional liver imaging (MT-FLI) for assessing the viable fraction of hepatocytes (VFH) in the liver. MATERIALS AND METHODS: We evaluated the change of VFH with using MT-FLI before and after inducing acute hepatic necrosis (AHN) with CCl4 in the liver of 15 beagle dogs. The MR imaging was performed on a 1.5T MRI unit with using the EFGRE-3D sequence (TR/TE=4.7/1.1 msec; flip angle: 20.0degree). We evaluated the linear dependence of the density of viable hepatocytes in AHN on the MR images as compared to that in the corresponding normal livers (DAHN/DN) on the VFH in their pathologic specimens, and the change of the VFH from the MT-FLI on that of the laboratory findings (AST, ALT, albumin, bilirubin, PT, ICG-R15) before and after AHN induction. RESULTS: The mean+/-SD of the VFH from the MT-FLI in AHN was 61.2+/-10.7% of that of the normal ones. The DAHN/DN showed strong positive linear dependence on the VFH in their pathologic specimens (β=.769, p.938, p<.05). CONCLUSION: The MT-FLI seems to be a feasible method for measuring VFH in the liver.

MR Imaging of Mucinous Carcinoma of the Breast Associated with Ductal Carcinoma In Situ: Case Report

A mucinous carcinoma of the breast is an uncommon carcinoma containing mucin that is associated with a mucocele-like tumor or other malignant tumors. We report the MR imagingfindings of two cases, a mucinous carcinoma and ductal carcinoma in situ (DCIS), associated with mucocele-like tumor. The mucinous carcinoma showed a gradually enhancing kinetic pattern on the dynamic MR and high signal intensity on the T2-weighted images. The MR findings were indistinguishable from a common benign mass of the breast.

MR Imaging of Mucinous Carcinoma of the Breast Associated with Ductal Carcinoma In Situ: Case Report

A mucinous carcinoma of the breast is an uncommon carcinoma containing mucin that is associated with a mucocele-like tumor or other malignant tumors. We report the MR imagingfindings of two cases, a mucinous carcinoma and ductal carcinoma in situ (DCIS), associated with mucocele-like tumor. The mucinous carcinoma showed a gradually enhancing kinetic pattern on the dynamic MR and high signal intensity on the T2-weighted images. The MR findings were indistinguishable from a common benign mass of the breast.

CT Differentiation of Periappendiceal Inflammation with Appendicitis and Pelvic Inflammatory Disease in Woman with Right Lower Quadrant Pain

PURPOSE: We wanted to determine the usefulness of the computed tomography (CT) findings for making the diagnosis between periappendiceal inflammation (PAI) with appendicitis and pelvic inflammatory disease (PID) for the women presenting with right lower quadrant pain. MATERIALS AND METHODS: We retrospectively analyzed the CT findings of 83 women with right lower quadrant pain: PAI in 36 and PID in 47 patients. We reviewed the CT images, including the appendiceal diameter and the enhancing wall thickening, the cecal thickening, the location of the appendix, thickening of the right anterior renal fascia, abscess, mesenteric fatty infiltration, ascites, heterogeneous uterine enhancement and paralytic ileus. Statistical analysis was performed by using the t-test for the diameter of appendix, and the x2 test or Fisher's exact test for the CT findings. RESULTS: The mean diameter of the appendix was 11.0+/-3.4 mm for the PAI subjects and it was 6.7+/-2.0 mm for the PID subjects (p<0.0001). Wall thickening of the appendix was more commonly detected in PAI (25 subjects, 69%) than in PID (15 subjects, 32%) (p=0.0007). Thickening of the right anterior renal fascia was more commonly detected in PAI (18 subjects, 50%) than in PID (7 subjects, 15%). Cecal thickening, ascitis, heterogeneous uterine enhancement and paralytic ileus were not significantly different between PAI and PID. Abscess and mesenteric fatty infiltration were more frequently detected in the RLQ, and in the abdomen or pelvic cavity in PAI and PID, respectively (p<0.05). There was no significant difference in the distribution of ascites between the diseases. CONCLUSION: The CT findings of the appendiceal diameter, enhancing wall thickening and thickening of the right anterior renal fascia are useful for making the diagnosis of PAI. The abdominal and pelvic distributions of abscess and mesenteric fatty infiltration are highly suggestive findings of PID.

CT Findings of Cystic and Solid Masses of the Mesentery

CT remains the optimal imaging modality for diagnosing cystic and solid masses in the mesentery. CT may provide important information regarding the lesion? location, size and shape, the presence and thickness of a wall, the presence of septa, calcifications or fat, and the involvement of adjacent structures. Although percutaneous imaging-guided or surgical biopsy is often necessary to guide medical management, analysis of the CT features along with the clinical history may be helpful in differentiating mesenteric masses, including cystic lesions and primary neoplasms arising from the mesenchymal tissues or the secondary metastatic lesions. CT is useful not only for detecting cystic and solid mesenteric masses, but also for helping physicians become familiar with the features of various mesenteric masses for accurate diagnosis and treatment.

CT Findings of Cystic and Solid Masses of the Mesentery

CT remains the optimal imaging modality for diagnosing cystic and solid masses in the mesentery. CT may provide important information regarding the lesion? location, size and shape, the presence and thickness of a wall, the presence of septa, calcifications or fat, and the involvement of adjacent structures. Although percutaneous imaging-guided or surgical biopsy is often necessary to guide medical management, analysis of the CT features along with the clinical history may be helpful in differentiating mesenteric masses, including cystic lesions and primary neoplasms arising from the mesenchymal tissues or the secondary metastatic lesions. CT is useful not only for detecting cystic and solid mesenteric masses, but also for helping physicians become familiar with the features of various mesenteric masses for accurate diagnosis and treatment.

Rectal Teratoma coexistent with an Ovarian Teratoma: A Case Report

We report a case of rectal teratoma coexistent with an ovarian teratoma. To our knowledge, this is the first radiologic report of rectal teratoma. Computed tomography (CT) showed a sharply demarcated cystic and fatty mass with amorphous calcification in the rectum. A double-contrast barium study showed a well-defined intraluminal rectal mass without mucosal destruction. Imaging findings of rectal teratoma allow for correct preoperative diagnosis. CT was helpful in differentiating rectal teratoma from other rectal lesions.

Recurrent Osteosarcoma in Skull Base: A Case Report

Osteosarcomas are highly malignant bone tumors which commonly affect metaphyseal portions of long bones and those of the skull are distinctly rare as primary neoplasm. We report a case of recurrent osteosarcoma originated from the skull base which destructed sphenoid bone in two months. The CT and MR images of 28 years old man with headache, dizziness, and loss of touch sense in right buccal area showed 3-cm sized homogenously well-enhancing mass with internal small cystic portions. Craniotomy and mass excision was done and chemotherapy was combined for 1 month. After about 2 month, follow up MR images showed larger recurrent mass in original site and confirmed as the same osteosarcoma after 2nd operation.

Recurrent Osteosarcoma in Skull Base: A Case Report

Osteosarcomas are highly malignant bone tumors which commonly affect metaphyseal portions of long bones and those of the skull are distinctly rare as primary neoplasm. We report a case of recurrent osteosarcoma originated from the skull base which destructed sphenoid bone in two months. The CT and MR images of 28 years old man with headache, dizziness, and loss of touch sense in right buccal area showed 3-cm sized homogenously well-enhancing mass with internal small cystic portions. Craniotomy and mass excision was done and chemotherapy was combined for 1 month. After about 2 month, follow up MR images showed larger recurrent mass in original site and confirmed as the same osteosarcoma after 2nd operation.

CT Findings of Primary Torsion of the Greater Omentum with Segmental Infarction: Case Report

Herein, we report on a case of primary torsion of the greater omentum with segmental infarction, which should provide useful information for the preoperative diagnosis of future such cases. Primary torsion of the greater omentum with omental infarction is a rare condition. There are only a few radiological reports of secondary torsion of the greater omentum caused by the hernial sac. During surgical exploration, infarction of the greater omentum was identified, due to the observation of omental torsion without any underlying cause. We describe a patient with characteristic computed tomography (CT) findings of primary omental torsion with segmental infarction, which correlated with the operative and pathologic results.

Differentiation of Recurrent Rectal Cancer and Postoperative Fibrosis: Preliminary Report by Proton MR Spectroscopy

PURPOSE: To know the differences of proton MR spectroscopic features between recurrent rectal cancer and fibrosis in post-operative period, and to evaluate the possibility to discriminate recurrent rectal cancer from post-operative fibrosis by analysis of proton MR spectra. MATERIALS AND METHODS: We evaluated the proton MR spectra from 25 soft tissue masses in perirectal area that developed in post-operative period after operation for the resection of rectal cancer. Our series included 11 cases of recurrent rectal cancer and 14 of fibrotic mass. All cases of recurrent rectal cancer and post-operative fibrosis were confirmed by biopsy. We evaluated the spectra with an attention to the differences of pattern of the curves between recurrent rectal cancer and post-operative fibrosis. The ratio of peak area of all peaks at 1.6 -4.1ppm to lipid (0.9 - 1.6ppm) [P (1.6 -4.1ppm)/P (0.9 -1.6ppm)] was calculated in recurrent rectal cancer and post-operative fibrosis groups, and compared the results between these groups. We also evaluated the sensitivity and specificity for discriminating recurrent rectal cancer from post-operative fibrosis by analysis of 1 H-MRS. RESULTS: Proton MR spectra of post-operative fibrosis showed significantly diminished amount of lipids compared with that of recurrent rectal cancer. The ratio of P (1.6 -4.1ppm)/P (0.9 -1.6ppm) in post-operative fibrosis was much higher than that of recurrent rectal cancer with statistical significance (p < .05) due to decreased peak area of lipids. Mean (standard deviations of P (1.6 -4.1ppm)/P (0.9 -1.6ppm) in post-operative fibrosis and recurrent rectal cancer group were 2.71 +/-1.48 and 0.29 +/- 0.11, respectively. With a cut-off value of 0.6 for discriminating recurrent rectal cancer from post-operative fibrosis, both the sensitivity and specificity were 100% (11/11, and 14/14). CONCLUSION: Recurrent rectal cancer and post-operative fibrosis can be distinguished from each other by analysis of proton MR spectroscopic features, and 1 H-MRS can be a new method for differential diagnosis between recurrent rectal cancer and post-operative fibrosis.