Accuracy for diagnosis of patients presented with painless hematuria by MDCT urography.

Background: Computed tomography urography (CTU) is a relatively new diagnostic imaging examination providing comprehensive evaluation of the upper and lower urinary tract. CTU is justified as a first-line test for patients with macroscopic hematuria, at high-risk for urothelial cancer. Objective: To assess the role of multi-detector row CT (MDCT) urography, using a MDCT for evaluation of patients presenting with painless hematuria, in Siriraj Hospital, Bangkok, Thailand. Methods: Between 2006 and 2008, 16 consecutive MDCT urography examinations were retrospectively reviewed by two radiologists. Sensitivity, specificity, PPV, NPV and accuracy of MDCT urography compared with surgical, histopathological findings and other imaging modalities were calculated. Results: In 11 out of 16 patients, the causes of painless hematuria were identified on MDCT urography. The most common cause was benign urothelial lesions in 5 cases. About uroepithelial malignancies, a detectable smallest lesion was about 0.8 cm in diameter. Conclusion: Sixty-four row MDCT urography provided satisfactory results in detection of urinary tract lesions with high accuracy in painless hematuria patients.

CT features of adrenal pheochromocytoma: Evaluation with clinical and pathological correlation.

Objective: To evaluate CT features of adrenal pheochromocytoma with clinical and histopathological correlation. Methods: A retrospective study was approved by the ethics committee. Forty-four patients with proven adrenal pheochromocytoma from January 2002- December 2007 at our institution were included. Only 10 out of the 44 had available pre-operative computed tomography (CT). All 10 CT were interpreted independently by two abdominal radiologists, with correlation with clinical and histopathological analysis. Results: All 10 patients had unilateral adrenal pheochromocytoma. Three were men and 7 were women. The mean age of patients was 45.1 years old. Eight out of 10 patients presented with hypertension. Four patients presented with neuroendocrine symptoms such as palpitation and diaphoresis. Other symptoms were palpable abdominal mass, headache and gastrointestinal symptoms (nausea, vomiting or abdominal pain). Pre-operative biochemistry tests for pheochromocytoma were performed in 8 patients. The tumor size varied from 2-15 cm in diameter. CT features of pheochromocytoma of this study showed 1 tumor of pure solid mass (2 cm tumor size) and 9 tumors of complex cystic masses. The range of density values at the solid part of tumors was 25-53 HU on non-contrast phase CT and the mean was about 41.4 HU. All 10 tumors showed enhancement of the solid part. Intratumoral hemorrhage and calcifications were detected. No intratumoral fatty component was detected. Conclusion: CT findings of adrenal pheochromocytoma were typical heterogeneous soft tissue density mass and moderate enhancement. Tumors with cystic component and hemorrhage were common in our study. CT was useful for tumor characterization in patient with nonclassic clinical manifestation of pheochromocytoma and also for pre-operative management.

Somatostatin receptor scintigraphy in localization of pancreatic neuroendocrine tumors: A preliminary study.

Objective: To study the ability of somatostatin receptor scintigraphy using Tc-99m-hydrazinonicotinyl-Tyr3-octreotide (Tc-99m-HYNIC-TOC) for localization of pancreatic neuroendocrine tumors. Methods: Five patients (3 female, 2 male; age range: 53 to 80 years; mean age: 65 years) with either histologically proven or clinically suspected insulinoma were studied. Ten mCi of Tc-99m-HYNIC-TOC were intravenously injected. Whole body scans were obtained 2 and 4 hours after injection. SPECT/CT studies of areas of interest were performed after the 4-hour whole body image. Scintigraphic findings were correlated not only with the results of conventional imaging methods, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound but also through 1-year clinical follow-up. Results: The Tc-99m-HYNIC-TOC study showed true-negatives in two patients suspected of insulinoma proven by intraoperative ultrasound in one case and 1-year clinical follow-up with no evidence of hypoglycemia in the other patient. Abnormal Tc-99m-HYNIC-TOC accumulation was demonstrated in three patients with pancreatic tumors. Additional metastatic lesions to lung and bone were detected in one patient formerly diagnosed of malignant insulinoma with multiple liver metastases. Conclusion: Tc-99m-HYNIC-TOC SPECT/CT imaging may provide more accurate staging of pancreatic neuroendocrine tumors than conventional imaging. It is an optional technique to recruit patients for somatostatin analogs therapy.

Accuracy of multi-detector CT scan in pre-operative staging of renal cell carcinoma: Comparison of radiological and histopathological findings.

Objective: To evaluate the accuracy of pre-operative multi-detector CT scan (MDCT) compared to histopathology findings in tumor staging of renal cell carcinoma. Methods: Retrospective review of 29 renal cell carcinomas at Siriraj Hospital from 2004-2007. Two blinded radiologists evaluated the pre-operative MDCT images independently. Imaging findings were compared with surgical specimens and pathological findings. Results: A total of 29 renal cell carcinomas were proven on histopathology. The respective accuracy for overall staging of reader 1 and 2 were 0.75 and 0.65. The reader 1 and 2 reached a sensitivity of 75% and 87%, a specificity of 70% and 50% for perinephric involvement, and a sensitivity of 100% and 100%, a specificity of 63% and 54% for renal pelvis involvement. The kappa interobserver agreements for perinephric involvement and renal pelvis involvement were 0.67 and 0.83, respectively. Conclusion: False positive finding of perinephric involvement causes overstaging of Robson stage I disease or in T1-T2 disease of TNM classification. Perinephric stranding may not be reliable or specific findings, and a result of perinephric involvement in CT scan is still limited. MDCT is accurate in the pre-operative evaluation of renal cell carcinoma in Robson stage II-IV disease.

Necessary for CT whole abdomen in post chemoradiation of rectosigmoid cancer stage 3: A comparative study.

Objective: To study the reliability of CT Scan interpretation in pre and post operative chemoradiation of rectosigmoid cancer. Methods: Retrospective review CT scan of 12 patients with diagnosis of rectosigmoid cancer stage 3 or more in pre and post operative chemoradiation were done by 2 radiologists. Data analysis included Maximum Wall Thickness, Distance of Lesion above Anal Verge, Perirectal Involvement, Regional node, Distant Metastasis. Chest radiograph (CXR), Endorectal Ultrasound (ERUS), Barium enema ( BE), Colonoscopy and treatment information were reviewed. Results: Reliability of TNM staging by CT scan interpretation were .66, .50 and .75, respectively total reliability is .75 and overall validation of CT scan staging is .40 with statistic significant at .05 reference with Pathological staging. Conclusion: There was CT scan interpretation reliability in pre and post chemoradiation for rectosigmoid cancer patients.

A young woman with rectal bleeding.

Rectal cancer is a common malignancy in Thailand. A case of 39-year-old female with rectal bleeding caused by adenocarcinoma of rectum is reported here. Successful treatment was achieved by preoperative chemoradiation therapy and low anterior resection. She is now symptom free and has good sphincter control. The history, physical examination, investigations, diagnosis and treatment are discussed.

Nocardial brain abscesses.

Five cases of nocardial infection of central nervous system were reported. All patients were immunocompromised hosts due to corticosteroid and cytotoxic drugs therapy for underlying disease. Two cases showed disseminated infection. The imagings of brain abscess were presented.