MR imaging of primary malignant bone tumors with surgical and histopathological correlation

Background: A bone tumor is a neoplastic growth of tissue in bone. Abnormal growths found in the bone can be either benign (noncancerous) or malignant (cancerous). Aims and objectives: The purpose of this study was to evaluate the role of MRI in cases of primary malignant bone tumors and MRI characteristics of different primary malignant bone tumors, to compare the imaging findings with surgical and gross pathological findings, Staging of tumor on MRI, correlating them with operative and histopathological findings. Materials and methods: This was a prospective study done in Department of Radiodiagnosis of NRIGH comprising of 40 patients 21 male and 19 female who were suspected or proven cases of the malignant bone tumor. Plain radiographs in AP and Lateral views (including the adjacent joint) were taken in all cases. The primary pulse sequences included T1 and T2 WI using spine echo and gradient echo techniques with TR of 600 msec. and TE 30msec. for T1WI and TR of 2740 msec. and TE of 85 msec. for T2 WI . The MR morphology was correlated with surgical and histopathological features. Results: The study “Multiplanar MR Imaging of primary malignant bone tumors with surgical and histopathological correlation” comprised of 40 patients in a two year period starting from august 2010 to September 2012 the age ranged from 8 years to 71 years (mean 40 years). There were 21 males and 19 females. Conclusion: MRI in combination with plain radiography is an excellent modality for evaluation of the musculoskeletal pathologies especially differentiating a malignant from a benign lesion. The multiplanar imaging capabilities place a major role in delineation of tumour extent in to the bone and Karuna V, R Vikash Babu. MR imaging of primary malignant bone tumors with surgical and histopathological correlation. IAIM, 2019; 6(10): 8-21. Page 9 soft tissues with high contrast and resolution with additional information of neurovascular bundle involvement, joint involvement and staging.

Intracranial ruptured dermoid cyst presenting as dysarthria: A case report

Intracranial dermoid cysts are tumors which are rare and are derived from ectopic epithelial cells. These dermoid cysts are slow-growing and are benign; they can cause morbidity by compressing the neurovascular structures. They also do rupture rarely into the subarachnoid space. Dermoid cystic tumors arise from the inclusion of ectodermal committed cells at the time of neural tube closure during the third to fifth week of embryogenesis. These lesions are slow growing due to the active production of hair and oils from the internal dermal elements. This is a case of a ruptured intracranial dermoid presenting as slurring of speech caused by the fat droplets.

CT Findings of Acute Gangrenous Cholecystitis

PURPOSE: Acute gangrenous cholecystitis (AGC) is a severe advanced form of cholecystitis, and it has a higher morbidity and mortality rate than that that of acute nongangrenous cholecystitis (ANGC). Identifying the CT findings of gangrenous cholecystitis will enable physicians to make an early diagnosis and administer aggressive treatment. METHODS: From January 2005 to October 2007, the CT scans in 277 patients (80 with AGC, 149 with ANGC and 45 with normal gallbladder (NGB)) were retrospectively reviewed by 2 radiologists. We evaluated the findings that included wall thickening (>3mm), distension (transverse diameter > 5cm), gallstones, pericholecystic fluid, pericholecystic inflammation, mural striation, adjacent hepatic enhancement, pericholecystic abscess, an intraluminal membrane, an irregular or absent wall, gas in the wall or lumen, and intraperitoneal fluid. The sensitivity and specificity of the each CT finding for diagnosing AGC were calculated. The dimension and wall thickness of the gallbladder were also measured. RESULTS: The sensitivity, specificity and accuracy of CT for diagnosing AGC were 27%, 94% and 74%, respectively. The findings with the highest specificity for AGC were gas in the wall or lumen (100%), intraluminal membranes (99.5%), pericholecystic abscess (99.5%), an irregular or absent wall (98.5%), adjacent hepatic enhancement (97.9%), intraperitoneal fluid (96.9%), pericholecystitic fluid (95.6%), and mural striation (93.8%). The difference of the mean gallbladder wall thickness between the groups was statistically significant. CONCLUSION: These specific CT findings, including the GB wall thickness, will assist clinicians in making an earlier and more exact diagnosis of gangrenous cholecystitis

Computed tomographic findings in differentiating between diverticulitis and colon cancer.

Objective: To determine the computed tomographic (CT) findings associated with diverticulitis or colonic cancer, and to evaluate the CT signs that may help in distinguishing between these two diseases. Methods: Fifty-five CT scans of patients with colonic diverticulitis (n=17) or colonic cancer (n=38) between January 2002 to October 2005 were retrospectively and independently evaluated by two abdominal radiologists who were blinded to the proved diagnosis. Discrepancies of each CT finding were resolved by consensus opinion. CT findings were assessed as follows: location of involved colon, length of involved segment, degree of pericolonic inflammation, pericolonic lymph nodes, thickness and pattern of bowel wall thickening, presence or absence of simple diverticula at the involved colonic segment, inflamed diverticula, intramural sinus tract, fistula, muscular wall hypertrophy, “arrowhead” sign, extraluminal air and bowel obstruction. The inter-observer agreement was assessed with the kappa statistic. The association of consensus opinion of each CT findings with the final diagnosis of colonic diverticulitis or colon cancer were evaluated by using chi-square test and odds ratios. Results: Bowel wall thickness less than 1 cm ( p < 0.0001, odds ratio 32.89, 95% CI 3.31,798.5), presence of simple diverticula at involved segment ( p < 0.001, odds ratio 28.13, 95% CI 4.56, 266.11), presence of inflamed diverticula ( p = 0.003, odds ratio 15.42, 95% CI 1.46, 386.32) and symmetrical pattern of bowel wall thickening( p < 0.0001, odds ratio 13.07, 95% CI 2.66, 73.36) were the statistically significant CT findings which are found more frequently in colonic diverticulitis than in colon cancer. On the other hand, bowel wall thickness 1 cm or greater, eccentric pattern of bowel wall thickening without evidence of simple diverticula or inflamed diverticula at the involved colonic segment were the statistically significant CT findings seen more frequently in colon cancer than in diverticulitis. Conclusion: Bowel wall thickness less than 1 cm, presence of simple diverticula at the involved segment, presence of inflamed diverticula and symmetrical pattern of bowel wall thickening were the helpful CT findings in distinguishing colonic diverticulitis from colon cancer. Bowel wall thickness 1 cm or greater, eccentric pattern of bowel wall thickening without evidence of simple diverticula or inflamed diverticula at the involved colonic segment were the useful CT findings in distinguishing colon cancer from colonic diverticulitis.

Solitary Fibrous Tumor Arising from Stomach: CT Findings

Solitary fibrous tumors are spindle-cell neoplasms that usually develop in the pleura and peritoneum, and rarely arise in the stomach. To our knowledge, there is only one case reporting a solitary fibrous tumor arising from stomach in the English literature. Here we report the case of a 26-year-old man with a large solitary fibrous tumor arising from the stomach which involved the submucosa and muscular layer and resembled a gastrointestinal stromal tumor in the stomach, based on what was seen during abdominal computed tomography. A solitary fibrous tumor arising from the stomach, although rare, could be considered as a diagnostic possibility for gastric submucosal tumors.

Rapidly Growing Small Peripheral Lung Cancers Detected by CT:Correlation Between CT Manifestation and Pathological Features / 医学研究杂志

Objective To characterize the CT features of peripheral small lung cancers of fast growthing and to correlate such features with pathological findings.Methods 12 peripheral small lung cancers(

The Management Strategy of Spontaneous Subarachnoid Hemorrhage in Patients with Initial Negative Angiogram

OBJECTIVE: The aim of this retrospective clinical study is to provide a proper management strategy for patients who present spontaneous subarachnoid emorrhage(SAH) with negative initial angiogram by investigating the clinical features, long-term outcomes and radiologic characteristics. METHODS: One hundred and twenty-eight out of 2887 SAH patients who were admitted to neurosurgery department from 1986 to 2002 had negative initial angiogram. We classified the 128 patients into 3 groups(Group I: no evidence of SAH on CT but confirmed by lumbar puncture, Group II: perimesencephalic(PM) SAH pattern, Group III: non-perimesencephalic(NPM) SAH pattern), and reviewed the radiologic findings, the clinical features, the rebleeding rate, the long-term outcome, and the results of repeated angiogram. Factors related to the false negative initial angiogram were also reviewed. RESULTS: The patients were 9(7.0%) in Group l, 85(66.4%) in Group ll, and 34(26.6%) in Group lll. There was no difference in long-term clinical outcome. Ninety-two out of 128 patients underwent a repeated angiogram in which 18 patients were found to have ruptured aneurysms that were not detected on the initial angiogram(false negative rate: overall 19.6%, 1.8% in Group II, 50.0% in Group lll). Small size( < 6mm) aneurysms, spasms, hematomas, and anterior communicating aneurysms were the factors affecting false negative initial angiogram. CONCLUSION: In SAH patients with negative initial angiogram, espeacially those who had a non-perimesencephalic SAH pattern on initial CT findings, a repeated angiogram should be considered for identifying the hidden ruptured aneurysm.

Acute Bacterial Renal Infection: Role of Computed Tomography / 대한비뇨기과학회지

Renal bacterial infection spans a continuum of severity from uncomplicated acute pyelonephritis through progressively worsening stages of interstitial inflammation to abscess formation. This study was done to evaluate CT findings in acute bacterial renal infection and correlation of clinical symptoms and renal scarring with CT findings. We studied 58 cases of acute pyelonephritis who were diagnosed clinically. Most of them had prolonged fever( >72 hours) and some of them suspected severe renal infections. We classified the patients regarding to CT findings. 58 cases were grouped into, 1) Group I (7 cases), normal or renal enlargement only; 2) Group II(31 cases), wedge-shaped lesions ( focal or diffuse) , 3) Group III(6 cases), focal mass-like lesions; 4) Group W(9 cases) , diffuse ( multifocal) mass-like lesions; 5) Group V (5 cases) , renal abscesses. There was the good correlation between the clinical parameters ( duration of fever, duration of hospitalization) and CT findings (P 0.05). To demonstrate the presence of renal scar, we recommended DMSA scan in 15 cases of ABN (Group III and Group IV). 8 cases were performed DMSA scan and renal scar formation was found in 3 cases( 2 cases in Group III and another 1 case in Group IV). Because the size of abscess was small( <3cm), the patients of renal abscess(5 cases) were treated with antibiotics only and their clinical symptoms were improved. Second CT scanning was performed in 3 cases and their CT findings showed resolution of renal abscess. We concluded that computed tomography is selectively indicated in acute renal bacterial infection for the detection of acute renal inflammatory disease and for defining the extent of disease for planning of treatment.

Isolated Traumatic Ganglionic Hemorrhage

The authors present a series of 6 patients with isolated traumatic ganglionic hemorrhage. Although the patient population is small, some characteristic features of this rare type of traumatic lesion can be drawn. Isolated traumatic ganglionic hemorrhage differs from traumatic intracerebral hemorrhage or diffuse white matter injury, but also shares some features of both types of lesion. Some characteristic CT findings of isolated traumatic ganglionic hemorrhage are discussed. The prognosis of this lesion can be predicted by the degree of motor deficit and pupillary change with high accuracy.

Evaluated Value of Multimodality Evoked Potential in Vascular Lesions of the Thalamus

We reviewed the cases of 9 patients with vascular lesions in thalamus, 5 hemorrhage and 4 infarctions that were confirmed clinical and CT findings. Generally CT scan and clinical datas proved to be helpful to the diagnosis and prognosis to thalamic lesion. However, these findings are not exactly correlated to prognosis of patients. We can gain more informative factors to our patients for Multimodal evoked potential examination (MEP) to analysis. Especially in our cases, MEP findings proved to be the most effective results in the determinations of the prognosis. We review the literature and discuss the treatment and discuss the treatment and prognosis in thalamic lesion. Emphasis is placed on the current and optimal method of the evaluation of prognosis in thalamic lesions using MEP combined with the finding of CT scan and clinical status.

Abnormal Brain CT Findings of Tuberous Sclerosis / 대한피부과학회지

The lesions of central nervous system in tuberous sclerosis often calcify, especially those present in the perivascular region, allowing the computed tomography to make early and definite diagnosis, even when patients intelligence was normal, seizures were absent, or clinical findings were not specific, We report three cases of tuberous sclerosis, which showed pathognomic subependymal paraventricular calcification in brain CT.

Clinical Observations of microabscess: Its diagnosis & managements

Recently for 2 years, 24 cases of microabscesses have been experienced and treated at St. Paul's Hospital, Catholic Medical College. Investigations had been made & analyzed to characteristic clinical symptoms and signs, typical CT findings and therapeutic management and prognosis. The CT scan is most choice of and early and accurate diagnosis and has made feasible the follow up of the evolution and eventual resolution of abscess lesions. In the authors opinion and experience, when microabscess is diagnosed at it early stage, it could be treated in 2week with the administration of antibiotics & not need any other surgical interventions.