Leiomyosarcoma of the Ovarian Vein: a Case Report with Radiological Findings

Leiomyosarcomas of the ovarian vein are very rare. Four cases have been reported in the English language clinical literature. We present a case of leiomyosarcomas where the use of multi-detector CT had a substantial role in the establishment of the preoperative diagnosis. The radiological images as well as intraoperative features are illustrated. We also discuss the radiological findings of the ovarian vein leiomyosarcoma in comparison with those of other venous or retroperitoneal leiomyosarcomas. We expect that the use of multi-detector CT will be the choice for the diagnostic work-up of vascular leiomyosarcomas.

Central Lucency of Pelvic Phleboliths: Comparison of Plain Radiographs and Noncontrast Helical CT

PURPOSE: Central lucency of pelvic phleboliths is frequently observed on plain pelvic radiographs. When it is also present on noncontrast helical CT images, pelvic phleboliths may be easily diagnosed, with no suspicion of distal ureteral calculi. The objective of this study was to determine the frequency with which this phenome-non is seen on plain radiographs and noncontrast helical CT images. MATERIALS AND METHODS: During a recent two-year period we identified 70 patients with renal colic who under-went both abdomino-pelvic radiography and noncontrast helical CT scanning. Radiographs were obtained at 70 -85 kVp and 30 -40 mA; CT scans were preformed within one month of plain radiography with parameters of 120 kVp, 200 -220 mA, 5-mm collimation, and pitch of 1 -1.6, and using soft tissue and bone window settings. With regared to the central lucency of pelvic phleboliths, as seen on both on radiographs and CT im-ages, two experienced radiologists reached a consensus. RESULTS: Among the 70 patients, a total of 150 pelvic phleboliths was found. In all cases except one, pelvic radi-ography and noncontrast helical CT revealed the same number of phleboliths. The exception was a case in which one of two phleboliths demonstrated by CT was not seen on radiographs. Pelvic radiography revealed central lucency in 95 of these 150 phleboliths (63%), but noncontrast helical CT failed to depict a hypodense center in any phlebolith. CONCLUSION: Central lucency of pelvic phleboliths, as frequently seen on plain pelvic radiographs, was not revealed by routine noncontrast helical CT in any patient.The presence or absence of central lucency on these CT images cannot, therefore, be used to differentiate phleboliths from distal ureteral calculi.

Spiral CT Venography in Central Venous Obstruction

PURPOSE: To determine the clinical usefulness of spiral computed tomographic (CT) venography for theevaluation of central venous obstruction. MATERIALS AND METHODS: The authors prospectively performed a total of29 spiral CT venography procedures in 25 consecutive patients with suspected central venous obstruction. Dilutedcontrast media were directly injected into the peripheral veins of the hand or the foot. Scan parameters were 3 mmX-ray beam collimation, table speed of 4-6 cm/sec, scan time of 32-40 sec, and injection delay of 20 sec. Axialimages were reconstructed at 2-mm intervals, and using shaded surface display (SSD), maximum intensity projection(MIP), and multiplanar reformation (MPR), 3-D reconstruction was performed. In all cases, ascending venograp-hy(n=13) and/or direct catheter venography (n=21) was performed within 2 days of CT venography. With regard to site,extent, extent, severity, and cause of obstruction and collateral circulation, we compared the results of CT andcontrast venography. RESULTS: In 24 patients, a total of 56 sites of central venous obstruction or stenosis(>50%) were demonstrated. The causes of obstruction were venous thrombosis (n=6), malignant tumors (n=4),arteriovenous fistula for hemodialysis (n=5), extrinsic compression (n=2), coincidence of extrinsic compressionand arteriovenous fistula (n=1), pacemaker (n=1), mediastinal inflammatory pseudotumor (n=1), spinal tuberculosis(n=1), membranous obstruction of the hepatic inferior vena cava (n=1), Behcet's disease (n=1), or unknown cause(n=1). When compared with ascending venography (n=13), CT venography was superior for evaluation of the extent andcause of obstruction and collateral circulation in two, four and one case(s), respectively. For the evaluation ofsite and severity of obstruction, CT venography was equal to ascending venography. In two cases, direct cathetervenography (n=21) was superior to CT venography for evaluating the obstruction site, but in three, five and onecase(s) respectively, CT venography was superior to direct catheter venograp-hy for evaluating the extent andcause of obstruction and collateral circulation. For the evaluation of severity of obstruction, CT and directcatheter venography were equal. CONCLUSION: In patients with suspected central venous obstruction, spiral CTvenography can be an alternative to replace not only conventional CT but also direct contrast venography.

The Significance of Collateral Vessels, as Seen on Chest CT, in Predicting SVC Obstruction

PURPOSE: To evaluate the significance of collateral veins, as seen on chest CT, in the diagnosis of superiorvena cava obstruction. MATERIAL AND METHOD: We retrospectively reviewed the records of 81 patients in whomcollateral veins were seen on chest CT. On spiral CT(n=49), Contrast material was infused via power injector, andon conventional CT(n=32), 50ml bolus infusion was followed by 50ml drip infusion. Obstruction of the SVC wasevaluated on chest CT ; if, however, evaluation of the SVC or its major tributaries was difficult, as in fivecases, the patient underwent SVC phlebography. Collateral vessels were assigned to one of ten categories. RESULT: On conventional CT, the common collaterals showing statistically significant difference between the two groupswere the jugular venous arch in the group with venous obstruction(n=6/15, 40.0%), and around the back and scapula(n=15/17, 88.2%) and paravertebral system(n=12/17, 70.6%) in the group without venous obstruction. On helical CT,the most common collaterals were around the back and scapular (n=9/14, 64.3%; n=26/35, 74.3%, respectively) andthe paravertebral system (n=9/14, 64.3%, n=22/35, 62.9%, respectively) in both groups, with or without venousobstruction. No collateral showed a statistically significant difference between the two groups. CONCLUSION: Onconventional CT, the jugular venous arch is the only collateral vessel to predict SVC obstruction ; on spiral CT,however, collateral vessels are not helpful in the diagnosis of SVC obstruction, but are a nonspecific finding.

The Difference of Variceal Distribution in the Portal Hypertension on CT between Hemorrhagic and Nonhemorrhagic Groups

PURPOSE: To determine whether there is any difference in variceal distribution between patients with and without a history of esophageal variceal bleeding. MATERIALS AND METHODS: To compare the distribution of varices, abdominal CT scans of 24 patients with a history of esophageal variceal bleeding (hemorrhagic group) and 90 patients without a history of bleeding (non-hemorrhagic group) were retrospectively assessed. RESULTS: The most common varices in both the hemorrhagic (n = 21, 87.5 %) and nonhemorrhagic group (n = 53, 58.9 %) were coronary varices, with a statistically significant frequency (p < .01). Esophageal varices were also more common in the hemorrhagic than the nonhemorrhagic group (n=19, 79.2 % vs n = 36, 40.0 % : P < .005). Splenorenal shunts were more common in the nonhemorrhagic (n = 8, 8.9 %) than in the hemorrhagic group(n = 0, 0 %) (P < .05). Other types of varice such as paraumbilical (n = 10, 41.7 % vs n = 21, 23.3 %), perisplenic (n = 6, 25 % vs n = 15, 16.7 %) and retroperitoneal-paravertebral (n = 11, 45.8 % vs n = 24, 26. 7 %) were more common in the hemorrhagic group, but without a statistically significant frequency. CONCLUSION: The frequency of coronary and esophageal varices was significant in patients with a history of esophageal variceal bleeding. In patients without such a history, splenorenal shunts were seen.

Comparison of Computed Tomography and Endoscopy in the Diagnosis and Grading of Esophageal Varices: Value of Computed Tomography for Predict Prognosis of Chronic Liver Disease

PURPOSE: To evaluate the sensitivity and specificity of conventional CT of abdomen in the detection of esophageal varices, and to correlate CT grade of esophageal varices with prognosis and risk for bleeding. MATERIALS & METHODS: Both CT and endoscopy were performed in 100 patients. Endoscopy revealed that while 54 patients had varices, 46 did not. CT criteria of variceal grading were follows : (1) wall thickening of more than 5mm or irregular wall contour(grade I) ; (2) intraluminal protruding tubular structures with contrast enhancement(grade II) ; (3) confluent varices in the wall of esophagus or multiplied paraesophageal collaterals(grade III). CT were reviewed by three radiologists without reference to clinical and endoscopic data. RESULTS: Sensitivity and specificity of CT in the detection of esophageal varices were 80%, retrospectively. CT and endoscopic grades agreed with each other in 68% of patients, and there was high correlation between CT and endoscopy.(Gamma statistics, p=0.828). No history or endoscopic evidence of variceal bleeding was present on gradeI, but there was a high incidence on grade II(35%) and on grade III(50%)(MH Chi-Square, Ridit scores=50.561,p=0.000). CONCLUSION: Abdominal CT is useful in the detection of esophageal varices, and can predict the risk factors of bleeding in patients with chronic liver diseases.