Role of diffusion-weighted MR imaging in predicting the grade of nonfunctional pancreatic neuroendocrine tumors.

PURPOSE: The purpose of this study was to describe the magnetic resonance imaging (MRI) findings including diffusion-weighted MRI of nonfunctional pancreatic neuroendocrine tumors (PanNETs) and their hepatic metastases, and investigate the relationships between MRI features and histopathological findings for each grade of PanNETs. MATERIALS AND METHODS: A total of 30 patients were included. There were 14 men and 16 women with a mean age of 61.60±11 (SD) years (range: 31-81years). PanNET lesions were analyzed qualitatively (signal intensities, contrast enhancement, lesion margins, presence of metastasis and characteristics of metastases) and quantitatively (signal intensity ratios, contrast enhancement indices and normalized apparent diffusion coefficient [ADC]). The relationships between MRI findings and histopathological findings were evaluated. RESULTS: Among 30 nonfunctional PanNETs, 11 were high-grade tumors, 10 were intermediate and 9 were low-grade tumors. All high grade PanNETs showed low to intermediate signal on T2-weighted images and ill-defined borders. All intermediate grade PanNETs had intermediate and 6 low grade PanNETs have high signal on T2-weighted images. Patients with hepatic metastases from high grade PanNETs had cystic component in 8/10 (80%) and wash-out in 7/10 (70%) whereas intermediate grade PanNETs had none (P<0.05). The normalized ADC values of high grade PanNETs was lower than those of intermediate and low grade PanNETs (P<0.05). CONCLUSION: The presence of cystic component or contrast wash-out in hepatic metastases correlates with high grade PanNETs. The pre-operative MRI combined with DWI has an important role in grading and surgical planning of PanNETs.

Variations of the celiac trunk and hepatic arteries: a study with 64-detector computed tomographic angiography.

OBJECTIVES: The aim of the present study was to evaluate variations in celiac trunk and hepatic artery with multi-detector computed tomography (MDCT). PATIENTS AND METHODS: Totally 820 patients who underwent angiography of the abdominal aorta were evaluated. Anatomical findings were grouped according to the Michels classification. RESULTS: Several variations and/or anomalies were noted in 33.2% of the patients (n=272). The most common abnormality was Michels type III (10.1%), followed by type V (7.3%), type II (4.7%) and others. Type X was not observed in our series. We have noted additional, previously unclassified variations in 12 cases (1.5%). CONCLUSIONS: Preoperative knowledge of variant anatomy may assist in the selection of treatment options and surgical planning, which in turn facilitates surgical dissection and helps avoiding iatrogenic injury. MDCT angiography allows detailed visualization of the vascular anatomy.

Role of diffusion-weighted MR in differential diagnosis of intracranial cystic lesions.

AIM: The purpose of this study was to evaluate the role of diffusion-weighted imaging (DWI) in characterizing cerebral cystic lesions. The usefulness of the apparent diffusion coefficient (ADC) map in lesion characterization was also evaluated. METHODS: We compared the findings of conventional MR images with those of DWI: 63 cystic masses in 48 patients were examined with routine MR imaging and echo-planar DWI. The routine MR imaging included at least the axial T2- and T1-weighted sequences, and post-contrast T1 axial sequences. The DWI included an echo-planar spin-echo sequence with three values (0, 500 and 1000s/mm(2)) sensitizing gradient in the x, y, z direction, and it obtained an ADC map. RESULTS: The sensitivity of DWI for differentiating abscesses from primary brain tumours was 100%; for differentiating abscesses from metastatic tumours was 73%; for differentiating benign from malignant lesions was 90%. CONCLUSION: Although some metastatic lesions may appear hyperintense on DWI thus imitating an abscess, evaluation of the lesions with both DWI and conventional MRI may have an important contribution to the differentiation of tumours from abscesses.

Visceral leishmaniasis with multiple nodular lesions of the liver and spleen: CT and sonographic findings.

Visceral leishmaniasis is a severe disease caused by the intracellular protozoa Leishmania donovani. Diagnosis is based on examination of bone marrow or serology. The role of imaging techniques as diagnostic tools remains to be established in visceral leishmaniasis. We report multiple nodular lesions in the liver and spleen on ultrasonography and computed tomography in a patient with visceral leishmaniasis. To our knowledge, this is the first reported case of multiple nodular hepatosplenic lesions in visceral leishmaniasis.

Retroperitoneal lipoblastoma involving the right common iliac artery and vein.

A case of benign lipoblastoma of the retroperitoneum in a 12-month-old boy, presenting as a huge abdominal mass and right lower extremity swelling, was reported. Surgery revealed involvement of the right common iliac artery and vein by lipoblastoma, requiring the sacrifice of both vessels for complete removal of the tumour. Vascular continuity of both vessels was re-established by a saphenous vein graft interposition. Involvement of a great artery by benign lipoblastoma has not been reported before.

Synovial cyst at the intervertebral foramina causing lumbar radiculopathy.

OBJECTIVE: To determine the presence of intraforaminal synovial cysts resulting in nerve root compression. METHODS: A 26 year old man presenting with left leg pain was admitted. He had no motor, sensory, or reflex changes. Magnetic resonance imaging (MRI) and MRI-myelography showed an intra and extra foraminal, extradural, cystic lesion at L4 vertebra on the left side. RESULTS: At surgery there was a cystic mass pressing on the nerve root, and no connection or communication with the dural structures could be found. CONCLUSION: Synovial cysts are uncommon extradural degenerative lesions. Intraspinal synovial cysts occur most often at the L4-5 level, but they have been reported in all areas of the spine except the intraforaminal region and the sacrum.

Growth rate of cerebral hydatid cyst, with a review of the literature.

This extremely rare case was one of secondary solitary cerebral echinococcosis associated with possible cerebral thromboembolism. A 7-year-old girl living in a rural area was admitted to our hospital with a history of headache, right-sided hemiparesis, and dysphasia. She had been treated 6 months previously for a cerebral infarct, diagnosed from sudden altered consciousness and a myoclonic generalised convulsion. The growth rate determined for the cerebral hydatid cyst was about 4.5 cm during the 6-month period. In children a parasitic cyst can be the source of a cerebral embolus, particularly in areas where hydatid disease resulting from cardiac echinococcosis is endemic.

Urogenital injuries in childhood: a strong association of bladder trauma to bowel injuries.

We analysed the inter-relationships of the cause and the type of trauma, the presence of pelvic fracture, the associated intraabdominal organ injuries, and the morbidity and mortality rates in 154 patients presenting and being treated for UGT between 1983 and 1997. The cause of injury was blunt in 77% of cases and penetrating in 13%. The most frequently injured organs were kidney followed by urethra and bladder. Bowels, liver and spleen were the most frequently associated injured organs. Moreover, bladder injuries were strongly associated with bowel injuries (p < 0.0001). Hemodynamically normal 49 children with minor or major kidney injuries were managed conservatively. Hemodynamically non-stable 11 patients were explored. The majority of urogenital injuries can be managed conservatively even when associated with intraabdominal organ injuries. Solid genitourinary organ injuries may accompany more frequently to intraperitoneal solid organ injury. Whereas, non-solid genitourinary organ injuries may more frequently associated with injuries of intraperitoneal hollow viscus.

Characteristics of penetrating abdominal firearm injuries in children.

Penetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children < or = 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8; 41 children had an ISS value of > or = 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value > or = 16 were hospitalized significantly longer than those with < or = 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.

Zenker's diverticulum in childhood: a new case.

Zenker's diverticulum (ZD) is a very rare pathology in childhood and to date only few pediatric cases have been reported in literature. Herein we report on a case of ZD with cervical abscess formation and oral purulent drainage in a 6-year old girl with severe malnutrition. Diverticulectomy was performed as surgical treatment. The patient is free of symptoms after two years' follow-up.

Lumbar epidural brucellar abscess causing nerve root compression.

OBJECTIVES: To evaluate the usefulness of MR sequences for the differential diagnosis of spinal brucellar abscesses which mimic lumbar disc herniation. METHODS: We analyzed six patients with brucellar abscesses who had symptoms mimicking lumbar disc herniation. The study group consisted of three women and three men who were 15-67 (mean = 37) years old. Patients were imaged in the axial and sagittal planes with a I.0-T MR scanner using a spine coil. RESULTS: The level of abscesses were accurate in 100% (six of six) of patients with MR imaging. MRI examinations revealed an extradural soft tissue mass which were iso- to hypointense compared to spinal cord on T1WI and hyperintense on T2-weighted images. By contrast study, diffuse homogeneous or slightly heterogeneous enhancements were seen. CONCLUSION: Lumbar extradural brucellar abscess can have lumbar disc disease symptoms. MRI may non-invasively and rapidly reveal the presence of spinal abscess and degree of extension to the spinal canal. Extradural brucellar abscess should be included in the differential diagnosis of radicular symptoms caused by disc herniation.