Radiofrequency thermal ablation of hepatic tumors: pitfalls and challenges.

Image-guided radiofrequency (RF) thermal ablation has been accepted as a promising interventional technique to control unresectable hepatic tumors. One important key to maximize the efficacy of RF ablation is to adhere to the therapeutic guidelines and to avoid preventable pitfalls. There are also several challenges obstructing successful ablation: poor approach path; small sonic window during multiple overlapping ablations; incomplete ablation due to the heat sink effect; subcapsular mass (too exophytic or the mass is adjacent to the gastrointestinal tract); focal residual tumors; too isoechoic or small masses; and mistargeting to adjacent another lesion. Knowledge of these challenges and pitfalls in RF ablation is helpful for a successful ablation.

Omental torsion: CT features.

A 33-year-old male presented to the emergency department complaining of right upper quadrant pain and was initially diagnosed with acute cholecystitis. Abdominal computed tomography showed a whirling pattern of fatty streaks and vessels within the greater omentum, and surgery confirmed infarction of the omentum secondary to torsion. We report a case of surgically and pathologically proven omental torsion that demonstrated the typical whirling appearance on computed tomography.

Solid and papillary epithelial neoplasm of the pancreas with peritoneal metastasis and its recurrence: a case report.

Solid and papillary epithelial neoplasm of the pancreas is a low-grade malignant tumor, generally occurring as a slowly growing upper abdominal mass in a young female. With complete excision, the prognosis is good. Malignant behavior with metastasis does occur, but the incidence is very low. We report a young woman who had this neoplasm in the pancreatic tail with peritoneal seeding and its recurrence.

Per-rectal contrast material for abdominal CT: usefulness of administration with an automatic injector.

Adequate distention of the gastrointestinal tract is essential for the best quality image in abdominal computed tomography. We introduce a new technique for per-rectal administration of contrast material with the use of an automatic injector. With this technique, more contrast material can be inserted and thus adequately distend the colon, including the proximal colon.

Peripheral cholangiocarcinoma with extensive tumor thrombi in the portal venous system: case report.

Peripheral cholangiocarcinoma is a primary liver tumor, with some features that distinguish it from hepatocellular carcinoma, especially the low incidence of vascular involvement relative to mass size. Radiologically, tumor thrombus seen as an expanding central filling defect is a rare finding of cholangiocarcinoma on computed tomography, even though microscopic invasion or vascular encasement has been reported in a few studies. We report a case of a peripheral cholangiocarcinoma with tumor thrombus expanding and spreading from the portal vein to the superior mesenteric vein.

Brenner tumor of the ovary: CT and MR findings.

PURPOSE: The purpose of this study was to determine the CT and MR characteristics of Brenner tumors, rare epithelial neoplasms of the ovary. METHOD: CT and MR scans of eight pathologically proven Brenner tumors of the ovary (seven benign, one malignant, and one associated with mucinous cystadenoma) were retrospectively reviewed. The masses were analyzed for location, size, external configuration, internal architecture, enhancement pattern, presence of calcification, and metastatic spread. RESULTS: The patients' median age was 63 years (range 39-79 years), and the mean size of the tumors was 11.4 cm (7.5-17 cm). All tumors were unilateral and had a well-defined margin. The mass was mostly solid in three, mostly cystic in one, and "mixed" solid and cystic in four cases. The tumors with cystic components (n = 5) were mostly multilocular in appearance (n = 4). All the solid components showed mild homogeneous enhancement on postcontrast CT and MRI. Extensive amorphous calcification within the solid component on CT was seen in five of six cases (83%). No characteristic findings discriminating malignancy from benign Brenner tumor could be found. CONCLUSION: Extensive amorphous calcification in a solid mass or solid component in a multilocular cystic mass is a characteristic finding of Brenner tumor of the ovary on CT and MRI.

Radiologic findings of renal hemangioma: report of three cases.

Renal hemangioma is an uncommon benign tumor which usually causes painless or painful gross hematuria. Its preoperative diagnosis is extremely difficult or even impossible. We experienced three cases of renal hemangioma, located mainly at the pelvocalyceal junction or in the inner medulla. US demonstrated variable echogenecity, and CT revealed a lack of significant enhancement. Where there is gross hematuria in a young adult, especially when the renal mass located in the pelvocalyceal junction or inner medulla shows little enhancement on CT, renal hemangioma should form part of the differential diagnosis.

Postadministration of oral contrast material for abdominal CT in patients with gastrectomy: modified drip ingestion method.

We introduce the modified drip ingestion method (MDIM) of administering oral contrast material for abdominal computed tomography (CT) in patients after gastrectomy. MDIM consists of the drip ingestion method, which we have recently reported, with additional ingestion of effervescent agent. MDIM in abdominal CT is a useful technique to improve the degree of distention of the gastrointestinal lumen including anastomotic sites in patients after gastrectomy.

MR imaging of primary uterine lymphoma.

Primary malignant lymphoma of the uterus is a rare disease. We present the MR findings in three cases where the uterus was the initial site. MR findings wer retrospectively evaluated. Although the intact junctional zone is a specific finding for lymphoma, diffuse enlargement of the uterus and relatively homogeneous signal intensity on MR imaging in spite of large tumor size are helpful for diagnosing uterine lymphoma.

Remote consultation for computerized tomography and magnetic resonance studies by means of teleradiology--experience at the Singapore General Hospital.

A teleradiology link was established between Singapore General Hospital in Singapore and Stanford University in California, USA. Over eight months, a total of 28 cases (involving 27 magnetic resonance investigations and three computerized tomography scans) were transmitted by ISDN to California. Our initial experience with teleradiology for remote consultation was encouraging, although the data transmission cost was higher than we anticipated. however, costs could be reduced by using data compression. Long-distance telecommunication charges continue to fall, so intercontinental teleradiology of this type may be financially viable in future.

Systemic lupus erythematosus with obstructive uropathy. Case report and review.

We report a case of patient with documented SLE who displayed dysuria, gastrointestinal (GI) symptoms and renal insufficiency associated with the unusual occurrence of bilateral hydroureteronephrosis due to urterovesical junction stricture (obstructive uropathy). Pathologic investigations disclosed chronic interstitial cystitis (IC) with evidence of focal immune complex deposition in the blood vessel walls of the bladder. The GI symptoms and dysuria regressed with initial therapy for SLE with steroids. However, the persistent obstructive uropathy (OU) and renal insufficiency required bilateral nephrostomy followed by steroids plus intravenous pulse injection of cyclophosphamide. The obstructive uropathy was relieved even after removing the nephrostomy tube and renal function remained stable. Including this case, nineteen SLE patients associated with clinical and radiographic findings of OU were found in the world literature and reviewed to find any consistent pattern of clinical features. Most of the patients with OU in SLE were female (mean age, 31.7 yr) and orientals (63%), and had interstitial cystitis (89%) as a common underlying cause with concomitant involvement of the GI tract (89%) and WHO class IV or V advanced glomerulonephritis (67%). Despite the remarkable response (68%) to steroids in majority of OU patients associated with SLE, certain patients still required surgical correction (32%) and some even died (32%). OU, potentially reversible, was not an exception in patients with SLE, which might be overshadowed by other major organ involvement of SLE.