Docetaxel (Taxotere®)-induced cavitary change of pulmonary metastatic lesions complicated by bilateral spontaneous pneumothoraces in a patient with primary adenocarcinoma of the lung.

Pneumothorax is a complication that rarely occurs after chemotherapy for lung cancer. We report the chest computed tomography findings of a case of spontaneous pneumothorax complicating docetaxel (Taxotere®) treatment for pulmonary metastasis in a 70-year-old woman with pulmonary adenocarcinoma. The patient developed bilateral pneumothoraces, which was induced by changes in the cavitary pulmonary metastatic lesions, after systemic chemotherapy with docetaxel. The chest computed tomography findings and possible mechanisms of this unusual complication are discussed in this report.

Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect.

BACKGROUND: Microvascular free flap transplantation is the current most common choice for reconstruction of difficult through-and-through buccal defect after cancer extirpation. The chimeric anterolateral thigh (ALT) flap is an ideal flap to cover this full thickness defect, but variation in the location of perforators is a major concern. Herein, we introduce computed tomographic angiography (CTA)-guided mathematical perforators mapping for chimeric ALT flap design and harvest. METHODS: Between September 2008 and March 2009, nine patients with head and neck tumour underwent preoperative CTA perforator mapping before free ALT flap reconstruction of full thickness buccal defects. The perforators were marked on a 64-section multi-detector CT image for each patient, and the actual perforator locations were correlated with the intra-operative dissection. The donor limb of choice, either right or left, was also selected based on the dominant vascularity. Flap success rates, any associated morbidity and complications were recorded. RESULTS: A total of 23 perforators were identified on CTA image preoperatively. Twenty-two of these perforators were chosen for chimeric flap design, and all were located as the CTA predicted, with the rate of utilization being 95.7% (22/23). There were two post-operative complications, including one partial flap necrosis and one microstomia. All of the ALT flaps survived, and there was no donor site morbidity. CONCLUSIONS: Preoperative CTA allows accurate perforator mapping and evaluation of the dominant vascularity. It helps the surgeon to get an ideal designing of the chimeric ALT flap with two skin paddles based on individual perforators, but only one vascular anastomosis in reconstruction of full thickness buccal defects.

Incidentally detected enhancing breast lesions on chest computed tomography.

OBJECTIVE: To evaluate the nature and imaging appearance of incidental enhancing breast lesions detected on a routine contrast-enhanced chest CT. MATERIALS AND METHODS: Twenty-three patients with incidental enhancing breast lesions on contrast-enhanced chest CT were retrospectively reviewed. The breast lesions were reviewed by unenhanced and enhanced CT, and evaluated by observing the shapes, margins, enhancement patterns and backgrounds of breast lesions. A histopathologic diagnosis or long-term follow-up served as reference standard. RESULTS: Sixteen (70%) patients had malignant breast lesions and seven (30%) had benign lesions. In 10 patients, the breast lesions were exclusively detected on contrast-enhanced CT. Using unenhanced CT, breast lesions with fibroglandular backgrounds were prone to be obscured (p < 0.001). Incidental primary breast cancer showed an non-significant trend of a higher percentage irregular margin (p = 0.056). All of the four incidental breast lesions with non-mass-like enhancement were proven to be malignant. CONCLUSION: Routine contrast-enhanced chest CT can reveal sufficient details to allow for the detection of unsuspected breast lesions, in which some cases may be proven as malignant. An irregular margin of incidental enhancing breast lesion can be considered a suggestive sign of malignancy.

Complex cystic lesions of the breast on ultrasonography: feature analysis and BI-RADS assessment.

PURPOSE: To analyze the features of breast complex cystic lesions at ultrasonography (US) and to determine appropriate Breast Imaging Reporting and Data System (BI-RADS) categories and management recommendations for these lesions based on US findings with pathologic correlation. MATERIALS AND METHODS: From July 2001 to June 2007, 152 consecutive pathologically proven complex cystic lesions on US were retrospectively reviewed. All lesions at US were evaluated for size, lesion characteristics, margins, and presence of abnormal axillary nodes. US features of lesions were classified into four types, and positive predictive values (PPVs) were calculated for each type. Clinical, imaging, and histopathological findings were reviewed. RESULTS: Of the 152 lesions based on US appearance, 36 (24%) were classified as type I, 49 (32%) as type II, 28 (18%) as type III, and 39 (26%) as type IV. The PPVs for malignancy in each type were 14% for type I, 16% for type II, 14% for type III, and 41% for type IV. There was a significantly higher frequency of malignancy among lesions of type IV compared with the other three types (16/39=41% vs 5/36=14%, p=0.0089; 16/39=41% vs 8/49=16%, p=0.0098; and 16/39=41% vs 4/28=14%, p=0.018 [Chi-squared test]). Lesions with maximum diameter equal to or larger than 20mm, not circumscribed margins, or a mammographic finding of suspected malignancy had a high probability of malignancy (p<0.05 for each). CONCLUSION: US is useful in evaluating the complex cystic lesions and in clarifying the indication for biopsy of these lesions. The four types of US classifications used in our study establish accepted benchmarks for these breast abnormalities when stratified according to BI-RADS categories.

Value of sonographically guided needle sampling of cystic versus solid components in the diagnosis of complex cystic breast masses.

BACKGROUND: The common practice for diagnosis of complex cystic breast masses (CCBM) may be imaging-guided aspiration or biopsy of cystic or solid components. PURPOSE: To assess the diagnostic value of sonographically guided needle sampling of cystic and solid components for CCBM. MATERIAL AND METHODS: Twenty patients with 20 CCBM underwent sonographically guided fine-needle aspiration biopsy (FNAB) for cystic components, followed by core needle biopsy (CNB) for residual solid components. The diagnostic results of each were evaluated. Excisional biopsy or mastectomy served as a reference standard. RESULTS: Fourteen (70%) masses were malignant. Needle sampling for cystic components of the 14 malignant tumors showed malignancy in one (7%), atypia in four (29%), benign findings in four (29%), and insufficient samples in five (36%). Needle sampling for residual solid components showed malignancy in 11 (79%), atypia in two (14%), and insufficient sample in one (7%). The diagnostic yield of needle sampling of solid components was significantly higher than that of cystic components for malignant CCBM (P<0.05). Sixteen (80%) of 20 CCBMs showed bloody fine-needle aspirates. There was no significant difference between the rates of bloody aspirates of malignant and benign CCBM (86% vs. 67%, P=0.55). CONCLUSION: Sonographically guided needle sampling of solid components may help to identify most malignant CCBMs, and the aspirated fluid may be discarded due to low diagnostic value.

Atypical pulmonary metastases from a true malignant mixed tumor of the parotid gland.

A 58-year-old male patient presented with a recurrent true malignant mixed tumor of the parotid gland. Patchy pulmonary opacities were identified with a chest radiograph. Subsequently, a CT scan of the chest showed pulmonary parenchymal consolidation with amorphous calcifications. This abnormality was confirmed to be the result of a metastatic true malignant mixed tumor by using CT-guided biopsy. The current case demonstrated an extremely rare example of atypical pulmonary metastases from a true malignant mixed tumor of the parotid gland showing an air-space pattern and calcification.

A late complication of augmentation mammoplasty by polyacrylamide hydrogel injection: ultrasound and magnetic resonance imaging findings of huge galactocele formation in a puerperal woman with pathological correlation.

Polyacrylamide hydrogel (PAAG) was widely used for injection augmentation mammoplasty in Eastern Europe and China although uncommon in the western countries. However, the safety of this procedure remained controversial. Herein, we report a 30-year-old woman with a history of augmentation mammoplasty by PAAG injection developed galactoceles during her pregnancy. Ultrasound and magnetic resonance imaging showed huge cystic lesions in bilateral breasts; as a result, the normal breast tissue was almost completely replaced. On the basis of the imaging findings, the patient underwent mastectomy as well as immediate breast reconstruction with satisfactory outcome. It is important to be familiar with the imaging findings of this rare yet severe complication after augmentation mammoplasty in order to make an accurate diagnosis and a proper management.

Enhancement characteristics of ultrasmall superparamagnetic iron oxide particle within the prostate gland in patients with primary prostate cancer.

OBJECTIVE: To analyze the enhancement of the prostate using ultrasmall superparamagnetic iron oxide (USPIO)-enhanced magnetic resonance imaging in patients with prostate cancer. METHODS: Sixty patients were enrolled. The signal-to-noise ratios (SNRs) of the central and peripheral zones (CZ and PZ, respectively) of the prostate were evaluated on T2- and T2*-weighted magnetic resonance imaging before and 24 hours after USPIO-enhanced MRI. The changes in SNR after USPIO-enhanced MRI were analyzed and correlated with serum prostate-specific antigen and histopathologic Gleason scoring based on surgically removed prostate gland. RESULTS: Decrease in SNR was noted in each zone of the prostate after USPIO-enhanced MRI (P < 0.001). Mean SNR decrease in the CZ was higher than that in the PZ (P < 0.05). High-grade prostate cancer was associated with a higher decrease in SNR (P < 0.05). The SNR change was negatively correlated with serum prostate-specific antigen at low or intermediate levels (P < 0.05). CONCLUSIONS: Enhancement of the prostate gland after USPIO administration may be associated with primary prostate cancer.

Value of automated coronal reformations from 64-section multidetector row computerized tomography in the diagnosis of urinary stone disease.

PURPOSE: We determined the value of automated coronal reformation using 64-detector computerized tomography for the detection of urinary stones. MATERIALS AND METHODS: A total of 72 patients underwent unenhanced 64-detector computerized tomography to diagnose urinary stones. Two radiologists independently reviewed coronal reformations and axial images at separate reading sessions. The stone detection rate, reader confidence and interpretation time per radiologist were recorded. Two radiologists reviewed coronal and axial images in consensus and served as the reference standard. RESULTS: A total of 175 stones were diagnosed by consensus. Using coronal reformations 162 stones (92.6%) were detected by reader 1 and 157 (89.7%) were detected by reader 2. Using axial images 157 stones (90.3%) were detected by reader 1 and 155 (88.6%) were detected by reader 2. The reading time of coronal reformations was significantly shorter than that of axial images for each reader (p <0.01). Using coronal imaging to complement axial imaging 12 additional stones were detected and 23 were diagnosed with increased confidence by reader 1, while an additional 15 were detected and 8 were diagnosed with increased confidence by reader 2. The mean size of stones detected with coronal reformations alone was significantly smaller than that of the total stones. Excellent interobserver agreement was noted for coronal reformations and axial images (kappa coefficient: 0.91 and 0.904, respectively). CONCLUSIONS: Review of automated coronal reformations allows equally accurate and more rapid detection of urinary stones compared with axial images alone. In addition, coronal reformation of 64-detector computerized tomography adds value when used in conjunction with axial data sets.

An unusual case of thymic carcinoma with endobronchial metastases manifesting as centrilobular opacities.

We report a case of a 75-year-old man having unusual manifestation of thymic carcinoma associated with endobronchial metastases. To our knowledge, endobronchial metastases secondary to thymic carcinoma has not been reported in the literature. On high-resolution computed tomograms, the tree-in-bud centrilobular opacities caused by metastatic cells accumulating within the small bronchioles is indistinguishable from that caused by inflammatory process. Thus, in patients with thymic carcinoma and persistent tree-in-bud centrilobular opacities, endobronchial metastatic disease should be considered.

Assessment of CT urography in the diagnosis of urinary tract abnormalities.

BACKGROUND: To evaluate the accuracy of helical computerized tomography urography (CTU) in diagnosing urinary tract disease. METHODS: We collected 102 patients who underwent CTU from March 2001 to September 2002. The clinical symptoms of these patients included: flank pain or hematuria, which were clinically suggestive of urinary system disorders. All patients received CT scan with or without intravenous contrast medium administration, except patients who had allergy history or poor renal function. Reformatted CT urography was performed and the accuracy of imaging diagnosis was evaluated. RESULTS: Of these 102 patients, 40 cases were proved to have urolithiasis, 24 cases were with renal or ureteral tumors, and there were 38 cases of other urinary system disorders (including inflammation, ureteral stricture and congenital anomalies). Precontrast CTU correctly diagnosed 39 of 40 urolithiasis cases (97.5%). Precontrast and contrast-enhanced CTU were performed in the non-urolithiasis group and correctly diagnosed 23 cases of renal or ureteral tumors, 4 cases of congenital disorder (2 duplications, 1 congenital renal agenesis due to VATER syndrome and 1 retrocaval ureter). Five of 34 patients with chronic inflammatory process of urinary tract or ureteral stricture were indistinct from malignancies according to the imaging of CT urography. CONCLUSIONS: CTU is good modality for demonstration of urinary tract disorders. It is better in showing radiolucent stones and non-opacified urinary system. CTU demonstrates more soft tissue information than IVU in the patients with urinary tract tumors. CTU may be an alternative modality for patients with deterioration of renal function or allergic history of contrast medium.

Diagnostic value of unenhanced computerized tomography urography in the evaluation of acute renal colic.

This study prospectively evaluated the diagnostic value of unenhanced computerized tomography (CT) urography in patients with acute renal colic. Fifty-nine patients with clinical manifestations of acute renal colic underwent unenhanced helical CT to evaluate urinary tract abnormalities. Reformatted three-dimensional CT urography was performed in all patients. The findings were correlated with ureteroscopy, surgical findings, histopathologic findings, and clinical course. CT urography detected urinary abnormalities in 57 of 59 patients with the clinical manifestation of acute renal colic, including 45 cases of urolithiasis, three urinary malignancies, one congenital abnormality, and eight ureteral strictures (due to chronic inflammation or fibrosis). CT urography showed negative findings in the urinary system in two patients, and after clinical follow-up, urinary abnormality was excluded in these patients. Incidental findings of extrarenal disease were noted in six patients (pulmonary abnormalities, n = 2; gallstones, n = 4). Only one patient with urolithiasis was misdiagnosed as having a renal tumor by CT urography. The sensitivity and specificity of CT urography in diagnosing urolithiasis was 97.8% (44/45) and 100% (14/14), respectively. Three-dimensional CT urography is a newly developed modality to evaluate anomalies of the urinary tract. The highly accurate diagnostic value of CT urography makes it a suitable alternative or substitutive modality in patients with acute flank pain.

Malignant renal epithelioid angiomyolipoma with aggressive behavior and distant metastasis.

Angiomyolipoma (AML) is a common renal tumor and mostly benign in entity. Malignant AML is extremely rare and most of them are found to be epithelioid AML histopathologically. We report the imaging features of a malignant epithelioid AML in a 58-year-old patient with liver and nodal metastases, and review the literatures. We have observed that AML of epithelioid subtype with tumoral necrosis may suggest the malignant change.

Tumor and tumor-like lesions of duodenum: CT and barium imaging features.

Neoplasms of the duodenum, either primary or secondary, are uncommon. However, imaging diagnosis for presurgical evaluation is extremely important due to complex regional anatomy. Computed tomography (CT) and barium-based double contrast examination (UGI series) are most frequently employed to evaluate the tumor invasion and intraluminal mucosal pattern. In this pictorial review, the CT and UGI series imaging features of benign and malignant duodenal tumors and tumor-like lesions are demonstrated and discussed.

A rare giant intracranial osteochondroma.

Osteochondroma is the most common benign bone tumor. However, intracranial osteochondroma is very rare, which usually arises from the skull base. Origination from the dura and falx occurs only in sporadical cases. To our knowledge, only twelve cases have been reported in English literature. We report a case of giant osteochondroma from the falx cerebri causing external compression on the brain. Radiographic findings, computed tomography and magnetic resonance imaging manifestation with histologic correlation are described.