All that bleeds is not black: susceptibility weighted imaging of intracranial hemorrhage and the effect of T1 signal.

PURPOSE: To determine if intracranial hemorrhages (ICH) are always hypointense on Susceptibility weighted imaging (SWI) and to determine the effect of T1-signal intensity on the appearance of ICH in SWI series. METHODS: SWI and T1-signal intensities of ICH were retrospectively studied in a series of patients. SWI signal intensities were statistically correlated with T1-signal intensities. RESULTS: In a series of 57 MRI scans from 40 patients, ICH was hypointense in 19, mixed-intensity in 21, and hyperintense in 17. Hyperintensity of ICH on SWI was significantly associated with increased T1 signal (P<.001). CONCLUSION: ICH can have a varied appearance on SWI.

Hepatic tumors: region-of-interest versus volumetric analysis for quantification of attenuation at CT.

PURPOSE: To evaluate the reproducibility of liver tumor attenuation measurement performed by using the routinely used manual region-of-interest (ROI) method and that of measurement performed by using a semiautomated volumetric approach at computed tomography (CT). MATERIALS AND METHODS: This HIPAA-compliant retrospective study had institutional review board approval. The requirement for patient informed consent was waived. Attenuation of colon cancer liver metastases in 208 patients was measured on portal venous phase multidetector CT images by using a single ROI, the average measurement in three ROIs on a single section, and with semiautomated segmentation of the entire tumor volume (volumetric attenuation) to evaluate intermethod agreement. Intraobserver and interobserver reproducibility were evaluated in the first 70 patients. Measurements were repeated after 30 days to assess intraobserver reproducibility. Differences between methods were tested by using repeated-measures analysis of variance. Intermethod, intraobserver, and interobserver agreements were tested by using Bland-Altman analysis and the Lin concordance correlation coefficient (ρc). P < .05 was considered to indicate a significant difference. RESULTS: A total of 208 pathologically proven colon cancer hepatic metastases larger than 20 mm in diameter in 100 women and 108 men (mean age, 61.6 years ± 11.6 [standard deviation]; range, 28-87 years) were evaluated. Attenuation was significantly different between the three methods of measurement (P < .001 for all). Volumetric measurements had better intraobserver agreement (precision = 3.3%, ρc = 0.996, P < .001) than single-ROI measurements (precision = 12.0%, ρc = 0.947, P < .001) and measurements averaged over three ROIs (precision = 9.3%, ρc = 0.965, P < .001). Volumetric measurements also had better interobserver agreement (precision = 3.6%, ρc = 0.993, P < .001) than single-ROI measurements (precision = 11.3%, ρc = 0.957, P < .001) and the average measurement in three ROIs (precision = 8.5%, ρc = 0.976, P < .001). CONCLUSION: Measurements of hepatic tumor attenuation at multidetector CT are reproducible. An approach based on the evaluation of whole-lesion attenuation demonstrated better reproducibility than ROI measurements.

The magnetic resonance spectroscopy findings of extrapontine myelinolysis in a patient with acute lymphoblastic leukemia.

The magnetic resonance (MR) spectroscopy findings of extrapontine myelinolysis have been rarely reported. Herein, we present MR spectroscopy findings as well as the conventional MR and diffusion MR findings of an acute lymphoblastic leukemia patient with extrapontine myelinolysis. Advanced MR imaging including diffusion-weighted imaging and MR spectroscopy may be helpful to exclude other pathologies in the differential diagnosis and make the diagnosis when there is a diagnostic difficulty on cases clinically suspicious for extrapontine myelinolysis.

MDCT evaluation of the growth kinetics of serous and benign mucinous cystic neoplasms of the pancreas.

We assessed the growth kinetics of pathologically proven benign neoplastic cystic lesions of the pancreas. The volume and longest axial diameter (LAD) of 20 pathologically proven pancreatic cystic lesions (12 mucinous cystic neoplasms (MCN) and 8 serous cystadenomas (SCN)) on 2 multidetector computed tomography scans, obtained before resection, were measured. Reciprocal of doubling time, doubling time and growth rate based on volume and LAD were calculated. A P value <0.05 was considered significant. For all cysts, growth kinetics based on volume were: reciprocal of doubling time (mean = 3.03, median=1.0), doubling time (mean = 644, median = 388 days) and growth rate (mean = 74.7, median = 5.7 ml/year). Results based on LAD were: reciprocal of doubling time (mean = 3.09, median = 1.3), doubling time (mean = 752, median = 273 days) and growth rate (mean = 24.5, median = 5.6 mm/year). These variables were not statistically different between MCNs and SCNs (P > 0.05 in all instances). Reciprocal of doubling time based on volume and LAD were comparable (P > 0.05). We concluded that the mean reciprocal of doubling time was 3.03 and 3.09 using volume and LAD, respectively. This may aid in designing follow-up guidelines for pancreatic cysts.

Two cases of inferior vena cava duplication with their CT findings and a review of the literature.

Duplication of the inferior vena cava (IVC) is the most common anomaly to affect the vena cava. Variations in the IVC are diagnosed in routine dissection studies, in retroperitoneal surgeries, or in computerised tomography (CT) sections ordered for various reasons. In this paper we present two cases of a double IVC together with the CT findings. The duplication might have occurred during embryological development. Although venous anomalies are rare, they have particular importance with respect to the interruptions that may occur during retroperitoneal and thoracic surgery or in the treatment of thrombo-embolic disease.

Magnetic resonance venography of double inferior vena cava.

Duplication of the inferior vena cava IVC is the most common anomaly affecting the vena cava. Variations of the IVC are diagnosed in routine dissection studies, in retroperitoneal surgeries, or in radiological studies for various reasons. In this paper, we present a case of double IVC with its magnetic resonance imaging findings.