The value of diffusion-weighted magnetic resonance imaging in the differential diagnosis in diffuse bowel wall thickening.

BACKGROUND/AIMS: We aimed to investigate the value of diffusion-weighted magnetic resonance imaging in the differentiation of benign-malignant diffuse bowel wall thickening (scirrhous colon carcinoma) and to discuss the diagnostic importance and potential use of apparent diffusion coefficient measurements. MATERIALS AND METHODS: A total of 41 patients (32 males, 9 females; mean age, 57 years) with diffuse bowel wall thickening diagnosed on computed tomography were included in this study. The magnetic resonance imaging was performed on a 1.5 T scanner (Siemens-Espree). Changes in the signal intensity of the lesions were determined by their appearance in images at b800 s/mm 2 , and apparent diffusion coefficient values were also calculated. Lesions were classified in two groups according to the presence of hyperintensity on b800 images and results of endoscopic biopsies. The differences in mean apparent diffusion coefficient values between the two groups were compared with the Mann-Whitney U test, and threshold values were determined with receiver operating characteristic curve analysis. RESULTS: The difference between the mean apparent diffusion coefficient values of benign and malignant groups was statistically significant, and the apparent diffusion coefficient values of benign lesions were significantly higher than of malignant lesions (p<0.05). By using a cut-off value of 1.21 x 10-3mm2 /s, apparent diffusion coefficient had a sensitivity of 100%, specificity of 87.3%, and accuracy of 89.3% in the discrimination of malignant colorectal pathologies. With the visual assessment of the diffusion weighted images and the measurement of apparent diffusion coefficient values, malignant and benign lesions could be differentiated, with 100% sensitivity, 89.2% specificity, and 90.4% accuracy. Although some benign lesions were interpreted as malignant,no malignant lesion was determined as benign in the visual assessment. CONCLUSIONS: Diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient values together can successfully differentiate malignant from benign diffuse bowel wall thickening.

Transverse colon diverticulitis with calcified fecalith.

Left colonic diverticula are common in Western populations, whereas right colonic diverticulosis primarily occurs in Oriental populations. Diverticulitis of the transverse colon is very rare, with very few cases reported in the literature. Herein, we report a case of transverse colon diverticulitis caused by a calcified stone in a 69-year-old female. This was a solitary diverticulum. The signs and symptoms of the disease are similar to acute pancreatitis. To the best of our knowledge, this is the first report describing the MRI findings of a patient with trans-verse colon diverticulitis caused by a calcified stone.

Abdominal wall endometrioma: ultrasonographic features and correlation with clinical findings.

BACKGROUND: The diagnosis of abdominal wall endometrioma (AWE) is often confused with other surgical conditions. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. AIMS: To present the clinical findings and ultrasonographic (US) features of AWE with special emphasis on size-related features. STUDY DESIGN: This study reviewed abdominal wall endometriomas during a 2-year period in the Radiology Department of Sifa University Hospital, Izmir. METHODS: Eleven women (mean age 32.6 years) with 12 scar endometriomas (mean diameter 29.2 mm) were consecutively evaluated by US and Colour Doppler examination (CDUS) prior to surgery. Lesions were grouped into large (≥3 cm) and small nodules. Vascularisation was classified as location (central, peripheral and mixed) and severity (absent, moderately vascular and hypervascular). In each patient, the nature of pain (absent, cyclic: associated with menstruation and continuous), historical and clinical data were documented. Four patients underwent Magnetic Resonance Imaging and their findings were presented. Fisher's exact test, χ(2) test for categorical data and the unpaired T-test for continuous variables were used for statistical analysis. RESULTS: In all the women, US of the AWE showed the presence of a solid hypoechoic mass (less echogenic than the surrounding hyperechoic fat) within the abdominal wall. There was a significant correlation between AWE sizes with repeated caesareans and the mean time between the last operation and admission to hospital (p<0.05). Large endometriomas showed increased central vascularity (p<0.05). Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05). CONCLUSION: AWE is often misdiagnosed clinically because endometriosis may occur years after the caesarean section, the pain is often non-cyclic in nature, and there is not always a palpable tender mass. The sonographic and Doppler findings, along with proper correlation with clinical data, may substantially contribute to the correct diagnosis of endometrioma.