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1.
Can Assoc Radiol J ; 75(1): 98-106, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37335612

RESUMO

OBJECTIVE: : To determine the prevalence of 'fat-poor' adrenal adenomas at chemical-shift-MRI. MATERIALS AND METHODS: : This prospective IRB approved study identified 104 consecutive patients with 127 indeterminate adrenal masses that underwent 1.5-T chemical-shift-MRI between 2021-2023. Two blinded radiologists independently measured: 1) 2-Dimensionsal (2D) chemical-shift signal intensity (SI)-index on 2D Chemical-shift-MRI (SI-index >16.5% diagnosed presence of microscopic fat), 2) unenhanced CT attenuation (in cases where unenhanced CT was available). RESULTS: : From 127 adrenal masses, there were 94% (119/127) adenomas and 6% (8/127) other masses (2 pheochromocytoma, 5 metastases, 1 lymphoma). 98% (117/119) adenomas had SI-Index >16.5%, only 2% (2/119) adenomas were 'fat-poor' by MRI. SI-Index >16.5% was 100% specific for adenoma, all other masses had SI-Index <16.5%. Unenhanced CT was available in 43% (55/127) lesions (50 adenomas, 5 other masses). 34% (17/50) adenomas were lipid-poor (>10 HU). Percentage of adenomas with SI-Index >16.5% were: 1) ≤10 HU, 100% (33/33), 2) 11-29 HU, 100% (12/12), 3) ≥30 HU, 60% (3/5). No other masses had attenuation ≤10 HU (0/5). CONCLUSION: : Fat-poor adrenal adenomas are uncommon using 2D chemical-shift signal intensity index >16.5% at 1.5-T, occurring in approximately 2% of adenomas in this large prospective series.


Assuntos
Adenoma , Neoplasias das Glândulas Suprarrenais , Humanos , Prevalência , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Neoplasias das Glândulas Suprarrenais/patologia , Imageamento por Ressonância Magnética , Diagnóstico Diferencial , Sensibilidade e Especificidade
2.
Abdom Radiol (NY) ; 47(11): 3828-3837, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36008733

RESUMO

OBJECTIVE: To compare image quality and detection of microscopic fat in adrenal adenomas imaged with 2-D and 3-D chemical shift imaging (CSI) and, to derive parameters which best match 2-D and 3-D-CSI. METHODS: This two-phase, retrospective, and phantom + prospective study was IRB approved. First, a retrospective assessment of 50 consecutive adrenal adenomas imaged at 1.5 T with 2-D (TR minimum, Flip Angle [FA] 70°, TE 2.2/4.4 ms.) and 3-D (TR minimum, FA 10°, TE 2.2/4.4 ms.] CSI was performed. Second, phantom (varied fat: water concentration) experiments guided a prospective assessment of 12 consecutive adrenal adenomas imaged at 1.5 T with 3-D CSI (FA 10°, 18°). Two blinded radiologists independently evaluated: image quality, signal intensity (SI) cancellation (5-point Likert scale), and CSI-index ([SI.In.Phase-SI.Opposed.Phase/SI.In.Phase]*100). RESULTS: 2-D-CSI yielded higher image quality (p < 0.001) and, subjectively (p < 0.001) and quantitatively (p < 0.001) had more SI cancellation from microscopic fat. Proportion of adenomas with no detectable microscopic fat (3-D; 26-36% subjectively, 18-24% quantitatively [CSI-index < 16.5%] versus 2-D; 20-22% subjectively, 6-8% quantitatively) differed (p = 0.008-0.08 subjectively, 0.008-0.03 quantitatively) by CSI technique. Phantom experiments indicated 18°FA 3-D-CSI compared favorably to 70° 2-D-CSI for fat detection between 5% and 50%. In vivo, there was no differences in subjective or quantitative SI cancellation comparing 18°3D-CSI and 2D-CSI (p = 0.16-0.56 and 0.73-0.60). Greater SI cancellation occurred with 18°3D compared to 10°3D-CSI evaluated subjectively (p = 0.003-0.01). CONCLUSION: 2-D CSI has subjectively higher image quality and shows more signal intensity loss from microscopic fat in adrenal adenomas compared to 10° flip angle 3-D-CSI. Increasing the 3-D flip angle to 18° more closely matches depiction of microscopic fat to 2-D-CSI at 1.5 T.


Assuntos
Adenoma , Neoplasias das Glândulas Suprarrenais , Adenoma Adrenocortical , Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética/métodos , Estudos Prospectivos , Estudos Retrospectivos , Água
3.
Abdom Radiol (NY) ; 47(7): 2453-2461, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35536326

RESUMO

OBJECTIVE: To compare diagnostic accuracy of washout (WO)-CT to chemical shift (CS)-MRI + T2W adrenal MRI Calculator (T2W-Calculator) to diagnose adrenal adenoma in indeterminate adrenal masses. METHODS: This retrospective, cross-sectional, non-inferiority study evaluated 40 consecutive indeterminate adrenal masses; each with WO-CT and MRI. Two blinded radiologists independently evaluated in mixed order: pre-contrast attenuation (Hounsfield Units, HU) and absolute WO ([Peak.HU-Delay.HU]/[Peak.HU-Pre.HU] × 100%), Chemical Shift Signal Intensity (CS-SI) Index, T2W SI ratio, and Entropy (which were imputed into the T2W-Calculator). Diagnostic accuracy for adrenal adenoma was tabulated using 2 × 2 tables. True -positive diagnoses of adenoma were CT = Pre-HU < 10 or absolute WO ≥ 60%, MRI = SI index ≥ 16.5% or T2W-Calculator < 0.631. RESULTS: There were 73% (29/40) adenomas and 27% (11/40) other masses (5 pheochromocytoma, 3 solitary fibrous tumor, 1 metastasis, 1 cavernous hemangioma, and 1 adrenocortical carcinoma). Sensitivity, specificity, and accuracy for diagnosis of adenoma using CT-WO were 78% (95% confidence intervals [CI] 56-93%), 35% (14-62%), and 57% (42-71%) Reader 1 and 72% (53-87%), 46% (17-77%), and 59% (41-76%) Reader 2. Sensitivity, specificity, and accuracy for diagnosis of adenoma using MRI were 100% (88-100%), 64% (34-90%), and 82% (67-97%) Reader 1 and 86% (68-96%), 73% (39-94%), and 80% (64-95%) Reader 2. MRI had higher overall accuracy (p = 0.02 Reader 1, 0.05 Reader 2) compared to CT-WO. CONCLUSION: Chemical shift MRI combined with the T2W adrenal MRI calculator is not inferior to CT Washout for diagnosis of adrenal adenoma among indeterminate adrenal masses.


Assuntos
Adenoma , Neoplasias do Córtex Suprarrenal , Neoplasias das Glândulas Suprarrenais , Adenoma Adrenocortical , Anormalidades do Sistema Digestório , Adenoma/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/patologia , Adenoma Adrenocortical/diagnóstico por imagem , Adenoma Adrenocortical/patologia , Estudos Transversais , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
4.
J Surg Case Rep ; 2022(2): rjac044, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35198147

RESUMO

Obturator hernia is a pelvic floor type of hernia in which abdominal or pelvic contents protrude through the obturator foramen. It is considered rare in patients with signs and symptoms of intestinal obstruction causing a diagnostic challenge for clinicians. This case reports a 91-year-old multiparous female who presented with vague lower abdominal pain associated with obstipation and vomiting. We present a successful laparoscopic repair of obturator hernia in an elderly female.

5.
Cureus ; 13(7): e16221, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34367821

RESUMO

Collision tumors are rare neoplasms defined by the presence of two distant tumors in the same organ without any histological intermixing. Ovarian tumors are often asymptomatic during the early stages and become symptomatic when increased in size causing vague abdominal pain, abdominal distention, vomiting, and frequent urination. We report here a case of a 28-year-old female who presented with a history of worsening abdominal pain and distension. An abdominopelvic ultrasound scan showed a huge complex mass occupying the pelvic area with non-visualization of the left ovary suggesting an ovarian origin; further characterization by cross-sectional imaging by both CT and MRI were performed confirming a left ovarian complex mass containing multiseptated cystic and fat component at the same time along with massive ascites. After surgical resection of the mass, histopathology revealed mucinous cystadenoma coexisting with cystic teratoma.

6.
Surg Radiol Anat ; 41(11): 1391-1394, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31250140

RESUMO

We report an extremely rare case of splenic artery arising from hepatic artery proper in a patient with celiacomesenteric trunk variant. This anatomical variation was detected angiographically during hepatic mapping prior to transarterial radioembolization (TARE) for hepatocellular carcinoma in an 84-year-old man. TARE of hepatic tumors is one of the frequent procedures done by interventional radiologists. The identification of such rare vascular aberrations is of great importance not only in current interventional radiology procedures such as radioembolization but also in surgery and diagnostic radiology. To the best of our knowledge, this vascular variant is a novel discovery.


Assuntos
Variação Anatômica , Embolização Terapêutica/métodos , Artéria Hepática/anatomia & histologia , Artéria Esplênica/anatomia & histologia , Idoso de 80 Anos ou mais , Angiografia Digital , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/terapia , Artéria Celíaca/anormalidades , Artéria Hepática/diagnóstico por imagem , Humanos , Achados Incidentais , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Masculino , Artéria Mesentérica Superior/anormalidades , Artéria Esplênica/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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