Metastatic lobular carcinoma of the breast: patterns of spread in the chest, abdomen, and pelvis on CT.

OBJECTIVE: We determined the pattern of spread of metastatic lobular carcinoma in the chest, abdomen, and pelvis on CT. MATERIALS AND METHODS: We identified 57 women (age range, 30-79 years; mean age, 57 years) with metastatic lobular carcinoma of the breast who underwent CT of the chest, abdomen, or pelvis between 1995 and 1998. Then two experienced oncology radiologists retrospectively reviewed 78 CT examinations of those patients to identify sites of metastatic disease and to identify complications caused by metastases. RESULTS: Metastases were identified in bone in 46 patients (81%), lymph nodes in 27 patients (47%), lung in 19 patients (33%), liver in 18 patients (32%), peritoneum in 17 patients (30%), colon in 15 patients (26%), pleura in 13 patients (23%), adnexa in 12 patients (21%), stomach in nine patients (16%), retroperitoneum in nine patients (16%), and small bowel in six patients (11%). Eighteen patients (32%) had gastrointestinal tract involvement that manifested as bowel wall thickening. Hydronephrosis was present in six patients (11%). CONCLUSION: Although lobular carcinoma metastasized to common metastatic sites of infiltrating ductal carcinoma, lobular carcinoma frequently metastasized to unusual sites, including the gastrointestinal tract, peritoneum, and adnexa. Gastrointestinal tract involvement was as frequent as liver involvement, appearing as bowel wall thickening on CT. Hydronephrosis was a complication of metastatic lobular carcinoma.

Staging of malignant pleural mesothelioma: comparison of CT and MR imaging.

OBJECTIVE: This article compares the accuracy of CT with that of MR imaging in staging of malignant pleural mesothelioma. SUBJECTS AND METHODS: Ninety-five patients were enrolled in a prospective staging protocol based on the International Mesothelioma Interest Group staging system. Sixty-five patients underwent CT and MR imaging and a surgical procedure (excluding percutaneous needle biopsy) to stage and resect the tumor. Receiver operating characteristic analyses were performed. CT and MR scans were interpreted independently by observers who were unaware of the results of the other imaging study; these imaging findings were compared with the results of surgery and pathologic examination. RESULTS: The areas under the receiver operating characteristic curves for eight of 10 features revealed by imaging showed no statistically significant differences between CT and MR imaging. However, MR imaging was superior to CT in revealing invasion of the diaphragm (A(z) = .55 for CT versus .82 for MR imaging) and in revealing invasion of endothoracic fascia or solitary resectable foci of chest wall invasion (A(z) = .46 for CT; A(z) = .69 for MR imaging). Several anatomic regions could not be evaluated because positive findings at surgery were rare. CONCLUSION: CT and MR imaging are of nearly equivalent diagnostic accuracy in staging malignant pleural mesothelioma. MR imaging is superior to CT in revealing solitary foci of chest wall invasion and endothoracic fascia involvement and in showing diaphragmatic muscle invasion; however, this advantage does not affect surgical treatment. For cost reasons, CT should be considered the standard diagnostic study before therapy.

Magnetic resonance imaging of the postpneumonectomy chest: normal and abnormal findings.

To determine the normal findings at magnetic resonance imaging (MRI) of the postpneumonectomy space (PPS), and to evaluate the utility of MRI in detection of recurrent tumor in the postpneumonectomy chest, 32 MRI scans were performed in 31 patients at varying time intervals after pneumonectomy. Eleven patients also had 12 computed tomography (CT) scans performed at the same time to evaluate possible tumor recurrence. Of the 32 scans, 5 demonstrated complete obliteration of the fluid containing PPS, and 4 showed gas in the PPS; the remainder (n = 23) demonstrated persistence of fluid-filled spaces of varying size. The presence of a fibrotic rim of tissue was constant. In 11 patients with clinically suspected tumor recurrences, both CT and MRI were obtained: the two modalities performed with similar accuracy in diagnosing tumor recurrence at 16 sites; CT detected opposite-lung metastatic nodules not seen on MRI in one patient, and a rib metastasis described as "indeterminate" on MRI in a second patient. MRI detected a focus of recurrence in the PPS that was indeterminate on CT. There is considerable variability in the amount of fluid seen in the PPS on MRI. CT remains the procedure of choice for routine follow-up or in suspected tumor recurrence in the postpneumonectomy patient; MRI can be helpful if the CT scan is nondiagnostic or equivocal.

Non-neoplastic causes of high signal intensity at T2-weighted MR imaging after treatment for musculoskeletal neoplasm.

OBJECTIVE: The objective of this study was to describe a variety of non-neoplastic causes of high-signal-intensity areas seen on T2-weighted magnetic resonance (MR) images obtained after treatment for malignant musculoskeletal neoplasm. DESIGN: MR examinations obtained after treatment for malignant musculoskeletal neoplasm in 11 patients were reviewed. The examinations of these patients were selected because at least one MR study of each patient showed high-signal-intensity areas on T2-weighted images at or near the site of the original tumor. The MR imaging findings were correlated with results of biopsy in four patients, and with information from follow-up radiologic examinations and the patients' medical records in all cases, to determine the cause of the high-signal-intensity areas. RESULTS: Non-neoplastic entities responsible for high-signal-intensity areas included postsurgical seroma, hematoma, postradiation therapy changes, fat necrosis and seroma, surgical hemostatic packing material, intercalary bone allograft, strut bone graft, atrophic muscle, and herniated colon and bladder. Knowledge of details of the surgical procedure and the time interval since surgery or irradiation aided in accurate interpretation of the findings, but did not allow immediate biopsy to be deferred in every case. CONCLUSION: High-signal-intensity areas on T2-weighted images in patients previously treated for malignant musculoskeletal neoplasm may represent a variety of entities other than residual or recurrent neoplasm, even in the presence of a mass. The MR imaging findings should be interpreted in conjunction with details of the specific clinical circumstances to prevent misdiagnosis and unnecessary biopsy.

Low-density supradiaphragmatic band artifact on advanced multiple-beam equalization radiography of the chest.

RATIONALE AND OBJECTIVES: A low-density dark band artifact was found above the diaphragm on advanced multiple-beam equalization radiography (AMBER) of the chest and was evaluated. METHODS: Fifty consecutive chest radiographs were evaluated for the presence of the artifact. AMBER radiographs of a phantom were scanned with a microdensitometer. RESULTS AND CONCLUSION: The presence of the artifact is confirmed on the patient chest radiographs (present in 84% on posteroanterior view; 94% on lateral view) and on the phantom images. The artifact was probably caused by a delayed system response to scanning across a sharp boundary.

The chief residency in radiology. Results of a survey of A3CR2 members.

Detailed questionnaires were sent to the 192 members of the American Association of Academic Chief Residents in Radiology (A3CR2) to learn about the logistics of chief resident selection, the responsibilities of the chief resident, the attitudes and perceptions of the chief resident about his or her position, and suggestions for improving the chief residency. Completed questionnaires were returned by 149 (78%) chief residents from 111 different residency programs. The results show that radiology residents have a greater voice in selecting their chief residents than in the past. The number and types of responsibilities given to the chief resident at different institutions vary considerably. Although only 62% of respondents felt that being chief resident was worth their time and effort, 88% would accept the position again. The most commonly voiced suggestion was for greater input from the chief resident during the formulation of policies that affect the residents. Based on these results and a review of previous reports about the chief residency in other specialties, several proposals are offered for increasing the effectiveness of the radiology chief residency.

Superior sulcus tumors: CT and MR imaging.

Thirty-one patients with superior pulmonary sulcus tumors underwent a total of 32 sets of computed tomographic (CT) and magnetic resonance (MR) imaging examinations before receiving therapy. Prospective, independent, and blinded interpretations of the studies were compared with both the surgical findings (15 patients) and the patient's clinical symptoms (17 patients). Thin-section (5-mm) coronal and sagittal MR images proved more accurate than CT scans (.94 accuracy with MR imaging, .63 with CT) in evaluation of tumor invasion through the superior sulcus. The improved accuracy of MR imaging in this region appears almost certainly to be related to the improved display of the anatomy of the superior sulcus on thin-section coronal and sagittal images.

Lung tumors: percutaneous implantation of I-125 sources with CT treatment planning.

Seven patients with lung tumors underwent percutaneous implantation of iodine-125 sources into the tumor. Needle placement and seed implantation were effected with biplane fluoroscopy and a computer planning model based on computed tomography. No complications were encountered. Five of the seven patients underwent the procedure at the outpatient center and were discharged the same day. Follow-up radiologic evaluations were available for six patients; in all six the examination demonstrated tumor shrinkage, and in four tumor shrinkage was essentially complete.

Abnormal gallium scintigraphy in pulmonary alveolar proteinosis (PAP).

A patient with medulloblastoma of the cerebellum developed dyspnea and hypoxemia. Pulmonary function tests showed decreased lung volume and diffusing capacity, while the chest radiographs initially showed only mild interstitial infiltrates. Repeated gallium scans showed diffuse lung uptake and diagnosis of pulmonary alveolar proteinosis was made by open lung biopsy.

Pulmonary Kaposi's sarcoma in the acquired immune deficiency syndrome. Clinical, radiographic, and pathologic manifestations.

Pulmonary Kaposi's sarcoma related to the acquired immune deficiency syndrome (AIDS) has not been well characterized. To define the clinical, radiographic, and pathologic features of this entity, 11 autopsy-proved cases of pulmonary Kaposi's sarcoma were reviewed. The most common clinical symptoms were dyspnea and cough, but hemoptysis and stridor were also found. Nodular infiltrates and pleural effusions were the most commonly found radiographic abnormalities. Pulmonary function tests were sensitive in detecting the pulmonary abnormalities due to Kaposi's sarcoma. A low diffusion capacity, lack of arterial desaturation with exercise, and obstruction to airflow were suggestive of pulmonary involvement with this malignancy. Although endobronchial Kaposi's sarcoma was visualized at bronchoscopy as cherry-red, slightly raised lesions, bronchial biopsy specimens always showed no abnormalities. Transbronchial brushings and biopsy specimens and analysis of pleural fluid were also not helpful in establishing a diagnosis. In the seven subjects with extensive parenchymal Kaposi's sarcoma at autopsy, the pleura was always involved. Eight subjects had involvement of the tracheobronchial tree. In all of the subjects, pulmonary Kaposi's sarcoma was a significant cause of morbidity, and in three of 11 subjects (27 percent) it was the direct cause of death.

Carcinomatous involvement of the hilum and mediastinum: computed tomographic and magnetic resonance evaluation.

Magnetic resonance (MR) imaging and computed tomography (CT) were compared in 20 patients who had primary lung tumors, and the results were correlated with findings at surgery and pathologic evaluation. Both studies demonstrated a similar ability to detect hilar and mediastinal tumor. MR imaging detected more enlarged nodes in the mediastinum, but in several patients these enlarged nodes did not contain tumor. Consequently, MR imaging has a slightly higher false-positive rate in the evaluation of the mediastinum. Both modalities were highly sensitive, with specificity limited by the presence of enlarged benign lymph nodes in this series of patients.

Non-small-cell lung cancer: results of the New York screening program.

Radiographs of 168 patients with non-small-cell lung cancer were reviewed. Following a negative initial examination, 102 tumors were detected during routine annual screening, while 66 were diagnosed during the interval between screenings. The cancers detected on routine yearly examination were smaller; the rate of resectability was higher, a larger number were Stage I, and survival was better. Within the routinely screened group, 65% had evidence of cancer on reviewing earlier radiographs; these patients tended to have earlier stages of cancer and a better survival rate.

Radiographic changes in primary osteogenic sarcoma following intensive chemotherapy. Radiological-pathological correlation in 63 patients.

Sixty-three patients with osteogenic sarcoma of the long bones, all of whom were treated with chemotherapy, demonstrated striking and unusual radiographic changes. Patients with a "good" radiographic response (48%) showed the most dramatic changes, including medullary sclerosis, prominent periosteal new bone formation, and disappearance of the soft-tissue mass; and these findings correlated well with the histological grading of the surgical specimens. Radiographic evaluation of patients receiving chemotherapy for osteogenic sarcoma is a valuable method of assessing response.