Primary intraluminal leiomyosarcoma of the inferior vena cava: value of MRI with contrast-enhanced MR venography in diagnosis and treatment.

BACKGROUND: Primary intraluminal leiomyosarcoma of the inferior vena cava (IVC) is extremely rare. Diagnostic imaging plays an important role in the diagnosis and conducting treatment strategy. METHODS: MRI with contrast-enhanced MR venography was performed in six patients with primary intraluminal leiomyosarcoma of the IVC. RESULTS: In the six patients, three had leiomyosarcoma of the middle IVC, and three the lower IVC. The mean axial diameter of tumor was 4.3 cm. MRI with contrast-enhanced MR venography not only demonstrated the tumor's location, morphology, extent, and collateral vessels but also distinguished tumor from thrombus of the IVC. Three patients underwent surgery and three did not. Four patients (three with surgery and one without surgery) were alive during the following periods, but one presented with local recurrence and all with metastases at a median time of 23 months. One patient died at 15 months after the diagnosis with liver and subcutaneous metastases, one lost to follow up. CONCLUSION: MR image with contrast-enhanced MR venography is a noninvasive and accurate technique for diagnosis of primary intraluminal leiomyosarcoma of IVC. Its providing information is very helpful for pre- and post-surgery. It can be used as one of the first choice examinations.

Detection of anomalous splenic artery aneurysms with three-dimensional contrast-enhanced MR angiography.

BACKGROUND: Aneurysms of the splenic artery which arise anomalously from the superior mesenteric artery are extremely rare but clinically important because of their life-threatening hemorrhage. Diagnostic imaging plays an important role in the diagnosis and conducting treatment strategy. The aim of this study was to evaluate the detection of anomalous splenic artery aneurysms with 3D contrast-enhanced MR angiography. METHODS: 3D contrast-enhanced MR angiography was performed in six patients with anomalous splenic artery aneurysms. RESULTS: The mean diameter of six aneurysms was 3.9 cm. All of them were saccular and located at the origin of the splenic artery that arose anomalously from the root of the superior mesenteric artery. 3D contrast-enhanced MR angiography clearly demonstrated the aneurysm's location, size, morphology, visceral arterial variations, and was superior to DSA in three-dimensional display of the aneurysm and its relationship with surrounding vessels and organs. Two patients underwent open vascular surgery and three endovascular procedure. CONCLUSION: 3D contrast-enhanced MR angiography is a noninvasive and accurate technique for diagnosis of anomalous splenic artery aneurysms. Its 3D anatomic information is very helpful for treatment planning. It can be used as one of the first choice examinations for anomalous splenic artery aneurysms.

Visceral artery aneurysms: evaluation using 3D contrast-enhanced MR angiography.

OBJECTIVE: Visceral artery aneurysms are uncommon, but they are clinically important because of the high incidence of rupture and life-threatening hemorrhage. Visceral artery aneurysms in patients with vascular anatomic variations are extremely rare, but detecting these variations is significant in this setting to determine the best treatment strategy; therefore, a thorough assessment of the aneurysm and of the vascular anatomy before treatment is paramount. CONCLUSION: Three-dimensional contrast-enhanced MR angiography is a noninvasive technique for the diagnosis and display of visceral artery aneurysms. It can provide 3D anatomic information that is needed for surgery or embolization.

[Natural history of small hepatocellular carcinoma: studied by MRI].

OBJECTIVE: To study natural history of small hepatocellular carcinoma (sHCC) and value of MRI in this research. METHODS: From 1999 to 2002, serial MR imagings were performed in 192 patients with cirrhosis no less than twice in order to detect sHCC focus. Characteristic MRI findings of focus were analysed. Diameters of focus (D) were measured. Tumorigenesis detected time (T) was counted; T and D were analysed by statistics and tumor volume doubling time (T(d)) was calculated. RESULTS: Fifty-eight new tumor foci in 33 patients were found, including 31 foci in 23 patients developed on the basis of cirrhosis, with a 12.0% cumulative tumorigenic rate of three years. The tumorigenesis detected time (T) was 386.9 +/- 256.4 days and the maximum diameter (D) was 2.258 +/- 1.074 cm. T was statistical correlated with D(3) (P < 0.01) and regressive formulas were established: D(3) = -2.69 + 0.058T (P = 0.0007), D(3) = -72.13 + 16.04lnT (P = 0.0064). Tumor volume doubling time was 20 approximately 279 days (mean: 104 days). CONCLUSION: The percentage of tumorigenesis is high in patients with cirrhosis. Regular MRI examinations are necessary to detect sHCC early. The optimal interval time is 3 approximately 6 months.

[Clinical value of MR cholangiopancreatography combining with dynamic enhanced MRI in the detection of cholangiocarcinoma].

OBJECTIVES: To evaluate the clinical value of breath-hold magnetic resonance cholangiopancreatography (MRCP) combining with dynamic enhanced MRI in the diagnosis of cholangiocarcinoma. METHODS: MRCP findings of 88 cholangiocarcinoma patients proved surgically and pathologically were analyzed retrospectively. RESULTS: MRCP examination succeeded in all the 88 patients and the pancreaticobiliary ducts were shown satisfactorily. The accuracy of MRCP in the location of both hilar and extrahepatic cholangiocarcinoma was 100%, and the accuracy of detecting hilar and extrahepatic cholangiocarcinoma were 100% and 52.2%, respectively. Combining with dynamic enhanced MRI, the detecting accuracy of extrahepatic cholangiocarcinoma improved to 91.3%. CONCLUSIONS: MRCP examination has a high successful rate and can accurately determine the location of hilar and extrahepatic cholangiocarcinoma, and the accuracy of qualitative diagnosis for the former two is high. Combining with dynamic enhanced MRI, the specificity of determining extrahepatic cholangiocarcinoma is also high.