Multiple focal nodular hyperplasia syndrome: diagnosis with dynamic, gadolinium-enhanced MRI.

We present a rare case of multiple focal nodular hyperplasia (FNH) with greater than 20 FNH lesions and coexistent liver hemangiomata. Particular attention is paid to the MRI characteristics of this disease process and the features of "multiple FNH syndrome" are discussed.

Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement.

BACKGROUND: The aim of this study was to identify predictors of outcome for pancreatic duct (PD) disruption managed by endoscopic transpapillary stent insertion. METHODS: An endoscopy database was used to identify patients with PD disruption, defined as extravasation of contrast from the PD during ERCP. Data collected included demographic information, the results of imaging studies, management before endoscopic intervention, and outcomes after stent placement. Stents typically were exchanged at intervals of 6 to 8 weeks. Success was defined as clinical and pancreatographic resolution of the PD disruption. RESULTS: Ninety-seven consecutive patients (34 women, 63 men; mean age, 53.7 [12.3] years) with PD disruption seen from 1995 to 2002 were identified. Causes of the disruption were the following: chronic pancreatitis (47), acute pancreatitis (44), operative injury (4), and trauma (2). Transpapillary PD stent insertion was technically successful in 92 (95%) patients; two underwent a combined cystenterostomy. The median duration of stent placement was 58 days (range 4-640 days). The outcome of stent insertion was successful in 52 patients (55%), unsuccessful in 32 (36%), and indeterminate in 8 (9%). On univariate analysis, a partially disrupted PD (p < 0.001), a disruption in the body of the pancreas (p = 0.04), a stent positioned to bridge the disruption (p < 0.001), and a longer duration of stent therapy (p = 0.03) were associated with a successful outcome. On multivariable logistic regression, only a partially disrupted duct and a stent bridging the disruption correlated with a successful outcome. Complications occurred in 6 patients. CONCLUSIONS: Successful resolution of PD disruption by transpapillary stent insertion depends on the type of disruption and the ability to bridge the disrupted duct with a stent.

Imaging and localization of islet-cell tumours of the pancreas on CT and MRI.

Islet-cell tumours are neuroendocrine tumours that arise from the endocrine pancreas. They may be associated with a variety of syndromes and are subclassified into functioning and non-functioning tumours. They range from benign to malignant. They demonstrate characteristic features when imaged with both computed tomography (CT) and magnetic resonance imaging (MRI). Sensitivity and specificity, as well as detection of extrapancreatic extension, are generally superior with MRI. However, CT is currently still more readily available to patients. Multiphase, post-contrast series are commended for the evaluation of islet-cell tumours with either modality.

Diffuse abdominal angiomatosis.

We present a rare case of diffuse abdominal angiomatosis occurring in a 19-year-old male; particular attention is paid to the MR imaging features of this disease process.

Abdominal imaging studies: comparison of diagnostic accuracies resulting from ultrasound, computed tomography, and magnetic resonance imaging in the same individual.

We retrospectively compared the diagnostic accuracy of abdominal ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) studies performed on the same individual to determine the relative performance of these modalities in the evaluation of disease processes, arising from different intra-abdominal organ systems. We retrospectively reviewed all procedure codes accrued by our abdominal imaging section during a 1-year period to determine how many patients underwent all three imaging procedures in our institution within a 2-week interval. These cases were then further evaluated to determine: (1) the primary organ system of disease involvement, (2) the final diagnosis, and (3) the imaging modality that provided the most accurate information upon which appropriate medical management was based. Imaging findings were determined by review of diagnostic reports, and medical management was determined by chart review. Two thousand six hundred-ninety five patients underwent ultrasound, 4,394 patients underwent CT, and 872 patients underwent MRI for the investigation of abdominal disease. Among these 5,126 patients, 26 underwent sequential US, CT, and MRI evaluation within a two-week interval. Appropriate clinical management was based on the US findings in 12/26 cases (46%; 95% CI: 27-67%), CT findings in 16/26 cases (62%; 95% CI: 41-80%), and MRI findings in 24 cases (92%; 95% CI: 75-99%). Significant differences in directing appropriate clinical management were found when comparing the relative diagnostic accuracies of MRI to US (p = 0.0003) and MRI to CT (p = 0.009). However, differences were not significant when comparing CT to US (p = 0.27). All final diagnoses in a given patient were accurately determined by US in 7/26 cases (27%), by CT in 10/26 cases (38%), and by MRI in 23/26 cases (88%). When analyzed according to individual diagnoses (61 total), US detected 33 of 61 (54%) abnormalities, CT detected 41 (67%) abnormalities, and MRI detected 51 (84%) abnormalities. US correctly characterized 32 (52%) abnormalities, CT correctly characterized 36 (59%) abnormalities, and MRI correctly characterized 49 (80%) abnormalities. Ultrasound, CT, and MR imaging correctly diagnosed the disease process in 3 of 12 (25%), 3 of 12 (25%), and 10 of 12 (83%) patients, respectively, with liver disease; 2 of 9 (22%), 6 of 9 (66%), and 9 of 9 (100%) patients, respectively, with pancreatic disease; 17 of 17 (100%), 8 of 17 (47%), and 10 of 17 (58%) patients, respectively, with gallbladder and biliary disease; 2 of 8 (25%), 5 of 8 (63%), and 5 of 8 (63%) patients, respectively, with renal disease; 0 of 3 (0%), 2 of 3 (66%), and 3 of 3 (100%) patients, respectively, with adrenal disease; and 8 of 12 (75%), 12 of 12 (100%), and 12 of 12 (100%) patients with free intraperitoneal fluid. Our results provide new information, regarding the relative benefits of ultrasound, CT, and MRI for the investigation of abdominal diseases at our institution. This initial data suggests that ultrasound provides the most accurate diagnoses in the investigation of gallbladder disease; MRI provides the most accurate diagnoses in the investigation of hepatic, adrenal, and pancreatic disease; and either CT or MRI may be the most appropriate first imaging study for the detection of renal disease.