Differentiation malignant from benign pericardial effusion with diffusion-weighted MRI.

AIM: To differentiate malignant from benign pericardial effusion with diffusion-weighted magnetic resonance imaging (MRI). MATERIAL AND METHODS: Retrospective analysis of diffusion-weighted MRI of 41 patients (29 men and 12 women; mean 39 years) with pericardial effusion. Apparent diffusion coefficient (ADC) of pericardial fluid, and associated pericardial mass or pleural effusion was calculated. ADC of pericardial fluid was calculated by two observers and correlated with cytological analysis. Receiver operating characteristic curves and Bland-Altman plots were used. RESULTS: There was significant differences in the ADCs between benign and malignant pericardial effusions (p=0.001) by both observers. Mean ADC of malignant pericardial effusions was (2.92±0.29 and 2.86±0.33×10-3 mm2/s) and of benign effusions was (3.36±0.31 and 3.28±0.28×10-3 mm2/s) for both observers, respectively. The cut-off values of the ADC used for differentiating malignant from benign pericardial effusion were 3.25 and 3.05×10-3 mm2/s with areas under curve of 0.839 and 0.791, sensitivities of 88.2% and 70.6%, specificities of 69.6% and 73.9%, and accuracies of 78% and 72.5% for both observers, respectively. The overall interobserver agreement of the ADC value of pericardial effusion by both observers was significant (r=0.808, p=0.001). The interobserver agreement of malignant effusion (r=0.861, p=0.001) and benign effusion was significant (r=0.659, p=0.001). The ADC of pleural effusion is well correlated with ADC of pericardial effusion (r=0.088, p=0.001). CONCLUSION: The ADC value is a non-invasive imaging parameter that can be used for differentiation of malignant from benign pericardial fluid.

MRI of retinoblastoma.

We review the role of MRI in retinoblastoma and simulating lesions. Retinoblastoma is the most common paediatric intra-ocular tumour. It may be endophytic, exophytic or a diffuse infiltrating tumour. MRI can detect intra-ocular, extra-ocular and intracranial extension of the tumour. MRI is essential for monitoring patients after treatment and detection of associated second malignancies. It helps to differentiating the tumour from simulating lesions with leukocoria.

Transrectal ultrasound in patients with hematospermia.

INTRODUCTION: To illustrate the lesions detected with transrectal ultrasound (TRUS) in patients with hematospermia. MATERIAL AND METHODS: This study included 74 male patients (25-73 years old) affected by hematospermia. Clinical history was obtained and all patients underwent rectal examination as well as TRUS examination in both axial and coronal planes to evaluate the prostate, ejaculatory ducts and seminal vesicles. Biopsy was performed in 10 patients. RESULTS: Abnormalities were detected in 59 patients. Calculi (n = 20) were seen within the prostate, seminal vesicles and along the course of the ejaculatory ducts. Chronic prostatitis (n = 14) appeared as hyperechoic and hypoechoic areas within the prostate with capsule thickening suggesting seminal vesiculitis (n = 8). Granulomatous prostatitis (n = 3) appeared as hyperechoic and calcified areas scattered within the prostate and the seminal vesicles. Hypoechoic focal lesions and heterogeneous texture were seen in prostate cancer (n = 5). Utricular cysts (n = 3) appeared as small midline lesions, and Mullerian duct cysts (n = 8) appeared as larger midline cysts protruding above the prostate. Ejaculatory duct cysts (n = 4) appeared as thick walled cystic lesions along the course of the ejaculatory duct. Seminal vesicle cysts were detected in 2 patients. CONCLUSION: Our conclusion is that TRUS is a safe, non-invasive technique which can be used to detect lesions of the prostate, seminal vesicles and the ejaculatory ducts in patients with hematospermia.

Assessment of nasal and paranasal sinus masses by diffusion-weighted MR imaging.

PURPOSE: To assess nasal and paranasal sinus masses by diffusion-weighted echoplanar magnetic resonance imaging (MRI). PATIENTS AND METHODS: This prospective study included 55 consecutive patients (34 males, 21 females; aged 14-64 years, mean 39 years) with nasal and paranasal sinus masses. All underwent diffusion-weighted MRI using single-shot echoplanar imaging (EPI) with a b factor of 0.500 and 1000 s/mm2. Apparent diffusion coefficient (ADC) maps were constructed, allowing ADC values of the mass to be calculated and correlated with histopathological findings. RESULTS: The mean ADC value of nasal and paranasal sinus malignant lesions (1.10+/-0.25x10(-3) mm2/s) was significantly different (P=0.001) from that of benign lesions (1.78+/-0.41x10(-3) mm2/s). Also, there was a significant ADC difference between carcinoma and sarcoma (P=0.01) as well as between well differentiated and poorly differentiated malignancies (P=0.005). Using an ADC value of 1.53x10(-3) mm2/s as the threshold value for differentiating malignant from benign lesions, the best result obtained had an accuracy of 93%, sensitivity of 94%, specificity of 92%, a positive predictive value of 92% and negative predictive value of 94%. However, the use of 0.97x10(-3) mm2/s and 1.16x10(-3) mm2/s as threshold values to differentiate carcinomas from sarcomas and poorly differentiated malignancy, respectively, gave the best results. CONCLUSION: The ADC value is a non-invasive imaging parameter that can be used to assess nasal and paranasal sinus masses, as it can help in the differentiation of malignant tumors from benign lesions, and in the characterization and grading of malignancies.

Sonography of the knee joint().

The aim of this article is to review the sonographic appearances of common disorders involving the knee joint. Ultrasound is a sensitive method for diagnosis of tendon injuries. Injured ligaments appear swollen with mixed echogenicity. Meniscal injuries and muscle tears can be easily diagnosed. Ultrasound shows synovial thickening and effusion in inflammatory arthropathy and erosions of the articular surface in degenerative arthritis. It can be used effectively in the detection of rheumatoid arthritic activity and for grading degenerative arthritis lesions. Cystic lesions, as well as benign and malignant soft-tissue masses, are clearly delineated. Ultrasound is a safe noninvasive imaging modality that can be used for diagnosis of different disorders involving the knee joint.