Computed tomography appearance of ovarian cysts with hyperenhancing rim during the menstrual cycle in women of different ages.

OBJECTIVE: To determine the frequency and computed tomography (CT) characteristics of ovarian cysts in women of different ages. METHODS: Five hundred ninety-five contrast-enhanced CT studies performed in 430 females aged 10 or older between January 2001 and December 2006 were retrospectively reviewed. For each study, we recorded the presence of ovarian cysts larger than 5 mm in diameter, with or without a hyperenhancing rim (HR, NR). The frequencies and CT characteristics of HR and NR cysts were analyzed according to phase of the menstrual cycle and patient age. Independent-sample t test, analysis of variance, chi test, and Fisher exact test were used to compare continuous data and categorical data between groups. RESULTS: Ovarian cysts were more frequently seen on CT studies of women between the ages of 20 and 49 years than on those of women older than 50 years (P = 0.004). Cysts with no HR were seen in every age group; HR cysts were present only in patients younger than 50 years. Cysts with HR were seen more frequently during periovulatory and secretory phase than during menses and proliferative phase (P = 0.003). Cysts with HR had a mean volume of 1.8 cm; NR cysts had a mean volume of 5.3 cm (P = 0.004). Cysts with HR had a thicker wall (3.4 mm vs imperceptible) and a higher attenuation value (31.4 vs 14.8 Hounsfield units) and were more commonly associated with pelvic fluid (P = 0.005) than were NR cysts. CONCLUSIONS: Cysts with HR, previously proven to represent corpus luteal cysts, can be readily seen on contrast-enhanced CT studies in women of reproductive age. Familiarity of the varied CT appearance of these cysts is essential, lest they be misinterpreted as pathological entities.

Aberrant right hepatic arterial anatomy and pancreaticoduodenectomy: recognition, prevalence and management.

BACKGROUND: Aberrant arterial anatomy is a common finding during foregut surgery. Anomalies to the right hepatic lobe are especially relevant during pancreaticoduodenectomy (PD) and their recognition serves to protect the blood supply to the liver and bile ducts. We report our experience with aberrant right hepatic arterial anatomy (ARHAA) found during PD. METHODS: All patients who underwent PD between February 2003 and June 2007 were retrospectively reviewed and those with ARHAA were identified. Preoperative imaging studies were assessed by one radiologist, graded according to the presence of ARHAA and compared with the original interpretations. RESULTS: We found ARHAA in 31 of 191 patients (16.2%). Operative management included dissection and preservation in 24, transection and reconstruction in four, and transection and primary anastomosis in three patients. Reconstruction of ARHAA was carried out through interposition grafts in two patients and implantation into the gastroduodenal stump in two patients. No cases of arterial thrombosis, liver infarction, abscess formation or biliary fistula were demonstrated in the immediate postoperative period. Review of preoperative imaging interpretations found that only nine of 23 reports indicated the presence of ARHAA; however, the retrospective review of the images found that ARHAA was readily apparent in 24 patients. DISCUSSION: Recognition of aberrant vasculature to the liver before PD is important. Preoperative imaging studies will often be adequate to identify these anomalies, but interpreting radiologists may not be aware of its clinical significance. Surgeons performing PD must be adept at managing ARHAA safely.