Bing-Neel syndrome with a paravertebral mass.

Bing-Neel syndrome, a rare neurological complication of Waldenström macroglobulinemia, is caused by the direct infiltration of malignant lymphoplasmacytic cells into the central nervous system. We report a patient who presented with back pain, weakness, lower extremity numbness, and gait disturbance accompanied by immunoglobulin M paraproteinemia and lymphoplasmacytic lymphoma in the bone marrow. Thoracic and lumbar magnetic resonance imaging revealed a long paravertebral mass around the spinal column, but the direct infiltration could not be proven. The patient was diagnosed with possible Bing-Neel syndrome and managed with bendamustine and rituximab. After chemotherapy, the patient's neurological and radiological findings improved. Magnetic resonance imaging should be considered when the Bing-Neel syndrome diagnosis is unclear.

The clinical significance of breast MRI in the management of ductal carcinoma in situ diagnosed on needle biopsy.

OBJECTIVE: To identify the factors associated with invasive disease in ductal carcinoma in situ diagnosed on needle biopsy by analyzing breast magnetic resonance imaging findings with the histopathological factors of biopsy specimens. METHODS: This was an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant study. Seventy-five ductal carcinoma in situ patients diagnosed by needle biopsy who underwent preoperative magnetic resonance imaging were retrospectively reviewed. The magnetic resonance imaging and histopathological variables were assessed between pure ductal carcinoma in situ and invasive breast cancer diagnosed on surgical specimens. Multivariable analyses were performed to determine the independent factors for invasion using a logistic-regression model. RESULTS: The median age of patients was 55 (34-76) years. On dynamic magnetic resonance imaging, 60 cases out of 75 (80%) were classified as non-mass-like enhancement type and 15/75 (20%) were Mass type. In non-mass-like enhancement, 11/60 (18%) were ultimately diagnosed as invasive breast cancer. Lesion size (P = 0.027), signal intensity ratios (calculated as the signal intensity of detected lesions divided by the signal intensity of surrounding normal breast tissue; P = 0.032) on magnetic resonance imaging and the number of biopsy-cores containing cancer nests (P = 0.012) were each independently associated with invasion. Furthermore, each signal intensity ratio of invasive and non-invasive components of invasive breast cancer represented a value significantly higher than that of 49 pure ductal carcinoma in situ classified as non-mass-like enhancement (P = 0.001 and P = 0.034, respectively). Conversely, there were no significant magnetic resonance imaging findings to distinguish seven invasive breast cancer from among Mass type. CONCLUSIONS: Needle-biopsy-proven ductal carcinoma in situ cases with non-mass-like enhancement type might be sufficiently managed using breast magnetic resonance imaging features such as enhanced lesion size and signal intensity, incorporating the number of cancer-cores at needle biopsy specimen in the clinical setting.

[Is intravenous contrast enhancement effective in improving CT diagnosis of hepatic disease?].

PURPOSE: The purpose of this study was to evaluate the effectiveness of contrast enhancement in the diagnosis of hepatic disease. MATERIALS AND METHODS: 2761 cases involving CT of the liver and abdomen were analyzed using logistic analysis. CT was either helical-CT (SDCT) or multi-detector CT (MDCT), with power injector. RESULTS: Contrast enhancement use was 92% in liver disease and 95% in tumor cases. A typical case involved a 66-year-old man given 2-4 ml/sec of contrast material using dual injection. CT imaging was done in the equilibrium stage. The use of contrast material was effective for the diagnosis of liver tumor except in the qualitative diagnosis of hepatocellular carcinoma with SDCT where the odds ratio was 0.084. CONCLUSION: Intravenous contrast enhancement was effective for the CT diagnosis of hepatic tumor. Dynamic CT was effective using MDCT, and dual injection of contrast material was also valid for SDCT. Multiphasic studies were needed for detecting liver tumors not only on MDCT but also on SDCT. CT imaging during the equilibrium phase alone is inadequate to document diagnosis of metastatic liver tumors. The addition of various phasic contrast materials during CT was effective in evaluating liver tumors that showed angiogenesis.