Solitary fibrous tumor of the pleura: Can computed tomography features help predict malignancy? A series of 56 patients with histopathological correlates.

OBJECTIVE: To identify computed tomography (CT) predictors of malignancy, from a retrospective study of preoperative CT scans of patients with solitary fibrous tumors (SFT) of the pleura. PATIENTS AND METHODS: The CT scans of 56 patients with histopathologically confirmed SFT (33 women and 23 men; mean age, 60years) who underwent surgery between December 2004 and November 2012 were retrospectively analyzed by three radiologists working in consensus, blinded to the final histological diagnosis. RESULTS: SFT was asymptomatic and incidentally discovered in 22 patients (45.8%). Resection specimen analysis (R0 resection in all cases) revealed that 23 tumors (41%) were malignant. The CT features, which significantly differed between malignant and benign SFTs were tumor size (P=0.002) with a discriminative threshold value of 10cm, tumor heterogeneity before (P=0.02) and after (P=0.03) intravenous administration of iodinated contrast material, presence of intratumoral hydric attenuation areas (P=0.01), pleural effusion (P=0.01), measurable intratumoral vessels (P=0.02), hypervascularization with visible intratumoral vessels and/or marked enhancement (P=0.001). Presence of intratumoral calcifications (P=0.2) and maximum post-contrast enhancement value (P=0.6) were not significantly different between the two groups. CONCLUSION: A size greater than or equal to 10cm, hypervascularization, attenuation heterogeneity and association with pleural effusion are individual variables that suggest malignant SFT on CT.

[Suspected acute appendicitis. Role of enhanced helical computed tomography. Prospective study of 100 patients]. / Suspicion d'appendicite aiguë. Intérêt de l'examen tomodensitométrique hélicoïdal. Etude prospective chez 100 patients.

AIM OF STUDY: To assess the diagnosis accuracy of helical computed tomography (CT) in patients with suspected appendicitis. PATIENTS AND METHODS: This prospective study included 100 consecutive patients hospitalized for suspected appendicitis. There were 57 men and 43 women with a median age of 30 years (range: 17-91). An enhanced helical CT was performed at admission, without digestive opacification. Four criteria were interpreted as positive signs for appendicitis: appendix enlarged > or = 7 mm, right lower quadrant inflammation, stercorolith, and peri-appendicular collection. The patient was managed by the surgeon without knowing the result of CT. The final diagnosis was made pathologically. RESULTS: Eighty-one patients were operated on laparoscopically for suspected appendicitis. Intraoperative diagnosis was corrected in three cases and 78 appendectomies were performed (73 histological appendicitis, six normal appendix). Final diagnosis was a medical disease in 19 patients. The findings of 67 CT were interpreted as positive (63 true positive and four false positive) and the findings of 33 CT were interpreted as negative (24 true negative, nine false negative). Sensitivity was 87%, specificity was 86%, positive predictive value was 94%, and negative predictive value was 73%. If the nine false negative cases with minimal lesions at pathological examination were considered as true negative, the rates would be 100%, 89%, 94%, 100%, respectively. CONCLUSION: Enhanced helical CT is a good imaging diagnostic tool for suspected appendicitis. It may reduce the number of patients admitted for observation and decrease the rate of negative appendectomy.

[Androgenic alopecia revealing an androgen secreting ovarian tumor]. / Alopécie androgénétique révélant une tumeur ovarienne androgéno-secrétante.

INTRODUCTION: Androgen-producing tumors of the ovary are rare in postmenopausal women and are revealed by severe virilization. Leydig hilus cell tumors are the most frequent postmenopausal virilizing tumors. In this report, an unusual and rare cause of alopecia due to Leydig cell hyperplasia within the wall of a simple cyst and in the ovarian hilus is described. OBSERVATION: An 80 year-old woman complained of a 10-year history of severe androgenic alopecia associated with very mild facial hirsutism, without others signs of virilization. Hormonal blood levels showed markedly elevated testosterone. Computed tomographic scan of the adrenals and the ovaries revealed an enormous left ovarian cystic mass. Bilateral hystero-ophorectomy was performed. Histological examination demonstrated bilateral Leydig cell hyperplasia within the wall of the cyst and in the right ovarian hilus. Two months postoperative hormonal evaluation demonstrated dramatically decreased plasma levels of testosterone. COMMENTARY: The clinical, X ray and histologic aspects of this case, although rare, show that the presence of virilization should lead to a search for an androgen-secreting ovarian or adrenal tumor.

[Malignant tumors of the ovaries: role of imaging]. / Tumeurs malignes de l'ovaire. Rôle de la radiologie.

Malignant ovarian tumors are developed in more than 95% in the epithelium surface of the ovary. In the mainly cystic forms, vegetations greater than 2cm, with an irregular surface, with a broad base on implantation, containing vessels on color Doppler are very suggestive of malignancy. Ultrasound is highly accurate in these forms. In most of the mixed forms on mainly solid forms, the irregular solid portions with degenerative changes containing tumoral vessels are very suggestive of malignancy. CT scan or MR imaging are usually more indicative of showing malignancy than ultrasound. In the multilocular forms, diagnosis of malignancy or benignity is often difficult. Extension to the pelvis, peritoneum and lymph nodes is easier to define on CT scan.

Association of macrophagic myofasciitis and fibromuscular dysplasia with renal fibromuscular dysplasia: first case report.

Two rare muscular diseases, macrophagic myofasciitis and fibromuscular dysplasia, are associated in the patient reported here. Their respective etiologies are unknown. The possible link has to be discussed.

Hyperreactio luteinalis in a normal pregnancy: sonographic and MRI findings.

A case of hyperreactio luteinalis in an otherwise normal pregnancy is reported. Ascites was present, but no peritoneal implants or adenopathy were seen. Findings that would have suggested the correct diagnosis are the symmetrical and bilateral pattern of the mass, as well as the rather uniform size of the loculi, which were 1 to 3 cm in diameter.

[Pulmonary embolism. The role of computed tomography angiography]. / Embolie pulmonaire. La place de l'angioscanner.

NONINVASIVE PROCEDURE: Helical CT angiography is a noninvasive procedure whose only relative contraindications are renal insufficiency and iodine allergy. MASSIVE PULMONARY EMBOLISM: If a massive pulmonary embolism is suspected, helical CT angiography is the examination of choice because of its high accuracy in detecting proximal thrombi and its safety profile. NON-MASSIVE PULMONARY EMBOLISM: If a non massive pulmonary embolism is suspected, helical CT angiography, because of its high specificity, can be the first examination instead of scintigraphy. If a thrombus is depicted by CT, the diagnosis of pulmonary embolism is confirmed and treatment is started. If no thrombus is visualized by CT, pulmonary embolism can be ruled out in most cases. In case of doubt, another noninvasive procedure should be performed. Angiography should be the exception and seldom is needed.

MR and CT findings in a case of hibernoma of the thigh extending into the pelvis.

Review of the literature shows no report of hibernoma of the thigh extending into the pelvis. Herein we report a case of hibernoma which appeared on CT and MR as a well-defined pelvic mass with contrast enhancement extending through the obturator foramen into the thigh. Fat was demonstrated by CT, whereas MR, using multiplanar sections, better analyzes the extension of the mass. This case demonstrates that hibernoma as liposarcoma can extend through the obturator foramen. However, no definite diagnosis could be made by CT or MR and the tumor must be considered as a "potential" malignant liposarcoma.

Swyer-James syndrome documented by spiral CT angiography and high resolution inspiratory and expiratory CT: an accurate single modality exploration.

Spiral CT angiography was performed in a patient suspected of having pulmonary embolism. The right pulmonary system was normal. The left arterial system was small but patent. The left upper lobe was small and hyperlucent. The left lower lobe was collapsed and contained bronchiectasis. The bronchi were patent. High resolution CT in inspiration and expiration confirmed air trapping in the left upper lobe. A diagnosis of Swyer-James syndrome of the left upper lobe was made.

[Value of plasma D-dimer assays in the diagnosis of venous thromboembolism]. / Intérêt du dosage des D-dimères plasmatiques dans le diagnostic des accidents thrombo-emboliques veineux.

The diagnostic usefulness of measuring plasma D-dimers using the ELISA method and the latex agglutination test has been prospectively evaluated in 117 patients hospitalized for suspicion of acute venous thrombo-embolism (AVTE): pulmonary embolism was suspected in 80 patients and the remaining 37 had a suspicion of deep vein thrombosis of the lower limbs. The diagnosis of AVTE was confirmed in 50% of the patients, all of whom underwent gold standard invasive investigation i.e. pulmonary angiography and/or contrast venography. The sensitivity, specificity, negative predictive value and positive predictive value of a D-dimers plasma concentration exceeding 500 ng/ml for the diagnosis of AVTE were respectively 98, 58, 97 and 70% when using the ELISA method, and 86, 71, 84 and 75% when using the latex assay. In 47 patients whose lung scans yielded abnormalities of indeterminate probability of pulmonary embolism, the sensitivity of the ELISA method was very high (94%), but that of latex assay was low (67%). Our results demonstrate that measuring the plasma D-dimers by the latex assay should not be used in the diagnosis of AVTE. On the other hand, the ELISA method might be of great interest in the diagnostic strategy of AVTE, as a normal concentration of D-dimers rules out almost definitely the diagnosis of AVTE, and hence, spares from performing invasive investigations.

Characterization of adnexal masses: combination of color Doppler and conventional sonography compared with spectral Doppler analysis alone and conventional sonography alone.

OBJECTIVE: To evaluate the importance of color Doppler combined with conventional sonography in characterizing adnexal masses and to compare the results with those of spectral Doppler analysis alone and conventional sonography alone. MATERIALS AND METHODS: One hundred and fifteen women with 132 adnexal masses (98 benign, three borderline, and 31 malignant) were prospectively studied with conventional and Doppler sonography (transabdominal in all patients and transvaginal in 111). Three methods differentiated benign from borderline and malignant masses. In the first, conventional sonography was used. In the second, conventional sonography was combined with color Doppler. In this method, the presence of color flow in an echogenic portion classified as indeterminate or malignant by conventional sonography indicated malignancy; the absence of color flow in an echogenic portion classified as indeterminant or malignant at conventional sonography indicated benignancy; the presence or absence of color flow in a regular wall or septum indicated benignancy. The third method used spectral Doppler analysis. Malignancy was indicated by a resistive index (RI) less than or equal to 0.4, a pulsatility index (PI) less than or equal to 1, or a peak systolic velocity (PSV) greater than or equal to 15 cm/sec. RESULTS: Using conventional sonography alone, accuracy was 83%, sensitivity was 88%, and specificity was 82%. Using conventional sonography and color Doppler, accuracy was 95%, sensitivity was 88%, and specificity was 97%. Using spectral Doppler analysis and an RI less than or equal to 0.4, accuracy was 77%, sensitivity was 18%, and specificity was 98%. For a PI less than or equal to 1, accuracy was 68%, sensitivity was 71%, and specificity was 67%. For a PSV greater than or equal to 15 cm/sec, accuracy was 72%, sensitivity was 47%, and and specificity was 81%. CONCLUSION: Adding color Doppler to conventional sonography produced a specificity and positive predictive value higher than those of conventional sonography alone. Specificity increased from 82% to 97% (p < .001), and positive predictive value increased from 63% to 91%. RI, PI, and PSV were of limited value.

Mature cystic teratomas of the ovary: CT and MR findings.

OBJECTIVE: To correlate CT and MR patterns of ovarian mature cystic teratomas (MCT). SUBJECTS AND METHODS: CT and MR findings in 25 histologically proven ovarian MCT were retrospectively reviewed. MCT characterization at CT and MR was based on detection of fat and/or a Rokitansky protuberance. MR signal intensity and CT density numbers of fat were correlated. RESULTS: At pathology, 24/25 tumors contained fat, 1/25 a water content, and 23/25 a Rokitansky protuberance. Twenty one MCT contained fat with a density number less than-20 HU (mean density: -95 HU) and a signal intensity superior or equal to sub-cutaneous fat on T1 images, however, only six of these had a signal intensity equal to sub-cutaneous fat on T1 and T2 images and 12 had a reversed chemical shift artifact. Three contained fat with a density number ranging from -13 to +8 HU and a signal intensity inferior to subcutaneous fat on T1 images. CT showed a Rokitansky protuberance in 21/23, containing adipose tissue in 16 and calcified structures in 21. Standard MR showed a Rokitansky protuberance in 14/23 and characterized adipose tissue in eight cases, and calcified material in six cases. Finally, CT characterized 24/25 (96%) MCT. Standard MR characterized 22/25 (88%) MCT, and standard MR with fat-suppression sequences characterized 23/25 (92%) MCT. CONCLUSION: Standard MR is less effective than CT in characterizing fat and has the same difficulty as CT in characterizing fat mixed with hair when its density is high. When fat cannot be identified by either technique, diagnosis of a Rokitansky protuberance is more easily made at CT than at MR.

CT in adnexal torsion with emphasis on tubal findings: correlation with US.

OBJECTIVE: Our goal was to determine the CT and US aspects of the fallopian tube in adnexal torsion. MATERIALS AND METHODS: The CT scans and US studies of 10 patients with surgically proven unilateral torsion of the adnexa were reviewed. RESULTS: On CT the fallopian tube on the involved side was identified in eight cases as an almost tubular or comma-shaped structure extending from the uterine cornua and covering partially the adnexal mass. This tube was significantly thickened and measured 20-40 mm. Hemorrhage (density > or = 50 HU on precontrast CT scans) was present in the tube in six patients. A heterogeneous contrast agent uptake was detected in the tube in five patients. An adnexal mass was visualized on the involved side in all patients, with hemorrhage in the mass in four patients. Peritoneal fluid and/or ileus were present in six patients. On US an echogenic structure that corresponded to the enlarged tube visualized on CT was detected in three cases and an adnexal mass in all cases. CONCLUSION: Thickening of the fallopian tube with hemorrhage could be detected by CT and is suggestive of torsion especially if associated with an adnexal mass.

[Value of CT scan and MRI in primary tumors of the ovary]. / L'intérêt de la TDM et de l'IRM dans les tumeurs primitives de l'ovaire.

Characterisation of an ovarian mass is of utmost importance in the preoperative evaluation of an ovarian neoplasm. It enables the surgeon to anticipate carcinoma of the ovary before the operation, so that adequate procedures are planned. Although, ultrasonography (US) remains the foremost imaging modality for screening patients with adnexal lesions, computed tomography (CT) recently has proved to be of value in the characterisation and management of tumors of the ovary. Magnetic resonance (MR) imaging has also been shown to have a high degree of diagnostic specificity for certain types of ovarian masses, such as dermoid cysts, and endometriomas. However, the potential of MR imaging to characterize tumors of the ovary has not yet been established. This study assesses the value of MR imaging and CT for the purpose of predicting the malignancy of ovarian lesions, and comparing findings of MR imaging with those of CT.

Fat suppression techniques in MR imaging of mature ovarian teratomas: comparison with CT.

OBJECTIVE: The aim of this study is to analyze the ability of MR fat suppression techniques to characterize fat components of ovarian mature cystic teratomas (MCT) shown by CT. SUBJECTS AND METHODS: MR images of eight MCTs of the ovary were obtained using standard sequences followed by a SPIR (spectral presaturation with inversion recovery) sequence in six cases and by Dixon sequences in two cases. In all cases correlation with CT and pathologic findings was achieved. RESULTS: MR fat suppression sequences showed to be as accurate as CT in detecting fat inside the cystic part of the teratomas (8/8). CONCLUSION: MR fat suppression sequences should be performed when presence of fat is suspected on images of ovarian tumors produced by standard MR sequences.

Fibrothecomas of the ovary: CT and US findings.

OBJECTIVE: Fibrothecomas of the ovary are mesenchymal tumors representing 4-5% of all ovarian neoplasms. The purpose of this study is to describe a large series of CT findings in this type of tumor. MATERIALS AND METHODS: We reviewed retrospectively the CT examinations in 25 unilateral cases confirmed by surgery and pathology. Unenhanced and enhanced CT scans were performed in all cases and dynamic CT scans were performed in nine cases. These findings were compared to ultrasound in all cases. RESULTS: Computed tomography detected all but two small ovarian tumors (< 2 cm). Eighteen of 23 fibrothecomas were solid, with significant (> 10 HU) enhancement between precontrast and delayed CT scans. In all eight uncomplicated cases, nonincremental dynamic CT scan did not visualize arterial vessels; in seven of nine cases examined dynamically, early uptake of contrast material was visualized. Three of 23 fibrothecomas were partly cystic, partly solid. Two cases with torsion were mainly cystic with thickening and hemorrhage of the tube. CONCLUSION: In conclusion, 79% of ovarian fibrothecomas appeared as solid masses with delayed accumulation of contrast medium. On dynamic CT, the absence of arterial vessels and absence or slight early uptake of contrast enhancement could be useful findings for preoperative diagnosis. When partly or mainly cystic (21% of cases), ovarian fibrothecomas could not be easily differentiated from other ovarian masses.

Focal hyperdense areas in endometriomas: a characteristic finding on CT.

OBJECTIVE: To assess the value of a hyperdense focus seen on CT scans of endometrial cysts in the differential diagnosis of a lesion. MATERIALS AND METHODS: The preoperative CT scans of 328 patients with 410 ovarian masses (54 patients with 62 pathologically proved endometriomas and 274 patients with 348 pathologically proved other ovarian masses) were retrospectively reviewed in a random fashion without knowledge of the pathologic findings to determine whether a hyperdense focus was visible inside a cyst. RESULTS: In nine of 62 endometrial cysts (sensitivity, 15%), CT scans showed a hyperdense round or crescent-shaped focus, measuring 2 to 15 mm. This focus was located close to the inner border of the cyst in eight cases and in the central part of the cyst in one case. A hyperdense focus was not seen on CT scans of 348 other ovarian masses (specificity, 100%). An in vitro CT study of two specimens showed that this hyperdense area corresponded to a blood clot next to the inner wall of the cyst. This hyperdense area appeared as a nonspecific hyperechogenic focus on sonograms in five of nine cases and as a hypointense signal on T1- and/or T2-weighted MR images in four of five cases. CONCLUSION: The finding on CT scans of a hyperdense focus inside an ovarian cyst is suggestive of endometrioma and should help distinguish endometrioma from other pelvic masses.