The detectability of small daughter nodules of hepatocellular carcinoma by computed tomography after hepatic arterial infusion of Lipiodol (iodized oil) and by infusion hepatic angiography was studied in 102 cases. The Lipiodol was selectively accumulated by the tumor. Tumors and small daughter nodules appeared as high-density areas on computed tomography. In 24 cases daughter nodules were identified only by computed tomography. In 50 cases computed tomography demonstrated superior ability to detect the daughter nodules when compared with infusion hepatic angiography. In 21 cases the daughter nodules were detected for the first time in areas other than the main site of the primary tumor. Lipiodol-computed tomography is very effective in the diagnosis of daughter nodules of hepatocellular carcinoma.
Two patients with massive prostate adenocarcinoma were evaluated by several imaging modalities. Computed tomography provided excellent anatomic delineation of the tumors. In one patient, computed tomography demonstrated significant tumor regression following orchiectomy. Giant prostate carcinoma should be considered in the differential diagnosis of a large, inhomogeneous pelvic mass.
A case of gliomatosis cerebri studied by computed tomography (CT) and magnetic resonance imaging (MRI) is reported. Follow-up by serial CT revealed a right parieto-occipital glioblastoma. Gliomatosis cerebri and multiform glioblastoma were demonstrated by histologic study. Anatomic and CT data were correlated. The role of CT and MRI in the diagnosis of this disease was evaluated and case studies of CT published in the literature were reviewed.
We report a case of renal sinus non-Hodgkin's lymphoma without contiguous adenopathy. Magnetic resonance and computed tomography images of this rare tumor were correlated with a pathologic specimen. On computed tomography the renal sinus lymphoma was evaluated as a well circumscribed, low-density mass owing to the mixture of the lymphomatous cells and fat tissues. Magnetic resonance showed the replacement of the renal sinus fat tissues with a spoke-like solid mass. The renal artery and vein were also evaluated thoroughly and were without tumor thrombosis.
We report a case of malignant melanoma, metastatic to the brain, in which disease was not detected by magnetic resonance imaging but was detected by contrast enhanced computed tomography. At least in some instances, magnetic resonance imaging fails to detect disease that is apparent by computed tomography.
Avulsion of the ureter is a rare but significant traumatic injury, and there is often a delay in diagnosis and treatment (1). Radiologic signs have been described for intravenous urography but are not always present (2). To our knowledge, the computed tomographic appearance of avulsion of the ureter has not been described. Herein, we report the contrast-enhanced computed tomography findings in a case of traumatic avulsion of the ureter.
We report the computed tomography findings in an unusual case of diffuse metastatic calcification secondary to renal failure.
The magnetic resonance findings in a patient with acquired partial lipodystrophy are described. Adipose tissue in a variety of locations, including the retroperitoneum and bone marrow, is well demonstrated by magnetic resonance in several anatomic planes. Magnetic resonance may provide complementary information to clinical findings in evaluation of patients with partial lipodystrophy.
Twenty-seven patients with locally advanced and inoperable bladder carcinoma (LABCa) were referred for chemotherapy. All were staged by cytoscopy, examination under anesthesia, and computed tomography (CT), and 18 also had bipedal lymphangiography (LAG). In 16 patients (56%), there was agreement between the clinical and the CT staging of the primary bladder tumor. In four of these 16 patients, CT detected lymphadenopathy in three and demonstrated pelvic bone invasion in one. Of the remaining 11 patients, CT underestimated the local extent of the bladder tumor in nine and overestimated in two. Lymphangiography was abnormal in nine patients (50%), in four of whom the abnormality was not seen on CT scan. Among the ten patients with normal LAG, six had abnormal pelvic nodes detected by CT. The LAG affected the overall staging of the tumor in five patients (16.6%). The total incidence of nodal metastasis as seen on CT, LAG, or both was 72%. Although CT and LAG may not add significantly to the clinical staging of the primary tumor in LABCa, they will affect the overall staging of the tumor by detecting lymphadenopathy. Accurate staging of these patients is important because, with aggressive chemotherapy, some of these patients might become candidates for more radical treatment such as surgery or radiotherapy.
Identification of a psoas abscess is often a diagnostic challenge. In this case report the diagnosis and subsequent treatment of a psoas abscess previously suggested by computed tomography was greatly enhanced by magnetic resonance imaging.
Skeletal metastases from colorectal carcinoma are unusual and osteoblastic metastases are quite rare. Three cases are described in which an isolated recurrence of a previous colorectal carcinoma occurred within the pelvic bones, without evidence of skeletal metastases elsewhere so that local spread via portocaval anastomoses in the pelvis is postulated. In all three cases, proliferative calcification and new bone formation occurred within an expansile, destructive lesion, suggesting the occurrence of a synergistic effect between the underlying bone and a malignant neoplasm which has a propensity to calcify.
The classic radiographic appearance of pulmonary aspergilloma is a solid, round, often mobile intracavitary mass. We describe an unusual “cavity-incavity” appearance seen on conventional roentgenograms and computed tomography studies in two patients with confirmed pulmonary aspergilloma. We are not aware of any previous report describing such appearance based on literature search.
Extracranial, cervical aneurysms and arterial thrombosis are uncommon entities. In most cases, they have diagnostic clinical presentations. However, on occasion the history and physical findings do not clearly suggest their presence. In these cases, postcontrast computed tomography scans can aid in rapidly establishing the correct diagnosis by revealing a "bull's-eye" appearance within the mass (vessel lumen). The diagnosis is less difficult to make when the involved vessel is the carotid artery, because this artery is routinely identified on postcontrast computed tomography scans and the lesion can be easily placed along its course. The vascular origin of such a lesion is not usually evident on computed tomography if the process does not lie along the course of a major vessel. In these cases, the bull's-eye sign can establish the diagnosis so that prompt consideration can be given to angiography and therapy.
A case report of an 11 year old boy with new onset of a seizure disorder is presented. A computed tomography scan demonstrated a noncalcified, nonenhancing focal region of abnormal cortex. A magnetic resonance imaging scan delineated both an isointense area of abnormally thickened gyri and linear areas of abnormal high signal intensity in the subjacent white matter. A review of the radiologic and pathologic literature suggests that this lesion represents the entity focal cortical dysplasia as described by Taylor, et al. This abnormality is part of a spectrum of disorders including hamartomas (of tuberous sclerosis), focal cortical dysplasia and heterotopias.
A case of Wyburn-Mason syndrome comprising unilateral retinocephalic vascular malformations is reported in a 7-year-old girl presenting with proptosis of the left eye associated with injection of the bulbar conjunctiva. This rare congenital vascular disorder is reviewed in the literature, and in particular the neuroradiological findings are detailed in the presented case.
Occipital condyle fractures can be easily overlooked on plain radiographic examinations of the head and cervical spine. This is especially true if such a fracture is not clinically suspected, since they are very rare fractures. Two patients presented with suspected tumors of the foramen magnum region. Both had old trauma and undiagnosed old fractures of the occipital condyle.
Computed tomography was performed in 100 patients for additional evaluation of suspected skeletal metastases following radionuclide bone scanning in 86 patients and conventional radiography in all. A retrospective review of these cases revealed that the majority (78%) involved the spine and pelvis. Computed tomography contributed to the diagnosis of a malignancy by revealing a definite destructive lesion of bone in 27 patients who had an abnormal radionuclide bone scan, a normal or inconclusive radiograph, or both. It excluded a malignant lesion in 19 patients. In 38 patients, computed tomography provided additional information that contributed to such aspects of patient care as obtaining tissue diagnosis, determining the extent of lesions, and evaluating the response to treatment. False diagnoses were made in two patients. Detection by computed tomography of a skeletal lesion and histologic documentation, frequently by computed tomography-guided percutaneous needle aspiration biopsy, greatly curtailed an otherwise extensive search for the primary site. Furthermore, this information altered the treatment plan by obviating the need for radical resection or biopsy of the primary tumor and by directing the choice of an appropriate chemotherapeutic regimen.
This small series reports on the computed tomography appearance of hyperdense iliac, inguinal, and femoral lymph nodes in four cases of lymphoma and one case each of ovarian and breast carcinoma. The mean attentuation value of the lymph nodes was 93.8 Hounsfield units (HU), compared to 61 HU for adjacent muscle and 110.7 HU for blood vessels. A relatively homogeneous enhancement pattern was noted, which could not be directly related to hypervascularity, inflammation, or previous treatment with drugs or radiation.
This report is a review of the findings of computed tomography and angiography of eight supratentorial gliomas with dural invasion. Computed tomography revealed localized increases in the thickness of ring enhancements at the sites of dural invasion in four cases, which was attributed to increased blood supplies by the meningeal vessels. Angiographically, feeders from the meningeal vessels entered the tumors mostly through relatively broad areas of tumor-dura attachment. A sunburst type of neovascularity from a meningeal artery was seen in only one case. In most such cases the differential diagnosis from meningioma was possible by the computed tomographic and angiographic findings. Selective external carotid angiography was the most important examination for diagnosing dural invasion by gliomas.
A case of spinal intradural metastasis from a carcinoid tumor is reported. The case is of interest due to the rarity of central nervous system involvement by these tumors and the long latency period of the patient's presentation.
