Benign notochordal cell tumours have recently been described as intraosseous benign lesions of notochordal cell origin. The lesions are found in vertebral bodies in 20% of autopsy studies and are a potential precursor of chordoma. We report a rare case of lumbar vertebral chordoma that was thought to arise from a benign intraosseous notochordal cell tumour and which showed significant osteosclerotic change. Radiologically, the lumbar vertebral mass lesion showed hyperintensity on T2 weighted images, with scanty enhancement on post-contrast T1 weighted MR images. High uptake corresponding to the mass was noted on fluorine-18-fluorodeoxyglucose positron emission tomography. Bone biopsy revealed proliferation of the physaliphorous cells between thickened bone trabeculae; no nuclear mitosis was observed. Although the mass was diagnosed clinically as spinal chordoma, histopathology contained both benign notochordal cell tumour and conventional chordoma. After heavy particle (11C)-charged radiation therapy was applied to the lesion with a sufficient radiation field margin, the tumour volume significantly decreased and there was improvement in the patient's symptoms. On follow-up radiological studies, the tumour had markedly regressed and there was no tumour regrowth or distant metastasis. In this case report, benign notochordal cell tumour and conventional chordoma are histopathologically identified in the L1 vertebral body, which contains osteosclerotic and osteolytic areas. It is suggested that the benign notochordal cell tumour coexists with a conventional chordoma and that this histopathological finding supports a hypothetical relationship between benign notochordal cell tumour and chordoma.

Category: Hepato-pancreato-biliary

“Booze fuels record deaths” 1 http://www.express.co.uk/news/uk/309635/Booze-fuels-record-deaths. Accessed 13/04/2017. Google Scholar , “Liver disease deaths reach record levels in England” 2 http://www.bbc.co.uk/news/health-17465403. Accessed 13/04/2017. Google Scholar , “Drinking sends liver deaths rocketing 25% in the last 10 years” 3 http://www.mirror.co.uk/news/uk-news/drinking-sends-liver-deaths-rocketing-768510. Accessed 13/04/2017. Google Scholar ; these are just a handful of headlines from national news networks in response to the report by the NHS National End of Life Care Programme in 2012, 4 Public Health England. Deaths from Liver Disease: Implications for end of life care in England. Available at: http://www.endoflifecare-intelligence.org.uk/resources/publications/deaths_from_liver_disease. Accessed 13/04/2017. Google Scholar which showed that fatal cases of chronic liver disease are steadily rising in the UK, although the key drivers are all avoidable or treatable, namely alcohol, obesity, hepatitis B, and hepatitis C. Despite transient outrage, there has been little response by way of an integrated healthcare policy to address these failings. Liver disease-related deaths in the UK have overtaken other Western European countries that have historically been significantly higher. This has prompted the setting up of a Lancet commission in 2014 to identify the underlying issues and to provide a matrix to improve the standard of care for patients with liver disease in the UK. 5 Williams R. Aspinall R. Bellis M. et al. Addressing liver disease in the UK: a blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis. Lancet. 2014; 384: 1953-1997 Abstract Full Text Full Text PDF PubMed Scopus (407) Google Scholar

Diffusion-weighted magnetic resonance imaging (DW MRI) is an established technique in neuroradiology and more recently has emerged as a useful adjunct to various oncological applications of MM. It has an expanding role in the evaluation of liver lesions, offers higher detection rates for Small lesions, and can increase confidence in differentiating between benign and malignant lesions. Other applications include assessment of tumour response to therapy, differentiating tumour from bland thrombus, and assessment of liver fibrosis. DW sequences can be performed on most modern MRI machines with relative ease, in a short time period and without the need for contrast medium. DW MRI can be of value in the detection and characterization of hepatic lesions but there are pitfalls, which can potentially cause interpretative difficulty. This article will review the rationale for DW MRI in liver imaging, demonstrate the clinical utility of the technique in a spectrum of hepatic diseases, and illustrate key interpretative pearls and pitfalls. (C) 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

BACKGROUND:Half of patients with colorectal cancer develop liver metastases. There remains great variability between hospitals in rates of liver resection for colorectal cancer liver metastases (CLM). This study aimed to determine how many patients with potentially resectable CLM are not seen by specialist liver surgeons.METHODS:Patients presenting with new CLM in a cancer network consisting of a tertiary centre and seven attached hospitals were studied prospectively over 12 months. Data were collected retrospectively for patients who did not have a complete data set. Outcomes for patients referred to the liver tertiary centre were collated. The radiology of tumours deemed inoperable by the local colorectal specialist teams was reviewed by specialist liver surgeons and radiologists.RESULTS:In total, 631 patients with CLM were assessed. Prospective data were complete for 241 patients, and 64 (26.6 per cent) of these were referred to the specialist liver team for consideration of resection. No decision was documented for 16 patients (6.6 per cent). Of those not referred, 30 (18.6 per cent) were deemed unfit or refused and 131 (81.4 per cent) were thought inoperable. Referral rates varied between hospitals (13-43.6 per cent). Of 131 patients deemed fit but inoperable by the colorectal specialist teams, 38 (29.0 per cent) were deemed operable and 20 (15.3 per cent) had equivocal imaging when assessed retrospectively by liver specialists. In total, 142 of the 631 patients were referred to liver specialists for consideration of treatments, and 107 (75.4 per cent) treated with curative intent.CONCLUSION:A considerable number of patients with potentially resectable CLM are not assessed by specialist liver teams. Improved referral rates could greatly improve resection rates for CLM, which may improve outcomes for patients with colorectal cancer.

Summary The purpose of our study was to compare the effectiveness of 3.2 mm, 5 mm and 7.5 mm slice thicknesses in the detection and characterisation of liver lesions found on CT in patients with known or suspected malignant disease. 110 patients underwent portal phase imaging using four‐slice MDCT. Two blinded observers independently read hard copy images at each slice thickness. The size and location of each lesion detected was recorded by each observer on a diagram of liver segmental anatomy. Each lesion was characterised as benign, malignant or indeterminate in nature. A diagnostic confidence score was allocated for each lesion on a scale of 1–4. The pathology or behaviour of lesions was assessed using surgery with intra‐operative ultrasound (IOUS) and histology, or interval imaging with MRI, CT, or sonography. 294 lesions were detected, 64 (22%) of which were malignant. Both observers detected significantly more lesions on the 3.2 mm versus 7.5 mm slice thickness (p < 0.0001). Both observers detected more malignant lesions on 3.2 mm and 5 mm slice thicknesses versus 7.5 mm. As slice thickness decreased there was a significant increase in the sensitivity of malignant lesion detection for observer 1 (p < 0.001) and borderline significance for observer 2 (p = 0.07). As slice thickness decreased the proportion of lesions characterised as indeterminate by both observers fell. With thinner slices, both detection and characterisation of liver lesions were improved. A slice thickness no greater than 5 mm should be used to maximise both detection and correct characterisation of liver lesions.

BACKGROUND:The impact of computed tomography (CT)-based follow-up for the detection of resectable disease recurrence following surgery for colorectal liver metastases (CRLM) was evaluated.METHODS:Some 705 patients undergoing resection of CRLM between January 1993 and March 2007 were included. Surveillance comprised 3-monthly CT (thorax, abdomen and pelvis) in the first 2 years after surgery, 6 monthly for 3 years and annually from years 6 to 10. Survival differences following recurrence between patients managed surgically and palliatively were determined, and the cost was calculated.RESULTS:Five-year disease-free and overall survival rates were 28.3 and 32.3 per cent respectively. Of 402 patients who developed recurrence within 2 years, 88 were treated with liver resection alone and 36 with lung and/or liver resection. Their 5-year overall survival rates were 31 and 30 per cent respectively, compared with 3.9 per cent in 278 patients managed palliatively (P < 0.001). For each 3-month interval during the first year of follow-up, patients with recurrence treated surgically had better overall survival than those treated palliatively. The cost of surveillance that identified 124 patients amenable to further resection was 12,338 pounds per operated recurrence. Assuming that patients with recurrence gained 5 years' survival, the mean survival gain was 4.28 years per resection and the cost per life-year gained was 2883 pounds.CONCLUSION:Intensive 3-monthly CT surveillance after liver resection for CRLM detects recurrence that is amenable to further resection in a considerable number of patients. These patients have significantly better survival with a reasonable cost per life-year gained.

Aim To evaluate magnetic resonance cholangiography (MRC) with high-resolution dynamic gadolinium-enhanced magnetic resonance imaging (MRI) in determining the imaging features of hilar cholangiocarcinoma that relate to tumour extent and influence resectability. Materials and methods Twenty-six patients that underwent resection were reviewed. Tumour location and extent, lobar atrophy, the degree of portal vein and hepatic artery involvement were recorded. The findings were correlated with surgical and histopathological findings. Results Biliary assessment was concordant in 14 and discordant in eight of 14 stented and four of 12 non-stented patients. In 63/82 veins and 43/74 arteries results were fully concordant. The mean sensitivity, specificity, positive and negative predictive values (PPV, NPV) in predicting involvement of the main portal vein (MPV) at surgery were 83.3, 100, 100, and 92.5%; of the left main branch of the portal vein (LPV) were 100, 91.6, 93.3, and 100%; and of the right branch of the portal vein (RPV) were 87.5, 100, 100, and 87.5%. The sensitivity, specificity, PPV and NPV of MRI in determining histological involvement of the MPV was 75, 90.9, 60, and 92.5%; 100, 73.3, 73, and 100% for the LPV, and 100, 66.6, 42.8, and 100% for the RPV, respectively. Conclusion MRC with high-resolution dynamic gadolinium-enhanced MRI is effective in determining tumour extent and vascular involvement, but prior stenting may lead to overestimation.

older patients [3‐6], and in CT series adrenal nodules greater than 1 cm in diameter are detected in 0.35‐5% of cases [7‐ 10]. Most incidentalomas are benign, non-hormonally active, adrenal cortical adenomas; however, they may be hormonally active, but clinically unsuspected, in up to 10% of cases [11]. The other clinically significant conditions that need to be considered are pheochromocytomas, the rare adrenal cortical carcinoma, and in the cancer patient an adrenal metastasis.

Background/Purpose: There is a considerable variation in the use of vascular imaging techniques in the preoperative assessment of children scheduled for liver transplantation. Duplex Doppler ultrasound scan (US), magnetic resonance angiography (MRA), and conventional angiography are used to varying extents. The authors compared the results of preoperative vascular imaging studies with operative findings to determine their accuracy and usefulness.Methods: Results of preoperative vascular imaging in 37 consecutive children undergoing cadaveric liver transplantation were compared with operative findings. Those undergoing relatively elective transplantations were investigated by US and MRA (group 1), whereas those requiring urgent transplants were assessed only by US (group 2).Results: The median age of the cohort (15 boys; 22 girls) was 4 years (19 days to 16 years) and the median weight was 17 kg (2.9 to 82 kg). In group 1 (n = 26), 20 children had a normal-caliber, patent portal vein at transplant and 6 had a narrow but patent portal vein requiring venous reconstruction in 4. The sensitivity and specificity of MRA in the detection of an abnormally narrow portal vein were 100% (6/6) and 95% (19/20), respectively. If reversed or absent flow in the portal vein on US was taken as an indication of a potentially abnormal vein, the sensitivity and specificity of Doppler US were 83% (5/6) and 95% (19/20), respectively. Magnetic resonance angiography revealed arterial anomalies in 4 children but failed to detect small accessory hepatic arteries in 5. The single patient with an aberrant vena cava was identified by MRA. In group 2 (n = 11), venous findings at operation and on US were concordant in 10 (91%) cases; one infant with reversed flow in the portal vein on US had a thrombosed vein at surgery. Magnetic resonance angiography was useful in 2 patient groups: those with reversed flow on Doppler US or suspected portal vein thrombosis in whom an abnormal portal vein was present in 86% (6/7) and infants with the biliary atresia splenic malformation syndrome who had multiple venous and arterial anomalies.Conclusions: A detailed Doppler examination of the hepatic vasculature by an experienced sonographer/radiologist provides sufficient vascular imaging for most children scheduled for cadaveric liver transplantation. Routine MRA is recommended in children with the biliary atresia splenic malformation syndrome and in those with abnormal duplex Doppler US findings. Although there are limited data in this study, MRA is also valuable in children with Budd-Chiari syndrome, liver tumors, or a previous portosystemic shunt. (c) 2005 Elsevier Inc. All rights reserved.

Picture quizPicture quizR Razzaq, S A Sukumar, H E Woodley, J Ward, P J A Robinson, C Messiou, A G Chalmers and J A GuthrieR Razzaq1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this author, S A Sukumar1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this author, H E Woodley1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this author, J Ward1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this author, P J A Robinson1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this author, C Messiou1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this author, A G Chalmers1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this author and J A Guthrie1Department of Radiology, Royal Bolton Hospitals NHS Trust, Minerva Road, Farnworth, Bolton, 2University Hospitals of South Manchester, Southmoor Road, Wythenshawe, Manchester, 3St. James' University Hospital, Beckett Street, Leeds, 4Clinical Radiology Department, St James's University Hospital, Leeds LS9 7TF and 5CT Unit, Department of Radiology, The General Infirmary at Leeds, Leeds, UKSearch for more papers by this authorPublished Online:28 Jan 2014https://doi.org/10.1259/imaging/22503988SectionsPDF/EPUBFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail About Previous article Next article FiguresReferencesRelatedDetails Volume 16, Issue 4September 2004Pages: 287-iv © The British Institute of Radiology History Published onlineJanuary 28,2014 Metrics Download PDF

Hepatocellular carcinoma (HCC) is the most common liver related cause of death in cirrhosis. The pathogenesis of HCC is through a progression from regenerative nodules through dysplastic nodules to overt HCC. Unenhanced MRI sequences are unreliable for identifying and characterising HCC. The majority of HCCs are hypervascular and do not take up superparamagnetic iron oxide (SPIO). The accuracy in the detection of HCCs less than 1 cm in diameter is low.

The aim of this study was to establish whether enhancement of the liver by the MRI contrast agent ferumoxides could be effectively achieved at a reduced dose of 7.5 micromol/kg in patients with advanced liver cirrhosis. Forty-two liver transplant candidates with end-stage cirrhosis underwent SPIO-enhanced MRI at 1.5T, using either 15 micromol/kg or 7.5 micromol/kg ferumoxides. The lower dose of ferumoxides was also used in 21 non-cirrhotic patients with colorectal liver metastases who acted as a control group. The percentage signal intensity loss (PSIL) after SPIO was measured in all patients, and in those patients with tumors the post-SPIO contrast-to-noise ratio (CNR) was measured. The median PSIL after SPIO in the high dose cirrhotic (HDLC), low dose non-cirrhotic (LDNC) and low dose cirrhotic (LDLC) patients was 86.3%, 74.6%, and 64.2% respectively. These differences were significant using the Mann-Whitney U test. Tumors were found in 8 patients in the high dose cirrhotic group, 9 in the low dose cirrhotic group, and all 21 of the control group. No significant differences were found between the CNR values after SPIO in the 3 groups (median values HDLC 15.1, LDNC 23.7, LDLC 19.5). In patients with late-stage cirrhosis the PSIL after SPIO was significantly less at 7.5 micromol/kg than at 15 micromol/kg, but both doses produced a substantial loss of signal. Lesion to liver CNR was not adversely affected by using the lower dose, so when imaging at 1.5T the authors would recommend using 7.5 micromol/kg in patients with liver cirrhosis.

OBJECTIVE:The aim of our study was to determine the sensitivity of double-contrast MR imaging in the detection of hepatocellular carcinomas in patients with a cirrhotic liver.SUBJECTS AND METHODS:Thirty-one patients underwent double-contrast MR imaging and subsequent liver transplantation. Breath-hold T1- and T2-weighted MR images were obtained before and after administration of superparamagnetic iron oxide, and three-dimensional T1-weighted gradient-recalled echo MR images were obtained 10, 40, and 120 sec after a bolus injection of gadolinium. Hypervascular lesions that failed to take up superparamagnetic iron oxide were regarded as showing typical characteristics of hepatocellular carcinoma; lesions that had only one of these two characteristics (either hypervascularity or failure to take up superparamagnetic iron oxide) were regarded as highly suspicious for hepatocellular carcinoma. Radiology reports were correlated with pathology reports for the explanted livers.RESULTS:Thirty-two hepatocellular carcinomas were found in 14 of the 31 patients. Combining the number of MR imaging reports citing lesions that were "typical of hepatocellular carcinoma" with the number of those citing lesions that were "highly suspicious," we found that for 25 of 32 lesions, an accurate MR imaging diagnosis of hepatocellular carcinoma was made (overall sensitivity, 78%). These lesions included 10 of the 11 lesions that were larger than 20 mm (sensitivity, 91%), 12 of the 13 lesions that were 11-20 mm (sensitivity, 92%), and three of the eight lesions that were 10 mm or less (sensitivity, 38%). Nineteen (76%) of 25 lesions had characteristics considered typical of hepatocellular carcinoma; the remaining six lesions either failed to take up superparamagnetic iron oxide and were hypovascular or were hypervascular but showed some uptake of superparamagnetic iron oxide.CONCLUSION:In patients with a cirrhotic liver, double-contrast MR imaging is highly sensitive in the diagnosis of hepatocellular carcinomas of 10 mm or larger, but success in the identification of tumors smaller than 10 mm is still limited.

PURPOSE: To compare the accuracy of four breath-hold magnetic resonance (MR) imaging sequences to establish the most effective superparamagnetic iron oxide (SPIO)-enhanced sequence for detection of colorectal hepatic metastases.MATERIALS AND METHODS: Thirty-one patients with colorectal hepatic metastases underwent T1-weighted gradient-echo (GRE) and T2-weighted fast spin-echo (FSE) MR imaging before and after SPIO enhancement. Four sequences were optimized for lesion detection: T2-weighted FSE, multiecho data image combination (MEDIC), T2-weighted GRE with an 11-msec echo time (TE), and T2-weighted GRE with a 15-msec TE. Images were reviewed independently by three blinded observers. The accuracy of each sequence was measured by using alternative free-response receiver operating characteristic analysis. All results were correlated with findings at surgery, intraoperative ultrasonography, or histopathologic examination. Differences between the mean results of the three observers were measured by using the Student t test.RESULTS: Postcontrast T2-weighted GRE sequences were the most accurate and were significantly superior to postcontrast T2-weighted FSE and unenhanced sequences alone (P < .05). For all lesions that were malignant or smaller than I cm, respectively, mean accuracies of postcontrast sequences were 0.082 and 0.64 for T2-weighted FSE, 0.90 and 0.78 for MEDIC, 0.92 and 0.80 for GRE with an 11-msec TE, 0.93 and 0.82 for GRE with a 15-msec TE, and 0.81 and 0.62 for unenhanced sequences.CONCLUSION: Optimized SPIO-enhanced T2-weighted GRE combined with unenhanced T2-weighted FSE MR sequences were the most sensitive. Breath-hold FSE postcontrast sequences offer no improvement in sensitivity compared with unenhanced sequences alone. (C) RSNA, 2003.

Excision of primary colorectal cancer associated with irresectable synchronous metastases confers high morbidity and mortality with uncertain benefit.