OBJECTIVE:Although the hepatotoxic effects of systemic chemotherapy are well known, CT findings in the liver after systemic chemotherapy have received little attention in the literature. In some patients with breast carcinoma metastatic to the liver who have received chemotherapy, a morphologic pattern develops similar to that associated with cirrhosis. This pattern is characterized by a lobular hepatic contour, segmental volume loss, and enlargement of the caudate lobe. The purpose of this study was to describe the CT appearance of this pseudocirrhosis and to correlate it with pathologic findings.MATERIALS AND METHODS:We reviewed 65 CT examinations of 22 patients with stage IV breast carcinoma with hepatic metastases, who were receiving systemic chemotherapy and for whom abdominal CT scans showed pseudocirrhosis. Nineteen of 22 patients had follow-up CT scans at intervals ranging from 1 to 15 months. Criteria for the diagnosis of pseudocirrhosis included a lobular hepatic contour, segmental volume loss, and enlargement of the caudate lobe. CT findings were correlated with pathologic findings in seven patients.RESULTS:In all patients, CT scans showed retraction of the capsular surface of the liver (15 diffuse, seven focal) with a lobular margin, a finding also seen in advanced cirrhosis. The retraction occurred at the site of subjacent metastases. Findings evolved over 1-3 months. Six of seven patients had pathologic findings suggestive of nodular regenerative hyperplasia. No patients had pathologic evidence of cirrhosis.CONCLUSION:In patients undergoing systemic chemotherapy for breast cancer metastatic to the liver, a pattern may develop that mimics the CT appearance of hepatic cirrhosis. Pathologic findings suggest nodular regenerative hyperplasia as a possible cause.

Objective Our goal was to compare short τ inversion recovery MRI (STIR) to CT during arterial portography (CTAP) in the detection of hepatic lesions. Materials and Methods Over a 24 month period, 40 patients evaluated for possible hepatic resection underwent T1, T2, and STIR MRI and CTAP. These studies were randomly ordered and interpreted by two independent readers. The total number of lesions and number of lesions within each hepatic segment were analyzed using McNemar's test. Results Readers 1 and 2 detected 95 and 91 lesions by CTAP and 78 and 83 by STIR, respectively, which was not significantly different (p = 0.1, reader 1; p = 0.4, reader 2). For both readers CTAP and STIR MRI detected more lesions than either T2 or TI MRI (p < 0.01). In the medial segment, readers 1 and 2 detected 18 and 17 lesions by CTAP and 7 and 9 by STIR, respectively (p = 0.01, reader 1; p = 0.035, reader 2). Conclusion Short τ inversion recovery MRI and CTAP are similar in total lesion detection except in the medial segment where lesions were more frequently identified by CTAP than STIR MRI.

OBJECTIVE:The purpose of this study was to describe the MR appearance of hepatic adenomas and correlate the MR imaging features with pathologic findings.MATERIALS AND METHODS:MR examinations were performed in 14 patients with 66 hepatic adenomas. The diagnosis of hepatic adenoma was proved pathologically in nine patients (22 lesions). In five other patients (44 lesions), who had type I glycogen storage disease and were known to be at risk for hepatic adenomas, the diagnosis was established by repeated sonographic examinations that showed stability, reduction, or resolution of hepatic tumors. T1- and T2-weighted spin-echo MR images obtained at 1.5 T were retrospectively reviewed for the signal intensity of the lesions relative to liver, the signal pattern, the presence of a capsule, and the presence of hemorrhage. Histopathologic specimens (22 lesions) were reviewed for fat content (graded 0-3), the presence of a capsule, and the presence of hemorrhage.RESULTS:On T1-weighted images, 51 (77%) of 66 lesions were hyperintense, 11 (17%) were hypointense, and four (6%) were isointense with respect to liver. On T2-weighted images, 49 (74%) of 66 lesions were hyperintense, 12 (18%) were isointense, and five (8%) were hypointense. Sixty-one (92%) of 66 lesions were heterogeneous. Eleven (17%) of 66 lesions were hemorrhagic. Of the 22 lesions reviewed histopathologically, 17 were hyperintense on T1-weighted images; 15 of these had a fat content of grade 2 or 3 and two had hemorrhage. All 15 lesions that had a fat content of grade 2 or 3 were hyperintense on T1-weighted images.CONCLUSION:Hepatic adenomas have a variable MR appearance but most often are hyperintense with respect to liver on T1- and T2-weighted images. The high signal intensity often relates to the increased fat content of these lesions.

OBJECTIVE:Oxidized regenerated cellulose (Surgicel), a sterile knitted fabric that causes thrombus formation because of its physical properties, is frequently used for intraoperative hemostasis. Unlike traditional surgical sponges, it is bioabsorbable and can be left in the surgical bed. On CT scans, the appearance of the retained oxidized cellulose can mimic that of an abscess. The purpose of this study was to describe the appearance of oxidized regenerated cellulose on postoperative CT scans so that an erroneous diagnosis of an abscess can be avoided.MATERIALS AND METHODS:We reviewed the CT examinations of five postoperative patients in whom oxidized regenerated cellulose had been used for surgical hemostasis. Operative reports and surgeons confirmed the use of oxidized cellulose. Four CT scans were abdominal examinations, and one was a head examination.RESULTS:In four cases, CT scans showed focal, linear collections of gas within masses with mixed attenuation in or near the operative site. No air-fluid levels were present. In three patients, cultures of specimens obtained by aspiration were negative for pyogenic organisms.CONCLUSION:Retained oxidized cellulose can mimic an abscess on CT scans. Focal collections of air centrally located within a mass should alert the radiologist that oxidized cellulose may have been placed in the operative site, and an appropriate history should be sought.

OBJECTIVE:The purpose of this work was to determine the frequency and significance of characteristic nontumorous low attenuation defects found in the left hepatic lobe during CT arterial portography (CTAP).MATERIALS AND METHODS:Eighty CTAPs performed over a 17 month period were retrospectively reviewed to identify nonsegmental low attenuation defects adjacent to the falciform ligament, gallbladder, or porta hepatis. Twenty-four separate defects were present in 14 of 80 (18%) patients. Cases in which a defect was present were compared with MR, surgical findings, and pathology reports.RESULTS:The defects were oval or triangular in shape with a mean maximum diameter of 1.7 cm (range 1-5 cm). None of these defects were identified on MR in the 12 patients who underwent T1, T2, and STIR MR; however, 3 showed dropout of signal on chemical shift MR, suggesting fatty infiltration. In the 12 patients who underwent surgery, no lesion was shown to represent tumor. Two intraoperative biopsies of the area of the defects showed fatty infiltration.CONCLUSION:Nontumorous low attenuation defects adjacent to the gallbladder, falciform ligament, or porta hepatis are a pitfall of CTAP and can be associated with focal fatty infiltration, as well as decreased perfusion due to technical factors or a variation in hepatic vascular supply.

Acquired C1 esterase inhibitor deficiency causing intestinal angioedema: CT appearance.D Ciaccia, S R Brazer and M E BakerAudio Available | Share

Laparoscopic cholecystectomy has become the procedure of choice for surgical removal of the gallbladder. The most significant complication of this new technique is injury to the bile duct. Twelve cases of bile duct injury during laparoscopic cholecystectomy were reviewed. Eight injuries were of a classic type: misidentification of the common duct for the cystic duct, resection of part of the common and hepatic ducts, and associated right hepatic arterial injury. Another injury was similar: clip ligation of the distal common duct with proximal ligation and division of the cystic duct, resulting in biliary obstruction and leakage. Three complications arose from excessive use of cautery or laser in the region of the common duct, resulting in biliary strictures. Evaluation of persistent diffuse abdominal pain led to the recognition of ductal injury in most patients. Ultimately, 10 patients required a Roux-en-Y hepaticojejunostomy to provide adequate biliary drainage. One patient had a successful direct common duct repair, and the remaining patient underwent endoscopic dilatation.

OBJECTIVE:We performed a study to determine if the appearance of the pancreatic duct on ERCP before and after placement of pancreatic duct stents correlates with the therapeutic response in patients treated for impaired pancreatic drainage.MATERIALS AND METHODS:Findings in 29 consecutive patients with a variety of benign pancreatic diseases in whom pancreatic stents were placed and subsequently removed within a 3-year period were reviewed retrospectively. Early (1-5 days) and late (1-3 months) clinical outcomes after stent placement were assessed. These findings were correlated with a blinded interpretation of ERCP findings (Cambridge criteria were used) before and after stent placement.RESULTS:ERCP findings before stent placement were normal in 10 patients. At the end of stent therapy, ERCP showed changes associated with chronic pancreatitis in all 10; five had focal narrowing at the tip of the stent. Subsequent ERCP studies in five of these 10 patients showed that ductal changes induced by stents diminished after stent removal. Of the 19 patients with abnormal findings on ERCP at the time of stent placement, ERCP at the end of stent therapy showed some improvement in seven patients, no change in eight, and deterioration in four. Changes seen on ERCP had no statistically significant correlation with clinical outcome (p = .36).CONCLUSION:Our findings show that pancreatic duct stents can induce abnormalities on ERCP indicative of chronic pancreatitis. However, diminution of these abnormalities after stent removal in some patients suggests that these changes may be due to edema rather than to fibrosis. Ductal changes seen on ERCP are not a useful guide for determining the degree of response to pancreatic stents.

OBJECTIVE:We studied the causes of technical failure and enhancement variability encountered during CT arterial portography.MATERIALS AND METHODS:CT arterial portograms and digital arteriograms were obtained via the superior mesenteric artery before partial liver resection in 43 patients with malignant tumors. These studies were reviewed for causes of technical failure and variable enhancement.RESULTS:Eleven (26%) of 43 procedures were technical failures. Causes of failure included aortic injection after catheter dislodgement (four), dense hyperenhancement associated with laminar flow in the portal vein produced by rapid venous return from a selective injection into a proximal branch vessel of the superior mesenteric artery (two), premature scanning beginning at the iliac crest (two), reflux into a replaced right hepatic artery (one), hepatic arterial enhancement via the pancreaticoduodenal arcade (one), and portal hypertension (one). Of the 32 remaining studies, 28 showed areas of parenchymal hypoenhancement or hyperenhancement. Causes of variable enhancement included impaired portal vein perfusion from mass effect of the tumor, laminar flow in the portal vein, and focal fatty infiltration.CONCLUSION:Technical failures and enhancement variability are common in CT arterial portography. Factors leading to technical failure include catheter choice and position, portal hypertension, and operator error.

OBJECTIVE:Several authorities advocate the use of preoperative angiography to determine the resectability of pancreatic and periampullary tumors, claiming that CT alone is not sufficiently accurate for this purpose. Our objective was to assess the value of CT in predicting surgical resectability in patients with malignant biliary obstruction.MATERIALS AND METHODS:We performed a retrospective analysis of 380 consecutive cases of malignant biliary obstruction spanning a 4-year period. Most patients (230) were treated nonoperatively. Sixty-seven patients had surgery, pathologic confirmation of malignancy, and preoperative CT scans available for review. The CT scans were assessed for surgical resectability of tumor by an interpreter who did not know the patient's history.RESULTS:Forty-two patients had pancreatic adenocarcinoma, six had ampullary carcinoma, seven had cholangiocarcinoma, and 12 had other malignant neoplasms. Of 47 patients with tumors thought to be unresectable on the basis of CT findings, 42 had tumors that were found to be unresectable at surgery (positive predictive value, 89%). Of 20 patients with tumors thought to be resectable, 16 had tumors that were surgically resectable (positive predictive value, 80%). CT did not show metastases to duodenal lymph nodes (n = 2), portal vein infiltration (n = 1), and small hepatic metastases (n = 1). Visualization of most of these at angiography would not be expected. The CT finding of infiltration of the periarterial fat around the celiac or superior mesenteric arteries was reliable for predicting surgical unresectability. Lymphadenopathy and infiltration of nonperivascular fat planes were less reliable predictors of unresectability.CONCLUSION:Although some findings on CT that suggest unresectability are less reliable than others, the accuracy of CT compares favorably with reports on the accuracy of angiography for assessing tumor resectability in cases of malignant biliary obstruction. The addition of angiography to the examination of patients with potentially resectable lesions is not justified when high-quality, thin-section dynamic CT has been performed.

In the treatment of pancreatic pseudocysts, percutaneous and endoscopic drainage have, in certain cases, become alternatives to surgery. However, each treatment modality carries risks of complications and recurrences that may be minimized by the appropriate allocation of therapy. This article proposes the use of an endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm as a means to allocate pseudocyst therapy based on the findings of pancreatic duct obstruction or pseudocyst communication. To evaluate this algorithm, the records of a series of patients with pancreatic pseudocysts seen at Duke University Medical Center from 1984 to 1990 were reviewed. Of 102 patients, 73 had symptomatic pseudocysts that required treatment. Forty of the 69 elective interventions were preceded by ERCPs and retrospectively applied to the algorithm. The number of adverse outcomes (treatment failures + complications) of the group that followed the algorithm was 3 of 26 (12%), while the number of adverse outcomes of the group that did not follow the algorithm was 6 of 14 (43%) (p less than 0.04 by Fisher's exact test). These two subgroups were similar in all other characteristics examined. Therefore, this ERCP-based algorithm may be used to allocate pseudocyst treatment; however, a prospective trial is necessary to prove its efficacy.

To determine the CT findings postfundoplication, we retrospectively compared CT in 22 postfundoplication patients with CT in 22 patients with unrepaired hiatal hernias and gastroesophageal (GE) junction abnormalities and 24 patients with gastric or esophageal carcinoma involving the GE junction. Seventeen of the 22 postfundoplication patients had undergone a Nissen procedure. Of the 22 patients, 11 had esophageal dilatation, 14 had GE junction masses, 4 had esophageal wall thickening, 7 had surgical clips, and none had hepatic metastases or upper abdominal lymphadenopathy. Statistically, on CT, postfundoplication patients are more likely to have a GE junction mass (p = 0.023) and least likely to have wall thickening (p = 0.021). Nonetheless, because the findings occur frequently in each group, they are not diagnostic in the individual patient. However, 11 of 12 post-Nissen masses had the unique finding of an oval or linear central fat density within the mass. This finding was absent in the other postfundoplication masses and in those patients with repaired hiatal hernia or tumor. We conclude that pseudomasses occur on CT postfundoplication and can be indistinguishable from hiatal hernias and GE junction neoplasms unless a central fat density is present.

HomeRadiologyVol. 180, No. 3 PreviousNext Pancreatic adenocarcinoma: are there pathognomonic changes in the fat surrounding the superior mesenteric artery?M E BakerM E BakerM E BakerPublished Online:Sep 1 1991https://doi.org/10.1148/radiology.180.3.1871269MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In Article HistoryPublished in print: 1991 FiguresReferencesRelatedDetailsCited ByInflammatory mimickers of pancreatic adenocarcinomaKunalKothari, CamilaLopes Vendrami, Linda C.Kelahan, Joon SooShin, PardeepMittal, Frank H.Miller2020 | Abdominal Radiology, Vol. 45, No. 5Magnetic resonance imaging of pancreatitis: An updateSriluxayiniManikkavasakar2014 | World Journal of Gastroenterology, Vol. 20, No. 40The Teaching Files: GastrointestinalFrank H.Miller2010Medical RadiologyLorenzoCereser, Maria AntoniettaBali, MyriamDelhaye, CelsoMatos2009Chronic Pancreatitis: Ultrasound, Computed Tomography, and Magnetic Resonance Imaging FeaturesAheed J.Siddiqi, FrankMiller2007 | Seminars in Ultrasound, CT and MRI, Vol. 28, No. 5Imaging of chronic pancreatitisErick MRemer, Mark EBaker2002 | Radiologic Clinics of North America, Vol. 40, No. 6Medical RadiologyO.Cay, V.Raptopoulos2000Pancreatic Carcinoma versus Chronic Pancreatitis: Dynamic MR Imaging1Pamela T. Johnson, , and Eric K. Outwater, 1 July 1999 | Radiology, Vol. 212, No. 1Pancreatic CancerMark E.Baker1998CT angiography of the visceral vasculatureHanh VNghiem, R.BrookeJeffrey1998 | Seminars in Ultrasound, CT and MRI, Vol. 19, No. 5CT and US of the pancreasYoung HeeChoi, William A.Rubenstein, Elizabeth RamirezDe Arellano, LisaIntriere, EliasKazam1997 | Clinical Imaging, Vol. 21, No. 6The staging of pancreatic adenocarcinomaR.H.Reznek, D.H.Stephens1993 | Clinical Radiology, Vol. 47, No. 6Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 180, No. 3 Metrics Altmetric Score PDF download

During a 13-month period, ovarian vein thrombosis (OVT) was detected with CT in six patients with malignant tumors, five of whom were receiving high-dose chemotherapy at the time of diagnosis. None of these patients belonged to previously recognized risk groups. Unlike most patients with postpartum or postoperative OVT, only one of our patients was symptomatic, and none had related CT findings, such as uterine enlargement or other enhancing pelvic masses. Patients with malignant tumors, particularly those undergoing chemotherapy, are at risk for developing OVT. As OVT is often asymptomatic in these patients, and thrombus may resolve without treatment, anticoagulation may not be routinely necessary.

The authors report four large-volume (greater than 20-mL) extravasations in adults and one intermediate-volume (18-mL) extravasation in an infant of iopamidol, a nonionic contrast medium, that occurred during dynamic enhanced computed tomography. The largest volume that extravasated (in two patients) was 150 mL. Although all five patients initially had swelling, erythema, and/or pain after extravasation, all recovered uneventfully. The authors suggest that emergent surgical drainage of all large-volume extravasations, a procedure that was recently recommended, is unnecessary. Large extravascular collections of nonionic contrast media can be well tolerated and are often resorbed without adverse sequelae.

Primary peritoneal tumors are rare neoplasms. The computed tomography findings in an adult patient with a primary peritoneal neuroblastoma are described. Discussion of these uncommon neoplasms and this unusual presentation of neuroblastoma forms the basis of this report.

Computed tomography-guided fine-needle aspiration was performed on 30 retroperitoneal lymph nodes in 29 patients with gynecologic cancer. There were no serious complications. Review of the cytologic material demonstrated malignant cells in 83% of the aspirates. Because the predictive value of a positive aspirate approaches 100%, therapy for metastatic disease can be initiated in these patients with the need for an open biopsy. Among five aspirates in which malignant cells were not seen, the cellularity of the specimen appeared to be the critical factor determining the predictive value of the aspirate. Whereas neither of two patients with negative aspirates of adequate cellularity has developed recurrent disease, two of three patients with hypocellular negative aspirates have. Because a hypocellular negative aspirate from a retroperitoneal lymph node may not be a true reflection of disease status, either repeat aspiration or open biopsy is advisable.

We retrospectively studied the value of MR imaging at 1.5 T to distinguish between nonadenomatous (n = 17) and adenomatous (n = 15) adrenal masses on the basis of (1) signal-intensity ratios on T1- and T2-weighted spin-echo images, (2) T2 relaxation times, and (3) T2 relaxation-time ratios. Univariate and then multivariate logistic regression were applied to these quantitative parameters to determine which of these best discriminated nonadenomas from adenomas, and whether or not more than one of these parameters improved the prediction. The adrenal mass/liver signal-intensity ratio on T2-weighted spin-echo images could not be used to differentiate nonadenomas from adenomas. Adrenal mass/fat signal-intensity ratios on T2-weighted spin-echo images, adrenal/liver T2 relaxation-time ratios, and adrenal mass T2 relaxation times were best for distinguishing nonadenomas from adenomas. By using a T2 value of greater than 61 msec, the true-positive ratio/false-positive ratio of differentiating nonadenomas from adenomas was 100%/20%; at greater than 82 msec, it was 64%/0.06%. The adrenal mass/fat signal-intensity ratios on T2-weighted spin-echo images and the adrenal/liver T2 relaxation-time ratios showed similar inherent discriminatory capacity. Overlap remains despite the use of these parameters. On the basis of this preliminary information, we conclude that MR has merit for the characterization of adrenal masses at 1.5 T. T2 relaxation time of the adrenal mass shows the greatest promise for discriminating nonadenomas from adenomas.

Using a new graphite tube, a prototype solid scintillating detector, and an automated injector, improvements were made in body computed tomography image quality. First, more scans with shorter interscan delay could be obtained with the improved tube. Second, liver image quality was improved with the use of higher techniques and a more consistent contrast bolus delivery with a mechanical injector. Last, body surveys were improved because the higher heat capacity tube provided the ability to rapidly scan and examine an entire region during the injection of contrast.

Central venous catheters have proven to be an important aid for the care of pediatric patients with malignancies receiving chemotherapy. A rare complication of such catheters is pulmonary septic emboli. This report describes a 15-year-old white girl with rhabdomyosarcoma who developed pulmonary nodules while on chemotherapy. These lesions appeared to be metastatic rhabdomyosarcoma. However, an excisional biopsy showed the lesions to be septic emboli. The patient was placed on antibiotic therapy and responded well. She was able to continue with her "front-line" therapy because the nodules were confirmed not to be metastatic disease.