1
|
Kernizan AL, Revels J, Hajdu C, Manning M, Taffel MT. Mesenteric Pathologic Conditions: Interactive Case-based Approach. Radiographics 2023; 43:e230077. [PMID: 37917539 DOI: 10.1148/rg.230077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Affiliation(s)
- Amelia L Kernizan
- From the Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 (A.L.K., J.R., C.H., M.T.T.); and ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.)
| | - Jonathan Revels
- From the Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 (A.L.K., J.R., C.H., M.T.T.); and ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.)
| | - Cristina Hajdu
- From the Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 (A.L.K., J.R., C.H., M.T.T.); and ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.)
| | - Maria Manning
- From the Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 (A.L.K., J.R., C.H., M.T.T.); and ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.)
| | - Myles T Taffel
- From the Department of Radiology, NYU Grossman School of Medicine, 660 1st Ave, New York, NY 10016 (A.L.K., J.R., C.H., M.T.T.); and ACR Institute for Radiologic Pathology, Silver Spring, Md (M.M.)
| |
Collapse
|
2
|
Tan Z, Mei H, Qin C, Zhang X, Yang M, Zhang L, Wang J. The diagnostic value of dual-layer CT in the assessment of lymph nodes in lymphoma patients with PET/CT as a reference standard. Sci Rep 2023; 13:18323. [PMID: 37884597 PMCID: PMC10603090 DOI: 10.1038/s41598-023-45198-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
This study aimed to evaluate the diagnostic performances of dual-layer CT (DLCT) for the identification of positive lymph nodes (LNs) in patients with lymphoma and retrospectively included 1165 LNs obtained by biopsy from 78 patients with histologically proven lymphoma, who underwent both pretreatment DLCT and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). According to 18F-FDG PET/CT findings as a reference standard, cases were categorized into the LN-negative and LN-positive groups. LNs were then randomly divided at a ratio of 7:3 into the training (n = 809) and validation (n = 356) cohorts. The patients' clinical characteristics and quantitative parameters including spectral curve slope (λHU), iodine concentration (IC) on arterial phase (AP) and venous phase (VP) images were compared between the LN-negative and LN-positive groups using Chi-square test, t-test or Mann-Whitney U test for categorical variables or quantitative parameters. Multivariate logistic regression analysis with tenfold cross-validation was performed to establish the most efficient predictive model in the training cohort. The area under the curve (AUC) was used to evaluate the diagnostic value of the predictive model, and differences in AUC were determined by the DeLong test. Moreover, the predictive model was validated in the validation cohort. Repeatability analysis was performed for LNs using intraclass correlation coefficients (ICCs). In the training cohort, long diameter (LD) had the highest AUC as an independent factors compared to other parameter in differentiating LN positivity from LN negativity (p = 0.006 to p < 0.001), and the AUC of predictive model jointly involving LD and λHU-AP was significantly elevated (AUC of 0.816, p < 0.001). While the AUC of predictive model in the validation cohort was 0.786. Good to excellent repeatability was observed for all parameters (ICC > 0.75). The combination of DLCT with morphological and functional parameters may represent a potential imaging biomarker for detecting LN positivity in lymphoma.
Collapse
Affiliation(s)
- Zhengwu Tan
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1277, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Heng Mei
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chunxia Qin
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiao Zhang
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ming Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1277, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Lan Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1277, Jiefang Avenue, Wuhan, Hubei, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1277, Jiefang Avenue, Wuhan, Hubei, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, Hubei, China.
| |
Collapse
|
3
|
Wang YN, Zhu YM, Lei XJ, Chen Y, Ni WM, Fu ZW, Pan WS. Intestinal natural killer/T-cell lymphoma presenting as a pancreatic head space-occupying lesion: A case report. World J Gastrointest Oncol 2023; 15:195-204. [PMID: 36684049 PMCID: PMC9850765 DOI: 10.4251/wjgo.v15.i1.195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Intestinal natural killer/T-cell lymphoma (NKTCL) is a rare and aggressive non-Hodgkin’s lymphoma, and its occurrence is closely related to Epstein-Barr virus infection. In addition, the clinical symptoms of NKTCL are not obvious, and the specific pathogenesis is still uncertain. While NKTCL may occur in any segment of the intestinal tract, its distinct location in the periampullary region, which leads clinicians to consider mimics of a pancreatic head mass, should also be addressed. Therefore, there remain huge challenges in the diagnosis and treatment of intestinal NKTCL.
CASE SUMMARY In this case, we introduce a male who presented to the clinic with edema of both lower limbs, accompanied by diarrhea, and abdominal pain. Endoscopic ultrasound (EUS) showed well-defined homogeneous hypoechoic lesions with abundant blood flow signals and compression signs in the head of the pancreas. Under the guidance of EUS- fine needle biopsy (FNB) with 19 gauge or 22 gauge needles, combined with multicolor flow cytometry immunophenotyping (MFCI) helped us diagnose NKTCL. During treatments, the patient was prescribed the steroid (dexamethasone), methotrexate, ifosfamide, L-asparaginase, and etoposide chemotherapy regimen. Unfortunately, he died of leukopenia and severe septic shock in a local hospital.
CONCLUSION Clinicians should enhance their understanding of NKTCL. Some key factors, including EUS characteristics, the right choice of FNB needle, and combination with MFCI, are crucial for improving the diagnostic rate and reducing the misdiagnosis rate.
Collapse
Affiliation(s)
- Ya-Nan Wang
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310032, Zhejiang Province, China
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yi-Miao Zhu
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Xiao-Ju Lei
- Department of Endoscopy Center, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Yuan Chen
- Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Wan-Mao Ni
- Cancer Center, Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People’s Hospital, Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
- Molecular Diagnosis Laboratory, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| | - Zheng-Wei Fu
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou 310032, Zhejiang Province, China
| | - Wen-Sheng Pan
- Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
| |
Collapse
|
4
|
Singh AK, Neyaz Z, Verma R, Gupta A, Mishra R, Mishra P. Diagnostic yield and safety of percutaneous CT-guided biopsy of retroperitoneal lesions and analysis of imaging features. Acta Radiol 2022; 63:149-158. [PMID: 33530697 DOI: 10.1177/0284185121990286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Computed tomography (CT)-guided biopsy is emerging as a preferred method for obtaining tissue samples from retroperitoneal lesions due to clear visualization of needle and vessels. PURPOSE To assess diagnostic yield and safety of CT-guided biopsy of retroperitoneal lesions and compare CT findings in different disease categories. MATERIAL AND METHODS This retrospective analytical study included 86 patients with retroperitoneal lesions who underwent CT-guided biopsy from December 2010 to March 2020. All procedures were performed with co-axial technique and multiple cores were obtained and subjected to histopathology. Additional tests like immunohistochemistry or microbiological analysis were done depending on clinical suspicion. Diagnostic yield calculation and comparison of imaging findings was done by one-way ANOVA, chi-square, and Fisher's exact tests. RESULTS CT-guided biopsy was technically successful in all cases with a diagnostic yield of 91.9%. Minor complications in the form of small hematomas were seen in two patients. Major disease categories on final diagnosis were lymphoma, tuberculosis, and metastases. A variety of malignant and benign soft-tissue neoplasms were also noted less commonly. With help of immunohistochemistry, lymphoma subtype was established in 88.8% of cases. Addition of microbiological tests like the GeneXpert assay helped in the diagnosis of tuberculosis in some cases. A mass-like appearance and vascular encasement was common in metastatic group and lymphoma. CONCLUSION Percutaneous CT-guided biopsy is a safe method for the sampling of retroperitoneal lesions with high diagnostic yield. Imaging findings are mostly overlapping; however, some features are more common in a particular disease condition.
Collapse
Affiliation(s)
- Anil Kumar Singh
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Zafar Neyaz
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ritu Verma
- Department of Pathology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshul Gupta
- Department of Hematology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Richa Mishra
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhakar Mishra
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
5
|
Kuo SH, Li CC, Yu SC. Marked Response to Chemoimmunotherapy in a Patient with Follicular Lymphoma of Huge Mesenteric Lymphadenopathy. JOURNAL OF CANCER RESEARCH AND PRACTICE 2022. [DOI: 10.4103/jcrp.jcrp_35_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
6
|
Pavlovic M, Rokvic Z, Berenji K. Efficacy of Prednisone in Children with Acute Nonspecific Mesenteric Lymphadenitis: A Pilot Study. ACTA MEDICA (HRADEC KRALOVE) 2022; 65:25-28. [PMID: 35793505 DOI: 10.14712/18059694.2022.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Acute nonspecific mesenteric lymphadenitis (ANML) is a common cause of acute abdominal pain in children with no specific treatment. METHODS A total of 13 patients (6 boys, 7 girls) aged 7.3 (5-13.5) years with severe acute abdominal pain were evaluated using ultrasonography and laboratory tests to establish the diagnosis of ANML. They were treated with prednisone 1 mg/kg (max 40 mg daily) for a maximum of 5 days. The intensity of abdominal pain was evaluated before and after treatment using a numeric rating scale. RESULTS All patients had pain scores above 6/10 before, and below 4/10 after treatment with prednisone. Intensity of abdominal pain after treatment for 1-5 days decreased significantly (p < 0.001), with no recurrence at follow-up within 3 months. All other pre-existing signs and symptoms, such as nausea, vomiting, anorexia, fever, diarrhea, and constipation were found to disappear with no adverse effects of corticosteroid therapy. CONCLUSION These results suggest that the treatment with prednisone in selective patients with ANML can reduce the duration of abdominal pain.
Collapse
Affiliation(s)
| | - Zeljko Rokvic
- Department of Diagnostic Imaging, General Hospital Subotica, Serbia
| | - Karolina Berenji
- Department of Hygiene and Human Ecology, Public Health Institute, Subotica, Serbia
| |
Collapse
|
7
|
Catano J, Sacleux SC, Gornet JM, Camus M, Bigé N, Saliba F, Azoulay E, Dumas G, Zafrani L. Gastrointestinal bleeding in critically ill immunocompromised patients. Ann Intensive Care 2021; 11:130. [PMID: 34420114 PMCID: PMC8380218 DOI: 10.1186/s13613-021-00913-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute gastrointestinal bleeding (GIB) may be a severe condition in immunocompromised patients and may require intensive care unit (ICU) admission. We aimed to describe the clinical spectrum of critically ill immunocompromised patients with GIB and identify risk factors associated with mortality and severe GIB defined by hemorrhagic shock, hyperlactatemia and/or the transfusion of more than 5 red blood cells units. Finally, we compared this cohort with a control population of non-immunocompromised admitted in ICU for GIB. RESULTS Retrospective study in 3 centers including immunocompromised patients with GIB admitted in ICU from January, 1st 2010 to December, 31rd 2019. Risk factors for mortality and severe GIB were assessed by logistic regression. Immunocompromised patients were matched with a control group of patients admitted in ICU with GIB. A total of 292 patients were analyzed in the study, including 141 immunocompromised patients (compared to a control group of 151 patients). Among immunocompromised patients, upper GIB was more frequent (73%) than lower GIB (27%). By multivariate analysis, severe GIB was associated with male gender (OR 4.48, CI95% 1.75-11.42, p = 0.00), upper GIB (OR 2.88, CI95% 1.11-7.46, p = 0.03) and digestive malignant infiltration (OR 5.85, CI95% 1.45-23.56, p = 0.01). Conversely, proton pump inhibitor treatment before hospitalization was significantly associated with decreased risk of severe GIB (OR 0.25, IC95% 0.10-0.65, p < 0.01). Fifty-four patients (38%) died within 90 days. By multivariate analysis, mortality was associated with hemorrhagic shock (OR 2.91, IC95% 1.33-6.38, p = 0 .01), upper GIB (OR 4.33, CI95% 1.50-12.47, p = 0.01), and long-term corticosteroid therapy before admission (OR 2.98, CI95% 1.32-6.71, p = 0.01). Albuminemia (per 5 g/l increase) was associated with lower mortality (OR 0.54, IC95% 0.35-0.84, p = 0.01). After matching with a control group of non-immunocompromised patients, severity of bleeding was increased in immunocompromised patients, but mortality was not different between the 2 groups. CONCLUSION Mortality is high in immunocompromised patients with GIB in ICU, especially in patients receiving long term corticosteroids. Mortality of GIB is not different from mortality of non-immunocompromised patients in ICU. The prophylactic administration of proton pump inhibitors should be considered in this population.
Collapse
Affiliation(s)
- Jennifer Catano
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Sophie Caroline Sacleux
- Intensive Care Unit, Paul Brousse Hospital, INSERM N°1193, Assistance Publique Des Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Jean-Marc Gornet
- Gastroenterology Department, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Marine Camus
- Department of Digestive Endoscopy, Saint-Antoine Hospital, Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine and Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Naike Bigé
- Intensive Care Unit, Saint-Antoine Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Faouzi Saliba
- Intensive Care Unit, Paul Brousse Hospital, INSERM N°1193, Assistance Publique Des Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Elie Azoulay
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Guillaume Dumas
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Lara Zafrani
- Intensive Care Unit, Saint-Louis Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France.
- INSERM UMR976, Paris University, Paris, France.
| |
Collapse
|
8
|
Gao YJ, Yang Z, Yu JY, Li N, Wang XJ, Zhou NN. Potential application value of PET/computed tomography in retroperitoneal leiomyosarcoma and a literature review. Nucl Med Commun 2021; 42:800-810. [PMID: 33741860 DOI: 10.1097/mnm.0000000000001388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To analyze the fluorine-18 fludeoxyglucose PET/computed tomography (18F-FDG PET/CT) findings of retroperitoneal leiomyosarcoma (RLMS) and the role of this method in differentiating between benign and malignant masses and classifying the malignant degree to improve the understanding of this rare disease. METHODS Eight leiomyomas (A group), 13 RLMSs (B group), and 20 postoperative recurrence/metastasis RLMSs (C group) were enrolled. PET/CT features of B group were analyzed. The differences of metabolic parameters between three groups were compared, receiver operating characteristic (ROC) curve analysis was performed to group A and B, and correlation analysis was performed to subgroup B. RESULTS (1) The RLMS patients were more likely to be female, and PET/CT showed a high degree of heterogeneous metabolism in the soft tissue mass. (2) The standardized uptake value (SUV) of RLMS were significantly higher than those of benign leiomyomas (P < 0.05). The area under the ROC curve was 0.909, the sensitivity and specificity for diagnosing RLMS were 0.923 and 0.750, respectively, The SUVmax and SUVstd of primary RLMS were moderately associated with the Ki67 index. The mean SUVmax in the G1, G2 and G3 subgroups increased successively (4.15 ± 0.35, 6.47 ± 0.83, and 10.13 ± 4.29, respectively). (3) Primary RLMS was characterized by local invasion, but hematogenous metastasis and lymph node metastasis were rare. Postoperative recurrence/metastasis of RLMS was characterized by local recurrence and hematogenous metastasis, but lymph node metastasis was rare. CONCLUSION PET/CT has potential value in the preoperative staging, benign and malignant differentiation, malignant degree classification and postoperative follow-up of RLMS.
Collapse
Affiliation(s)
- Yu-Jie Gao
- Department of Nuclear Medicine, Chifeng Municipal Hospital, Inner Mongolia Medical University, Inner Mongolia
| | - Zhi Yang
- Department of Nuclear Medicine, Chifeng Municipal Hospital, Inner Mongolia Medical University, Inner Mongolia
| | - Jiang-Yuan Yu
- Department of Nuclear Medicine, Chifeng Municipal Hospital, Inner Mongolia Medical University, Inner Mongolia
| | - Na Li
- Department of Nuclear Medicine, Chifeng Municipal Hospital, Inner Mongolia Medical University, Inner Mongolia
| | - Xue-Juan Wang
- Department of Nuclear Medicine, Chifeng Municipal Hospital, Inner Mongolia Medical University, Inner Mongolia
| | - Ni-Na Zhou
- Department of Nuclear Medicine, Chifeng Municipal Hospital, Inner Mongolia Medical University, Inner Mongolia
| |
Collapse
|
9
|
Kim SY, Lee JY. Multiple Primary Malignant Neoplasms: A Case Report of Breast Mucinous Carcinoma and Extramammary Diffuse Large B-Cell Lymphoma in a Male Patient. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:729-736. [PMID: 36238796 PMCID: PMC9432434 DOI: 10.3348/jksr.2020.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/27/2020] [Accepted: 08/27/2020] [Indexed: 11/15/2022]
Abstract
Multiple primary malignant neoplasms refer to two or more malignancies in an individual that are not related. We report a case of a 78-year-old male with concurrent breast mucinous carcinoma and extramammary lymphoma. The patient initially presented with palpable masses in the left breast and the right groin, which were pathologically confirmed after a surgical biopsy as breast mucinous carcinoma and diffuse large B-cell lymphoma, respectively. He underwent whole-body 18-fluorine deoxyglucose PET/CT before surgery, and an enhancing nodular lesion in the left lingual tonsil was found incidentally. It was later confirmed as a diffuse large B-cell lymphoma, a pathology of the same type as the right inguinal mass. Unspecified lymphadenopathies in breast cancer patients may easily be considered as metastatic lesions. However, this case suggests that lymphomas should be included in the differential diagnoses to avoid misdiagnosis and treatment delay, especially in older adult patients.
Collapse
Affiliation(s)
- Su Young Kim
- Department of Radiology, Inje University, Ilsan Paik Hospital, Goyang, Korea
| | - Ji Young Lee
- Department of Radiology, Inje University, Ilsan Paik Hospital, Goyang, Korea
| |
Collapse
|
10
|
Aftan MK, Alfalahi A, Alzeena E, albastaki U, Houcinat Y, Mahmoud K. Leiomyosarcoma: a rare presentation as multifocal lesion. BJR Case Rep 2020; 6:20190117. [PMID: 32922833 PMCID: PMC7465754 DOI: 10.1259/bjrcr.20190117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 04/07/2020] [Accepted: 04/16/2020] [Indexed: 11/26/2022] Open
Abstract
Leiomyosarcoma is a rare type of connective tissue cancer, accounting for 5–10% of all soft tissue sarcomas. We present a case of leiomyosarcoma as unusual multifocal presentation. Retroperitoneal, mediastinal, pulmonary, uterine and bony regions were all involved at the time of presentation. The liver was normal without detected lesions.
Collapse
Affiliation(s)
| | | | | | - Usama albastaki
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Yamina Houcinat
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Khalid Mahmoud
- Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| |
Collapse
|
11
|
Liu C, Lee M, Tung C, Tsai K, Chen C, Chou C. Primary mesenteric follicular lymphoma with mesenteric panniculitis—A rare differential diagnosis of abdominal pain. ADVANCES IN DIGESTIVE MEDICINE 2019. [DOI: 10.1002/aid2.13154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Che‐Yu Liu
- Department of Internal MedicineDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
| | - Ming‐Yang Lee
- Department of Internal MedicineDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Division of Oncology and HematologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Min‐Hwei Junior College of Health Care Management Tainan Taiwan
| | - Chun‐Liang Tung
- Department of PathologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Department of Food Nutrition and Health BiotechnologyAsia University Taichung Taiwan
| | - Kun‐Feng Tsai
- Department of Internal Medicine, Gastroenterology and Hepatology Section, An‐Nan HospitalChina Medical University Taichung Taiwan
- Department of Internal MedicineNational Taiwan University College of Medicine and National Taiwan University Hospital Taipei Taiwan
| | - Chi‐Yi Chen
- Division of Gastroenterology and HepatologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
| | - Chu‐Kuang Chou
- Division of Gastroenterology and HepatologyDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
- Clinical Trial CenterDitmanson Medical Foundation Chia‐Yi Christian Hospital Chiayi Taiwan
| |
Collapse
|
12
|
Kim MS, Park JH, Kim JY, Lim SN, Lee J. Upper gastrointestinal bleeding caused by direct invasion of diffuse large B-cell lymphoma into the stomach in a patient with HIV infection: A case report. Medicine (Baltimore) 2019; 98:e16363. [PMID: 31305432 PMCID: PMC6641793 DOI: 10.1097/md.0000000000016363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Diffuse large B-cell lymphoma (DLBCL) is the most frequent human immunodeficiency virus (HIV)-related Non-Hodgkin's Lymphoma of the stomach. Although gastrointestinal (GI) bleeding due to primary gastric lymphoma has been previously reported in the literature, there have been no reports of stomach wall involvement of intra-abdominal lymphoma presenting as GI bleeding. PATIENT CONCERNS We present a rare case of direct invasion of DLBCL to the stomach wall that presented as upper GI bleeding in a patient with HIV. DIAGNOSIS Upper endoscopy showed a large ulcerofungating mass in the lesser curvature of upper stomach body. The computed tomography scan showed an about 22 × 12 cm sized huge mass that invades into the stomach wall in the abdominal cavity. A diagnosis of DLBCL was established after histological examination. INTERVENTION The patient was treated with 6 courses of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). OUTCOMES The patient achieved a complete response with 6 courses of R-CHOP treatment. No recurrence was observed during the 4-month follow-up period. LESSONS Because of the high incidence of lymphoma in patients with HIV, if such patients complain of dyspepsia, epigastric soreness, or melena, malignant tumors, such as lymphomas or stomach cancers, should be suspected. As in this patient, doctors should be aware that intra-abdominal lymphoma can invade into the stomach wall and cause bleeding.
Collapse
Affiliation(s)
- Mo Se Kim
- Departement of Internal Medicine, Gab-Eul Jang Yu Hospital, Gimhae
| | - Jong Hwa Park
- Department of Internal Medicine, Dongkang Medical Center, Ulsan
| | | | - Sung-Nam Lim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jin Lee
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| |
Collapse
|
13
|
Marko J, Wolfman DJ. Retroperitoneal Leiomyosarcoma From the Radiologic Pathology Archives. Radiographics 2018; 38:1403-1420. [PMID: 30207936 PMCID: PMC6166742 DOI: 10.1148/rg.2018180006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 04/21/2018] [Accepted: 04/26/2018] [Indexed: 12/28/2022]
Abstract
Leiomyosarcoma is a malignant neoplasm that shows smooth muscle differentiation. It is the second most common sarcoma to affect the retroperitoneum. Retroperitoneal leiomyosarcomas may grow to large sizes before detection and may be an incidental finding at imaging. When symptomatic, retroperitoneal leiomyosarcoma may cause compressive symptoms, including pain. Retroperitoneal leiomyosarcoma most commonly manifests as a large soft-tissue mass, with areas of necrosis. The most frequent pattern of growth is an entirely extravascular mass. Less commonly, leiomyosarcoma may demonstrate both extravascular and intravascular components. Rarely, retroperitoneal leiomyosarcomas are completely intravascular, typically arising from the inferior vena cava. Given its variable imaging features, a large variety of neoplastic and nonneoplastic conditions are included in the differential diagnosis of retroperitoneal leiomyosarcoma. In this review, the authors discuss retroperitoneal leiomyosarcoma, with emphasis on the pathologic basis of disease, and illustrate the multimodality imaging appearances of retroperitoneal leiomyosarcoma using cases from the Radiologic Pathology Archives of the American Institute for Radiologic Pathology. The authors review important differential considerations of retroperitoneal leiomyosarcoma, focusing on the extravascular pattern of growth, and emphasize clinical and imaging features that help radiologists differentiate leiomyosarcoma from the most frequent mimics. The information presented in this review will aid radiologists in fulfilling their key roles in the diagnosis, operative planning, and follow-up of patients with retroperitoneal leiomyosarcoma.
Collapse
Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Johns Hopkins School of Medicine, Washington, DC (D.J.W.)
| | - Darcy J. Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); and Community Radiology Division, Johns Hopkins School of Medicine, Washington, DC (D.J.W.)
| |
Collapse
|
14
|
Zhang S, Chen M, Li CM, Song GD, Liu Y. Differentiation of Lymphoma Presenting as Retroperitoneal Mass and Retroperitoneal Fibrosis: Evaluation with Multidetector-row Computed Tomography. Chin Med J (Engl) 2017; 130:691-697. [PMID: 28303852 PMCID: PMC5358419 DOI: 10.4103/0366-6999.201606] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Retroperitoneal fibrosis (RPF) and lymphoma presenting as retroperitoneal mass may closely resemble each other and misdiagnosis may occur. This study investigated the differential imaging features of RPF and lymphoma which presented as a retroperitoneal soft tissue using multidetector-row computed tomography (MDCT). Methods: The 42 consecutive patients were included in this retrospective review, including 19 RPF patients (45.2%; including 13 males and 6 females; mean age: 56.7 ± 6.2 years) and 23 patients with lymphoma (54.8%; including 14 males and 9 females; mean age: 57.4 ± 12.3 years). An array of qualitative computed tomography (CT) features of lesions in 42 consecutive patients with newly diagnosed untreated RPF and lymphoma were retrospectively analyzed. The quantitative size of the lesion at the para-aortic region and attenuation in the precontrast, arterial, and portal phases were calculated in regions of interest and compared between the patients with newly diagnosed untreated RPF and with lymphoma. Receiver operating characteristic curve analysis was used to assess the potential diagnostic value of each quantitative parameter. Inter-reader concordance was also calculated. Results: Mean ages between patients with RPF and lymphoma were not significantly different (56.7 ± 6.2 years vs. 57.4 ± 12.3 years P = 0.595). Compared to those in patients with lymphoma, homogeneous enhancement (65.2% vs. 94.7%, P = 0.027) and pelvic extension (52.2% vs. 89.5%, P = 0.017) were significantly more common while the involvement of additional nodes (78.3% vs. 5.3%, P < 0.001), suprarenal extension (60.9% vs. 15.8%, P = 0.004), and aortic displacement (43.5% vs. 5.3%, P = 0.006) were significantly less common in patients with RPF. Lesion size at the para-aorta was significantly greater in patients with lymphoma, compared with RPF patients (3.9 ± 1.2 cm vs. 1.8 ± 0.6 cm; P < 0.001). The attenuation values in three phases were not significantly different between patients with RPF and lymphoma. Inter-reader concordance for subjective features ranged from very good to excellent (range: 85.7–100.0%). Conclusions: This study showed that MDCT can help differentiate between untreated RPF and lymphoma on the basis of qualitative CT features and lesion sizes. Differentiating RPF from lymphoma on the basis of attenuation values in the precontrast, arterial, and portal phases was difficult to accomplish.
Collapse
Affiliation(s)
- Shuai Zhang
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730; Graduate School, Peking Union Medical College, Beijing 100005, China
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730; Graduate School, Peking Union Medical College, Beijing 100005, China
| | - Chun-Mei Li
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Guo-Dong Song
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730; Graduate School, Peking Union Medical College, Beijing 100005, China
| | - Ying Liu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing 100730; Graduate School, Peking University Health Science Center, Peking University, Beijing 100083, China
| |
Collapse
|
15
|
Manzella A, Borba-Filho P, D'Ippolito G, Farias M. Abdominal manifestations of lymphoma: spectrum of imaging features. ISRN RADIOLOGY 2013; 2013:483069. [PMID: 24967280 PMCID: PMC4045537 DOI: 10.5402/2013/483069] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/23/2013] [Indexed: 12/30/2022]
Abstract
Non-Hodgkin and Hodgkin lymphomas frequently involve many structures in the abdomen and pelvis. Extranodal disease is more common with Non-Hodgkin's lymphoma than with Hodgkin's lymphoma. Though it may be part of a systemic lymphoma, single onset of nodal lymphoma is not rare. Extranodal lymphoma has been described in virtually every organ and tissue. In decreasing order of frequency, the spleen, liver, gastrointestinal tract, pancreas, abdominal wall, genitourinary tract, adrenal, peritoneal cavity, and biliary tract are involved. The purpose of this review is to discuss and illustrate the spectrum of appearances of nodal and extranodal lymphomas, including AIDS-related lymphomas, in the abdominopelvic region using a multimodality approach, especially cross-sectional imaging techniques. The most common radiologic patterns of involvement are illustrated. Familiarity with the imaging manifestations that are diagnostically specific for lymphoma is important because imaging plays an important role in the noninvasive management of disease.
Collapse
Affiliation(s)
- Adonis Manzella
- Hospital das Clínicas da Universidade Federal de Pernambuco, UFPE, Escola Paulista de Medicina, UNIFESP, Avenida Professor Moraes Rego, s/n, Cidade Universitária, 50670-420 Recife, PE, Brazil
| | - Paulo Borba-Filho
- Hospital das Clínicas da Universidade Federal de Pernambuco, UFPE, Escola Paulista de Medicina, UNIFESP, Avenida Professor Moraes Rego, s/n, Cidade Universitária, 50670-420 Recife, PE, Brazil
| | - Giuseppe D'Ippolito
- Hospital das Clínicas da Universidade Federal de Pernambuco, UFPE, Escola Paulista de Medicina, UNIFESP, Avenida Professor Moraes Rego, s/n, Cidade Universitária, 50670-420 Recife, PE, Brazil
| | - Marcella Farias
- Hospital das Clínicas da Universidade Federal de Pernambuco, UFPE, Escola Paulista de Medicina, UNIFESP, Avenida Professor Moraes Rego, s/n, Cidade Universitária, 50670-420 Recife, PE, Brazil
| |
Collapse
|
16
|
Myga-Porosiło J, Borowiak H, Sraga W, Jackowska Z, Serafin M, Kluczewska E. Usefulness of the computed tomography and magnetic resonance in evaluation of progress of treatment of the neoplasmatic diseases in children. Pol J Radiol 2012; 77:46-52. [PMID: 23049581 PMCID: PMC3447433 DOI: 10.12659/pjr.883374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/09/2012] [Indexed: 11/30/2022] Open
Abstract
Background: Neoplastmatic diseases constitute about 1% diseases in children in Poland, what makes about 1200 new incidents during one year. Fast diagnosis in those illnesses is crucial in treatment results. The point of this work was to value usefulness of CT and MRI in diagnostics of neoplasmatic diseases in children. Material/Methods: The retrospective study involved 121 children examined in CT and MRI because of suspicion or during treatment of neoplasmatic disease. Together 184 CT and 119 MRI examination were performed. Eventually in 106 children neoplasmatic disease was diagnosed. In 16 cases neoplasm was excluded. Results: In the analyzed group of patients acute lymphoblastic and non lymphoblastic leukemia was diagnosed in 68 children (55.7%); among them mycosis was identified after radiological examinations in 7 cases (10.3%). 8 children (6.6%) with non Hodgkin lymphoma and 11 (9%) with Hodgkin lymphoma were examined. Nephroblastoma was found after MRI and CT in 6 cases (4.9%). Presence of tumors, that were classified histopatologically as PNET, was confirmed in 4 children. In 15 cases after MRI and CT neoplasmatic disease was excluded. Conclusions: Depending on the kind of sickness MRI and CT may fulfill basic or subsidiary role in diagnostic and estimating the progress of treatment in neoplasmatic diseases among children.
Collapse
Affiliation(s)
- Jolanta Myga-Porosiło
- Department and Institute of Medical Radiology and Radiodiagnosis in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | | | | | | | | | | |
Collapse
|
17
|
Choi YJ, Moon NR, Lee SJ, Park DC. Diffuse large B-cell lymphoma mimicking an ovarian tumor in a patient with HIV. Int J Gynaecol Obstet 2012; 119:196-7. [PMID: 22906958 DOI: 10.1016/j.ijgo.2012.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Revised: 06/20/2012] [Accepted: 07/24/2012] [Indexed: 11/18/2022]
Affiliation(s)
- Youn Jin Choi
- Department of Obstetrics and Gynecology, St Vincent's Hospital, School of Medicine, The Catholic University of Korea, Suwon, Korea
| | | | | | | |
Collapse
|
18
|
Tuberculosis versus lymphoma in the abdominal lymph nodes: a comparative study using contrast-enhanced MRI. Eur J Radiol 2011; 81:2513-7. [PMID: 22154603 DOI: 10.1016/j.ejrad.2011.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/04/2011] [Accepted: 11/05/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE The purpose of this study was to determine the differential characteristics on MRI between tuberculosis and lymphoma in abdominal lymph nodes. MATERIALS AND METHODS We conducted a retrospective analysis for the counter, size, signal intensity, enhancement patterns, and anatomic distribution of lymph nodes in 57 consecutive patients with documented tuberculosis (28 patients; 49.1%) and newly diagnosed, untreated lymphoma (29 patients; 50.9%). RESULTS Twenty-four cases (85.7%) in the tuberculosis group were hyperintense on T2-weighted images and either hypointense or isointense on T1-weighted images with respect to the abdominal wall muscle. All cases in the lymphoma group were hyperintense on T2-weighted images and isointense on T1-weighted images with respect to the abdominal wall muscle. Concerning the main anatomic distribution of lymph nodes, the lymph nodes in the lower paraaortic region were more frequently involved in the lymphoma group (48.3%) than in tuberculosis (17.9%, p<0.05). Moreover, mesenteric lymph nodes were more often involved in tuberculosis (32.1%) than in lymphoma (6.9%, p<0.05). Tuberculous lymphadenopathy showed predominantly peripheral enhancement, frequently with a multilocular appearance; whereas lymphomatous adenopathy often demonstrated uniform homogeneous enhancement (all p<0.001). CONCLUSION Contrast-enhanced MRI can be useful in differentiation between these two entities.
Collapse
|
19
|
Zhang M, Li M, Xu GP, Liu HJ. Neoplasm-like abdominal nonhematogenous disseminated tuberculous lymphadenopathy: CT evaluation of 12 cases and literature review. World J Gastroenterol 2011; 17:4038-43. [PMID: 22046094 PMCID: PMC3199564 DOI: 10.3748/wjg.v17.i35.4038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 03/11/2011] [Accepted: 03/18/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the diagnostic value of computed tomography (CT) imaging in screening for abdominal nonhematogenous disseminated tuberculous lymphadenopathy (TL).
METHODS: The CT scans of 12 patients with abdominal nonhematogenous disseminated TL suggestive of neoplasm were retrospectively analyzed in this review. The final diagnoses were confirmed by lymph node pathology for seven patients and by laparoscopic surgery for five patients. All of the patients were treated at our institution between April 1995 and August 2009.
RESULTS: The sites of involvement were the periportal (n = 6), peripancreatic (n = 3), periaortic (n = 3), and mesenteric (n = 2) regions. On the plain CT scan, the lymphadenopathy showed a heterogeneous isodensity or hypodensity in 11 patients and a low density in one patient. Peripheral enhancement was observed on the dynamic contrast-enhanced CT scans for all patients. In two cases, scans were more revealing during the portal venous and delayed phases.
CONCLUSION: Abdominal lymphadenopathy with predominant peripheral rim-like enhancement on the dynamic contrast-enhanced CT scan may suggest a diagnosis of TL.
Collapse
|
20
|
Johnson PT, Horton KM, Fishman EK. Nonvascular mesenteric disease: utility of multidetector CT with 3D volume rendering. Radiographics 2009; 29:721-40. [PMID: 19448112 DOI: 10.1148/rg.293085113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Creation of isotropic volumes with submillimeter multidetector computed tomography (CT) has expanded interpretative practice to routinely include two-dimensional (2D) and three-dimensional (3D) postprocessing techniques. Currently, 2D multiplanar reformatting, maximum intensity projection, and 3D volume rendering are available on most workstations. Only volume rendering yields a 3D display that depicts all tissue types from any orientation. Utility is not limited to vascular applications, as 3D volume rendering can be used to evaluate neoplastic, infectious, and inflammatory processes that affect the small-bowel mesentery. Specifically, interactive interpretation of multidetector CT data sets with volume rendering can help characterize nonvascular mesenteric disease, elucidate its extent through more comprehensive display, and facilitate the identification of complications.
Collapse
Affiliation(s)
- Pamela T Johnson
- Russell H. Morgan Department of Radiology and Radiologic Sciences, Johns Hopkins School of Medicine, 601 N Caroline St, Room 3140D, Baltimore, MD 21287, USA.
| | | | | |
Collapse
|
21
|
Li S, Xue HD, Li J, Sun F, Jiang B, Liu D, Sun HY, Jin ZY. Application of whole body diffusion weighted MR imaging for diagnosis and staging of malignant lymphoma. ACTA ACUST UNITED AC 2009; 23:138-44. [PMID: 18853847 DOI: 10.1016/s1001-9294(09)60028-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the clinical impact of whole body diffusion weighted imaging (WB-DWI) on diagnosis and staging of malignant lymphoma. METHODS Thirty-one patients with suspected lymphadenopathy were enrolled. WB-DWI was performed by using short TI inversion recovery echo-planar imaging sequence with free breathing and built-in body coil. Axial T2-weighted imaging images of the same location were used as reference. The results of WB-DWI were compared with pathological results and other imaging modalities. The mean apparent diffusion coefficient (ADC) values of different kinds of lymph nodes were compared. RESULTS WB-DWI was positive in all 18 cases with lymphoma, 5 cases with metastatic lymph nodes and 4 of 8 cases with benign lymphadenopathy. The mean ADC value of lymphomatous, metastatic and benign lymph nodes was (0.87 +/- 0.17) x 10(-3), (0.98 +/- 0.09) x 10(-3) and (1.20 +/- 0.10) x 10(-3) mm2/s. There was significant difference in ADC value between benign lymph nodes and other two groups (P < 0.01). The sensitivity, specificity and accuracy of WB-DWI in diagnosis of lymphoma were 100% (18/18), 30.8% (4/13) and 71.0% (22/31). When an ADC value of 1.08 x 10(-3) mm2/s was used as the threshold value for differentiating malignant from benign lymph nodes, the best results were obtained with sensitivity of 87.8% and specificity of 91.3%. Sixteen of eighteen cases (88.9%) of lymphoma were accurately staged in accordance with clinical staging. CONCLUSIONS WB-DWI is a sensitive, but less specific technique for diagnosis of lymphoma. It is difficult to differentiate lymphomatous from metastatic lymph nodes using WB-DWI. However, it is a valuable imaging modality for staging of patients with malignant lymphoma.
Collapse
Affiliation(s)
- Shuo Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Chamroonrat W, Houseni M, Li G, Alavi A, Zhuang H. PET and PET/CT in Pediatric Gastrointestinal Tract Oncology. PET Clin 2008; 3:227-38. [DOI: 10.1016/j.cpet.2008.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|