Intraductal papillary mucinous tumors of the pancreas

Purpose: To compare the effectiveness of thin-section helical CT and MR imaging with gadolinium-enhanced dynamic technique and MR cholangiopancreatography (MRCP) in the examination of patients with intraductal papillary mucinous tumors.

Material and Methods: Helical CT, dynamic MR imaging, and MRCP of 25 intraductal papillary mucinous tumors were compared with ERCP and surgical findings.

Results: The duodenal papilla was identified by helical CT and dynamic MR imaging in 11 (44%) and 20 (80%) of the 25 patients, respectively ( p<0.05). The main pancreatic duct was visualized on helical CT, dynamic MR imaging, and MRCP in all patients (100%): 25 (96.2%), 24 (92.3%), and 26 (100%) cystic lesions were depicted, respectively. A communicating duct between the main pancreatic duct and the cystic lesion was visualized on helical CT, dynamic MR imaging, and MRCP in 14 (53.8%), 11 (42.3%), and 15 (55.7%) lesions, respectively. The papillary projections corresponding to 3 mm or larger papillary neoplasms were depicted on helical CT and MR imaging in 7 patients (25%).

Conclusion: MR imaging was equal or slightly superior to thin-section helical CT in the evaluation of intraductal papillary mucinous tumors.

Intraductal papillary mucinous tumors of the pancreas. Comparison of helical CT and MR imaging

PURPOSE

To compare the effectiveness of thin-section helical CT and MR imaging with gadolinium-enhanced dynamic technique and MR cholangiopancreatography (MRCP) in the examination of patients with intraductal papillary mucinous tumors.

MATERIAL AND METHODS

Helical CT, dynamic MR imaging, and MRCP of 25 intraductal papillary mucinous tumors were compared with ERCP and surgical findings.

RESULTS

The duodenal papilla was identified by helical CT and dynamic MR imaging in 11 (44%) and 20 (80%) of the 25 patients, respectively (p<0.05). The main pancreatic duct was visualized on helical CT, dynamic MR imaging, and MRCP in all patients (100%): 25 (96.2%), 24 (92.3%), and 26 (100%) cystic lesions were depicted, respectively. A communicating duct between the main pancreatic duct and the cystic lesion was visualized on helical CT, dynamic MR imaging, and MRCP in 14 (53.8%), 11 (42.3%), and 15 (55.7%) lesions, respectively. The papillary projections corresponding to 3 mm or larger papillary neoplasms were depicted on helical CT and MR imaging in 7 patients (25%).

CONCLUSION

MR imaging was equal or slightly superior to thin-section helical CT in the evaluation of intraductal papillary mucinous tumors.

Left renal vein aneurysm: imaging findings

A renal vein aneurysm is a rare vascular disease. To our knowledge, only six cases have been reported. We describe a 57-year-old woman with a left renal vein aneurysm diagnosed by a combination of ultrasonography, color Doppler ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging.

Focal fatty infiltration in the posterior aspect of hepatic segment IV: relationship to pancreaticoduodenal venous drainage

OBJECTIVE

We aimed to investigate the relationship between fatty infiltration in the posterior aspect of hepatic segment IV and pancreaticoduodenal venous drainage.

METHODS

Pancreaticoduodenal arteriography was performed in 21 patients who had nontumorous portal perfusion defects in the posterior aspect of hepatic segment IV, as demonstrated on CT during arterial portography (CTAP).

RESULTS

In 10 patients, pancreaticoduodenal arteriography showed an aberrant nonportal vessel with flow toward the hepatic hilum in the venous phase. Four of the 10 patients with nonportal vessels from the pancreaticoduodenal arterial system had fatty infiltration in segment IV. In three of these four patients, the fatty infiltration was focal and localized to that area. On the other hand, none of the 11 patients without nonportal vessels from the pancreaticoduodenal arterial system had fatty infiltration in the regions corresponding to the nontumorous portal perfusion defects on CTAP. Moreover, three patients with diffuse fatty liver had a focal nonfatty area in segment IV.

CONCLUSIONS

Focal fatty infiltration in the posterior aspect of hepatic segment IV seems to be related to pancreaticoduodenal venous drainage.

Cholangiolocellular carcinoma of the liver: CT and MR findings

The authors report two cases of surgically proved cholangiolocellular carcinoma of the liver. Marked contrast enhancement was observed at the periphery of the tumor on CTs and MRIs obtained during the hepatic arterial and portal venous phases, with concentric filling on the delayed images. On T1-weighted and T2-weighted MRIs, the tumor was, respectively, hypointense and hyperintense, with a central hypointense area. Therefore, helical CT and MRI features of these cholangiolocellular carcinomas were thought to be similar to those of cholangiocarcinoma.

Intraductal papillary mucinous tumors of the pancreas: thin-section helical CT findings

OBJECTIVE

The purpose of this study was to evaluate the thin-section helical CT findings of intraductal papillary mucinous tumors and to investigate whether helical CT could distinguish between malignant and benign intraductal papillary mucinous tumors.

MATERIALS AND METHODS

Twenty-seven patients (nine with malignant and 18 with benign intraductal papillary-mucinous tumors) underwent thin-section (3- or 5-mm) helical CT. Two-phase enhanced CT was started 30 and 60-70 sec after injection of contrast material at 3 ml/sec.

RESULTS

In six patients (22.2%), a bulging papilla was depicted on CT. Twenty-five patients (92.6%) had a dilated main pancreatic duct. Cystic lesions were seen in 25 patients (92.6%). Thirteen lesions (48%) were located in the uncinate process, seven (25.9%) were in the head, two (7.4%) were in the body, and three (11%) were in the tail. The cystic lesion was unilocular in five patients (18.5%) and multilocular with a lobulated margin in 20 patients (74%). Communication between the main pancreatic duct and the cystic lesion was depicted in 19 patients (70.4%). The papillary projections corresponding to 3-mm or larger papillary neoplasms were depicted in five patients (18.5%). The bulging papilla was more often observed in malignant than in benign intraductal papillary mucinous tumors (p < 0.05). The caliber of the main pancreatic duct was significantly larger in patients with malignant intraductal papillary mucinous tumors (p > 0.001).

CONCLUSION

The most frequently found feature of intraductal papillary mucinous tumors was a lobulated multilocular cystic lesion located in the uncinate process and in contiguity with the dilated main pancreatic duct. In some patients, a bulging papilla and papillary projections in the ducts, which were specific findings, were visualized on CT. The bulging papilla and the caliber of the main pancreatic duct helped differentiate malignant from benign intraductal papillary mucinous tumors.

HASTE MR cholangiopancreatography in the evaluation of intraductal papillary-mucinous tumors of the pancreas

PURPOSE

The aim of this study was to determine the usefulness of MR cholangiopancreatography (MRCP) of intraductal papillary-mucinous tumors.

METHOD

Thirteen patients with intraductal papillary-mucinous tumors were examined by breath-hold MRCP using a half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence with a body phased-array coil.

RESULTS

Endoscopic retrograde cholangiopancreatography (ERCP) and MRCP completely imaged the entire main pancreatic duct in 12 and in all 13 patients, respectively. ERCP demonstrated the whole opacification of the cystic lesion in only one patient. MRCP depicted the whole of the cystic lesion in all 11 patients who had cystic lesions. ERCP and MRCP source images depicted a communicating duct between the main pancreatic duct and the cystic lesion in 8 and in all 11 patients, respectively. ERCP depicted papillary projections in the main pancreatic ducts in two patients. MRCP source images depicted papillary projections in the main pancreatic ducts or cystic lesions in five patients.

CONCLUSION

MRCP may be more useful to reveal the main pancreatic duct, cystic lesion, communicating duct between the main pancreatic duct and cystic lesion, and papillary projections than ERCP in patients with intraductal papillary-mucinous tumors of the pancreas.

Sclerosing hemangioma of the lung: MR findings and correlation with pathological features

Two sclerosing hemangiomas of the lung had mixed areas of high and low signal intensity on both T1- and T2-weighted images and were totally enhanced on postcontrast T1-weighted images. The T1 high signal intensity areas corresponded to those including abundant clear cells, and the T2-weighted low signal intensity areas corresponded to the fibrotic or hemorrhagic areas in the tumors. The T2 high signal intensity areas with remarkable contrast enhancement corresponded to the hemangiomatous parts of the tumors.

Lymphoepithelial cysts of the pancreas: demonstration of lipid component using CT and MRI

We present two cases of surgically proven lymphoepithelial cyst (LEC) of the pancreas that had a lipid component visualized by CT and MRI. Identification of this component in a pancreatic cystic lesion is a key to favor the diagnosis of LEC or splenic epidermoid cyst over other cystic lesions when the lesion is noted in an elderly patient.

MR imaging during arterial-portography (MR-AP) in the detection of hepatic tumor: comparison with CT-AP

This study was undertaken to compare the detection rate of hepatic space occupying lesion (SOL)s between computed tomography during arterial portography (CT-AP) and magnetic resonance imaging during arterial portography (MR-AP) and the differences in time intensity curve on MR-AP between HCC, metastatic tumor, FNH, and hemangioma. We performed CT-AP and MR-AP in 17 patients including 14 cases of HCC and one each of metastasis, FNH, and hemangioma. MR-AP was performed by Turbo-FLASH sequence. There was no statistically significant difference between CT-AP and MR-AP in detecting satellite lesions in terms of smallest diameter and number of flow defects (p > 0.05). Hemangioma showed rapid enhancement after the first pass and, consequently, the same enhancement as the hepatic parenchyma. MR-AP was comparable to CT-AP in the detection of hepatic SOLs. Hemangioma showed an enhancement pattern different from those of HCC, metastatic tumor, and FNH, which showed patterns similar to each other.

[Construction of an MRI reporting system using the Internet]

Out university hospital, includes a LAN (Local Area Network) and uses network services such as WWW(World Wide Web). We have constructed an MRI diagnostic reporting system on the Internet in which interactive date management was established on WWW by using CGI (Common Gateway Interface) software. Linking database information such as MRI reports with WWW browsers using by CGI provides easy data access to the database and offers hypertext and searching. This system suggests the possibility of creating a cheaper and more flexible network using Internet technology.

A case of retroperitoneal pseudomyxoma

We experienced a rare case of pseudomyxoma that progressed into the retroperitoneum. This patient presented with complaints of polyuria and back pain. CT and MRI showed a retroperitoneal cystic tumor. Surgical and pathological findings confirmed mucinous cystadenoma of the appendix that reached the posterior space behind the right kidney through the retroperitoneum.

A case of sclerosing hemangioma of the lung: correlation of MR images with pathological findings

The authors present a case of sclerosing hemangioma of the lung in which MRI was performed. The tumor had areas of various signal intensities on both T1- and T2-weighted images, including high-intensity areas and isointensity areas relative to muscle. We compared the signal intensity of the tumor with its pathological findings. The relatively high signal intensity of the tumor on T1-weighted images was thought to be a reflection of lipids of clear cells, and the isointensity relative to muscle on T1-weighted images to be a reflection of fibrosis. Hyperintensity was also seen on both T1- and T2-weighted images, and was intralesional hemorrhage. Use of Gd-DTPA strongly enhanced the tumor. This enhancement was thought to be abundant blood cavities, since not many capillaries were seen in the specimen. The signal intensity of the tumor corresponded closely to the pathognomonic findings, and it is thought that MRI may be helpful in diagnosing sclerosing hemangioma of the lung because of its high contrast resolution.

[Complications of arterial infusion of CDDP in the treatment of malignant neoplasms]

Arterial infusion of cis-diamminedichloroplatinum (CDDP) is an effective therapy for malignant neoplasms. Severe complications after this therapy in 298 patients with malignant tumors were reviewed in our institute from March 1982 to August 1989. Arteries infused with CDDP and the number of infusions were as follows: bronchial artery (a.) 277, hepatic a. 153, internal iliac a. 51, femoral or popliteal a. 15, lumbar a. 6, pulmonary a. 5, esophageal a. 3 and intercostal a. 3. Eight cases of severe complications were encountered: 3 of esophageal ulcer, 3 of spinal paralysis, and one each of mediastinitis and toe necrosis. The arteries responsible for complications were the bronchial a. in 3 cases of esophageal ulcer and 2 of spinal paralysis, intercostal a. in one of spinal paralysis, esophageal a. in one of mediastinitis and popliteal a. in toe necrosis. Complication rates were 2.7% (8/298 cases) and 1.5% (8/518 infusions). Angiotensin II was infused in 6 of 8 of the cases with complications. The complication rate was 2.9% (6/209 infusions) in the group with CDDP and angiotensin II and 0.6% (2/309 infusions) in the group with CDDP only. Arterial infusion of CDDP, especially combined with angiotensin II, should be done in consideration of the arteries responsible for such complications.

[Kinetic estimation of infused Lipiodol within a hepatoma using a CT dynamic study]

Distribution of Lipiodol within hepatic tumor was evaluated using serial computed tomography. Imagistic Lipiodol transition into the tumor via hepatic artery was slower than that of water soluble contrast medium, spreading to central part first and turn to peripheral part of the tumor. This method was thought to be useful to clarify Lipiodol distribution in hepatic tumor and to decide the method or necessity of additional trans-arterial therapy.

Subtotal vertebrectomy and spinal fusion for cervical spondylotic myelopathy

To perform decompression of the spinal cord and stabilization of the cervical spine in the patients with cervical spondylotic myelopathy, subtotal vertebrectomy and spinal fusion of the cervical spine were carried out in 30 patients. In 18 patients, three vertebrectomies and a spinal fusion were carried out, and in 12 patients, four vertebrectomies and a spinal fusion were carried out. Neurologic symptoms that were present before the operations ranged from transverse lesion type myelopathy to motor system syndrome. The patients' symptoms improved significantly after the operations. By the final consultation, the cervical spine motion reduced by about half in the four level vertebrectomy patients and about one third in the three level vertebrectomy patients. No patients reported cervical pain or pain in the arms.

Simultaneous measurement of intraosseous and cerebrospinal fluid pressures in lumbar region

Intraosseous pressure (IOP) and cerebrospinal fluid pressure (CSFP) in the lumbar region were measured simultaneously in two groups of patients with either spinal canal stenosis or disc herniation, to compare dynamic changes with positional changes, and to learn whether these pressure changes may have some role in the onset of claudication. IOP and CSFP showed almost the same change patterns with positional changes in two groups. They were lowest in the prone position and highest at the standing position. In standing with flexion, they were almost the same as in the prone position, but in extension they increased above the standing pressure. These dynamic pressure changes could act as a compression force to the cauda equina in the patient with spinal canal stenosis.