Adib R. Karam

Focal nodular hyperplasia: Central scar enhancement pattern using gadoxetate disodium

To illustrate the unusual enhancement pattern of the focal nodular hyperplasia central scar using Gadoxetate Disodium.

Evidence Supporting LI-RADS Major Features for CT- and MR Imaging–based Diagnosis of Hepatocellular Carcinoma: A Systematic Review

The Liver Imaging Reporting and Data System (LI-RADS) standardizes the interpretation, reporting, and data collection for imaging examinations in patients at risk for hepatocellular carcinoma (HCC). It assigns category codes reflecting relative probability of HCC to imaging-detected liver observations based on major and ancillary imaging features. LI-RADS also includes imaging features suggesting malignancy other than HCC. Supported and endorsed by the American College of Radiology (ACR), the system has been developed by a committee of radiologists, hepatologists, pathologists, surgeons, lexicon experts, and ACR staff, with input from the American Association for the Study of Liver Diseases and the Organ Procurement Transplantation Network/United Network for Organ Sharing. Development of LI-RADS has been based on literature review, expert opinion, rounds of testing and iteration, and feedback from users. This article summarizes and assesses the quality of evidence supporting each LI-RADS major feature for diagnosis of HCC, as well as of the LI-RADS imaging features suggesting malignancy other than HCC. Based on the evidence, recommendations are provided for or against their continued inclusion in LI-RADS.

Incidentally detected misty mesentery on CT: risk of malignancy correlates with mesenteric lymph node size.

Objective To determine the natural history of incidentally detected misty mesentery on computed tomography (CT) and to correlate the risk of malignancy with size of mesenteric lymph nodes. Methods A retrospective review of all CT abdomen/pelvic examinations from January 1, 2004 through December 31, 2008 identified cases of misty mesentery. The largest mesenteric lymph node was measured, and additional areas of lymphadenopathy were identified. Follow-up was obtained by reviewing all subsequent CT examinations, clinical notes, and pathologic specimens. Patients were excluded if they had a known malignancy at the time of initial CT, CT or clinical history revealing a cause for the misty mesentery, or CT follow-up of less than 2 years. Results Thirty-seven patients with misty mesentery were included. The mean time from the original CT to the latest follow-up was 3.8 years. The largest lymph node measured less than 10 mm in 30 (81%) of 37 patients. All 30 patients demonstrated stable lymph node size, had no other regions with lymphadenopathy, and none developed malignancy. The largest lymph node was 10 mm or greater in 7 (19%) of 31 patients. Three of these patients developed non-Hodgkin lymphoma, 2 of which had other areas of lymphadenopathy. No cases of nonlymphomatous malignancy were identified. Conclusions The development of malignancy in patients with incidentally detected misty mesentery correlates with mesenteric lymph node size. Patients with misty mesentery and largest mesenteric lymph node less than 10 mm without additional areas of lymphadenopathy demonstrate a benign course, and no further follow-up may be necessary.

Osteoblastoma of the frontal sinuses presenting with headache and blurred vision: case report and review of the literature.

Osteoblastoma is a rare benign bone tumor that usually arises in the vertebral column and long bones of young adults. Craniofacial involvement is extremely rare. To date, osteoblastoma of the frontal sinus has not been reported in the English literature. We report an osteoblastoma of both frontal sinuses in a 23-year-old male who presented with headache and blurry vision in the left eye. Computed tomography (CT) demonstrated an expansile lesion involving both frontal sinuses with sclerotic and fibrous components, eroding into the roof of the left orbit. On magnetic resonance imaging (MRI) the dense portion of the lesion showed signal void on all sequences, while the fibrous matrix was isointense to grey matter on T1-weighted and T2-weighted images and showed avid enhancement following intravenous contrast administration. Surgical resection was performed and histology was consistent with osteoblastoma.

Determination of cystic duct patency using hepatobiliary MRI with gadoxetate disodium: Is T1 precontrast imaging necessary?

To determine the need for precontrast T1‐weighted imaging in determining cystic duct patency using hepatobiliary phase imaging with gadoxetate disodium‐enhanced magnetic resonance imaging (MRI).

Delayed splenic rupture presenting 70 days following blunt abdominal trauma

Delayed splenic rupture following conservative management of splenic injury is an extremely rare complication. We report a case of an adult patient who presented with delayed splenic rupture necessitating splenectomy, 2 months following blunt abdominal trauma. Imaging at the initial presentation demonstrated only minimal splenic contusion and the patient was discharge following 24 hours of observation.

Multifocal extra-adrenal myelolipoma arising in the greater omentum.

Myelolipomas are rare benign tumors composed of mature fat and hematopoietic elements. They are most often discovered incidentally within the adrenal glands, with extra-adrenal myelolipomas being extremely rare tumors. We report a case of multifocal omental extra-adrenal myelolipoma in a patient who had undergone bilateral adrenalectomy. To our knowledge, this is the first reported case of an intraperitoneal extra-adrenal myelolipoma.

Pneumothorax Following Ultrasound-Guided Jugular Vein Puncture for Central Venous Access in Interventional Radiology 4 Years of Experience

Purpose: The purpose of our study was to review the rate of pneumothorax following central venous access, using real-time ultrasound guidance. Materials and methods: Data related to ultrasound-guided venous puncture, for central venous access, performed between July 1, 2004 and June 30, 2008 was retrospectively and prospectively collected. Access route, needle gauge, catheter type, and diagnosis of pneumothorax on the intraprocedure spot radiographs and or the postprocedure chest radiographs, were recorded. Results: A total of 1262 ultrasound-guided jugular venous puncture for central venous access were performed on a total of 1066 patients between July 1, 2004 and June 30, 2008. Access vessels included 983 right internal jugular veins, 275 left internal jugular veins, and 4 right external jugular veins. No pneumothorax (0%) was identified. Conclusion: Due to an extremely low rate of pneumothorax following ultrasound-guided central venous access, 0% in our study and other published studies, we suggest that routine postprocedure chest radiograph to exclude pneumothorax may be dispensed unless it is suspected by the operator or if the patient becomes symptomatic.

Alcohol sclerosis of a giant liver cyst following failed deroofings

Percutaneous alcohol sclerotherapy for simple liver cysts is an established and safe procedure. We report alcohol ablation of a very large (5.5 liters) liver cyst that had failed laparoscopic deroofing procedures twice. The cyst responded to multisession alcohol sclerotherapy.

Diaphragm injury after liver stereotactic body radiation therapy

Stereotactic body radiation therapy (SBRT) is an increasingly common treatment for lung and liver malignancies. Chest wall toxicity following SBRT for peripheral tumors has been reported and there are published dose constraint guidelines to minimize the risk for rib fracture, chest wall necrosis, and cutaneous ulceration.1-4 There are no documented reports of diaphragm injury after SBRT and no defined tolerance dose. We describe in this report the clinical course of a patient who developed severe back pain following liver SBRT and was found to have focal necrosis, fibrosis, and atrophy of the diaphragm in the high-dose region on autopsy.