Cheng-Yen Chang

Preoperative staging of cervical carcinoma with MR imaging: a reappraisal of diagnostic accuracy and pitfalls

Abstract. The purpose of this study was to assess the diagnostic accuracy and pitfalls of MR imaging in preoperative staging of cervical cancer. Magnetic resonance imaging was performed to determine the tumor staging for 41 patients with cervical carcinoma emphasizing tumor size, parametrial invasion, vaginal invasion, and lymph node metastases. According to the correlation of MR findings with surgical–pathological features, there was less than 5xa0mm discrepancy in the size in 29 of 34 tumors (85.3%) that were larger than 1xa0cm. In assessing parametrial invasion, vaginal invasion and lymph node metastases, MR imaging had an accuracy of 95, 83, and 86%, respectively. In determining stage of disease and differentiating operable (≤stage IIA) from advanced disease (≥stage IIB), MR imaging had an accuracy of 82.9 and 93%. Pitfalls leading to staging errors included difficulties in differentiating cancer foci from surrounding tissue edema and detecting microscopic tumor extension. Magnetic resonance imaging is accurate in the evaluation of parametrial invasion and differentiation of operable from advanced disease. The ability of MR imaging to detect microscopic extra-cervical tumor extension and differentiate cancer foci from surrounding tissue edema is not as reliable.

Radiologic and pathologic correlation of adenomyomatosis of the gallbladder

AbstractBackground: To demonstrate the radiologic–pathologic correlation of adenomyomatosis of gallbladder (GBA) and emphasize the role of high-resolution real-time ultrasound (RTUS) in the diagnosis of GBA.n Methods: Ten (four male and six female, mean age = 49 years) patients with proven GBA (three diffuse, three segmental, and four fundal) diagnosed by histopathology or confirmed by oral cholecystography (OCG) were reviewed. Radiologic studies included OCG (n = 8), RTUS (n = 8), and computed tomography (CT; n = 4). Six patients subsequently underwent cholecystectomy.n Results: Histopathologic correlation between pathologic specimens and OCG, RTUS, and CT was possible in six patients. The diagnostic criteria with ultrasound included numerous tiny intramural cysts containing echogenic foci with reverberation artifacts and associated segmental or diffuse gallbladder wall thickening. OCG with fatty meal demonstrated intramural diverticula. Localized fundal GBA was better visualized on RTUS and CT scan than on OCG.n Conclusion: Accurate diagnosis of GBA may be made by either OCG or high-resolution RTUS preoperatively. CT scan may used as an alternative method to help make the diagnosis in equivocal cases.

Osteoporosis: prevalence in Taiwanese women

The aim of this study is to understand the current status of bone mineral density (BMD) among Taiwanese women and to determine the relationship between bone mass, weight, height and body mass index (BMI), and the proportion of osteoporosis sufferers, based on World Health Organization standards, in each age group. A total of 4689 women underwent lumbar vertebrae (L2–L4) BMD measurements, and 3529 women underwent femoral neck bone mineral density measurements. BMD was measured using dual-energy X-ray absorptiometry. Standards were based on the BMD of the 20- to 40-year-old age group, as were relationships between height, weight, BMI, and BMD. Pearson correlation revealed a positive relationship between body weight, BMI, and BMD in the femoral neck; other correlations were insignificant. The defined BMD value for a diagnosis of osteoporosis was 0.827xa0g/cm2 for lumbar vertebrae and 0.605xa0g/cm2 for the femoral neck. The proportion of osteoporosis calculated for each age group in the lumbar vertebrae group was: 40–49 years old, 8.25%; 50–59 years old, 8.62%; 60–69 years old, 14.14%; 70–79 years old, 14.25%; >80 years old, 16.07%. For the femoral neck group, the values were: 40–49 years old, 5.24%; 50–59 years old, 5.28%; 60–69 years old, 11.17%; 70–79 years old, 17.30%; >80 years old, 24%. The total proportion of osteoporosis in the lumbar vertebrae was 10.08%, and in the femoral neck, 7.45%. The BMD of Taiwanese women shows a positive relationship to body weight and BMI in the femoral neck group but not in the lumbar vertebrae group. The proportion of osteoporosis by age group in this cohort was lower than that among Western women.

FAT-SUPPRESSED THREE-DIMENSIONAL FAST SPOILED GRADIENT-RECALLED ECHO IMAGING: A MODIFIED FS 3D SPGR TECHNIQUE FOR ASSESSMENT OF PATELLOFEMORAL JOINT CHONDROMALACIA

Fast fat-suppressed (FS) three-dimensional (3D) spoiled gradient-recalled echo (SPGR) imaging of 64 articular cartilage regions in 16 patellofemoral joints was evaluated to assess its feasibility in diagnosing patellofemoral chondromalacia. It demonstrated good correlation with arthroscopic reports and took about half of the examination time that FS 3D SPGR did. This modified, faster technique has the potential to diagnose patellofemoral chondromalacia with shorter examination time than FS 3D SPGR did.

Testicular microlithiasis: Analysis of prevalence and associated testicular cancer in Taiwanese men

To determine the incidence of testicular microlithiasis (TM) in Taiwanese males who were referred for scrotal sonography (US) and to evaluate the association between TM and cancer, with state‐of‐the‐art equipment.

Peritoneal serous papillary carcinoma: a reappraisal of CT imaging features and literature review

We evaluated the imaging features of primary serous peritoneal carcinoma (PSPC) on computed tomography (CT) and reviewed the literature. Preoperative CT images of 11 women with PSPC were retrospectively reviewed. The clinical presentations and serum levels of CA-125 were recorded. Special attention was paid to the operative and histopathologic findings of the ovaries. Imaging features were correlated with those in the literature. An elevation of serum CA-125 was found in 91% of cases. The CT findings included ascites (82%), peritoneal nodules or masses (73%), and omental nodules or omental caking (64%). Absence of an overt ovarian mass was observed in 64% of cases. The clinical manifestations and imaging features in our patients were consistent with those in the literature. Eighty-five percent of the ovaries in our study were superficially involved by PSPC in histopathologic examination. In none of our cases could the ovarian size be clearly assessed in the CT images. In conclusion, the presence of diffuse peritoneal disease and the absence of an ovarian mass on CT and an elevation of serum CA-125 level is suggestive of PSPC. However, in our experience, the evaluation of ovarian morphology and size by CT alone may not be as reliable.

Pictorial review : Radiological diagnosis of duodenal abnormalities

This article depicts the radiological findings of many common gastrointestinal entities. Specifically, examples of disease processes that affect the stomach, gall bladder, small intestine, pancreas and colon are shown. In most cases there is correlation between ultrasound, computed tomography (CT) and fluoroscopic imaging. The major emphasis of the article, however, is to demonstrate classic barium imaging of a large number of gastrointestinal disease processes.

Different and Identical Features of Chondroblastic Osteosarcoma and Chondrosarcoma: Highlights on Radiography and Magnetic Resonance Imaging

Background: To identify the different and identical features of 2 tumors with similar pathologic findings, chondroblastic osteosarcoma (OGS) and chondrosarcoma (CSA), with highlights on radiography and magnetic resonance imaging (MRI). Methods: Ten patients with chondroblastic OGS and 10 patients with CSA were enrolled. After recording the tumor location, tumor morphology was evaluated for patterns of bony destruction, visible tumor matrix, and aggressive periosteal reactions, endosteal scalloping, cortical expansion, cortical breakthrough and pathologic fracture by radiographic analysis. Signal intensity changes, enhancement pattern, and tumor extensions were evaluated by MRI. Results: The mean patient ages were 24.7 and 56.7 years in patients with chondroblastic OGS and CSA, respectively (p = 0.001). Tumor occurrence was detected in the appendicular bones in 8 chondroblastic OGS and 3 CSA. Three chondroblastic OGS occurred around the knee (p = 0.003). In addition, there were 6 tumors arising from the metaphysis and 2 arising from the diaphysis in chondroblastic OGS patients. In CSA patients, 1 tumor arose in the metaphysis, 1 in the diaphysis, and 1 in the epiphysis (p = 0.039). On radiographs, visible bone‐forming tumor matrix was present in 8 chondroblastic OGS, and coexistence of bone‐ and cartilage‐forming patterns were detected in 2. Visible cartilage‐forming tumor matrix was present in 7 CSA, and atypical radiodensity patterns were detected in 2 (p < 0.001). Aggressive periosteal reaction was present in 7 chondroblastic OGS, and non‐aggressive periosteal reaction was found in 1 CSA (p = 0.008). MRI revealed the presence of a lobular structure of high signal intensity on T2‐weighted images, and peripheral rim and septal enhancement pattern was noted in 2 chondroblastic OGS and 10 CSA patients. Inhomogeneous and marginal enhancement patterns were noted in 6 and 2 chondroblastic OGS, respectively (p = 0.001). Conclusion: Metaphysis origin, bone‐forming tumor matrix, aggressive periosteal reaction, and young patient age favored chondroblastic OGS. Some chondroblastic OGS showed radiologic and MRI appearances that were typical of CSA.

Percutaneous transtracheal computed tomography-guided biopsy of cervical esophageal carcinoma: an alternative approach.

Editor: Endoscopic biopsy is a widely adopted procedure performed for obtaining specimens for histologic or cytologic examination of esophageal cancer. We report a patient who could not tolerate and refused the endoscopic procedure because his tooth broke on the first trial; a percutaneous computed tomography (CT)–guided biopsy was successfully performed and he was proven to have squamous-cell carcinoma of the esophagus. A 63-year-old male patient was admitted to our institution with swallowing difficulty and weight loss of approximately 6 kg in the past 4 months. In the month before admission, his condition had deteriorated to the extent that he was able to tolerate only a liquid diet. He reported smoking one half pack of cigarettes and drinking 300 mL of red wine daily for 40 years and he had no history of esophageal disease. An upper gastrointestinal examination series suggested a cervical esophageal lesion, and he was referred to our hospital for further management. A biopsy via rigid laryngoscopy was performed and revealed chronic inflammation. After obtaining clinical consultations and reviewing CT images, and considering the patient’s refusal of further endoscopic procedures after a loose tooth broke on the first trial, a CT-guided percutaneous biopsy was arranged for tissue confirmation to facilitate further treatment planning. The patient received fluid via a venous route, supplemental oxygen via a nasal cannula, and pulse oximetry for monitoring blood oxygen saturation during the procedure. The biopsy was performed under CT guidance (Somatom Plus 4; Siemens, Erlangen, Germany) in supine position without moderate sedation. During CT scanning and needle advancement, the patient was instructed to hold his breath with persist inspiratory effort so the needle tip could approach the desired positions. Considering the DOI: 10.1097/01.RVI.0000196320.61641.7F

Inflammatory Myofibroblastic Tumor of the Soft Tissue — Sonographic and Computed Tomographic Features: A Case Report

Soft-tissue inflammatory myofibroblastic tumor (IMT) is a rare benign lesion. Only six cases of IMT of the skin and subcutaneous tissue have been reported recently. We report a rare case of soft-tissue IMT with multifocal recurrence after surgical excision. Sonographic features of these discrete lesions revealed heterogeneous hypoechoic masses with irregular margins and several echogenic foci in the lesion. Stranding of the adjacent fat and mild thickening of the overlying skin were also evident. Color Doppler ultrasound showed increased flow in some portions of the lesion. Computed tomography showed an ill-defined nodule at each site with homogeneous hypodensity but no obvious enhancement.