Claude Guinet

CT in adnexal torsion with emphasis on tubal findings : correlation with US

Objective Our goal was to determine the CT and US aspects of the fallopian tube in adnexal torsion. Materials and Methods The CT scans and US studies of 10 patients with surgically proven unilateral torsion of the adnexa were reviewed. Results On CT the fallopian tube on the involved side was identified in eight cases as an almost tubular or comma-shaped structure extending from the uterine cornua and covering partially the adnexal mass. This tube was significantly thickened and measured 20–40 mm. Hemorrhage (density ≥50 HU on precontrast CT scans) was present in the tube in six patients. A heterogeneous contrast agent uptake was detected in the tube in five patients. An adnexal mass was visualized on the involved side in all patients, with hemorrhage in the mass in four patients. Peritoneal fluid and/or ileus were present in six patients. On US an echogenic structure that corresponded to the enlarged tube visualized on CT was detected in three cases and an adnexal mass in all cases. Conclusion Thickening of the fallopian tube with hemorrhage could be detected by CT and is suggestive of torsion especially if associated with an adnexal mass.

Preoperative assessment of the extension of rectal carcinoma: correlation of MR, surgical, and histopathologic findings.

Nineteen patients with rectal carcinoma were evaluated prospectively. The extent of tumor and the relationship of the tumor to the levator ani muscle were studied as this determines the choice of the surgical procedure (abdominoperineal resection versus low anterior resection). Peroperative assessment and detailed evaluation of the pathologic specimens were correlated with magnetic resonance (MR) features. Magnetic resonance staging and surgical findings were at variance in four of 15 cases (27%). Magnetic resonance had sensitivities and specificities of 75 and 100% in the detection of perirectal growth. Magnetic resonance demonstrated invasion of adjacent pelvic side wall and sacrum in two of two cases. The comparison with TNM classification demonstrated that MR correctly staged 15 of 19 cases (79%). This study shows that MR is a good examination to evaluate the involvement of perirectal fatty tissues and adjacent structures. The low prevalence of involved lymph nodes in our cases prevents significant positive predictive values. Nevertheless, MR can help to select patients for local excision or for preoperative radiotherapy.

Mature cystic teratomas of the ovary: CT and MR findings

OBJECTIVE To correlate CT and MR patterns of ovarian mature cystic teratomas (MCT). SUBJECTS AND METHODS CT and MR findings in 25 histologically proven ovarian MCT were retrospectively reviewed. MCT characterization at CT and MR was based on detection of fat and/or a Rokitansky protuberance. MR signal intensity and CT density numbers of fat were correlated. RESULTS At pathology, 24/25 tumors contained fat, 1/25 a water content, and 23/25 a Rokitansky protuberance. Twenty one MCT contained fat with a density number less than-20 HU (mean density: -95 HU) and a signal intensity superior or equal to sub-cutaneous fat on T1 images, however, only six of these had a signal intensity equal to sub-cutaneous fat on T1 and T2 images and 12 had a reversed chemical shift artifact. Three contained fat with a density number ranging from -13 to +8 HU and a signal intensity inferior to subcutaneous fat on T1 images. CT showed a Rokitansky protuberance in 21/23, containing adipose tissue in 16 and calcified structures in 21. Standard MR showed a Rokitansky protuberance in 14/23 and characterized adipose tissue in eight cases, and calcified material in six cases. Finally, CT characterized 24/25 (96%) MCT. Standard MR characterized 22/25 (88%) MCT, and standard MR with fat-suppression sequences characterized 23/25 (92%) MCT. CONCLUSION Standard MR is less effective than CT in characterizing fat and has the same difficulty as CT in characterizing fat mixed with hair when its density is high. When fat cannot be identified by either technique, diagnosis of a Rokitansky protuberance is more easily made at CT than at MR.

Fat suppression techniques in MR imaging of mature ovarian teratomas: comparison with CT

OBJECTIVE The aim of this study is to analyze the ability of MR fat suppression techniques to characterize fat components of ovarian mature cystic teratomas (MCT) shown by CT. SUBJECTS AND METHODS MR images of eight MCTs of the ovary were obtained using standard sequences followed by a SPIR (spectral presaturation with inversion recovery) sequence in six cases and by Dixon sequences in two cases. In all cases correlation with CT and pathologic findings was achieved. RESULTS MR fat suppression sequences showed to be as accurate as CT in detecting fat inside the cystic part of the teratomas (8/8). CONCLUSION MR fat suppression sequences should be performed when presence of fat is suspected on images of ovarian tumors produced by standard MR sequences.

Subsolid Lung Nodule Classification: A CT Criterion for Improving Interobserver Agreement

Purpose To evaluate an objective computed tomographic (CT) criterion for distinguishing between part-solid (PS) and nonsolid (NS) lung nodules. Materials and Methods This study received institutional review board approval, and patients gave informed consent. Preoperative CT studies in all patients who underwent surgery for subsolid nodules between 2008 and 2015 were first reviewed by two senior radiologists, who subjectively classified the nodules as PS or NS. A second reading performed 1 month later used predefined classification criteria and involved a third senior radiologist as well as three junior radiologists. Subsolid nodules were classified as PS if a solid portion was detectable in the mediastinal window setting (nonmeasurable, < 50%, or > 50% of the entire nodule) and were otherwise classified as NS (subclassified as pure or heterogeneous). Interreader agreement was assessed with κ statistics and the intraclass correlation coefficient (ICC). Results A total of 99 nodules measuring a median of 20 mm (range, 5-47 mm) in lung window CT images were analyzed. Senior radiologist agreement on the PS/NS distinction increased from moderate (κ = 0.54; 95% confidence interval [CI]: 0.37, 0.71) to excellent (κ = 0.89; 95% CI: 0.80, 0.98) between the first and second readings. At the second readings, agreement among senior and junior radiologists was excellent for PS/NS distinction (ICC = 0.87; 95% CI: 0.83, 0.90) and for subcategorization (ICC = 0.82; 95% CI: 0.77, 0.87). When a solid portion was measurable in the mediastinal window, the specificity for adenocarcinoma invasiveness ranged from 86% to 96%. Conclusion Detection of a solid portion in the mediastinal window setting allows subsolid nodules to be classified as PS with excellent interreader agreement. If the solid portion is measurable, the specificity for adenocarcinoma invasiveness is high.

Correlation between radiological and pathological features of operated ground glass nodules.

Abstract The aim of this study was to evaluate, in a predominantly white population, correlations between radiological and pathological diagnoses based on the latest classifications of pulmonary adenocarcinomas. We analysed data from patients undergoing lung resection for ground glass nodules (GGNs) less than 3 cm and whose solid component was

Comparison of coronal and axial computed tomography measurements of mediastinal nodes before primary surgery for non-small cell lung cancer

OBJECTIVE To assess computed tomography (CT) evaluation of mediastinal nodes in non-small cell lung cancer to predict metastatic involvement by measurement of their axis and surface area in the coronal plane, as compared to standard short-axis measures in the axial plane. METHODS Evaluation of mediastinal nodes was retrospectively performed on CT scans of 100 patients before thoracotomy. In all patients, mediastinal dissection was performed in the appropriate stations (n=264) according to the side (59 right, 41 left) of the tumor. Measurements of short axis and surface area of the largest node in each dissected station were performed on axial and coronal planes. RESULTS By using the standard threshold of axial short axis ≥10 mm, sensitivity and specificity were 25% and 98%, respectively. Areas under receiver operating characteristic curves were 0.828 and 0.821 for axial short axis and axial surface area data. For comparison, areas under receiver operating characteristic curves were 0.843 and 0.845 for coronal short axis and coronal surface area data, respectively. So, for a specificity of 98%, sensitivity was 29% for coronal short axis ≥11 mm and 33% for coronal surface area ≥123 mm(2). When using axial short axis ≥10 mm or coronal surface area ≥120 mm(2), sensitivity was 45%, whereas specificity remained at 96%. CONCLUSION Coronal measurements of mediastinal nodes give a slightly albeit non-significant improvement of diagnostic accuracy over axial ones. If both axial short axis and coronal surface area are taken into account, accuracy is improved.