Fumito Fujiyoshi

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.

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.

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.

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.

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.

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.

Left renal vein aneurysm: imaging findings

AbstractA 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 associated with aberrant pancreaticoduodenal venous drainage

The posterior aspect of hepatic segment IV shows a spared area in a fatty liver [1], and is rarely affected by focal fatty infiltration [2]. It is also a common site for pseudolesions (localized portal perfusion defect) on computed tomography during arterial portography (CTAP) due to drainage of aberrant gastric veins. Aberrant gastric venous drainage is thought to be the main cause of the focal spared area at segment IV in fatty liver [3]. We present a case of focal fatty infiltration in the posterior aspect of hepatic segment IV drained by an aberrant posterior superior pancreaticoduodenal vein.