Gulden Acunas

Hydatid disease with unusual localization

Abstract. Hydatid disease (HD) may develop in almost any part of the body. The liver is the most frequently involved organ (75 %), followed by the lung (15 %) and the remainder of the body (10 %). Hydatid cysts with unusual localizations may cause serious problems in the differential diagnosis. In this article the various imaging findings of hydatid cysts with unusual localizations are reviewed, based on our experience. Findings in brain, heart, pericard, kidney, intraperitoneum, retroperitoneum, bone, soft tissue, and breast are discussed. Hydatid disease should be considered in the differential diagnosis of all cystic masses in all anatomic locations, especially when they occur in areas where the disease is endemic. The combination of clinical history, imaging findings, and serologic test results usually help the diagnosis.

Imaging features of thalassemia

Abstract. Thalassemia is a kind of chronic, inherited, microcytic anemia characterized by defective hemoglobin synthesis and ineffective erythropoiesis. In all thalassemias clinical features that result from anemia, transfusional, and absorptive iron overload are similar but vary in severity. The radiographic features of β-thalassemia are due in large part to marrow hyperplasia. Markedly expanded marrow space lead to various skeletal manifestations including spine, skull, facial bones, and ribs. Extramedullary hematopoiesis (ExmH), hemosiderosis, and cholelithiasis are among the non-skeletal manifestations of thalassemia. The skeletal X-ray findings show characteristics of chronic overactivity of the marrow. In this article both skeletal and non-skeletal manifestations of thalassemia are discussed with an overview of X-ray findings, including MRI and CT findings.

Frequency of Sternal Variations and Anomalies Evaluated by MDCT

OBJECTIVE Our objective was to reveal the frequency and MDCT appearances of sternal variations and anomalies in subjects without sternal deformities. SUBJECTS AND METHODS One thousand consecutive patients who underwent thoracic MDCT examination were enrolled in the study. All MDCT data, including multiplanar and curved-planar reconstructed images, were evaluated for detection of sternal variations and anomalies. Various kinds of sternal variations and anomalies, such as suprasternal bones and tubercles, manubriosternal and sternoxiphoidal fusions, sternal clefts and foramina, and sternal sclerotic bands were documented. RESULTS In 1,000 subjects, the frequencies of main sternal variations and anomalies were as follows: suprasternal bone in 4.1%, suprasternal tubercle in 4%, complete manubriosternal fusion in 19.6%, complete sternoxiphoidal fusion in 30.3%, sternal foramen in 4.5%, and sternal sclerotic band in 37.1%. Xiphoidal foramen was seen in 27.4%, and the most common type was single foramen. Xiphoid process mostly ended as a single process (71%). Double-ended xiphoid process was also frequent (27.2%). Pseudocleft and pseudoforamen at the sternoxiphoidal junction were detected in 3.3% and in 3.6% of subjects, respectively. CONCLUSION MDCT exhibited various sternal variations and anomalies. Sternal foramen is a frequent minor anomaly and generally associated with sternal sclerotic bands. Early manubriosternal and sternoxiphoidal fusions can be seen in early adulthood without osteodegeneration. Double-ended xiphoid process and single xiphoidal foramen are frequent sternal variations. Awareness of MDCT appearances of sternal variations and anomalies provides a better differential diagnosis with pathologic conditions.

Multimodality imaging features of idiopathic granulomatous mastitis: outcome of 12 years of experience.

PurposeThis study was done to determine mammographic, sonographic and magnetic resonance imaging (MRI) appearances of idiopathic granulomatous mastitis, an entity clinically and radiographically resembling breast carcinoma.Materials and methodsA total of 36 women (mean age 37 years, range 21–51 years) with histopathological diagnosis of idiopathic granulomatous mastitis were enrolled in the study. The Breast Imaging Reporting and Data System (BI-RADS) was used to categorise the levels of suspicion of malignancy on mammography. Mammography findings were classified also according to density, margin, architectural distortion and number of lesions. Lesions were classified according to number, heterogeneity and echogenic features on sonography. Dynamic MRI findings were categorised as enhancing mass lesion, nonmass lesion or both mass lesions and nonmass lesions together. Subclassification criteria for MRI included lesion shape, margin, border and internal enhancement pattern.ResultsThe most common mammographic finding was either focal or diffuse asymmetric density (n=15, 44%). The most common sonographic findings were solitary or multiple circumscribed heterogeneous hypoechoic masses (n=19, 52%). Among other sonographic findings were diffuse abscess formation with fistulae and massive parenchymal heterogeneity and hypoechogenicity in 12 (33%) and five (13%) women, respectively. On MRI, enhancing mass lesions were detected in 24 patients, whereas enhancing nonmass lesions were observed in 28. Sixteen patients had both enhancing mass lesions and nonmass lesions together.ConclusionsAlthough not characteristic for this entity, asymmetric density on mammography, solitary or multiple clustered heterogeneous hypoechogenicity with a tubular configuration on sonography and round, smooth-contoured masslike lesion with rim enhancement or segmental non-mass-like lesion on MRI are the most common features of the disease.RiassuntoObiettivoLo scopo del lavoro è determinare gli aspetti in mammografia, ecografia e risonanza magnetica della mastite granulomatosa idiopatica, un’entità clinicamente e radiologicamente simile al carcinoma mammario.Materiali e metodiSono state arruolate nello studio 36 donne (età media: 37 anni, range: 21–51 anni) con diagnosi isto-patologica di mastite granulomatosa idiopatica. è stato utilizzato il Breast Imaging Reporting and Data System (BI-RADS) per classificare il livello di sospetto e di malignità sulla base della mammografia. I rilievi mammografici sono stati classificati anche in base a densità, margini, distorsione strutturale e numero di lesioni. Le lesioni sono state classificate all’ecografia secondo il numero, l’eterogeneità e le caratteristiche di ecogenicità. I reperti sono stati classificati in risonanza magnetica come lesioni con aumentato enhancement di tipo masslike, non-masslike, o contestualmente masslike e non-masslike. Ulteriori criteri in risonanza magnetica hanno incluso forma, margini, bordi e pattern interno di enhancement della lesione.RisultatiIl rilievo mammografico più comune era caratterizzato da densità asimmetriche sia focali che diffuse (n=15, 44%). I reperti ecografici più comuni erano masse circoscritte, solitarie o multiple, eterogenee ed ipoecogene (n=19, 52%). Altri segni ecografici tipici erano diffuse formazioni ascessuali con fistole, caratterizzate da intensa eterogeneità in 12 (33%) donne ed ipoecogenicità parenchimale in 5 (13%) donne. Sulla base della risonanza magnetica, lesioni masslike sono state rilevate in 24 pazienti, mentre lesioni non-masslike sono state osservate in 28 donne. Sedici pazienti avevano contemporaneamente lesioni masslike e non-masslike.ConclusioniSebbene non specifiche di questa entità, le più comuni caratteristiche della mastite granulomatosa idiopatica sono risultate essere: lesioni con densità asimmetrica alla mammografia, lesioni eterogeneamente ipoecogne, solitarie o multiple, con configurazione tubulare, in ecografia, e lesioni masslike, rotondeggianti a margini lisci, con enhancement anulare, o lesioni segmentate non-masslike, in risonanza magnetica.

Preoperative CT staging of colon carcinoma (excluding the recto-sigmoid region)

Twenty-eight patients with colon carcinoma (excluding the recto-sigmoid region) underwent preoperative staging with computed tomography (CT). The CT had a sensitivity and a specificity of 60 and 67% for detection of extramural invasion, 75% sensitivity and specificity for lymph node metastases and a sensitivity of 87% and specificity of 95% for liver metastases. Compared with the modified Dukes classification, CT correctly staged 50% of the patients with Dukes A lesions; 40% with Dukes B; 75% with Dukes C and 85% with Dukes D lesions. The data presented in this study showed that CT has limitations in the sensitivity and accuracy of staging local colonic carcinoma. However, we recommend its use for patients who are clinically suspected of having extensive disease.

Granulomatous mastitis: Gray‐scale and color Doppler sonographic findings

We examined the roles of gray‐scale and color Doppler sonography in the diagnosis of granulomatous mastitis.

Analysis of the Thymus in 151 Healthy Infants From 0 to 2 Years of Age

Objective. A prospective sonographic study of the normal thymus was performed to determine the size changes with age and to compare the results according to some clinical conditions, such as sex, breast versus formula feeding, and term or preterm status. Methods. One hundred fifty‐one healthy infants underwent thymic sonography. Maximal transverse and longitudinal dimensions and anteroposterior dimensions of the right and left lobes were measured, and thymic indices were calculated. Mean values of thymic measurements for each group (sex, age, breast or formula feeding, and term or preterm status) were determined. The results were statistically evaluated. Results. Thymic dimensions showed the maximal values at about 4 to 6 months and gradually decreased after 6 to 8 months. No significant differences were found between mean values of thymic dimensions according to the sex and formula‐ versus breast‐fed groups. As expected, the term group had greater thymic size values than the preterm group, probably because of positive correlations between thymus size, birth weight, and height. Conclusions. The thymus is clearly and easily visualized on sonography in the 0‐ to 2‐year age period. This may be useful for evaluating qualitative and quantitative properties of the thymus and determining size changes according to age in various clinical conditions.

Dynamic Contrast Enhancement Patterns of Solitary Pulmonary Nodules on 3D Gradient-Recalled Echo MRI

OBJECTIVE The purpose of this study was to determine whether contrast enhancement features on 3D volumetric gradient-recalled echoMR images allow differentiation of benign from malignant solitary pulmonary nodules. MATERIALS AND METHODS Forty patients with solitary pulmonary nodules (range of greatest diameter, 7-40 mm) detected on CT underwent unenhanced MRI and contrast-enhanced MRI performed in 10 consecutive dynamic 3D volumetric gradient-recalled echo sequences every 30 seconds. Contrast enhancement patterns (homogeneous, heterogeneous, rim, peripheral, and central) of the lesions were visually evaluated, and time-intensity curves of the lesions were drawn. RESULTS Twenty patients had benign lesions (nine, tuberculoma; one, aspergilloma; nine, round atelectasis; one, postinflammatory nodule). The other 20 patients had malignant lesions (18, primary lung cancer; two, metastasis). At visual analysis, all 20 malignant lesions displayed peripheral enhancement with progressive heterogeneous fill-in on the late images. All nine tuberculomas and the aspergilloma had rim enhancement, and all nine round atelectasis lesions and the postinflammatory nodule had early intense homogeneous enhancement. Regarding the time-intensity curves, all malignant lesions except one lung cancer lesion had early peak enhancement with rapid washout. All benign lesions displayed early increasing enhancement with an early plateau in the second minute after contrast administration (nine tuberculomas and one aspergilloma) or a late plateau in the fourth minute (nine round atelectasis lesions and one postinflammatory nodule). CONCLUSION Rim contrast enhancement is highly valuable in the diagnosis of tuberculoma. Time-intensity curve types can be taken into consideration for noninvasive differentiation of lung cancer, tuberculoma, and round atelectasis.

Sialoblastoma: MRI findings.

Sialoblastoma is a rare, aggressive and potentially malignant salivary gland tumour diagnosed in the neonatal period. A total of 28 cases have been reported in the literature, but reports of the imaging findings are limited. We describe a neonate with a right parotid sialoblastoma. MRI showed a large facial mass, which was mostly hypointense to the brain on T1-weighted images and mildly hyperintense on T2-weighted images. There were foci of haemorrhage and necrosis. Heterogeneous and weak contrast enhancement was detected on contrast-enhanced images. The tumour invaded the maxilla and adjacent muscles.

Congenital bilateral perisylvian syndrome with pituitary hypoplasia and ectopic neurohypophysis

Congenital bilateral perisylvian syndrome (CBPS) is a congenital neurological syndrome characterized by pseudobulbar palsy, cognitive deficits and bilateral perisylvian abnormalities observed on imaging. The described abnormality in CBPS is polymicrogyria located in the frontal, parietal, and/or occipital lobes. A few syndromes or abnormalities associated with this syndrome have been documented. Pituitary abnormalities are rare disorders. Association of CBPS with pituitary abnormalities has not been reported previously. In this case, a combination of bilateral perisylvian polymicrogyria with pituitary hypoplasia and ectopic neurohypophysis, caused by a possible single common insult, is presented.