H. R. Degryse

Focal nodular hyperplasia of the liver: Radiologic findings

A retrospective analysis of the results of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) of 24 cases (28 lesions) of proven focal nodular hyperplasia (FNH) is presented. While US exhibited nonspecific features, CT frequently showed characteristic features: hypodensity on precontrast scans (69%), transient immediate enhancement after bolus injection (96%), and homogeneity (85%). A scar was noted in 31% of the cases. The typical MR triad of isointensity on T1- and/or T2-weighted (T2-WI), homogeneity, and a scar which shows hyperintensity on T2-WI was seen in only 12% of our cases. The most common finding was homogeneity (94%). In two cases the scar was hypointense on T2-WI. To our knowledge, this finding has not been described before. We conclude that the features of FNH, although fairly constant, are at times indistinguishable from those of other hepatic tumors, such as hepatic adenoma (HA), fibrolamellar hepatocellular carcinoma (FLHCC), small hepatocellular carcinoma, and a hyperplastic nodule. Therefore, a multimodality approach is essential for the correct diagnosis in order to prevent unnecessary surgery.

Randomised double blind trial of the safety and efficacy of two gadolinium complexes (Gd-DTPA and Gd-DOTA)

The main difference between macrocyclic Gd-DOTA and linear Gd-DTPA complexes is the greater stability of the former which theoretically might reduce biological interactions in man. To evaluate the clinical relevance of this property, 300 unselected neurological patients were included in a randomised double-blind comparison involving five European centres, focused mainly on the tolerance of these two contrast media. Clinical tolerance was assessed immediatley after the procedure and 24 h later. Adverse events were found with a similar frequency in the two groups (17.3% for Gd-DOTA and 19.3% for Gd-DTPA). Minor neurological symptoms were the most frequent (48.6%) headache being the most common (29.2% of adverse events). No difference in efficacy was found.

Reject analysis: a pilot programme for image quality management

The radiographic film wastage and the different parameters affecting this wastage were analysed for a 9-week period at a 600-bed University Hospital. An overall reject rate of 7.6% was found. The different reasons for rejection were evaluated, while retake rate, relation between working experience of the personnel, amount of rejected films and total film wastage in surface (m2), were registered and analysed.

Calcific tendinitis of the vastus lateralis muscle

Three cases of calcific tendinitis occurring at an unusual site (vastus lateralis tendon) are described. Findings on conventional radiography and computed tomography together with the clinical history are characteristic for this disorder and reflect its natural evolution. The actual role of magnetic resonance imaging seems limited to excluding neoplasm and to demonstrating inflammatory changes better in the early stages of disease.

Computed tomography of the polysplenia syndrome in the adult

The computed tomographic appearance of the polysplenia syndrome in 2 cases is presented. Both are associated with absence of the hepatic segment of the inferior vena cava. Computed tomography can determine the exact location of the malpositioned organs, the presence of multiple spleens, and the type of the associated venous anomalies, which are the major features of the polysplenia syndrome.

Aphthoid esophageal ulcers in Crohn's disease of ileum and colon

We report 4 cases of tiny aphthous ulcers of the esophagus occurring in patients with confirmed Crohns disease of the terminal ileum and the colon. These ulcers presented as small collections of barium surrounded by a radiolucent halo, and were demonstrable on double-contrast radiographs of the esophagus. They were located in the middle and distal thirds of the otherwise normal esophagus. A more advanced stage of Crohns ileocolitis was present in these patients.

Clinical significance of focal echogenic liver lesions

During a 4-year period, 53 focal echogenic liver lesions were demonstrated by sonography in 41 patients, in whom there was no evidence of metastatic origin. Most of the lesions were hemangiomas.One of the purposes of this study was to determine the characteristic ultrasound features for liver hemangioma. Small (less than 2 cm), homogeneous, echogenic, well-circumscribed, subcapsular lesions almost prove their hemangiomatous nature. Lesions with a diameter of more than 2 cm are usually more lobulated and heterogeneous. They are located more centrally in the liver and nearly all show a close anatomical relation with 1 of the hepatic veins. Very large lesions (greater than 5 cm) with a heterogeneous and irregular aspect suggest focal nodular hyperplasia, which must be proven by a Tc-isotopic liver scan.

A Double-Blind Fluoroscopic Study of Cisapride on Gastrointestinal Motility in Patients with Functional Dyspepsia

Twenty patients with functional dyspepsia were referred for radiologic examination and, upon confirmation of a hypomotile stomach, were given either 10 mg cisapride or placebo in a double-blind manner (10 patients per group). The movement of a 250-ml barium meal was assessed by means of television fluoroscopy performed at regular time intervals. Cisapride significantly improved antral contractility and enhanced gastric emptying compared with placebo. Deep peristaltic waves occurred over the entire small bowel, and motility and small-bowel transit time of the barium meal were significantly increased in the cisapride group compared with the placebo group. The study demonstrates that when a carefully defined protocol is observed, fluoroscopy following barium ingestion offers considerable potential in the assessment of gastrointestinal motility.

Improved sensitivity of MRI in multiple sclerosis by use of extensive standardized procedures

The relative value of two different MRI procedures for the assessment of infratentorial extension in multiple sclerosis (MS) was studied. Multislice spin-echo techniques were used overall. Procedure A consisted of parasagittal T1-weighted images (500/30) and axial T2-weighted images (2500/30, 2500/120). Procedure B consisted of parasagittal T2-weighted images (1600/35, 1600/90). In the parasagittal T2-weighted images clear visualization of MS lesions is achieved because signal intensities of CSF and normal nervous tissue are nearly identical. All images were performed with a 0.5 Tesla MR system. Data were obtained in 98 patients with definite (N = 30) or probable MS (N = 68). Areas with abnormal signal intensity in the infratentorial regions (brainstem, cerebellum, and/or cervical spinal cord) were identified in 44% of the patients with procedure A and in 64% with procedure B. The standard application of the combination of both procedures improves the sensitivity of the MR examination for the diagnosis of MS, the delineation of infratentorial lesions and the correlation between clinical and MR data without excessively increasing imaging time.

Acute Cytomegalovirus Infection as a Rare Cause of Portal Vein Thrombosis with Small Bowel Infarction in an Immunocompetent Patient

Portal vein thrombosis (PVT) refers to thrombosis that develops in the trunk of the portal vein including its right and left intrahepatic branches and may even extend to the splenic or superior mesenteric veins. PVT due to Cytomegalovirus (CMV) infection is a rare complication, scarcely described in English literature. We present a case of a 58-year-old immunocompetent patient with PVT and small bowel ischemia.