James G. Bova

Detection of bile duct leaks using MR cholangiography with Mangfodipir trisodium (teslascan)

Mangafodipir trisodium (Teslascan), a hepatobiliary contrast agent, has the potential of providing functional biliary imaging similar to hepatobiliary scintigraphy. To our knowledge. the potential role of this biliary contrast agent in the detection of bile duct leaks has not been reported. In this case report, we report the first case of a bile duct leak diagnosed with enhanced MRI with mangafodipir trisodium in a patient following laparoscopic cholecystectomy. Our case illustrates that functional MR cholangiography images can be successfully acquired by using a post-mangafodipir fat-suppressed GRE technique and that bile duct leaks can be detected.

Radiographic manifestations of eosinophilic gastroenteritis

Eosinophilic gastroenteritis (EG) is a rare inflammatory disease of unknown etiology, characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract. Although little over 250 cases of EG have been reported in the literature, EG is probably more common than reports in the literature would indicate. A retrospective review of 25 patients with EG along with a review of the literature was done to identify clinical, laboratory, radiographic, and therapeutic features. An allergic disorder was present in 14 (56%) and a peripheral eosinophilia was present in 24 (96%) of our patients. The most common radiographic manifestations of the stomach and small bowel included stenosis and fold thickening, respectively. Thirteen patients had esophageal involvement, with the esophageal stricture being the most common abnormality found in these patients. Steroids produced a good therapeutic result in most patients; the remaining patients responded to cromolyn and/or surgery.

CT vs MRI in diagnosis of recurrent rectosigmoid carcinoma

Objective Our goal was to compare the relative values of MRI vs. CT in diagnosing recurrent rectosigmoid cancer. Materials and Methods We conducted a retrospective review of 18 patients who had surgical resection of primary rectosigmoid carcinoma and suspected recurrence. They were studied with CT and MR and followed for up to 4 years. Results At the time of the initial imaging, 10 patients had recurrent tumor and 4 of the remaining 8 patients later demonstrated local recurrence. Magnetic resonance demonstrated 91% sensitivity, 100% specificity, a positive predictive value (PPV) of 100%, and a negative predictive value (NPV) of 89% with a 95% accuracy. Computed tomography demonstrated a sensitivity of 82% and a specificity of 50% with a PPV of 69% and an NPV of 67% with an accuracy of 68%. In three cases interpreted on CT as presacral masses, all were shown on MR to represent displaced but normal pelvic structures. In four cases MR revealed tumor involving the sacrum and sacral nerves not apparent on CT. Conclusion Magnetic resonance showed superior sensitivity, specificity, and accuracy to CT and better definition of the extent of tumor.

Safety and efficacy of mangafodipir trisodium (MnDPDP) injection for hepatic MRI in adults: results of the U.S. multicenter phase III clinical trials (safety).

The short‐term1 safety of mangafodipir trisodium (MnDPDP) injection was studied in 546 adults with known or suspected focal liver lesions. An initial contrast‐enhanced computed tomography examination was followed by unenhanced magnetic resonance imaging (MRI), injection of MnDPDP (5 μmol/kg), and enhanced MRI. Adverse events were reported for 23% of the patients; most were mild to moderate in intensity, did not require treatment, and were not drug related. The most commonly reported adverse events were nausea (7%) and headache (4%). The incidence of serious adverse events was low (nine events in six patients) and not drug related. Injection‐associated discomfort was reported for 69% of the patients, and the most commonly reported discomforts included heat (49%) and flushing (33%). Changes in laboratory values and vital signs were generally transient, were not clinically significant, and did not require treatment. There were no clinically significant short‐term risks from exposure to MnDPDP. J. Magn. Reson. Imaging 2000;12:186–197.

Primary angiosarcoma of the spleen—CT, MR, and sonographic characteristics: report of two cases

Primary angiosarcoma of the spleen is a rare entity, but it is the most common primary splenic malignancy. These tumors demonstrate an aggressive growth pattern and can be single or multiple. The diagnosis should be suspected in a patient who presents with splenomegaly but without evidence of lymphoma, malaria, leukemia, or portal hypertension. The tumor may also present with acute abdominal symptoms secondary to spontaneous splenic rupture. We describe two cases of primary angiosarcoma of the spleen with computed tomographic, magnetic resonance, and sonographic features.

Computed tomography of primary transitional cell carcinoma of upper urinary tracts

Preoperative computed tomography (CT) was utilized to evaluate 20 patients with primary transitional cell carcinoma of the upper urinary tracts. Of the 20 patients, 18 (90%) had CT visualization of the tumor as either a discrete mass or local ureteral and/or renal pelvic wall thickening; 2 (10%) had false-negative examinations. Seven of the 20 patients (35%) had CT evidence of tumor extension demonstrated by frank tumor invasion beyond the urothelium or by perirenal pelvic and/or periureteral fat streaks. Of the 4 patients with fat streaks, 2 (50%) had superficial tumors (T(A)T2), 1 had a T1 (25%) tumor, and 1 had a T3 (25%) tumor. All 3 patients with CT findings of direct extension of tumor through the wall of the ureter or renal pelvis had T3 tumors. Among the 13 with localized noninvasive tumor on CT, 5 (38%) had superficial tumors (TA, TIS, T1), 5 (38%) had T2 tumors, and 3 (21%) had T3 tumors. Of the 5 patients with enlarged regional lymph nodes (greater than or equal to 1.5 cm) on CT, 2 had tumor confirmed histologically, 2 had subsequent negative CT-guided biopsies, and 1 had a negative lymphadenectomy. Distant metastasis was discovered in 1 patient. The data suggest that when CT demonstrates direct tumor extension through the renal pelvic or ureteral wall, it is a sensitive indicator of high-stage disease. However, in the absence of this finding, CT is of limited value in staging patients with primary transitional cell carcinoma of the pyeloureteral system.

Magnetic resonance angiography in the preoperative evaluation of abdominal aortic aneurysms

Magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) are noninvasive techniques of visualizing blood vessels without the use of intravenous contrast or ionizing radiation. This prospective study assessed preoperative MRA and MRI in the evaluation of 28 patients with abdominal aortic aneurysm (AAA). MRI and MRA accurately predicted the extent of cephalad AAA, the patency of the superior mesenteric artery, and the course of the left renal vein, but were less accurate in defining the extent of caudal AAA, flow of the inferior mesenteric artery, and multiple renal arteries. This study suggests that MRI and MRA are alternatives to the combination of angiography and computed tomographic scan in the preoperative evaluation of patients with suspected AAA and no evidence of mesenteric or renal ischemia. When combined with preoperative segmental Doppler arterial studies, an accurate surgical plan may be formulated. Further refinements in image acquisition and postprocessing software analysis will advance the use of MRI and MRA for complete evaluation prior to elective AAA repair.

CT of superior mesenteric vein thrombosis complicating periappendiceal abscess.

Acute mesenteric vein thrombosis is a rare complication of appendicitis. In this report we describe the clinical association of these entities and emphasize how early diagnosis by CT can expedite treatment.

Preoperative 3D rendering of MR imaging in liver metastases

In 15 patients who were to undergo resection of hepatic metastases, three-dimensional (3D) images of the liver were rendered from axial T2-weighted MR images by a dedicated 3D workstation. This report assesses the utility of these images in preoperative planning and intraoperative guidance. In three patients, the preoperative 3D images convinced the surgeon of resectability. All patients had laparotomies and in 12 patients, in whom the liver lesions were evaluated, there was good to excellent spatial correlation. Intraoperatively, the 3D images aided the surgeon by allowing early detection of unresectability, by showing relationships of lesions to major vessels, and by directing the surgeon to lesions otherwise difficult to find. In two patients, the original MR images failed to show multiple small lesions, thus limiting the usefulness of the 3D images.

Utilization Review of Simultaneously Ordered Multiple Radiologic Tests for the Same Symptom

The purpose of this study was to analyze the utiliza tion of multiple radiologic procedures ordered simulta neously for the same clinical problem. The method was a retrospective study of patients referred to an urban community hospital who had multiple radiologic tests ordered simultaneously before the referring physician reviewed any of the results. Utilization Findings Codes, beta versions II and III, of the American College of Radiology were applied. In- and outpatient charts were reviewed for initial indication, subsequent diagnosis, and treatment. Ninety-three patients had 214 radiologic ex aminations (2.3 per patient). Of the 214 total, 129 (60%) were retrospectively coded as inappropriate (beta II ver sion). For 98 reports, the initial interpreting radiolo gists coded 16% as inappropriate versus 55% when retrospectively coded by the authors (P < 0.0001). After applying the beta III version, 18% were coded as posi tive (and related to symptoms), 79% negative, and 3% equivocal. There were 161 (74%) examinations ordered by primary care physicians and 53 tests ordered by spe cialists. Using the beta III version, the negative rate for primary care physicians was 81 and 75% for specialists (P = 0.447). It was concluded that ordering multiple ra diologic tests simultaneously on the same patient resulted in a high number of inappropriate procedures and negative results.