L. Vlahos

Focal nodular hyperplasia: imaging findings.

Abstract Focal nodular hyperplasia is an uncommon benign hepatic tumor that continues to pose diagnostic dilemmas. Imaging techniques are of great value in diagnosis of this tumor. In this article we present the US, CT, MR imaging, scintigraphy, and angiography findings. The demonstration of a central vascular scar is very helpful. Although the radiologic features may be diagnostic, many atypical cases must be differentiated from other benign or malignant hepatic tumors. In these cases excisional biopsy and histopathologic examination are necessary to determine a definite diagnosis.

Abdominal retained surgical sponges: CT appearance

Abstract. Retention of surgical sponges is rare. They cause either an aseptic reaction without significant symptoms or an exudative reaction which results in early but nonspecific symptoms. Computed tomography is very useful for recognition of retained sponges. The appearance of retained sponges is widely variable. Air trapping into a surgical sponge results in the spongiform pattern which is characteristic but unfortunately uncommon. A low-density, high-density, or complex mass is found in the majority of cases, but these patterns are not specific. Sometimes, a thin high-density capsule may be seen. Rim or internal calcification is a rare finding. Finally, a radiopaque marker is not a reliable sign. Differentiation from abscess and hematoma is sometimes difficult.

A short radiotherapy course for locally advanced non-small cell lung cancer (NSCLC). Effective palliation and patients’ convenience

In order to facilitate patients with symptomatic locally advanced NSCLC, especially those coming from remote areas we have employed two palliative RT schedules. The first (S1) is the well known from Medical Research Council (MRC) randomized studies 2 x 8.5 Gy one week apart and the second (S2) is a two-day RT schedule: three fractions of 4.25 Gy are given on the first day and two fractions of 4.25 Gy on the second day. The records of 92 patients were reviewed (48 for S1 and 44 for S2). Patients, disease characteristics and results were similar for both groups; rates of symptom disappearance were for S1 and S2, respectively: cough 24 and 20%, hemoptysis 60 and 67%, chest pain 57 and 64% and dyspnoea 55 and 45% The overall condition improved in 39 and 36%, respectively. The median palliation time in days was in S1 and S2, respectively: cough 70 and 66, haemoptysis 133 and 139, chest pain 68 and 62 and dyspnoea 74 and 69 days. The median survival was 25 weeks in both S1 and S2 groups (P=0.89 log-rank test). At 52 weeks (one year), ten (21%) and seven (16%) of the patients were alive in S1 and S2 groups, respectively. At 104 weeks, the corresponding figures were two (4%) and two (4.7%) for S1 and S2. Our results are in accordance to those reported in literature regarding the safety and efficacy of palliative hypofractionated radiotherapy schemes. Their use in selected patients could be cost-effective and convenient for patients especially those coming from remote areas.

Differences in perfusion parameters between upper and lower lumbar vertebral segments with dynamic contrast-enhanced MRI (DCE MRI)

To investigate the influence of age, sex and spinal level on perfusion parameters of normal lumbar bone marrow with dynamic contrast-enhanced MRI (DCE MRI). Sixty-seven subjects referred for evaluation of low back pain or sciatica underwent DCE MRI of the lumbar spine. After subtraction of dynamic images, a region of interest (ROI) was placed on each lumbar vertebral body of all subjects, and time intensity curves were generated. Consequently, perfusion parameters were calculated. Statistical analysis was performed to search for perfusion differences among lumbar vertebrae and in relation to age and sex. Upper (L1, L2) and lower (L3, L4, L5) vertebrae showed significant differences in perfusion parameters (p<0.05). Vertebrae of subjects younger than 50 years showed significantly higher perfusion compared to vertebrae of older ones (p<0.05). Vertebrae of females demonstrated significantly increased perfusion compared to those of males of corresponding age (p<0.05). All perfusion parameters, except for washout (WOUT), showed a mild linear correlation with age. Time to maximum slope (TMSP) and time to peak (TTPK) showed the same correlation with sex (0.22<r<0.32, p<0.05). Our results indicate increased perfusion of the upper compared to the lower lumbar spine, of younger compared to older subjects and of females compared to males.

Dermatitis during radiation for vulvar carcinoma: prevention and treatment with granulocyte-macrophage colony-stimulating factor impregnated gauze

The aim of this study was to determine the effectiveness of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) impregnated gauze in preventing or healing radiation‐induced dermatitis. Sixty‐one patients were irradiated for vulvar carcinoma. Thirty‐seven applied steroid cream at irradiated areas throughout radiotherapy (Group A) and 24 patients applied additionally GM‐CSF impregnated gauze (40μg/cm2 of skin‐irradiated area, twice per day) in addition to the steroid cream, after 20Gy of irradiation (Group B). The score of skin reactions (P=0.008, chi2 test) and the time interval of radiotherapy interruption (P=0.037, Mann‐Whitney U test) were statistically significantly reduced in Group B patients. Multivariate analysis of variance showed for this group not only a significant reduction in the Sum of Gross Dermatitis Scoring (P<0.001, adjusted for Duration of Dermatitis) but also a significant reduction of the healing time (P=0.02, adjusted for Sum of Gross Dermatitis Scoring). The pain grading was less (P=0.014, chi2 test) and pain reduction was noticed sooner after the application of GM‐CSF impregnated gauze (P=0.0017, Mann‐Whitney U test). Multivariate logistic regression analysis showed that the only significant effect on dermatitis score is due to Body Mass Index (P=0.034) and the application of GM‐CSF (P=0.008). GM‐CSF impregnated gauze can be effective in preventing and healing radiation‐induced dermatitis and in reducing the interruption intervals of radiotherapy for vulvar carcinomas.

Imaging of a supernumerary kidney.

Abstract. A 33-year-old female patient was investigated for a right lower quadrant pain. The investigation, which included an excretory urography and a computed tomography examination, revealed a normal kidney on the right side and another two normal sized, complete kidneys on the left side, which appeared to have a small parenchymal bridge. The patient was treated surgically for a cyst of the right ovary.

A comparative study between Gd-DTPA and oral magnetic particles (OMP) as gastrointestinal (GI) contrast agents for MRI of the abdomen

In the present study we compared two gastrointestinal contrast agents--Gd-DTPA, a positive signal, and oral magnetic particles (OMP), a negative signal contrast agent--in patients who were referred for MR imaging of the abdomen. Altogether 60 patients were examined with the former and 28 patients with the latter contrast before and after the administration of contrast media. Gd-DTPA was given either per os or per rectum. In comparing the results, it was shown that the diagnostic accuracy of postcontrast MRI in both groups was more or less similar to CT but much higher as compared with plain MRI. In the OMP series, first the contrast between the GI-filled lumen and the surrounding fat was much superior to that of the Gd-DTPA and, second, there was no evidence of any artifacts from bowel motion. However, the overall accuracy of the Gd-DTPA group was better compared with that of the OMP group. This was due to underfilling of the distal bowel because the OMP in those patients was administered only per os. Finally, Gd-DTPA had a more pleasant taste and fewer side effects. It is concluded that both contrast media are suitable for the upper abdomen because the results are comparable, whereas for the lower abdomen Gd-DTPA is superior because it can be used from both routes.

Horseshoe kidney associated with anomalous inferior vena cava

Abstract. Horseshoe kidney associated with anomalous inferior vena cava is a rare congenital anomaly. Radiological demonstration of this combined anomaly is also uncommon, with only two cases of preisthmic inferior vena cava with horseshoe kidney in the imaging literature. We report a case of simultaneous horseshoe kidney and inferior vena cava lying anterior to the right renal moiety diagnosed by ultrasound and computed tomography.

Management of Renal Angiomyolipoma by Selective Arterial Embolization

4 Patients with renal angiomyolipomas are presented. One of them had tuberous sclerosis with synchronous bilateral tumors. All the patients were symptomatic, 2 of them with retroperitoneal hemorrhage. In all patients selective arterial embolization was performed. Permanent control of the symptoms was successful in 2 patients. In 1 patient temporary resolution of the symptoms was observed, and a second embolization was required. Retroperitoneal bleeding in 1 patient continued and nephrectomy was undertaken.

Acute Iliac Artery Rupture: Endovascular Treatment

The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results.