Marc Lemmerling

Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features

Abstract. This study was conducted to determine characteristic CT findings following the Whipple procedure and to evaluate the usefulness of CT in predicting tumor recurrence. Eighty-four postoperative abdominal CT scans and medical records of 43 patients were retrospectively reviewed. Perioperative histopathologic examinations revealed malignancy in 32 patients (74.4 %). Time interval between surgery and CT varied from 13 days to 6 years and 7 months. Common postoperative findings were unopacified anastomotic bowel loops in the porta hepatis (n = 69 scans), perivascular cuffing (n = 42 scans), pneumobilia (n = 40 scans), dilated intrahepatic bile ducts (n = 22 scans), reactive lymphadenopathy (n = 21 scans), and transient fluid collections (n = 20 scans). Postoperative complications were detected on 17 CT scans (20.2 %): generalized ascites (n = 8 patients), deep abscesses (n = 3 patients), wound abscess (n = 1 patient), pancreatitis (n = 1 patient), and pseudomembranous colitis (n = 1 patient). Tumor recurrence appeared in 15 patients (46.8 %) after a mean postoperative period of 11 months (1 month to 3 years): local (9 of 15), regional lymph nodes (9 of 15), and liver metastasis (8 of 15). Detection of generalized ascites more than 30 days after surgery was associated with tumor recurrence in 6 of 6 patients (100 %). Diffuse ascites (> 30 days after surgery) behaved as an early predictive sign of tumor recurrence. In our series CT accuracy for detecting recurrent tumor with CT was 93.5 %. No predilection site for disease recurrence could be determined.

Imaging of the normal pontine cisternal segment of the abducens nerve, using three-dimensional constructive interference in the steady state MRI.

Abstract Our objective was to determine the visibility of the cisternal segment of the normal abducens nerve using a three-dimensional Fourier-Transform constructive interference in the steady state (3DFT-CISS) sequence. Its visibility was rated in 150 patients without clinical evidence of abducens nerve disturbance. Axial 1-mm 3DFT-CISS images were obtained (TR/TE 17/7 ms, flip angle 50 °, field of view 160 mm, matrix 256 × 256). The cisternal segment was seen in 79 % of cases, bilaterally in 73 % and unilaterally in 11 % of cases; neither cisternal segment was seen in 16 % of cases. Identification of Dorellos canal was often of help in detecting the point lateral to the dorsum sellae at which the nerve pierces the dura mater. Flow artifacts and vascular loops in the pontine cistern sometimes caused problems in interpretation. 3DFT-CISS MRI with 1-mm-thick sections can however be considered a reasonably reliable technique for showing the cisternal segment of the abducens nerve.

Bilateral recurrent adult rhabdomyomas of the pharyngeal wall

Abstract Adult rhabdomyomas of the head and neck are uncommon benign skeletal muscle tumors. Only a few cases occurring in the pharyngeal wall have been described in the world literature. We present a case of recurrent bilateral rhabdomyomas in the pharynx and discuss the clinicopathological features of this lesion, comparing it to those of other neoplasms from which it must be differentiated. To our knowledge, bilaterality of this type of lesion has not been described previously. Although adult rhabdomyomas have a distinct histology, they often are mistaken for a variety of other lesions, particularly granular cell tumor.

MRI of the brain in cerebrotendinous xanthomatosis (van Bogaert-Scherer-Epstein disease)

Abstract. The clinical, biochemical and magnetic resonance imaging findings of two patients with cerebrotendinous xanthomatosis are reported. This is a rare hereditary disease. Early recognition of this entity is important in view of the existing treatment possibilities. Magnetic resonance imaging findings typically include a bilateral and almost symmetrical increase of the signal intensity on the T2-weighted images in the cerebellar and periventricular cerebral white matter, the basal ganglia, the dentate nuclei and the brainstem as well as cerebellar and cerebral atrophy.

Accuracy of single-sequence MRI for investigation of the fluid-filled spaces in the inner ear and cerebellopontine angle.

Abstract We prospectively studied 163 patients referred for MRI of the temporal bone. A presumed diagnosis was made using only one of three sequences: a single thick (12 mm) slice fast T2-sequence, 3D fourier transform constructive interference in steady state (3DFT-CISS) sequence and a gadolinium-enhanced T1-weighted sequence. The visibility of the cochlea, vestibule and superior, lateral and posterior semicircular canals of normal temporal bones was assessed on the T2-weighted images: they were almost always visible (98–100 %), with exception of the superior semicircular canal, seen in only 35 % of cases. The images were interpreted as abnormal in 34 patients (21 %). Using only the fast T2-weighted, 3DFT-CISS and gadolinium-enhanced T1-weighted sequences a presumed false positive diagnosis was made in 5, 1 and 0 cases and a false negative diagnosis in 2, 2 and 4 cases respectively. The overall reliability of the thick-section fast T2-weighted images is limited. This study suggests that a combination of gadolinium-enhanced T1-weighted and 3DFT-CISS images can be considered the gold standard for temporal bone MRI and neither sequence performed separately is as accurate as both together.

Ossified retroperitoneal malignant Schwannoma with spinal leptomeningeal metastases

Abstract A malignant retroperitoneal schwannoma in a patient without von Recklinghausens disease is reported. Ossification in the tumour, shown on CT and MRI in this previously untreated patient is exceptional. MRI demonstration of spinal leptomeningeal metastases supports the hypothesis of haematogenous metastatic spread of systemic malignant tumours to the leptomeningeal spaces.