Rodney H. Reznek

Assessment of tumor invasion of the vena caval wall in renal cell carcinoma cases by magnetic resonance imaging.

PURPOSE We evaluated the role of magnetic resonance imaging (MRI) in patients with renal cancer and inferior vena caval involvement with reference to its ability to characterize the extent and nature of inferior vena caval tumor extension and wall invasion. MATERIALS AND METHODS The study included 12 consecutive patients with renal cancer and inferior vena caval involvement. All patients underwent imaging on a 1.5 Tesla MRI unit. Coronal, axial T1 and axial T2-weighted images were performed in all cases, while in 6 3-dimensional gadolinium enhanced magnetic resonance angiography and venography were also performed. Images were assessed for the extent and nature of tumor extension, that is tumor versus thrombus, and invasion of the inferior vena caval wall. Imaging results were compared with operative findings. RESULTS On MRI the extent and nature of the inferior vena caval tumor was correctly defined in all cases. The sensitivity, specificity and accuracy of inferior vena caval wall invasion were 100%, 89% and 92%, respectively. CONCLUSIONS In patients with renal cancer and inferior vena caval involvement MRI defines the tumor level in the inferior vena cava. It is also a sensitive technique for detecting vessel wall invasion and provides important preoperative information for surgical planning.

The indeterminate adrenal lesion

Abstract With the increasing use of abdominal cross-sectional imaging, incidental adrenal masses are being detected more often. The important clinical question is whether these lesions are benign adenomas or malignant primary or secondary masses. Benign adrenal masses such as lipid-rich adenomas, myelolipomas, adrenal cysts and adrenal haemorrhage have pathognomonic cross-sectional imaging appearances. However, there remains a significant overlap between imaging features of some lipid-poor adenomas and malignant lesions. The nature of incidentally detected adrenal masses can be determined with a high degree of accuracy using computed tomography (CT) and magnetic resonance imaging (MRI) alone. Positron emission tomography (PET) is also increasingly used in clinical practice in characterizing incidentally detected lesions. We review the performance of the established and new techniques in CT, MRI and PET that can be used to distinguish benign adenomas and malignant lesions of the adrenal gland.

Imaging the Ancients

Mummified remains and artefacts, since their discovery, have attracted the interest of scientific investigators. Consequently virtually every paleoimaging modality has been applied to bioarchaeology soon after its technological development. Indeed, the first use of X-rays in mummy investigation was only one year after William Rontgen discovered X-rays in 1895 when, in March 1896, Carl Koenig, a German physicist, published the first X-rays involving mummies, that of an Egyptian mummified cat and the knees of an Egyptian child mummy. The first systematic analysis of a major mummy collection was undertaken at the Field Museum in Chicago in 1931. CT scans of mummies were first carried out in 1977. Not surprisingly, over the years, several problems have been identified in interpreting the images on CT. The presence of many layers of mummy wrapping, organ removal, diagenetic changes, particularly desiccation, may all result in confusion. Special problems in X-ray and CT scanning arise when the diagenetic changes are so massive that the remaining tissues, including bone, are severely degraded - a feature best shown by bog bodies, all of which date to the Northern European Iron Age (approximately 500 BC to 500 AD). Recent technological advances have made MDCT an especially useful means for presentation of findings of anthropological inquiry as exemplified in a brilliant recent exhibition at the British Museum. However, this short lecture will show an almost unique personal experience of imaging of mummies performed over almost a decade in the mid-80s and early 90s. Investigations were undertaken of a bog body discovered in Lindow near Manchester, Muisca bodies discovered in the Andes, and Egyptian mummies from Fayum. All three projects revealed fascinating insights into the lifestyle of these ancients and answered several lines of anthropological inquiry. This presentation will illustrate examples from each of these projects.