Thomas J. Barloon

Paraovarian and paratubal cysts: preoperative diagnosis using transabdominal and transvaginal sonography.

Paraovarian and paratubal cysts constitute about 10% of adnexal masses. Our purpose was to determine whether pathologically proven examples of these lesions were correctly identified during preoperative transabdominal and transvaginal sonographic evaluations.

Intracranial granulocytic sarcoma (chloroma): MR findings

Complications of the central nervous system are not uncommon in patients with a diagnosis of leukemia including infections and hemorrhage. We present the magnetic resonance (MR) findings of granulocytic sarcoma (chloroma) in two leukemic patients who presented with masses in the cerebellopontine angle and in the cavernous and the sphenoid sinuses. The MR signal displayed by these two lesions was isointense to the brain on both T1- and T2-weighted images. This signal intensity differs from that observed in cases of hemorrhage or infection.

MR imaging of primary tumors of trigeminal nerve and Meckel's cave

MR imaging features of 11 primary tumors of the trigeminal nerve and Meckels cave were analyzed. The tumors consisted of two trigeminal schwannomas, five meningiomas, one lipoma, and three epidermoid tumors. The trigeminal schwannomas had homogeneously decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. Three of the five meningiomas had signal intensity similar to that of surrounding brain on both T1- and T2-weighted images. One meningioma had decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. The other had relatively low signal intensity on both T1- and T2-weighted images owing to heavy calcification demonstrated on CT. The lipoma had homogeneous signal intensity that was isointense with orbital and subcutaneous fat on both T1- and T2-weighted images. The epidermoid tumors had decreased signal intensity on T1-weighted images and markedly increased signal intensity on T2-weighted images. In addition, the epidermoids had an insinuating growth pattern and minimal mass effect. The extent of involvement in the trigeminal nerve distribution was well demonstrated in each case. Because of its multiplanar capability, exquisite anatomic detail, and characteristic tissue signal intensity, we conclude that MR is helpful in the differential diagnosis of primary tumors of the trigeminal nerve and Meckels cave and in the evaluation of tumor involvement for preoperative planning.

MR imaging of unusual chordomas

Chordomas are uncommon primary skeletal neoplasms arising from notochordal remnants. Approximately 50% arise in the sacrum, 35% in the clivus, and <15% in the true vertebrae. We report magnetic resonance (MR) studies of four unusual primary chordomas, three in the lumbar region (L1, L2, and L3) and one in the Meckel cave. It is often difficult to differentiate the MR findings of these four tumors from other common neoplasms.

Spinal subarachnoid tumor seeding from intracranial metastasis: MR findings

We describe the magnetic resonance findings in two cases of spinal subarachnoid seeding from an intracranial metastatic lesion. Magnetic resonance imaging techniques using T1 and intermediate T1-T2 pulse sequences improve anatomical definition of the spinal cord-thecal sac and allow for optimal contrast to define metastatic deposits in the subarachnoid space. Heavily T2 weighted pulse sequences do not appear to be useful in the diagnosis of subarachnoid metastases.

Cerebral Ventriculitis: Mr Findings

Cerebral ventriculitis is an uncommon site and manifestation of infection of the central nervous system. We report the magnetic resonance findings in two patients with cytologic and CSF culture proof of ventriculitis. The findings included abnormal signal intensity of the ependyma and CSF on T2-weighted images. In addition, ependymal, meningeal, and dural enhancement was seen in one case, on T1-weighted images, after administration of Gd-diethylenetriamine pentaacetic acid.

Replacement lipomatosis of the kidney: CT features.

Replacement lipomatosis of the kidney is a severe loss of renal parenchyma with massive fat deposition associated with long-standing inflammation and calculi. We report two pathologically proven cases of total replacement lipomatosis and one partial replacement lipomatosis diagnosed by CT. The CT images demonstrated a large fat-attenuating mass with perirenal capsule surrounded by thick pararenal fascia, streaky densities in the mass, elongated collecting system, large calculi, and absence of renal parenchyma.

Evaluation of a PACS workstation for assessment of body CT studies.

Conventional hardcopy images from 266 body CT studies were compared with those provided at a commercially available picture archiving communication system (PACS) workstation. Unprocessed PACS images were larger but otherwise precisely duplicated hardcopy images. The PACS images were evaluated before and after application of various image processing/display features. Approximately three-quarters of the cases were depicted equally well with PACS and hardcopy, but in one quarter of the cases, diagnostic features were judged to be shown more clearly at the PACS workstation. When PACS images were viewed first, change in diagnosis after subsequent hardcopy inspection was infrequent (confidence change: 4%; different findings: 2%). Conversely, when hardcopy images were viewed first, change in diagnosis after subsequent PACS inspection was more frequent (confidence change: 19%; different findings: 8%). Specialized image manipulation available on PACS was critical for its performance. Review of cases with new findings discovered during the second inspection showed the majority of them to be clinically significant, true-positives discovered by PACS. We conclude that PACS is a useful modality for interpretation of body CT images.

Pulsatile lower limb venous Doppler flow: prevalence and value in cardiac disease diagnosis.

The purpose of this study was to assess the frequency and significance of pulsatile Doppler waveforms in lower limb veins. We used Doppler sonographic data from the common femoral vein. In the first of two groups, the findings in 250 patients were correlated with the presence of cardiac decompensation on concurrent chest radiographs. In the second group, the findings in 81 patients were correlated with the presence of tricuspid regurgitation on Doppler echocardiograms. A venous Doppler sonographic examination was considered normal if spontaneous anterograde phasic flow was present and pulsatile if flow had a cyclic retrograde component. In group 1, 21% had pulsatile waveforms whereas 24% had cardiac decompensation. In group 2, 36% had pulsatile waveforms and 43% had tricuspid regurgitation. A statistically significant correlation was found between the presence of these abnormal waveforms and cardiac decompensation or tricuspid regurgitation, with sensitivities of 57% and 54%, specificities of 91% and 78%, positive predictive values of 66% and 66%, negative predictive values of 87% and 69%, and accuracies of 82% and 68%, respectively. In a subgroup of 55 patients who had both tests for correlation and in whom both were in agreement, the sensitivity of venous Doppler sonographic examination for detecting pathologic cardiac conditions was 79%, specificity was 87%, positive predictive value was 83%, negative predictive value was 84%, and accuracy was 84%. In 77 patients with pulsatile waveforms, including 24 without concurrent chest radiographs or echocardiograms, 63 (82%) had no prior history of cardiac disease. When correlated separately with chest radiograph or Doppler echocardiography, the test is not very sensitive in the diagnosis of cardiac disease; however, when both correlating tests are performed and are in agreement, all diagnostic parameters of the venous Doppler sonographic test, including sensitivity, become fairly high. The presence of pulsatile lower limb venous Doppler flow should alert the sonologist that a pathologic cardiac condition may be the culprit, especially in patients who have no such prior diagnosis.

Trigeminal nerve lipoma: MR findings.

Trigeminal nerve lipomas are rare tumors that typically cause progressive focal neurologic symptoms due to their intimate involvement with nerve fascicles and adjacent neural structures. We describe the CT and magnetic resonance (MR) findings of this unusual tumor. The changes in signal intensity on T1 and T2 weighted MR scans provide precise anatomic location and tissue characterization prior to surgical intervention.