Wei Jun Peng

Imaging findings of Castleman disease of the abdomen and pelvis.

BackgroundThe purpose of this study was to analyze the characteristic features of Castleman disease in the abdomen and pelvis as suggested by imaging findings in order to deepen the recognition and understanding of this rare disease.MethodsA group of ten patients with pathologically proven Castleman disease in the abdomen (nxa0=xa09) and pelvis (nxa0=xa01) were included in this study. Patients were 18∼56-year-old (meanxa0=xa040); seven of them were men and three were women. Imaging findings (CT&MRI, nxa0=xa04; only CT, nxa0=xa04; only MRI, nxa0=xa02) were retrospectively reviewed and correlated with clinical and pathologic findings.ResultsThe lesions were divided into those with localized Castleman (nxa0=xa09) and disseminated Castleman (nxa0=xa01). The pathologic subtype of all nine cases of localized disease was hyaline vascular with six patients showing a solitary mass and three having a single dominant mass surrounded by small satellite nodules. On nonenhanced CT images, the lesions were manifested as homogeneous masses of soft tissue attenuation, which was isoattenuated relative to normal muscle. On MRI, the lesions were isointense or slightly hypointense compared with that of normal muscle on T1-weighted images and hyperintense on T2-weighted images. After intravenous injection of contrast media, most of the masses (7/9) showed marked enhancement and slow washout with the degree of enhancement approaching that of the large arteries. And in the interior of four cases of larger masses (>5xa0cm) was observed fissured and radial patterns in both low-density area on CT and low-signal area on MRI. These patterns were pathologically proved to be fibrous. The pathological subtype of a sole disseminated case was plasma-cell type, where imaging findings showed a lining of well defined, sharply enhanced soft-tissue nodules in retroperitoneal zone.ConclusionImaging findings of Castleman disease in the abdomen and pelvis are closely related to pathological type diagnosed. The characteristic features of localized and hyaline vascular type of Castleman disease include a solitary mass or a dominant mass surrounded with small satellite nodules, and high enhancement and slow washout with the degree of enhancement approaches that of large arteries. The presence of central areas of fibrosis of the larger tumors is one of the characteristic features of this disease.

In vivo detection of metabolic changes by 1 H-MRS in the DEN-induced hepatocellular carcinoma in wistar rat

Purpose: To investigate the serial changes of the hepatic metabolites in a chemical-induced rat model of hepatocellular carcinoma (HCC) in vivo by a clinical 1.5 T MR scanner. Methods: Diethyl nitrosamine (DEN) induced HCC model rats (n=60) and control rats (n=20) were included. From week 7 to week 20 after DEN administration, every other week 10–12 animals (8–9 treated and 2–3 controls) were randomly scanned before being sacrificed. According to the pathologic changes, the whole process of tumorigenesis was divided into early and late periods (week 7–13 and week 14–20, respectively). The serial hepatic changes were tested by both routine MRI and single voxel 1H-MRS and compared with pathological results. Point resolved spectroscopy sequence (PRESS) was used for the location in MRS. The integrations of lipid- and choline-containing metabolites were calculated and analyzed. Results: All of the listed tests were fully finished in 66 rats (48 treated and 18 controls). Of the MRS curves, 65.2% (43/66) could be analyzed (mainly with resistant baseline with peaks appearing at right positions). From those qualified MRS curves, there were up to seven peaks which could be identified. The peaks of methylene lipids and methyl lipids were combined together in most cases and became the most notable component. The relative integrals of the combined lipid peak and that of the choline-containing compounds in different groups and stages were measured. Comparing with that of the controls of the same stage, the lipid of treated rats decreased in the late stage, and the choline-containing compounds increased in the same stage. Statistically significant differences were found (P<0.05) for the integrals of the lipid and the choline-containing metabolites between treated and controls in the late stage. Conclusions: Our initial studies for the integrals of the lipid compounds and the choline-containing metabolites might be useful for a better understanding of the metabolic activity of this DEN-induced rat HCC model.

Imaging diagnosis of colorectal liver metastases

Rapid advances in imaging technology have improved the detection, characterization and staging of colorectal liver metastases. Multi-modality imaging approach is usually the more useful in diagnosis colorectal liver metastases. It is well established that hepatic resection improves the long-term prognosis of many patients with liver metastases. However, incomplete resection does not prolong survival, so knowledge of the exact extent of intra-hepatic disease is crucially important in determining patient management and outcome. The diagnosis of liver metastases relies first and totally on imaging to decide which patients may be surgical candidates. This review will discuss the imaging options and their appropriate indications. Imaging and evaluating of colorectal liver metastases (CRLM) have been performed with contrast-enhanced ultrasound, multi-detector computed tomography, magnetic resonance imaging (MRI) with extra-cellular contrast media and liver-specific contrast media MRI, and positron emission tomography/computed tomography. This review will concentrate on the imaging approach of CRLM, and also discuss certain characteristics of some liver lesions. We aim to highlight the advantages of each imaging technique, as well as underscoring potential pitfalls and limitations.

Comparison of total splenic artery embolization and partial splenic embolization for hypersplenism.

AIMnTo evaluate whether total splenic artery embolization (TSAE) for patients with hypersplenism delivers better long-term outcomes than partial splenic embolization (PSE).nnnMETHODSnSixty-one patients with hypersplenism eligible for TSAE (n = 27, group A) or PSE (n = 34, group B) were enrolled into the trial, which included clinical and computed tomography follow-up. Data on technical success, length of hospital stay, white blood cell (WBC) and platelet (PLT) counts, splenic volume and complications were collected at 2 wk, 6 mo, and 1, 2, 3, 4 years postoperatively.nnnRESULTSnBoth TSAE and PSE were technically successful in all patients. Complications were significantly fewer (P = 0.001), and hospital stay significantly shorter (P = 0.007), in group A than in group B. Post-procedure WBC and PLT counts in group A were significantly higher than those in group B from 6 mo to 4 years (P = 0.001), and post-procedure residual splenic volume in group A was significantly less than that observed in group B at 1, 2, 3 and 4 years post-procedure (P = 0.001). No significant differences were observed in red blood cell counts and liver function parameters between the two groups following the procedure.nnnCONCLUSIONnOur results indicate that TSAE for patients with hypersplenism not only delivers a better long-term outcome, but is also associated with lower complication rates and a shorter hospital stay than PSE.

Total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism

AIMnTo study the safety and feasibility of total embolization of the main splenic artery as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.nnnMETHODSnFifteen consecutive patients with hypersplenism due to cirrhosis were enrolled in this study from January 2006 to June 2010. All patients underwent total embolization of the main splenic artery. Clinical symptoms, white blood cell (WBC) and platelet (PLT) counts, splenic volume, and complications of the patients were recorded. The patients were followed up for 1 and 6 mo, and 1, 2, 3 years, respectively, after operation.nnnRESULTSnTotal embolization of the main splenic artery was technically successful in all patients. Minor complications occurred in 13 patients after the procedure, but no major complications were found. The WBC and PLT counts were significantly higher and the residual splenic volume was significantly lower 1 and 6 mo, and 1, 2, 3 years after the procedure than before the procedure (P < 0.01). Moreover, the residual splenic volume increased very slowly with the time after embolization. All patients were alive during the follow-up period.nnnCONCLUSIONnTotal embolization of the main splenic artery is a safe and feasible procedure and may serve as a supplemental treatment modality for hypersplenism with thrombocytopenia or leukocytopenia accompanying liver cirrhosis.

Metabonomic studies of pancreatic cancer response to radiotherapy in a mouse xenograft model using magnetic resonance spectroscopy and principal components analysis.

AIMnTo investigate the metabolic profiles of xenograft pancreatic cancer before and after radiotherapy by high-resolution magic angle spinning proton magnetic resonance spectroscopy (HRMAS (1)H NMR) combined with principal components analysis (PCA) and evaluate the radiotherapeutic effect.nnnMETHODSnThe nude mouse xenograft model of human pancreatic cancer was established by injecting human pancreatic cancer cell SW1990 subcutaneously into the nude mice. When the tumors volume reached 800 mm(3), the mice received various radiation doses. Two weeks later, tumor tissue sections were prepared for running the NMR measurements. (1)H NMR and PCA were used to determine the changes in the metabolic profiles of tumor tissues after radiotherapy. Metabolic profiles of normal pancreas, pancreatic tumor tissues, and radiation- treated pancreatic tumor tissues were compared.nnnRESULTSnCompared with (1)H NMR spectra of the normal nude mouse pancreas, the levels of choline, taurine, alanine, isoleucine, leucine, valine, lactate, and glutamic acid of the pancreatic cancer group were increased, whereas an opposite trend for phosphocholine, glycerophosphocholine, and betaine was observed. The ratio of phosphocholine to creatine, and glycerophosphocholine to creatine showed noticeable decrease in the pancreatic cancer group. After further evaluation of the tissue metabolic profile after treatment with three different radiation doses, no significant change in metabolites was observed in the (1)H NMR spectra, while the inhibition of tumor growth was in proportion to the radiation doses. However, PCA results showed that the levels of choline and betaine were decreased with the increased radiation dose, and conversely, the level of acetic acid was dramatically increased.nnnCONCLUSIONnThe combined methods were demonstrated to have the potential for allowing early diagnosis and assessment of pancreatic cancer response to radiotherapy.

Mammographic, magnetic resonance imaging and clinicopathological characteristics of primary breast lymphoma

OBJECTIVEnTo analyze the mammographic, MRI, and clinicopathological characteristics of primary breast lymphoma (PBL).nnnMETHODSnClinicopathological characteristics were retrospectively reviewed and analyzed in 32 patients with histopathologically proven PBL. All cases were female (mean age, 50 years; median age 46 years; range, 30-68 years).nnnRESULTSnIn the 32 cases, there were bilateral tumors in 5 cases and 27 cases of unilateral involvement. The patients presented with a painless mass in 25 cases and with pain in 7 cases. Rapid enlargement was observed in 6 cases. Mammograms of 17 tumors showed a round, circumscribed mass with high density or iso-density in 9, asymmetry in 7 and no abnormality was found in one. 37 lesions were detected on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in 29 patients, among which 25 (67.6%) lesions appeared as enhancing masses and 12 (32.4%) lesions as non-mass enhancements. All lesions showed iso- or hypo-intense signal on the T1WI and hyper-intense signal on the T2W1. Analysis of the enhancing masses based on the 2013 ACR BI-RADS lexicon revealed that among the mass descriptors in 25 lesions, the most common features were circumscribed or irregular margin in 24 (96.0%) and homogeneous internal pattern in 19 (76.0%). Of the 12 non-mass enhancing lesions, the most common descriptors included regional or multiple regional distribution in 6 (50.0%), and heterogeneous internal pattern in 8 (66.7%). The tumors showed early enhancement with penetrating vessels on DCE-MRI in 16 lesions, associated with skin thickening in 14, and axillary lymphadenopathy in 19. The time-signal intensity curve (TIC) in 14 patients was mainly of type Ⅲ (7/14, 50.0%).nnnCONCLUSIONSnSome imaging features may alert the diagnosis of primary breast lymphoma, but final diagnosis depends on histopathology. Early diagnosis is helpful for selecting appropriate treatment regimens.

Neuroendocrine carcinoma of the breast: Mammography features correlated with sonography and histopathological findings

OBJECTIVEnThe purpose of this study was to describe the X-ray features of the neuroendocrine carcinoma (NEC) of breast to raise the awareness for the disease.nnnMETHODSnThe mammography, sonography and clinicopathologic features in a total of 16 cases of pathologically proven breast neuroendocrine carcinoma in Fudan University Cancer Hospital were analyzed retrospectively.nnnRESULTSnAll the 16 patients were women with a mean age of 67.3 years old (ranged from 45 to 75 years old). Twelve patients had palpable masses and the other four patients had outflow from the nipple. Pathological diagnosis included endocrine ductal carcinoma in situ (E-DCIS) in 4 cases, E-DCIS with microinvasion in 5, and invasive solid neuroendocrine carcinoma in 7. On mammography, 9 of 16 cases exhibited round or slightly lobulated masses. Five of the 16 cases exhibited irregular or asymmetric opacities. Two of the 16 cases had negative findings. The borders of the 14 masses detected on mammography were vague in 7, partly unclear in 3 and clear-cut in 4 cases. Malignant microcalcification was not found in all cases. The accuracy rates of preoperative qualitative diagnosis for NEC with mammography and sonography were 68.8% (11/16) and 81.3% (13/16), respectively. Given the application of combined mammography and sonography, the accuracy rates could be improved to 87.5% (14/16).nnnCONCLUSIONSnA round mass and irregular or asymmetric opacities without malignant calcification are the most frequent appearances of mammography in neuroendocrine carcinoma of the breast. Combination of mammography and sonography may be useful to improve the accuracy of diagnosis and early detection of neuroendocrine carcinoma of the breast.