CT in malignancy grading and prognostic prediction of non-Hodgkin's lymphoma.

PURPOSE: The presence of tumor inhomogeneities in MR images of non-Hodgkin's lymphoma (NHL) provides information about malignancy grade and prognosis. The aim of this study was to determine whether CT images are also informative in these respects. MATERIAL AND METHODS: Sixty-three CT examinations in patients with NHL (32 high-grade and 31 low-grade tumors) were reviewed retrospectively by two senior radiologists. The tumor patterns were classified subjectively as homogeneous, slightly inhomogeneous or severely inhomogeneous and their relations to malignancy grade, clinical characteristics and prognosis were determined. RESULTS: Sixteen out of 17 patients with a severely inhomogeneous tumor pattern had high-grade NHL tumors while 21 out of 29 patients with a homogeneous tumor appearance had low-grade NHL tumors. Among chemotherapy-treated patients, those with the highest degree of inhomogeneity had a significantly worse prognosis (9 out of 11 patients died). This relationship was not found in patients treated with radiotherapy. CONCLUSION: A severely inhomogeneous tumor pattern on CT images was found to be associated with a high malignancy grade in NHL. This CT pattern was also compatible with a poor prognosis in patients treated with chemotherapy.

Ultrasound-guided biopsy of abdominal and pelvic lesions in children. A comparison between fine-needle aspiration and 1.2 mm-needle core biopsy.

BACKGROUND: Tissue diagnosis is mandatory prior to treatment of an abdominal or pelvic lesion in a child. OBJECTIVES: To compare the diagnostic yield and complications of fine-needle aspiration biopsy (FNAB) and 1.2-mm needle core biopsy (NCB) for abdominal and pelvic lesions in children using US guidance. MATERIAL AND METHODS: Ninety consecutive abdominal or pelvic US-guided biopsies in 61 children; 53 FNAB procedures in 43 children and 37 NCB procedures in 34 children were retrospectively analysed. Fifty-seven biopsies were performed on malignant lesions and 33 on benign lesions. In 15 children, both FNAB and NCB were performed at the same occasion. RESULTS: FNAB was diagnostic in 41 (77 %) of 53 biopsies while NCB provided a correct diagnosis in 35 (95 %) of 37 biopsies. Results were similar in both malignant and benign conditions. Clinically important bleeding complicated three biopsies (3.3 %); in two after FNAB and in one after combined FNAB and NCB. CONCLUSION: If FNAB were to be replaced with 1.2-mm NCB using an automatic gun, the diagnostic yield for abdominal and pelvic focal lesions in children would improve significantly (P < 0.05) while the complication rate would remain low. NCB may reduce the need for diagnostic and staging surgery and repeated procedures.

Yield and complications in percutaneous renal biopsy. A comparison between ultrasound-guided gun-biopsy and manual techniques in native and transplant kidneys.

PURPOSE: To compare the yield and complications of ultrasound-guided gun-biopsy and manual Tru-Cut techniques in percutaneous renal biopsy. MATERIAL AND METHODS: A total of 448 biopsies were reviewed. They comprised 124 manual and 131 gun-biopsies in native kidneys, and 111 manual and 82 gun-biopsies in transplant kidneys. The gun-biopsies were performed under real-time ultrasound (US) guidance. The manual technique used US mainly for marking the position of the kidney. RESULTS: There was a significantly higher diagnostic yield and fewer complications in the gun-biopsy group. A total of 8 major complications were found, all in the manual group. CONCLUSION: Provided that the operator is experienced in US scanning, a switch from the manual technique to real-time US-guided gun-biopsy will result in the improvement of diagnostic accuracy together with a reduced risk of complications.

Tumour inhomogeneities on magnetic resonance imaging, a new factor with prognostic information in non-Hodgkin's lymphomas.

The prognostic importance of inhomogeneities on magnetic resonance imaging (MRI) in non-Hodgkin lymphomas (NHL) was evaluated. Forty-six consecutive patients with high-grade NHL were examined and, for comparison purposes, 13 patients with low-grade NHL. The degree of inhomogeneity was measured with a quantitative method (IH8) and a subjective evaluation was also performed. Patients with localized disease (stage I), who had all been treated with radiotherapy, had an excellent prognosis, which was independent of the degree of tumour inhomogeneity. In generalized NHL (stages II-IV) treated with chemotherapy, IH8 provided prognostic information in high-grade NHL. Patients with pronounced tumour inhomogeneity, in particular, had a very poor prognosis. The prognostic impact was also seen if the analyses were performed with high-grade and low-grade NHLs grouped together. The inhomogeneities may indicate a mechanism related to treatment failure after chemotherapy, but not after fractionated radiotherapy.

Imaging of tuberculosis--experience from 503 patients. I. Tuberculosis of the chest.

PURPOSE: To give an overview of 503 patients with tuberculosis (TB) and to describe the radiologic findings of chest TB. MATERIAL AND METHODS: A total of 503 patients with proven TB were reviewed; 266 had chest involvement. RESULTS: Lung lesions were demonstrated in 214 patients. Infiltrates in the basal parts of the lungs or pleural effusion were often primarily mistaken for viral or bacterial infections. Consolidations within the lungs and pleural thickening were sometimes indistinguishable from malignancy. Positive culture of the sputum without lung lesions was encountered in 12 cases. Enlarged mediastinal lymph nodes were demonstrated in 67 cases, 35 without lesions in the lungs. The lymphadenopathy could be extensive, and both clinically and radiologically indistinguishable from lymphoma. CONCLUSION: Due to the present increase in incidence of TB and the fact that TB can mimic many other conditions, it is important that both clinicians and radiologists have TB high on the list for differential diagnoses.

Imaging of tuberculosis. IV. Spinal manifestations in 63 patients.

PURPOSE: To describe the radiologic findings in patients with spinal tuberculosis (TB). MATERIAL AND METHODS: Out of a total of 503 patients with TB, 63 (13%) had involvement of the spine. RESULTS: In 40 patients, the spine was the only location; 20 patients had concomitant chest TB. Conventional radiographs gave a good overview, CT visualized the disko-vertebral lesions and the paravertebral abscesses, while MR imaging was useful to determine the spread of disease to the soft tissues and the spinal canal. The typical findings were destroyed vertebrae with associated paraspinal soft-tissue mass, with or without abscess formation, sometimes also involving the epidural space together with adjoining disk lesion and focal gibbus formation. Involvement of a single vertebra was a relatively common finding. Large psoas abscesses could occur without any signs of bone involvement. The TB process could sometimes be indistinguishable from malignant processes, and in 3 patients, with multiple lesions in the spine, it mimicked metastatic disease. CONCLUSION: It is stressed that TB should always be considered in the differential diagnosis when radiologic findings suggest spinal infections or primary or secondary spinal tumors.

Imaging of tuberculosis. V. Peripheral osteoarticular and soft-tissue tuberculosis.

PURPOSE: To assess frequency, location, and appearance of peripheral osteoarticular and soft-tissue tuberculosis (TB). MATERIAL AND METHODS: Twenty-five of 503 patients with TB had peripheral osteoarticular TB and 5 had soft-tissue TB. Chest radiography, CT, and MR imaging were applied. RESULTS: The location of the osteoarticular lesion was articular/epiphyseal in 14 patients, articular/metaphyseal in 3, and metaphyseal without joint involvement in 3. Involvement of flat bone was found in 4 patients (5 lesions). The morphologic appearance was similar to that of a lytic tumour in 9 patients (10 lesions) and that of a destructive joint lesion in 16 patients. The soft-tissue TB in all 5 patients presented as an abscess. Twelve patients had a total of 20 additional sites of involvement: chest in 9, abdomen in 4, spine in 4, the neck in 3, and the central nervous system in one patient. CONCLUSION: On the basis of radiologic appearance, it can be difficult to differentiate peripheral osteoarticular and soft-tissue TB from other degenerative, inflammatory, or neoplastic disorders, and the importance of a high awareness is stressed in order to reach an early diagnosis.

Yield and complications in ultrasound-guided biopsy of abdominal lesions. Comparison of fine-needle aspiration biopsy and 1.2-mm needle core biopsy using an automated biopsy gun.

A series of 458 consecutive ultrasound-guided biopsies in 347 patients-171 fine-needle aspiration biopsies (FNABs) and 287 1.2-mm needle core biopsies (NCBs)-was analysed for diagnostic yield and complications. FNAB was diagnostic in 107 (64%) biopsies of focal lesions with a correct diagnosis of malignancy in 86 of 125 biopsies (69%) and of benign disease in 21 of 43 (49%) biopsies. NCB provided a correct diagnosis in 189 (90%) biopsies for focal lesions, divided into 140 of 159 (88%) correct for malignancy and 49 of 50 (98%) correct for benign disease. In 69 patients examined with both FNAB and NCB on the same occasion, 50 out of 55 malignant lesions were identified with NCB but only 34 with FNAB; all 14 benign lesions were correctly identified by NCB, and only 6 by FNAB. Clinical relevant bleeding complications occurred in 6 out of 458 biopsies (1.3%)-3 out of 287 following NCB (1.0%) and 3 out of 171 following FNAB (1.8%). It is concluded that if FNAB is replaced with 1.2-mm NCB using an automated biopsy gun, the diagnostic accuracy for abdominal lesions increases significantly (p < 0.001), while the complication rate remains the same.

Left internal mammary artery flap aortoplasty.

In 14 consecutive 9- to 18-year-old patients with preductal aortic coarctation and isthmic hypoplasia, we resected the coarctation ridge through a longitudinal aortotomy and widened the aorta with an in situ left internal mammary artery flap. This technique resulted in no surgical complications. At 6-month follow-up examination, the average decrease in systolic pressure across the repair was 8.8 mmHg; all patients showed a clear reduction in arterial hypertension at rest and during exercise. Femoral pulses were easily palpable in all cases. Angiography and magnetic resonance imaging showed no aneurysm formation. The narrowest internal diameter of repair was 88% +/- 12% (mean +/- SD) of the diameter of the aortic arch. The internal mammary artery flap technique, which reflects the basic principle of autogenous arterial grafting in situ, allows appropriate circumferential widening of the aorta in many patients with coarctation and hypoplasia of the aortic isthmus involving delayed repair. This procedure should be considered when the internal mammary artery is of good caliber and quality and the anatomic conditions are not ideal for classic end-to-end anastomotic repair.

Non-Hodgkin lymphoma: predicting prognostic grade with MR imaging.

Fifty patients with non-Hodgkin lymphoma (NHL) were examined with magnetic resonance (MR) imaging in order to analyze whether it is possible to distinguish in vivo between the two major prognostic groups, low-grade NHL and high-grade NHL. Most high-grade NHL nodes (15 of 24 [63%]) had an inhomogeneous appearance at MR imaging, in contrast to low-grade NHL nodes, which were homogeneous in almost all patients (18 of 20 [90%]) (P less than .001). A homogeneous image was also found in six patients who had previously received a diagnosis of low-grade NHL; at the time of examination their lesions had transformed into high-grade NHL. Necrosis, detectable in the histopathologic sections, was usually (five of six cases) associated with an inhomogeneous image. However, the images were also inhomogeneous [corrected] in 12 of 44 cases (27%) in which there were no signs of necrosis in the histopathologic sections. Patients with high-grade NHL and a homogeneous signal intensity pattern tended to have a better survival rate than those with an inhomogeneous pattern.

Residual mediastinal masses in Hodgkin disease: prediction of size with MR imaging.

Eighteen patients with mediastinal involvement of Hodgkin disease were examined with magnetic resonance (MR) imaging before and during therapy to find out if size of residual masses could be predicted from the MR characteristics of the tumor at diagnosis. After the first treatment, a significant decrease in T2 values and signal intensity ratios of tumor to fat and tumor to muscle was found in all patients. There was no significant change in T1 values. The relative decrease in tumor size correlated well with signal intensity ratios and poorly with T2 values of the original tumor. No correlation with T1 values was found. The authors conclude that size of the residual mass can be predicted from the initial size of the tumor and the signal intensity ratios at diagnosis. Since the degree of low signal intensity in the tumor before treatment probably reflects the amount of fibrotic tissue, these results support the hypothesis that residual masses after treatment are remnants of the fibrotic stroma of the original tumor.