The prevalence and morphometric features of mastoid emissary vein on multidetector computed tomography.

BACKGROUND: The aim of the study was to evaluate the prevalence and morphometric features of mastoid emissary vein (MEV) on multidetector computed tomography (MDCT) scans, emphasize its clinical significance and review its surgical implications. MATERIALS AND METHODS: Cranial and temporal bone MDCTs of 248 patients (496 sides) were analysed by 2 radiologists. Mastoid foramen (MF) was defined on the 3 dimensional volume rendered (3DVR) images. The MF and mastoid emissary canal (MEC) were investigated in axial thin slices and the diameters of the largest MF and MEC were measured. Mean diameters of MF and MEC were determined. The number of the mastoid foramina was noted. Differences in MF prevalence by sex and side were evaluated. RESULTS: The overall prevalence of MEC was 92.3%. It was observed in 91.5% of women and 93.3% of men. MEC was present on the right side in 84.7% and on the left side in 82.3% of temporal bones. The mean diameter of MF was 1.92 ± ± 1.02 mm on the right and 1.84 ± 0.98 mm on the left. In both sides the number of the MF's changed from absent to triple. The mean diameter of MEC was 1.58 ± 0.86 mm on the right and 1.48 ± 0.79 mm on the left side. The mean diameter of MEC was significantly larger in men. No significant correlation was detected between age and the MEC diameter. CONCLUSIONS: The preoperative detection of mastoid emissary veins is necessary. The radiologists should be familiar with their clinical significance and variant appearances and report them accurately. Knowledge of their morphology and surgical implications by the surgeons will make them aware to avoid unexpected and fatal complications while operating in the suboccipital and mastoid area. MDCT is a reliable diagnostic tool for imaging the MEC and MF.

The anterior extraperitoneal approach to the rare presacral/ retroperitoneal schwannoma.

Presacral/retroperitoneal schwannomas are extremely unusual and their surgical approach is challenging. Various surgical approaches have been proposed. Here we describe our experience with the anterior extraperitoneal approach for the Type 3 presacral/retroperitoneal schwannoma. A 33-year-old woman presented with a history of infertility and a presacral/retroperitoneal mass. The patient underwent abdominal/pelvic CT and MRI that demonstrated presence of a solid, well circumscribed Type 3 presacral/retroperitoneal schwannoma. The anterior extraperitoneal approach was successfully used to remove the presacral/retroperitoneal schwannoma. The histopathological evaluation confirmed the preoperative diagnosis. The anterior extraperitoneal approach is helpful as an alternative approach in the surgical management of benign Type 3 presacral/retroperitoneal schwannomas (Fig. 4, Ref. 15).

Stent implantation in chronic mesenteric ischemia.

BACKGROUND: Chronic mesenteric ischemia (CMI) is a life-threatening disorder, which is usually associated with stenosis or occlusion of celiac or mesenteric arteries. PURPOSE: To review our experience and to assess short-term results of stent placement in stenotic mesenteric arteries. MATERIAL AND METHODS: Primary stent placement was performed in 15 patients who had nausea, vomiting, postprandial pain, and weight loss due to steno-occlusive diseases of mesenteric arteries. After stenting, the patients were followed clinically and with Doppler ultrasound at 1, 6, and 12 months. Symptomatic patients with restenosis were examined with digital subtraction angiography and were referred for retreatment with balloon dilatation. RESULTS: Twenty-three stenoses and 11 occlusions were detected in 15 patients, and 18 stenoses were treated with primary stenting. Single-vessel endovascular treatment was performed in 12 patients. In three patients, two arteries were stented in the same session. Technical success rate was 18/18 (100%). Clinical success was achieved in 13/15 (86.6%) patients. First-month mortality was 13%. During the mean 16.1-month follow-up period, restenoses developed in three patients. One of them was successfully treated with balloon angioplasty. Primary patency was 9/11 (81%) and primary assisted patency was 81% at 12 months. The complication rate was 1/15 patients (0.06%). CONCLUSION: Our experience suggests that stent placement has a potential role in chronic mesenteric ischemia with low incidence of complications and high technical and clinical success rates.

Horner's syndrome from giant schwannoma of the cervical sympathetic chain: case report.

OBJECTIVES: Nerve sheath tumours are uncommon lesions in adults. Schwannomas originating from the cervical sympathetic chain are a rare subgroup of nerve sheath tumours. Moreover, the existence of Horner's Syndrome before surgery is uncommon, with only five cases reported in the literature. Here we review the presentation, imaging characteristics, and operative considerations of a patient with a large cervical sympathetic chain schwannoma, presenting with Horner's Syndrome. A 60-year-old woman with a left upper eyelid ptosis presented to our outpatient department complaining of a painless left-sided neck mass. RESULTS: Histopathologic examination of excised mass, which was nearly 9.0 cm x 7.0 cm x 6.0 cm, revealed a benign schwannoma. CONCLUSION: When dealing with cervical masses, schwannoma should be considered in the differential diagnosis, especially when some neurological symptoms exist.

Hepatocellular carcinoma in liver transplant era: a clinicopathologic analysis.

Hepatocellular carcinoma (HCC) is one of the most common tumors in the world, and the prognosis is usually poor. Today, liver transplantation (LT) is a radical but frequently curative treatment modality for HCC. In selected patients, it cures HCC and the underlying cirrhosis at the same time. The present clinicopathological study examined the importance of tumor characteristics for their effects on recurrence and survival rates after LT for HCC. Forty-two native hepatectomy specimens among 250 consecutive orthotopic liver transplantations contained HCC. Patients were predominantly men (30 men, 12 women), ranging in age from 1 to 61 years (median 51). While 20 patients received cadaveric organs, 22 were transplanted from living donors. In 14 patients (33%) HCC presented as a solitary nodule, 5 (12%) as two nodules; 2 (5%) as three nodules; and 21 patients (50%) as more than three nodules. The maximal diameter of the largest tumor not larger than 3 cm in 28 patients (66%), exceeding this size in 14 patients (34%). There was a significant correlation between nodule number and tumor size (r = 0.36, P = 0.05). While 23 patients had no sign of vascular involvement, 17 tumors showed microscopic invasion and two large vessel involvement. There was a positive correlation between vascular invasion and nodule number (r = 0.41, P = 0.05). The histopathological grade of differentiation of the tumors was assessed as "well" in seven patients (14%), moderate in 28 (72%), and poor in 7 (14%). The differentiation was significantly poorer when vascular invasion was observed (r = 0.43, P =.01). According to the TNM classification, 11 patients (26%) were stage I, 6 (14%) stage II, 13 (31%) stage III, and 12 (29%) stage IV. After a median follow-up of 10 months (1-50 months), the overall mortality was 18% (n = 8). Patient survival at 6 month, 1, and 4 years was 88%, 80%, and 60%, respectively. The outcome was significantly poorer for TNM stage IV versus stage I,II, and III tumors to (P =.02). Tumor recurred in three patients at 4,6, and 50 months after liver transplantation. The sites of recurrence were bone, lung, and adrenal glands. In conclusion, liver transplantation represents a safe and feasible treatment for hepatocellular carcinoma with excellent outcomes compared with other treatment modalities. Liver transplantation offers excellent survival rates and chance for cure in stages I, II, and III hepatocellular carcinoma in cirrhotic patients.

MR imaging of fetal abnormalities.

Our purpose was to evaluate the capability of ultrafast single-shot fast spin-echo MR imaging to assess normal fetal anatomy and abnormalities of different fetal organ systems. Fetal MR imaging was performed prospectively in consecutive 40 pregnant women because of abnormal findings or suspected fetal abnormalities on prenatal US. No statistically significant difference between US and MR imaging was found for the detection of abnormality in any organ system. MR imaging was slightly superior to US with regard to cerebral abnormalities only. In four (10%) of 40 fetuses, additional information provided by MR imaging altered counseling. However, MR imaging of the extremities-face and soft tissues was limited because of the lack of real-time information.

MR imaging of pachydermoperiostosis.

A case of pachydermoperiostosis who demonstrated the whole syndrome (pachyderma, periostitis, and cutis verticis gyrata) is presented, and the Magnetic Resonance Imaging (MRI) appearances of the long bone and scalp changes are demonstrated. MRI of the cruris demonstrated fluffy periosteal new bone formation that encroached on the medullary cavity as well as expansion of the diaphysis. Cranial changes included thickening of the diploe associated with diminished signal of the intradiploic fat, and thickening of the scalp with furrowing.

Transrectal ultrasound in detecting prostate cancer compared with serum total prostate-specific antigen levels.

We carried out a retrospective study to review the efficiency of grey-scale transrectal ultrasonography (TRUS) in detecting prostate cancer compared with the data in recent published work, including alternative imaging methods of the prostate gland. Our study group consisted of 830 patients who underwent TRUS-guided biopsy of the prostate between May 2000 and June 2004. The relation between abnormal TRUS findings and serum total prostate-specific antigen (tPSA) levels was evaluated in patients with prostate cancer who were divided into three different groups according to serum tPSA levels. Group I included patients with tPSA levels of 4-9.9 ng/mL, group II included tPSA levels of 10-19.9 ng/mL and group III included patients with tPSA levels of 20 ng/mL or more. In general, TRUS detected 185 (64%) of 291 cancers with a specificity of 89%, a PPV of 76% and an accuracy of 80%. TRUS findings enabled the correct identification of 22 (56%) of the 39 cancers in group I, 28 (30%) of the 93 cancers in group II and 135 (85%) of the 159 cancers in group III. In conclusion, TRUS alone has a limited potential to identify prostate cancer, especially in patients with tPSA levels lower than 20 ng/mL. Therefore, increased numbers of systematically placed biopsy cores must be taken or alternative imaging methods are required to direct TRUS-guided biopsy for improving prostate cancer detection.

Power Doppler US patterns of vascularity and spectral Doppler US parameters in predicting malignancy in thyroid nodules.

AIM: The purpose of this study was to determine whether spectral Doppler ultrasound (US) parameters, including resistive index (RI) and maximal systolic velocity (MSV), or vascular pattern can be used to distinguish malignant from benign thyroid nodules. MATERIALS AND METHODS: We prospectively examined 169 thyroid nodules in 134 patients undergoing sonographically guided fine-needle aspiration biopsy (FNAB). Vascularity as determined by power Doppler US imaging was defined as absent, perinodular alone, or intranodular. For each nodule, the RI and MSV values were recorded as the average of the recordings obtained. Results of the FNAB and surgical pathological examination, if available, were used as a proof of final diagnosis to categorize all nodules as benign or malignant. RESULTS: Seven nodules were excluded from study because of non-diagnostic FNAB results due to hypocellular or insufficient cytological material. Of the remaining nodules, nine were malignant (all confirmed at surgery) and 153 were benign. Of the 145 nodules with intranodular vascularity, nine (6.2%) were malignant and the remaining 136 (93.8%) were benign. The malignant nodules had a mean RI of 0.60 on intranodular and 0.58 on perinodular arteries. These values were not significantly higher than those associated with benign nodules (RI=0.57 and RI=0.56, respectively). Malignant nodules had a mean MSV of 20.4cm/s on intranodular and 35.3cm/s on perinodular arteries that were also not significantly different from those associated with benign nodules (p>0.05). CONCLUSION: The results of this study indicate that Doppler US characteristics including vascular pattern, RI and MSV are not useful parameters for distinguishing malignant from benign thyroid nodules. Therefore, Doppler US characteristics including vascular pattern, RI and MSV values of thyroid nodules can not be used as a diagnostic method to determine which nodules should undergo FNAB.

The potential value of power Doppler ultrasound imaging compared with grey-scale ultrasound findings in the diagnosis of local recurrence after radical prostatectomy.

AIM: To determine the value of power Doppler ultrasound (PDUS) imaging during transrectal ultrasonography (TRUS) in detecting local recurrence after radical retropubic prostatectomy (RRP). MATERIALS AND METHODS: Eighteen patients were evaluated in whom local recurrence of prostate cancer was suspected on the basis of elevated serum prostate-specific antigen (PSA) levels (above 0.4 ng/ml) after RRP with no evidence of metastatic disease. Grey-scale TRUS and PDUS-guided biopsies of the vesicourethral anastomosis (VUA) and perianastomotic soft tissues were obtained after TRUS examinations of the prostatic fossa. The ability to detect locally recurrent prostate cancer using grey-scale TRUS alone was compared with TRUS combined with PDUS. RESULTS: Fifteen of the 18 patients (83%) had positive biopsies for local recurrent tumour at histological examination. TRUS alone detected grey-scale abnormalities in 15 of 18 patients (83%), of whom 14 (77%) had positive TRUS-guided biopsies. PDUS during TRUS showed hypervascularity in 14 of 18 patients (77%). Biopsies of these hypervascular regions were positive in all patients (100%). The sensitivity and specificity of TRUS alone in detecting recurrent tumour were 93 and 67%, respectively, with a positive predictive value (PPV) of 93% and a negative predictive value (NPV) of 67%. TRUS combined with PDUS had a sensitivity and specificity of 93 and 100%, respectively, with a PPV and a NPV of 100 and 75%, respectively.

Unusually large cisterna chyli: US and MRI findings.

We report a rare appearance of cisterna chyli appearing as a giant cystic structure on routine abdominal ultrasonography (US). Diagnosis was established with color Doppler US and after magnetic resonance imaging. This report describes an unusual appearance of the cisterna chyli that radiologists should be familiar with, especially on the routine conventional gray-scale US to avoid mistaking it for a pathologic condition.

An unusual cause of mediastinal widening: bilateral innominate vein aneurysms.

We present a case of aneurysm of bilateral innominate veins and vena cava superior. Chest X-ray, computed tomography, and 3D contrast enhanced magnetic resonance angiography findings are described. The etiology of venous aneurysms is reviewed and clinical management options are discussed.

Mesenteric Castleman's disease: case report.

An asymptomatic case of hyaline vascular-type Castleman's disease localized to the mesentery and detected incidentally by ultrasound is presented. Computed tomographic, angiographic, and histologic findings are reported. This type of Castleman's disease predominates in the thorax and is very rare in the mesentery.

Aneurysmal bone cyst secondary to infantile cartilaginous hamartoma of rib.

We report the first case, in a 4-month-old girl, of an aneurysmal bone cyst secondary to infantile cartilaginous hamartoma of the rib. Infantile cartilaginous hamartoma of the rib (benign mesenchymoma) is a large, expansile tumour that is characterised by cartilaginous, vascular and primitive-appearing stromal and mesenchymal elements. Most cases are diagnosed at less than 1 year of age and may even be congenital. Aneurysmal bone cyst may be a secondary lesion to pre-existing tumours such as giant cell tumours, osteoblastomas, angiomas and chondroblastomas. This unique case is presented with radiological and pathological findings.

Carotid steal: report of ten cases.

The blood flow may be diverted from the external to the internal carotid artery via the carotid bulb in the absence of flow in the common carotid artery. We aimed to investigate the prevalence, hemodynamics, and clinical features of this condition. Reviewing the records of color duplex ultrasonographic examinations, we found carotid steal in 12 carotid arteries of 10 patients. In three patients flow in the ipsilateral external carotid artery was bidirectional. The steal had been demonstrated angiographically in six patients. The cause of the phenomenon was atherosclerosis, Takayasu arteritis, or trauma. Awareness of this pathway of collateral circulation may contribute to diagnostic work-up and expand management alternatives.