Hepatocellular carcinoma: State of the art diagnostic imaging.

Primary liver cancer is the fourth most common malignancy worldwide, with hepatocellular carcinoma (HCC) comprising up to 90% of cases. Imaging is a staple for surveillance and diagnostic criteria for HCC in current guidelines. Because early diagnosis can impact treatment approaches, utilizing new imaging methods and protocols to aid in differentiation and tumor grading provides a unique opportunity to drastically impact patient prognosis. Within this review manuscript, we provide an overview of imaging modalities used to screen and evaluate HCC. We also briefly discuss emerging uses of new imaging techniques that offer the potential for improving current paradigms for HCC characterization, management, and treatment monitoring.

Multisystem imaging review of human schistosomiasis: characteristic imaging findings.

Human schistosomiasis is one of the major tropical/subtropical parasitic diseases with significant morbidity and mortality. Although, the majority of the cases are seen within the endemic region, upsurge in recent immigration as well as frequent travel to endemic areas allows cases reported worldwide. Thus, it is important for radiologists and physicians be familiarized with the imaging features of schistosomiasis. Human schistosomiasis affects multiple target organs among which hepatosplenic, gastrointestinal and genitourinary organs are common. Rarely does it also affect pulmonary, central nervous system, testes etc. This article presents a comprehensive review of the characteristic imaging findings of schistosomiasis involving multiple target organs. The typical imaging findings are thoroughly correlated with the pathophysiology of parasite in human body. In addition, we have emphasized the key learning points to differentiate it from close differentials.

Complications of minimally invasive procedures of the abdomen and pelvis: a comprehensive update on the clinical and imaging features.

Minimally invasive gastrointestinal, genitourinary, and gynecological procedures are widely used in the clinical practice for diagnostic and therapeutic purposes. Complications both minor and major are not uncommon with these procedures. Imaging plays an important role in the detection and optimal management of these complications. Familiarity with the clinical and imaging features of these complications by radiologists can help in their timely detection.

Current update on primary and secondary sclerosing cholangitis.

Sclerosing cholangitis can be idiopathic (primary) or secondary to an identifiable cause. Irrespective of cause, sclerosing cholangitis usually progresses to end-stage liver disease and warrants orthotopic liver transplantation. Recent studies provide new insights into the etiopathogenesis, natural history, diagnosis, and management of these different entities.

Emphysematous cholecystitis: Imaging findings in nine patients.

OBJECTIVE: Emphysematous cholecystitis is a severe form of acute cholecystitis and can be rapidly fatal. We present the imaging features of nine patients with proven emphysematous cholecystitis.

Mesenchymal neoplasms of the kidney in adults: imaging spectrum with radiologic-pathologic correlation.

Mesenchymal neoplasms of the kidney in adults cover a wide spectrum with characteristic ontogeny and histologic findings and variable biologic profiles and imaging findings. Benign mesenchymal renal tumors include angiomyolipoma, leiomyoma, hemangioma, lymphangioma, juxtaglomerular cell tumor, renomedullary interstitial cell tumor (medullary fibroma), lipoma, solitary fibrous tumor, and schwannoma. Malignant renal tumors of mesenchymal origin include leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, osteosarcoma, synovial sarcoma, fibrosarcoma, malignant fibrous histiocytoma, and solitary fibrous tumor. Cross-sectional imaging findings for mesenchymal renal tumors in adults are varied. Although angiomyolipomas and lipomas show macroscopic fat, lymphangiomas are cystic in appearance. Renal hemangioma may show phleboliths and a characteristic enhancement pattern. Leiomyoma typically arises from the capsule and causes buckling of the renal cortex. Although osteosarcoma may demonstrate characteristic dense ossification, most renal sarcomas demonstrate imaging features that are indistinguishable from the more common renal cell carcinoma. Although some renal mesenchymal tumors have typical imaging findings, biopsy is warranted to establish a definitive diagnosis. Awareness of the various mesenchymal renal tumors and familiarity with their imaging findings permit optimal patient management.

Pancreatic tuberculosis: a clinical and imaging review of 32 cases.

BACKGROUND: Tuberculosis of the pancreas is a rare entity, and anecdotal reports describing imaging features of pancreatic tuberculosis have been described in medical literature. The imaging features including computed tomography (CT) and ultrasonography in diagnosed cases of tubercular involvement of the pancreas are described, with an overview of clinical features and laboratory investigations. MATERIALS AND METHODS: We analyzed records of 384 patients of diagnosed cases of abdominal tuberculosis for involvement of pancreas and detected 32 patients (8.33%) who had pancreatic involvement. This included 22 men and 10 women with an age range of 19 to 64 years (mean age of 42.5 years), who were detected to have pancreatic tuberculosis from 1999 to 2004 in our institute. We reviewed the clinical, radiologic (ultrasonographic and CT features), and laboratory findings of all patients. The criteria for diagnosis of tuberculosis were based on ascitic fluid adenosine deaminase level in 14 patients, fine-needle aspiration cytology of lymph nodes in 9 patients, and presence of pulmonary tuberculosis on chest radiograph, which was found in 9 patients. On follow-up, 6 months after antituberculous treatment, 25 patients showed response to anti-Koch's treatment, 3 patients had drug-resistant tuberculosis, 2 patients died, and 2 patients were lost to follow-up. RESULTS: The male/female ratio was 2.2:1. The maximum number of patients was in the fourth decade (30-39 years). The duration of symptoms was spanning between 2 and 11 months, with a mean duration of 6 months. The most common symptom was abdominal pain localized to the epigastrium. Sixteen patients were seropositive for HIV-1 infection. Fourteen patients had history of tuberculosis of the lungs, whereas 18 patients had pancreatic and peripancreatic involvement as the primary manifestation. Ultrasonography showed bulky inhomogenous pancreas in 5 patients; solitary or multiple hypoechoic collections were observed in all 7 and 20 patients, respectively. CT findings demonstrated hypodense collections within the pancreas associated with peripancreatic lymphadenopathy in 29 patients. Three patients had a complex pancreatic mass lesion. CONCLUSIONS: Pancreatic tuberculosis can present with a variable spectrum of imaging findings. Tuberculosis of the pancreas should be considered as a diagnostic possibility in patients who present with a pancreatic space occupying lesion associated with peripancreatic lymphadenopathy.

Avascular necrosis of spine: a rare appearance.

STUDY DESIGN: Avascular necrosis (AVN) of two contiguous vertebrae along with the intervening disc is presented. OBJECTIVES: AVN of two contiguous vertebrae and the intervening disc is a rare entity and can be confused with infective and neoplastic processes. We present the role of magnetic resonance imaging (MRI) in the diagnosis of AVN. SUMMARY OF BACKGROUND DATA: AVN of vertebral bodies is a known entity; however, involvement of two contiguous vertebrae along with the intervening disc is atypical. The imaging features can be confused with an infective etiology, which involves the disc more commonly as compared to AVN. Neoplastic destruction of vertebrae also needs to be ruled out in appropriate clinical situations. METHODS: Frontal and lateral radiographs of the lumbar spine were performed followed by an MRI. Subsequently CT-guided fine needle aspiration cytology was performed. RESULTS: These radiographic features were correlated with the clinical and pathologic findings. The MRI findings of a wedge-shaped lesion with classic fluid intensity (hyperintense signal, like that of cerebrospinal fluid on T2-weighted images) are characteristic of AVN. Fine needle aspiration cytology confirmed the diagnosis and excluded an infective or a neoplastic process. CONCLUSIONS: The MRI findings described in this report are very characteristic of AVN of spine. Clinical and radiologic correlation could help in making the diagnosis and avoid unnecessary investigations.

Imaging features of calvarial tuberculosis: a study of 42 cases.

BACKGROUND AND PURPOSE: Tuberculosis of the calvaria is a rare entity, and only anecdotal reports describing its imaging features have been previously published in the literature. We report the role of conventional radiography and CT findings on in the evaluation of calvarial tuberculosis in 42 cases. METHODS: Forty-two cases of pathologically verified calvarial tuberculosis were analyzed retrospectively by using conventional radiography and CT imaging. The patients included 28 male and 14 female subjects ranging in age from 5 to 48 years (mean age, 16 years). Surgery was performed in 28 patients, and the remaining 14 patients underwent fine needle aspiration cytology. The histologic findings were consistent with the diagnosis of tuberculosis. At follow-up after 2 years, all patients had completely recovered. RESULTS: The male-to-female ratio was 2:1 (28 male and 14 female). The maximum number of patients affected by calvarial tuberculosis ranged in age from 11 to 20 years (61.2%). The average duration of symptoms was 2.5 months. Thirty-nine (92.8%) patients had subgaleal soft tissue swelling, whereas 31(73.8%) patients had a well-defined lytic lesion in the calvaria. The parietal bone was most commonly affected site of the calvaria (ie, in 22 patients [52.4%]). These lesions were detected at conventional radiography in 34 (80.95%) patients. CT depicted bone destruction in 36 patients (85.7%) cases. Extradural lesions and intraparenchymal pathologies were detected in 22 (52.3%) patients and 5 (11.9%) patients, respectively. CONCLUSION: In calvarial tuberculosis, conventional radiographs of the skull show focal bone destruction often with accompanying soft tissue opacity. CT helps in assessing the extent of bone destruction, scalp swelling, and degree of intracranial involvement. Surgery involving bone debridement is resorted to only in cases where bone destruction is extensive.

Antenatal detection of idiopathic arterial calcification with hydrops fetalis.

Idiopathic arterial calcification of infancy, or occlusive infantile arterial calcification, is a rare cause of arterial calcification. This condition is inherited as an autosomal recessive pattern, which is almost always fatal. In most of the 100 cases described in the literature, the diagnosis was made at autopsy; a few cases have been reported in which an antemortem diagnosis was made on the basis of radiographic or sonographic demonstration of arterial calcification. The clinical characteristics are extremely variable, and respiratory distress with cardiac failure is the most common finding. Hypertension that is refractory to treatment is present in most cases. Most infants die before the age of 6 months, and very few have survived for more than 1 year. Mortality in this condition is caused by myocardial ischemia due to coronary artery involvement or refractory cardiac failure. The purpose of this report is to describe the prenatal diagnosis of idiopathic arterial calcification. Fewer than 10 cases of antenatal detection of this condition have been reported in the literature. This case is 1 of 2 cases with the earliest diagnosis of this condition so far (Table 1).