Sonographic Findings of Malignant Appendix Tumors in Seven Cases.

We report the sonographic features of confirmed malignant appendiceal tumors in seven cases. The histologic diagnoses of these tumors were mucinous cystadenocarcinoma (n = 2), colonic type adenocarcinoma (n = 4), and signet-ring cell carcinoma (n = 1). The 2 mucinous cystadenocarcinomas showed mucocele type, which had markedly enlarged inner luminal diameters (mean, 23 mm; range, 15-31 mm) and thick, irregular walls (mean wall thickness, 5.5 mm; range, 5-6 mm). In contrast, the 5 nonmucinous carcinomas (4 adenocarcinomas and 1 signet-ring cell carcinoma) showed nonmucocele type, which had relatively small inner luminal diameters (mean ± standard deviation [SD], 6.6 ± 4.5 mm; range, 2-15 mm) and prominent wall thickening (mean wall thickness ± SD, 6.2 ± 2.3 mm; range, 3-10 mm). Of the 5 nonmucinous tumors, only one had a discernible mass, three had thick irregular walls, two had loss of the wall layer pattern, and four had submucosal hypoechogenicity. Regardless of the histologic type, five of the seven malignant appendiceal tumors showed a severe periappendiceal fat infiltration or periappendiceal abscess, suggestive of perforation. Although the sonographic findings of the malignant appendiceal tumors were nonspecific, some of the sonographic features seen in these seven cases may help radiologists consider the possibility of underlying malignant appendiceal tumors.

3D T2-weighted turbo spin-echo MR sequence for identifying cerebrospinal fluid leak after endoscopic endonasal pituitary surgery.

BACKGROUND: This study aimed to assess the efficacy of MR images with 3D T2-weighted turbo spin-echo (3D T2-TSE) sequences for early identification of postoperative cerebrospinal fluid (CSF) leaks. METHODS: We analyzed the medical records and radiological reports for 72 consecutive patients who underwent an endoscopic endonasal approach for sellar and parasellar lesions between April 2009 and December 2010. Patients were 38 men and 34 women with a mean age of 46.4 years. All underwent MR scanning within 2 postoperative days, which included 3D T2-TSE sequences as well as a conventional T2-weighted (T2W) protocol. Sequence accuracy in predicting postoperative CSF leaks was assessed for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: A postoperative CSF leak was confirmed in 6 of 72 patients (8.3 %). On immediate postoperative MR images, 39 patients were suspicious for CSF leaks on conventional T2W sequences, while 18 patients on 3D T2-TSE. The 3D T2-TSE imaging had superior specificity and PPV (50 % vs. 81.8 %, 15.4 % vs. 33.3 %), while there was no difference in sensitivity and NPV compared with conventional T2W sequences. CONCLUSION: Compared to the conventional T2W protocol, MR imaging with the 3D T2-TSE protocol provides differential images around the sellar area with improved specificity and PPV for the detection of postoperative CSF leaks.