MR imaging of brachial plexopathy in breast cancer patients without palpable recurrence.

OBJECTIVE: To investigate the role of MR imaging in detecting brachial plexus (BP) abnormalities in breast cancer patients with plexopathy but without palpable masses. DESIGN: MR imaging of the BP was performed on 26 breast cancer patients with brachial plexopathy without palpable regional masses, using 0.5 T and 1.5 T imaging systems. Findings were correlated with the clinical diagnoses. PATIENTS: Twenty-six patients with brachial plexopathy and history of breast cancer were enrolled in the study. All patients presented with plexopathy symptoms. Fourteen patients were positive and 12 patients were indeterminate for BP metastasis according to clinical criteria. RESULTS AND CONCLUSION: MR imaging demonstrated masses involving the BP representing metastases in two patients. Nine patients had other regional abnormalities with a normal brachial plexus. It is concluded that MR imaging is useful in the assessment and direction of therapy of brachial plexopathy in breast cancer patients by detecting both metastases to the BP as well as other abnormalities, unrelated to the BP, which may explain the patient's symptoms.

Primary adrenal leiomyosarcoma in a man with acquired immunodeficiency syndrome (AIDS). Further evidence for an increase in smooth muscle tumors related to Epstein-Barr infection in AIDS.

We report a rare primary adrenal leiomyosarcoma in a 30-year-old, human immunodeficiency virus--positive man. This is, we believe, the third documented case in the English literature of this tumor in this site, and the first to be reported in an adult male with acquired immunodeficiency syndrome. The smooth muscle origin of this tumor was apparent by routine microscopy and confirmed by positive immunostaining for smooth muscle actin. The patient is presently well and shows no evidence of recurrence 20 months after surgery. The present findings are discussed with reference to the reported rising incidence of smooth muscle tumors in human immunodeficiency virus--infected patients and the associated etiologic role of Epstein-Barr virus in the pathogenesis of these tumors.

MR imaging of adrenal masses: value of chemical-shift imaging for distinguishing adenomas from other tumors.

OBJECTIVE: CT and conventional MR imaging are helpful in characterizing adrenal tumors, but a specific diagnosis is not achieved for a substantial number of lesions. Chemical-shift imaging relies on the different resonance frequencies of protons in water and triglyceride molecules and therefore may permit a more specific diagnosis of adrenal adenomas, which are known to contain abundant lipid. The purpose of this study was to evaluate the usefulness of chemical-shift MR imaging in the differentiation of adrenal adenomas from other adrenal masses. SUBJECTS AND METHODS: Forty-one adrenal masses (17 nonhyperfunctioning adenomas, two aldosteronomas, six pheochromocytomas, one ganglioneuroma, five adrenal carcinomas, one lymphoma, seven metastases, one case of extramedullary hematopoiesis, and one leiomyosarcoma) suspected clinically or identified by sonography or CT in 38 patients were prospectively evaluated with MR imaging. Pathologic proof of diagnosis was obtained for 28 lesions, and stability on imaging follow-up (mean, 19 months) was accepted as proof of diagnosis of benign adenoma for 13 lesions. In-phase T1-weighted spin-echo sequences (500/20 [TR/TE]) and opposed-phase gradient-echo sequences (142/6.3, flip angle = 90 degrees) of the adrenal regions were applied. Quantitative analysis of signal intensity loss in the adrenal lesions relative to reference tissues (liver, muscle, and spleen) on in-phase and opposed-phase sequences was done to differentiate adenomas from nonadenomas. Region-of-interest signal intensity measurements were obtained in a standard fashion by selection of the largest possible representative sample. RESULTS: Using liver as the reference standard, we found that mean signal intensity ratios were 0.47 (range, 0.23-0.97) for adrenal adenomas and 0.88 (range, 0.65-1.32) for nonadenomas; signal intensity ratios for two adenomas overlapped those of the nonadenomas. Using muscle as the reference standard, we found that mean signal intensity ratios were 0.44 (range, 0.22-0.66) for adrenal adenomas and 0.85 (range, 0.59-1.39) for nonadenomas; signal intensity ratios for two adenomas overlapped those of the nonadenomas. Using spleen as the reference standard, we found that mean signal intensity ratios were 0.45 (range, 0.27-0.73) for adrenal adenomas and 0.97 (range, 0.8-1.18) for nonadenomas, with no overlap. The mean signal intensity ratios were significantly different between adenomas and nonadenomas for all three reference tissues (p < .001). CONCLUSION: Our results show that chemical-shift MR imaging is an important new technique that enables the differentiation of adrenal adenomas from other adrenal masses, reducing the need for biopsy and prolonged imaging follow-up in patients with adrenal tumors.

Testicular pseudotumor in the acquired immunodeficiency syndrome.

We describe a case of testicular pseudotumor evaluated with both diagnostic ultrasound (US) and magnetic resonance (MR) imaging. The findings were inconclusive and eventually radical orchiectomy and pathologic analysis were required to make the diagnosis. The typical US and MR findings of both inflammatory and neoplastic lesions of the testis are discussed.

Tumors of the adrenal gland: findings on CT and MR imaging.

Adrenal gland imaging has improved drastically since the advent of CT and MR imaging. The purpose of this essay is to illustrate findings on cross-sectional imaging of adrenal gland tumors. Emphasis is given to imaging features that help to characterize specific lesions.

MR imaging of disorders of the brachial plexus.

The authors evaluated 64 consecutive patients with suspected brachial plexus (BP) abnormalities of diverse cause with magnetic resonance (MR) imaging, using the body coil and a standardized protocol. Of the 43 patients for whom follow-up was available, 25 were suspected of having neoplastic involvement of the BP, nine had sustained injuries, and nine presented with BP symptoms of uncertain cause. MR imaging was 63% sensitive, 100% specific, and 77% accurate in demonstrating the abnormality in this diverse patient population. When patients with neoplastic and traumatic disorders were considered separately, sensitivity increased to 81%, accuracy to 88%, and specificity remained unchanged. In the patients with a clinical diagnosis of idiopathic or viral plexitis, the MR imaging findings were normal, serving to exclude other structural abnormalities. It is concluded that MR imaging is valuable in the assessment of a wide range of BP disorders.

Conservative management of mitral valve aneurysm.

A 35-year-old woman had infective endocarditis and an aneurysm of the anterior mitral leaflet. The patient was managed conservatively and the mitral valve aneurysm remained stable over 3 years. Two-dimensional, color flow Doppler, and magnetic resonance images of the aneurysm are presented and features of mitral valve aneurysms are discussed. Conservative management of mitral valve aneurysms with careful follow-up is an acceptable approach.

MRI diagnosis of a ruptured breast implant presenting as an infraclavicular mass.

The authors report a case of a ruptured breast implant presenting as an infraclavicular mass lesion. The findings of film-screen mammography, plain radiography, computed tomography and initial biopsy were nondiagnostic. Magnetic resonance imaging demonstrated the extent of the abnormality and permitted the correct diagnosis.

Are there predictors for future academic radiologists? A Canadian survey.

In 1990 the authors surveyed all members of the Canadian Association of Radiologists and all graduates of the radiology residency program at the University of British Columbia in the previous 10 years. They compared radiologists with and those without a university affiliation to determine the influences on career choice. The factors considered included teaching, research and publication experience, as well as educational background. Most respondents had decided on a career path during the second half of the residency or later. The authors found certain predictors and influences associated with a greater probability that a radiologist would pursue an academic career. For example, academic radiologists were more likely to have performed research, published and presented the results of their research activities, and taught before undertaking the residency program in radiology than their counterparts who were not affiliated with a university or a residency program. However, class standing in medical school and prior educational experience were similar for academic and nonacademic radiologists. The influences most often cited as leading toward an academic career were a desire to teach, the inspiration of a role model and an interest in research. Job satisfaction was higher among nonacademic radiologists, as indicated by the number that would consider a career change. Most of the respondents disapproved of a special residency curriculum for academic radiologists.

Thoracic outlet syndrome: evaluation with CT.

Diagnosis of the thoracic outlet syndrome is often difficult, particularly in patients without osseous abnormalities on plain radiographs. The radiographic and computed tomographic (CT) findings were reviewed from 27 patients with thoracic outlet syndrome and 21 normal subjects. The plain radiographs and CT scans were assessed by two independent observers without awareness of the clinical history. Fifteen patients with thoracic outlet syndrome had osseous abnormalities (anomalous cervical ribs; abnormally long, drooping C-7 transverse processes) identifiable on plain radiographs. CT did not provide further diagnostic information in the patients with abnormal radiographs. Eight of 12 patients (66%) with normal plain radiographs had abnormal findings on CT scans, consisting of impingement of the C-7 transverse process on the scalene triangle or anteromedial aspect of the middle scalene muscle. Only two of 21 control patients (9.5%) displayed this CT abnormality (P less than .01). CT may be useful in patients with symptoms suggestive of thoracic outlet syndrome and no osseous abnormalities on plain radiographs.

Ultrasonography in acute appendicitis.

Although the disease is common, the clinical diagnosis of appendicitis remains difficult. Since the indications for surgery are imprecise, greater diagnostic accuracy depends on the development of other methods for detection of inflammatory changes in the appendix. During eight months, high-resolution ultrasonography (US) was used for the evaluation of 37 patients with clinically suspected appendicitis. The US findings were confirmed by surgery or pathology and clinical follow-up. With a sensitivity of 0.87, a specificity of 0.95, and an accuracy of 0.92, high-resolution US is a valuable adjunct in the evaluation of appendicitis.

Localized fibrous mesothelioma of pleura following external ionizing radiation therapy.

Carcinogenesis is a well-known complication of radiation exposure. Ionizing radiation also leads to an increased incidence of benign tumors. A 36-year-old woman had a localized fibrous mesothelioma of the pleura and an ipsilateral breast carcinoma 23 years after receiving external radiation therapy for treatment of a chest wall keloid.