Whole-Body Low-Dose CT in Multiple Myeloma: Diagnostic Value of Appendicular Medullary Patterns of Attenuation.

OBJECTIVE. The purpose of this article is to analyze whole-body low-dose CT-detected appendicular medullary patterns of attenuation in patients with newly diagnosed multiple myeloma and to determine the diagnostic performance of whole-body low-dose CT in detecting diffuse marrow infiltration. MATERIALS AND METHODS. A total of 76 patients with myeloma who underwent whole-body low-dose CT and spinal MRI at initial assessment were retrospectively analyzed. The medullary cavities of femurs and humeri were evaluated qualitatively and quantitatively on CT. Medullary attenuation and SD-to-mean attenuation ratio were recorded for each long bone. The pattern of marrow involvement on spinal MRI was used as reference. The chi-square test was used to evaluate the relationship between the CT-based appendicular medullary cavity pattern and the MRI pattern, and ROC analysis was performed to assess the diagnostic accuracy of CT attenuation measurements for the differentiation between diffuse and mixed CT-based appendicular medullary cavity patterns. RESULTS. Medullary attenuation differed significantly among mixed, nodular, and diffuse CT-based appendicular medullary cavity patterns in the femurs (mean, 34.23 HU and range, 15-61 HU; mean, 66.26 HU and range, 26-104 HU; mean, 92.80 HU and range, 53-127 HU, respectively) and humeri (mean, 22.18 HU and range, 9-41; mean, 61.18 HU and range, 23-93 HU; mean, 77.50 and range, 25-105 HU, respectively). To discriminate between diffuse and mixed CT-based appendicular medullary cavity patterns, optimal cutoff attenuation values were 63 HU (sensitivity, 97.7%; specificity, 100.0%) for the femurs, and 52 HU (sensitivity, 97.4%; specificity, 100.0%) for the humeri. A total of 24 of 30 (80.0%) patients with a diffuse MRI pattern showed a diffuse CT-based appendicular medullary cavity pattern on whole-body low-dose CT, and all patients with a diffuse CT-based appendicular medullary cavity pattern also showed a diffuse pattern on MRI. CONCLUSION. According to analysis of peripheral medullary patterns of attenuation, whole-body low-dose CT can identify patients with multiple myeloma with diffuse marrow involvement.

Fascioliasis: A challenging differential diagnosis for radiologists.

We report a case of a 39 year old male who presented with nausea and right upper quadrant pain. Marked eosinophilia and a hypoechoic liver lesion on ultrasound were identified. The differential diagnosis included neoplasms, infectious diseases and hepatic abscess. Indirect hemagglutination test using purified adult Fasciola hepatica f1Ag confirmed serologic diagnosis of fascioliasis. Radiologists should keep in mind the importance of correlating imaging, clinical and laboratory findings in order to reach the correct diagnosis.

Leiomyoma of the Retzius space in a male patient: A case report and a diagnostic approach to Retzius space diseases.

Retzius space is a small anatomical compartment located directly posterior to the pubic symphysis and anterior to the urinary bladder. Diseases developing primarily in this space are rare; only 7 cases of leiomyomas of the Retzius space have been reported in the literature so far, all of them in female patients. We present a unique case of a leiomyoma of the Retzius space in a male patient. An imaging-based diagnostic approach to Retzius space disease is proposed.