A mimicker of inflammatory breast carcinoma: Lupus mastitis and evolving imaging features.

Rare case of lupus mastitis in a 58-year-old female with discoid lupus erythematosus presented with fever, left breast swelling, and painful palpable lesion. Accurate imaging and histopathologic evaluation allowed for appropriate management and regression of breast findings with hydroxychloroquine treatment, emphasizing the need to avoid unnecessary biopsies and surgeries.

Intravoxel incoherent motion magnetic resonance imaging for breast cancer: A comparison with molecular subtypes and histological grades.

PURPOSE: The purpose of this paper is to investigate whether the IVIM parameters (D, D *, f) helps to determine the molecular subtypes and histological grades of breast cancer. METHODS: Fifty-one patients with breast cancer were included in the study. All subjects were examined by 3 T Magnetic Resonance Imaging (MRI). Diffusion-weighted imaging (DWI) was undertaken with 16 b-values. IVIM parameters [D (true diffusion coefficient), D* (pseudo-diffusion coefficient), f (perfusion fraction)] were calculated. Histopathological reports were reviewed to histological grade, histological type, and immunohistochemistry. IVIM parameters of tumors with different histological grades and molecular subtypes were compared. RESULTS: D* and f were significantly different between molecular subtypes (p = 0.019, p = 0.03 respectively). D* and f were higher in the HER-2 group and lower in Triple negative (-) group (D*:36.8 × 10-3 ± 5.3 × 10-3 mm2/s, f:29.5%, D*:29.8 × 10-3 ± 5.6 × 10-3 mm2/s, f:21.5% respectively). There was a significant difference in D* and f between HER-2 and Triple (-) subgroups (p = 0,028, p = 0.024, respectively). D* was also significantly different between the HER-2 group and the Luminal group (p = 0,041). While histological grades increase, D and f values tend to decrease, and D* tends to increase. While the Ki-67 index increases, D* and f values tend to increase, and D tend to decrease. CONCLUSION: D* and f values measured with IVIM imaging were useful for assessing breast cancer molecular subtyping. IVIM imaging may be an alternative to breast biopsy for sub-typing of breast cancer with further research.

The Performance of Radiographic Criteria for Bone Malignancy When Applied to Computed Tomography and Magnetic Resonance Imaging.

BACKGROUND: The conventional radiologic features that differentiate benign from malignant bone lesions were originally described using radiography (x-ray [XR]). When evaluating sectional imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT), one may apply these principles to identify malignant bone lesions. The aim of this study was to evaluate the performances of these radiographic features for detecting malignity when applied to CT and MRI. MATERIALS AND METHODS: This retrospective study was approved by our institutional ethical board. Thirty-nine patients with histopathologic proof of a high-grade bone malignancy and preoperative imaging data obtained with a minimum of two different modalities were included in the study. Four radiologists reviewed the images and scored the lesions for distinctness of margins, presence and type of periosteal reaction, matrix mineralization, and presence of soft tissue mass. The average score for each modality was then tested for accuracy with regard to the histopathology. RESULTS: When lesion margins were considered, XR was the best modality to detect a high-grade malignancy. MRI, especially postcontrast T1-weighted sequence, was the least helpful in this regard. There was no significant difference between CT and XR and between CT and MRI. When the periosteal reaction was considered, XR was the best modality to detect the malignant type of periosteal reaction. In this regard, MRI and CT were misleading; either by not detecting or undergrading periosteal reaction. MRI was the best modality to detect soft tissue mass. CONCLUSION: Conventional imaging criteria for bone malignancy can be misleading when applied to MRI or CT. When cross-sectional imaging features contradict those from XR, the latter should be the guide for clinical management.

Diagnostic Accuracy of Dynamic Contrast Enhanced Magnetic Resonance Imaging in Characterizing Lung Masses.

BACKGROUND: Imaging plays a critical role not only in the detection, but also in the characterization of lung masses as benign or malignant. OBJECTIVES: To determine the diagnostic accuracy of dynamic magnetic resonance imaging (MRI) in the differential diagnosis of benign and malignant lung masses. PATIENTS AND METHODS: Ninety-four masses were included in this prospective study. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, followed by a T1-weighted FFE sequence in the late phase (5th minutes). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained and the maximum relative enhancement, wash-in rate, and time-to-peak enhancement of masses in both groups were calculated. RESULTS: The early phase contrast enhancement patterns were homogeneous in 78.2% of the benign masses, while heterogeneous in 74.4% of the malignant tumors. On the late phase images, 70.8% of the benign masses showed homogeneous enhancement, while most of the malignant masses showed heterogeneous enhancement (82.4%). During the first pass, the maximum relative enhancement and wash-in rate values of malignant masses were significantly higher than those of the benign masses (P = 0.03 and 0.04, respectively). The cutoff value at 15% yielded a sensitivity of 85.4%, specificity of 61.2%, and positive predictive value of 68.7% for the maximum relative enhancement. CONCLUSION: Contrast enhancement patterns and SI-time curve analysis of MRI are helpful in the differential diagnosis of benign and malignant lung masses.

Diffusion-weighted Magnetic Resonance Imaging in the Differential Diagnosis of Benign and Metastatic Malignant Pleural Thickening.

PURPOSE: Imaging plays a critical role not only in detection but also in characterization of pleural thickening as benign or malignant. The aim of the study was to investigate the value of diffusion-weighted (DW) imaging in the differential diagnosis of benign and metastatic malignant pleural thickening. MATERIALS AND METHODS: Thirty-four patients with 64 pleural foci of nodular thickening (47 metastatic malignant and 17 benign) were included in this prospective study. DW imaging was performed using a breath-hold single-shot spin-echo echo-planar sequence. Two different apparent diffusion coefficient (ADC1,2) maps were obtained with different b factors (ADC1 reconstructed from b factors of 0 and 650 mm/s and ADC2 reconstructed from b factors of 0 and 1000 mm/s), and ADCs were calculated. Quantitatively, ADCs were compared between the groups, and the optimal cutoff value was found by using receiver operating characteristic curve analysis. RESULTS: Quantitatively, differences in signal intensities on DW trace images with b factors of 650 and 1000 mm/s were not statistically significant. The ADC1 and ADC2 of the metastatic malignant thickening were significantly lower than those of benign ones [mean ADC1 was 1.37±0.65×10 mm/s for metastatic malignant thickening and 2.11±0.69×10 mm/s for benign thickening (P=0.045); ADC2 was 1.06±0.56×10 mm/s for metastatic malignant thickening and 1.56±0.71×10 mm/s for benign thickening (P=0.038)]. However, because of the ADC overlap between malignant and benign disease, a sufficiently discriminative cutoff value could not be defined by the receiver operating characteristic curve analysis. CONCLUSION: Despite fair sensitivity and specificity, DW imaging may serve as a complementary tool that improves the differential diagnosis of pleural thickening.

Comparison of the diagnostic performances of diffusion parameters in diffusion weighted imaging and diffusion tensor imaging of breast lesions.

PURPOSE: To evaluate the diagnostic efficiency of the diffusion parameters measured by conventional diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) for discrimination of malignant breast lesions from benign lesions and the normal breast. MATERIALS AND METHODS: The study included 52 women with 55 breast lesions (30 malignant, 25 benign). DTI and DWI were performed complementary to dynamic contrast MRI at 3T. Apparent diffusion coefficient (ADC) of DWI, mean diffusivity (MD) and fractional anisotropy (FA) values of DTI were measured for lesions and contralateral breast parenchyma in each patient. We used b factors of 0, 50, 850, 1000 and 1500 s/mm(2) for DWI and b 0 and 1000 s/mm(2) for DTI. ADC, MD and FA values were compared between malignant and benign lesions, and the normal parenchyma by univariate and multivariate analyses. RESULTS: Diffusion parameters showed no difference according to menopausal status in the normal breast. ADC and MD values of the malignant lesions were significantly lower than benign lesions and normal parenchyma (p=0.001). The FA showed no statistical significance. With the cut-off values of ≤ 1.23 × 10(-3)mm(2)/s (b 0-1000 s/mm(2)) and ≤ 1.12 × 10(-3)mm(2)/s (b 0-1500 s/mm(2)), ADC showed 92.85% and 96.15% sensitivity; 72.22% and 73.52% PPV, respectively. With a cut-off value of ≤ 1.27 × 10(-3)mm(2)/s (b 1000 s/mm(2)), MD was 100% sensitive with a PPV of 65.90%. Comparing the diagnostic performance of the parameters in DTI with DWI, we obtained similar efficiency of ADC with b values of 0,1000 and 0,1500 s/mm(2) and MD with a b value of 0, 1000 s/mm(2) (AUC = 0.82 ± 0.07). CONCLUSION: ADC of DWI and MD of DTI values provide significant discriminative factors for benign and malignant breast lesions. FA measurement was not discriminative. Supported with clinical and dynamic contrast MRI findings, DWI and DTI findings provide significant contribution to the final radiologic decision.

Malignant versus benign mediastinal lesions: quantitative assessment with diffusion weighted MR imaging.

OBJECTIVES: We aimed to evaluate the performance of diffusion-weighted magnetic resonance imaging in differentiating malignant from benign mediastinal lesions. METHODS: Fifty-three mediastinal lesions were examined with T1- and T2-weighted (W) conventional images. Then, two diffusion-weighted images were obtained with b = 0 and 1000 s/mm² values and apparent diffusion coefficients (ADC) were calculated. The statistical significance of differences between measurements was tested using the Student-t test. RESULTS: The mean ADC of malignant lesions was significantly lower than that of the benign masses (p < 0.001). The cut-off value of ≤ 1.39 × 10(-3) mm²/s indicated a malignant lesion with a sensitivity of 95% and specificity of 87%. CONCLUSION: Diffusion-weighted imaging may be helpful in differentiating benign from malignant mediastinal masses.

Conventional and diffusion-weighted MRI of extrahepatic hydatid cysts.

PURPOSE: To evaluate the value of conventional and diffusion-weighted (DW) magnetic resonance imaging (MRI) in the diagnosis of extrahepatic hydatid cysts. MATERIALS AND METHODS: Forty-one extrahepatic hydatid cysts (12 renal, 6 pulmonary, 5 peritoneal, 4 bone, 3 soft tissue, 3 pancreatic, 2 splenic, 2 retroperitoneal, 1 adrenal, 1 scrotal, 1 diaphragmatic, and 1 cardiac) were included in this retrospective study. After a series of routine conventional MRI, DW imaging was performed using a breath-hold, single-shot, echo-planar, spin echo sequence with three b factors (0, 500 and 1,000 s/mm(2)), and apparent diffusion coefficient (ADC) maps were created. On DW trace images, signal intensity of the cysts was visually compared to the signal intensity of the muscle with the use of a 3-point scale: 0, isointense; 1, moderately hyperintense; 2, significantly hyperintense. For quantitative evaluation, signal intensity ratio and ADC of the cystic lesions were calculated. RESULTS: On conventional MR images, all but 3 patients had concomitant liver involvement. Three of them were disseminated. On DW trace images (b = 1,000 s/mm(2)), most hydatid cysts (86%) were hyperintense, while five hydatid cysts (14%) were isointense. Quantitatively, the mean ADC of the hydatid cysts was 2.8 x 10(-3) +/- 0.5 mm(2)/s. CONCLUSION: DW imaging may help in the differential diagnosis of extrahepatic hydatid cysts.

Diffusion-weighted MRI in the characterization of pleural effusions.

PURPOSE: To evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of pleural effusions. MATERIALS AND METHODS: 58 pleural effusions (21 transudative, 37 exudative) were included in this prospective study. Single-shot echo-planar spin echo DWI was performed with two b factors (500 and 1000 s/mm (2)), and apparent diffusion coefficients (ADCs) were calculated. On diffusion- weighted (DW) trace images, signal intensity (SI) of the pleural effusions was visually compared to the SI of the paraspinal muscles with the use of a 3-point scale: 0: isointense, 1: moderately hyperintense, 2: significantly hyperintense. For quantitative evaluation, effusion- to-paraspinal muscle SI ratios, and ADCs of the effusions were compared between the groups. RESULTS: On visual evaluation, most of the transudative effusions were isointense, while most of the exudative effusions were hyperintense on DWI with b factors of 500 and 1000 s/mm (2). Quantitatively, with a b factor of 500 and 1000 s/mm(2), effusion-to-paraspinal muscle SI ratios of the exudative effusions were significantly higher than those of transudative effusions. The ADCs of the exudative effusions were significantly lower than those of transudative effusions (mean ADC was 3.3 x 10 (-3)+/- 0.7 mm(2)/s for exudative effusions, and 3.7 x 10 (-3)+/-0.3 mm(2)/s for transudative effusions). Setting the cutoff value at 3.6 x 10(-3), ADC had a sensitivity of 71% and a specificity of 63% for differentiating transudative from exudative effusions. CONCLUSION: DWI may help in the differential diagnosis of pleural effusions.

Diffusion-weighted imaging in the differential diagnosis of cystic lesions of the pancreas.

OBJECTIVE: The purpose of our study was to evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of pancreatic cysts. SUBJECTS AND METHODS: Forty-two cysts (16 simple cysts, seven pseudocysts, five abscesses, three hydatid cysts, two serous cystadenomas, three mucinous cystadenomas, two mucinous cystadenocarcinomas, four cystic degenerated adenocarcinomas) were included in this prospective study. Single-shot spin-echo echo-planar DWI was performed with three b factors (0, 500, and 1,000 s/mm(2)), and apparent diffusion coefficients (ADCs) were calculated. On DWI, the signal intensity of the cysts was visually compared with the signal intensity of the pancreas parenchyma. For the quantitative evaluation, cyst-to-pancreas signal intensity ratios, ADC of the lesions, and cyst-to-pancreas ADC ratios were compared. RESULTS: On visual evaluation, all cystic lesions were hyperintense on DWI with b factors of 0 and 500 s/mm(2). On DWI with a b factor of 1,000 s/mm(2), all abscesses and hydatid and neoplastic cysts were hyperintense, whereas most of the simple and pseudocysts were isointense. Quantitatively, with b factors of 0 and 500 s/mm(2), no statistical significance was achieved. With a b factor of 1,000 s/mm(2), the cyst-to-pancreas signal intensity ratios of the abscesses and hydatid and neoplastic cysts were significantly higher than those of the simple cysts and pseudocysts. Setting the cutoff value of signal intensity ratio at 1.9, the cyst-to-pancreas signal intensity ratio had a sensitivity of 70% and a specificity of 90% for differentiating abscesses, hydatid cysts, and neoplastic cysts from simple cysts and pseudocysts. The ADC and the ADC ratios of the abscesses, hydatid cysts, and neoplastic cysts were significantly lower than those of the simple cysts and pseudocysts. CONCLUSION: DWI may help in the differential diagnosis of pancreatic cysts.

Apparent diffusion coefficient and cerebrospinal fluid flow measurements in patients with hydrocephalus.

OBJECTIVE: To evaluate the efficacy of diffusion magnetic resonance imaging and compare with cerebrospinal fluid (CSF) flow imaging in patients with hydrocephalus before and after treatment. METHODS: Twenty patients with hydrocephalus (group 1, pediatric, with primary aqueductal stenosis, n = 10; group 2, adult, with normal-pressure hydrocephalus, n = 10) and 20 age-matched healthy subjects that served as controls were examined. Cerebrospinal fluid flow velocity interval was calculated as the mean absolute values of the peak craniocaudal velocity and caudocranial velocity on CSF flow measurements. On diffusion magnetic resonance imaging, apparent diffusion coefficient (ADC) values from 8 regions were evaluated. RESULTS: The decrease in ADC values after treatment was significant in both groups (P < 0.001 for both). Preoperative mean CSF flow velocity interval value was significantly lower in group 1 and significantly higher than postoperative and control group values in group 2 (P < 0.001 for all). CONCLUSION: The ADC values increase in hydrocephalus and decrease significantly after treatment. Preoperative ADC value may serve as baseline, and the change in ADC may be an indicator of response to treatment and CSF flow measurements.

Gender and the lateral angle of the internal acoustic canal meatus as measured on computerized tomography of the temporal bone.

INTRODUCTION: Cadaveric studies yielded promising results in sexing the temporal bones by measuring the lateral angle of the internal acoustic canal meatus. In this study, we evaluated the capability of computerized tomography of the temporal bone to reproduce these results. METHODS: Lateral angle of the internal acoustic canal meatus was measured in 92 patients (47 females and 45 males) on axial slices of high resolution computerized tomography scans of the temporal bone. The patients underwent computerized tomography as part of clinical work up for ear-related complaints. The measurement technique was modified from a cadaveric study in which a significantly higher mean lateral angle measurement was observed in females than in males. The mean values from females and males were compared statistically. RESULTS: The mean lateral angle as measured on computerized tomography of the temporal bone is greater in females (45.5+/-7.1 degrees ) than in males (41.6+/-6.7 degrees ). The difference is significant at p<0.01, as tested by one-way ANOVA. Due to significant overlap in ranges of measurements, no single cut-off value that satisfactorily differentiates between the genders could be determined. However, measurements of 35 degrees and lesser were 93.6% specific for male gender and measurements of 60 degrees and greater were 97.7% specific for female gender. CONCLUSION: Computerized tomography of the temporal bone is capable of replicating the results from the cadaveric measurements in determining the lateral angle. Due to the large range of measurements within both genders, this measurement should be regarded as supportive and not conclusive evidence for the sex of the subject.

Unusual magnetic resonance image of an insulinoma with extensive desmoplastic reaction.

CONTEXT: Unlike other islet-cell tumors, insulinomas are usually benign. Most insulinomas have a high signal intensity on T2-weighted images and a low signal intensity on T1-weighted images, and are hyperintense on immediate post-gadolinium images. However, in rare cases, insulinomas may be hypointense on T2-weighted images and on immediate post-gadolinium images, mimicking a ductal adenocarcinoma. CASE REPORT: We present a case of a surgically proven insulinoma which was hypointense on both T2-weighted and immediate post-gadolinium T1-weighted images, but hyperintense on late phase T1-weighted images. Histopathological examination of the surgical specimen revealed a prominent desmoplastic reaction which accounted for the low signal on T2-weighted images and the contrast enhancement pattern. Delayed contrast enhancement reflects the desmoplastic component of this tumor. CONCLUSIONS: Insulinomas with an extensive desmoplastic reaction may appear hypointense on T2-weighted images with minimal enhancement on immediate post-gadolinium images. Late phase fat-suppressed T1-weighted post-gadolinium images may be useful in the detection of such tumors.

Dynamic contrast enhanced MRI in the differential diagnosis of adrenal adenomas and malignant adrenal masses.

OBJECTIVE: To evaluate the value of dynamic MR imaging in the differential diagnosis of adrenal adenomas and malignant tumors, especially in cases with atypical adenomas. MATERIALS AND METHODS: Sixty-four masses (48 adenomas, 16 malignant tumors) were included in this prospective study. Signal loss of masses was evaluated using chemical shift MR imaging. Five dynamic series of T1-weighted spoiled gradient echo (FFE) images were obtained, with the acquisition starting simultaneously with i.v. contrast administration (0-100 s) followed by a T1-weighted FFE sequence in the late phase (5th minute). Contrast enhancement patterns in the early (25th second) and late (5th minute) phase images were evaluated. For the quantitative evaluation, signal intensity (SI)-time curves were obtained according to the SIs on the 0th, 25th, 50th 75th and 100th second. Also, the wash-in rate, maximum relative enhancement, time-to-peak, and wash-out of contrast at 100 s of masses in both groups were calculated. The statistical significance was determined by Mann-Whitney U test. To evaluate the diagnostic performance of the quantitative tests, receiver operating characteristic (ROC) analysis was performed. RESULTS: Chemical shift MR imaging was able to differentiate 44 out of 48 adenomas (91.7%) from non-adenomas. The 4 adenomas (8.3%) which could not be differentiated from non-adenomas by this technique did not exhibit signal loss on out-of-phase images. With a cut-off value of 30, SI indices of adenomas had a sensitivity of 93.8%, specificity of 100% and a positive predictive value of 100%. On visual evaluation of dynamic MR imaging, early phase contrast enhancement patterns were homogeneous in 75% and punctate in 20,83% of the adenomas; while patchy in 56.25% and peripheral in 25% of the malignant tumors. On the late phase images 58.33% of the adenomas showed peripheral ring-shaped enhancement and 10.41% showed heterogeneous enhancement. All of the malignant masses showed heterogeneous enhancement. At the 25th second, the SIs and wash-in rates of the adenomas were significantly higher than those of the malignant masses (p=0.010). Time-to-peak enhancement of the malignant masses was significantly longer than that of the adenomas. With a cut-off value of 52.85 s, the time-to-peak enhancement had 87.5% sensitivity and 80% specificity. CONCLUSION: Chemical shift MR has a high sensitivity and specificity in the differential diagnosis of adenomas and malignant adrenal masses. However, taking into consideration only the atypical adenomas, chemical shift MRI is of no diagnostic value. Although the diagnostic value of dynamic MRI is lower than chemical shift MRI, in the atypical cases contrast enhancement patterns and time-to-peak and wash-in rates derived from SI-time curve of dynamic MRI give are contributory to the results of chemical shift MRI.

Color Doppler ultrasonographic flow parameters in the differentiation of benign and malignant causes of omental thickening.

OBJECTIVE: The purpose of the study was to determine if color Doppler ultrasonographic (US) quantitative flow parameters are valuable to differentiate malignant peritoneal or omental involvement from benign causes. MATERIALS AND METHODS: Twenty-six consecutive patients with peritoneal or omental thickening detected by gray scale US, computed tomography, and magnetic resonance underwent color Doppler US examinations. All the Doppler signal waveforms were recorded, and resistive (RI) and pulsatility indices (PI) were calculated automatically by the US machine. In the statistical analysis of RI and PI, unpaired t test was used. A P < 0.05 was considered significant. RESULTS: Nineteen of 20 malignant and 5 of 6 benign lesions had detectable color Doppler US pulsatile flow signals. The mean RI and PI values were 0.6260 and 1.36, respectively, for the benign group and 0.5384 and 1.4147, respectively, for the malignant group. For malignant lesions, mean RI was lower (P = 0.0796), and mean PI was higher (P = 0.9183) than benign lesions. However, these differences were not statistically significant. CONCLUSIONS: Overlapping RI and PI values in benign and malignant omental lesions limit the clinical value of flow parameters in the differentiation of benign and malignant involvement of the omentum.

Diffusion-weighted imaging in the differential diagnosis of simple and hydatid cysts of the liver.

OBJECTIVE: The purpose of our study was to evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of simple and hydatid cysts of the liver, particularly in the completely liquid type of hydatid cyst. SUBJECTS AND METHODS: Eighty-two cysts (43 simple cysts, 39 hydatid cysts) were included in this prospective study. DWI was performed using a breath-hold single-shot echo-planar spin-echo sequence, and apparent diffusion coefficients (ADCs) were calculated. On DW trace images, the signal intensity of cysts was visually compared with the signal intensity of the liver using a 3-point scale: 0, isointense; 1, moderately hyperintense; and 2, significantly hyperintense. Quantitatively, signal intensity of the cysts, cyst-to-liver signal intensity ratios, ADC of the cysts, and cyst-to-liver ADC ratios were compared between the groups. The statistical significance was determined using the Mann-Whitney U test. RESULTS: On trace DWI (b = 1,000 s/mm2), most hydatid cysts (37/39, 95%) were hyperintense, whereas most simple cysts (40/43, 93%) were isointense with the liver. Three simple cysts (7%) were moderately hyperintense and two hydatid cysts (5%) were isointense. Quantitatively, both the signal intensity and cyst-to-liver signal intensity ratio of the hydatid cysts were significantly higher than those for simple cysts (p < 0.001). The cutoff value at 1.5 yielded a sensitivity of 77%, a specificity of 86%, and positive predictive value of 83% for the cyst-to-liver signal intensity ratio. The ADC and cyst-to-liver ADC ratio of the hydatid cysts were significantly lower than those of simple cysts (p < 0.005). For the completely liquid type in particular, we observed statistically significant differences in signal intensity, signal intensity ratio, ADC, and ADC ratios from those of simple cysts (p < 0.005). With a cutoff value of 1.5, signal intensity ratio had a sensitivity of 81%, specificity of 86%, and positive predictive value of 74%. CONCLUSION: DWI may help in the differential diagnosis of hydatid and simple cysts of the liver.

Colitis cystica profunda: MRI appearance.

Colitis cystica profunda (CCP) is an uncommon benign condition characterized by mucin-filled cysts located in the submucosa, frequently associated with the solitary ulcer and rectal prolapse syndromes. The diagnosis of this entity is important as it can mimic rectal cancer and therefore may result in unnecessary surgical resection. Endoscopic examination and barium enema findings are suggestive but not specific, neither are superficial biopsy findings. Transrectal ultrasound is helpful in the diagnosis by imaging the layers of the rectal wall. The authors report a 16-year-old male with a rectal lesion mimicking malignant mass on endoscopic examination. The lesion was defined as CCP, based on MR imaging findings which disclosed multiple noninfiltrating submucosal cysts, confirmed by histopathological examination. To our knowledge, this is the first case of CCP in the radiology literature describing MRI findings.

Incomplete duodenal obstruction in a newborn.

A case of newborn with incomplete duodenal obstruction caused by superior mesenteric artery syndrome has been presented with this report. A full term, 1-day-old baby girl was referred to our hospital because of recurrent bilious vomiting since birth and upper gastrointestinal barium study revealed the incomplete obstruction at the 3rd part of the duodenum with a vertical abrupt cutoff. The diagnosis of superior mesenteric artery syndrome was made with ultrasonography and duodenojejunostomy was carried out. Although it is extremely rare, superior mesenteric artery syndrome should also be considered as one of the rare cause of incomplete duodenal obstruction in newborn period.