The ability of phased-array MRI in preoperative staging of primary rectal cancer: correlation with histopathological results.

PURPOSE: This study evaluated the accuracy of phased-array magnetic resonance imaging (MRI) for preoperative local tumor staging in primary rectal cancer and emphasized the importance of the preoperative differentiation of T2 tumors from T3 tumors so the appropriate treatment can be applied. MATERIALS AND METHODS: Twenty-four patients with primary rectal cancer were examined preoperatively using 1.5 T MRI with a phased-array coil. Multiplanar T2-weighted images were obtained. Rectum anatomy, depth of tumor invasion, mesorectal involvement and lymph nodes were assessed. All patients underwent radical surgery. The histological sections were evaluated microscopically. The correlation of magnetic resonance imaging and histopathology was assessed using the kappa statistic. Overstaging with MRI was compared with Fischer's exact test. RESULTS: Histopathological examination of the tumors revealed adenocarcinoma. When the tumors were staged, there was one patient with a pT1 tumor, six patients with pT2 tumors, and 17 patients with pT3 tumors. Using MRI, four patients with pT2 were overstaged as T3, and one patient with pT3 was overstaged as T4. In the remaining cases (one pT1, two pT2, and 16 pT3), MRI correctly assessed the stage of transmural invasion. The accuracy of T staging and metastatic lymph node detection with MRI was calculated as 79.2% and 58.5%, respectively. CONCLUSION: Phased-array MRI is a valuable technique for the preoperative staging of rectal cancer, especially in the differentiation of T2 and T3 tumors.

Subcutaneous fatty tissue metastasis from renal cell carcinoma detected with fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography and magnetic resonance imaging.

A patient who had undergone left radical nephrectomy 11 years ago for renal cell carcinoma (RCC) was referred to our clinic for restaging. Fluorine-18 fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (F18-FDG PET/CT) showed hypometabolic area in left frontal region of the brain and increased FDG uptake in the subcutaneous fatty tissues of the right thigh. Histopathological examination of the biopsy material from the left frontal region and right gluteal region revealed metastasis of clear cell type RCC. Seven months later, a magnetic resonance imaging (MRI) of right cruris showed a contrast-enhancing lesion with a diameter of 3.5 cm, located at the subcutaneous area of posterior part of right cruris. A concomitant F18-FDG PET/CT detected an increased FDG uptake focus in the proximal third of right cruris adjacent to the muscle planes and this finding was consistent with metastasis of RCC.

The efficacy of magnetic resonance imaging and x-ray in the evaluation of response to radiosynovectomy in patients with hemophilic arthropathy.

OBJECTIVE: We aimed to assess the role of Magnetic Resonance Imaging (MRI) and X-Ray in the evaluation of response to radiosynovectomy (RS) in patients with hemophilic arthropathy. MATERIAL AND METHODS: Eleven patients who suffered from hemophilic arthropathy with a mean age of 11.7 (range between 7-15) were included in this study. 148-185 MBq Yttrium 90 silicate (Y-90) was administered intraarticularly to ten knee joints and one patient was treated with intraarticular 74 MBq Rhenium 186 (Re-186) injection into his ankle. Before radiosynovectomy, plain anteroposterior and lateral X-rays of the target joints were obtained by standard technique. The follow-up MRI and X-ray studies of the patients were done 6 months after RS. Pettersson hemophilic arthropathy scales were utilized to stage the condition of the joints on plain X-ray and classification of the investigated joints on MRI were done according to Denver score. The clinical assessment of the efficacy of the RS was made with the comparison of the average bleedings before and after the intervention. RESULTS: During the 6-month follow-up period after RS, an improvement in number of hemarthrosis 75% or greater compared with the prior six months occurred in six joints (54.5%). The Pettersson scores worsened in 1/11 (9%), remained unchanged in 9/11 (81.8%), and improved in 1/11 (9%) joints. At the 6-month follow-up, the MRI score worsened in one (9%) and was unchanged in 10/11 joints (90.9%). CONCLUSION: MRI is a more sensitive tool than plain radiography for evaluating and follow-up of joint disease in persons with hemophilia, but both methods don't show correlation with the therapeutic response Conflict of interest:None declared.

The efficacy of (99m)Tc-MIBI scintimammography in the evaluation of breast lesions and axillary involvement: a comparison with X-rays mammography, ultrasonography and magnetic resonance imaging.

This study was performed because the efficacy of technetium-99m methoxyisobutyl isonitrile scintimammography ((99m)Tc-MIBI-SM) in the evaluation of the breast lesions and axillary lymph node involvement in comparison with X-rays mammography (XRM), ultrasonography (US) and magnetic resonance imaging (MRI) has not been fully investigated. Forty six female patients were included in this study, with suspicious lesions detected in their breasts by palpation, by imaging modalities or clinically. All patients underwent (99m)Tc-MIBI-SM, US and MRI for the evaluation of breast lesions. All patients according to clinical situation and imaging studies underwent fine needle aspiration, mass extirpation, core biopsy, modified radical mastectomy or partial lumpectomy in order to confirm the nature of the lesions. Our results showed that (99m)Tc-MIBI-SM detected 15 of 16, US 11 of 16, XRM 13 of 16 and MRI 13 of 16 malignant lesions. Sensitivities were 93%, 68%, 81% and 81%, respectively. Among these cases there were 4 of 15 false positive (FP) results on SM whereas 4 of 11 on US, 11 of 13 on XRM and 8 of 13 on MRI. The specificities of the above modalities were 86%, 87%, 63% and 73%, respectively. The sensitivities of the above imaging modalities for the detection of axillary lymph node metastases were 55%, 55%, 11% and 77% for SM, US, XRM and MRI, respectively. The sensitivity and specificity of SM for the palpable lesions (n=31) were 100% and 84% and for the nonpalpable lesions (n=15) were 75% and 90%, respectively. In conclusion, although the number of patients studied was small it is the opinion of the authors that (99m)Tc-MIBI-SM has a much better sensitivity and less FP results in detecting malignant breast lesions than the other 3 modalities and also better sensitivity than XRM and MRI. Thus (99m)Tc-MIBI-SM can be included in the diagnostic algorithms for detecting malignancy in breast tumors.

Huge pancreas helps diagnosis in von Hippel-Lindau disease.

We describe five patients diagnosed with von Hippel-Lindau disease who complained of abdominal distension, pain and discomfort for a long time. All patients underwent ultrasonography, CT scan and MRI, which showed huge pancreas filled with multiple cysts. Additionally, extrapancreatic findings such as cerebellar hemangioblastoma (3 patients), retinal hemangioblastoma (2), renal cell carcinoma (3), renal adenoma (1), renal cysts (4), and splenic cyst (1) helped to reach the right diagnosis. One patient who had no known associated pathology had a family history of von Hippel-Lindau disease. Pancreatic cysts detected on imaging may be a clue to the diagnosis of von Hippel-Lindau disease. In all patients with multiple pancreatic cysts, this disease should be included in the differential diagnosis.