Computed tomographic distinction of perirenal liposarcoma from exophytic angiomyolipoma: a feature analysis study.

PURPOSE: To identify computed tomographic (CT) findings that distinguish perirenal liposarcomas from exophytic angiomyolipomas. MATERIALS AND METHODS: We identified CT scans of 20 patients (13 women and 7 men; mean age, 63 years) with either perirenal liposarcoma (n = 11) proven at histopathology or large exophytic angiomyolipomas (n = 9) determined by 2-year stability (n = 6) or histopathology (n = 3). Two independent readers unaware of the final diagnoses recorded the presence of the following CT findings: (1) tumoral vessel extending into the renal cortex, (2) tumoral vessel extending into the renal hilum, (3) renal parenchymal defect at the site of tumor contact, (4) intratumoral hemorrhage, (5) nonfat attenuating intratumoral nodules, and (6) calcification. RESULTS: A tumoral vessel extending into the renal cortex was seen only in angiomyolipomas (7 and 6 of 9 patients versus 0 and 0 of 11 liposarcomas for readers 1 and 2, respectively; P < 0.005 for both). A parenchymal defect was more commonly seen in angiomyolipomas (7 and 6 of 9 angiomyolipomas versus 1 and 1 of 11 liposarcomas for readers 1 and 2, respectively; P < 0.05 for both). Calcifications were seen by both readers in 6 of 11 liposarcomas but not in any angiomyolipomas (P < 0.05). The other recorded findings were not useful in distinguishing CT features (P > 0.1 for both readers). CONCLUSIONS: In the evaluation of a fatty perinephric mass at CT, the presence of a tumoral vessel extending into the renal cortex or a renal parenchymal defect at the site of tumor contact strongly favors the diagnosis of exophytic angiomyolipoma, whereas calcifications suggest liposarcoma.

CT cholangiography in potential liver donors: effect of premedication with intravenous morphine on biliary caliber and visualization.

PURPOSE: To retrospectively determine whether premedication with intravenously administered morphine improves bile duct caliber and visualization in potential liver donors undergoing computed tomographic (CT) cholangiography. MATERIALS AND METHODS: This was a retrospective single institution study approved by the institutional review board and compliant with requirements of the HIPAA. Multidetector CT cholangiography was performed after slow infusion of 20 mL of iodipamide meglumine 52% diluted in 80 mL of normal saline in 143 consecutive potential liver donors (81 men and 62 women; mean age, 37 years); 43 received premedication with intravenous morphine sulfate (0.04 mg per kilogram of body weight) and 100 did not. Two independent readers recorded common bile duct diameter and area on axial CT images. Readers also scored bile duct visualization, including all second-order biliary branches, on a four-point scale (0, not seen; 3, excellent visualization). RESULTS: For scans obtained without and those obtained with morphine, there was no significant difference in the mean common bile duct diameter (4.1 vs 4.3 mm for reader 1 and 4.4 vs 4.6 mm for reader 2, respectively; P > .39 for both readers), in common bile duct area (20.7 vs 21.5 mm(2), for reader 1 and 21.3 vs 20.2 mm(2) for reader 2, respectively, P > .60 for both), or in second-order bile duct visualization score (2.34 vs 2.36 for reader 1 and 2.58 vs 2.50 for reader 2, respectively; P > .5 for both). CONCLUSION: The results suggest that premedication with intravenous morphine prior to CT cholangiography in potential liver donors does not increase bile duct caliber or improve biliary visualization.