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OBJECTIVES: Temporal artery magnetic resonance angiography (TAMRA) is a useful tool to investigate possible diagnoses of GCA. As acquired images also reveal other local structures, they may assist in finding alternative diagnoses when assessing for possible GCA. We sought to assess the utility of TAMRA in identifying other significant abnormalities either associated with a diagnosis of GCA or potentially mimicking a clinical presentation of GCA. METHODS: A retrospective cohort study was undertaken at St Joseph's Healthcare in Hamilton, Ontario, Canada between February 2007 and April 2020 and included patients who underwent TAMRA for a possible diagnosis of GCA. Patient demographics, diagnosis and imaging findings were extracted, and descriptive analysis of findings was performed. RESULTS: We included 340 individuals who underwent TAMRA for assessment of a potential diagnosis of GCA and had clinical information available; there were 126 (37.1%) diagnoses of GCA. Fourteen (4.1%) patients had findings on TAMRA that demonstrated an alternative diagnosis, findings were predominantly in the temporomandibular joint, orbit and meninges. Eighteen (14.3%) patients with GCA had intracranial vascular changes that were demonstrative of intracranial vasculitis; one stroke was attributed to intracranial GCA. CONCLUSIONS: TAMRA has proven utility in diagnosing GCA, and these data suggest that it also has utility in identifying alternative diagnoses to rule out the disease. Intracranial vasculitis was also seen in 14.3% of patients; the clinical impact of these findings is currently poorly understood and requires further study.
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Arterite de Células Gigantes , Humanos , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/patologia , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/patologia , Angiografia por Ressonância Magnética , Estudos Retrospectivos , Ontário , Biópsia/métodosRESUMO
BACKGROUND: In rectal cancer surgery, larger mesorectal fat area has been shown to correlate with increased intraoperative difficulty. Prior studies were mostly in Asian populations with average body mass indices (BMIs) less than 25 kg/m2. This study aimed to define the relationship between radiological variables on pelvic magnetic resonance imaging (MRI) and intraoperative difficulty in a North American population. METHODS: This is a single-center retrospective cohort study analyzing all patients who underwent low anterior resection (LAR) or transanal total mesorectal excision (TaTME) for stage I-III rectal adenocarcinoma from January 2015 until December 2019. Eleven pelvic magnetic resonance imaging measures were defined a priori according to previous literature and measured in each of the included patients. Operative time in minutes and intraoperative blood loss in milliliters were utilized as the primary indicators of intraoperative difficulty. RESULTS: Eighty-three patients (39.8% female, mean age: 62.4 ± 11.6 years) met inclusion criteria. The mean BMI of included patients was 29.4 ± 6.2 kg/m2. Mean operative times were 227.2 ± 65.1 min and 340.6 ± 78.7 min for LARs and TaTMEs, respectively. On multivariable analysis including patient, tumor, and MRI factors, increasing posterior mesorectal thickness was significantly associated with increased operative time (p = 0.04). Every 1 cm increase in posterior mesorectal thickness correlated with a 26 min and 6 s increase in operative time. None of the MRI measurements correlated strongly with BMI. CONCLUSION: As the number of obese rectal cancer patients continues to expand, strategies aimed at optimizing their surgical management are paramount. While increasing BMI is an important preoperative risk factor, the present study identifies posterior mesorectal thickness on MRI as a reliable and easily measurable parameter to help predict operative difficulty. Ultimately, this may in turn serve as an indicator of which patients would benefit most from pre-operative resources aimed at optimizing operative conditions and postoperative recovery.
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Laparoscopia , Neoplasias Retais , Cirurgia Endoscópica Transanal , Idoso , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/complicações , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/cirurgia , Reto/diagnóstico por imagem , Reto/cirurgia , Estudos Retrospectivos , Cirurgia Endoscópica Transanal/métodosRESUMO
OBJECTIVES: Imaging modalities have become common in evaluating patients for a possible diagnosis of GCA. This study seeks to contextualize how temporal arterial magnetic resonance angiography (TA-MRA) can be used in facilitating the diagnosis of GCA. METHODS: A retrospective cohort study was performed on patients who had been previously referred to a rheumatologist for evaluation of possible GCA in Hamilton, Ontario, Canada. Data including clinical features, inflammatory markers, imaging, and biopsy results were extracted. Multivariable logistic regression model to predict the diagnosis of GCA. Using these models, the utility of TA-MRA in series with or in parallel to clinical evaluation was demonstrated across the cohort as well as in subgroups defined by biopsy and imaging status. RESULTS: In total 268 patients had complete data. Those diagnosed with biopsy- and/or imaging-positive GCA were more likely to demonstrate classic features including jaw claudication and vision loss. Clinical multivariable modelling allowed for fair discriminability [receiver operating characteristic (ROC) 0.759, 95% CI: 0.703, 0.815] for diagnosing GCA; there was excellent discriminability in facilitating the diagnosis of biopsy-positive GCA (ROC 0.949, 0.898-1.000). When used in those with a pre-test probability of 50% or higher, TA-MRA had a positive predictive value of 93.0%; in those with a pre-test probability of 25% or less TA-MRA had a negative predictive value of 89.5%. CONCLUSION: In those with high disease probability, TA-MRA can effectively rule in disease (and replace temporal artery biopsy). In those with low to medium probability, TA-MRA can help rule out the disease, but this continues to be a challenging diagnostic population.
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Arterite de Células Gigantes/diagnóstico por imagem , Artérias Temporais/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
A relative afferent pupillary defect (RAPD) is a very important clinical finding in neuro-ophthalmology, and is almost always accompanied by other signs of afferent visual pathway dysfunction including visual field defect, decreased acuity and abnormal colour vision. We present a case of isolated RAPD and describe the anatomic localisation of the lesion with a review of the literature for similar cases.
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A 45-year-old man presented with a slowly progressive pupil-involving third nerve palsy. Magnetic resonance imaging (MRI) revealed a tubular lesion extending from the interpeduncular cistern through the cavernous sinus and into the left orbit where it branched into a superior and an inferior division, clearly outlining the anatomy of the third cranial nerve. Multiple other, less pronounced, enlarged cranial nerves were noted. The differential diagnosis included chronic inflammatory demyelinating polyneuropathy (CIDP), hereditary motor and sensory neuropathy (HMSN), neurofibromatosis (NF), and schwannomatosis. The absence of other muscle weakness and of sensory symptoms combined with normal peripheral nerve conduction studies effectively ruled out the hypertrophic polyneuropathies and pointed to a syndromic cause of multiple benign peripheral nerve sheath tumours (PNSTs). The authors are treating this case as presumed schwannomatosis, a syndrome similar to NF2 with much lower frequency of acoustic neuromas.
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PURPOSE: To assess the efficacy of a variety of oral contrast agents in obtaining small bowel distention for computed tomography (CT) enterography examinations. METHODS: A retrospective study was developed to quantitatively assess small bowel luminal distension during CT enterography by using 4 contrast agents, which included water, Metamucil, polyethylene glycol, and lactulose. A total of 256 patients were enrolled in the study and included 64 individuals for each oral regimen. The widest loop of small bowel in each of 4 quadrants on representative coronal images was separately measured for luminal distension. Overall distension and the greatest number of "useful" quadrants were evaluated. Overall distension was calculated by summing the 4 quadrant values into an overall luminal diameter distention score (cm). A "useful" quadrant was defined as having a measurement of ≥2 cm. Each "useful" quadrant was assigned a score of 1, with values that ranged from 0-4. RESULTS: For overall distension, multivariable liner regression analysis showed that the lactulose group had a significantly higher overall distension value than Metamucil, polyethylene glycol, and water by 0.88, 0.92, and 1.63 cm, respectively, with 95% confidence interval. The categorical multivariable logistic regression analysis showed that the lactulose group had greater odds of having more "useful" quadrants than the Metamucil, polyethylene glycol, and water groups, with odds ratios of 3.51, 2.68, and 9.19, respectively. CONCLUSION: Lactulose achieves better small bowel distension for CT enterography studies than the other 3 agents and, therefore, is the preferred oral regimen at our institution.
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Meios de Contraste , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Administração Oral , Adulto , Idoso , Meios de Contraste/farmacologia , Feminino , Humanos , Intestino Delgado/efeitos dos fármacos , Lactulose/farmacologia , Masculino , Pessoa de Meia-Idade , Polietilenoglicóis/farmacologia , Psyllium/farmacologia , Estudos Retrospectivos , Água/farmacologiaRESUMO
OBJECTIVE: Acute visual impairment is the most feared complication of giant cell arteritis (GCA) but is challenging to predict. Magnetic resonance imaging (MRI) evaluates orbital pathology not visualized by an ophthalmologic examination. This study combined orbital and cranial vessel wall MRI to assess both orbital and cranial disease activity in patients with GCA, including patients without visual symptoms. METHODS: Patients with suspected active GCA who underwent orbital and cranial vessel wall MRI were included. In 14 patients, repeat imaging over 12 months assessed sensitivity to change. Clinical diagnosis of ocular or nonocular GCA was determined by a rheumatologist and/or ophthalmologist. A radiologist masked to clinical data scored MRI enhancement of structures. RESULTS: Sixty-four patients with suspected GCA were included: 25 (39%) received a clinical diagnosis of GCA, including 12 (19%) with ocular GCA. Orbital MRI enhancement was observed in 83% of patients with ocular GCA, 38% of patients with nonocular GCA, and 5% of patients with non-GCA. MRI had strong diagnostic performance for both any GCA and ocular GCA. Combining MRI with a funduscopic examination reached 100% sensitivity for ocular GCA. MRI enhancement significantly decreased after treatment (P < 0.01). CONCLUSION: In GCA, MRI is a sensitive tool that comprehensively evaluates multiple cranial structures, including the orbits, which are the most concerning site of pathology. Orbital enhancement in patients without visual symptoms suggests that MRI may detect at-risk subclinical ocular disease in GCA. MRI scores decreased following treatment, suggesting scores reflect inflammation. Future studies are needed to determine if MRI can identify patients at low risk for blindness who may receive less glucocorticoid therapy.
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A 26-year-old woman presented with painless vision loss secondary to hypertensive retinopathy in the setting of Takayasu arteritis and renal artery stenosis.
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There are a number of T1- and T2-based dynamic contrast-enhanced magnetic resonance imaging pharmacokinetic modeling approaches to study cancer microvasculature. Alternatively, model-free approaches offer an easy, quantitative assessment of microcirculation. In this work, we investigate a 6-parameter model-free approach applied to a T2*-weighted echo-planar imaging bolus response curve. We tested this new approach on a small cohort of patients with clinically diagnosed primary rectal carcinoma before adjuvant chemoradiotherapy and surgical excision. Comparison with healthy muscle tissue shows that logistic parameters P1/P2, P4, and P5 offer good discrimination between tumor and healthy tissue. Bolus response logistic parameters P4 and P5 have been implicated in previous T1-based works as being important in the assessment of cancer malignancy. Further comparison of T2* parameters with signal attenuation amplitude (maximum signal drop) and percentage baseline signal loss also corroborates the models' ability to quantify the microenvironment.
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Meios de Contraste/farmacocinética , Modelos Logísticos , Angiografia por Ressonância Magnética/métodos , Compostos Organometálicos/farmacocinética , Neoplasias Retais/patologia , Algoritmos , Humanos , Aumento da Imagem/métodos , Microcirculação , Pessoa de Meia-Idade , Neoplasias Retais/terapiaRESUMO
PURPOSE: Our objectives were to assess if diffusion-weighted imaging (DWI) can help identify abscess formation in the setting of soft tissue infection and to assess whether abscess formation can be diagnosed confidently with a combination of DWI and other unenhanced sequences. METHODS: Eight cases of soft tissue infection imaged with MRI including DWI were retrospectively reviewed. RESULTS: Two male and six female patients were studied (age range 23-50 years). Unenhanced MRI including DWI was performed in all patients. Post-contrast images were obtained in seven patients. All patients had clinically or surgically confirmed abscesses. Abscesses demonstrated restricted diffusion. DWI in conjunction with other unenhanced imaging showed similar confidence levels as post-contrast images in diagnosing abscess formation in four cases. In two cases, although the combined use of DWI and other unenhanced imaging yielded the same confidence levels as post-contrast imaging, DWI was more definitive for demonstrating abscess formation. In one case, post-contrast images had a better confidence for suggesting abscess. In one case, DWI helped detected the abscess, where gadolinium could not be administered because of a contraindication. CONCLUSION: This preliminary study suggests that DWI is a useful adjunct in the diagnosis of skeletal soft tissue abscesses.
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Abscesso/diagnóstico , Abscesso/etiologia , Imagem de Difusão por Ressonância Magnética/métodos , Fasciite/complicações , Fasciite/diagnóstico , Miosite/complicações , Miosite/diagnóstico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
PURPOSE: To perform a descriptive analysis of individuals with suspected Polyarteritis nodosa (PAN) referred for second opinion imaging consultation. METHODS: A retrospective observational cohort study was performed at a single institution. A consecutive sample was performed of individuals who underwent a second opinion CT or MR angiography subspecialty radiologist consultation between January 2008 and September 2019 for suspected abdominal medium vessel vasculitis. Demographic, clinical, and imaging data were collected. Clinical and imaging findings were reported for PAN, small vessel vasculitis, and "non-vasculitis" groups. Agreement and diagnostic accuracy between final clinical and second opinion imaging diagnoses for PAN were determined. Two-tailed t-tests with a significant p-value < 0.05 were utilized. RESULTS: Of the 58 participants, 9 were clinically diagnosed with PAN, 11 with small vessel vasculitis (including lupus, IgA, and ANCA-associated vasculitis), and 38 with non-vasculitis diagnoses. The non-vasculitis group included 15 SAM, 3 FMD, and 1 SAM-FMD spectrum diagnoses. Higher C-reactive protein level (51 vs 17, p = 0.04) and superior mesenteric artery involvement (56% vs 21%, p = 0.04) were more common in PAN than non-vasculitis diagnoses, while arterial dissection (40% vs 0%, p = 0.02) and celiac vasculature involvement (53% vs 0%, p = 0.003) were more common in the non-vasculitis group. There was 88% agreement (51/58; Cohen's kappa 0.56); sensitivity was 67% [95%-confidence interval (CI) 30-93%] and specificity was 92% (95%-CI 80-98%). CONCLUSION: Isolated celiac artery involvement and arterial dissection were more common in non-inflammatory vasculopathies than PAN. Our findings highlight the need for multidisciplinary collaboration and awareness of the diverse findings of abdominal vasculopathies.
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Poliarterite Nodosa , Radiologia , Vasculite , Humanos , Poliarterite Nodosa/diagnóstico por imagem , Encaminhamento e Consulta , Estudos Retrospectivos , Vasculite/diagnóstico por imagemRESUMO
Hepatic perfusional changes are common in response to, or as a result of, a multitude of pathological processes. These can be neoplastic, inflammatory, fibrotic, or ischemic in origin, to name a few. The liver, having a dual blood supply, is a unique organ to study using contrast-enhanced CT and MRI imaging due to its varied appearance on multiphasic imaging. Knowledge of the CT and MRI appearance of hepatic perfusional changes, in addition to the clinical presentation, can often result in an accurate differential diagnosis. Many of the conditions that cause these changes in hepatic blood flow result in similar appearances on imaging. As a result, it is important that radiologists be aware of common pitfalls when dealing with hepatic perfusional changes to prevent misdiagnosis or delayed diagnosis. As such, this review will focus on some of the various causes of hepatic perfusional changes and how to accurately identify and diagnose them based on their CT and MRI appearance.
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Neoplasias Hepáticas , Radiologia , Meios de Contraste , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Radiografia , Tomografia Computadorizada por Raios XRESUMO
The peripheral nerves of the upper limb are affected by a number of entrapment and compression neuropathies. These discrete syndromes involve the brachial plexus as well as the musculocutaneous, axillary, suprascapular, ulnar, radial, and median nerves. Clinical examination and electrophysiologic studies are the traditional mainstay of diagnostic work-up; however, ultrasonography and magnetic resonance imaging provide spatial information regarding the affected nerve and its surroundings, often assisting in narrowing the differential diagnosis and guiding treatment. Imaging is particularly valuable in complex cases with discrepant nerve function test results. Familiarity with the clinical features of various peripheral neuropathies of the upper extremity, the relevant anatomy, and the most common sites and causes of nerve entrapment assists in diagnosis and treatment.
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Neuropatias do Plexo Braquial/diagnóstico , Plexo Braquial/diagnóstico por imagem , Plexo Braquial/patologia , Diagnóstico por Imagem/métodos , Síndromes de Compressão Nervosa/diagnóstico , Técnica de Subtração , Extremidade Superior/inervação , Humanos , RadiografiaRESUMO
OBJECTIVE: Giant cell arteritis (GCA) is the most common primary vasculitis affecting the elderly population. GCA preferentially involves the extracranial branches of the carotid artery; intracranial vasculitis is thought to be a rare occurrence. This study determined the prevalence of intracranial vasculitis in a large series of patients evaluated for GCA and describes the clinical presentation of such cases. DESIGN: Retrospective chart review using a prospective database. When possible, subjects underwent high-resolution 3T contrast-enhanced magnetic resonance imaging (MRI) and MR angiography (MRA) of the scalp and intracranial arteries. PARTICIPANTS: Patients presenting with suspected GCA between January 2015 and December 2018. Four additional, non-database cases of GCA with intracranial involvement are also described. RESULTS: Of 197 patients, 168 had a contrast-enhanced MRI of the head and 51 had imaging findings suggestive of vasculitis. Five patients showed probable or definitive involvement of both the anterior and posterior intracranial circulation with isolated posterior intracranial circulation involvement in one additional patient. One of these patients showed evidence of acute posterior circulation ischemia and presented with vertigo but no evidence of ischemic optic neuropathy or ophthalmic artery enhancement. Of the 51 patients, 14 had abnormal enhancement of the ophthalmic arteries, including 1 with arteritic ischemic anterior optic neuropathy and vertebral arteritis and 1 patient with involvement of the internal carotid and posterior cerebral arteries but no reported vision changes. CONCLUSION: Although uncommon, clinicians should be aware that GCA can directly involve the intracranial circulation with both the anterior and posterior circulation affected in most of our cases.
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Arterite de Células Gigantes , Neuropatia Óptica Isquêmica , Idoso , Arterite de Células Gigantes/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Artéria Oftálmica , Estudos RetrospectivosRESUMO
BACKGROUND: Surgical decision-making in the case of postpartum complications affecting fibroids can be difficult. We present a case that illustrates the potential role of MRI in assisting these decisions. CASE: A 28-year-old woman with a known uterine leiomyoma presented on postpartum day 10 with abdominal pain, fever, and foul-smelling vaginal discharge. Her condition improved after antibiotic therapy, but she subsequently returned to hospital with a liquefied fibroid filling the vagina and a solid mass palpable above the dilated cervix. Pelvic ultrasound did not conclusively identify the vascular supply or myometrial involvement of the mass. MRI identified one fundal vascular pedicle and a very thin posterior uterine wall. At abdominal myomectomy, the myometrium was found to be only minimally involved, and the fundal vascular pedicle was easily cross-clamped. CONCLUSION: When available, MRI can be used to clarify the location of vascular pedicles and the extent of myometrial involvement of uterine fibroids, and it can assist in fibroid-related surgical decision-making.
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Tomada de Decisões , Leiomioma/cirurgia , Imageamento por Ressonância Magnética , Transtornos Puerperais/cirurgia , Neoplasias Uterinas/cirurgia , Feminino , Humanos , Leiomioma/patologia , Neoplasias Uterinas/patologiaRESUMO
BACKGROUND: Cholesteatoma is a destructive, erosive growth of keratinizing squamous epithelium in the middle ear cleft. Following treatment with a canal wall-up (CWU) tympanomastoidectomy, surveillance of residual and recurrent disease has traditionally been achieved through a second look tympanotomy following the initial procedure. Historically, MRI sequences have been inadequate at differentiating between granulation tissue, inflammation, and cholesteatoma. Recent literature has shown diffusion-weighted magnetic resonance imaging (DWMRI) to be a viable alternative to second look surgery for the detection of residual or recurrent disease. The goal of the present study was to perform a cost analysis of DWIMRI versus second look surgery in the detection of residual or recurrent cholesteatoma following combined approach tympanomastoidectomy. METHODS: A probabilistic decision tree model was generated from a literature review to compare traditional second look surgery with DWMRI. Cost inputs were obtained from the Ontario Case Costing Initiative, the Ontario Health Insurance Plan (OHIP) schedule of benefits. Costs were reported in Canadian dollars and a payer perspective was adopted. A probabilistic sensitivity analysis was performed. RESULTS: According to the probabilistic sensitivity analysis, mean cost difference of traditional second look tympanotomy versus echo planar imaging (EPI) DWMRI was $180.27CAD, 95%CI [$177.32, $188,32] in favour of second-look tympanotomy. However, mean cost difference of traditional second look tympanotomy versus non-EPI DWMRI was $390.66CAD, 95%CI [$381.52, $399.80] in favour of non-EPI DWMRI. CONCLUSIONS: Diffusion-weighted MRI, specifically non-EPI sequences, are a viable cost-saving alternative to second-look tympanotomy in the setting of detecting residual or recurrent cholesteatoma.
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Colesteatoma da Orelha Média/diagnóstico , Colesteatoma da Orelha Média/cirurgia , Imagem de Difusão por Ressonância Magnética/economia , Cirurgia de Second-Look/economia , Canadá , Custos e Análise de Custo , Árvores de Decisões , Humanos , Recidiva , Sensibilidade e EspecificidadeRESUMO
Spontaneous CSF-venous fistulas may be present in up to one-fourth of patients with spontaneous intracranial hypotension. This is a recently discovered type of CSF leak, and much remains unknown about these fistulas. Spinal CSF-venous fistulas are usually seen in coexistence with a spinal meningeal diverticulum, suggesting the presence of an underlying structural dural weakness at the proximal portion of the fistula. The authors now report the presence of soft-tissue venous/venolymphatic malformations associated with spontaneous spinal CSF-venous fistulas in 2 patients with spontaneous intracranial hypotension, suggesting a role for distal venous pathology. In a third patient with spontaneous intracranial hypotension and a venolymphatic malformation, such a CSF-venous fistula is strongly suspected.
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Vazamento de Líquido Cefalorraquidiano/cirurgia , Hipotensão Intracraniana/cirurgia , Malformações Vasculares/complicações , Malformações Vasculares/cirurgia , Adulto , Vazamento de Líquido Cefalorraquidiano/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Feminino , Fístula/líquido cefalorraquidiano , Fístula/complicações , Fístula/diagnóstico , Humanos , Hipotensão Intracraniana/complicações , Hipotensão Intracraniana/diagnóstico , Masculino , Pessoa de Meia-Idade , Mielografia/métodos , Coluna Vertebral/cirurgia , Malformações Vasculares/diagnóstico , Veias/cirurgiaRESUMO
OBJECTIVE: To examine the concordance between high-resolution magnetic resonance imaging (MRI) of the scalp arteries and temporal artery biopsy for the diagnosis of giant cell arteritis (GCA). METHODS: We conducted a prospective cohort study of patients with suspected GCA. Participants underwent high-field 3T MRI of the scalp arteries followed by temporal artery biopsy. Arterial wall thickness and enhancement on multiplanar postcontrast T1-weighted spin-echo images were graded according to a published severity scale (range 0-3). MRI findings were compared with temporal artery biopsy results and the American College of Rheumatology (ACR) criteria for GCA. RESULTS: One hundred seventy-one patients were included in the study. Temporal artery biopsy findings were positive in 31 patients (18.1%), and MRI findings were abnormal in 60 patients (35.1%). ACR criteria were met in 137 patients (80.1%). With temporal artery biopsy as the reference test, MRI had a sensitivity of 93.6% (95% confidence interval [95% CI] 78.6-99.2) and a specificity of 77.9% (95% CI 70.1-84.4). The corresponding negative predictive value of MRI was 98.2% (95% CI 93.6-99.8) and positive predictive value was 48.3% (95% CI 35.2-61.6). CONCLUSION: In patients with suspected GCA, normal findings on scalp artery MRI are very strongly associated with negative temporal artery biopsy findings. This suggests that MRI could be used as the initial diagnostic procedure in GCA, with temporal artery biopsy being reserved for patients with abnormal MRI findings.
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Artérias/diagnóstico por imagem , Arterite de Células Gigantes/diagnóstico por imagem , Arterite de Células Gigantes/patologia , Imageamento por Ressonância Magnética , Couro Cabeludo/irrigação sanguínea , Idoso , Biópsia , Estudos de Coortes , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Estudos ProspectivosRESUMO
INTRODUCTION: Solitary fibrous tumor is a rare, mesenchymal neoplasm that has been reported in numerous sites. Occurrence in the parotid gland is exceedingly rare. CASE REPORT: A 53-year-old man with a 2 cm solitary fibrous tumor of the left parotid gland, that was observed clinically and operatively and thought to be a neoplasm arising from Stensen's duct, is described. A pre-operative CT scan demonstrated a well-circumscribed, solid, avidly-enhancing nodule superficial to the masseter muscle, deep to the platysma, and intimately associated with the parotid duct. Multiple fine needle aspirations yielded scant fibrous tissue and lymphocytes. A superficial parotidectomy was performed. The histopathological and immunohistochemical findings were in keeping with solitary fibrous tumor, fibrous variant, with a low mitotic rate and a peripherally-entrapped parotid duct surrounded by abundant periductal collagen and lymphocytes. At a 2-year follow up, there was no evidence of tumor recurrence or metastasis. CONCLUSION: Solitary fibrous tumor should be suspected in the context of a slow-growing, well-circumscribed, solid, avidly-enhancing nodule of the parotid gland. Grossly intimate association with the parotid duct may reflect peripheral entrapment. Fine needle aspirations that predominantly yield collagen without spindle cell clusters should be correlated with clinical and radiological findings, as it is expected in tumor sampling of the fibrous variant. Although solitary fibrous tumor of the parotid gland usually exhibits benign behavior, it is best regarded as potentially malignant. Patient management and follow-up should be tailored to each individual and clinicopathological risk assessment of the recurrent/metastatic potential.