Crohn's disease: A retrospective analysis between computed tomography enterography, colonoscopy, and histopathology.

INTRODUCTION: To investigate the spectrum of computed tomography enterography (CTE) findings of active Crohn's disease (CD) in comparison to endoscopic, histopathologic and inflammatory markers. METHODS: Hospital records of 197 patients with known or suspected CD who underwent CTE over a period of 5 years were reviewed. Eighty-nine patients fulfilled the inclusion criteria. Three-point severity scores for endoscopy, pathology, and haematologic inflammatory markers were recorded. The findings on CTE were identified by three readers and correlated with endoscopic, pathologic, and haematologic severity scores. Statistical analysis was carried out employing a Pearson Chi square test and Fisher exact test. Receiver operating characteristic (ROC), visual grading characteristic (VGC) and Cohens' kappa analyses were performed. RESULTS: The CTE findings which were significantly correlated with the severity of active disease on endoscopy include bowel wall thickening, mucosal hyperenhancement, bilaminar stratified wall enhancement, transmural wall enhancement, and mesenteric fluid adjacent to diseased bowel (p < 0.05). Only bowel wall thickening and bilaminar stratified wall enhancement correlated with the pathological severity of active CD. ROC and VGC analysis demonstrated significantly higher areas under the curve (p < 0.0001) together with excellent inter-reader agreement (k = 0.86). CONCLUSION: CTE is a reliable tool for evaluating the severity of active disease and helps in the clinical decision pathway.

Ductal cysts of the accessory lacrimal glands: CT findings.

Benign ductal cysts of the accessory lacrimal glands are uncommon lesions of the orbit, arising from the glands of Wolfring and Krause. We report two patients with histopathologically proved cysts in whom CT scans revealed well-circumscribed extraconal cystic lesions adjacent to the globe, involving both eyelids. Radiologists should be aware of these rare lesions so as to include them in the differential diagnosis of orbital cysts.

Perineurioma (localized hypertrophic neuropathy).

Three patients with localized hypertrophic neuropathy ( LHN ) had a painless, slowly progressive mononeuropathy over many years, resulting in severe focal neurologic deficit. Grossly, the affected nerves showed a fusiform enlargement. Histologically, there was loss of nerve fibers, disorganization of the fascicular pattern, and proliferation of elongated cells with whorl formation. These cells exhibited no immunoreactivity for S-100 protein, and ultrastructural features set them apart from Schwann's cells. We conclude that LHN is not a disorder caused by hyperplasia of Schwann's cells but a benign peripheral nerve tumor of perineurial cell origin. This study also suggests that perineurial and Schwann's cells may not derive from the same precursor element.

Unenhanced spiral CT scan in the initial evaluation of renal colic: AUBMC experience.

BACKGROUND AND OBJECTIVE: Until recently, intravenous urography and ultrasonography have been the standard diagnostic modalities in the initial evaluation of acute flank pain. However, since 1995 the role of non-enhanced CT scan (NECT) has become more important in establishing the diagnosis of renal colic. In this retrospective descriptive study, we evaluated the usefulness of NECT in the diagnosis and management of patients with suspected urinary tract stones at the American University of Beirut-Medical Center (AUBMC). MATERIALS AND METHODS: We reviewed the records of 102 patients who presented to AUBMC over a period of two years for flank pain with or without hematuria. NECT were obtained in all patients. We studied the images for the presence of stones and frequency of associated urinary findings. Incidental abdominal and pelvic abnormalities were recorded. RESULTS: Fifty-four patients were found to have positive CT examinations for the presence of urinary tract stones on the ipsilateral side of the flank pain. Twenty-two stones were present in the kidneys, 23 in the ureters and 16 at the ureterovesical junction (UVJ). In these 54 patients with stone disease, 31 had associated pelvicalyceal dilatation (57%), and 16 had perinephric streaking (29.6%). In the 39 patients with ureteral and UVJ stones, 26 had ureteral dilatation (66.6%), and 17 had periureteral streaking (43.5%). In the 23 patients with only ureteral stones, 10 had a positive rim sign (43.4%). CONCLUSION: A diagnosis of urinary tract stone is not always readily apparent on the basis of physical exam and laboratory studies. NECT is now universally accepted as a preferred method for the evaluation of ureteral and kidney stones in patients with suspected renal colic.

A preliminary investigation of Beta-hCG expression in patients with osteosarcoma.

There are eight reported cases in the literature of osteosarcomas secreting ß-hCG. Our primary aim was to investigate the rate of ß-hCG expression in osteosarcoma and attempt to understand the characteristics of osteosarcomas that secrete ß-hCG. We reviewed 37 histopathology slides (14 biopsies and 23 surgical specimens) from 32 patients with osteosarcoma. The slides were retrospectively stained for ß-hCG expression. Patient and tumour characteristics, including age, gender, tumour location, subtype, proportion of necrosis, presence of metastases and recurrence were recorded. A total of five of the 32 tumours were found to be positive for ß-hCG expression (one strongly and four weakly). This incidence of this expression was found in tumours with poor histological response to neoadjuvant chemotherapy. The use of ß-hCG expression as a diagnostic, prognostic or follow-up marker is questionable and needs further investigation with a larger sample size.

Aberrant cervical thymus in an infant: an unusual cause of stridor.

We report an 8-month-old infant presenting with stridor caused by a nonpalpable neck mass discovered at imaging and surgery. The diagnosis of aberrant thymic tissue was confirmed at histopathology. The authors reviewed the literature and discuss the embryology, imaging findings and differential diagnosis of this rare disorder.

Tibial and fibular developmental fields defects.

Malformations of the lower limbs are rare and heterogeneous anomalies. To explain the diversity and complexity of these abnormalities, authors introduced the concept of tibial and fibular developmental fields. Defects in these fields are responsible for different malformations, which have been described, to our knowledge, in only one report in the radiology literature. We present a case of a newborn with femoral bifurcation, absent fibulae and talar bones, ankle and foot malformations, and associated atrial septal defect. Our case is an example of defects in both fibular and tibial developmental fields.

MRI diagnosis of diabetic muscle infarction: report of two cases.

Diabetic muscle infarction (DMI) is a rare complication of diabetes mellitus occurring in patients with poorly controlled insulin-dependent diabetes. In previous reports, the diagnosis of this condition was based on the pathologic studies, although MRI examinations were performed in a few patients as part of the diagnostic work-up. In this report, we describe two additional cases of DMI where the diagnosis was based on the MRI findings in conjunction with the clinical picture and laboratory studies. The patients usually present with thigh or calf pain and swelling, are afebrile, and have normal white blood cell count. MRI examination typically shows diffuse swelling and increased signal intensity on T2-weighted images in the affected muscles, with no focal fluid collections. In the proper clinical setting, these findings are diagnostic of DMI and patients should be spared unnecessary invasive diagnostic examinations such as lower extremity venograms and biopsies.

Peroneus longus and brevis tendon tears: MR imaging evaluation.

PURPOSE: To evaluate magnetic resonance (MR) findings of surgically proved peroneal tendon tears. MATERIALS AND METHODS: MR images, medical records, and surgical findings were retrospectively reviewed in the cases of 12 patients who underwent surgery because of suspected peroneal tendon tear (14 tendons). Sagittal and oblique axial T1-weighted spin-echo and T2-weighted fast spin-echo images were obtained in all patients. RESULTS: At surgery, isolated peroneus longus tendon tears were seen in four patients, isolated peroneus brevis tendon tears in five, and both peroneus brevis and peroneus longus tendon tears in two. When correlated with surgical findings, findings at MR imaging were correct in 12 tendons. Findings were false-positive in two patients and false-negative in one, who underwent surgery anyway because unrelated abnormal MR findings were present. The most common MR finding was increased intra-substance signal intensity on T1- and T2-weighted images (11 tendons), in linear or rounded areas on oblique axial images (n = 11) and in linear areas along the longitudinal axis of the tendons on sagittal images (n = 7). Tendon distortion was noted in severe cases (five tendons). The most frequent surgical finding was a longitudinal tendon tear (split) (10 tendons). CONCLUSION: MR imaging enabled detection of peroneus brevis and peroneus longus tendon tears.

Intraarticular foot and ankle injections to identify source of pain before arthrodesis.

OBJECTIVE: The purpose of our study was to evaluate the usefulness of diagnostic joint injections in patients with foot and ankle pain when the radiologist attempts to identify the source of pain. This study also correlated the results of injection with outcome after arthrodesis. MATERIAL AND METHODS: We retrospectively reviewed the records of 22 patients who had a foot or ankle joint injected to identify a source of pain and who later underwent arthrodesis of the painful joint. All patients had long-term foot and ankle symptoms of variable causes. Twenty-four joints were assessed: 13 subtalar, five talonavicular, four ankle, one calcaneocuboid, and one metatarsocuneiform. All patients had plain radiographs, 11 had CT studies, and five had bone scans. Contrast material was used to assess adequate positioning of the needle inside the joint before injection. All joints were injected under fluoroscopic control. Steroid was added in eight joints. After injection, patients were assessed for relief of symptoms. Patients subsequently underwent arthrodesis on the basis of the results of the injection. RESULTS: In 20 patients (22 joints), long-term follow-up showed that injections allowed us to correctly identify the source of pain and successfully guide arthrodesis. Of these 20 patients, 17 had significant pain relief after injection and fusion, whereas three patients had mild or no response. With one of these patients, we injected other joints and changed surgical plans. One of the two remaining patients had more pain relief after injection than after arthrodesis. The other patient had no relief after injection, but subsequent fusion because of persistent pain was successful. We found imaging studies to be less useful than diagnostic injections when we were attempting to identify the source of pain. CONCLUSION: Intraarticular injection of anesthetic in painful foot and ankle joints helped us confirm the source of pain in 20 of 22 patients, which in turn led to successful arthrodesis and good outcomes for these patients.

MR imaging of posterior tibial tendon dysfunction.

OBJECTIVE: The purpose of this study was to describe the MR findings of posterior tibial tendon dysfunction. MATERIALS AND METHODS: MR images and medical records were reviewed for 11 patients with surgically proven posterior tibial tendon abnormalities (i.e., tears or tenosynovitis) and for six patients with clinical evidence of posterior tibial tendon dysfunction. Our study group included 16 women and one man from 37 to 70 years old (mean, 53.5 years old). MR examinations used T1-weighted and T2-weighted spin-echo sequences in the oblique axial and sagittal planes. RESULTS: Abnormal MR findings were observed in all 17 patients. The spectrum of MR abnormalities included fluid in the tendon sheath of a normal tendon interpreted as isolated paratenonitis (tenosynovitis, n = 3); tendon thickening and surrounding fluid with normal tendon signal interpreted as tendinosis (degeneration, n = 1); tendon thickening with increased linear or heterogeneous intrasubstance signal interpreted as partial tear (n = 11); tendon discontinuity with fluid-filled tendon sheath interpreted as complete rupture (n = 2). In 11 patients, the posterior tibial tendon was explored at surgery. In these patients, MR imaging accurately showed two cases of isolated paratenonitis, one case of tendinosis, four partial tears, and two complete ruptures. In the remaining two patients, the presumed MR diagnosis did not correlate very closely with the surgical findings: one patient with isolated paratenonitis shown by MR imaging had tendinosis found at surgery; however, the surgery in this patient followed the MR examination by 10 months, a time during which degeneration might have occurred. The other patient had an MR diagnosis of partial tear, which was not found at surgery; however, tendon degeneration was severe and a small tear not reaching the tendon surface could have been missed at inspection. MR imaging characteristics of severe tendinosis and partial tear may overlap. CONCLUSION: MR imaging is effective for detecting abnormalities related to posterior tibial tendon dysfunction. Familiarity with the appearance of these changes facilitates accurate characterization.

Metastatic rhabdomyosarcoma to the breast.

Rhabdomyosarcoma is a common extramammary primary malignancy in childhood that rarely metastasises to the breast. We present a patient with primary sinonasal rhabdomyosarcoma who was in remission when she developed breast metastases. We describe particular imaging findings of this disease, using ultrasound and MR imaging. To our knowledge, MR findings have only been described in one previous case report in the literature.

Use of limited MR protocol (coronal STIR) in the evaluation of patients with hip pain.

OBJECTIVE: To assess the role of a limited MR protocol (coronal STIR) as the initial part of the MR examination in patients with hip pain. DESIGN AND PATIENTS: Eighty-five patients presenting with hip pain, and normal radiographs of the pelvis, and who underwent our full MR protocol for hips were included retrospectively in the study. The full protocol consists of coronal T1-weighted and short tau inversion-recovery (STIR), and axial T2-weighted sequences. Ninety-three MR examinations were performed. Two radiologists interpreted the STIR (limited) examinations and the full studies separately, masked to each other's findings and to the final diagnosis. Comparison between the two protocols was then undertaken. RESULTS: For both readers, all normal MR examinations on the coronal STIR limited protocol were normal on the full protocol, with an interobserver reliability of 0.96. The STIR protocol was able to detect the presence or absence of an abnormality in 100% of cases (sensitivity). The STIR-only protocol provided a specific diagnosis in only 65% of cases (specificity). CONCLUSION: A normal coronal STIR study of the hips in patients with hip pain and normal radiographs precludes the need for further pelvic MR sequences. Any abnormality detected on this limited protocol should be further assessed by additional MR sequences.

Perirenal fluid in renal parenchymal medical disease ('floating kidney'): clinical significance and sonographic grading.

AIM: To study the clinical significance and radiologic features of perirenal fluid in patients with renal parenchymal disease. MATERIALS AND METHODS: During the previous 5 years, nine patients were found to have perirenal fluid on sonography associated with renal parenchymal medical disease. The clinical, radiological, histopathological and laboratory data were analysed. RESULTS: The perirenal fluid is a spontaneous subcapsular transudate in patients suffering from a nephropathy with a sodium retention state, with or without renal failure. Three sonographic patterns of perirenal fluid were observed: grade 1 is a thin layer of perirenal fluid; grade 2 is a moderate amount of perirenal fluid collection with indentations of the renal parenchyma and strands in the fluid, grade 3 is a large fluid collection surrounding the kidney. CONCLUSION: The perirenal fluid represents a sign of sodium retention state and oedema in patients with intrinsic renal parenchymal medical disease which may be caused by several nephropathies.

Unilocular hepatic echinococcal cysts: sonography and computed tomography findings.

AIM: In endemic regions, unilocular hepatic echinococcal cysts (HEC) may be difficult to differentiate radiologically from simple non-parasitic cysts, especially if serological tests were negative. The aim of this descriptive study is to elucidate distinctive imaging findings that allow a diagnosis of HEC. MATERIALS AND METHODS: The sonographic and computed tomography (CT) findings of 21 patients with proven unilocular HEC were retrospectively analysed. A total of 28 examinations were reviewed, including 14 sonograms (ultrasound; US) of the liver and 14 CT studies. RESULTS: Seven imaging features that help in the diagnosis of unilocular HEC were identified by US and/or CT in 14 patients (14/21; 66.6%). They are, by order of frequency: hydatid sand (29.2%), focal or segmental thickening of the cyst wall (29.2%), coexistent echinococcal cysts in the spleen or lungs (16.6%), pericystic biliary radicles dilatation (8.3%), atrophy of the right lobe with compensatory hypertrophy of the left hepatic lobe (8.3%), satellite cysts typical of HEC in the liver (4.2%) and pericyst calcification (4.2%). CONCLUSION: These ancillary signs should prompt us to consider HEC as the cause of a unilocular cyst in approximately two-thirds of patients.