Liver Masses: What Physicians Need to Know About Ordering and Interpreting Liver Imaging.

PURPOSE OF REVIEW: This paper reviews diagnostic imaging techniques used to characterize liver masses and the imaging characteristics of the most common liver masses. RECENT FINDINGS: The role of recently adopted ultrasound and magnetic resonance imaging contrast agents will be emphasized. Contrast-enhanced ultrasound is an inexpensive exam which can confirm benignity of certain liver masses without ionizing radiation. Magnetic resonance imaging using hepatocyte-specific gadolinium-based contrast agents can help confirm or narrow the differential diagnosis of liver masses.

MRI of the stomach: a pictorial review with a focus on oncological applications and gastric motility.

The purpose of this pictorial review is to demonstrate gastric pathology seen on magnetic resonance imaging (MRI) and discuss the essential MRI sequences for the evaluation of benign and malignant gastric pathologies. Common tumors of the stomach, polyposis syndromes, iatrogenic conditions, as well as other conditions of the stomach will be reviewed. The utility of MRI in the evaluation of patients with gastric malignancies and disorders of gastric motility will also be discussed.

Combined hepatocellular and cholangiocarcinoma (biphenotypic) tumors: imaging features and diagnostic accuracy of contrast-enhanced CT and MRI.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic accuracy of preoperative imaging for diagnosis of combined hepatocellular cholangiocarcinoma tumors and to evaluate the clinical and imaging features and demographics of patients presenting to our institution with such tumors. MATERIALS AND METHODS: From January 2001 to January 2011, 29 patients presented with pathologically proven combined hepatocellular cholangiocarcinoma tumors to our institution. A retrospective review of the imaging studies, clinical data, and demographic information in these patients was conducted. Two radiologists with 6 and 18 years of experience reviewed the imaging studies of patients with combined hepatocellular cholangiocarcinoma tumors and matched control cases of hepatocellular carcinoma (HCC) (n = 15) and cholangiocarcinoma (n = 18). The reviewers were blinded to the pathologic diagnosis. Imaging features on contrast-enhanced MRI and CT with the suggested final diagnosis were recorded. RESULTS: The demographics of our patient population were similar to other reported U.S. populations, with cirrhosis and hepatitis present in a minority of patients. The imaging features of combined hepatocellular cholangiocarcinoma tumors overlapped with those of HCC and cholangiocarcinoma. The correct diagnosis of combined hepatocellular cholangiocarcinoma tumors was made in a minority of cases by either radiologist, with misdiagnosis more often leading to suggestion of cholangiocarcinoma than HCC. Sensitivities and specificities for diagnosis of combined hepatocellular cholangiocarcinoma tumors ranged from 33% to 34% and 81% to 100%, respectively. CONCLUSION: Preoperative diagnosis of combined hepatocellular cholangiocarcinoma tumors on the basis of imaging features is accurate in the minority of cases. Tumor markers and risk factors may help improve accuracy; however, in the absence of classic imaging features and supportive information for HCC or cholangiocarcinoma, biopsy should be considered for confirmation of diagnosis.

Retrievable inferior vena cava filters in neurosurgical patients: Retrieval rates and clinical outcomes.

OBJECTIVE: To assess inferior vena cava (IVC) filter retrieval rates and clinical outcomes in neurosurgical patients and to determine patient characteristics associated with filter retrieval. PATIENTS AND METHODS: This single-center retrospective study included 204 consecutive neurosurgical patients (120 men, 84 women; mean age 60 ± 13 years) who underwent retrievable IVC filter insertion between 1/2011-9/2013. Institutional IVC filter database review was used to identify demographic and clinical data, indication for IVC filtration, and IVC filter type. Patients were followed clinically by the neurosurgical, hematology, and interventional radiology services until removal or conversion to a permanent device. Measured outcomes included filter retrieval rates and parameters associated with device removal. RESULTS: The majority of filters were placed for venous thromboembolism (200/204, 98%). Of 204 filters, 38(19%) were retrieved at median 186 days post-placement (range 3-665 days), 112(55%) converted to permanent devices, 44(22%) patients were deceased, and 10(5%) patients were lost to follow-up after transfer to an outside healthcare facility. Patients with subarachnoid hemorrhage (18% vs. 35%, p = 0.025) and malignancy (5% vs. 25%, p = 0.009) were less likely to have filters removed. Filter type (p = 0.475), gender (p = 0.221), neurosurgical procedure (p = 0.639), and insurance status (p = 0.207) did not demonstrate a significant association with filter retrieval. CONCLUSION: IVC filter retrieval rates in neurosurgical patients are low despite tracking patients clinically in a multidisciplinary setting. Those neurosurgical patients with intracranial hemorrhage or malignancy requiring IVC filters have a lower likelihood of filter retrieval and may benefit from use of permanent devices.

Cerebral Embolization of Ethiodized Oil following Intranodal Lymphangiography.

Intranodal lymphangiography (IL) has supplanted pedal lymphangiography (PL) as an easier and more practical approach to opacifying lymphatic vessels for interventional radiologists treating refractory chyle leaks. As more interventional radiologists-many of who are not trained in or have not performed PL-incorporate IL into their practice, it is imperative that they be familiar with the risks of lymphangiography, including pulmonary and systemic embolization of oily contrast material. Herein, the authors report a devastating case of cerebral embolization of ethiodized oil following IL and review the literature regarding systemic embolization following lymphangiography.