OBJECTIVETo analyze the value of MR imaging in diagnosis of intraductal papillary neoplasm of the bile duct (IPN-B).

METHODSFourteen patients with intraductal papillary neoplasms of the bile duct confirmed by surgical pathology were included in this study. The patients underwent MR routine plain scanning and enhancement scanning (including T1WI, T2WI with fat suppression, FALSH T1WI, and three-phase enhancement scanning), diffusion weighted imaging(DWI) and magnetic resonance cholangiopancreatography (MRCP) before operation. The imaging data were reviewed and analyzed retrospectively in comparison with the surgical and pathological results.

RESULTSIn these patients, 7 cases had tumors located in the left lobe, 2 cases had tumors in both the left and right lobes, 2 cases in the hepatic hilum, 2 cases in the common bile duct, and 1 case in both the right lobe and the common bile duct. Solitary or multiple intraductal masses could be found in 12 cases, with 11 cases appeared as papillary masses and one case as flat mass. In the other two cases the tumor was not visible (one case had too many stones, and in another case the tumor was too small). The tumors in the 12 cases showed hypointensity on T1WI and hyperintensity on T2WI. On the dynamic contrast-enhanced MRI, 11 cases showed mild and one showed moderate enhancement in arterial phase, and all the cases showed mildly and gradually delayed enhancement. On DWI, the lesion areas showed high signal intensity in all the cases, and the ADC value of the tumor area (1.697×10(-3)mm(2)/s) was significantly lower than that of the normal bile (3.973×10(-3)mm(2)/s) (t = -10.94, P < 0.05). Twelve cases demonstrated filling defects on primary MRCP coronary thin section images. On 3D-reconstruction MRCP images, 7 cases exhibited diffuse bile duct dilatation with the tumor areas more prominent, 3 cases exhibited aneurysmal bile dilatation, while the rest 4 cases exhibited segmental or lobar bile duct dilatation ( including 2 with invisible tumors ). In the 3 cases with aneurysmal bile dilatation, the multiple directions of MRCP images helped to find the communication between the aneurysmal dilatation and the bile duct. All the cases showed significant proximal bile duct dilatation (the extent of dilatation >100%), and 9 cases also showed distal bile duct dilatation. Bile duct stones were noted in 6 cases, 4 at the tumor area, and the other 2 away from the tumor area. No adjacent tissue invasion and no distal tissue or lymph node metastasis were observed.

CONCLUSIONIntraductal papillary neoplasms of the bile ducts have characteristic imaging appearances on MRI, and MRI is an important method helpful to making correct diagnosis.

Bile Duct Neoplasms ; diagnosis ; Bile Ducts ; Cholangiopancreatography, Magnetic Resonance ; Common Bile Duct ; Diagnostic Imaging ; Diffusion Magnetic Resonance Imaging ; Humans ; Magnetic Resonance Imaging ; Retrospective Studies

Objective To explore and evaluate MRI in diagnosing primary muscle non-Hodgkin lymphoma. Methods Six surgically confirmed primary muscle non-Hod#in lymphoma underwent MR examination including T_1WI, T_2WI and T_1 WI enhanced studies. The acquired images date was reviewed and analysed retrospectively in comparison with surgical and pathological results. Results The locations of 6 cases were cervical part (2), upper extremity (1), lower extremity (3), respectively. All cases involved of more than one anatomical compartment with poorly defined solid masses in 5 cases and well defined in 1 cases, 5 extended to subcutaneous fat and 3 extended along the neurovascular bundle. The mean tumor diameter was 13.9 cm, ranging from 7.3 to 22.5 cm. One was well demarcated and 5 were ill-defined. On T_1 WI, 2 were slighdy high signal intensity and 4 were slighdy low signal intensity. On T_2 WI, 2 were slightly high signal intensity, 3 were intermediate signal intensity and 1 was high signal intensity. Five were inhomogeneous and 1 was homogeneous. The intrinsic structure such as muscle fiber, tendo, spatium intermusculare were detected on 5 cases. Of the 5 dynamic contrast-enhanced cases, it showed moderate enhamcement during arterial phase, 2 were homogeneous and 3 were inhomogeneous. And it showed progressive enhancement during interstitial phase, 3 were homogeneous and 2 were inhomogeneous. Conclusions Primary muscle lymphoma always originated deep to the fascia showing subcutaneous extension and multiple compartment invasion. Typically form poorly defined solid masses with slightly high in signal intensity on MR T_2WI and middle degree dynamic delayed contrasted-enhanced in which intrinsic anatomic structure such as muscle fiber, tendo, spatium intermusculare and so on can be discerned, almost all cases involve more than one muscle compartment and some of tumor extend along the neurovascular bundle.

Objective To correlate CT findings of secondary hepatic lymphoma with pathology and to evaluate it's clinical value.Methods Nine patients with secondary hepatic lymphoma confirmed by pathology underwent spiral CT scanning and dual-phase dynamic contrast-enhancement scanning before operation, the CT data were reviewed and analysed retrospectively in comparison with surgical and pathological results.Results Twenty-three lesions of secondary hepatic lymphoma in 9 patients were located in the left lobe (9 lesions), the fight lobe (6 lesions),the porta of the liver (5 lesions) and the caudate lobe (3 lesions), respectively.Sixteen of these 23 lesions were distributed over an area near the portal vein, 7 were seattered in the exterior of liver.17 lesions had an ellipsoid contour and 6 showed irregular contour.The diameter of the lesions ranged from 2.7 to 16.5 cm, with a mean diameter of 5.9cm.The tumor demonstrated mild homogeneous dynamic delayed contrasted-enhancement and the CT value of the non-contrast scans, AP phases and PVP phases were 20.7 to 31.5 HU(with a mean value of 25.3 HU), 23.8 to 48.5 HU(with a mean value of 31.9 HU) and 35.3 to 60.2 HU(with a mean value of 47.8 HU) respectively.Intrinsic hepatic vessels could be discerned in 6 lesions.The lesions situated in the perta of the liver encased the portal vessels, but there was no vessel compression or occlusion.Conclusion Recognition of the dynamic CT features of hepatic lymphoma could enhance its diagnostic accuracy.

Objective To Explore the imaging features relative to pathology of pelvic chondrosarcoma and to evaluate the clinical value.Methods All 12 cases patients with primary pelvic chondrosarcoma confirmed by pathological examination underwent radiography,spiral CT plain scanning,MR SE-T1WI,FSE-T2WI and SE-Tl WI enhancement scanning before operation.The imaging data was reviewed and analyzed retrospectively to compare with surgical and pathological results.Results Eleven conventional chondrosarcoma and one dedifierentiated chondrosarcoma were located in different parts of pelvis.The diameters of the tumors ranged from 4.7 to 17.0 cm with one case less than 5.0 cm,6 cases being 5.O-10.0 am and 5 cases more than 10.0 Cln.The CT valHe of 5 cases was identical or inferior to muscle with mild to moderate"ring-and-arc"mineralization and soft mass.MR imaging depict the high water content of these lesions as very high signal intensity was detected on T2 WI.Six cases showed typical"ring-and-arc"fibrous tissue which enhanced persistently.Aggressive features of deep endosteal scalloping and soft-tissue extension was also found in these cases.Conclusions Radiographic findings Can suggest the diagnosis of pelvic chondrosarcoma when there is typical"ring-and.arc"fibrous tissue,mineralization,aggressive features of deep endosteal scalloping and large soft-tissue extension.MR imaging reflect directly this pathologic structure,superior to that of CT and radiography.CT is optimal to detect the matrix mineralization,particularly when it is subtle or when the lesion is located in anatomically complex pelvic areas.

Objective To explore the imaging features of primary malignant fibrous histiocytoma(MFH)of bone and correlate them with pathological findings.Methods Thirteen cases patients with primary MFH of bone confirmed by surgical pathology underwent radiography,spiral CT plain scanning and MR SE-T1 WI,T2 WI and SE-T1 WI enhancement scanning before operation.The imaging date was reviewed and analysed retrospectively in comparison with surgical and pathological results.Results Of 13 MFH,11 were located in the end of long bone,and 2 in the diaphysis.The distance between tumors in the end of long bone and adjacent joint surface was 1 to 5 cm.All lesions showed osteolytic destruction with the maximum diameter of the tumors from 5.3 to 12.7 cm.The tumors had eccentric aggressive osteolytic destruction in 10 lesions,internal crest within the lesions in 7,inconsecutive marginal osteosclerosis in 11,little periosteal reaction in 2 and small soft tissue masses in 9,respectively.The CT value of lesions was similar to muscle.MR imaging depicted low signal intensity with aggressive features on T1 WI,iso to slight high signal intensity on T2 WI,and middle or high degree contrast enhancement on enhanced T1 WI images.Macroscopically,MFH was usually located eccentrically within the bone and produced little or no osseous expansion.The soft tissue component appeared multi-nodules and pseudo-encapsulated.Histologically,they consisted of spindle-shaped fibroblasts,which radiated outward in a spiral array from a central focus and produced a nebula or storiform appearance,and cells,which were small and oval with little visible cytoplasm.Conclusions The imaging manifestations of MFH were specific to some extent.Combined utilization of plain X-ray,CT,and MRI is helpful for the diagnosis and differential diagnosis of MFH.

Angiography ; Female ; Hepatic Artery ; abnormalities ; diagnostic imaging ; Humans ; Middle Aged ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVESTo study the usefulness of CT virtual colonoscopy (CTVC) in patients with incomplete conventional colonoscopy (CC) and assess the statistical differences between two methods of colorectal segment examination.

METHODSSixty patients with incomplete CC underwent volume scanning using spiral CT. CT VC images were obtained using a navigator software in workstation. All patients were confirmed by surgical or CC biopsy histology. Statistical analysis was done using t test comparing two sample percentages.

RESULTSCTVC succeeded in 55/60 patients (91.7%) who had incomplete CC. Additional lesions were identified in the proximal colon in 15/55 patients (27.3%), including 1 primary carcinoma, 16 polyps in 13 patients and 1 ulcerative colonitis. The main cause of incomplete CC was occlusive mass; others were redundant, tortuous colon loops, and excessive colonic spasm. There was a statistically significant difference between the two methods in colorectal segment examination.

CONCLUSIONCTVC is a feasible and effective adjunctive method for evaluating the entire colorectal segment following an incomplete CC procedure. It offers a new approach for colorectal examination.

Adult ; Aged ; Colonoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; methods

OBJECTIVETo investigate intratumoral microvessel density (MVD) and expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (BFGF) in hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) and to evaluate their significance.

METHODSMVD and expression of VEGF and BFGF in cancerous tissues were examined in forty specimens resected from patients with HCC using immunohistochemical methods. Among these patients, 20 patients received 1 to 7 treatments of TACE prior to II-phase surgical resection (TACE group), the other 20 patients were treated by operation without receiving any other treatment preoperatively (surgical group). There was no significant difference in clinical features between the two groups. MVD was assessed by counting immunostained endothelial cells within a certain area, and staining intensity of VEGF was assessed quantitatively with computer-assisted image analyzer. The expression of BFGF was determined by cell-positive or cell-negative.

RESULTSThe average MVD was 130.51 75.5 in TACE group and 152.35 58.80 in surgical group. There was no significant difference between the two groups (t=-1.021, P=0.341). Staining intensity of VEGF was 645.60 543.27 in TACE group, higher than in surgical group (158.28 188.48, t=281, P<0.001). BFGF-positive rate was 35% in TACE group and 40% in surgical group. There was no significant difference (x(2)=0.107, P=0.744).

CONCLUSIONSThe results indicate that survived cancerous tissue has rich vascularity and the expression of VEGF of the cancerous cells can be enhanced by TACE which may play an important role in reestablishment of blood supply to tumor after TACE.

Carcinoma, Hepatocellular ; metabolism ; pathology ; physiopathology ; therapy ; Catheterization ; Embolization, Therapeutic ; Endothelial Growth Factors ; biosynthesis ; Fibroblast Growth Factor 2 ; biosynthesis ; Humans ; Liver Neoplasms ; metabolism ; pathology ; physiopathology ; therapy ; Lymphokines ; biosynthesis ; Neovascularization, Pathologic ; Vascular Endothelial Growth Factor A ; Vascular Endothelial Growth Factors

Adult ; Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; methods ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; therapy ; Catheterization ; Chemoembolization, Therapeutic ; Diagnostic Imaging ; methods ; Follow-Up Studies ; Humans ; Iodized Oil ; Liver Neoplasms ; diagnostic imaging ; pathology ; therapy ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; methods

OBJECTIVETo investigate role of exocrine cells in the pancreatic enhancement images at Manganese (II) N, N'-dipyridoxylethlenediamine-N, N'-diacetate 5, 5'-bisc (Mn-DPDP)-enhanced magnetic resonance (MR) imaging.

METHODSArtificial pancreatic leakage was constructed in six dogs using a fistula tube inserted into the duodenum papillae. Pancreatic juice was collected before and after intravenous infusion of 2 ml/kg of Mn-DPDP at a rate of 2 - 3 ml/min. The Mn content of pancreatic juice was measured by atomic absorption spectroscopy. T(1)-weighted spin-echo images and T(1)-weighted spoiled phase gradient-echo (SPGR) images were obtained prior and approximately 30 min after the administration of Mn-DPDP at 1.5T.

RESULTSThe Mn content of pancreatic secretion increased 60.47 +/- 21.83 micro g/dl after the administration of Mn-DPDP (t = 6.785, P < 0.01). The signal/noise ratio (S/N) of the pancreas increased 53 percent +/- 49 percent and 62 percent +/- 44% on T(1)W spin echo images and SPGR images, respectively.

CONCLUSIONSExocrine cells of the pancreas can absorb manganese and excrete it through the pancreatic juice. Exocrine cells play an important role in the enhancement of the pancreas in MR imaging with Mn-DPDP.

Animals ; Contrast Media ; Dogs ; Edetic Acid ; analogs & derivatives ; pharmacokinetics ; Image Enhancement ; Magnetic Resonance Imaging ; Manganese ; pharmacokinetics ; Pancreas ; anatomy & histology ; metabolism ; Pyridoxal Phosphate ; analogs & derivatives ; pharmacokinetics