American Journal of Roentgenology

OBJECTIVE. This study was designed to investigate whether the use of MR diskography would result in improved reader confidence over the use of CT diskography alone for evaluating foraminal impingement causing lumbar radiculopathy.

SUBJECTS AND METHODS. Sixteen disk levels in 14 consecutive patients with suspected foraminal impingement causing lumbar radiculopathy were prospectively included in the study. A mixture of diluted gadodiamide and iodinated contrast material was injected at each disk level. After diskography, a CT scan (CT diskography) and T1-weighted fat-suppressed MR image (MR diskography) were obtained. Two spine radiologists and an orthopedic spine surgeon independently scored CT diskography and MR diskography for foraminal evaluation on a 3-point scale: 1, low confidence; 2, moderate confidence; and 3, high confidence. Each reader also assessed whether MR diskography showed an additional benefit over CT diskography with regard to the depiction of foraminal abnormalities only. Another radiologist reviewed conventional MR images focused on disk height and morphology.

RESULTS. The reviewers' confidence scores for MR diskography were superior to those for CT diskography (reader 1, p = 0.00008; reader 2, p = 0.0008; reader 3, p = 0.0015) (p < 0.05). MR diskography was considered beneficial in 13 of 16 disk levels (reader 1), 14 of 16 (reader 2), and 14 of 16 (reader 3). MR diskography increased the confidence scores for the detection of foraminal impingement, especially in cases of severe disk degeneration, but did not show additional benefits in cases of an extensive vacuum in the disk or large disk extrusion.

CONCLUSION. Simultaneous MR diskography and CT diskography with a mixture of gadodiamide and iodinated contrast material may be beneficial for evaluating foraminal impingement causing lumbar radiculopathy.

OBJECTIVE. The purpose of this study was to analyze the sonographic appearance of a large series of pathologically proven ganglia.

MATERIALS AND METHODS. A computer search of sonography and pathology reports for hand and wrist ganglia was performed. All sonography reports and images were reviewed for ganglion size, location, presence of a neck, echogenicity, acoustic enhancement, locules, color Doppler flow, margins, wall thickness, and calcifications and to determine if the ganglion was palpable or collapsed. All pathology reports were reviewed for histologic features that were then correlated with the sonographic images. Ganglia were categorized into three groups: simple, complex cystic, and solid-appearing.

RESULTS. Of 60 ganglia, 34 were complex, 91% of which were located within the dorsal or volar wrist; 97% had well-defined margins; 76%, locules; 68%, acoustic enhancement; 47%, a thick wall; 15%, internal reflectors; and 12%, blood flow. Of the 23 simple ganglia, 11 involved the extensor or flexor tendon sheath, 73% of which were simple. Complex ganglia had a larger mean volume than simple. Three ganglia were solid-appearing. A visible neck was seen in 25% of ganglia.

CONCLUSION. Most ganglia are complex rather than simple on sonography. Complex ganglia are larger than simple ganglia; located within the dorsal or volar wrist; and usually have well-defined margins, thick walls, locules, and acoustic enhancement. A small percentage have blood flow and internal reflectors. Simple ganglia are smaller and can occur within the volar or dorsal wrist, or flexor tendon sheath. Most flexor tendon sheath ganglia are simple rather than complex. Solid-appearing ganglia, although unusual, may mimic a benign neoplasm or synovitis.

OBJECTIVE. The purpose of this study was to investigate the in vivo morphologic and elastic parameters of trabecular bone with high-resolution 3-T MRI in a healthy reference population.

SUBJECTS AND METHODS. A series of wrist MR images were acquired with high-spatial-resolution (180 μm) isotropic voxels from 40 subjects without reported bone disease. After image postprocessing, the bone volume-to-total volume ratio, trabecular thickness, trabecular separation, and trabecular number were calculated in the morphologic analysis. Trabecular bone was mechanically simulated using the finite-element method to calculate the apparent elastic modulus parameter. The relationship between morphologic and mechanical parameters was studied. The influence of the analyzed bone volume was also investigated.

RESULTS. Statistically significant sex influences were found on the bone volume-to-total volume ratio (p = 0.003), trabecular thickness (p = 0.02), and apparent elastic modulus (p = 0.01); these parameters were lower in women. However, trends were found only on trabecular separation (p = 0.06) and trabecular number (p = 0.07). Age had no statistically significant influence in any morphologic (bone volume-to-total volume ratio, r = –0.24, p = 0.13; trabecular thickness, r = –0.03, p = 0.88; trabecular separation, r = 0.12, p = 0.47; and trabecular number, r = –0.23, p = 0.16) or elastic (apparent elastic modulus, r = –0.18, p = 0.26) parameter. A statistically significant relationship between apparent elastic modulus and the square of bone volume-to-total volume ratio was found (r = 0.968, p < 0.001). This association was not seen (r = 0.185, p = 0.25) and apparent elastic modulus results were considerably different (p < 0.001) if the volume of analyzed bone was reduced.

CONCLUSION. We found that bone volume-to-total volume ratio, trabecular thickness, and apparent elastic modulus are parameters significantly influenced by sex. Apparent elastic modulus results show a relationship with bone volume-to-total volume ratio. Trabecular bone volume should be maximized for an appropriate mechanical analysis.

OBJECTIVE. Posterolateral rotatory instability of the elbow is a diagnosis largely made by clinical examination; no relevant radiographic signs have been reported. We have seen four patients with an osseous defect and detachment of a fragment of bone in the posterolateral margin of the capitellum. These patients had chronic posterolateral rotatory instability of the elbow.

CONCLUSION. An osseous defect of the posterolateral corner of the capitellum is an uncommon finding that in each instance was associated with chronic posterolateral rotatory instability of the elbow. We termed this lesion the “Osborne-Cotterill lesion.” We report our findings in these patients; when this lesion is diagnosed, clinicians should consider posterolateral rotatory instability.

OBJECTIVE. The purpose of this article is to present the cases of four consecutive patients with preoperative MR diagnosis of humeral avulsion of the glenohumeral ligament (HAGL) who had no evidence of HAGL at arthroscopy.

CONCLUSION. These four cases suggest that the diagnosis of HAGL should be reserved for arthroscopy and illustrate the difficulty in distinguishing HAGL from other abnormalities of the inferior glenohumeral ligament complex with MRI. Thus, MRI findings classically associated with HAGL should be more broadly described as defects of the inferior glenohumeral ligament complex. This terminology more accurately describes the abnormalities of the inferior glenohumeral ligament complex that may be depicted by MRI.

OBJECTIVE. The purpose of our study is to review the accuracy of our method of non-imaging-guided anterior glenohumeral gadolinium contrast injection targeting the rotator interval in 100 consecutive patients.

MATERIALS AND METHODS. One hundred consecutive community-referred patients at our MRI facility underwent non-imaging-guided glenohumeral contrast injection targeting the rotator interval, with no patients excluded on the basis of expected diagnosis. The studies were then retrospectively reviewed for accuracy of injection based on patient factors and diagnosis.

RESULTS. This method was 99% accurate in our study, regardless of diagnosis.

CONCLUSION. The relative ease, efficiency, reproducibility, and accuracy of this method of non-imaging-guided anterior glenohumeral injection make it the method of choice at our institution, and we believe this technique merits consideration for more widespread utilization.

OBJECTIVE. The purpose of this article is to describe the imaging findings after laparoscopic cholecystectomy, including the normal postoperative findings and the typical appearances of major complications. The relative merits of the imaging techniques available are discussed.

CONCLUSION. Laparoscopic cholecystectomy is a commonly performed surgical procedure and radiologists are often called on to identify or rule out postoperative complications. In such cases, the correct diagnosis is crucial in optimizing patient management.

OBJECTIVE. Current generation MDCT technology facilitates identification of small, nonenhancing lesions in the pancreas. The objective of this study was to determine the prevalence of findings of unsuspected pancreatic cysts on 16-MDCT in a population of adult outpatients imaged for disease unrelated to the pancreas.

MATERIALS AND METHODS. Contrast-enhanced MDCT scans of the abdomen were reviewed from 2,832 consecutive examinations to identify pancreatic cysts. Patients with a history of pancreatic lesions or predisposing factors for pancreatic disease or who were referred for pancreatic CT were excluded.

RESULTS. A total of 73 patients had pancreatic cysts, representing a prevalence of 2.6 per 100 patients (95% CI, 2.0–3.2). Cysts ranged in size from 2 to 38 mm (mean, 8.9 mm) and were solitary in 85% of cases. Analysis of demographic information showed a strong correlation between pancreatic cysts and age, with no cysts identified among patients under 40 years and a prevalence of 8.7 per 100 (95% CI, 4.6–12.9) in individuals from 80 to 89 years. After controlling for age, cysts were more common in individuals of the Asian race than all other race categories, with an odds ratio of 3.57 (95% CI, 1.05–12.13). There was no difference by sex in the prevalence of cysts (p = 0.527); however, cysts were on average 3.6 mm larger (p = 0.014) in men than women.

CONCLUSION. In this outpatient population, the prevalence of unsuspected pancreatic cysts identified on 16-MDCT was 2.6%. Cyst presence strongly correlated with increasing age and the Asian race.

OBJECTIVE. The purpose of this study was to evaluate the clinical significance of endoleaks detected on combined arterial and delayed contrast-enhanced follow-up CT examinations of patients who have undergone endovascular aneurysm repair of abdominal aortic aneurysm.

MATERIALS AND METHODS. One hundred forty-four patients underwent periodic follow-up CT examinations 12–72 months after abdominal aortic aneurysm repair. The CT protocol consisted of an unenhanced scan and contrast-enhanced scans in the arterial and 90-second delayed phases. The endoleaks detected on dual-phase CT scans were evaluated in association with the outcome (therapeutic intervention or endoleak resolution).

RESULTS. The 144 patients underwent 728 CT examinations with a mean follow-up period of 35.5 ± 14.5 months. Fifty endoleaks were detected in 50 (34.7%) of the patients. Eight endoleaks were detected in the arterial phase only, eight in the delayed phase only, and 34 in both phases. Intervention was performed to manage 16 endoleaks detected in both phases. CT showed that three endoleaks were stable (two in the arterial phase only and one in both phases) and that 31 had resolved completely (six in the arterial phase only, eight in the delayed phase only, and 17 in both phases). This finding represents a higher frequency of resolution of endoleaks detected in one phase only than in both phases (Fisher's exact test, p = 0.006).

CONCLUSION. Endoleaks detected only in the delayed phase of CT had resolved spontaneously without intervention. Therefore, we can consider eliminating the delayed phase of acquisition to minimize radiation exposure.

OBJECTIVE. The objective of our study was to illustrate various CT findings of peritoneal mesotheliomas, to review their clinicopathologic features, and to discuss the differential diagnoses.

CONCLUSION. The clinicopathologic features of peritoneal mesotheliomas vary among the subtypes such as malignant mesotheliomas, cystic mesotheliomas, and well-differentiated papillary mesotheliomas, and accordingly, there is a spectrum of CT appearances.

OBJECTIVE. Visceral artery aneurysms are uncommon, but they are clinically important because of the high incidence of rupture and life-threatening hemorrhage. Visceral artery aneurysms in patients with vascular anatomic variations are extremely rare, but detecting these variations is significant in this setting to determine the best treatment strategy; therefore, a thorough assessment of the aneurysm and of the vascular anatomy before treatment is paramount.

CONCLUSION. Three-dimensional contrast-enhanced MR angiography is a noninvasive technique for the diagnosis and display of visceral artery aneurysms. It can provide 3D anatomic information that is needed for surgery or embolization.

OBJECTIVE. The purpose of this article is to review the CT appearance of postoperative morphology and complications after surgical correction of congenital heart anomalies.

CONCLUSION. Echocardiography is typically the initial imaging technique used for congenital heart disease; however, some thoracic regions are beyond the imaging scope of echocardiography, particularly after surgical revision. This article shows, through a series of illustrative cases, the usefulness of 64-MDCT in these patients.

OBJECTIVE. The objective of our study was to use MRI to analyze the topographic localization of myocardial lesions and their relationship to plasma brain natriuretic peptide (BNP) levels and several cardiac function parameters in patients with cardiac sarcoidosis.

MATERIALS AND METHODS. Delayed contrast-enhanced MRI was performed in 40 patients with sarcoidosis (11 cardiac, 29 extracardiac cases). Using a 29-segment model of the left ventricle (LV), the extent of myocardial hyperenhancement was visually scored (0 = no hyperenhancement, 1 = 1–25%, 2 = 26–50%, 3 = 51–75%, 4 = 76–100% hyperenhancement) and was compared with plasma BNP level and several parameters of cardiac function.

RESULTS. Ten of the 11 patients with cardiac sarcoidosis showed myocardial hyperenhancement, whereas none of the 29 patients without cardiac sarcoidosis did. In patients with cardiac sarcoidosis, hyperenhancement was significantly more extensive in basal short axis slices than in apical short axis slices (p < 0.0005). Myocardial hyperenhancement was significantly more frequent in subepicardial layers than in subendocardial layers. The global extent of myocardial hyperenhancement was significantly correlated with plasma BNP levels and the LV end-diastolic volume index and was negatively correlated with the LV ejection fraction.

CONCLUSION. In patients with cardiac sarcoidosis, myocardial lesions detected on delayed contrast-enhanced MRI were predominantly localized in the basal and subepicardial myocardium. The extent of myocardial lesions may be related to LV dysfunction and plasma BNP level in patients with cardiac sarcoidosis.

OBJECTIVE. The purpose of this study was to determine whether a dedicated coronary CT protocol provides adequate contrast enhancement and artifact-free depiction of coronary, pulmonary, and aortic circulation.

MATERIALS AND METHODS. Dedicated coronary 64-MDCT data sets of 50 patients (27 men; mean age, 54 ± 12.4 years) consecutively admitted from the emergency department with suspected acute coronary syndrome were analyzed. Two independent observers graded overall coronary arterial image quality and qualitative and quantitative contrast opacification, motion, and streak artifacts within the pulmonary arteries and aorta.

RESULTS. Coronary image quality was excellent in 48 patients (96%) and moderate in two patients (4%). Eleven left main and 22 left upper lobar pulmonary arteries were not visualized. Qualitative evaluation showed pulmonary arterial tree opacification to be excellent except for the right and left lower lateral and posterior segmental branches (52–54% rate of poor opacification). Quantitative evaluation showed four central (8%), six lobar (8%), and 206 segmental (29%) branches had poor contrast opacification (< 200 HU). Nineteen right upper lobar arteries (38%) were slightly and one was severely affected by streak artifact. At the segmental pulmonary artery level, marked differences in contrast enhancement were detected between the upper (292 ± 72 HU) and both the middle (249 ± 85 HU) and the lower lobes (248 ± 76 HU) (p < 0.01). Mean aortic opacification was 300 ± 34 HU with excellent contrast homogeneity without severe motion or streak artifacts.

CONCLUSION. In the evaluation of patients presenting to the emergency department with suspected acute coronary syndrome, a dedicated coronary CT protocol enables excellent assessment of the coronary arteries and proximal ascending aorta but does not depict the pulmonary vasculature well enough for exclusion of pulmonary embolism.

OBJECTIVE. The purpose of this study was to compare the frequency of detection of pulmonary nodules on cardiac CT scans acquired with a limited field of view with the frequency of detection at full field of view.

CONCLUSION. Viewing of cardiac CT scans obtained only at a limited field of view can result in missing more than 67% of nodules larger than 1 cm and more than 80% of nodules smaller than 1 cm.

OBJECTIVE. We explored the potential for patients with proven venous thromboembolism or pulmonary embolism (PE) to have occult malignancies detected during the same CT examination. To verify this, we compared the presence of occult malignancies identified on pulmonary artery CT angiography (CTA) and CT venography (CTV) when venous thromboembolism (VTE) was present.

SUBJECTS AND METHODS. Pulmonary artery CTA combined with CTV was performed on a 16-MDCT scanner on 186 adult patients suspected of having pulmonary embolism without any known malignancies. CTV was performed from the diaphragm to the knee 180 seconds after CTA. Two radiologists evaluated the presence of VTE, that is PE or deep venous thrombosis (DVT), and tumor lesions on both examinations in consensus. The malignant nature of the possibly identified tumors was confirmed by pathologic examination.

RESULTS. VTE was found in 49 patients (26%). Malignant tumors were detected in 24 patients (13%). Eleven patients with malignant tumors had VTE (46% of patients with malignant tumors; 22% with VTE and 6% of all patients). There was correlation with presence of malignancies between both and DVT and DVT associated with PE but not between presence of malignancies and PE only. Patients with DVT and those with DVT associated with PE had a risk ratio of 3.2 and 3.3, respectively, for having a malignant tumor discovered simultaneously.

CONCLUSION. A high number of malignant tumors can be incidentally discovered on pulmonary artery CTA, even more so with additional CTV. Radiologists should scrutinize scans to pick up unknown malignancies, especially in patients with identified VTE.

OBJECTIVE. Pulmonary tuberculosis (TB) is a common worldwide infection and a medical and social problem causing high mortality and morbidity, especially in developing countries. The traditional imaging concept of primary and reactivation TB has been recently challenged, and radiologic features depend on the level of host immunity rather than the elapsed time after the infection. We aimed to elaborate the new concept of the diagnosis and treatment of pulmonary TB, to review the characteristic imaging findings of various forms of pulmonary TB, and to assess the role of CT in the diagnosis and management of pulmonary TB.

CONCLUSION. Fast and more accurate TB testing such as bacterial DNA fingerprinting and whole-blood interferon-γ assay has been developed. Miliary or disseminated primary pattern or atypical manifestations of pulmonary TB are common in patients with impaired immunity. CT plays an important role in the detection of TB in patients in whom the chest radiograph is normal or inconclusive, in the determination of disease activity, in the detection of complication, and in the management of TB by providing a roadmap for surgical treatment planning. PET scans using ¹⁸F-FDG or ¹¹C-choline can sometimes help differentiate tuberculous granuloma from lung malignancy.

OBJECTIVE. The vibration response imaging device that we studied (VRIxp) records the intensity and location of lung sounds during a cycle of breathing. The goals of this study were to describe the characteristic features and quantitative lung data recorded by the VRIxp device from healthy asymptomatic subjects.

SUBJECTS AND METHODS. Breath sounds (frequency range, 150–250 Hz) recorded from the backs of 151 healthy asymptomatic subjects (96 nonsmokers and 55 smokers) by the VRIxp device were mapped to create a sequence of 2D images. Three raters interpreted and scored the images for predefined static and dynamic features. In addition, quantitative lung data were analyzed for characteristic regional distributions.

RESULTS. The readers of the images had good inter- and intrarater agreement. Image development in 93% of the evaluations showed an inspiratory and expiratory phase with a progressive and regressive stage that developed bilaterally in a vertical and synchronized manner. Characteristic image features of the maximum energy frame included a smooth, rounded, uninterrupted contour and a planar distribution, area size, and intensity that had right–left symmetry. Quantitative lung data expressed as percentages of the total (100%) vibration energy were normally distributed with mean values (± SD) of 55% ± 6% for the left lung and 45% ± 6% for the right lung. Most of the subjects with images, quantitative lung data, or both lacking these typical features were cigarette smokers or had a history of smoking (p < 0.05).

CONCLUSION. Breath sounds in healthy asymptomatic subjects can be recorded and displayed in a dynamic series of images that have predictable and characteristic features recognizable and complemented by quantitative lung data. Identification and description of these characteristic image features in this study will facilitate future studies of vibration imaging in specific pulmonary diseases.

OBJECTIVE. The purpose of this study was to evaluate the usefulness of low-dose MDCT for radiologic monitoring of patients who have undergone placement of bronchial stents for airway bypass.

SUBJECTS AND METHODS. In a prospective study, seven patients underwent MDCT according to a low-dose protocol (40 mAs, 120 kVp) before and after stent placement. The positions of the stents in the segmental bronchi were analyzed and compared with the bronchoscopic findings, which were reference standard. Patency versus lack of patency of stents was classified with five levels of confidence, and a definitive diagnosis was assigned to each stent. Prediction of stent dislodgment, follow-up findings, and complications occurring during the observation period were recorded. Consensus reading was performed by two radiologists. Statistical analysis was conducted by receiver operating characteristic analysis or four-field table.

RESULTS. Seven patients underwent implantation of 37 stents (mean, 5 ± 2 [SD] stents per patient; range, 2–8 stents). The area under the curve for differentiating patent from occluded stents was 0.995 with resulting sensitivity and specificity of 86.5% and 98.1%. The correct diagnosis of patency was established with MDCT for all but one stent (sensitivity, 94.7%; specificity, 100%). Sensitivity and specificity for prediction of dislodgment were 80% and 91%. Five stents were not identified during inspection bronchoscopy but were found in a regular position at MDCT. Three instances of minor bleeding and one of pneumothorax resolved spontaneously. The mean effective dose of the scan was 1.3 ± 0.6 mSv.

CONCLUSION. Low-dose MDCT is feasible for radiologic monitoring after airway bypass procedure.

OBJECTIVE. This article will review the current role of MDCT and 3D imaging in the diagnosis and management of adults with enteroenteric intussusception.

CONCLUSION. Because of significant advancements in CT along with its increasing use, detection of enteroenteric intussusceptions by CT has increased. These findings are sometimes in asymptomatic patients, often transient, and without an identifiable lead point. This has complicated the management of adult patients with intussusception because not every patient with intussusception may need surgery.

OBJECTIVE. The purpose of this study was to examine the relation between the CT whirl sign and outcome among patients with a clinical and radiologic diagnosis of small-bowel obstruction (SBO).

MATERIALS AND METHODS. The cases of 453 patients who underwent abdominal CT because of clinical suspicion of SBO were reviewed retrospectively. Patients with a radiologic diagnosis of SBO were included. Management with surgery or medical therapy was correlated with the presence of the whirl sign and other radiologic findings. Statistical calculations were performed to determine the value of the whirl sign in predicting the type of management needed for SBO.

RESULTS. According to CT criteria, 194 patients received a diagnosis of SBO and were included in the study. The whirl sign was identified on the CT scans of 40 of the 194 patients. Thirty-two of the 40 patients had SBO necessitating surgery, for a positive predictive value of 80%; 133 of 154 patients did not need surgery, for a negative predictive value of 86%. Fifty-three of 194 patients either underwent surgery or died of SBO during conservative therapy. The whirl sign was present on the CT scans of 32 of the 53 patients, for a sensitivity of 60%. One hundred thirty-three of 141 patients did not need surgery and did not have a whirl sign, for a specificity of 94%. The odds ratio for the whirl sign in predicting the presence of SBO necessitating surgery was 25.3 (95% CI, 10.3–62.3).

CONCLUSION. A patient with the whirl sign on CT is 25.3 times as likely as a patient without the sign to have SBO necessitating surgery. The results suggest an important role of the whirl sign in assessment of treatment options for patients with clinical and radiologic signs of SBO.

OBJECTIVE. This study was designed to quantify and characterize the air-containing thoracic esophagus on CT to help diagnose diseases and facilitate correlation with lung diseases that may be associated with aspiration.

SUBJECTS AND METHODS. The maximal air-containing esophageal lumina on each section of standard CT scans of 110 subjects were measured. These subjects came from a cohort of 10,132 self-reported healthy individuals who underwent CT for measurement of coronary artery calcium. Measurements were interpolated to account for variation in the length of the thoraces.

RESULTS. Greater than 60% of the esophageal segments contained no air. On average the maximum air column was 10.5 (SD, 5.0) mm. Only 7.9% of the lumina were > 10 mm. Only 2% were > 15 mm, and only 0.2% were > 20 mm. The average number of lumina > 10 mm as a proportion of the entire esophageal length was 8% (14%). The average size at the carina was 2.6 (4.1) mm. In the upper 30% and from 61% to 75% down the length of the esophagus, < 5% of the lumina were > 10 mm. Less than 3% of subjects had air in the lowest two sections, indicating that the normal lower esophageal sphincter was closed.

CONCLUSION. Esophageal air of > 10 mm should be considered abnormal in all segments except between the cardiac ventricles and lower esophageal sphincter. In this area, > 15 mm should be considered abnormal. An air–fluid level is abnormal.

OBJECTIVE. The objective of this study was to compare the diagnostic accuracy of tumor staging in patients with advanced esophageal cancer based on contrast-enhanced CT findings alone with that based on a combination of CT and double-contrast esophagography and to evaluate the relevance of tumor stage to survival rate.

MATERIALS AND METHODS. In 94 patients who underwent surgery as the primary treatment for esophageal cancer and had a diagnosis of postoperative T stage 3 (pT3) or pT4 disease based on pathologic examination, T stage was evaluated using CT alone and using a combination of CT and double-contrast esophagography. The diagnostic criterion for T4 disease using CT alone was tumor strongly displacing or deforming adjacent organs. The diagnostic criterion for T4 disease using the combined method was tumor displacing or deforming adjacent organs in the direction that corresponded to the direction of the location of the tumor or the deepest ulcer as diagnosed by barium esophagography. Concordance of T staging based on imaging with postoperative T staging based on pathology results, the gold standard, and survival rate were assessed for CT alone and for the combined method.

RESULTS. The concordance rate with postoperative T staging pathology results was 78% for CT alone and 84% for CT and double-contrast esophagography combined, with a significant difference between the two diagnostic methods. For patients with a diagnosis of T3 and those with a diagnosis of T4 using CT alone, the 3-year survival rate was 42% and 26%, respectively, with no significant difference between the two. For patients with a diagnosis of T3 and those with a diagnosis of T4 using the combined method, the 3-year survival rate was 42% and 21%, respectively, with a significant difference between the two.

CONCLUSION. The diagnostic performance of contrast-enhanced CT and double-contrast esophagography combined in staging advanced esophageal tumors is better than that of CT alone and thus has potential for estimating prognosis.

OBJECTIVE. The purpose of this study was to determine the frequency and appearance of esophageal wall thickening on CT scans in a series of patients with findings of diffuse esophageal spasm on barium studies.

CONCLUSION. CT revealed marked esophageal wall thickening in seven (21%) of 33 patients who had findings of diffuse esophageal spasm on barium studies. CT showed significantly greater esophageal wall thickening in the lower thoracic esophagus 5 cm above the gastroesophageal junction than in the upper thoracic esophagus at the level of the aortic arch or in the midthoracic esophagus at the level of the carina (p < 0.01). This esophageal wall thickening corresponded to the presence of multiple strong nonperistaltic contractions in the lower thoracic esophagus on barium studies. Our findings suggest that diffuse esophageal spasm should be included in the differential diagnosis when CT shows smooth circumferential wall thickening in the lower half of the thoracic esophagus, particularly in elderly patients with dysphagia or chest pain.

OBJECTIVE. The purpose of our study was to report the results of screening CT colonography (CTC) in an asymptomatic average-risk Asian population.

MATERIALS AND METHODS. In 2005 and 2006, 1,015 Korean adults (609 men and 406 women; mean age, 51 years) underwent screening CTC using a 16-MDCT scanner and an automated CO₂ delivery system. During the study period, the protocols were changed to use less vigorous purgation and lower radiation doses; fecal tagging (n = 890) and primary 3D interpretation (n = 966) were generally used. CTC results were categorized as C0, inadequate; C1, no significant polyp; C2, one or two 6- to 9-mm polyps; C3, polyps ≥ 10 mm or ≥ three 6- to 9-mm polyps; and C4, mass. Patients with positive CTC results were referred to gastroenterologists for follow-up or management planning.

RESULTS. Categories C0–C4 were assigned to 21 (2.1%), 916 (90.2%), 54 (5.3%), 23 (2.3%), and one (0.1%) patients, respectively. Fifty-four patients with C4 (n = 1), C3 (n = 20), or C2 (n = 33) underwent subsequent optical colonoscopy: complete (n = 53) and incomplete (n = 1). Per-patient positive predictive values (PPVs) for categories C3–C4 and C2–C4 were 90% (18/20) and 74% (39/53), respectively. Per-polyp PPVs at 10- and 6-mm thresholds were 92% (22/24) and 69% (45/65), respectively. The diagnostic yield for advanced neoplasm was 1.5% (15/1,015).

CONCLUSION. Our results seem comparable to Western experiences, showing that a successful screening CTC program can be reproduced in an Asian population.

OBJECTIVE. Parathyroid adenomas cause hypercalcemia and are culprits in the development of renal stone disease. With serum assays available, early detection of parathyroid tumors is possible. We performed this retrospective review to determine whether the prevalence of nephrocalcinosis and nephrolithiasis is still increased in patients with primary hyperparathyroidism compared with those not affected by the disorder in view of the early detection of parathyroid adenomas.

MATERIALS AND METHODS. We retrospectively reviewed the renal sonograms of 271 patients with surgically proven primary hyperparathyroidism. All patients had undergone renal imaging within 6 months before parathyroid surgery. Our control group consisted of 500 age-matched subjects who had right upper quadrant sonograms obtained for various reasons.

RESULTS. Nineteen (7.0%) of the 271 patients with primary hyperparathyroidism had renal stones, and eight (1.6%) of the 500 subjects in the control group had stones. Pearson's chi-square analysis showed that this difference in prevalence is significant (p < 0.0001).

CONCLUSION. Our results showed a fourfold increased prevalence of asymptomatic renal stone disease in patients with surgically proven primary hyperparathyroidism compared with subjects not affected by the disorder. The National Institutes of Health consensus conference on asymptomatic primary hyperparathyroidism recommended that patients with renal stone disease undergo parathyroid surgery. These patients should undergo surgery even if they have minimal or no elevation of the total serum calcium value and no other metabolic manifestations of hyperparathyroidism. The finding of nephrocalcinosis or nephrolithiasis is, therefore, a significant finding in evaluating patients for parathyroid surgery. Routine imaging of the kidneys is necessary when primary hyperparathyroidism is documented.

OBJECTIVE. Renal volumetry is an essential part of split renal function assessment in MR urography. The aim of this study was to assess the accuracy and repeatability of a 3D segmentation algorithm based on the belief functions theory for calculating renal volumes from MR images.

MATERIALS AND METHODS. The true volumes of 20 animal kidneys of various sizes were obtained by fluid displacement. Each kidney was examined using two different MR units. Three-dimensional proton density–weighted acquisitions with an incremental slice thickness were performed. The MR volume was then measured with a segmentation algorithm based on the belief functions theory. Two independent observers performed all segmentations twice. Accuracy, intraobserver variability, and interobserver variability were evaluated by the Bland-Altman method. The number and type of manual corrections were recorded as well as the entire processing time.

RESULTS. The mean renal volume estimated by fluid displacement was 114 mL (range, 38–224 mL). With regard to the renal volumes obtained from assessments of adjacent axial MR images, the maximal SDs of the difference were 2.2 mL (accuracy), 0.6 mL (intraobserver variability), and 1.8 mL (interobserver variability). Segmentation of axial slices provided better accuracy and reproducibility than coronal slices. Overlapped coronal slices yielded poor results because of the partial volume effect. The mean processing time including optional manual modifications was less than 75 seconds.

CONCLUSION. The belief functions theory can be considered an accurate and reproducible mathematic method to assess renal volume from MR adjacent images.

OBJECTIVE. The purpose of this study was to review the imaging features of congenital variants of and pathologic conditions affecting the brachiocephalic vein.

CONCLUSION. CT and MRI are excellent for visualizing developmental anomalies and mediastinal tumors that involve the brachiocephalic vein. Although they affect this vein less commonly than do developmental anomalies and tumors, trauma, aneurysm formation, stenosis related to dialysis or other conditions, and various complications related to central venous catheters do occur, and familiarity with the imaging findings is helpful for diagnosis.

OBJECTIVE. The objective of our study was to determine the diagnostic value of analyzing the pattern of gallbladder wall enhancement on MDCT to characterize diffuse gallbladder wall thickening as benign or malignant.

MATERIALS AND METHODS. MDCT scans obtained during the portal venous phase in 78 patients with gallbladder wall thickening caused by various pathologic conditions were retrospectively reviewed by two blinded observers. The CT features of benign and malignant gallbladder wall thickening were compared by means of univariate and multivariate analyses. The study cases were then divided into five patterns according to enhancement pattern. Using these five patterns, two radiologists reviewed the MDCT images and recorded their diagnostic confidence for differentiating benign versus malignant cause on a 5-point scale. The diagnostic performance of CT was evaluated by each observer using a receiver operating characteristic curve analysis.

RESULTS. The thicknesses of the inner and outer layers (“thick” enhancing inner layer ≥ 2.6 mm, “thin” outer layer ≤ 3.4 mm), strong enhancement of the inner wall, and irregular contour of the affected wall were significant predictors for a malignant cause of gallbladder wall thickening (p < 0.001). The two-layer pattern with a strongly enhancing thick inner layer and weakly enhancing or nonenhancing outer layer and the one-layer pattern with a heterogeneously enhancing thick layer were patterns that were significantly associated with gallbladder cancer (p < 0.05). When we consider those two enhancing patterns as a sign of malignancy, the diagnostic accuracy of MDCT was 89.1% and 87.6% for the two observers, respectively.

CONCLUSION. Analyzing the enhancement pattern of a thickened gallbladder wall on MDCT is helpful in differentiating gallbladder cancer from benign inflammatory diseases.

OBJECTIVE. The purpose of this study is to estimate the optimal time delay before the initiation of arterial phase scanning for detection of hypervascular hepatocellular carcinoma (HCC) on 16-MDCT when a rapid bolus injection of contrast medium is administered.

SUBJECTS AND METHODS. In this prospective study, 25 patients (19 men and six women; mean age, 63.5 years; age range, 50–81 years) with pathologically confirmed HCC were included. Dynamic 16-MDCT imaging was performed in cine mode using 70 mL of nonionic iodinated contrast medium (300 mg I/mL) at an injection rate of 7 mL/s. Four consecutive 5-mm-thick slices at the maximum diameter of the HCC were selected as the region of interest. Time–attenuation curves were generated by region of interest drawn on the aorta, tumor, and liver. Qualitative assessments of conspicuity for contrast medium wash-in, peak, and wash-out of aorta and tumor were performed.

RESULTS. There were 108 arterial phase enhancing lesions (mean [±SD], 4.9 ± 2.4 cm; range, 0.7–12.9 cm) in the 25 patients. The maximum Hounsfield value of aorta, tumor, and background liver parenchyma were 463.8 ± 98 HU, 106.5 ± 19 HU, and 98.3 ± 14 HU, respectively. At the time of onset of peak tumor enhancement, the difference between tumor density and background liver density was 38.2 ± 19 HU. The time–attenuation curve showed that the mean times of contrast enhancement start, peak, and end were 9.2 ± 2.7 seconds, 19.4 ± 2.1 seconds, and 38 ± 13.5 seconds, respectively, for the aorta, and 15.5 ± 2.6 seconds, 26.3 ± 2.9 seconds, and 57.7 ± 14.4 seconds, respectively, for 25 pathologically confirmed hepatocellular carcinomas. Qualitatively, the mean times of contrast enhancement wash-in, peak, and washout were 10.2 ± 2.8 seconds, 19.9 ± 3 seconds, and 39.9 ± 9.2 seconds, respectively for the aorta, and 18 ± 4.2 seconds, 27 ± 3 seconds, and 55.7 ± 21 seconds, respectively, for tumor. There were no differences between quantitative and qualitative measurements of wash-in and peak time for the aorta (p = 0.00017, p = 0.00016) and tumor (p = 0.00163, p = 0.00040).

CONCLUSION. When using 70 mL of 300 mg I/mL of contrast medium with an injection rate of 7 mL/s in 16-MDCT scanning, the optimal time to initiate scanning for HCC is 26.3 ± 2.9 seconds (range, 24.0–34.5 seconds) after contrast medium administration.

OBJECTIVE. The purpose of this study was to evaluate the imaging features of intrahepatic biliary intraductal papillary-mucinous neoplasm manifesting only as dilatation of the lobar or segmental bile ducts without a visible mass to determine whether this type of cholangiocarcinoma can be recognized on the basis of distinct imaging features.

CONCLUSION. Intrahepatic biliary intraductal papillary-mucinous neoplasm can spread along the mucosa without forming a mass and can produce a large amount of mucin. Severe dilatation of the lobar or segmental intrahepatic bile ducts with crowding and severe atrophy of the hepatic parenchyma are helpful imaging findings.

OBJECTIVE. The purpose of this article is to illustrate the radiologic features of various biliary and nonbiliary complications after laparoscopic cholecystectomy.

CONCLUSION. Various complications should be considered in patients who do not make an uneventful postoperative recovery after laparoscopic cholecystectomy. Sonography is the easiest and most noninvasive method for screening for such complications. MR cholangiography is most effective in showing biliary complications and CT, for the evaluation of nonbiliary complications. Endoscopic retrograde cholangiography enables not only detailed biliary estimation but also biliary decompression.

OBJECTIVE. In radiofrequency ablation of lesions that require probe repositioning, distinguishing between treated and untreated regions can be difficult. We describe a method of using existing CT equipment to summate images of a current probe placement with those of earlier placements or scans of transiently enhancing targets.

CONCLUSION. Summation of CT scans during radiofrequency ablation involving multiple probe placements is feasible and results in a better appreciation of probe positioning relative to the target lesion.

OBJECTIVE. The purpose of this study was to determine whether injection of hemostatic agents directly into an injury site under the guidance of contrast-enhanced sonography can effectively control hemorrhage due to hepatic trauma.

MATERIALS AND METHODS. Fifteen mixed-breed dogs 2–3 years old and weighing 17–20 kg were anesthetized with intramuscular pentobarbital sodium (30 mg/kg). A special impacting device was used to induce hepatic trauma with a mean force of 5.3 ± 0.3 kN. Twelve of the 15 dogs had hepatic injuries with a grade of 3–4 or 4. The 12 dogs were divided into treatment and control groups. In the treatment group, hemocoagulase atrox (1 Klobusitzky unit) and α-cyanoacrylate (1 mL) were administered by transcutaneous injection into the injury site and the bleeding site, respectively, under the guidance of contrast-enhanced sonography. The control group received injections of 0.9% normal saline solution.

RESULTS. After injection into the treatment group, no active bleeding was observed at the liver injury site. In the control group, evidence of active bleeding was present on contrast-enhanced sonograms. Laparotomy of the treatment group showed that hepatic injuries had been covered and adhered by clots and the glue membrane of the hemostatic agents and that free intraperitoneal blood volume was significantly less than in the control group (p < 0.001). Bleeding did not stop in the control group.

CONCLUSION. In dogs, transcutaneous local injection of hemostatic agents can effectively reduce blood loss due to severe liver trauma. Because it is simple, convenient, and effective, the technique may be an alternative for bedside and battlefield management of hepatic hemorrhage due to trauma.

OBJECTIVE. MRI at 3 T, which has a higher signal-to-noise ratio than 1.5-T MRI, is potentially more sensitive and specific at delineating epileptogenic lesions and may influence management of refractory epilepsy. The purposes of the current study were to compare image quality of 3-T MRI with that of 1.5-T MRI in the evaluation of epilepsy and, in cases of focal epilepsy, to compare the two field strengths in terms of lesion detection and characterization.

MATERIALS AND METHODS. Retrospective review was performed on 50 sets of MR images of 25 patients who underwent both 3-T and 1.5-T brain imaging with a dedicated epilepsy protocol, including fast spin-echo T2-weighted, coronal FLAIR, coronal fast multiplanar inversion recovery, and 3D spoiled gradient-recalled echo pulse sequences. Parameters assessed were distortion and artifact, lesion conspicuity, gray–white matter differentiation, and motion. Each pulse sequence was graded on a 4-point scale. Reviewers performed qualitative assessments of the site of abnormality and the most likely diagnosis.

RESULTS. MRI at 3 T outperformed MRI at 1.5 T in all four parameters and was statistically superior (p < 0.05) to 1.5-T MRI in all categories except motion. On 3-T MRI, lesions were detected in 65 of 74 cases compared with 55 of 74 cases at 1.5 T (p = 0.0364), and lesions were accurately characterized in 63 of 74 cases compared with 51 of 74 cases at 1.5 T (p = 0.0194). The odds ratios showed identification of a focal epileptogenic lesion with 3-T MRI 2.57 times as likely as identification with 1.5-T MRI and accurate characterization of lesions 2.66 times as likely as characterization with 1.5-T MRI.

CONCLUSION. In evaluation of epilepsy, MRI at 3 T performed better than 1.5-T MRI in image quality, detection of structural lesions, and characterization of lesions. High-field-strength imaging should be considered for patients with intractable epilepsy and normal or equivocal findings on 1.5-T MRI.

OBJECTIVE. Limited coverage of the brain in the z-axis has been a drawback of perfusion CT. The purpose of this study was to evaluate the usefulness of perfusion CT with extended coverage in the z-axis for the assessment of acute stroke in an emergent clinical setting.

MATERIALS AND METHODS. Fifty-eight patients who underwent 80-mm-coverage perfusion CT within 24 hours after stroke onset were included. Perfusion CT was performed using a 64-MDCT unit equipped with 40-mm-wide detector and the toggling table technique. Lesion detection by perfusion CT was analyzed using follow-up diffusion-weighted imaging and MR angiography as the reference standards. More conventional 20-mm-coverage perfusion CT was simulated by extracting data obtained at the basal ganglia level for comparison with 80-mm-coverage perfusion CT.

RESULTS. Fifty-one patients had acute infarctions and seven patients did not. For 80-mm-coverage perfusion CT, perfusion abnormality was detected in 42 of 51 patients (sensitivity, 82.4%; and specificity, 85.7%). When patients with small artery disease (small acute infarctions in the basal ganglia, thalamus, corona radiata, and pons) were excluded, sensitivity increased to 92.3%. As compared with 80-mm-coverage perfusion CT, 20-mm-coverage perfusion CT missed nine acute infarctions located above or below the level of the basal ganglia (p = 0.0039).

CONCLUSION. Perfusion CT with 80-mm-coverage was found to be useful as an initial imaging method in acute ischemic stroke, although it had low sensitivity for detecting small acute infarctions. In particular, this technique provided higher lesion detection than 20-mm-coverage perfusion CT.

OBJECTIVE. The purpose of this pictorial essay is to illustrate several clinical situations in which SPECT/CT can be effectively applied in nuclear radiology practice.

CONCLUSION. SPECT/CT has recently emerged as a valuable adjunct to standard techniques in clinical nuclear radiology. This technique provides significantly improved scintigraphic localization and characterization of disease, increasingly important in this era of minimally invasive surgery and targeted radiotherapy.

OBJECTIVE. The aim of this essay is to describe the imaging features of marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) type throughout various organs.

CONCLUSION. Awareness of the expected locations of MALT lymphoma combined with knowledge of the incidence and imaging findings leads to accurate diagnosis of lesions suspicious for this disorder and helps to differentiate this disease from other abnormalities.

OBJECTIVE. The purpose of this study was to evaluate the accuracy of CT in the diagnosis of chronic infiltrative lung disease in children.

MATERIALS AND METHODS. Fifty-nine patients selected over a 14-year period (29 girls, 30 boys; mean age, 6 ± 4.9 years; range, 2 months–18 years) had nine disorders. CT scans were evaluated independently by two experienced chest radiologists, who were unaware of pathologic or clinical data. The radiologists recorded specific CT findings of infiltrative lung disease and were asked to give the most likely diagnosis and up to two differential diagnoses. Descriptive statistic analysis was followed by logistic regression analysis for each elementary lesion on the grid of abnormalities.

RESULTS. A correct first-choice diagnosis was made in 38% of CT observations. The correct diagnosis was among the three main choices in 59% of CT observations. Pulmonary alveolar proteinosis (n = 18) was most frequently correctly diagnosed; it was the first-choice diagnosis 47% of the time and among the three main choices 72% of the time. The correct first-choice diagnosis of idiopathic pulmonary fibrosis (n = 16) was made 43% of the time; of hypersensitivity pneumonitis (n = 4), 37% of the time; of sarcoidosis (n = 7), 28% of the time; of idiopathic pulmonary hemosiderosis (n = 6), 16% of the time; and of connective tissue diseases (n = 5), 10% of the time. All single cases of pulmonary fibrosis with calcification, lymphangiectasia, and Langerhans' cell histiocytosis were correctly diagnosed.

CONCLUSION. Our results showed there are limitations to diagnosing chronic infiltrative lung disease in children on the basis of CT data alone. We suppose that these differences are explained by the technical difficulties of high-resolution CT in children, the insufficient number of cases of and data on high-resolution CT of children, and the heterogeneity of lesions of a given cause.

OBJECTIVE. The purpose of this study was in vitro sonographic–pathologic correlation of findings in dissected axillary lymph nodes from breast cancer patients undergoing axillary lymph node dissection and classification of the sonographic appearance of the nodes on the basis of cortical morphologic features to facilitate early recognition of metastatic disease.

MATERIALS AND METHODS. High-resolution sonography was used for in vitro examination of 171 lymph nodes from 19 axillae in 18 patients with unknown nodal status who underwent axillary lymph node dissection for early infiltrating breast cancer. The images were evaluated by two blinded observers, and discordant readings were referred to a third blinded observer. Each lymph node was classified as one of types 1–6 according to cortical morphologic features. Types 1–4 were considered benign, ranging from hyperechoic with no visible cortex to thickened generalized hypoechoic cortical lobulation. Type 5 (focal hypoechoic cortical lobulation) and type 6 (hypoechoic node with absent hilum) nodes were considered metastatic. The reference standard for metastatic disease was histopathologic evaluation of sectioned nodes by a single pathologist blinded to sonographic findings. Largest nodal diameter also was measured.

RESULTS. Interobserver agreement was 77% for classification of nodal morphology (types 1–6) and 88% for characterization of a node as benign or malignant. Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of cortical shape in prediction of metastatic involvement of axillary nodes were 77%, 80%, 36%, 96%, and 80%. Type 4 nodes had the most false-negative findings (four of 36). Node size ranged from 0.2 to 3.8 cm, and subcentimeter nodes of all types were detected.

CONCLUSION. In breast cancer, axillary lymph nodes can be classified according to cortical morphologic features. Predominantly hyperechoic nodes (types 1–3) can be considered benign. Generalized cortical lobulation (type 4) is uncommonly a false-negative finding, but metastasis, if present, is invariably detected at sentinel node mapping. The presence of asymmetric focal hypoechoic cortical lobulation (type 5) or a completely hypoechoic node (type 6) should serve as a guideline for universal performance of fine-needle aspiration for preoperative staging of breast cancer. This classification, when verified with larger samples, may serve as a useful clinical guideline if proven with results of in vivo studies.

OBJECTIVE. The purpose of this study was to evaluate the applicability of the current BI-RADS for sonography to the assessment of synchronous breast nodules other than the primary malignant tumor in patients with breast cancer.

MATERIALS AND METHODS. One hundred eighty-nine synchronous nodules in 147 breast cancer patients were surgically excised after localization, and 412 synchronous nodules in 191 patients were observed or biopsied or excised without localization. Among a total of 601 synchronous nodules, 372 nodules were ipsilateral and 229 were contralateral to a primary malignant tumor. Two radiologists retrospectively reviewed sonograms of these nodules and determined the sonographic BI-RADS category without clinical information or pathologic results. For each nodule, the preoperative BI-RADS category and pathologic or follow-up results were compared.

RESULTS. Four hundred eighty-two nodules were classified category 3; 112 nodules, category 4; and seven nodules, category 5. Fifty-five (11.4%) of the category 3 nodules and 57 (47.9%) of the category 4 and 5 nodules were confirmed malignant. Thirty-six (21.2%) of 170 category 3 synchronous nodules in the same quadrant as the primary tumor were confirmed malignant, as were 12 (9.8%) of 122 nodules in a different quadrant and eight (4.2%) of 190 nodules in the contralateral breast.

CONCLUSION. For assessment of synchronous nodules in breast cancer patients, application of conventional screening sonographic BI-RADS categories may not account for possible increased risk of malignancy in synchronous nodules, especially those in the same quadrant of the breast as the index malignant tumor.

OBJECTIVE. The purpose of this study was to assess the role of sonography in the diagnosis and management of palpable solid breast masses in adolescents and to correlate the sonographic findings with the histopathologic findings and clinical outcome.

MATERIALS AND METHODS. A retrospective study was conducted with the breast sonograms of 20 adolescent girls 13–19 years old who presented with palpable breast masses found to be solid at breast sonography. The Stavros sonographic criteria were used to assess the benignity or malignancy of solid breast masses. All sonographic findings were correlated with histopathologic or clinical follow-up findings.

RESULTS. Sonography showed 21 solid masses in 20 patients (one patient had bilateral solid breast masses). All but six solid masses were presumed benign according to the Stavros sonographic criteria. All solid masses were proved benign at histopathologic or clinical follow-up examination.

CONCLUSION. Sonography was not useful for predicting the histologic diagnosis of all solid benign breast masses in adolescent patients. The Stavros sonographic criteria, however, were useful for predicting benignity in 65% of the breast masses on which histopathologic examination was performed. Tissue biopsy may be performed on solid breast masses that do not meet the criteria for benign masses according to the Stavros sonographic criteria.

OBJECTIVE. The purpose of our study was to determine the efficacy of contrast-enhanced CT in detecting a thickened endometrium. We used transvaginal sonography as the reference standard.

MATERIALS AND METHODS. Between March 2005 and January 2007, data from 259 patients (mean age, 47 years; age range, 18–90 years) who underwent transvaginal sonography and contrast-enhanced CT of the pelvis were analyzed retrospectively. The endometrium was quantitatively measured in millimeters on sonography. On CT it was qualitatively categorized as normal, thickened, indeterminate, or not visualized and compared with the sonography findings and original radiology reports. When the endometrium was indeterminate (thickened or triangular in shape on axial images), sagittal reconstructions were performed for final categorization. Two reviewers evaluated the CT scans and sonograms jointly with differences resolved by consensus. Kappa, Wilcoxon's rank sum test, and intraclass correlation statistics were derived.

RESULTS. The overall sensitivity and specificity of CT in detecting the thickened endometrium was 53.1% and 93.5%, respectively, relative to transvaginal sonography. The positive and negative predictive values were 66.7% and 89.1%, respectively. Kappa, the statistical measure of agreement between CT and sonography data, was 0.5049. All cases of a triangular endometrium were normal in size on sagittal reconstruction images.

CONCLUSION. Routine pelvic CT correctly identifies a normal endometrium in most patients. Sagittal reconstruction images are helpful to further evaluate the endometrium on CT in cases with a prominent or triangular endometrium because these are often related to uterine version. CT is relatively insensitive in detecting the thickened endometrium but better able to identify gross rather than subtle thickening, which must be further characterized by transvaginal sonography.

OBJECTIVE. This study aimed to evaluate the utility of MDCT in planning abdominal perforator surgery for breast reconstruction in patients who have undergone mastectomy.

SUBJECTS AND METHODS. One hundred twenty-six consecutive patients scheduled for postmastectomy breast reconstruction using deep inferior epigastric perforator flaps underwent MDCT. The images were evaluated to identify, characterize, and map the dominant musculocutaneous perforator vessels of the deep inferior epigastric artery. In the first 36 patients, we compared the intraoperative findings with the preoperative MDCT findings. In the latter 90 patients, the dominant perforator vessels were directly selected on the basis of MDCT findings.

RESULTS. We found an exact correlation between the intraoperative and radiologic findings in the first 36 cases. In the following 90 cases, the average operating time saved per patient was 1 hour 40 minutes and there was a significant reduction in postsurgical complications. The preoperative evaluation by MDCT confirmed the wide range of variability in the vascular anatomy of the abdominal wall previously described in anatomic studies.

CONCLUSION. MDCT provides valuable information before surgery about the arterial anatomy of the inferior abdominal wall. It enables accurate identification of the most suitable dominant perforator vessel and makes surgical perforator flap procedures for breast reconstruction faster and safer.

OBJECTIVE. Polyacrylamide gel injection mammoplasty has recently been used for breast augmentation. However, many complications have been reported including complications that in some patients resulted in the need for mastectomy. This article reviews the MRI appearances of various complications of polyacrylamide gel injection mammoplasty including breast asymmetry; intramammary or extramammary gel displacement, including intrathoracic extension; and glandular atrophy, inflammation, and infection resulting in mastectomy.

CONCLUSION. Because poly acrylamide gel has a high water content, we found that sagittal and axial T2-weighted are the best sequences to use to detect complications.

OBJECTIVE. The purpose of this article is to describe and illustrate the variety of common morphologic features, enhancement patterns, and kinetics of pure ductal carcinoma in situ (DCIS) on dynamic contrast-enhanced MRI of the breast, using the American College of Radiology BI-RADS lexicon.

CONCLUSION. Breast MRI plays an important role in the detection of DCIS, which most often appears as nonmass clumped enhancement, in a ductal or segmental distribution, with variable enhancement kinetics.

OBJECTIVE. Papillary lesions of the breast are a heterogeneous group of lesions that are difficult to diagnose as benign or malignant. The purpose of this article is to review clinical presentation, imaging features, and pathologic correlation of papillary lesions of the breast and to discuss the prognosis and management of these lesions.

CONCLUSION. Recognition of the variety of benign and malignant papillary lesions of the breast will facilitate diagnosis and proper management.

OBJECTIVE. The objective of our study was to compare the detectability and distinguishability of simulated soft-tissue opacities of 50 variants of an anthropomorphic breast phantom in mammograms acquired with a digital direct flat-panel detector versus an analog system; we also compared the image settings “analog film,” “digital film,” and “digital monitor.”

MATERIALS AND METHODS. The studies were performed on digital (Lorad Selenia) and analog (Mammomat 3) mammography systems. Four hundred fifty silicone cubes devised with different randomly distributed columns, holes, or both columns and holes (diameter, 3–7 mm; height, 0.5–4.0 mm) were used as test bodies. One experimental series was performed with a silicone scatter body and one with a silicone and an anthropomorphic ground-meat scatter body. All x-rays were obtained at identical settings and exposures. Four radiologists rated the films and monitor-displayed images independently of each other in randomized order on a standardized electronic questionnaire.

RESULTS. The digital monitor technique generally scored better than digital film viewing and analog readings. The McNemar test for multiple paired comparisons mostly yielded a p value of < 0.0005. The smallest volume category counted as the most valid test scenario for all raters, where the percentage of correct positive findings ranged between 30% and 58% (analog technique), 43% and 68% (digital film viewing), and 55% and 66% (monitor viewing). The corresponding accuracy rates were 77–93%, 75–95%, and 81–85%, respectively, with kappa values of 0.2–0.5 (analog) and 0.3–0.6 (digital) for comparing the gold standard with raters' evaluations.

CONCLUSION. Digital flat-panel mammography is superior to the analog screen-film method for the detection of simulated opacities.

OBJECTIVE. The objective of our study was to describe the imaging features of polyacrylamide gel breast implants in women with and those without complications from mammoplasty.

CONCLUSION. Although polyacrylamide gel implants may mimic conventional implants on both sonography and MRI in women who do not have complications from mammoplasty, polyacrylamide gel implants have some distinguishing features. The imaging appearance of polyacrylamide gel implants is related to the technique of injection and whether there are any associated complications. The implants are usually in a retroglandular location. Mammography, sonography, and MRI can be used to evaluate short-term complications, although MRI appears to be the most sensitive. Common short-term complications include extravasation of polyacrylamide gel and secondary infection, which may be related to lactation. The long-term complications of polyacrylamide gel mammoplasty are unknown. Knowledge of the appearances of polyacrylamide gel implants in women with and those without complications from mammoplasty is useful in the radiologic evaluation of such patients.