Background: Intravascular embolization of device fragments is a
rare but potentially serious complication. Method: A systematic
search of the PubMed and MEDLINE databases for all articles pertaining ...to
central catheter related embolization published in English between 1985 and
2007 was made. Results: A total of 215 cases of intravenous catheter
embolization were identified. There were 143 totally implanted venous devices
(TIVD) or port catheters and 72 percutaneous venous catheters (PVC). Sites of
catheter fragments following embolization were the superior vena cava or
peripheral veins (15.4%), the right atrium (27.6%), right ventricle (22%), and
pulmonary arteries (35%). Clinical signs of catheter embolization included
catheter malfunction (56.3%), arrhythmia (13%), pulmonary symptoms (4.7%), and
septic syndromes (1.8%), but 24.2% of cases were asymptomatic. The causes of
intravascular catheter embolization were pinch-off syndrome (40.9%), catheter
injury during explantation (17.7%), catheter disconnection (10.7%), and
catheter rupture (11.6%). In 19.1% of cases, the cause of catheter
embolization could not be identified. Most embolized catheter fragments
(93.5%) were removed percutaneously. In 4.2% of cases, fragments were retained
in the vascular bed; in 2.3%, embolized fragments were removed surgically via
thoracotomy. Conclusion: Intravascular catheter embolization can go
undiagnosed for prolonged periods. Patients might be asymptomatic or may
develop severe systemic clinical signs. The mortality rate is 1.8%. There were
no significant differences in clinical features of embolization between TIVD
and PVC groups.
Abstract OBJECTIVES: To analyze diffusion-weighted imaging (DWI) findings of meningiomas and to compare them with tumor grade, cell count, and proliferation index and to test a possibility of use of ...apparent diffusion coefficient (ADC) to differentiate benign from atypical/malignant tumors. METHODS: Forty-nine meningiomas were analyzed. DWI was done using a multislice single-shot echo-planar imaging sequence. A polygonal region of interest was drawn on ADC maps around the margin of the lesion. In all lesions, minimal ADC values (ADCmin ) and mean ADC values (ADCmean ) were estimated. Normalized ADC (NADC) was calculated in every case as a ratio ADCmean meningioma/ADCmean white matter. All meningiomas were surgically resected and analyzed histopathologically. The tumor proliferation index was estimated on Ki-67 antigen–stained specimens. Cell density was calculated. Collected data were evaluated by means of descriptive statistics. Analyses of ADC/NADC values were performed by means of two-sided t tests. RESULTS: The mean ADCmean value was higher in grade I meningiomas in comparison to grade II/III tumors (0.96 vs 0.80 × 10 − 3 mm2 s − 1 , P = .006). Grade II/III meningiomas showed lower NADC values in comparison to grade I tumors (1.05 vs 1.26, P = .015). There was no significant difference in ADCmin values between grade I and II/III tumors (0.69 vs 0.63 × 10 − 3 mm2 s − 1 , P = .539). The estimated cell count varied from 486 to 2091 (mean value, 1158.20 ± 333.74; median value, 1108). There were no significant differences in cell count between grade I and grade II/III tumors (1163.93 vs 1123.86 cells, P = .77). The mean level of the proliferation index was 4.78 ± 5.08%, the range was 1% to 18%, and the median value was 2%. The proliferation index was statistically significant higher in grade II/III meningiomas in comparison to grade I tumors (15.43% vs 3.00%, P = .001). Ki-67 was negatively associated with ADCmean ( r = − 0.61, P < .001) and NADC ( r = − 0.60, P < .001). No significant correlations between cell count and ADCmean ( r = − 0.20, P = .164) or NADC ( r = − 0.25, P = .079) were found. ADCmin correlated statistically significant with cell count ( r = − 0.44, P = .002) but not with Ki-67 ( r = − 0.22, P = .129). Furthermore, the association between ADCmin and cell count was stronger in grade II/III tumors ( r = − 0.79, P = .036) versus grade I meningiomas ( r = − 0.41, P = .008). An ADCmean value of less than 0.85 × 10 − 3 mm2 s − 1 was determined as the threshold in differentiating between grade I and grade II/III meningiomas (sensitivity 72.9%, specificity 73.1%, accuracy 73.0%). The positive and negative predictive values were 33.3% and 96.8%, respectively. The same threshold ADCmean value was used in differentiating between tumors with Ki-67 level ≥ 5% and meningiomas with low proliferation index (Ki-67 < 5%). This threshold yielded a sensitivity of 70.6%, a specificity of 81.2%, and an accuracy of 77.6%. The positive and negative predictive values were 66.6% and 83.9%, respectively. CONCLUSIONS: Grade II/III tumors had lower ADCmean values than grade I meningiomas. ADCmean correlated negatively with tumor proliferation index and ADCmin with tumor cell count. These associations were different in several meningiomas. ADCmean can be used for distinguishing between benign and atypical/malignant tumors.
Our purpose was to correlate different intravoxel incoherent motion (IVIM), histopathological and clinical parameters in rectal cancer. 17 patients with histologically proven rectal cancer ...investigated on a 3.T device were included into the study. DWI was performed using a multi-slice single-shot echo-planar imaging sequence with b values of 0, 50, 200, 500 and 1000 s/mm.2 A polygonal region of interest was drawn within the tumors on every b image. The following parameters were retrieved from IVIM: apparent diffusion coefficient (ADC), true diffusion (D), pseudo diffusion coefficient (D*), perfusion factor (f), and relative perfusion f·D*. In every case, cell count, nucleic areas, proliferation index KI 67, and microvessel density were estimated on histopathological specimens. Pearson's correlation coefficient was used to analyze the association between the parameters. ADC correlated well with KI 67 index and D tended to correlate with cell count and KI 67. ADC and D tended to correlate with total nucleic area. The perfusion factor f correlated well with stained vessel area, total vessel area, and vessel count. D* and fD* correlated with mean vessel diameter. Distant metastasized tumors had higher D* and fD* values. IVIM parameter reflected different clinical and histopathological features in rectal cancer.
Most secondary intramammary tumors occur as metastatic involvement from the contralateral breast. Breast metastases (BM) from nonmammary malignancies are very rare. The aims of this study were to ...estimate retrospectively the prevalence of BM from nonmammary malignancies and to describe their radiologic appearance.
BM were identified in 51 patients, including 43 women and eight men with a median age of 61 years (range, 24-84 years). Computed tomography of the thoracic region identified 108 lesions in 38 patients. Mammography was available for 37 patients (54 lesions). Ultrasound evaluation was performed in 43 patients (71 lesions). In 24 patients (93 lesions), magnetic resonance imaging of the breast was done. Images were reviewed in consensus by two radiologists according to the Breast Imaging Reporting and Data System lexicon.
The prevalence of BM in several tumors ranged from 0.12% to 4.92%. On computed tomography, most metastases were round or oval in shape with marked or moderate enhancement. On mammography, solitary or multiple round or oval masses with circumscribed margins were the most common pattern of BM. Ten percent showed microcalcifications. On ultrasound, most BM were hypoechoic, oval or round in shape, with microlobulated or circumscribed margins, and posterior acoustic enhancement. Doppler imaging showed hypervascularity in 39% of BM. On magnetic resonance imaging, most lesions demonstrated marked homogenous contrast enhancement. Type 1 kinetic curve was seen in 18%, type 2 in 52%, and type 3 in 30%.
The radiologic features reported in this study should be taken into consideration in the differential diagnosis of breast lesions.
Pulmonary embolism (PE) is a common cause of morbidity and mortality in oncologic patients. Furthermore, PE is an unsuspected finding in many cases.
To determine the frequency and embolus burden of ...PE in a consecutive oncologic patient group including symptomatic as well as incidental and initially unreported events.
In a retrospective, single-center study from June 2005 to January 2010 all patients with an oncologic disease (ICD-10 code C00 to C96) that received at least one contrast-enhanced computed tomography (CT) examination of the chest were reviewed. The study group included 3270 patients with 6780 examinations. A validated pulmonary artery obstruction index (Mastora score) was used to assess embolus burden.
PE was found in 240 of 3270 (7.3%) oncologic patients. The frequency was highly variable among different malignancies ranging from 0% to 25%. In the present study about half of all PE were unsuspected. The mean embolus burden was significantly higher in symptomatic PE than in unsuspected PE (P <0.001). The risk of developing a PE was 1.5 times higher in patients with metastases compared to patients without metastases (P <0.005). Age and sex had no influence on PE risk and embolus burden.
PE is a frequent unsuspected finding in staging examinations: particularly in patients with malignancies of the ovary, brain, and pancreas, and in patients with metastases. Therefore, the status of the pulmonary vasculature should be assessed in every staging examination that includes the chest. The effect of therapeutic actions on PE events and the unsuspected finding of PE in follow-up CT examinations require further prospective studies.
Abstract Our purpose was to estimate apparent diffusion coefficient (ADC) values from brain metastases (BMs). Our patient sample included 159 patients with 948 BMs. Magnetic resonance imaging was ...obtained with a 1.5-T device. For diffusion-weighted imaging, a multislice single-shot echo-planar imaging sequence was used ( b values of 0, 500, and 1000 s/mm2 ). The mean ADC value of BMs was 0.98±0.32×10 − 3 mm2 s − 1 . A total of 72.8% of BM lesions showed ADC values under 0.90×10 − 3 mm2 s − 1 . Small-cell lung cancer had the lowest ADC values (0.86±0.27) in comparison to BMs from non-small-cell lung cancer (1.17±0.49), breast carcinoma (0.97±0.21), and malignant melanoma (0.99±0.36).
Abstract Nonthrombotic pulmonary embolism is defined as embolization to the pulmonary circulation caused by a wide range of substances of endogenous and exogenous biological and nonbiological origin ...and foreign bodies. It is an underestimated cause of acute and chronic embolism. Symptoms cover the entire spectrum from asymptomatic patients to sudden death. In addition to obstruction of the pulmonary vasculature there may be an inflammatory cascade that deteriorates vascular, pulmonary and cardiac function. In most cases the patient history and radiological imaging reveals the true nature of the patient's condition. The purpose of this article is to give the reader a survey on pathophysiology, typical clinical and radiological findings in different forms of nonthrombotic pulmonary embolism. The spectrum of forms presented here includes pulmonary embolism with biological materials (amniotic fluid, trophoblast material, endogenous tissue like bone and brain, fat, Echinococcus granulosus , septic emboli and tumor cells); nonbiological materials (cement, gas, iodinated oil, glue, metallic mercury, radiotracer, silicone, talc, cotton, and hyaluronic acid); and foreign bodies (lost intravascular objects, bullets, catheter fragments, intraoperative material, radioactive seeds, and ventriculoperitoneal shunts).
Meningioma is the most common intracranial tumor. The aim of the present study was to correlate apparent diffusion coefficient (ADC) values with cellularity, Ki-67 and nucleic area in meningioma ...cases.
Twenty-four meningothelial meningiomas were included in the study. Diffusion-weighted imaging was performed using a multi-slice single-shot echo-planar imaging sequence. In all lesions minimal ADC values (ADCmin), mean ADC values (ADCmean), and maximal ADC values (ADCmax) were estimated. Additionally, true ADC values (D) were calculated. All tumors were resected and analyzed histopathologically. The tumor proliferation index was estimated on Ki-67 antigen-stained specimens. Cell density was calculated in every case as an average cell count per five high-power fields. All histological samples were analyzed for estimation of nucleic size and nucleic area. The ImageJ software 1.48v was used for analysis. Analyses of the estimated parameter were performed by means of two-sided t-tests. Correlation analysis was performed using the Pearson's product moment correlation.
The mean values of ADCmin, ADCmean, ADCmax, and D were 0.64±0.11, 0.89±0.13, 1.15±0.27, and 0.75±0.20×10-3 mm(2)s(-1), respectively. The estimated mean cell count was 1160.08±33.86 cells and the mean level of the proliferation index was 3.46±2.84%. The mean values of average nucleic area and total nucleic area were 65.42±19.38 μm(2) and 64481.87±21120.02 μm(2), respectively ADCmean correlated significant with Ki-67 level, average nucleic area, and total nucleic area, but not with cell count. ADCmin and D correlated significant with cell count and total nucleic area, but not with Ki-67. D was also associated with average nucleic area. ADCmax correlated slightly with cell count.
Several relationships between ADC and histological parameters in meningioma were assessed. ADCmean was negatively associated with Ki-67 level, average nucleic area, and total nucleic area. There was no significant correlation between ADCmean and cell count. ADCmin and D correlated well with total nucleic areas and cell count, but not with Ki-67. ADCmax correlated slightly with cell count.
Abstract Purpose Incidental findings are a common feature in computer tomographic examinations of the chest. Breast incidentalomas, however, were described only sporadically. The purpose of this ...study was to evaluate retrospectively incidental breast findings and to compare radiological features of benign and malignant breast lesions. Materials and methods From January 2006 to December 2010 a total of 8105 computer tomographic examinations were performed at our institution. In 89 patients incidental breast lesions were diagnosed. 64 of the identified patients were referred for further clinical, radiological, and hystopathological examination. All patients were female with a median age of 62 years, range 39–82 years. Results A total of 98 breast lesions were identified in the 64 patients. The mean size was 12.0 ± 8.0 mm. Primary breast carcinoma was identified in 9, breast metastases in 27, and benign findings in 28 patients. Malignant lesions demonstrated more often marked enhancement and showed a higher density compared with benign lesions. Benign findings were more often lobular in shape and had spiculated margins. Most of the breast metastases were round or oval in shape with circumscribed margins and marked homogenous enhancement. There was no significant difference between the breast cancer and benign findings groups in the characteristics of the lesions. Conclusion The breast is a very important region and should be carefully evaluate on chest CT. There are no certain radiological criteria to differentiate between malignant and benign breast lesions on CT. Therefore all breast incidentalomas should be evaluated by further radiological/histological investigations.
Abstract A number of people injured during the second world war harbour foreign bodies such as grenade splinters or bullets in some part of the body. Most of these metal fragments remain clinically ...silent. Some of them, however, may cause delayed complications. The purpose of this study was to determine the characteristics of delayed complications associated with foreign bodies after world war II injuries. 159 patients with retained foreign bodies after world war II injuries were retrospectively identified radiologically in our data bases in the time interval from 1997 to 2009. Diverse delayed complications secondary to the metal objects were diagnosed in 3 cases (2%): one patient with grenade splinter migration into the choledochal duct, one case with pseudotumoural tissue reaction, and one patient with late osteomyelitis. The time from injury to clinical presentation varied from 56 to 61 years. PubMed and Medline were screened for additional cases with delayed sequelae after foreign body acquisition during the 2nd world war. A 30 year search period from 1980 up to date was selected. 15 cases were identified here. Our study demonstrates that health consequences of the 2nd world war extend into the present time, and therefore physicians should be aware of the presence of hidden foreign bodies and their different possible late reactions.
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