Eccentric Wall Thickening Research Articles

High-Resolution MRI Vessel Wall Imaging: Spatial and Temporal Patterns of Reversible Cerebral Vasoconstriction Syndrome and Central Nervous System Vasculitis

High-resolution MR imaging is an emerging tool for evaluating intracranial artery disease. It has an advantage of defining vessel wall characteristics of intracranial vascular diseases. We investigated high-resolution MR imaging arterial wall characteristics of CNS vasculitis and reversible cerebral vasoconstriction syndrome to determine wall pattern changes during a follow-up period. We retrospectively reviewed 3T-high-resolution MR imaging vessel wall studies performed on 26 patients with a confirmed diagnosis of CNS vasculitis and reversible cerebral vasoconstriction syndrome during a follow-up period. Vessel wall imaging protocol included black-blood contrast-enhanced T1-weighted sequences with fat suppression and a saturation band, and time-of-flight MRA of the circle of Willis. Vessel wall characteristics including enhancement, wall thickening, and lumen narrowing were collected. Thirteen patients with CNS vasculitis and 13 patients with reversible cerebral vasoconstriction syndrome were included. In the CNS vasculitis group, 9 patients showed smooth, concentric wall enhancement and thickening; 3 patients had smooth, eccentric wall enhancement and thickening; and 1 patient was without wall enhancement and thickening. Six of 13 patients had follow-up imaging; 4 patients showed stable smooth, concentric enhancement and thickening; and 2 patients had resoluton of initial imaging findings. In the reversible cerebral vasoconstriction syndrome group, 10 patients showed diffuse, uniform wall thickening with negligible-to-mild enhancement. Nine patients had follow-up imaging, with 8 patients showing complete resolution of the initial findings. Postgadolinium 3T-high-resolution MR imaging appears to be a feasible tool in differentiating vessel wall patterns of CNS vasculitis and reversible cerebral vasoconstriction syndrome changes during a follow-up period.

Characterization of Rectal Neoplasms Using Computerized Tomography

The aims of this study were to characterize and localize the rectal neoplasms by the computerized tomography (CT) and sigmoidoscopy in patients who suspected to have colorectal neoplasms. It was conducted at Radiology and Endoscopy Departments - Soba Hospital-Khartoum-Sudan. This study was extended from October 2011 to December 2011, fifty patients were studied including 34 males and 16 females, and their mean age was 52.5 years ranged from 25–85 years. All patients underwent sigmoidoscopy, axial CT images for pelvis, enhanced with contrast medium, and biopsy as confirmation method. The location of rectal neoplasm was measured in (cm) and the lesions were characterized in CT as circumferential, eccentric rectal wall thickening, masses, tumors according to thier contrast enhancement, in Sigmodioscopy the lesions were classified as seen into polyploidy, obstructive, ulcerative, circumferential lesions and tumor. In the histopathology findings, the lesions were characterized as poor, moderate, well differentiated adenocarcinoma and Tubulovillous adenoma.The study showed that the males were more affected than females. Sigmoidoscopy and CT can predict the lesion type and characterize the changes in the rectum and rectosigmoid region according to its citation from the anal verge significantly at p- value 0.001and 0.038. No significant relation was found between the biopsy results and the presence of the lesions through distance from anus at P-value 0.161. When comparing the CT, sigmoidoscopy and biopsy results; CT has an accuracy of 72% and sensitivity of 69.9 %, sigmoidoscopy has an accuracy of 86.0%and sensitivity of 88.9% where the biopsy has accuracy of 90% and sensitivity 89.1% in differentiation of rectal neoplasms. It can be believed that CT and sigmoidiscopy should be performed together and used as essential methods in diagnosing of rectal neoplasms in addition to histopathological examination as an effective tool in determining the possibility of malignancy of this detected neoplasms.

High resolution MR imaging in patients with symptomatic middle cerebral artery stenosis

PurposeHigh resolution magnetic resonance imaging (HRMRI) has been used as an imaging modality to depict the intracranial artery wall. The aim of this study was to compare images of the vessel wall between symptomatic and asymptomatic atherosclerotic plaques of the middle cerebral artery (MCA) using HRMRI. Materials and methodsFrom September 2009 to August 2010 we prospectively screened consecutive patients for MCA stenosis using time-of-flight (TOF) MR angiography. We studied 14 patients with symptomatic MCA stenosis and 16 patients with asymptomatic MCA stenosis. The HRMRI protocol included three different scans: T1-, T2-, and proton density (PD)-weighted black blood MRI. The cross-sectional images of the MCA wall on HRMRI were compared between the two groups based on the degree of stenosis, remodeling ratio, outward or inward remodeling, plaque signal intensity, plaque surface irregularity, and presence of an intact inner wall. ResultsThe degree of MCA stenosis and the ratio of plaque thickening to patent lumen in the symptomatic group were significantly higher than in the asymptomatic group. Outward remodeling of the stenotic area in symptomatic group was significantly higher than that seen in the asymptomatic group, and the reverse was true for inward remodeling of the stenotic area (it was significantly higher in the asymptomatic group compared to the symptomatic group). T2- and PD-weighted high signal foci, eccentric wall thickening, and plaque volume in the stenotic area were all similar between the two groups. ConclusionsHRMRI has the potential to distinguish between atherosclerotic plaques in symptomatic and asymptomatic MCA stenoses.

Hepatobiliary and Pancreatic: Traumatic bile duct neuroma

A man, aged 76, was recovering after surgery for a perforated rectosigmoid cancer. His past history included a cholecystectomy for gallstones, 17 years previously. A computed tomography scan of the abdomen showed a small enhancing nodule in the mid-bile duct. Liver function tests were normal but the serum carbohydrate antigen, 19.9 (CA19.9) level was elevated at 302 U/mL (reference <37 U/mL). A magnetic resonance cholangiogram showed eccentric wall thickening of the mid-bile duct (arrow) consistent with a bile duct neoplasm (Figure 1). At surgery, he had a hard mass, 1 cm in diameter, in the mid-bile duct and had a segmental resection with a Roux-en-Y hepaticojejunostomy. Histological examination revealed hyperplastic and disorganised nerve fibers surrounded by fibrous connective tissue (H&E x200, Figure 2). Immunohistochemical stains were positive for S100 (inset Figure 2). The diagnosis was that of a post-operative (traumatic) neuroma of the bile duct. A neuroma or traumatic neuroma is an exuberant but non-neoplastic proliferation of a nerve that occurs after injury or surgery. After biliary surgery, neuromas can occur in the cystic duct stump but neuromas involving the bile duct are rare. Macroscopically, they are small white-gray nodules that develop at the proximal end of the injured or transected nerve. Histologically, there is a haphazard proliferation of nerve tissue that includes axons, Schwann cells and fibroblasts surrounded by a fibrous capsule. Cystic duct neuromas may be a cause of biliary-type pain after cholecystectomy and, historically, one surgical option was shortening of the cystic duct stump. The results of this procedure remains unclear. More recently, an interesting case report described three patients with pain after cholecystectomy whose symptoms were aggravated by pushing on cystic duct clips with a needle guided by endoscopic ultrasound. Symptoms improved after an injection of local anesthetic and steroid into the region and 2 of 3 patients had resection of the cystic duct stump (Am J Gastroenterol, 2005; 100: 491). Whether neuromas of the bile duct cause pain remains unclear but these nodules can result in extra-hepatic obstruction. In the latter setting, the differential diagnosis can include post-operative strictures, retained stones, benign tumors and bile duct cancer. A pre-operative diagnosis of bile duct neuroma is likely to be difficult and most patients have been treated by surgery, usually with an hepaticojejunostomy. Contributed by

Colonoscopic Findings and Histologic Diagnostic Yield of Colorectal Endometriosis

No study has systematically investigated the colonoscopic findings and histologic diagnostic yield in the diagnosis of colorectal endometriosis. We classified the colonoscopic features of colorectal endometriosis and determined the diagnostic yield of endoscopic biopsy in relation to endoscopic subtypes of colorectal endometriosis. A total of 17 patients with colorectal endometriosis were assessed. The data from the colonoscopic and histologic assessments made between November 1994 and October 2009 were retrospectively analyzed in single tertiary referral teaching hospital. Colonoscopy showed eccentric wall thickening in 14 patients (82%) and polypoid lesions in 3 patients (18%). Surface nodularities were noted in 11 of the 14 patients (79%) with eccentric wall thickening, and in 1 of the 3 patients (33%) with polypoid lesions. The overall histologic diagnostic yield was 47% (8 of the 17 patients). The rate of histologic confirmation was higher in patients with surface nodularities (8 of the 12 patients, 67%) versus those without (0 of the 5 patients, 0%) surface nodularities (P=0.02). Eccentric wall thickening is the most common colonoscopic finding of colorectal endometriosis, and the histologic diagnostic yield of endoscopic biopsy is high when lesions are accompanied by surface nodularities.

Deeply infiltrating endometriosis of the sigmoid and lymph nodes simulating obstructive neoplasm

A rare case of endometriosis of the sigmoid with lymph node involvement is described in a 35-yea-rold patient. The patient presented with a 12-month history of abdominal pain and diarrhoea with catamenial aggravation. A full clinical and laboratory investigation was performed with normal results, with the exception of the tumour marker CA-125 which was elevated. An abdominal CT scan demonstrated an eccentric bowel wall thickening of the sigmoid colon. Colonoscopy revealed extensive stenosis of the bowel lumen covered by normal mucosa. The histopathology results of an endoscopic biopsy were inconclusive in regard to the nature of the obstruction. Preoperative assessment excluded colonic adenocarcinoma but could not rule out the possibility of a gastrointestinal stromal tumour (GIST) or other type of tumour. Nevertheless, the diagnosis of endometriosis appeared more likely. Intraoperatively, a solid, hard tumour of the sigmoid colon was palpated with a jejunal loop attached to it; consequently, sigmoidectomy for malignancy was decided as the optimal plan of action. There was no evidence of additional pathology in the abdominal cavity. Histology of the specimen revealed intramural endometriosis of the sigmoid with involvement of two regional nodes. Treatment options for large bowel endometriosis include hormonal manipulation with additional surgical resection depending on the patient’s age, the severity and the potential complications of the disease.

Gastric hepatoid adenocarcinoma: CT findings

In this study, we evaluated the CT findings of patients with hepatoid adenocarcinoma of the stomach. The CT scans of eight patients (seven males and one female; age range 44-70 years; mean age 59 years) with histologically proven hepatoid adenocarcinoma of the stomach were retrospectively evaluated by two radiologists in consensus. Scans were evaluated for gastric wall thickening, involved site enhancement, adjacent organ invasion, lymphadenopathy, distant metastases, and venous tumor thrombosis. Tumors appeared as eccentric wall thickening (n = 8) and heterogeneous enhancement (n = 7). Adjacent organ invasions were noted to liver (n = 3), pancreas (n = 2), and esophagus (n = 1). All eight patients had a regional lymphadenopathy larger than 8 mm in its short axis. Distant metastases (liver, n = 4; non-regional lymph node, n = 1) were also noted. Venous tumor thrombosis was identified in the portal vein (n = 3), splenic vein (n = 1), main portal vein (n = 1), or right gastroepiploic vein (n = 1) in the regions near primary gastric tumors or metastatic masses. On CT scans, hepatoid adenocarcinoma of the stomach appears as an eccentric gastric wall thickening and shows a strong tendency for liver and lymph node metastasis and venous invasion around the primary gastric tumor or a metastatic hepatic mass.

Tracheal Metastasis of Lung Cancer: CT Findings in Six Patients

Our objective was to assess CT findings of tracheal metastasis of lung cancer. Tracheal metastasis of primary non-small cell lung cancer manifested as an endotracheal nodule or eccentric wall thickening of the trachea, showing contrast enhancement with a predilection for the upper trachea on CT. During postoperative evaluation of patients with surgically resected lung cancer, the possibility of tracheal metastasis of lung cancer should be suggested when an endotracheal nodule or eccentric wall thickening is present on CT.