Indium chloride bone marrow scintigraphy for hepatic myelolipoma: A case report

BACKGROUND As hepatic myelolipoma is rarely encountered,its radiological diagnosis using ultrasonography(US),computed tomography(CT),and magnetic resonance imaging(MRI)is challenging.Hepatic myelolipoma is similar to fat-contained hepatic lesions seen in hepatocellular carcinoma and angiomyolipoma.Therefore,further development of techniques to diagnose hepatic myelolipoma is warranted.CASE SUMMARY A 44-year-old obese man was found to have a hepatic lesion during his medical checkup.The lesion was 50 mm×57 mm in size and was detected in segment 8(S8)of the liver by US.The patient was diagnosed with hepatic lesion 20 years ago,but it was left unresolved.The patient had no symptoms,liver dysfunction,hepatitis virus antibody,or tumor marker elevation.Plain CT showed a welldefined lesion in S8 of the liver.The central and peripheral areas of the lesion primarily exhibited fat density and hypodensity,respectively.MRI revealed a capsule-like structure.Biopsy was performed to address the probability of hepatocellular carcinoma.The lesion was pathologically confirmed as a myelolipoma.Bone marrow scintigraphy performed using 111InCl3 revealed accumulation of the radiopharmaceutical in the soft tissue component,except in the fat-dominant part of the tumor,as well as in the surrounding liver parenchyma due to the presence of reticuloendothelial cells in the liver.CONCLUSION This is the first report on the diagnosis of hepatic myelolipoma using 111InCl3 scintigraphy.The effectiveness of bone marrow scintigraphy for diagnosing hepatic myelolipoma might be limited.As radiopharmaceuticals accumulate in both hematopoietic and reticuloendothelial cells,the accumulation of radiopharmaceuticals in the lesion is obscure.

Diagnostic efficacy of gadoxetic acid-enhanced MRI for hepatocellular carcinoma and dysplastic nodule

AIM:To evaluate the relationship between the signal intensity of hepatobiliary phase images on gadoxetic acid-enhanced magnetic resonance imaging(MRI)and histological grade.METHODS:Fifty-nine patients with 82 hepatocellular lesions were evaluated retrospectively.Hepatobiliary phase images on gadoxetic acid-enhanced MRI were classified into 3 groups:low,iso or high.Angiographyassisted computed tomography(CT)findings were also classified into 3 groups:CT during arterial portography,and CT hepatic arteriography:A:iso,iso or low;B:slightly low,iso or low;;and C:low,high.We correlated angiography-assisted CT,hepatobiliary phase findings during gadoxetic acid-enhanced MRI and histological grades.Furthermore,correlations between MRI findings and histological grade for each hemodynamic pattern were performed.Correlations among radiologicaland pathological findings were statistically evaluated using the chi-square test and Fisher's exact test.RESULTS:There was a significant correlation between histological grade and hemodynamic pattern(P<0.05).There was a significant correlation between histological grade and signal intensity in the hepatobiliary phase(P<0.05)in group A lesions.There was no significant correlation between histological grade and signal intensity in the hepatobiliary phase in group B or C lesions(P>0.05).CONCLUSION:Signal intensity in the hepatobiliary phase correlated with histological grade in the lesions that maintained portal blood flow,but did not correlate in lesions that showed decreased or defective portal blood flow.

Diffusion-weighted imaging of the liver:Current applications

Diffusion-weighted imaging(DWI) of the liver can be performed using most commercially available machines and is currently accepted in routine sequence. This sequence has some potential as an imaging biomarker for fibrosis, tumor detection/characterization, and following/predicting therapy. To improve reliability including accuracy and reproducibility, researchers have validated this new technique in terms of image acquisition, data sampling, and analysis. The added value of DWI in contrastenhanced magnetic resonance imaging was established in the detection of malignant liver lesions. However, some limitations remain in terms of lesion characterization and fibrosis detection. Furthermore, the methodologies of image acquisition and data analysis have been inconsistent. Therefore, researchers should make every effort to not only improve accuracy and reproducibility but also standardize imaging parameters.

Diffusion-weighted imaging might be useful for reactive lymphoid hyperplasia diagnosis of the liver: A case report

BACKGROUND Reactive lymphoid hyperplasia(RLH)of the liver is a rare liver lesion.It is considered difficult to differentiate radiologically from hepatocellular carcinoma,metastatic liver tumor and other pathologies.CASE SUMMARY A 54-year-old woman presented to our hospital with RLH of the liver.The patient had a diagnosis of metastatic carcinoma of the liver from an unknown origin and subsequently underwent partial hepatectomy.However,histopathological analysis revealed RLH.The lesion showed perinodular enhancement in the arterial phase on contrast-enhanced computed tomography and magnetic resonance imaging.On diffusion-weighted imaging(DWI),we encountered linear hyperintensity along the portal tract consecutive to the liver lesion,which is a new characteristic radiologic finding.This finding corresponded to the lymphoid cell infiltration of the portal tract.Furthermore,there was strongly restricted diffusion on the apparent diffusion coefficient map.We used these characteristic radiologic findings to diagnose the lesion as a lymphoproliferative disease.CONCLUSION The linear hyperintensity consecutive to the liver lesion on DWI provided additional valuable diagnostic information.

Eustachian tube involvement in a patient with relapsing polychondritis detected by magnetic resonance imaging:A case report

BACKGROUND Relapsing polychondritis(RP)is a rare inflammatory disease involving the systemic cartilage,such as the auricle,trachea,and bronchiole,among others.A patient with RP shows variable symptoms based on the involved cartilage.CASE SUMMARY A 72-year-old Japanese woman with a history of redness of the bilateral auricles for 3 d was referred to a clinician.The clinician prescribed antibiotics to the patient;however,the symptoms worsened;thus,she was referred to our hospital.Head and neck magnetic resonance imaging(MRI)showed edematous auricle with remarkable contrast,fluid collection in the bilateral mastoid cells,suggesting otitis media.The eustachian tube(ET)on the right side was also edematous with contrast enhancement.The patient was suspected of RP according to the diagnostic criteria.A biopsy of the auricular cartilage was performed by an otorhinolaryngologist,confirming pathological proof of RP.Treatments with steroids were immediately administered thereafter.CONCLUSION We highlight a rare case of RP with radiologically confirmed involvement of ET in the MRI.

Transcatheter arterial embolization for traumatic injury to the pharyngeal branch of the ascending pharyngeal artery:Two case reports

BACKGROUND The ascending pharyngeal artery(APhA)comprises the pharyngeal trunk(PT)and neuromeningeal trunk.The PT feeds the nasopharynx and adjacent tissue,which potentially connects with the sphenopalatine artery(SPA),branched from the internal maxillary artery(IMA).Due to its location deep inside the body,the PT is rarely injured by trauma.Here,we present two cases that underwent transcatheter arterial embolization(TAE)of the PT of the APhA due to trauma and iatrogenic procedure.CASE SUMMARY Case 1 is a 49-year-old Japanese woman who underwent transoral endoscopy under sedation for a medical check-up.The nasal airway was inserted as glossoptosis occurred during sedation.Bleeding from the nasopharynx was observed during the endoscopic procedure.As the bleeding continued,the patient was referred to our hospital for further treatment.Contrast-enhanced computed tomography(CT)demonstrated extravasation in the nasopharynx originating from the right Rosenmuller fossa.TAE was performed and the extravasation disappeared after embolization.Case 2 is a 28-year-old Japanese woman who fell from the sixth floor of a building and was transported to our hospital.Contrastenhanced CT demonstrated a complex facial fracture accompanying extravasation in the left pterygopalatine fossa to the nasopharynx.Angiography demonstrated an irregular third portion of the IMA.As angiography after TAE of the IMA demonstrated extravasation from the PT of the APhA,additional TAE to the artery was performed.The bleeding stopped after the procedure.CONCLUSION Radiologists should be aware that the PT of the APhA can be a bleeding source,which has a potential connection with the SPA.

Brachiocephalic to left brachial vein thrombotic vasculitis accompanying mediastinal pancreatic fistula:A case report

BACKGROUND Pancreatitis is a severe inflammatory pancreatic disease commonly due to bile duct stones or excessive alcohol usage,with clinical manifestations of abdominal pain,nausea,fever,and fluid collections.Healthy persons with less symptomatic pancreatitis are quite rare.Herein,we report a case of a patient with an undetermined onset of pancreatitis mimicking left arm cellulitis due to thrombotic vasculitis of the brachiocephalic vein.CASE SUMMARY A 50-year-old woman visited our hospital for tenderness in the left arm over several recent days.She was diagnosed with cellulitis on the left arm due to left elbow tenderness.Intravenous antibiotics administration did not improve symptoms and laboratory data worsened;thus,chest and abdominal computed tomography(CT)was performed.CT demonstrated pancreatitis with pseudocyst around the pancreas extending to the mediastinum.Thrombotic vasculitis of the brachiocephalic to left brachial vein was observed,which could be the cause of left elbow pain.A pancreatic fistula was found in the head of the pancreas by endoscopic retrograde cholangiopancreatography,so a pancreatic cyst drainage tube via the duodenum was placed in the pseudocyst.Cyst content culture was positive for Escherichia coli infection.Clinical symptoms,imaging findings,and inflammatory reactions resolved gradually after starting therapeutic intervention.The mediastinal pancreatic pseudocysts shrunk,and the venous thrombi remained but shrunk.CONCLUSION The case of a patient with pancreatitis with an undetermined onset that mimics left arm cellulitis is reported.Deep vein thrombosis should be kept in mind when treating patients with severe inflammatory disease.