Faculty Bibliography

Angiomyolipoma with epithelial cysts (AMLEC) is a rare variant of angiomyolipoma with minimal fat that contains epithelial-lined cysts and may mimic a cystic renal cell carcinoma. While 17 cases have been described in the pathology literature since this entity was first described in 2006, the radiologic appearance was not demonstrated in any of these cases. We report the CT and MRI appearance of AMLEC found incidentally in a patient with lupus nephritis

Oncocytic adrenocortical neoplasm is a rare adrenal tumour that usually follows a benign clinical course. In some cases, however, these tumours have exhibited malignant behaviour. Here, we present the first published case showing bulk fat within an oncocytic adrenocortical neoplasm on CT and MRI, a finding that mimics fat within an adrenal myelolipoma. The distinction between these entities is important, as the current suggested management of an oncocytic adrenocortical neoplasm is resection with subsequent imaging surveillance

OBJECTIVE: The purpose of this study was to compare a 3D T2-weighted imaging sequence with a conventional multiplanar 2D turbo spin-echo T2-weighted sequence in terms of tumor detection and staging of prostate cancer, as well as image quality. MATERIALS AND METHODS: Before prostatectomy, 38 men (mean age, 60 years) with prostate cancer underwent MRI of the prostate with multiplanar 2D turbo spin-echo T2-weighted sequences (total acquisition time, approximately 11 minutes 4 seconds) and a 3D T2-weighted sampling perfection with application optimized contrasts sequence with different flip angle evolutions (SPACE) (acquisition time, approximately 3 minutes 52 seconds). Two blinded observers in consensus reviewed 2D turbo spin-echo T2-weighted images and SPACE images for detection of peripheral zone cancer, extracapsular extension, and seminal vesicle invasion. The observers also assessed subjective image quality and measured the signal-to-noise ratio (SNR) of normal peripheral zone and tumor-to-peripheral zone contrast. Prostatectomy was used as the reference standard. The diagnostic accuracy of the two sequences was assessed with generalized estimating equations and McNemar tests. The agreement between sequences was assessed with kappa coefficients. A paired Wilcoxon signed rank test was used to compare the subjective image quality, SNR, and tumor-to-peripheral zone contrast of the two sequences. RESULTS: For tumor detection and diagnosis of extracapsular extension, there was substantial agreement between the two sequences (kappa = 0.79, kappa = 0.76) with no difference in sensitivity, specificity, positive predictive value, negative predictive value, accuracy (p = 0.25-1), or image quality (p = 0.937). Images obtained with the 2D turbo spin-echo sequence had a significantly higher SNR ratio for normal peripheral zone (p = 0.0010), but SPACE images had significantly greater tumor-to-peripheral zone contrast (p < 0.0001). CONCLUSION: In comparison with conventional multiplanar 2D turbo spin-echo MRI of the prostate, 3D T2-weighted SPACE MRI was associated with substantial time saving (nearly 8 minutes), had similar image quality and accuracy in the diagnosis of tumor and extracapsular extension, and had better tumor conspicuity

OBJECTIVE: The purpose of this retrospective study was to qualitatively and quantitatively compare image quality of a time-efficient 3D T2-weighted sequence-the sampling perfection with application-optimized contrasts using different flip angle evolutions (SPACE) sequence-with a standard 2D T2-weighted turbo spin-echo (TSE) sequence for liver imaging at 3 T. MATERIALS AND METHODS: Twenty patients underwent liver MRI at 3 T using T2-weighted breath-hold 2D TSE and respiratory-triggered SPACE sequences. Two radiologists independently assessed image quality for both sequences during separate sessions, followed by a side-by-side comparison. One reader performed a quantitative analysis of the estimated signal-to-noise ratio (SNR) and the relative contrast between the liver and other tissues. RESULTS: Image quality scores for the SPACE sequence were significantly better than those for the 2D TSE sequence for motion (p < 0.0001) and pulsation (p < 0.0001) artifact, flow signal suppression (p = 0.0015), sharpness of intrahepatic vessels (p < 0.0001), and sharpness of liver edge (p = 0.0015), with motion and pulsation artifacts being nearly eliminated using the SPACE sequence. However, the scores for B(1) inhomogeneity artifact were significantly worse for the SPACE sequence (p = 0.0117). Overall, both readers preferred SPACE sequence, although this difference was significant for only one reader (p = 0.025, p = 0.275). There was no significant difference between the sequences for estimated liver SNR (p = 0.1564), but the SPACE sequence showed significantly higher relative contrast between the liver and the kidney (p < 0.0001), gallbladder (p = 0.0476), and spleen (p < 0.0001). Relative contrast between the liver and parenchymal lesions was higher with the SPACE sequence than with the TSE sequence, although this difference was not statistically significant (p = 0.125). CONCLUSION: For T2-weighted liver imaging at 3 T, the respiratory-triggered SPACE sequence shows better image quality with near elimination of motion and pulsation artifacts and improved tissue contrast than the breath-hold 2D TSE sequence, but suffers from increased B(1) inhomogeneity artifact and longer scanning time

The pelvic cake kidney in which there is complete fusion of both kidneys into a single renal parenchymal mass has been described as the rarest of renal fusion anomalies. Pelvic cake kidney most commonly drains via 2 separate ureters, with fewer than 10 reports demonstrating a cake kidney drained by a single ureter. We present the first ever reported case of a pelvic cake kidney drained by a single ureter in association with a unicornuate uterus. These findings were identified in a young female patient who underwent pelvic magnetic resonance imaging for pelvic pain

The computed tomographic or magnetic resonance imaging appearance of solitary fibrous tumors of the abdominopelvic cavity has previously only been presented in the English literature as individual case reports. In this article, we present the cross-sectional imaging appearance of 5 such cases, all of which exhibited highly similar imaging features, including well-circumscribed margins, lack of invasion of adjacent structures, and avid enhancement. In view of these shared imaging features, it may be possible to suggest the diagnosis preoperatively. Given their unpredictable biologic behavior with infrequent reports of recurrent or metastatic disease, complete surgical excision and long-term follow-up for these lesions is recommended

We report an extremely rare case of a renal parapelvic neurofibroma. The mass was an incidental finding on an abdominal CT scan of an asymptomatic 59-year-old male with hepatitis C. Subsequent MRI demonstrated a complex mass occupying the left renal sinus that had mass effect on the pelvicalyceal system. The patient underwent left radical nephrectomy, and histological and immunohistochemical findings confirmed the lesion to be a neurofibroma. Given that similar imaging features have been reported previously in four additional cases, we suggest that it may be possible to include this entity in the pre-operative differential diagnosis