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Extrahepatic Abdominal Imaging in Patients with Malignancy: Comparison of MR Imaging and Helical CT, with Subsequent Surgical Correlation

¹ Department of Radiology, Sharp and Children's MRI Center, Sharp Memorial Hospital, 7901 Frost St, San Diego, CA 92123 (R.N.L., G.D.A., J.S.S.)
² Department of Radiology, University of North Carolina at Chapel Hill (R.C.S., S.W.).

View larger version (128K): [in a new window]   Figure 1a. Images of the abdomen of a 70-year-old man with metastatic carcinoma of the colon. (a) Helical CT scans at two contiguous levels, with 5-mm collimation, show metastasis in the right hepatic lobe (curved arrow) and a thin rim of perihepatic ascites (long straight arrows). Isoattenuating perihepatic soft tissue (short straight arrow) is poorly defined. (b) Gadolinium chelate–enhanced FMPSPGR MR images (140/2.6, 70° flip angle) with fat suppression. Left: Portal venous phase image shows hypointense metastasis in the right hepatic lobe. Note the abnormal enhancement of the right subphrenic peritoneum (arrow). Right: Delayed equilibrium-phase FMPSPGR image is from a section 1 cm lower than the image at left. Note the thick rind of enhancing right subphrenic and perihepatic peritoneal tumor (arrows). Surgical findings of extensive peritoneal metastatic tumor correlated with the tumor extent in b.

View larger version (107K): [in a new window]   Figure 1b. Images of the abdomen of a 70-year-old man with metastatic carcinoma of the colon. (a) Helical CT scans at two contiguous levels, with 5-mm collimation, show metastasis in the right hepatic lobe (curved arrow) and a thin rim of perihepatic ascites (long straight arrows). Isoattenuating perihepatic soft tissue (short straight arrow) is poorly defined. (b) Gadolinium chelate–enhanced FMPSPGR MR images (140/2.6, 70° flip angle) with fat suppression. Left: Portal venous phase image shows hypointense metastasis in the right hepatic lobe. Note the abnormal enhancement of the right subphrenic peritoneum (arrow). Right: Delayed equilibrium-phase FMPSPGR image is from a section 1 cm lower than the image at left. Note the thick rind of enhancing right subphrenic and perihepatic peritoneal tumor (arrows). Surgical findings of extensive peritoneal metastatic tumor correlated with the tumor extent in b.

View larger version (162K): [in a new window]   Figure 2a. Images of the abdomen of a 48-year-old man with renal cell carcinoma. (a) Helical CT scan, (b) spoiled GRE MR image (140/4, 80° flip angle), and (c) coronal T2-weighted half-Fourier RARE SE image (TR/effective TE, /90). In a, a large heterogeneous enhancing mass (arrow) with central necrosis arises from the lower pole of the right kidney. Venous tumor involvement is poorly shown in a and was not detected prospectively. In b, the large heterogeneous enhancing renal cancer (long arrow) with central low signal intensity is shown. Well-defined low-signal-intensity material (short arrow) is clearly seen in the vena cava, consistent with venous tumor involvement, which was prospectively described. In c, the renal mass (white arrow) and the extent of venous tumor involvement, which extends to the level of the intrahepatic vena cava (black arrow), are seen. The MR demonstration of venous tumor invasion affected treatment planning in this patient. Renal cell carcinoma with venous tumor extension was confirmed surgically.

View larger version (171K): [in a new window]   Figure 2b. Images of the abdomen of a 48-year-old man with renal cell carcinoma. (a) Helical CT scan, (b) spoiled GRE MR image (140/4, 80° flip angle), and (c) coronal T2-weighted half-Fourier RARE SE image (TR/effective TE, /90). In a, a large heterogeneous enhancing mass (arrow) with central necrosis arises from the lower pole of the right kidney. Venous tumor involvement is poorly shown in a and was not detected prospectively. In b, the large heterogeneous enhancing renal cancer (long arrow) with central low signal intensity is shown. Well-defined low-signal-intensity material (short arrow) is clearly seen in the vena cava, consistent with venous tumor involvement, which was prospectively described. In c, the renal mass (white arrow) and the extent of venous tumor involvement, which extends to the level of the intrahepatic vena cava (black arrow), are seen. The MR demonstration of venous tumor invasion affected treatment planning in this patient. Renal cell carcinoma with venous tumor extension was confirmed surgically.

View larger version (171K): [in a new window]   Figure 2c. Images of the abdomen of a 48-year-old man with renal cell carcinoma. (a) Helical CT scan, (b) spoiled GRE MR image (140/4, 80° flip angle), and (c) coronal T2-weighted half-Fourier RARE SE image (TR/effective TE, /90). In a, a large heterogeneous enhancing mass (arrow) with central necrosis arises from the lower pole of the right kidney. Venous tumor involvement is poorly shown in a and was not detected prospectively. In b, the large heterogeneous enhancing renal cancer (long arrow) with central low signal intensity is shown. Well-defined low-signal-intensity material (short arrow) is clearly seen in the vena cava, consistent with venous tumor involvement, which was prospectively described. In c, the renal mass (white arrow) and the extent of venous tumor involvement, which extends to the level of the intrahepatic vena cava (black arrow), are seen. The MR demonstration of venous tumor invasion affected treatment planning in this patient. Renal cell carcinoma with venous tumor extension was confirmed surgically.

View larger version (131K): [in a new window]   Figure 3a. Images of the abdomen of a 79-year-old woman with primary ovarian cancer. (a) Helical CT scan shows perihepatic ascites (arrows). Fluid or soft tissue (arrowheads) is also present adjacent to the spleen. Distinguishing between ascites and peritoneal implants can be difficult at CT. (b) Fat-suppressed FMPSPGR MR image (140/2.6, 70° flip angle) obtained 10 minutes after intravenous injection of gadopentetate dimeglumine shows a rim of enhancing peritoneal tumor (short solid straight arrows) in the right subphrenic space. Note that the tumor extends into the left intersegmental fissure (open arrow), into the superior recess of the lesser sac (curved arrow), and along the portal vein (arrowheads). Enhancing perisplenic tumor (long solid straight arrow) is also present. Extensive peritoneal tumor was confirmed surgically.

View larger version (125K): [in a new window]   Figure 3b. Images of the abdomen of a 79-year-old woman with primary ovarian cancer. (a) Helical CT scan shows perihepatic ascites (arrows). Fluid or soft tissue (arrowheads) is also present adjacent to the spleen. Distinguishing between ascites and peritoneal implants can be difficult at CT. (b) Fat-suppressed FMPSPGR MR image (140/2.6, 70° flip angle) obtained 10 minutes after intravenous injection of gadopentetate dimeglumine shows a rim of enhancing peritoneal tumor (short solid straight arrows) in the right subphrenic space. Note that the tumor extends into the left intersegmental fissure (open arrow), into the superior recess of the lesser sac (curved arrow), and along the portal vein (arrowheads). Enhancing perisplenic tumor (long solid straight arrow) is also present. Extensive peritoneal tumor was confirmed surgically.

View larger version (164K): [in a new window]   Figure 4a. Images of the abdomen of a 52-year-old woman who presented with jaundice. (a) Helical CT scan, (b) spoiled GRE MR image (140/4, 80° flip angle) obtained immediately after injection of gadopentetate dimeglumine, and (c) coronal T2-weighted half-Fourier RARE SE MR image (TR/effective TE, /90). In a, dilated distal common bile duct (arrow) is seen at the level of the pancreatic head. No tumor is identified in a. In b, MR image obtained with a phased-array surface coil shows a small 1-cm, low-signal-intensity mass (arrows) surrounding the distal common bile duct at the level of the inferior pancreatic head; this mass represents a small ampullary carcinoma. In c, the level of obstruction is clearly demonstrated. An abnormal low-signal-intensity mass (arrow) at the ampulla of Vater represents an ampullary carcinoma. The ampullary carcinoma depicted on the MR images was confirmed surgically.

View larger version (190K): [in a new window]   Figure 4b. Images of the abdomen of a 52-year-old woman who presented with jaundice. (a) Helical CT scan, (b) spoiled GRE MR image (140/4, 80° flip angle) obtained immediately after injection of gadopentetate dimeglumine, and (c) coronal T2-weighted half-Fourier RARE SE MR image (TR/effective TE, /90). In a, dilated distal common bile duct (arrow) is seen at the level of the pancreatic head. No tumor is identified in a. In b, MR image obtained with a phased-array surface coil shows a small 1-cm, low-signal-intensity mass (arrows) surrounding the distal common bile duct at the level of the inferior pancreatic head; this mass represents a small ampullary carcinoma. In c, the level of obstruction is clearly demonstrated. An abnormal low-signal-intensity mass (arrow) at the ampulla of Vater represents an ampullary carcinoma. The ampullary carcinoma depicted on the MR images was confirmed surgically.

View larger version (158K): [in a new window]   Figure 4c. Images of the abdomen of a 52-year-old woman who presented with jaundice. (a) Helical CT scan, (b) spoiled GRE MR image (140/4, 80° flip angle) obtained immediately after injection of gadopentetate dimeglumine, and (c) coronal T2-weighted half-Fourier RARE SE MR image (TR/effective TE, /90). In a, dilated distal common bile duct (arrow) is seen at the level of the pancreatic head. No tumor is identified in a. In b, MR image obtained with a phased-array surface coil shows a small 1-cm, low-signal-intensity mass (arrows) surrounding the distal common bile duct at the level of the inferior pancreatic head; this mass represents a small ampullary carcinoma. In c, the level of obstruction is clearly demonstrated. An abnormal low-signal-intensity mass (arrow) at the ampulla of Vater represents an ampullary carcinoma. The ampullary carcinoma depicted on the MR images was confirmed surgically.

View larger version (171K): [in a new window]   Figure 5a. Images of the abdomen of a 60-year-old woman with metastatic adenocarcinoma discovered at laparoscopic cholecystectomy. (a) Helical CT scan shows colon distended with stool. Mild thickening (>2 mm) of the descending colon (arrow) was not noted prospectively. (b) Helical CT scan 6 cm caudal to a shows rectal contrast material with air and fluid in the rectosigmoid colon (arrow) but no evidence of an obstructing mass. (c) Gadolinium chelate–enhanced FMPSPGR MR image (141/2.6, 70° flip angle) with fat suppression shows marked mural thickening and enhancement (arrows) of the descending colon, which represent hyperemia and ischemic colitis proximal to a distal colonic obstruction. Enhancing right and left paracolic tumor was depicted on other MR images (not shown). (d) Gadolinium chelate–enhanced fat-suppressed FMPSPGR MR image (141/2.6, 70° flip angle) obtained 7 cm below c shows an enhancing mass (arrows) in the rectosigmoid colon. The position of d is lower than that of b because of the presence of rectal contrast material that distended and elevated the sigmoid colon. Primary colon carcinoma with peritoneal metastases was confirmed surgically.

View larger version (158K): [in a new window]   Figure 5b. Images of the abdomen of a 60-year-old woman with metastatic adenocarcinoma discovered at laparoscopic cholecystectomy. (a) Helical CT scan shows colon distended with stool. Mild thickening (>2 mm) of the descending colon (arrow) was not noted prospectively. (b) Helical CT scan 6 cm caudal to a shows rectal contrast material with air and fluid in the rectosigmoid colon (arrow) but no evidence of an obstructing mass. (c) Gadolinium chelate–enhanced FMPSPGR MR image (141/2.6, 70° flip angle) with fat suppression shows marked mural thickening and enhancement (arrows) of the descending colon, which represent hyperemia and ischemic colitis proximal to a distal colonic obstruction. Enhancing right and left paracolic tumor was depicted on other MR images (not shown). (d) Gadolinium chelate–enhanced fat-suppressed FMPSPGR MR image (141/2.6, 70° flip angle) obtained 7 cm below c shows an enhancing mass (arrows) in the rectosigmoid colon. The position of d is lower than that of b because of the presence of rectal contrast material that distended and elevated the sigmoid colon. Primary colon carcinoma with peritoneal metastases was confirmed surgically.

View larger version (194K): [in a new window]   Figure 5c. Images of the abdomen of a 60-year-old woman with metastatic adenocarcinoma discovered at laparoscopic cholecystectomy. (a) Helical CT scan shows colon distended with stool. Mild thickening (>2 mm) of the descending colon (arrow) was not noted prospectively. (b) Helical CT scan 6 cm caudal to a shows rectal contrast material with air and fluid in the rectosigmoid colon (arrow) but no evidence of an obstructing mass. (c) Gadolinium chelate–enhanced FMPSPGR MR image (141/2.6, 70° flip angle) with fat suppression shows marked mural thickening and enhancement (arrows) of the descending colon, which represent hyperemia and ischemic colitis proximal to a distal colonic obstruction. Enhancing right and left paracolic tumor was depicted on other MR images (not shown). (d) Gadolinium chelate–enhanced fat-suppressed FMPSPGR MR image (141/2.6, 70° flip angle) obtained 7 cm below c shows an enhancing mass (arrows) in the rectosigmoid colon. The position of d is lower than that of b because of the presence of rectal contrast material that distended and elevated the sigmoid colon. Primary colon carcinoma with peritoneal metastases was confirmed surgically.

View larger version (191K): [in a new window]   Figure 5d. Images of the abdomen of a 60-year-old woman with metastatic adenocarcinoma discovered at laparoscopic cholecystectomy. (a) Helical CT scan shows colon distended with stool. Mild thickening (>2 mm) of the descending colon (arrow) was not noted prospectively. (b) Helical CT scan 6 cm caudal to a shows rectal contrast material with air and fluid in the rectosigmoid colon (arrow) but no evidence of an obstructing mass. (c) Gadolinium chelate–enhanced FMPSPGR MR image (141/2.6, 70° flip angle) with fat suppression shows marked mural thickening and enhancement (arrows) of the descending colon, which represent hyperemia and ischemic colitis proximal to a distal colonic obstruction. Enhancing right and left paracolic tumor was depicted on other MR images (not shown). (d) Gadolinium chelate–enhanced fat-suppressed FMPSPGR MR image (141/2.6, 70° flip angle) obtained 7 cm below c shows an enhancing mass (arrows) in the rectosigmoid colon. The position of d is lower than that of b because of the presence of rectal contrast material that distended and elevated the sigmoid colon. Primary colon carcinoma with peritoneal metastases was confirmed surgically.