6. Miscellaneous Musculoskeletal System

Clinical Breast Lymphoscintigraphy: Optimal Techniques for Performing Studies, Image Atlas, and Analysis of Images


Borys R. Krynyckyi, MD ; Chun K. Kim, MD ; Martin R. Goyenechea, MD ; Peggy T. Chan, MD ; Zhuang-Yu Zhang, PhD ; Josef Machac, MD

1 From the Department of Radiology, Mount Sinai School of Medicine, New York, NY. Received August 14, 2002; revision requested November 18; final revision received August 21, 2003; accepted August 22. All authors have no financial relationships to disclose. Address correspondence to B.R.K., Department of Radiology, Box 1141, Mount Sinai Medical Center, One Gustave L. Levy Pl, New York, NY 10029-6574.

Breast lymphoscintigraphy is increasingly performed before surgery to delineate the drainage to the sentinel node (SN) in the axilla. On the basis of the histologic status of harvested SNs, the disease status of the entire axilla can be predicted. This prediction allows a more limited dissection to be performed while maintaining staging accuracy comparable with that of classic axillary lymph node dissection. Lymphoscintigraphy assists surgeons in harvesting the SN during gamma probe–assisted axillary biopsy or dissection and provides a wide field of view survey, among other benefits. When certain injection protocols are used, lymphoscintigraphy can be performed in the afternoon before surgery the next morning, thus minimizing disruptions of tight surgical schedules. Image acquisition can be optimized and SN activity can be maximized by means of such factors as parameters for preparation of the radiotracer, injection techniques, energy settings for the gamma camera, breast displacement maneuvers, and techniques for marking and outlining the patient’s body. The ultimate goals are to delineate the true SN, maximize activity in the node for facilitated removal (even at next-day surgery), and deliver the information to the surgeon without delaying the surgical schedule.

Cross-Sectional Nodal Atlas: A Tool for the Definition of Clinical Target Volumes in Three-Dimensional Radiation Therapy Planning


Rafael Martinez-Monge, MD ; Patrick S. Fernandes, MD ; Nilendu Gupta, PhD ; Reinhard Gahbauer, MD

1 From the Division of Radiation Oncology, the Arthur G. James Cancer Hospital, Ohio State University, 300 W Tenth Ave, Columbus, OH 43210. Received July 15, 1998; revision requested August 27; revision received October 16; accepted November 23, 1999.

Virtual three-dimensional clinical target volume definition requires the identification of areas suspected of containing microscopic disease (frequently related to nodal stations) on a set of computed tomographic (CT) images, rather than the traditional approach based on anatomic landmarks. This atlas displays the clinically relevant nodal stations and their correlation with normal lymphatic pathways on a set of CT images.

Neuroimaging in Pediatric Leukemia and Lymphoma: Differential Diagnosis


Elida Vázquez, MD ; Javier Lucaya, MD ; Amparo Castellote, MD ; Joaquim Piqueras, MD ; Pilar Sainz, MD ; Teresa Olivé, MD ; José Sánchez-Toledo, MD ; Juan J. Ortega, MD

1 From the Department of Pediatric Radiology and Institut de Diagnòstic per la Imatge (E.V., J.L., A.C., J.P., P.S.), Department of Pediatric Hematology (T.O., J.J.O.), and Department of Pediatric Oncology (J.S.T.), Hospital Vall d’Hebron, Ps Vall d’Hebron 119–129, 08035 Barcelona, Spain. Presented as an education exhibit at the 2001 RSNA scientific assembly. Received February 18, 2002; revision requested April 26 and received June 13; accepted June 14.

Recent advances in therapy for pediatric hematologic neoplasms have greatly improved the prognosis but have resulted in an increased incidence of associated complications and toxic effects. The main neuroimaging features in pediatric patients with leukemia or lymphoma treated with chemotherapy or radiation therapy were retrospectively reviewed. To simplify the approach and facilitate differential diagnosis, the neuroimaging features have been classified into three main categories: central nervous system manifestations of primary disease, side effects of therapeutic procedures (radiation therapy, chemotherapy, bone marrow transplantation), and complications due to immunosuppression, particularly infections. Manifestations of primary disease include cerebrovascular complications (hemorrhage, cerebral infarction) and central nervous system involvement (infiltration of the meninges, parenchyma, bone marrow, orbit, and spine). Effects of radiation therapy include white matter disease, mineralizing microangiopathy, parenchymal brain volume loss, radiation-induced cryptic vascular malformations, and second neoplasms. Effects of chemotherapy and bone marrow transplantation include hemorrhage, dural venous thrombosis, white matter disease, reversible posterior leukoencephalopathy syndrome, and anterior lumbosacral radiculopathy. Both the underlying malignancy and antineoplastic therapy can cause immunosuppression. Fungi are the most frequent causal microorganisms in immunosuppressed patients with infection. Familiarity with the imaging findings is essential for proper diagnosis of neurologic symptoms in pediatric patients with oncohematologic disease.

Peripheral T-Cell Lymphoma: Spectrum of Imaging Findings with Clinical and Pathologic Features


Hyun Ju Lee, MD ; Jung-Gi Im, MD ; Jin Mo Goo, MD ; Kyoung Won Kim, MD ; Byung Ihn Choi, MD ; Kee Hyun Chang, MD ; Joon Koo Han, MD ; Moon Hee Han, MD

1 From the Department of Radiology, Gachon Medical School, Gil Medical Center, Inchon, Korea (H.J.L.); and the Department of Radiology and the Insitute of Radiation Medicine, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea (J.G.I., J.M.G., K.W.K., B.I.C., K.H.C., J.K.H., M.H.H.). Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. Received February 8, 2002; revision requested April 25 and received May 16; accepted May 17.

Most radiologists are unfamiliar with peripheral T-cell lymphoma (PTCL) because PTCL represents a relatively small proportion of lymphomas and has a lower prevalence in Western countries. The World Health Organization classification of lymphoid neoplasms announced in 1999 resolved criticisms about lymphoma classification and aroused new interest in PTCL. The specific clinicopathologic entities of PTCL have particular primary locations and particular clinical and pathologic features. Radiologic images of patients with pathologically proved PTCL were retrospectively reviewed; clinical and pathologic data were also reviewed. PTCL involves various organs including the sinonasal cavity, airway, intestinal tract, skin, lymph nodes, liver, lung, and musculoskeletal system. The pattern of disease involvement in PTCL is not random. There is a correlation between specific clinicopathologic entities and the primary site of involvement, although the findings in the disseminated stage of disease do not allow differential diagnosis. It is significant that the radiologic features or locations of several entities are different from those of lymphoma with the B-cell phenotype. Radiologic demonstration of disease progression beyond the primary site is clinically important because systemic dissemination in most of the entities leads to a dramatic change in the prognosis.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s