Lee, Christine U.

Epithelioid hemangioendothelioma is a rare vascular malignancy often characterized by a clinically indolent course and delayed diagnosis. The authors present the radiologic and pathologic features of a case of pulmonary epithelioid hemangioendothelioma which was initially thought to be calcified granulomas.

This pictorial essay briefly discusses methods for optimizing bowel imaging with magnetic resonance imaging (MRI) and illustrates the MRI appearance of a variety of unusual lesions involving or related specifically to the large bowel.

The purpose of this pictorial essay is to demonstrate the imaging features (ultrasound, mammogram, and magnetic resonance imaging (MRI)) of AlloDerm®(LifeCell Corp.; Branchburg, NJ), an acellular dermal matrix sometimes used in both primary and reconstructive breast surgeries. AlloDerm®is derived from cadaveric dermis and provides an immunologically inert scaffold in tissue reconstruction. Since there is little literature on the imaging of this substance, radiologists may be unfamiliar with its appearance in breast imaging. For this manuscript,ex vivoandin vivoimages of AlloDerm®in postmastectomy patients were evaluated using different imaging modalities. The appearance of AlloDerm®can vary based on length of time postsurgery and incorporation into the host. AlloDerm®appears as an isodense to glandular tissue on a mammogram and isoechoic to glandular tissue on ultrasound imaging. On MRI, in comparison with normal breast parenchyma, AlloDerm®is hyperintense on T2-weighted imaging and isointense on T1-weighted imaging and demonstrates mild enhancement. To the best of the authors’ knowledge, this is the first multimodality imaging description of AlloDerm®used in postmastectomy patients. The conformation of AlloDerm®at surgical placement and the degree of host cell migration and neoangiogenesis are factors to take into consideration when performing diagnostic evaluations; and, familiarity with the various imaging appearances of AlloDerm®can be helpful to exclude residual or recurrent disease.

Despite its nonionizing technique and exquisite soft tissue characterization, noncardiovascular, and nonmusculoskeletal magnetic resonance imaging (MRI) of the chest has been considered impractical due to various challenges such as respiratory motion, cardiac motion, vascular pulsatility, air susceptibility, and paucity of signal in the lung. With advances in MRI, it is now possible to perform diagnostically useful and good quality MRIs of the chest, but literature on subspecialized chest MRI practices is limited. The purpose of this manuscript is to describe the rationale, nuances, and logistics that went into developing such a practice in the Division of Thoracic Radiology at our institution. The topics addressed include technical and clinical considerations, support at administrative and clinical levels, protocol development, and economic considerations compared with conventional practices. Various MRI techniques are also specifically discussed to facilitate chest MRI at other sites. Although chest MRI is used in a relatively small number of patients at this point, in certain patients, chest MRI can provide additional information to optimize medical management. A few clinical cases illustrate the quality and clinical utility of chest MRI. Given recent advances in MRI techniques, it is now an opportune time to develop a chest MRI practice.