Retained Surgical Sponges (Gossypiboma)

Imaging liver metastases: Review and update

Retained surgical sponges have been reported to occur after a diversity of surgical procedures, but transmural migration is a very unusual sequela. This article reports a case in which a retained surgical sponge eroded from the intra-abdominal space into the intestinal lumen, migrated distally, and spontaneously passed with defecation 12 weeks after the cesarean section. We performed a systematic review of the literature in Pubmed and found 64 cases of transmural migration of retained surgical sponges. Sixty-four cases have been reported of transmural migration, mainly after intra-abdominal surgery. The most frequent site of impaction is the intestine (75%), but we also found 2 cases that describe migration into the stomach and 7 into the bladder. Five more cases have been published describing transdiaphragmic migration. Only 4 cases describe a sponge spontaneously expelled through the rectum, whereas more than 93% needed re-intervention. We strongly advise only the use sponges with radiopaque markers during surgery and additional methodical wound/body cavity examination.

Transmural migration of retained surgical sponges: a systematic review.

OBJECTIVE. We compared radiologists' performance on combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR imaging with their performance on helical CT during arterial portography (CTAP) and biphasic CT during hepatic arteriography (CTHA) for the preoperative detection of malignant hepatic tumors.SUBJECTS AND METHODS. MR images and CT scans obtained in 33 patients were retrospectively analyzed. Images of the liver were reviewed on a segment-by-segment basis; a total of 261 segments with 39 hepatocellular carcinomas and 21 metastases were independently reviewed by three radiologists who were invited from outside institutions. Unenhanced and gadolinium-enhanced MR images were reviewed first, then ferumoxides-enhanced MR images were added for combined review. CTAP images and biphasic CTHA images were reviewed together.RESULTS. Sensitivity for the detection of hepatic tumors was analogous for combined unenhanced, gadolinium-enhanced, and ferumoxides-enhanced MR images (86%) and for combined CTA...

Preoperative detection of malignant hepatic tumors: comparison of combined methods of MR imaging with combined methods of CT.

Purpose:The purpose of our study was to assess the efficacy of single-level dynamic CT during hepatic arteriography (D-CTA) in the differentiation between hypervascular hepatocellular carcinoma (HCC) and hypervascular pseudolesion.Method:D-CTA was performed in nine cases with HCC and nine cases with

Differentiation of Hypervascular Hepatic Pseudolesions from Hepatocellular Carcinoma: Value of Single-Level Dynamic CT During Hepatic Arteriography

Background: To assess the frequency and characteristics of nonpathological focal enhancements seen on spiral computed tomographic (CT) hepatic angiography (CTA).

Nonpathological focal enhancements on spiral CT hepatic angiography.

Purpose
To evaluate the feasibility of detecting and measuring gastro-esophageal reflux (GER) with esophageal MR fluoroscopy in patients suffering from heartburn.

Observation of gastro-esophageal reflux by MRI: a feasibility study

OBJECTIVE The purpose of this study was to try to delineate the esophageal passage under dynamic conditions and to determine optimum settings for esophageal magnetic resonance (MR) imaging. METHODS Ten healthy volunteers underwent MR fluoroscopy with two T1-weighted sequences: turbo field echo (TFE) and T1-weighted fast field echo (T1-FFE). These sequences were compared for signal-to-noise ratios (SNRs) and image quality. To determine the optimum slice thickness, an additional 10 healthy volunteers underwent MR fluoroscopy. Results obtained for slice thicknesses of 25, 35, 45, and 55 mm were compared for delineated length of the esophagus and image quality. RESULTS The T1-FFE sequences provided higher SNRs and better image quality than the TFE sequences (T1-FFE: 89.4 +/- 28.0, TFE: 52.4 +/- 16.7; P < 0.001). Artifacts were less prominent and delineation of the esophageal wall was better on the T1-FFE images. The delineation of the esophageal wall was best with a 35-mm slice thickness, although delineated length was the longest with a 55-mm slice thickness. CONCLUSION This study showed T1-FFE to be a more suitable sequence than TFE and that the 35-mm slice thickness was the optimum slice thickness for esophageal MR fluoroscopy.

Esophageal magnetic resonance fluoroscopy: optimization of the sequence.

We describe ferumoxides-enhanced magnetic resonance imaging findings in a 60-year-old man with confluent hepatic fibrosis in advanced cirrhosis. The extension and internal structure of confluent fibrosis were well demonstrated with ferumoxides-enhanced proton-density spin-echo magnetic resonance images, showing a wedge-shaped area of high signal intensity corresponding to the extension of fibrosis and internal focal areas of low signal intensity, presumably corresponding to residual functioning liver parenchyma. This case suggests a potential utility of ferumoxides-enhanced magnetic resonance imaging for characterizing this tumor-mimicking disorder.

Confluent hepatic fibrosis in cirrhosis: ferumoxides-enhanced MR imaging findings.

Objective: We attempt to clarify specific imaging findings useful for differential diagnosis between endometrioid cancer and clear cell cancer. Methods: We examined magnetic resonance imaging features on 11 endometrioid cancer and 9 clear cell cancer patients. We compared them, focusing on the locularity, characteristic and growth pattern of solid components, and association with endometrial diseases. Results: Endometrioid cancer had a predominantly multilocular appearance, but clear cell cancer showed almost equally multilocular and unilocular appearances. For the growth pattern, endometrioid cancer in 6 patients demonstrated a "centric pattern" and an "eccentric pattern" in 4, whereas clear cell cancer showed predominantly an eccentric pattern. An internal slit in the solid component was seen in 4 endometrioid cancer patients but not seen in any of the patients with clear cell cancer. Conclusions: The magnetic resonance imaging appearance of the internal slit in solid components and the presence of endometrial disease are key factors in differentiating endometrioid cancer from clear cell cancer, although lesion locularity and growth pattern are not specific in both.

Magnetic resonance imaging of endometrial cancer and clear cell cancer.

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