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Radiological assessment of mesenteric and retroperitoneal cysts in adults: is there a role for chemical shift MRI?

  • Author Footnotes
    1 Present Affiliation: Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, Texas 79905, USA. Tel.: +1 915 545 6845; fax: +1 915 545 6607.
    Anoop P. Ayyappan
    Correspondence
    Corresponding author. Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada.
    Footnotes
    1 Present Affiliation: Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, Texas 79905, USA. Tel.: +1 915 545 6845; fax: +1 915 545 6607.
    Affiliations
    Abdominal Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada
    Search for articles by this author
  • Kartik S. Jhaveri
    Affiliations
    Abdominal Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada
    Search for articles by this author
  • Masoom A. Haider
    Affiliations
    Abdominal Imaging Division, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Canada
    Search for articles by this author
  • Author Footnotes
    1 Present Affiliation: Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, Texas 79905, USA. Tel.: +1 915 545 6845; fax: +1 915 545 6607.

      Abstract

      Objective

      The purpose of this study was to assess the potential role for chemical shift magnetic resonance imaging (MRI) in identifying lymphangiomas from other cystic mesenteric and retroperitoneal masses.

      Materials and methods

      A retrospective search of radiology database identified 24 consecutive patients with mesenteric and retroperitoneal cysts (nine men, 15 women; mean age, 41 years; age range, 19–75 years) who had undergone MR which included in-phase and opposed-phase chemical shift imaging. Signal intensity (SI) decrease between in-phase and opposed-phase MR images of the cyst was evaluated qualitatively by two radiologists. Ultrasound (US), computed tomography (CT), and MRI findings of the morphological appearances of all the cystic lesions that demonstrated significant signal drop on chemical shift MR were also recorded.

      Results

      Of mesenteric and retroperitoneal cysts, 33% (8/24) revealed qualitative decrease in intensity on opposed-phase MR images relative to that seen on in-phase images. On ultrasound, these cysts demonstrated anechoic simple fluid. Their mean CT attenuation was 13 HU (range: 5–20 HU). Signal loss on fat-suppressed T1-weighted sequences was displayed only by a single cyst. None of the lesions with qualitative SI decrease on opposed-phase MR showed suggestion of lipid on US and CT.

      Conclusion

      The presence of intra cystic lipid detected by chemical shift MR may not be overt on cross-sectional imaging such as US and CT. Chemical shift MRI provides additional sensitivity and specificity as an imaging test for demonstration of lipid within mesenteric and retroperitoneal cysts enabling a higher diagnostic yield for lymphangioma leading to more appropriate patient management.

      Keywords

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