Search

Arteriovenous fistula is any abnormal connection between an artery and a vein that bypasses the normal capillary bed and shunts arterial blood directly to the venous circulation. Uterine arteriovenous fistula (UAVF) is a potentially life-threatening condition by causing massive bleeding. This report describes a case of UAVF with massive hemorrhage. Prior to surgery, endovascular catheters for balloon occlusion were placed within bilateral uterine arteries. During surgery, the surgeon requested temporary balloon inflation for navigating and identifying inflow arteries. The balloon was kept inflated during the ligation of the vessels. Once ligation was completed, the balloon was deflated to confirm hemostasis. A total hysterectomy with removal of the UAVF was successfully achieved without significant blood loss. The fistula, in the resected specimen, was confirmed histologically with Elastica van Gieson staining. The preoperative placement of endovascular balloon-occlusion catheters should be considered when hysterectomy is planned where UAVF is located at the cardinal ligament.

Background/Aim: A new gross classification of hepatocellular carcinoma in which Eggel's nodular type is subclassified into type 1 (single nodular type), type 2 (single nodular type with extranodular growth), and type 3 (contiguous multinodular type) has been widely used in Japan. The aim of the study was to determine whether this classification is correlated with patient outcome. Methods: Sixty-five resected hepatocellular carcinoma nodules (⩽5 cm) were classified using this new classification. Results: The 65 tumors were classified into 30 type 1 (46%), 20 type 2 (31%), and 15 type 3 (23%) hepatocellular carcinomas. The rate of microscopic vascular invasion significantly increased from type 1 to type 2, and to type 3 tumors ( p =0.03). Kaplan-Meier estimates showed that type 1 was significantly associated with lower recurrence rate (type 1 vs . type 2, p =0.01; type 1 vs . type 3, p =0.004; log-rank test), and higher disease-specific survival (type 1 vs . type 2, p =0.02; type 1 vs . type 3, p =0.002). Cox's proportional-haz-ards model demonstrated that type 1 was an independent factor for low risk of recurrence ( p =0.002) and low risk of disease-specific death ( p =0.02). Conclusion: The gross classification of hepatocellular carcinoma is of clinical value in predicting patient outcome.

Hepatic transarterial interventional therapies such as chemoembolization and radiation embolization are important treatment options for hepatocellular carcinoma. Understanding the anatomy of individual arterial branches and hepatic segments is critical for selecting the correct embolization technique for treatment and to avoid complications. The authors describe the morphologic characteristics of hepatic arterial branches (and their mimickers) and hepatic segments on conventional angiograms. These vessels and segments include the celiac artery, the common and proper hepatic arteries, the left and right hepatic arteries and branches, the caudate lobe, and the portal vein and branches. Mimickers of hepatic arteries include the cystic, accessory left gastric, and right gastric arteries, as well as branches of the left gastric artery that resemble segmental branches of the replaced left hepatic artery. The authors describe how each segmental branch of the hepatic artery and the area it supplies correlates at computed tomography (CT) and angiography. Finally, the authors demonstrate how the vascular anatomy changes with the respiratory cycle by creating a virtual movie from calculations with dynamic CT data, in which the arterial and venous phases are acquired at end expiration and inspiration, respectively. Each segmental branch of the hepatic artery has morphologic characteristics that help distinguish it from mimickers. The location of each hepatic segment can be estimated if the artery supplying the segment can be correctly identified on angiograms. Notably, morphologic differences in the hepatic artery system caused by respiration should be recognized.

MRCPはMRIの高度T2強調画像を用いて胆汁・膵液を強調表示することにより造影法に類似した画像を得る検査法である. MRCPは再構成画像とその元画像から成り立っており,胆石や悪性腫瘍の評価には元画像の観察が不可欠である.閉塞性黄疸の診断にMRCPが担う役割については検討を要するが,緊急ドレナージの必要が無い症例については非侵襲性という利点を生かして第一選択の検査となる可能性が期待される.

A case of life-threatening lower gastrointestinal hemorrhage from Crohn's disease is reported. Several promising studies have recently been published that describe superselective embolization for the treatment of massive lower gastrointestinal hemorrhage in patients with bleeding colonic diverticular disease and angiodysplasia, and success rates of 74%-93% have been reported. But in patients with Crohn's disease, successful superselective embolization has rarely been reported. This is a report of successful superselective embolization in a patient with Crohn's disease; this should be the initial treatment of choice in Crohn's disease in an attempt to avoid surgical resection, because repeated resections predispose patients to the development of short-bowel syndrome.

Cases of percutaneous transluminal renal angioplasty for renal artery stenosis are increasing. However, percutaneous transluminal renal angioplasty with stenting for stenotic venous bypass grafts has never been reported. Herein, the authors describe two cases of percutaneous transluminal renal angioplasty with stenting for a stenotic venous bypass graft. The patients in both cases had undergone bypass grafting using autologous saphenous veins, which were anastomosed directly to their abdominal aortas. We successfully conducted percutaneous transluminal renal angioplasty with stenting. One of the keys for technical success is an appropriate selection of guiding catheter compatible with postoperative nonanatomical vasculature, and the other is relatively high pressure dilation for venous stenosis.

A 65-year-old male with a pancreatic neuroendocrine tumor presenting with a duodenal ulcer was referred to our department. The tumor involved the common hepatic artery, gastroduodenal artery, left hepatic artery and the right posterior hepatic artery, but not the right anterior hepatic artery originating from the superior mesenteric artery. The hepatic arteries, except the aberrant right anterior hepatic artery, were embolized using coils 18 days before the surgery. The patient underwent pancreaticoduodenectomy with resection of the tumor-encased hepatic arteries, while preserving the aberrant artery. The patient was discharged uneventfully on postoperative day 13 with no ischemic complications. A histopathological examination revealed a grade 2 pancreatic neuroendocrine tumor according to the classification of the World Health Organization, and the surgical margin was negative. The patient developed hepatic metastases 16 months after surgery; hence, hepatic resection was performed. The present surgical strategy is applicable in patients with relatively low-grade pancreatic malignancies involving major hepatic arteries.

Both hepatic steatosis (HS) and colorectal cancer (CRC) are conditions associated with metabolic syndrome. The liver is the most frequent site of distant metastasis of CRC; however, the impact of HS on the incidence of liver metastasis of CRC is not clearly defined. Then, the correlation with the presence or absence of HS was analyzed. A total of 604 CRC patients receiving curative surgical resection who had a preoperative non-enhanced computed tomography (CT) were enrolled. The mean attenuation values (in Hounsfield units) of the liver and spleen were obtained on a plain CT slice, and the patients with liver–spleen attenuation ratio lower than 1.1 were objectively defined as HS. The clinicopathological features of these patients were analyzed, and the association between HS and the clinical features of CRC was examined. Sixty-three (10.4 %) among the 604 patients were diagnosed as HS. Recurrence-free survival (RFS) and hepatic RFS, but not extrahepatic RFS, were significantly higher in the group with HS (p = 0.04 and p = 0.006). However, this effect was not evident in the group of patients with obesity, defined as body mass index > 25.0. Among the stage I~III cases, HS was significantly associated with lower hepatic, but not extrahepatic, RFS. Moreover, absence of HS was an independent risk factor for hepatic RFS (p = 0.003). Metastases of CRC are less frequent in fatty liver. Steatosis may be an unfavorable microenvironment for metastatic formation in the liver.

Gastric carcinoma is the fourth most common cancer worldwide, behind lung, breast and colorectal carcinomas, and is the second leading cause of death in both sexes worldwide and in Asia [1, 2]. There is about twice male predominance.Gastric carcinoma is particularly common in countries such as Korea (incidence 62.2 per 100,000 males; mortality 22.8 per 100,000 males), Japan (46.8; 20.5), China (41.3; 30.5), Chile (27.3; 23.1), Russia (26.9; 24.0) but not as common in a large part of western societies such as the United States (5.7; 2.7) and United Kingdom (8.0; 4.8) [1].

In this study, we proposed and developed support system to make teaching materials of catheterization. Main functions of proposed system are multiplying and attending can make teaching materials himself easily. Especially, we improved Interfaces in proposed system, and decide suitable equipment for operating-room.

PURPOSE We assessed the wait time of non-contrast renal artery magnetic resonance (MR) angiography with a single breath hold using inflow inversion recovery-fan shaped inward outward view ordering technique in normal volunteers. METHODS The wait time (WT)-the duration between the data acquisition and the following inversion recovery pulse-was varied from 10 ms to 2000 ms, and the contrast ratio between the renal artery and the background structures for each WT was assessed quantitatively. A simulation was also performed. RESULTS The contrast ratio between the renal artery and each background structure with 2000 ms of WT was higher than that with 10 ms of WT. The contrast ratio between the renal artery and renal cortex with 1500 ms of WT was also higher than that with 10 ms of WT. In the simulation, when WT lengthened, the residual longitudinal magnetization of each background structure lowered. CONCLUSION The WT affects contrast; adjustment of WT should be added to the assessment of the imaging parameter.

a b s t r a c t Objective: To investigate whether computed tomography (CT) attenuation test for differential diagnosis of adrenal nodule is applicable in patients with hepatocellular carcinoma (HCC) which shows similar image characteristics to adrenal adenoma. Materials and methods: This retrospective study was approved by our institutional review board, and the requirement for informed consent from study patients was waived. Searching picture archiving and com- munication system, we identified 3678 patients with HCC who underwent upper abdominal unenhanced CT scans between April 2002 and March 2010, and 114 adrenal nodules (39 adenomas and 75 metastases) were included for analysis. Ten nodules were confirmed pathologically while 104 had imaging diagnosis (enlarged or emerged during the study period). Size, CT number, and the internal characteristics of the lesions were recorded. Results: Mean CT numbers of adrenal adenomas were significantly lower than those of metastases (P < 0.0001, t-test) on unenhanced CT. Thresholds of 17 and 33 Hounsfield units (HU) provided the fol- lowing sensitivity, specificity, and accuracy: 46.2%, 100%, and 81.6% at 17 HU, and 94.9%, 89.3%, and 91.2% at 33 HU, respectively. The area under receiver operating characteristic curve for the CT number test was 0.96. Metastases were significantly larger than adrenal adenoma (P = 0.009, t-test). However, the accuracy of testing using mass size was 64.0% at most. All adenomas and metastases were depicted as homoge- neous masses with the exception of two metastases that presented as heterogeneous masses (necrotic or lipomatous). Conclusion: Adrenal adenomas can be differentiated from HCC metastases using CT number on unen- hanced CT.

OBJECTIVES: The combination of computed tomography with hepatic arteriography and arterial portography (CTHA/CTAP) can detect additional hepatocellular carcinoma (HCC) nodules undetected by conventional dynamic CT. METHODS: In this single-center, randomized, open-label, controlled trial, we randomly assigned 280 patients who were diagnosed as having HCC by conventional dynamic CT, and eligible for radiofrequency ablation (RFA), to undergo CTHA/CTAP before treatment, or to the control group. Newly detected HCC nodules by CTHA/CTAP were intended to be ablated completely. The primary end point was recurrence-free survival and the key secondary end point was overall survival. The analysis was conducted on an intention-to-treat basis. Those with nonablated nodules were treated as for recurrence. RESULTS: A total of 75 nodules were newly diagnosed as HCC by CTHA/CTAP in 45 patients. Three patients (one in the CTHA/CTAP group and two in the control group) who refused treatment were excluded from all analyses. The cumulative recurrence-free survival rates at 1, 2, and 3 years were 60.1, 29.0, and 18.9% in the CTHA/CTAP group and 52.2, 29.7, and 23.1% in the control group, respectively (P=0.66 by log-rank test; hazard ratio, 0.94 for CTHA/CTAP vs. control; 95% confidence interval (CI), 0.73–1.22). The cumulative overall survival rates at 3 and 5 years were 79.7 and 56.4% in the CTHA/CTAP group and 86.8 and 60.1% in the control group, respectively (P=0.50; hazard ratio, 1.15, 95% CI, 0.77–1.71). CONCLUSIONS: CTHA/CTAP may detect recurrent lesions earlier. However, CTHA/CTAP before RFA did not improve cumulative recurrence-free survival or overall survival.

Pancreas divisum (PD) and meandering main pancreatic duct (MMPD) are common developmental variants of the pancreatic ductal system. They always appear in the head of the pancreas and are associated with idiopathic pancreatitis. The condition of these variants is rarely reported to have changed after birth. We present a rare case of false PD that occurred with alteration of loop-type MMPD after endoscopic retrograde pancreatography (ERP) and brush cytology followed by post-procedural pancreatitis. A 76-year-old female underwent pre-surgical ERP and brush cytology for an incidentally detected, expanding branch-type intraductal papillary mucinous neoplasm in the body of pancreas. The guidewire was inserted along the main pancreatic duct (MPD) and had uncoiled the loop-shaped MPD into a linear shape; soon afterwards, the patient developed post-procedural acute pancreatitis. Follow-up magnetic resonance cholangiopancreatography study 1 month later revealed the morphology of PD with an absent ventral duct. We hypothesize that inflammatory synechia had occluded the uncoiled ventral duct. This single case provides evidence that pancreatic ductal anatomy is flexible in some situations.

Purpose To investigate the respiratory motion of metal clips or surgical staples placed in the gastric wall for planning of radiation therapy in gastric cancer patients. Methods This study examined 15 metal markers in the gastric walls of 12 patients with gastric cancer treated with external-beam photon RT. Motion assessment was analyzed in 41 respiratory phases covering 20 s acquired with computed tomography (CT) in the RT position using 320-multislice CT. The intra-fraction displacement was assessed in the cranio-caudal (CC), antero-posterior (AP), and right-left (RL) directions. Results Motion in the CC direction showed a very strong correlation (R2 > 0.7) with the respiratory curve in all 15 markers. The mean (+/− SD) intra-fractional gastric motion (maximum range of displacement) was 12.5 (+/− 3.4) mm in the CC, 8.3 (+/− 2.2) mm in the AP, and 5.5 (+/− 3.0) mm in the RL direction. No significant differences in magnitude of motion were detected in the following: a) among the upper (n = 6), middle (n = 4), and lower (n = 5) stomach regions; b) between metal clips (n = 5) and surgical staples (n = 10); and c) between full (n = 9) and empty (n = 6) stomachs. Conclusions Motion in primary gastric tumor was evaluated with 320-multislice CT. According to this study, the 95th percentile values from the cumulative distributions of the RL, AP, and CC direction were 6.3 mm, 9.0 mm, and 13.6 mm, respectively.

Our aim was to investigate when halfcycle reconstruction (HCR) was feasible in patients who were predicted to have a heart rate over 65 bpm in coronary CT angiography (CTA) using 320-row CT. Seventy-four patients who underwent multiple heart beat scanning were included. The time to reach 230 HU at the ascending aorta during the bolus tracking scan was recorded (T230). HCR image and multicycle reconstruction (MCR) image were reconstructed for each patient. Image quality for each coronary segment was rated on a 3-point scale (3: good, 1: poor). For each patient, we determined that a single beat acquisition was feasible for diagnosis (HCR group) when the number of segments graded score 1 in the HCR image was the same or less than that in the MCR image. Otherwise, we included the patients in the MCR group. HCR group and MCR group included 38 and 36 patients, respectively. Regression analysis showed that body height1.66 m (odds ratio (OR), 5.74; CI 1.59-25.6; p0.007), T23016 s (OR 3.11; CI 1.07-9.58; p = 0.04), and heart rate ≤72 bpm (OR 3.18; CI 1.11-9.49; p = 0.03) were related with the HCR group. When all three criteria were fulfilled, the calculated probability that MCR would improve image quality was only 7 %. When the heart rate is ≤72 bpm, single heart beat acquisition is feasible for patients with body height1.66 m and T23016 s in coronary CTA using 320-row CT.

We examined whether the presence of pancreatic cysts could be a risk for pancreatic cancer by comparing the incidence and characteristics of cysts found by magnetic resonance (MR) imaging in patients with and without pancreatic cancer.Half-Fourier rapid acquisition with relaxation enhancement images and MR cholangiopancreatography were performed in 116 patients with pancreatic cancer (PC group) and 1226 with nonpancreatic disease (NP group). Incidence and characteristics of cysts were analyzed.Pancreatic cysts were detected in 65 patients (56%) of the PC group and in 123 patients (10%) of the NP group. According to the multivariate analysis, cyst presence was a significant risk factor for pancreatic cancer (odds ratio [OR], 10.27; P0.01), especially cysts larger than 10 mm (OR, 4.718; P0.01). When the definition of cyst presence in the PC group was restricted to the 33 cases with cysts considered to have existed before the development of cancer, the incidence was still high (OR, 2.976; P0.01) and size remained significant (OR, 4.428; P0.01).Patients with pancreatic cysts, especially larger than 10 mm, were considered to be at an increased risk of pancreatic cancer over the entire pancreas.

Uterine arteriovenous fistula (AVF) is a rare entity, but may lead to life-threatening hemorrhage. Although transcatheter embolization, surgical ligation, or hysterectomy would be considered for treatment of uterine AVF, there is poor knowledge as to how gynecologists can manage the uterine AVF with multiple large inflow arteries. Herein we report a uterine AVF successfully treated using multiple-step transcatheter embolization. The patient, a 58-year-old postmenopausal woman with a history of dilation and curettage, had intermittent massive uterine bleeding. Radiologic imaging revealed the presence of a large vasculature mass. The mass occupied the entire pelvis, and the source of hemorrhage was identified as an accompanying AVF. We thought that surgical intervention was contraindicated because of the potential risk of uncontrollable intraoperative bleeding. Multiple-step transcatheter embolization was performed, with complete resolution of the AVF. Thereafter, the patient had no further uterine bleeding. Multiple-step transcatheter embolization might be the most beneficial and efficient treatment option for a uterine AVF with multiple large inflow arteries.

For the time being, in Japan, two recently approved implantable ventricular assist devices (VADs) are indicated only when a patient has been listed for heart transplantation or approved to be eligible for heart transplantation by in-hospital committee. The reversibility of end-organ dysfunction must be expected before VAD implantation, but it is often hard to prove during worsening clinical status. We report two patients whose end-organ dysfunction had been eventually demonstrated to be reversible by invasive procedures such as transluminal liver biopsy or transient insertion of intra-aortic balloon pumping.

BackgroundMeandering main pancreatic duct (MMPD), which comprises loop type and reverse-Z type main pancreatic duct (MPD), has long been discussed its relation to pancreatitis. However, no previous study has investigated its clinical significance. We aimed to determine the non-biased prevalence and the effect of MMPD on idiopathic pancreatitis using non-invasive magnetic resonance (MR) technique.Methods and findingsA cross-sectional study performed in a tertiary referral center. The study enrolled 504 subjects from the community and 30 patients with idiopathic pancreatitis (7 acute, 13 chronic, and 10 recurrent acute). All subjects underwent MR scanning and medical examination. MMPD was diagnosed when the MPD in the head of pancreas formed two or more extrema in the horizontal direction on coronal images of MR cholangiopancreatography, making a loop or a reverse-Z shaped hairpin curves and not accompanied by other pancreatic ductal anomaly. Statistical comparison was made among groups on the rate of MMPD including loop and reverse-Z subtypes, MR findings, and clinical features. The rate of MMPD was significantly higher for all idiopathic pancreatitis/idiopathic recurrent acute pancreatitis (RAP) (20%/40%; PConclusionsMMPD is a common anatomical variant and might be a relevant factor to the onset of idiopathic RAP.

Recently, previous studies have improved surgical simulations. As the technology improve, surgical simulations grow in diversity. Also, as the IT technology improve, learning support system for doctors such as e-learning began to expand. But doctors can't get errors such as unexpected bleed with surgical simulations and e-learning. Unexpected things are good one for adept doctors.

Background Several methods have been developed to reduce the radiation dose in coronary computed tomography angiography (CTA). Objective The objective of our study was to evaluate the effects of Adaptive Iterative Dose Reduction (AIDR) on objective and subjective image quality as well as the radiation dose, compared with conventional filtered back projection (FBP), in coronary CTA. Methods We retrospectively reviewed 100 consecutive patients who underwent coronary CTA. In the first 50 patients, a higher tube current was used, and images were reconstructed with FBP. In the last 50 patients, a lower tube current was used, and images were reconstructed with AIDR. Subjective and objective image quality (noise, signal-to-noise ratio, contrast-to-noise ratio) were assessed. Results The median radiation dose of the AIDR group was 22% lower than that of the FBP group (4.2 vs 5.4 mSv; P = 0.0001). No significant difference was found in subjective image quality, noise, signal-to-noise ratio, or contrast-to-noise ratio between the 2 groups. Conclusion AIDR reduced the tube current which resulted in reduction of radiation dose in coronary CTA while maintaining subjective and objective image quality compared with coronary CTA reconstructed with FBP.

Intraoperative detection of new nodules is common in patients undergoing hepatectomy for colorectal liver metastases, although the value of intraoperative diagnosis is not well assessed.A prospectively collected and recorded database was retrospectively analyzed. Helical computed tomography (CT) results were correlated with those of the intraoperative diagnosis in 183 consecutive patients undergoing 254 consecutive hepatectomies, including repeated resection for colorectal liver metastases.In total, 270 nodules were newly detected during 65 hepatectomies. The sensitivity of CT to detect metastatic nodules was 72.8% (722/992), but it decreased to 34.6% (125/361) for small (≤ 1 cm diameter) tumors. Intraoperative visual inspection and/or palpation detected 207 of 270 nodules. Intraoperative ultrasonography (IOUS) played an important role in identifying deep (≥ 1 cm from the surface) and comparatively small (≤ 1 cm diameter) nodules (4/9 vs. 16/18, respectively, for those1 cm vs. ≤ 1 cm diameter). The likelihood of intraoperative detection of new nodules increased from 10 in 112 to 6 in 9 when the preoperative tumor number increased from solitary to ≥ 10, resulting in an overall likelihood of 65 in 254 (25.6%). Of 65 patients with new nodules, 21 had at least one nodule that was detected only by IOUS. Preoperatively scheduled hepatectomy was altered in 47 (72%) patients, although additional limited resection(s) were sufficient to remove these nodules in 43 (91%) of them.Visual inspection, palpation, and IOUS had equally indispensable roles in detecting new nodules during hepatectomy. Detection was common and usually necessitated alteration, albeit moderately, of the surgical plan.

Although hepatocellular carcinoma (HCC)-specific serum tumor markers, α-fetoprotein (AFP) and des-γ-carboxy prothrombin (DCP), are used in the screening for HCC, their utility in pre-transplantation evaluation is not well established. This study aimed to evaluate the accuracy of AFP and DCP measurement for the diagnosis of HCC in liver transplant candidates. A total of 315 consecutive adult patients (174 men and 141 women, mean age 52 years), who were to receive liver transplantation for end-stage liver diseases, were enrolled. The pre-transplant levels of AFP and DCP were compared with the histopathology of explanted liver. Hepatocellular carcinoma was present in the explanted liver of 106 recipients (median number of nodules 2, mean diameter 2.5 cm). The area under receiver operating characteristic curve for the diagnosis of HCC was 0.83 (95% confidence interval, 0.78-0.88) for AFP and 0.47 (0.41-0.54) for DCP. With the cut-off value of 100 mAU/mL, 20/106 (18.9%) patients with HCC and 54/194 (27.8%) patients without HCC were positive for DCP. DCP positivity was associated with vascular invasion, tumor differentiation and size among patients with HCC, which was associated with albumin level among patients without HCC. Vitamin K was administered prior to transplantation to 20 patients who were positive for DCP (two with and 18 without HCC), resulting in a decrease in DCP levels in 19 of them. Serum DCP levels may be raised in end-stage liver disease patients without HCC, and cannot be used as a reliable marker for HCC among liver transplant candidates.

Purpose To investigate the natural outcome and clinical implication of hypointense lesions in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI. Materials and methods Forty patients underwent Gd-EOB-DTPA-enhanced MRI for preoperative evaluation of HCC. Hypointense lesions in the hepatobiliary phase that were hypovascular 5mm of more were extracted for follow-up. We performed a longitudinal study retrospectively for these lesions regardless of whether classical HCC developed or emerged in a different area from that of the lesions being followed. Results Thirty one patients displayed 130 hypointense lesions on MRI and only nine showed no hypointense lesions. In total, 17 (13.1%) of 130 hypointense lesions on MRI developed into classical HCC. The cumulative rates for these lesions to develop into classical HCC were 3.2% at 1 year, 11.1% at 2 years and 15.9% at 3 years. The total occurrence rates of classical HCC (25.8% at 1 year, 52.6% at 2 years and 76.4% at 3 years) were higher compared to those regarding only occurrence of classical HCC from hypointense lesions on MRI (10.0% at 1 year, 35.6% at 2 years and 44.6% at 3 years), although no significant difference was observed ( p =0.073). Conclusions Hypointense lesions that are detected in the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI have some malignant potential, although treating these lesions aggressively in patients who already have HCC may be too severe.

Objective To evaluate the radiographic features of the thyroid on postmortem computed tomography (PMCT). Methods We studied the bodies of 32 subjects who had been treated and subsequently died in our tertiary care hospital between April and December 2009. The thyroids were imaged by antemortem computed tomography (AMCT), PMCT, and examined by conventional autopsy. Differences between the radiographic features of the thyroid on AMCT and PMCT, and time since AMCT were evaluated statistically. Results CT values of the thyroid decreased after death with an average of 114.2Hounsfield Units (HUs) on AMCT vs. 107.7HU on PMCT (paired t -test, P =0.023). There was no correlation between the elapsed time from AMCT and differences of CT values of the thyroid on AMCT and PMCT (Spearman's rank correlation test, P >0.05). Conclusion We showed that CT values of the thyroid decreased after death.

Objectives The purpose of this study was to investigate hypostasis in the heart and great vessels (HHGV) by postmortem computed tomography (PMCT) in cases of non-traumatic in-hospital deaths and to analyze relationships between clarity of HHGV and antemortem blood markers. Material and methods The study included 31 cadavers of patients who died while receiving treatment in our academic tertiary-care hospital between April and December 2009. Antemortem blood tests including both hematological and blood coagulation markers were performed within 48h before death, and PMCT and conventional autopsies were performed. The findings of HHGV were assessed in the following six locations: the superior vena cava, right atrium, right ventricle, thoracic aorta, left atrium, and left ventricle. The clarity of HHGV on PMCT was divided into two groups using attenuation of the left ventricular wall as a reference: no/obscure HHGV group and clear HHGV group. The relationships between clarity of HHGV and six blood markers [red blood cell (RBC) count, hemoglobin (Hb), hematocrit (Ht), prothrombin percentage activity (PT%), activated partial thromboplastin time (aPTT), and fibrinogen] were evaluated statistically. Results We observed no/obscure HHGV in 14 patients (45%) and clear HHGV in 17 patients (55%). The level of fibrinogen in clear HHGV group was significantly higher than in no/obscure HHGV group ( P =0.029). No relationships were found between clarity of HHGV and other five blood markers. Conclusion HHGV is a common PMCT finding. Clear HHGV on PMCT was related to higher level of fibrinogen in non-traumatic in-hospital death cases.

Objective The purpose of this study was to evaluate the correlation between bolus-tracking parameters and heart rate (HR) with attenuation of the ascending aorta and create a linear regression model for predicting coronary attenuation in coronary computed tomography angiography (CCTA). Methods A total of 50 patients (31 men, 19 women; mean age, 67.2 ± 10.8 y) underwent CCTA using a 320-detector CT scanner. A bolus-tracking scan was performed to optimize the scan timing. The average HR under normal breathing for 10 s was recorded just before the bolus-tracking scan started. Attenuation values of the pulmonary artery at 7 s (PA 7 ) and 10 s (PA 10 ) after the beginning of the injection were recorded during the bolus-tracking scan and the ascending aortic attenuation (CE AAo ) was measured during the diagnostic scan. Results A positive correlation was observed between PA 7 and CE AAo ( r = 0.41, P = 0.003) and PA 10 and CE AAo ( r = 0.66, P AAo ( r = −0.46, P = 0.15). A multivariable linear regression model for predicting CE AAo was evaluated, and the residual error between the predicted and the measured CE AAo was within approximately ±100 HU. Conclusions Coronary attenuation could be predicted using HR and pulmonary artery attenuation during the bolus-tracking method.

It is a controversial issue whether pancreas divisum (PD) induces pancreatitis. All previous studies have investigated this issue based on endoscopic procedures, which inevitably involve a selection bias.To determine the unbiased prevalence rate of PD in a community population and to investigate the effect of PD on idiopathic pancreatitis using a non-invasive magnetic resonance (MR) technique.Cross-sectional study.The study enrolled 504 subjects from the community who participated in the medical check-up programme and 46 patients with idiopathic pancreatitis (8 acute, 23 chronic, 15 recurrent) extracted from 70,122 consecutive MR studies performed at an academic tertiary care hospital.All subjects underwent magnetic resonance (MR) scanning and medical examination.Statistical comparison between subjects from the community and patients with idiopathic pancreatitis was made for the rate of PD (and its subtypes: classical PD, PD with absent ventral duct, and incomplete PD), MR findings, and clinical features.Multiple logistic regression analysis revealed PD as a significant factor that induces pancreatitis (OR 23.4; p0.0001). The PD rate was significantly higher for all/chronic/recurrent idiopathic pancreatitis patients (35%/43%/33%; p0.001 for all) than for subjects in the community group (2.6%), but was not higher for acute pancreatitis (13%; p=0.357). All PD subtypes were indicated to induce idiopathic pancreatitis but showed different associations with each onset type of pancreatitis.This is the first study to describe the prevalence of PD and PD subtypes in a community population and their association with idiopathic pancreatitis in vivo based on the findings of non-invasive MR and with minimal selection bias. It is concluded that PD should be considered a predisposing factor for chronic and recurrent pancreatitis.

The objective was to investigate the influence of the beat-to-beat movement of the coronary arteries on image quality of multi-segment reconstruction (MSR) images. Although MSR improves temporal resolution, image quality would be degraded by beat-to-beat movement of the coronary arteries. In a retrospectively review, 18 patients (mean age, 67.0 years) who underwent coronary CT angiography using a 320-detector row CT were included. The displacement and diameter of coronary artery segments for each of the identified nine landmarks was recorded. The motion ratio was calculated as the division of displacement by diameter. Image quality (IQ) was graded by a four-point scale. The correlation between MSR IQ score and the motion ratio showed stronger negative correlation than that between MSR IQ score and the displacement (r = −0.54 vs. r = −0.36). The average motion ratio for segments in which half-scan reconstruction (HSR) IQ was better than MSR IQ (29.1%, group A) was higher than that for segments in which MSR IQ was better than HSR IQ (16.0%, group C). The motion ratio in group C was lower than 25%. Difference in IQ scores of the HSR images was more frequent in group A than in the remaining segments in which the motion ratio was lower than 25% (16.7% vs. 66.0%; P < 0.0002). The motion ratio could be a better index than the displacement to evaluate the influence of the motion of coronary arteries on image quality. MSR images would be impaired by a motion ratio larger than 25%. Image impairment of one of the HSR images might also impair MSR images.

Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a four-channel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multi-detector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.

Purpose To compare the diagnostic performance of Gd-EOB-DTPA-enhanced MRI with that of triple phase 64-MDCT in the detection of hepatocellular carcinoma (HCC). Patients and methods Thirty-four patients with 52 surgically proven lesions underwent Gd-EOB-DTPA-enhanced MRI and triple phase 64-MDCT. Two observers independently evaluated MR and CT imaging on a lesion-by-lesion basis. Sensitivity, positive and negative predictive values and reproducibility were evaluated. The diagnostic accuracy of each modality was assessed with alternative-free response receiver operating characteristic (ROC) analysis. Results Both observers showed higher sensitivity in detecting lesions with MRI compared to CT, however, only the difference between the two imaging techniques for observer 2 was significant (P = 0.034). For lesions 1 cm or smaller, MRI and CT showed equal sensitivity (both 62.5%) with one observer, and MRI proved superior to CT with the other observer (MRI 75% vs. CT 56.3%), but the latter difference was not significant (P = 0.083). The difference in positive and negative predictive value between the two imaging techniques for each observer was not significant (P > 0.05). The areas under the ROC curve for each observer were 0.843 and 0.861 for MRI vs. 0.800 and 0.833 for CT and the differences were not significant. Reproducibility was higher using MRI for both observers, but the result was not significant (MRI 32/33 vs. CT 29/33, P = 0.083). Conclusion Gd-EOB-DTPA-enhanced MRI tended to show higher diagnostic accuracy, sensitivity and reproducibility compared to triple phase 64-MDCT in the detection of hepatocellular carcinoma, however statistical significance was not achieved.

Endometrial stromal sarcoma (ESS) most commonly grows from the uterine endometrium into the endometrial cavity; it is rarely located in the myometrium alone, where it may resemble degenerated leiomyoma on magnetic resonance imaging (MRI). We present three cases of intramyometrial ESS mimicking degenerated leiomyoma, all of which have a characteristic low-intensity rim on T2-weighted images. Histopathological examination revealed the rim to consist of fibrous tissue layers and/or a decrease in free water caused by distortion of myometrial tissue following tumor expansion. ESS should be included in the differential diagnosis of intramyometrial mass with low-intensity rim on T2-weighted image, especially if the mass shows degeneration with no or mild intratumoral hemorrhage.

AIM Autoimmune pancreatitis (AIP) is a rare subtype of chronic pancreatitis. AIP has been suggested to be complicated by tubulointerstitial nephritis or glomerulonephritis, implying that the kidney is involved as a phenotype of IgG4-positive multi-organ lymphoproliferative syndrome; however, the clinical significance of this novel entity is not well-defined. METHODS We conducted a retrospective cohort analysis of 47 (male, 39; female, 8) AIP patients. RESULTS The patients (mean age, 70.3 +/- 9.5 years) had a mean observation period of 4.1 years. Before treatment, renal dysfunction with an eGFR of 30 and 15 ml/min/1.73 m2 developed only in 10.6% (5/47) and 2.1% (1/47) of the patients, respectively. Nevertheless, urinary N-acetyl-beta-D-glucosaminidase and alpha1-microglobulin levels were elevated in 78.6% (11/14) and 30.8% (4/13) of the patients, respectively. Renal involvement in contrast-enhanced CT imaging was present in 18.2% (8/44) of the patients and was associated with proteinuria (p = 0.04) and a decrease in eGFR (p < 0.01). Furthermore, a follow-up CT study (mean, 545 days) revealed improved kidney lesions in 80.0% (4/5) of the patients after oral corticosteroid administration. In contrast, first-time kidney involvements appeared newly in 3.6% (1/28) of the patients after steroid therapy for nonrenal AIP symptoms, and in 14.3% (1/7) of the patients under no specific therapy (p = 0.02). CONCLUSION Although severe renal failure develops rarely in AIP patients, renal abnormalities have been significantly detected by biochemical and radiological tests. Oral corticosteroid administration, even when not targeting symptomatic nephropathy, can treat and prevent kidney involvements in AIP.

Objective: To evaluate the efficacy of double-arterial phase gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (MRI) using 3-dimensional gradient-echo sequences compared with double-arterial phase multi-detector row helical computed tomography (CT). Methods: This study included 15 patients with 24 surgically proven hepatocellular carcinomas. Dynamic MRI and CT were evaluated by 2 observers using a 4-point scale. We compared the scores of double-arterial phase MRI and CT for each observer and determined whether a significant difference existed. Results: Using MRI, 83% and 79% of the lesions were considered hypervascular by the two observers versus 88% for both observers using CT. The difference between MRI and CT was not significant. Conclusions: Double-arterial phase gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced MRI is as useful as double-arterial phase multi-detector row helical CT for detecting the hypervascularity of hepatocellular carcinoma.

The prepancreatic postduodenal portal vein (PPPV) is an unusual anomaly, having been reported in only 11 cases including ours. Although its incidence is rare, this anomaly can cause intraoperative complications such as hemorrhage from the abnormal vein. Radiologists therefore need to be aware of this anomaly and, when identifi ed, report it to surgeons before surgery. Here we report two cases of PPPV and present a new hypothesis for development of the portal venous system.

We report a case of a 27-year-old man with a right skull base transitional meningioma. Preoperative evaluation with F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) revealed different imaging characteristics in a single tumor according to the histopathologic differences. A fib

Various splenic inflammatory pseudotumours are reported to be infected with Epstein-Barr virus (EBV), which is thought to be associated with the pathogenesis of the lesion. The term "inflammatory pseudotumour (IPT)-like follicular dendritic cell tumour", all cases of which are also EBV positive, has recently been proposed. Here, we describe the imaging findings of these splenic tumours and present the cases of an IPT-like follicular dendritic cell tumour and two EBV-positive inflammatory pseudotumours in two female patients and one male patient. These splenic lesions were found incidentally on pre-operative or post-operative screening or at medical check-up. CT performed on all three patients revealed low-density solitary masses in the spleen. MRI was performed on one patient; the solitary mass demonstrated isointensity on T(1) weighted images and low intensity on T(2) weighted images relative to the surrounding splenic parenchyma. Dynamic MRI study revealed that the mass did not enhance on the early phase but enhanced to the same degree as the surrounding splenic parenchyma on the delayed phase. The imaging findings are almost identical to those found in conventional IPT because the morphology is similar in both cases; however, attention should be paid to this new entity in the diagnosis of splenic lesions because of its neoplastic nature. Longer follow-up is also necessary for these patients compared with those with conventional IPT.

Objective To report the successful treatment of a patient with lymphomatoid granulomatosis (LYG), a rare Epstein-Barr virus–positive lymphoproliferative disorder, using rituximab (anti-CD20 monoclonal antibody). The prognosis for LYG has been reported to be poor, and no satisfactory treatment has been established. Because central nervous system (CNS) involvement of LYG has been known to show poor prognosis, the establishment of an effective treatment for CNS LYG with mild adverse effects is desired. Design Case report. Setting University hospital. Patient A 48-year-old Japanese man presenting with slowly progressive spastic paraparesis diagnosed as LYG involving the CNS and lungs. Interventions The patient was treated with rituximab (375 mg/m 2 , once weekly for 1 month) alone. Main Outcome Measure Improvement of the lesions on imaging. Results The neurological signs resolved and the lesions in the CNS and lungs were mostly diminished after the rituximab monotherapy without any adverse effects. The patient stayed in remission for 18 months. Conclusion Rituximab monotherapy was effective in treating the patient; hence, rituximab should be considered as the initial treatment against LYG involving the CNS.

A 19-year-old man presented to our department because of a 3-year history of left upper abdominal distention. He had no notable past medical history such as abdominal trauma or pancreatitis. On physical examination, a huge elastic hard mass was …

Objective: To evaluate the usefulness of super paramagnetic iron oxide-enhanced, diffusion-weighted, periodically rotated overlapping parallel lines with enhanced reconstruction (SPIO DWI PROPELLER) T2-fast spin echo (FSE) magnetic resonance imaging (MRI) for the detection of hepatic metastases. Methods: Fourteen patients were examined with SPIO-enhanced T2-FSE (SPIO FSE) imaging and SPIO DWI PROPELLER T2-FSE imaging. The b-value of the diffusion-sensitizing gradient was 10 s/ mm 2 so as to suppress the signal of the hepatic vessels. Hepatic resections were performed on all patients, and the number of lesions on MRI was compared between the 2 pulse sequences with references from pathologic reports. Results: Nearly all metastases 1 cm or larger, totalling 38 metastases, were detected with both pulse sequences. Among the 30 metastases less than 1 cm, more lesions were detected on SPIO DWI PROPELLER T2-FSE imaging than on SPIO FSE imaging (16 for SPIO FSE imaging and 24 for DWI PROPELLER T2-FSE imaging; P < 0.05, McNemar test). Conclusion: Super paramagnetic iron oxide-enhanced DWI PROPELLER T2-FSE is useful for detecting small hepatic metastases.

The aim of this study was to assess the feasibility of an original reformation method of cervical myelographic computed tomography (CT) using the Bezier surface technique. Presurgical myelographic computed tomography (CT) scans using a multidetector row CT scanner were performed in 25 patients with avulsion injury of the cervical nerve roots. Each volumetric data set was reformatted using Bezier surface technique to depict the individual nerve root in a single image. In the reformatted images, visualization of the dorsal and ventral nerve roots between C4 and T1 on the uninjured side (300 nerves) was rated. Bezier surface reformation (BSR) images depicted the dorsal and the ventral nerve roots between C4 and C8 in 125 (100%) and 125 (100%) of 125 nerves, respectively. The dorsal and the ventral nerve roots of T1 were depicted in 25 (100%) and 22 (88%) in 25 nerves, respectively. The BSR technique of cervical myelographic CT enables simultaneous display of multiple cervical nerve roots in one image. BSR is a feasible technique for the assessment of the cervical nerve roots.

Multidetector-row computed tomography (MDCT) studies were performed in three adult patients with pulmonary atresia with a ventricular septal defect. In all patients, the native pulmonary arteries were absent, and the pulmonary circulation was totally supplied by major aortopulmonary collateral arteries (MAPCAs). MDCT studies with 1-mm collimation provided detailed information on MAPCAs and bronchial collaterals, such as the numbers and sites of origin, their varying diameters, their courses, and the areas of the lungs they supply. MDCT studies may provide an efficient road map for safe and successful selective catheterization and may substitute for conventional angiography in patients with considerable risks.