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The authors present the case of a newborn girl with extreme fenestration of the basilar artery. This anomaly was found incidentally during MR imaging study for cleft palate and nasopharyngeal teratoma. Magnetic resonance angiography showed a totally duplicated basilar artery with connections at the proximal and distal ends of the artery, suggesting an extreme fenestration. Duplicated pituitary gland was also found on MR imaging.

We reviewed N-isopropyl-p-[123I]iodoamphetamine (123I-IMP) single-photon emission tomography (SPET) images of brain tumours and assessed the usefulness of 123I-IMP SPET for the diagnosis of primary central nervous system (CNS) lymphoma. We analysed 52 tumours that showed enhancement on magnetic resonance imaging: 11 malignant lymphomas, 3 anaplastic astrocytomas, 17 glioblastomas, 12 meningiomas, 4 metastatic brain tumours and 5 other brain tumours. 123I-IMP uptake in the tumours on early (15-min) and delayed (4-h) scans was visually classified as high, moderate or low as compared with the contralateral brain cortex. Early and delayed 123I-IMP uptake ratios comparing tumours with contralateral brain cortex (T/N ratio) were also calculated. In malignant lymphomas, the visual uptake of 123I-IMP was moderate to high on the delayed scans. The delayed T/N ratios were significantly higher than the early ratios (P

We present a case of antiphospholipid antibody syndrome (APS) with repeated transient ischemic attacks (TIAs). Magnetic resonance imaging showed multiple cerebral infarcts and ischemic changes in the cerebral white matter. Cerebral angiographies showed no abnormalities. Technetium-99m-ethyl cysteinate dimer (Tc-99m-ECD) brain SPECT showed multiple decreased perfusion areas, which were more extensive than the lesions demonstrated on MRI. After treatment with an antiplatelet agent, the patient subsequently recovered from the TIAs. Although no interval changes were observed by MRI after therapy, follow-up Tc-99m-ECD SPECT revealed a marked improvement in brain perfusion. This is the first imaging report of remarkable post-therapy improvement in brain perfusion in APS cases.

Middle cerebral artery (MCA) variations are found incidentally on cranial magnetic resonance angiography (MRA). Our goal was to examine the incidence and types of MCA variations detected by MRA. Between April 1996 and March 1999, cranial MRA was performed in 432 cases at our institution. Most of the patients examined had or were suspected to have cerebrovascular disease. After excluding 7 patients with moyamoya disease, we retrospectively reviewed 425 MRA results. A 1.5-T scanner was used in all studies, and maximum-intensity projection images obtained using the three-dimensional time-of-flight technique were displayed stereoscopically. In the 425 patients MRA revealed 16 anomalous MCAs, including 9 duplicated MCAs, 5 accessory MCAs, and 2 fenestrated MCAs, which is a rate of 3.8 %. Thus, although the clinical significance is not great, we found a relatively high incidence of anomalous MCAs on MRA. We stress that knowledge and recognition of these variations are useful and important during the interpretation of cranial MRA.

We report a case of adjacent intracranial tumours: malignant fibrous histiocytoma (MFH) and meningioma. Thallium-201 single-photon emission computed tomography demonstrated different thallium kinetics between the tumours (slow washout from the MFH and rapid clearance in the meningioma) and could be said to have been useful for preoperative histological estimation.

Sclerosing stromal tumor is a rare ovarian neoplasm. We describe the radiologic findings of sclerosing stromal tumor in two patients. In both patients, MR and CT images showed a large mass in the left adnexal region. On dynamic contrast-enhanced images, the tumors showed early peripheral enhancement with centripetal progression.

We report the MRI findings in two patients with cystic dilatation of the ventriculus terminalis. The latter is usually a tiny ependyma-lined cavity of the conus medullaris. In both cases the markedly dilated ventriculus terminalis was seen as a rounded cavity with regular margins, the content of which gave the same signal as cerebrospinal fluid with all MR pulse sequences. No contrast enhancement was seen.

Reported here is a case of an inferior mesenteric varix demonstrated by 99mTc-red blood cell (RBC) scintigraphy performed for gastrointestinal bleeding in a 47-year-old man. It was shaped like a question mark ranging from the left upper abdomen to the pelvis. This is the first report of scintigraphic recognition of an inferior mesenteric varix.

The purpose of this study was to elucidate the roles of endoscopic ultrasonography (EUS), conventional US, CT, and MRI in differential diagnosis of gallbladder wall thickening. We scrutinized images for the presence of the multiple-layer patterns of the thickened gallbladder walls during preoperative images (EUS, n = 22; US, n = 23; CT, n = 20; MRI, n = 15) and retrospectively correlated them with surgical results in 25 patients. The pathological diagnoses included 7 gallbladder cancers, 9 cases of chronic cholecystitis, 5 cases of xanthogranulomatous cholecystitis, and 4 cases of adenomyomatosis. Multiple-layer patterns of gallbladder wall were observed in patients with inflammatory and benign diseases by US, EUS, CT, and MRI. This pattern was demonstrated by EUS more efficiently compared with other means of imaging. All subjects with loss of multiple layers were finally diagnosed by use of EUS as having gallbladder cancer at surgery. Loss of multiple-layer patterns of the gallbladder wall demonstrated by EUS was the most specific finding in diagnosing gallbladder cancer.

We report a patient with a myxolipoma that appeared as a cystic mass on ultrasonography, computed tomography, and magnetic resonance imaging.

Acute renal failure (ARF) with loin pain after exercise with development of wedge-shaped contrast enhancement on computed tomography (CT) has been described as a new disease entity. We report 2 patients who developed ARF with severe loin pain after exercise, showing wedge-shaped lesions both on CT and ultrasonography. Renal ultrasonography showed indistinct wedge-shaped lesions when performed at oliguric or recovery phase of ARF, whereas it showed distinct lesions when done between these two phases. Contrast CT performed at the recovery phase disclosed distinct wedge-shaped lesions. Our findings suggested that the best time to detect these lesions by ultrasonography is between at the beginning of diuresis and at the time of serum creatinine levels of 2 mg/dl.

論文(Article)

OBJECTIVE We report MR findings in three patients with dysembryoplastic neuroepithelial tumor (DNT), which is a recently described benign tumor in childhood or young adolescents. MATERIALS AND METHODS The MR studies of three patients with surgically proven DNT were reviewed. All cases presented with partial complex seizures. Axial and coronal T1- and T2-weighted MR imaging of the head was performed using a 1.5 T MR unit. T1-weighted imaging after Gd-DTPA was also performed. RESULTS The tumors were located mainly in the cortical to subcortical area with very little perifocal mass effects on MR imaging. They were essentially hypointense on T1-weighted imaging and hyperintense well-demarcated mass on T2-weighted imaging and retained a thick gyrus-like configuration within the lesions. None of them exhibited contrast enhancement after administration of Gd-DTPA. CONCLUSION Differentiation of DNT from gangliogliomas or other low grade gliomas is possible using these MR features and is important because DNT does not recur after epilepsy surgery, therefore postoperative radiation and chemotherapy are not needed.

Diffusion-weighted imaging (DWI) reflects changes in proton mobility caused by pathological alterations of tissue cellularity, cellular membrane integrity, extracellular space perfusion, and fluid viscosity. Functional imaging is becoming increasingly important in the evaluation of cancer patients because of the limitations of morphologic imaging. DWI is being applied to the detection and characterization of tumors and the evaluation of treatment response in patients with cancer. The advantages of DWI include its cost-effectiveness and brevity of execution, its complete noninvasiveness, its lack of ionizing radiation, and the fact that it does not require injection of contrast material, thus enabling its use in patients with renal dysfunction. In this article, we describe the clinical application of DWI to gynecological disorders and its diagnostic efficacy therein.

Williams-Campbell syndrome is a rare type of cystic bronchiectasis that is due to defective cartilage of fourth-to sixth-order bronchi. The diagnosis has been made either at autopsy or by bronchographic findings. The article describes an adult case of this syndrome with CT findings that are characteristic of this entity. CT showed areas of emphysematous lung parenchyma distal to the dilated bronchi, suggesting bronchiolitis obliterans secondary to proximal cystic bronchiectasis. These findings are useful in differentiating Williams-Campbell syndrome from other causes of cystic bronchiectasis, thus obviating bronchography.

Pulmonary endometriosis is the likely cause in patients with hemoptysis during menses. While we describe two cases of catamenial hemoptysis, which were localized with chest CT scanning, angiograms revealed normal appearance. We suggest that angiograms may have little value in the evaluation of patients with pulmonary endometriosis.

Thirty-three patients with hemoptysis caused by nonmalignant diseases underwent arterial embolization. In seven (21.2 percent) of 33 patients, hemoptysis recurred after initial embolization in a follow-up period ranging from one day to four years. Although there was no difference in age and daily quantity of bleeding among patients with and without recurrences, those with mycetoma suffered the highest recurrence of bleeding after initial embolization (three [75 percent] of four patients). In the initial arteriograms of the seven patients were found six cases of markedly increased vascularity, three of increased vascularity in the bilateral lung, and three of nonbronchial systemic arterial supply to the diseased lung. Of six patients who received reexamination at the time of recurrent bleeding, the arteriogram demonstrated recanalization of previously embolized artery in five and revascularization by collateral circulation in five. In addition, hemoptysis recurred in three (60 percent) of five patients after second embolization and in one (50 percent) of two after third embolization. Four patients underwent surgical therapy: two after the initial embolization, one after the second, and one after the third, and these patients had no recurrence. While arterial embolization as initial treatment of hemoptysis is a highly useful procedure, this is a palliative procedure and potential for recurrence of hemoptysis exists as the lesion that has initially caused hemoptysis is not cured by the embolization. We emphasize that a combination therapy of repeated embolization and surgery will probably improve the efficacy of treatment of recurrent bleeding after initial embolization.

This is a report of CT and MRI findings in a patient with a sellar spine which caused deformity of the pituitary gland. The sellar spine is an infrequent anatomical variant characterized by an osseous spine which arises in the midline from the anterior aspect of the dorsum sellae and extends into the pituitary fossa. The CT and MRI findings of sellar spine have been described in previous reports; however, only one investigator reported deformity of the pituitary gland as revealed by CT. This is the first report of the MRI finding of the sellar spine associated with a deformity and superior extension of the pituitary gland, mimicking pituitary hypertrophy.

The Radiation Effects Research Foundation (formerly, Atomic Bomb Casualty Commission; ABCC) was established in April 1975 as a private non-profit Japanese Foundation, supported equally by the Government of Japan through the Ministry of Health and Welfare, and the Government of the United States through the National Academy of Sciences under contract with the United States Department of Energy. Accepted 4 December 1988. In a review of the chest radiographs of 1 152 consecutively examined subjects, 10 cases (0.87%) of extensive tracheobronchial calcification were identified. In addition, 51 subjects having this coded diagnosis were identified among 11758 members of a fixed population sample. Sixty of these 61 subjects were women. Tracheobronchial calcification usually appeared after the age of 60. The subjects' clinical and other radiologic diagnoses were reviewed and tracheobronchial calcification appeared to have no clinical significance. Histologic findings in autopsied cases showed the calcifications and ossificiations to be in the cartilaginous rings themselves. However, the reason for the overwhelming prevalence of this entity in women remains to be resolved.

Fourteen patients suspected of having Moya Moya disease underwent intravenous digital subtraction angiography (DSA), and the findings from nine of these patients were reviewed and analyzed. Obstruction or stenosis of the supraclinoid portion of the internal carotid artery and the proximal portions of the anterior and middle cerebral arteries was observed in all cases. Arteriography, however, was better than intravenous DSA in demonstrating Moya Moya vessels, differentiating complete occlusion from severe stenosis, and demonstrating important transdural collaterals. The disadvantages of intravenous DSA included inferior spatial resolution, the need for large amounts of contrast media, and relatively high radiation doses. Since the summation of vessels cannot be avoided using DSA, arteriography is necessary for the precise evaluation of cerebral hemodynamics before bypass surgery. Intravenous DSA is a safe, reliable method for diagnosing Moya Moya disease and is suitable for the screening and follow-up examinations of patients with the disease.

Two cases of extremely rare aneurysms of peripheral portions of the AICA are reported with a review of the pertinent literature. According to reported surgical findings, nearly all of the aneurysms originated from arterial loops near the internal acoustic meatus. These aneurysms can therefore, cause the cerebellopontine angle syndrome, with or without subarachnoid hemorrhage.

A patient with acute lymphoblastic leukemia, who developed acute renal failure, was imaged by computed tomography (CT). Persistent wedge-shaped areas of low attenuation in the kidneys were shown by sequential scans but not areas of infarction were found at autopsy. This case suggests that a wedge-shaped low-density lesion on CT may occur not only in infarcted areas, but also in areas where patchy vasoconstriction occurs.

Intravenous digital subtraction angiography was performed on 59 patients with ovarian tumors. Dilatation of the uterine artery and its ovarian branch was relatively frequent in both benign and malignant tumor groups, while dilation of the ovarian artery, and hyper-vascularity from the uterine artery or the ovarian artery were fairly specific to the malignant tumor group. These five abnormal vascular patterns were evaluated by a scoring system and approximately 75% of malignant and 87% of benign ovarian tumors were correctly diagnosed preoperatively by digital subtraction angiography alone. Intravenous digital subtraction angiography can be applied as an easy, safe, and valuable diagnostic method for ovarian malignancies and can replace conventional pelvic angiography.