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Objectives: To investigate prognostic values of maximum standardized lymph node (LN) uptake (SUVmax), minimum apparent LN diffusion coefficient (ADCmin), and LN short-axis length in women with cervical cancer., Study Design: Retrospective review of diffusion-weighted magnetic resonance imaging (DWI) and positron emission tomography/computed tomography (PET/CT) of LN confined to the pelvis in 80 cervical cancer patients before undergoing radiotherapy (RT) with or without concurrent chemotherapy. Optimal cut-off values for disease-free survival (DFS) and overall survival (OS) were determined by receiver operating characteristic (ROC) curve analysis. We used ROC curve analyses to evaluate whether LN SUVmax, LN ADCmin and LN short-axis length predicted risk of recurrence or survival., Results: Median DFS and OS for all patients were 18.97 and 22.28 months, respectively. DFS and OS rates of patients with high LN SUVmax was significantly lower than those of patients exhibiting low LN SUVmax (P=0.003 and P=0.019). Patients with low LN ADCmin had poorer DFS and OS than those with high LN ADCmin (P=0.033 and P=0.005). DFS for patients exhibiting longer LN short-axis length was significantly lower than those of patients exhibiting shorter LN short-axis length (P=0.018). Multivariate analyses indicated that high LN SUVmax was an independent predictor for both DFS and OS (P=0.0231 and P=0.0146)., Conclusions: LN SUVmax could be an important predictor of recurrence and survival in patients with cervical cancer confined to the pelvis., (Copyright © 2013. Published by Elsevier Ireland Ltd.)

The objective of this study was to investigate the correlation of pretreatment and posttreatment measurements as the mean apparent diffusion coefficient (ADCmean) by diffusion-weighted magnetic resonance imaging (DWI) findings with prognostic factors in patients with squamous cell carcinoma (SCC) of primary cervical cancer. The pretreatment and posttreatment ADCmean of the primary tumor were examined for their correlations with the prognosis in 69 patients with SCC of primary cervical cancer by radiotherapy (RT) with or without concurrent chemotherapy (CCRT). The median disease-free survival (DFS) and overall survival (OS) times of patients were 20.97 and 23.47 months (follow-up periods for DFS and OS: 1-72 and 1-72 months). The DFS and OS rates of patients with low pretreatment and posttreatment ADCmean of the primary tumor were also significantly worse than those of patients exhibiting high pretreatment and posttreatment ADCmean of the primary tumor (DFS; P = 0.0130 and P < 0.0001, OS; P = 0.0010 and P < 0.0001). Multivariate analyses showed that low posttreatment ADCmean of the primary tumor was an independent prognostic factor for DFS and OS (P < 0.0001 and P < 0.0001). The low posttreatment ADCmean of the primary tumor is a useful clinical prognostic biomarker for recurrence and survival in patients with cervical cancer.

Purpose: The purpose of this study was to investigate the prognostic value of the minimum apparent diffusion coefficient (ADCmin) derived from diffusion-weighted MR imaging and of the maximum standardized uptake value (SUVmax) derived from PET/CT imaging of the primary tumour in patients with endometrial cancer., Methods: SUVmax reflects the highest tumour metabolism rate and ADCmin reflects the highest cellularity, and both parameters have been used for tumour grading and prediction of prognosis. The correlations between prognosis and SUVmax and ADCmin of the primary tumour were determined in 131 patients with endometrial cancer. The patients were divided into groups based on ADCmin and SUVmax cut-off values to predict recurrence and survival, which were derived from receiver operating characteristic curves. Disease-free survival (DFS) and overall survival (OS) of the groups were analysed using the Kaplan-Meier method, and differences between survival curves were evaluated using the log-rank test., Results: The median DFS and OS times of all patients were 19.2 and 20.5 months (follow-up periods 1-70 months for both DFS and OS), respectively. Patients with high SUVmax had significantly lower DFS (P < 0.0001) and OS (P = 0.0092) than patients with low SUVmax. Multivariate analysis showed that high SUVmax was an independent prognostic factor for both DFS (P = 0.0161) and OS (P = 0.0232)., Conclusion: The SUVmax of the primary tumour derived from PET/CT imaging could be an important prognostic indicator of recurrence and survival in patients with endometrial cancer.

Objective: The purpose of this study is to investigate the correlation of the max, mean and minimal apparent diffusion coefficient values (ADCmax, ADCmean, and ADCmin) on diffusion weighted imaging findings with prognostic factors in cervical cancer., Methods: A cohort of 80 cervical cancer patients underwent pelvic magnetic resonance imaging (MRI) within the 2 to 4 weeks prior to radical hysterectomy. The optimal cutoff value for segregating disease free survival (DFS) was determined by receiver operating characteristic (ROC) curve analysis. We used ROC curve analyses to evaluate whether preoperative ADCmax, ADCmean, ADCmin on MRI predicted the risk group of recurrence., Results: Analyses of ROC curves identified an optimal The ROC curves identified an optimal ADCmax, ADCmean, and ADCmin cutoff values of 1.122 × 10(-3)mm(2)/s, 0.852 × 10(-3)mm(2)/s, 0.670 × 10(-3)mm(2)/s and for predicting the recurrence of cervical cancer. The patients categorized into the lower ADCmean or ADCmin groups showed the shorter disease free survivals compared with the higher ADCmean or ADCmin, respectively (P<0.0001 or P=0.0210). In particular, the ADCmean of primary cervical cancer was an independent predictive factor for disease recurrence by a multivariate analysis (P=0.0133)., Conclusions: The ADCmean of primary cervical cancer calculated by MRI could be an important factor for identifying patients with a risk of disease recurrence., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Objective: The purpose of this study was to evaluate whether preoperative measurements of the minimum apparent diffusion coefficient (ADCmin) on magnetic resonance imaging (MRI) and the tumor marker CA125 are correlated with the clinical characteristics and prognosis of patients with endometrial cancer., Methods: The distribution of cases that scored positive for each of the biological parameters examined and the correlations with the ADCmin of the primary tumor and the serum tumor marker CA125 were examined for 111 patients with preoperative assessment of primary endometrial cancer., Results: There were significant correlations between the ADCmin of the primary tumor and the FIGO stage (P=0.001), depth of myometrial invasion (P<0.001), cervical involvement (P=0.003), lymph node metastasis (P=0.027), ovarian metastasis (P<0.001), peritoneal cytology (P=0.027) and tumor maximum size (P<0.001). The disease-free survival (DFS) rate of patients with high serum CA125 was significantly lower than that of patients with low serum CA125 (P=0.0395). The DFS rate of patients with a low ADCmin of the primary tumor was significantly lower than that of patients with a high ADCmin of the primary tumor (P<0.001). In particular, the ADCmin of the primary tumor was an independent factor for disease recurrence in a multivariate analysis (P=0.019)., Conclusions: The present findings indicate that a low preoperative ADCmin of the primary tumor is an important predictive factor for identifying endometrial cancer patients with a risk of disease recurrence., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: The objectives of this study were to determine if measurements of the maximum standardized uptake value (SUVmax) by positron emission tomography/computed tomography and minimum apparent diffusion coefficient (ADCmin) by magnetic resonance imaging are correlated with the clinical characteristics and prognosis of primary cervical cancer., Methods: The correlations between biological parameters and prognosis and SUVmax and ADCmin of the primary tumour were determined in 66 patients with cervical cancer before radiotherapy or concurrent chemoradiotherapy., Results: There were significant correlations between SUVmax of the primary tumour and FIGO stage (p = 0.036), tumour maximum size (p = 0.018) and pelvic lymph node metastasis (p = 0.044). The median durations of disease-free survival (DFS) and overall survival (OS) were 16.1 and 19.2 months, respectively. The DFS and OS of patients exhibiting high SUVmax of the primary tumour were significantly lower than those of patients exhibiting low SUVmax of the primary tumour (p = 0.0171 and p = 0.0367). The OS of patients exhibiting low ADCmin of the primary tumour was significantly lower than that of patients exhibiting high ADCmin of the primary tumour (p = 0.0376). The DFS and OS of patients exhibiting high SUVmax together with low ADCmin of the primary tumour were significantly lower (p = 0.003 and p = 0.001). Multivariate analyses showed that high SUVmax together with low ADCmin of the primary tumour was an independent prognostic factor for both DFS (p = 0.0030) and OS (p = 0.0036)., Conclusion: High SUVmax together with low ADCmin of the primary tumour is an important predictive factor for identifying patients with cervical cancer who have a poor prognosis.

The purpose of this study is to evaluate the diagnostic usefulness of magnetic resonance imaging (MRI) characteristics of endometrial polyps in order to differentiate them from other endometrial lesions. MRI was retrospectively reviewed in 40 patients with pathologically proven endometrial polyps. Special attention was paid to the sizes, shapes, margins, internal structures, signal intensities, and post-contrast enhancement patterns. A central fibrous core, intratumoral cysts, and hemorrhage were seen in 30 (75%), 22 (55%), and 14 (35%) patients, respectively. The predominant signal intensity of the lesions showed iso-to slightly low signal intensity relative to the endometrium on T2-weighted images in 36 (90%), low signal intensity on diffusion-weighted images in 32 (80%), and strong or moderate enhancement on enhanced T1-weighted images in 28 patients (70%), respectively. In 32 (80%) patients, the endometrial polyps showed global or partial early enhancement. On dynamic study, rapid enhancement with a persistent strong enhancement pattern was seen in 17 (42.5%) and a gradually increasing enhancement pattern was seen in 17 patients (42.5%). These MRI features can be helpful to distinguish the endometrial polyps from various other endometrial lesions.

With the aim of sequence optimization in susceptibility-weighted imaging (SWI), 2 image acquisition parameters (slice thickness and matrix size) and 2 image processing conditions (number of slices per minimum intensity projection (MIP) and Sliding Window) were investigated using a 1.5-T magnetic resonance imaging (MRI) system. The subjects were 12 healthy volunteers and the target region for scanning was the whole brain. Informed consent was obtained from all subjects. First, susceptibility-weighted images were acquired with various slice thicknesses from 1mm to 5mm and various matrix sizes from 256 x 256 to 512 x 512, and the images were assessed in terms of the contrast-to-noise ratio (CNR) and were also visually evaluated by three radiologists. Then, the number of slices per MIP and the usefulness of the Sliding Window were investigated. In the study of the optimal slice thickness and matrix size, the results of visual evaluation suggested that a slice thickness of 3mm and a matrix size of 448 x 448 are optimal, while the results of evaluation based on CNR were not significant. As regards the image processing conditions, the results suggested that the number of slices per MIP should be set to a minimum value of 2 and that the use of Sliding Window is effective. The present study provides useful reference data for optimizing SWI sequences.

Epidermoid cyst of the ovary is a very rare tumor. There have been only 21 case reports of it previously. We describe the computed tomography (CT) and magnetic resonance (MR) findings of 2 cases of ovarian epidermoid cyst. To our knowledge, this is the first report describing CT and MR findings of epidermoid cysts of the ovary, and ruptured epidermoid cyst of the ovary has never been reported.

Cepharanthine (Ce) is a biscoclaurine alkaloid extracted from Stephania cepharantha Hayata. In our previous study, Ce significantly enhanced thermosensitivity and thereby reduced thermotolerance in vitro, and intra-peritoneal injection of Ce slightly enhanced thermosensitivity in vivo. In the present study, we investigated Ce's effect in vitro on the pattern of cell death after heating and the effect of intra-tumoral injection of Ce on in vivo thermosensitivity using a mouse fibrosarcoma, FSa-II, and C3H/He mice. Ce significantly enhanced the in vitro thermosensitivity of FSa-II cells with heating at 44 degrees C, with increased Ce concentration. Time-lapse microscopic observation of individual cells confirmed that Ce treatment hastened both apoptosis (specifically, apoptotic budding) and necrosis (as indicated by staining with propidium iodide). Staining with annexin V-enhanced green fluorescent protein indicated that Ce used concomitantly with heating significantly increased the proportion of cells in the early stage of apoptosis. Ce combined with heating also significantly increased the proportion of cells with high intracellular caspase-3 activity, as detected by a substrate of caspase-3, PhiPhiLux-G1D2. The intra-tumoral injection of Ce, followed by heating at 44 degrees C, significantly delayed in vivo tumor growth, and this delay increased in a Ce concentration-dependent manner. Ce injected 30 min before heating delayed tumor growth more than Ce injected immediately before heating. These findings suggest the potential of Ce as a thermosensitizer to increase apoptosis of tumor cells.

The purpose of this study was to investigate the efficacy of dynamic MR imaging in the assessment of parametrial involvement by cervical carcinoma with full-thickness stromal invasion on thin-section oblique axial T2-weighted images. Dynamic MR images of 24 patients with cervical carcinoma with full-thickness stromal invasion on thin-section oblique axial T2-weighted images were evaluated with pathologic correlation. Dynamic MR imaging was performed using a turboFLASH, 3D-FISP, or 2D-FLASH technique. The imaging planes of dynamic MR imaging were oblique axial planes of the uterine cervix. Dynamic MR imaging was performed twice, once for the early phase (40 to 60 sec after the administration of contrast media) and once for the late phase (5 min). Contrast enhancement of the tumor was divided into six types. Type I, cervical stroma with low signal intensity surrounding a tumor with high signal intensity, was seen in the early phase of dynamic MR imaging; type II-RR, the hyperintense rim was seen from the early phase to the late phase; type II-RO, the hyperintense rim was seen in the early phase only; type II-OR, the hyperintense rim was seen in the late phase only; type II-O, the hyperintense rim was not seen at all; and type III, tumor invasion with high signal intensities was seen beyond the cervical stroma in the early phase of dynamic MR imaging. The numbers for each type of cervical carcinoma on dynamic MR images were as follows: type I, four parametrial sites; type II-RR, 0; type II-RO, 0; type II-OR, 13; type II-O, 14; and type III, one. Three-dimensional diameters (transverse, craniocaudal, and anteroposterior) of the primary tumor were measured using dividers. All parametrial sites of type I and type II-OR showed no parametrial involvement. One parametrial site of type III and three parametrial sites of type II-O showed parametrial involvement, and 11 of type II-O showed no parametrial involvement. None of the patients showed type I-RR or type II-RO. When type I and type II-OR were categorized as criteria of no parametrial involvement and type III and transverse diameters of 3.5 cm or over classified as type II-O were categorized as criteria of parametrial involvement, the rate of diagnostic accuracy was 95.8%. Dynamic MR imaging is considered to be substantially useful in the assessment of parametrial involvement with cervical carcinoma with full-thickness stromal invasion by thin-section oblique axial T2-weighted images.

Purpose: The purpose of this work was to investigate the relationship between tumor size on T2-weighted images and parametrial involvement by cervical carcinoma with full-thickness stromal invasion and to evaluate whether the size of the tumor on T2-weighted images is a useful index of parametrial involvement., Method: T2-weighted images of 33 patients with cervical carcinoma showed full-thickness stromal invasion. Three-dimensional diameters (transverse, anteroposterior, and craniocaudal) of the primary tumor were measured on T2-weighted images. The area and volume of the tumor were also calculated., Results: There were statistically significant differences between the patients with parametrial involvement and those without parametrial involvement for each tumor size. The criteria that showed the best accuracy for each tumor size were determined., Conclusion: The tumor size on T2-weighted images is considered to be a useful index for evaluating parametrial involvement by cervical carcinoma with full-thickness stromal invasion.

The US, MR, and dynamic MR findings in four patients with sclerosing stromal tumor of the ovary are reported. US showed a tumor with multilocular cystic components and irregularly thickened septa and tumor walls or a solid tumor including several small cystic components. On T2-weighted MR images, signal intensities of the cystic components were high and those of the solid components were inhomogeneous, ranging from intermediate-high to high. Dynamic MRI demonstrated marked early enhancement of the solid components.

Objective: We attempted to prospectively determine the role of magnetic resonance imaging (MRI) in very early cervical cancer., Study Design: T2-weighted and T1-dynamic enhanced images from patients with invasive or noninvasive lesions of the cervix were reviewed by two radiologists who had no clinical information on these patients. At least 12 longitudinal sections prepared from the surgically removed cervix were reviewed by a pathologist. The correlation between MRI and histological findings was analyzed in terms of depth of invasion., Results: Seventy-nine cases were entered into the study and 75 were evaluable. Accuracy of T2 MR images for invasive and noninvasive disease by Radiologist 1 and Radiologist 2 was 0.8533 and 0.7733, respectively. Accuracy was greater (0.9867 and 0.9467, respectively) for the detection of noninvasive plus microinvasive lesions 5 mm. Dynamic technique provided only limited additional value in the detection of microinvasive cervical carcinoma., Conclusion: Simple T2 MRI is useful in differentiating noninvasive or microinvasive cervical lesions from invasive cervical carcinoma of the cervix >5 mm., (Copyright 2000 Academic Press.)

Helical computed tomography (CT) was used to demonstrate the distribution of crossing vessels in patients with ureteropelvic junction (UPJ) obstruction for planning surgical management. Twenty patients with symptomatic UPJ obstruction were evaluated with dual-phase contrast material-enhanced helical CT. In addition to axial images, coronal, sagittal, and curved paracoronal images along the crossing vessels or the UPJ were obtained by means of multiplanar reconstruction. Crossing vessels were evaluated according to type, position, and association with UPJ obstruction. Fifteen vessels in 12 of the 20 patients were found to cross the UPJ at helical CT. Nine vessels were arteries and six were veins; seven vessels crossed anteriorly and eight crossed posteriorly. In 11 patients, crossing vessels were thought to be associated with UPJ obstruction at helical CT; retroperitoneoscopic repair was performed, and the diagnosis was found to have been accurate in all except one. In the eight patients in whom no significant vessels were seen and the one patient in whom the crossing vessel was not associated with UPJ obstruction at helical CT, endopyelotomy was performed and UPJ obstruction was relieved, with no complications. Helical CT is useful for evaluation of vessels crossing the UPJ and for planning surgical management.

The aim of this study was to prospectively determine if invasive carcinoma of the cervix can be ruled out by negative magnetic resonance image (MRI) findings. Eligible patients were those who were scheduled to undergo either hysterectomy or conization because of invasive or non-invasive lesions of the cervix. T2-weighted and T1-dynamic enhancement images were reviewed by two radiologists who had no information on these patients except for the preoperative diagnosis. Clinical information regarding location of the disease was not given. At least 12 longitudinal sections prepared from the surgically removed cervix were reviewed by a pathologist who was not provided with MRI information. The correlation between MRI and histological findings was analyzed in terms of depth of invasion. Seventy cases were entered and 66 were evaluable. Sensitivities of T2 and dynamic MRI for invasive and non-invasive disease by radiologist 1 were 0.8824 and 0.8235, respectively, and those by radiologist 2 were 0.6296 and 0.7647, respectively. Specificities were 0.8776 and 0.8571, respectively, for radiologist 1 and 0.8974 and 0.8367, respectively, for radiologist 2. When sensitivities and specificities were calculated for prediction of non-invasive plus microinvasive lesions < or = 5 mm vs. invasive lesions > 5 mm, specificities of T2 and dynamic MRI became 1.0000 for both radiologists. Negative findings on T2 and/or dynamic MRI indicated non-invasive or early invasive cervical diseases < or = 5 mm. The dynamic technique provided only limited additional value in the detection of early invasive cervical carcinoma.

Unlabelled: We assessed the ability of 201TI planar scintigraphy and fine-needle aspiration (FNA) biopsy to differentiate malignant from benign lesions by comparing the findings of these techniques with those of surgical histopathology for 107 patients with 109 thyroid nodules., Methods: 201TI (74 MBq) was injected intravenously, and an early image and a delayed image were acquired after 10 and 120 min, respectively, for 10 min each. For 201TI planar scintigraphy, accumulation of the tracer in the nodules was visually scored and the nodules were grouped. Group A showed high activity in both early and delayed images. Group B revealed high activity in only the early image. Group C showed activity in the early image equal to that in normal tissues. Quantitative calculation of the washout rate was less than 0 in group CI and 0 or higher in group CII. Group D revealed low activity in the early image and variable activity in the delayed image. Three differential diagnosis methods were used for 201TI planar scintigraphy: method 1, in which only group A was considered malignant; method 2, in which both group A and group B were considered malignant; and method 3, in which groups A, B and CI were considered malignant. FNA results were assessed and classified by experienced pathologists. Two differential diagnosis methods were used for FNA: method a, in which malignancy was assigned to class IV (probably malignant or higher), and method b, in which malignancy was assigned to class III (possibly malignant or higher)., Results: Concerning 201TI methods 1, 2 and 3, sensitivity was 74.0%, 84.0% and 92.0%, respectively; specificity was 83.1%, 64.4% and 54.2%, respectively; and accuracy was 78.9%, 73.4% and 71.6%, respectively. For FNA, method a and method b had a sensitivity of 36.0% and 50.0%, respectively, and a specificity of 96.6% and 84.7%, respectively. The accuracy of both methods was 68.8%. For follicular lesions, sensitivity ranged from 80.0% to 90.0% for 201TI scintigraphy and from 10.0% to 30.0% for FNA., Conclusion: 201TI planar scintigraphy was found to be easier to use and more accurate than FNA in the differentiation of diagnosis of benign and malignant thyroid nodules based on visual scoring combined with quantitative evaluation.

Purpose: Our aim was to investigate the usefulness of multisection dynamic MR imaging using a 3D FLASH technique during breath holding in assessing myometrial invasion by endometrial carcinoma., Materials and Methods: Twenty-eight endometrial carcinomas were evaluated with pathologic correlation. Dynamic MR imaging was performed using the 3D FLASH technique during breath holding. We compared accuracy in the assessment of myometrial invasion by endometrial carcinoma between T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MR images., Results: The accuracy rates in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MR images were 64.3%, 67.8%, and 85.7%, respectively. Statistically significant differences were seen between dynamic MR images and both T2-weighted images and contrast-enhanced T1-weighted images., Conclusion: Multisection dynamic MR imaging using the 3D FLASH technique during breath holding is useful for the evaluation of myometrial invasion by endometrial carcinoma with polypoid growth or an unclear junctional zone on T2-weighted images.

We analyzed the influence of various parameters on the results of radiotherapy for T1 glottic cancer by assessing the outcomes of 60 patients with this cancer who received definitive radiotherapy between 1985 and 1994. Seven patients were treated with a cobalt-60 unit, and the other 53 with a linear accelerator (26 patients at 3-MV, 10 at 6-MV, and 17 at 10-MV). Of the 17 patients treated at 10-MV, 4 also received part of their treatment with a cobalt-60 unit. The total radiation dose ranged from 56 Gy to 70 Gy (mean, 61 Gy). The total radiation dose of 51 patients (85%) was 60 Gy. The factors found to influence local control were the strength of the radiation beam energy and whether or not there was gross tumor invasion of the anterior commissure. The local control rate was 71% in the patients treated with a 10-MV linear accelerator, 56% in those treated with a 6-MV linear accelerator and, 97% in those treated with a cobalt-60 unit or a 3-MV linear accelerator (P = 0.0173). The local control rate was 43% in the patients with gross anterior commissure invasion and 88% in those without (P = 0.0075). We conclude that low energy photon beams are more suitable for the treatment of early glottic cancers, especially if the lesion grossly invades the anterior commissure.

It is extremely important to have a good grasp of the acceptable limit of hepatectomy before operation because postoperative liver failure can take a fatal course; however, baseline data on the limit of hepatectomy have not been clearly defined. We therefore evaluated and compared the predicted remnant liver function obtained by computed tomography(CT) and technetium-99m diethylenetriamine penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) liver scintigraphy in order to obtain precise data regarding remnant liver function before hepatectomy. We investigated 20 patients undergoing hepatectomy using the clearance rate of indocyanine green (KICG) as a parameter, and compared the predicted postoperative KICG obtained by CT and by transaxial single-photon emission tomographic (SPET) images acquired by 99mTc GSA liver scintigraphy before hepatectomy. In GSA studies, based on time-activity curves for the heart and liver, we compared HH15 (heart activity at 15 min divided by heart activity at 3 min), LHL15 (liver activity at 15 min divided by heart plus liver activity at 15 min) and KL (obtained from the time-activity curve for the liver) in 103 patients. In 58 patients without increased serum bilirubin, KL was compared with KICG. In four patients, occlusion of the right portal vein was performed with the aim of carrying out secondary hepatectomy, and changes in liver volume were compared between CT and 99mTc GSA liver scintigraphy. The correlation coefficient between the postoperative KICG predicted by CT and the actual postoperative KICG was rather poor, at r = 0.569 (P < 0.05); that between the postoperative KICG predicted by 99mTc GSA liver scintigraphy and the actual postoperative KICG was good, at r = 0.788 (P < 0.01); correlations between KL and HH15 and between KL and LHL15 in 103 patients were very good or good, at r = 0.906 (P < 0.001) and r = 0.807 (P < 0.001), respectively, and that between KL and KICG in 58 patients was very good, at r = 0.916 (P < 0.001). In all four cases of right portal vein occlusion, the remnant liver volume ratio was markedly increased after occlusion in GSA compared with CT, and the postoperative KICG predicted by GSA after occlusion was closer to the actual postoperative KICG than that predicted by CT. It is concluded that 99mTc GSA liver scintigraphy is useful for predicting remnant liver function before hepatectomy and for evaluating changes in regional liver function after occlusion of the portal vein unilaterally.

We present a case of endometrial carcinoma accompanied with mucinous cystadenoma in a 70-year-old postmenopausal woman treated with tamoxifen for breast cancer demonstrated by MR imaging. Tamoxifen therapy (20 mg/day) had been carried out for more than 11 years since the surgical procedure for the primary tumor. MR images showed a markedly enlarged uterus containing endometrial carcinoma, cystic atrophy of the endometrium, and a right adnexal mass with multicystic components of various signal intensities.

Unlabelled: Regional attenuation/signal intensity differences seen on CT/magnetic resonance imaging can be a clue in detecting regional hepatic blood flow abnormality. Sometimes, however, they can be misinterpreted as a hepatic neoplasm or, in the case of a true neoplasm, they can lead to an overestimation of its size because these regions often have similar attenuation or signal intensity to hepatic neoplasms. We evaluated 99mTc-diethylenetriaminepentaacetic acid-galactosyl human serum albumin (99mTc-DTPA-GSA) liver scintigrams in patients manifesting regional attenuation/signal intensity differences to further analyze the findings., Methods: Technetium-99m-DTPA-GSA scintigrams of 23 patients with regional attenuation/signal intensity differences in the liver at dynamic contrast-enhanced CT/magnetic resonance imaging were evaluated. The causes of the differences were arterioportal (AP) shunts in seven patients, decreases in the portal venous flow in seven patients, occlusion of right hepatic vein in one patient, confluent hepatic fibrosis in one patient and unknown in seven patients. The accumulation of 99mTc-DTPA-GSA was compared with each known cause of attenuation/signal intensity difference. Count ratios of the regions to normal hepatic parenchyma also were calculated in all cases., Results: In AP shunts, none of seven patients showed any decreased accumulation in the region. Accumulation of 99mTc-DTPA-GSA decreased in six of seven patients who had decreases in portal venous flow; this incidence was significantly higher than that in patients who had AP shunts (p < 0.005). In cases of unknown cause, two of seven patients showed a decrease in accumulation, but the other five showed no such decrease. The one patient with occlusion of the right hepatic vein showed no decrease, but the confluent hepatic fibrosis showed a significant decrease. The count ratio in AP shunts was significantly larger than that of the decrease in the portal venous flow (p < 0.005)., Conclusion: Technetium-99m-DTPA-GSA accumulation in AP shunts has a different pattern from that found in patients with a decrease in portal venous flow. Therefore, differentiation between AP shunts, which showed no decrease in 99mTc-DTPA-GSA accumulation, and hepatic neoplasms can be made more easily.

A case of nonfunctional struma ovarii preoperatively diagnosed by scintigraphy of the pelvis using I-123 NaI is reported. US, CT, and MRI revealed a multilobulated mass composed of cystic and solid components. CT showed cystic components with slightly high density and MRI showed various signal intensities on T1- and T2-weighted images. I-123-scintigraphy of the pelvis showed uptake in the pelvic mass. Microscopic examination revealed the histologic appearance of thyroid tissue accompanied by follicular adenoma. I-123 scintigraphy of the pelvis was useful for reaching the correct preoperative diagnosis in this patient with nonfunctional struma ovarii.

The purpose of this study was to evaluate the characteristic findings of cervical carcinoma in dynamic MR imaging with a turbo-FLASH technique and to investigate the cause of the hyperintense rim surrounding the tumor on dynamic MR images by comparing them with the pathological findings in the resected specimens. Sixty consecutive patients with cervical carcinoma were included in this study. Dynamic MR imaging was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique. After dynamic MR imaging, T1-weighted spin echo (SE) images were obtained. Dynamic patterns of the lesions were investigated from images acquired in the early and late phases of dynamic MR imaging. The causes of the hyperintense rim were investigated by comparing dynamic MR images with the pathological findings. Most of the cervical carcinomas showed higher signal intensity than normal cervical stroma in the early phase of dynamic MR imaging. The pathological findings of the hyperintense rim on dynamic MR images differed according to the time of appearance of the hyperintense rim. Dynamic MR imaging with the turbo-FLASH technique, which shows high contrast between the lesion and normal cervical stroma, should be performed before obtaining contrast-enhanced T1-weighted SE images in patients with cervical carcinoma.

Volume reduction surgery has recently been an important surgical procedure for patients with severe pulmonary emphysema. We compared the sagittal and coronal images taken by the HASTE sequence with those obtained by turbo FLASH during deep breathing and with CT images obtained under deep inspiration. Clear images were obtained from both sequences, without cardiac or respiratory motion artifacts. The emphysematous areas were demonstrated as low signal intensity areas, as in CT images. The ratio of signal intensity in the expiratory phase to that in the inspiratory phase was lower than that of volunteers in the HASTE sequence. The HASTE sequence provides useful information about respiratory movement as well as about changes in the pulmonary parenchyma when used for preoperative examination.

The authors report a case of idiopathic portal hypertension in which radioaccumulation in the peripheral region of the liver decreased markedly. On dynamic CT, peripheral regional enhancement of the liver was seen in the arterial phase. The region was hypointense on T1-weighted MR images and hyperintense on T2-weighted images. On portograms via the superior mesenteric artery, markedly decreased portal venous perfusion was seen in the peripheral region of the liver. Tc-99m galactosyl human serum albumin (GSA) liver scintigrams showed decreased accumulation in the peripheral region and unchanged accumulation in the central region of the liver. Tc-99m GSA liver scintigraphy clearly showed localized liver dysfunction in the peripheral region.

Purpose: Our goal was to investigate the usefulness of dynamic MRI with the turbo-FLASH technique in estimating myometrial invasion by endometrial carcinoma., Method: Forty-six patients with endometrial carcinomas were evaluated with pathologic correlation. Dynamic MRI was performed with the rapid administration of Gd-DTPA using the turbo-FLASH technique., Results: The inner muscle layer showed more rapid contrast enhancement effects than the outer muscle layer even after menopause. Contrast-to-noise ratio between the inner muscle layer and endometrial carcinoma was maximum at approximately 50 s after administration of Gd-DTPA. In postmenopausal women, the accuracy in estimating myometrial invasion with T2-weighted images, contrast-enhanced T1-weighted images, and dynamic MRI was 66.7, 77.8, and 92.6%, respectively., Conclusion: Dynamic MRI with the turbo-FLASH technique is considered to be a useful imaging method for the estimation of myometrial invasion by endometrial carcinoma, especially in postmenopausal patients.

Uterine cirsoid aneurysm is uncommon. It is important to make a diagnosis of this disease preoperatively, because repeated curettages may induce life-threatening massive genital bleeding. We present a case of a 51-year-old woman with uterine cirsoid aneurysm in whom MRI and MRA were very useful for the preoperative diagnosis. The radiologic appearances on ultrasonography, CT, conventional SE MRI, MRA, dynamic MRI, and pelvic angiography are presented. Conventional SE T1-weighted and T2-weighted images demonstrated multiple flow voids in the uterus and bilateral adnexal regions. MRA demonstrated a cluster of distinct, tortuous, and coiled vascular channels in the pelvis. MRA could obtain images almost equal to angiography and was considered to be an excellent noninvasive imaging technique for the diagnosis of uterine cirsoid aneurysm.

We performed a long-term follow-up of 4 patients with penile cancer who underwent hyperthermotherapy from August 1985 until August 1992. Hyperthermia was applied using a frequency of 350 MHz with a waveguide applicator twice a week for 60 min each for an average of 9.5 times (varying from 6 to 13 times). The total heating time that the temperature of urethra could be kept above 42 degrees C, was 166 min on the average (ranging from 0 to 463 min). Two patients classified as stage I according to the Jackson classification and 1 patient classified as stage IV underwent combined radiotherapy and received an average radiation dose of 53 Gy (range, 40-70 Gy). Among these patients 2 underwent combined chemotherapy with bleomycin or peplomycin. Malignant cells disappeared posttherapeutically and in August 1992, after an average of 5 years and 9 months (varying from 4 years 6 months to 6 years 10 months), the patients were free of recurrences. The one patient on stage IV had extensive invasion of the abdominal wall, but still recovered completely. One patient on stage III underwent combined chemotherapy and hyperthermotherapy, but heating had obviously been insufficient. There was a residue of malignant cells after the treatment and we performed a penectomy. Regarding functional preservation of the penis a multidisciplinary therapy incorporating hyperthermotherapy can be expected to increase the curativity. This indicates that it could induce in an advanced case, where an operation would be difficult, complete remission.

Three-Dimensional MR angiography (3D-MRA) of the lung was performed in 5 healthy volunteers and 14 patients with primary pulmonary cancer in the hilum, and compared with 2D-MRA. As 3D-MRA could be obtained with single breath holding after intravenous bolus injection of Gd-DTPA, pulmonary vessels of the hilum and peripheral zone were demonstrated more definitely than those of 2D-MRA. In all patients except one case, the relation between the tumor and pulmonary vessels was visualized more clearly by 3D-MRA than 2D-MRA. This technique is considered a non-invasive and effective method for evaluation of pulmonary vessels in the patient with hilar tumor.

Metallothionein inhibited in a concentration-dependent fashion the reduction of nitroblue tetrazolium [NBT] mediated by xanthine oxidase and by NADH-phenazine methosulfate. This catalytic activity of metallothionein for dismutation of O2- is dependent on the copper content in metallothionein.