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Poor posture in young adults and middle-aged people is associated with neck and back pain which are among the leading causes of disability worldwide. Training posture maintenance muscles and learning about ideal posture are important for improving poor posture. However, the effect of using both approaches simultaneously has not been verified, and it is unclear how long the effects persist after the intervention. Forty female university students were randomly and evenly assigned to four groups: physical function improvement training, posture learning, combination, and control groups. Four weeks of intervention training was conducted. Postural alignment parameters were obtained, including trunk anteroposterior inclination, pelvic anteroposterior inclination, and vertebral kyphosis angle. Physical function improvement training for improving crossed syndrome included two types of exercises: “wall-side squatting” and “wall-side stretching”. The posture learning intervention consisted of two types of interventions: “standing upright with their back against the wall” and “rolled towel”. A multiple comparison test was performed after analysis of covariance to evaluate the effect of each group’s postural change intervention on postural alignment. Only the combination group showed an effective improvement in all posture alignments. However, it was found that a week after the 4-week intervention, the subjects’ postures returned to their original state.

Tissue flossing aims to improve range of motion (ROM), reduce pain, and enhance injury prevention. However, evidence is lacking regarding its effects. Therefore, this study examined the effects of flossing on hamstring muscles function in comparison to dynamic stretching (DS). Seventeen healthy young men ([mean ± SD] age, 23.2 ± 1.1 years; height, 1.72 ± 0.08 m; body mass, 63.5 ± 9.3 kg) volunteered as subjects in this randomized crossover trial. The subjects received flossing, DS, and control interventions in random order at least 1 week apart to eliminate the influence of the previous intervention. Flossing involved passive twisting and active movement using a floss band (Sanctband COMPRE Floss Blueberry, Sanct Japan Co., Ltd.). DS was performed for 4 minutes in 30-second sets consisting of 15 repetitions of 2 seconds stretching. The following were measured before and after each intervention: straight leg raise (SLR) test, passive knee extension (KE) test, passive torque, passive stiffness, fascicle length in the biceps femoris long head as an indication of hamstring muscles flexibility, and maximal isometric knee flexion contraction, maximal eccentric knee extension/flexion contraction, rate of force development, and muscle activity. Flossing yielded significant improvements in the SLR test (mean difference in post-intervention changes between interventions: 5.4°, percentage change from pre- to post-value: 13.4%, p = 0.004), passive KE test (6.2°, 4.5%, p < 0.001), passive torque at end-ROM (3.8 Nm, 4.7%, p = 0.03), and maximal eccentric knee flexion contraction (14.9% body weight, 8.2%, p = 0.03) than control. Moreover, flossing yielded 2.1-fold greater improvements in the passive KE test (3.8°, 4.5%, p = 0.03) and yielded significant improvements in the maximal eccentric knee extension contraction (29.9% body weight, 13.8%, p = 0.02) than DS. Therefore, flossing on hamstring muscles is more beneficial than DS with respect to increasing ROM and muscle exertion.

Background Total hip arthroplasty (THA) is one of the most effective treatments for hip pain and hip dysfunction. There are, however, problems associated with postoperative changes in the nonoperative hip joint and in particular, it is not uncommon for patients with osteoarthritis (OA) to experience increased pain and progression of OA. Appropriate physical activity (PA) and exercise can help maintain and improve physical function in OA patients, but excessive activity may increase the risk of progression of OA. This study aimed to clarify the influence of PA on the progression of OA of the nonoperative hip after unilateral THA. Design: This prospective cohort study was conducted from six to 24 months post-THA. Subjects were female patients with hip OA who had undergone unilateral THA. The primary outcome was change in minimal joint space (MJS) (ΔMJS, MJS at 24 months - MJS at six months). Daily step count and moderate to vigorous physical activity (MVPA) were also measured. Patients were divided into two groups by Kellgren-Lawrence (KL) grade (0 or ≥ 1). To identify factors that influence ΔMJS, a generalized linear model approach was used, with adjustment factors (age, body weight, and MJS at six months), KL grade, PA (daily step count/MVPA), and interaction terms between PA and KL grade as explanatory variables. Results Eighty-five patients were analyzed. ΔMJS was 0.18 mm at 24 months post-THA. The interaction term between daily step count and KL grade significantly influenced the progression of OA. The regression coefficient of daily step count for ΔMJS was significant in the KL ≥ 1 group, but not in the KL = 0 group. A model with adjustment factors, an interaction term, and both PA measures showed that daily step count and decreasing MVPA increased ΔMJS. Conclusions PA influenced the progression of OA in patients with KL grade ≥ 1, but did not influence onset in patients without OA post-THA. Excessive daily step count and/or low MVPA may be a risk factor for the progression of OA.

BackgroundCurved periacetabular osteotomy (CPO) was developed to treat acetabular dysplasia. Given that CPO can improve physical function in the early post-operative period, patients might be able to participate in sports activities post-operatively. Therefore, this study examined the post-operative sports activity participation and characteristics of acetabular dysplasia patients who have undergone CPO.MethodsA total of 52 patients who underwent CPO for acetabular dysplasia were given a questionnaire on pre- and post-operative sports activities; 43 patients responded. We surveyed patients’ sports activities, satisfaction, and physical function. Patients were divided according to whether they participated in sports activities after CPO. Physical function was compared before and after CPO.ResultsThe pre- and post-operative sports activity participation rates were 55.8 and 72.1%, respectively. Patients mostly performed low-impact sports activities. Moreover, patients who participated in sports activities post-operatively had smaller pre-operative range of motion of hip flexion and returned to full weight bearing earlier.ConclusionsAmong acetabular dysplasia patients who underwent CPO, 72.1% participated in sports activities post-operatively. Post-operatively, patients participated not only in low-impact sports activities, but also in high-impact ones. These findings might be useful for advising patients who are concerned about participating in sports activities after CPO.

Purpose The aim of this study was to clarify the incidence, clinical risk factors, and dose–volume relationship of upper gastrointestinal (GI) ulcer after carbon-ion radiotherapy (C-ion RT) for pancreatic cancer. Materials and methods Fifty-eight pancreatic cancer patients were treated with C-ion RT from April 2014 to December 2015. The total dose was 55.2Gy (RBE) in 12 fractions. D 2cm3 of GI tracts were restricted under 46Gy (RBE); RBE-weighted absorbed dose. The association between dosimetric parameters (V 10–50 , D max , D 1cm3 , D 2cm3 ) and GI ulcer was examined using Spearman's correlation. The incidence of GI ulcer was compared between the two groups divided by the cutoff value. Results Twelve patients (21%) experienced gastric ulcer including only one (2%) grade 3 ulcer. There was no grade 4/5 toxicity or duodenal ulcer. V 10–30 was significantly associated with gastric ulcer. The 1-year estimated risk of gastric ulcer for the determined cutoff values were 51% vs. 10% (V 10 , ⩾102cm 3 or less), 42% vs. 9% (V 20 , ⩾24cm 3 or less), 34% vs. 4% (V 30 , ⩾6cm 3 or less). Conclusions The incidence of GI ulcer after C-ion RT was very low with the dose constraint of D 2cm3 10–30 should also be reduced.

Amnesic shellfish poison (ASP) is regarded as one of the shellfish poison groups in the EU, though it is not subject to regulation in Japan. We have developed an analytical method of ASP based on the report by Hatfield et al. and other methods. Validation studies were carried out with certified compositional reference materials (CRM). Performance parameters were estimated based on 17 analytical results. The estimate of trueness was 97.5%, and the estimate of intralaboratory reproducibility (RSD) was 1.5%. The HorRat(r) value was 0.16. These performance parameters meet the criteria in the Codex Procedural Manual. Furthermore, internal quality control was performed by using the CRM. The action limits were set based on the performance parameters of the method. Most of the results of the internal quality control were within the action limit range. The results confirmed that the quality of the analyses was well maintained. The purpose of the analytical method is to confirm that the level of ASP in scallop is less than 4.6 mg/kg. The applicability of the analytical method to scallops was confirmed by using spiked samples.

Recent advances in external beam radiotherapy have allowed us to deliver higher doses to the tumors while decreasing doses to the surrounding tissues. Dose escalation using high-precision radiotherapy has improved the treatment outcomes of prostate cancer. Intensity-modulated radiation therapy has been widely used throughout the world as the most advanced form of photon radiotherapy. In contrast, particle radiotherapy has also been under development, and has been used as an effective and non-invasive radiation modality for prostate and other cancers. Among the particles used in such treatments, protons and carbon ions have the physical advantage that the dose can be focused on the tumor with only minimal exposure of the surrounding normal tissues. Furthermore, carbon ions also have radiobiological advantages that include higher killing effects on intrinsic radio-resistant tumors, hypoxic tumor cells and tumor cells in the G0 or S phase. However, the degree of clinical benefit derived from these theoretical advantages in the treatment of prostate cancer has not been adequately determined. The present article reviews the available literature on the use of particle radiotherapy for prostate cancer as well as the literature on the physical and radiobiological properties of this treatment, and discusses the role and the relative merits of particle radiotherapy compared with current photon-based radiotherapy, with a focus on proton beam therapy and carbon ion radiotherapy.

Background and objective Many lung diseases arise as the consequence of inhalational injury. When pathogenic materials are inhaled, it is possible that their clearance routes become the main focus of injury in the lung. Lymphatic clearance is important in the removal from the lung of small inhaled particles. The leak of toxic agents from the lymphatic flow potentially explains the topographic distribution of diffuse lung diseases triggered by inhaled materials, for example asbestosis. The aim of this study was to evaluate the differences in lymphatic distribution across various craniocaudal levels of the lung by using carbon dust deposition (CDD) as a tracing marker. Methods We evaluated 61 HE-stained slides of the normal lung area from 61 lobectomy specimens. The intensity of CDD was scored into five degrees (0–4) in bronchiolovascular (BV) areas and subpleural/septal (SP) areas per slide. The distribution was highlighted by subtraction scores of SP areas from those of bronchiolovascular areas. Results The subtraction scores of the upper lung area were significantly greater than those in the lower area, whereas there was no significant difference in scores by pulmonary lobes. Conclusions Our results indicated that the main lymphatic clearance routes vary according to the craniocaudal levels, and are predominant in BV areas of the upper areas and in SP areas of the lower areas of the lung. This may explain the histological variations in anatomical distribution observed in the biopsy specimens of some diffuse lung diseases.

SAGA HIMAT [1], the fourth carbon ion beam therapy facility in Japan, is located in Tosu city, Saga prefecture (Figures 1 and 2). The SAGA HIMAT Project is a collaborative work among the local governments, regional industries, and medical societies in the Kyushu area. The initial cost of this facility was approximately ¥15 billion, which was covered by donations, investments, and local government aid. The facility is managed by a nonprofit organization, SAGA HIMAT Foundation. At SAGA HIMAT [2], carbon ions are accelerated to up to 70% of light speed by 2 linear accelerators and a synchrotron. The accelerated ion beams are transported to treatment rooms A and B. The range of extracted energy is 140 to 400 MeV/u (Table 1). Room A has horizontal and 458 oblique beam lines; room B has horizontal and vertical beam lines. Broad beams are used and each outlet measures 15 cm3 15 cm (Figures 3 and 4). In preparation for treatment, radiation technologists create an immobilization device customized for each patient placed on a mock treatment couch. Dose compensation boluses adjusted to the shape of the irradiation fields are designed from the computed tomography (CT) simulation data and produced by outside manufacturers. We also have a regular CT scanner and magnetic resonance imaging for diagnosis. Treatment room C is now under construction for pencil beam scanning therapy. SAGA HIMAT is a stand-alone outpatient clinic specialized for carbon ion cancer therapy. The patients initially visit a cancer treatment facility of their choice, receive a diagnosis and staging of the cancer, and are referred to our institution for carbon ion

Purpose : Patients with moyamoya disease (MMD) exhibit narrowed internal carotid arteries (ICAs) because the distal ends of the bilateral ICAs have become progressively stenosed, starting mainly in childhood. Accordingly, the petrous carotid canals in MMD patients are suspected to be more hypoplastic than those in control subjects. In this study, the diagnostic value of conventional computed tomography for MMD patients was retrospectively evaluated by comparing the caliber of the bilateral carotid canals in MMD patients with that in control subjects. Materials and methods : Thirty-five patients with MMD (15 males, 20 females; age range/average age : 6-71 / 26.1 years old) and age- and sex-matched control subjects underwent conventional head computed tomography. The maximal petrous carotid canal diameters of the two groups were measured and compared. Results : The maximal petrous carotid canal diameter was significantly smaller in the moyamoya patients (mean ±standard deviation[mm] = 4.70 ± 0.61) than in the control subjects (5.62 ± 0.61,p < 0.01). Conclusion : Conventional head computed tomography revealed narrowed petrous carotid canals in the MMD patients. This basic information could be utilized to screen patients who will require further examination, especially among those with underlying MMD., 目的：もやもや病は幼少期から内頸動脈終末部が進行性に狭窄する．もやもや病症例では頸動脈管が健常者と比較して，より低形成となることが考えられる．本後向き研究では頭部CT検査で頸動脈管径を測定することによるもやもや病早期診断の可能性につき検討した．対象と方法：25例のもやもや病症例群（男性15例，女性20例，年齢：6-71歳，平均26.1歳）と明らかな頭蓋内病変を認めない性別と年齢を一致させ，頭部CT検査を受けた症例を対照群とした．頭部CT検査で両群の頸動脈管最大径を測定し，両群間を比較検討した．結果：もやもや病症例群の頸動脈管最大径（平均4.70 ± 0.61mm）は対照群（平均5.62 ±0.61mm，p < 0.01）と比較して有意な狭小化が示された．考察：頭部単純CT検査で頸動脈管径を評価することにより，もやもや病の早期検出をできる可能性があると考えられた．結論：もやもや病早期診断における頸動脈管径測定の有用性が示唆された．

OBJECTIVE. The objective of this article is to review the clinical, pathologic, and MRI findings of mediastinal neurogenic tumors according to the three tumor origins: the peripheral nerves, sympathetic ganglia, and paraganglia. CONCLUSION. MRI findings reflect pathologic features of mediastinal neurogenic tumors. Integrating consideration of age and clinical findings of the patient, lesion location, and imaging findings is important in the diagnosis of mediastinal neurogenic tumors.

Background Several studies have reported the effectiveness of high b-value diffusion-weighted MR imaging (DWI) in the abdominal region, and have found that various malignant tumors may show high signal intensity on DWI, reflecting their high cellularity and/or their long relaxation time. The value of ADC measurement has also been documented for the diagnosis of several abdominal malignancies. Purpose To retrospectively evaluate the usefulness of high b-value DWI in differentiating between benign and malignant polypoid gallbladder lesions. Material and Methods The study population consisted of 10 benign (three hyperplastic polyps and seven adenomas) and 13 malignant (all adenocarcinomas) polypoid gallbladder lesions. DWI was evaluated by two observers. Qualitatively, the signal intensity of the lesions on DWI was visually evaluated and categorized as iso, high, or very high. Quantitatively, the ADC values of the lesions were measured from ADC maps. Statistical analysis was performed using a two-tailed Fisher's exact test and the Mann-Whitney test, respectively. Results Qualitative analysis revealed a statistical difference (P = 0.0041). Six of 10 benign lesions were categorized as iso, and the remaining four were categorized as high. In the 13 malignant lesions, one was categorized as iso, five as high, and seven as very high. The ADC values of the malignant lesions (1.34 ± 0.50 × 10–3 mm2/sec) were significantly lower than those of the benign lesions (2.26 ± 0.44 × 10–3 mm2/sec) (P = 0.00016). Conclusion High b-value DWI may be useful for differentiating between benign and malignant polypoid gallbladder lesions by the visual assessment of DWI and ADC measurement.

3.0-T magnetic resonance (MR) angiography and MR imaging were compared with conventional angiography for the evaluation of moyamoya disease in 13 preoperative patients (26 hemispheres) with moyamoya disease (4 males and 9 females aged 21-54 years). The correlation between MR angiography scores determined by modified Houkin's grading system (MRA score) and conventional angiography stages determined by Suzuki's grading system (CA stage) was analyzed. Other MR findings such as moyamoya vessel scores, “ivy sign” scores, and the presence of small, medium, and large cerebrovascular attack (CVA) lesions were compared with CA stages. MRA scores were significantly correlated with CA stages (p < 0.01). Moyamoya vessel scores correlated well with CA stages (p < 0.01). There was no significant correlation between “ivy sign” scores and CA stages, and no significant differences in CA stages with the presence and absence of CVA lesions of any size. 3.0-T MR angiography can be used as a vascular assessment in moyamoya disease with its priority of noninvasive nature and visual clarity compared with conventional angiography. The findings of 3.0-T MR angiography may reflect the steno-occlusive changes in moyamoya disease.

It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions.We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed.At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p0.05).Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.

Computed tomography and MRI findings of 40 cases of autoimmune pancreatitis (AIP) were reviewed, and AIP classified into three types: diffuse, segmental and multifocal. A capsule-like rim can play an important role in diagnosing AIP. A smooth contour of the lesion without circumference fat tissue change is also considered to be a characteristic of AIP. The important differential diagnosis of diffuse type AIP is lymphoma. Differentiating clues are main pancreatic duct change and enhancement pattern on dynamic study. Differentiation between segmental type AIP and pancreatic cancer is often difficult or may be almost impossible. Although rare, AIP may show multifocal delayed enhanced masses within the pancreas. Recognition of this type of AIP is mandatory in diagnosing pancreatic abnormalities.

Hibernoma is an uncommon, benign soft tissue tumor that arises in brown adipose tissue. The computed tomography (CT) and magnetic resonance imaging (MRI) findings of hibernomas are similar to those of well-differentiated liposarcoma or angiolipoma. We report the unique appearance of a rare thoracic wall hibernoma, which appeared as a dumbbell-shaped lipomatous tumor across an intercostal region. A dynamic contrast-enhanced study on MRI revealed early enhancement, which corresponded to the branching low-signal intensity on T2-weighted images of the mass.

The superior ophthalmic veins (SOVs) are sometimes visualized on three-dimensional time-of-flight magnetic resonance (3D-TOF-MR) angiograms obtained with a 3 Tesla system. The purpose of this retrospective study was to determine the incidence of visualization of normal SOVs on 3D-TOF-MR angiograms, and their characteristic features. We reviewed 3D-TOF-MR angiograms of 345 consecutive patients obtained with a 3 Tesla MR device. Patients comprised 170 males and 175 females, aged five to 93 years. Most of the patients had, or were thought to have, cerebrovascular disease. The SOV was visualized in 13 of the 345 patients (3.8%). The visualized SOV was on the left side in seven of the 13, and on the right side in two. Both the right and left SOVs were visualized in four patients. The left SOV was more clearly visualized in two of these patients, whereas the SOVs were equally visible on both sides in the other two. There was a female predominance (M:F = 1:12) but no relation between age and visualization of SOVs. None of the visualized SOVs were dilated, and no dilated cavernous sinus was seen. The facial veins and angular veins were also visualized, continuing to the SOVs, suggesting rapid retrograde flow in the facial veins. SOVs are sometimes visualized on 3D-TOF-MR angiograms. This phenomenon should not be misdiagnosed as an asymptomatic dural carotid-cavernous fistula.

症例は80歳女性．1972年頃に薬物性肝障害の疑いで2回肝生検を行われている．2007年5月に腹部超音波検査で大量腹水を指摘され紹介となった．血液検査では汎血球減少と肝胆道系酵素上昇を認めた．5年前のCTと比較すると肝両葉とも萎縮が著しく，肝動脈造影で右肝動脈は拡張，蛇行し，門脈の早期描出を認め，右肝動脈と門脈右枝との間に短絡路を形成していた．上部消化管内視鏡検査ではRC sign陽性の食道静脈瘤を認めた．肝内動門脈瘻による門脈圧亢進症と診断し，コイルによる肝動脈塞栓術を施行した．術直後に門脈血流は求肝性となり，治療後早期に腹水消失，血清学的検査所見の改善，食道静脈瘤の消失，肝形態と萎縮の改善を認めた．肝生検後35年の経過を経て有症状化した肝内動門脈瘻の症例で，肝動脈塞栓術により劇的に血行動態が改善し，各所見が可逆性変化を示した興味深い症例であった．

Manganese (Mn) accumulation in the brain is detected as symmetrical high signal intensity in the globus pallidi on T1-weighted MR images without an abnormal signal on T2-weighted images. In this review, we present several cases of Mn accumulation in the brain due to acquired or congenital diseases of the abdomen including hepatic cirrhosis with a portosystemic shunt, congenital biliary atresia, primary biliary cirrhosis, congenital intrahepatic portosystemic shunt without liver dysfunction, Rendu-Osler-Weber syndrome with a diffuse intrahepatic portosystemic shunt, and patent ductus venosus. Other causes of Mn accumulation in the brain are Mn overload from total parenteral nutrition and welding-related Mn intoxication.

We report on the case of a patient with breast cancer with diffuse cranial nerve and cauda equina lesions. Magnetic resonance imaging of the patient's brain and spinal cord showed diffuse abnormal enhancement and slight enlargement of the cranial nerves and cauda equina. Although the results of subsequent testing for two antineural antibodies were negative, paraneoplastic sensorimotor neuropathy associated with breast cancer was considered to be the most likely clinical diagnosis.

Radiofrequency ablation has been applied to treat hepatocellular carcinoma, with favorable therapeutic outcomes. Nevertheless, practitioners have approached radiofrequency ablation with some reluctance due to the difficulty of identifying isoechoic tumors and recurrent tumors. The aim of the present study is to investigate the efficacy of Real-time Virtual Sonography to treat hepatocellular carcinoma difficult to detect by conventional ultrasonography. Real-time Virtual Sonography is a system generating multiplanar reconstruction images in real-time using the Hitachi medico EUB-8500 equipped with a probe. The system included following components: 1) digital imaging and communications in medicine (DICOM) data from dynamic CT, 2) a magnetic field generator to match the multiplanar reconstruction image on the monitor and the actual ultrasonography image, 3) the cross section with the tumor displayed as a multiplanar reconstruction image. Total twenty-five nodules of twenty-one patients underwent radiofrequency ablation monitored by Real-time Virtual Sonography. All nodules difficult to detect via conventional ultrasonography were clearly visualized in real-time. The average nodule diameter was 2.4 +/- 1.6 cm, and punctures and coagulation were performed an average of 2.2 and 3 times per session. Dynamic CT after session confirmed effective coagulation of each nodule. In conclusion, this study demonstrates that the present system is capable of effectively and accurately treating tumors difficult to detect by conventional ultrasonography.

Introduction Retrograde flow in the left dural sinuses is sometimes detected by three-dimensional time-of-flight (3D-TOF) magnetic resonance (MR) angiography. The purpose of this study was to evaluate the incidence of this phenomenon and its characteristic features on 3D-TOF MR angiograms. Methods We retrospectively reviewed cranial MR angiography images of 1,078 patients examined at our institution. All images were obtained by the 3D-TOF technique with one of two 1.5-T scanners. Maximum intensity projection (MIP) images in the horizontal rotation view were displayed stereoscopically. We reviewed the source images, inferosuperior MIP images, and horizontal MIP images and identified retrograde flow in the dural sinuses. Results We found retrograde flow in the dural sinuses of 67 patients on the source images from 3D-TOF MR angiography; the incidence was 6.2%. In 47 of the 67 patients, retrograde flow was identified in the left inferior petrosal sinus, in 13, it was seen in the left sigmoid sinus, and in 6, it was seen in the left inferior petrosal and left sigmoid sinuses. The remaining patient had retrograde flow in the left inferior petrosal and left and right sigmoid sinuses. The mean age of the patients with retrograde flow was slightly greater than that of the patients without this phenomenon (70 years vs 63 years). Conclusion Retrograde flow in the dural sinuses frequently occurs on the left side in middle-aged and elderly patients during 3D-TOF MR angiography performed with the patient in the supine position. This phenomenon should not be misdiagnosed as a dural arteriovenous fistula.

From anatomical and angiographic studies, it is well known that there are several variations of the anterior cerebral artery (ACA). However, ACA variations have rarely been studied by magnetic resonance (MR) angiography. The purpose of this study was to investigate not only the type, location, configuration, and incidence of ACA variations, but also coexisting arterial pathology such as aneurysms detected by cranial MR angiography. We retrospectively reviewed cranial MR angiography images of 891 patients at our institution. All images were obtained with one of two 1.5-T scanners using the three-dimensional time-of-flight technique. Maximum intensity projection (MIP) images in the horizontal rotation view were displayed stereoscopically. We reviewed these horizontal MIP images, inferosuperior MIP images, and source images, and identified variations of the ACA. We found 50 instances (5.6%) of unilateral A1 segment aplasia, 27 (3.0%) of three A2 segments, 18 (2.0%) of an unpaired A2 segment, and 11 (1.2%) fenestrations of the A1 and/or A2 segment. Seven anterior communicating artery (ACoA) aneurysms and one ACA territory embolic infarction were found among the 50 patients with unilateral A1 segment aplasia. One ACoA aneurysm and one pericallosal infarction were found in the 27 patients with three A2 segments. Two distal ACA aneurysms were detected among the 18 patients with an unpaired A2 segment. No associated aneurysm was seen at the fenestrations. Although the clinical significance of ACA variations is usually minor, an associated aneurysm is found relatively frequently. Thus, recognizing ACA variations during the interpretation of cranial MR angiograms is important.

In this pictorial review, we illustrate acquired diseases or conditions of the corpus callosum that may be found by magnetic resonance (MR) imaging of the brain, including infarction, bleeding, diffuse axonal injury, multiple sclerosis, acute disseminated encephalomyelitis, Marchiafava-Bignami disease, glioblastoma, gliomatosis cerebri, lymphoma, metastasis, germinoma, infections, metabolic diseases, transient splenial lesion, dilated Virchow-Robin spaces, wallerian degeneration after hemispheric damage and focal splenial gliosis. MR imaging is useful for the detection and differential diagnosis of corpus callosal lesions. Due to the anatomical shape and location of the corpus callosum, both coronal and sagittal fluid-attenuated inversion recovery images are most useful for visualizing lesions of this structure.

We illustrate the various types of secondary degeneration in the brainstem and/or cerebellum detected on magnetic resonance (MR) images obtained after cerebrovascular accidents. The changes include: (a) ipsilateral nigral degeneration after striatal infarction; (b) Wallerian degeneration of the pyramidal tract in the brainstem after supratentorial pyramidal tract or motor cortex injury; (c) Wallerian degeneration of the corticopontine tract in the brainstem after frontal lobe infarction; (d) ipsilateral brainstem atrophy and crossed cerebellar atrophy due to an extensive supratentorial lesion; (e) ipsilateral superior cerebellar peduncle atrophy, contralateral rubral degeneration, contralateral inferior olivary degeneration and ipsilateral cerebellar atrophy after dentate nucleus hemorrhage; (f) ipsilateral inferior olivary degeneration after pontine tegmentum hemorrhage; (g) bilateral wallerian degeneration of the pontocerebellar tracts after ventromedial pontine infarction or basis pontis hemorrhage; and (h) ipsilateral cerebellar atrophy after middle cerebellar peduncle hemorrhage.

The purpose of this study was to scrutinize morphological characteristics of thin-section CT of the histopathological subtypes of adenocarcinoma of the lung. The subjects consisted of 83 patients with 87 adenocarcinomas measuring 3 cm or less in the largest. The tumors were divided into three groups (group I: Noguchi's histological subtypes type A and B tumors, group II: type C tumors, and group III: type D, E, and F tumors). In each group, tumor size, shape (round versus polygonal), presence of air bronchogram, bubble-like areas, coarse spiculation, pleural tag, and ratio of ground glass attenuation (GGA) were evaluated. Most of the group II lesions showed polygonal shape, whereas tumors in other groups were round in shape (P

Carotid-anterior cerebral artery anastomosis is a rare anomaly of the anterior part of the circle of Willis. We report here magnetic resonance (MR) angiographic findings in 2 patients with this anomaly. MR angiographic source images are useful in evaluating the anatomical details of this anomaly. Including the 2 present cases, 27 patients with this anomaly have been reported in the English-language literature. Thirty anomalous arteries were found in the 27 patients (R/L/bilateral=22/2/3). The reason for the right-sided predominance is unknown.

We report computed tomography (CT) features in a case of segmental thrombosis of the superior sagittal sinus. On the initial cranial CT scan, both frontal cortices showed focal areas of slightly increased attenuation. The lesions were isointense on magnetic resonance (MR) images no matter what pulse sequence was used, except on fluid-attenuated inversion recovery images, which showed curvilinear sulcal hyperintensity. On postcontrast T1-weighted images, curvilinearly enhancing structures were apparent in both frontal cortical sulci. No lesion appeared on follow-up CT or in MR images. We speculated that the areas of slightly increased attenuation in the cortices represented blood congestion in the cortical veins, venules and capillaries without serum leakage. Cranial CT images should be carefully interpreted to avoid overlooking subtle lesions.

Pulmonary glomus tumor is rare and its manifestations on magnetic resonance imaging (MRI) have not, to our knowledge, been reported previously. A round mass was detected in the right upper lung field on a routine chest radiograph. With dynamic contrast-enhanced MRI, the mass showed strong, early-phase peripheral enhancement that expanded in a centripetal direction with time. Postoperative pathologic examination confirmed the diagnosis of glomus tumor.

We report three patients with a cerebrovascular accident studied serially by MRI, including diffusion-weighted imaging (DWI). In case 1, DWI 1 day after the onset of left frontoparietal cortical infarcts showed no abnormal signal in the left corticospinal tract. DWI 12 days after onset showed high signal in the corticospinal tract, interpreted as early wallerian degeneration. This had disappeared by 22 days after onset. In case 2, DWI obtained 7 days after the onset of a right internal capsule lacunar infarct showed high signal from the right corticospinal tract in the brainstem, which was less marked 15 days after onset. In case 3, MRI on postnatal day 7 showed a cerebral haemorrhage in the right corona radiata and high signal from the right corticospinal tract on DWI. The latter disappeared by day 23. DWI shows early wallerian degeneration; transient signal abnormalities within 2 weeks of stroke should not be mistaken for new ischaemic lesions.

The purpose of this paper is to show several diseases that manifest symmetrical hyperintense lesions on the middle cerebellar peduncles, the largest connecting peduncles between the brainstem and the cerebellum, in conventional magnetic resonance (MR) images. We retrospectively reviewed cranial MR images obtained with 0.3-, 0.5-, 1.0-, and 1.5-Tesla scanners. We found symmetrical middle cerebellar peduncular lesions in patients with Wilson's disease; hepatic encephalopathy; extrapontine myelinolysis; acute disseminated encephalomyelitis; wallerian degeneration of the pontocerebellar tracts after either pontine infarction, pontine hemorrhage, or central pontine myelinolysis; leukodystrophy; olivopontocerebellar atrophy; and toluene abuse. Definitive diagnosis of these diseases can be made relatively easily on the basis of clinical data; however, examination of associated brainstem or supratentorial lesions in MR images is also important.

A 62-year-old man with a traumatic high-flow right carotid-cavernous fistula was treated by transarterial balloon occlusion technique. However, because of the relatively small size of the fistula, the balloon could not enter into the cavernous sinus via the fistula. During the procedure, the shunt flow decreased significantly, and we stopped the procedure. Follow-up angiography performed 14 days after the procedure showed complete occlusion of the fistula with a small residual pseudoaneurysm. One year later, the pseudoaneurysm had decreased in size. Repeated transient decrease and stagnancy of blood flow at the fistula during the balloon procedure may have played an important role in the thrombosis in this patient.

Central pontine myelinolysis (CPM) is one of the serious neurological complications of alcoholism. This study evaluated magnetic resonance images of sequelae of CPM. Approximately 600 alcoholic patients were examined by a 1.0-T magnetic resonance imaging device, and 11 patients were retrospectively found to have a central pontine lesion, a presumed sequela of CPM. The lesions had various shapes and most were cavitary. In 3 of the 11 patients bilateral symmetrical oval lesions were faintly visible in the middle cerebellar peduncles. These middle cerebellar peduncular lesions were diagnosed as having Wallerian degeneration of the pontocerebellar tract secondary to CPM.

We investigated 7505 inpatients who underwent intravenous urography or contrast-enhanced computed tomography to assess risk factors for delayed adverse drug reactions to iohexol, a non-ionic iodinated contrast medium. Focusing on delayed adverse reactions, all adverse events were prospectively investigated for 7 days after injection of iohexol. To explore the relevant risk factors, the relationship between occurrence of adverse reactions to iohexol and 17 different variables was evaluated by logistic regression analysis. To assess the influence of seasonal factors, adverse reactions were separately evaluated during two periods: February to April (the pollinosis period in Japan) and July to September (the non-pollinosis period). The prevalence of delayed adverse events and delayed adverse reactions was 3.5 and 2.8%, respectively, whereas the prevalence of adverse events and adverse reactions was 5.7 and 5.0%, respectively. Multivariate analysis showed that six parameters had a significant influence on delayed adverse reactions to iohexol, including (a) a history of allergy, (b) season, (c) radiographic procedure, (d) age, (e) concomitant surgery or other invasive procedures, and (f) concomitant medication. The prevalence of delayed reactions was lower than in previous large-scale studies. Significant risk factors included a history of allergy and performance of radiography during the pollinosis period, suggesting that allergy was involved in delayed adverse reactions. The type of radiographic procedure also had an influence.

目的. 佐賀県総合保健協会における肺がん検診の読影は, 読影班1班2名, これら2班による二重読影方式を採用し, さらに各班が独立して比較読影を行い, 最終判定までを行っている. 精度管理指標は全国値に比し, 陽性反応的中度, 精検受診率ともに上回り, 要精検率は低く, がん発見率は同等かそれ以上であり, 精度管理は比較的適切に行われているものと考えられた. 今回, 読影技術における精度管理の更なる向上を目的として, 1999年度より読影委員全員の参加による肺がん検診症例検討会を開催した. 方法. 症例検討会において. 読影委員に種々の情報を還元し, 共有することによって, 読影技術の標準化を図った. 結果. これにより, がん発見率は全国値を上回り, 要精検率も上昇傾向となった. 陽性反応的中度はやや低下傾向となったが全国平均を大きく上回っており, 精検受診率の上昇傾向も含めて更にバランスがとれてきたものと考えられる. 結論. 新しい方式による肺がん症例検討会は, 読影技術の精度管理に有用であることが示唆された.

We present a case of persistent primitive olfactory artery (PPOA) diagnosed with the aid of magnetic resonance (MR) angiography. The proximal right anterior cerebral artery (ACA) had an extremely long anteroinferomedial course along the ipsilateral olfactory tract, made a hairpin turn posterosuperiorly, and became a normal distal ACA. After reviewing the literature, we considered the proximal segment of this anomalous ACA to be a PPOA. To our knowledge, this is the first report of a patient with this anomalous ACA diagnosed with MR angiography.

Elastofibroma dorsi is a benign fibroelastic tumor of unknown etiology that arises bilaterally or unilaterally at the lower subscapular level. It can be easily diagnosed on computed tomography or magnetic resonance images and should not be mistaken for a malignant tumor.

Thecoma of the ovary is a stromal tumor composed of lipid-containing cells with a variable component of fibroblasts. To our knowledge, there have been no reports in the English literature describing detection of intracellular lipid in thecomas by preoperative imaging. We present 2 cases of thecomas of the ovary, in which intratumoral lipid was detected using dual-echo chemical shift magnetic resonance imaging.

To investigate the histologic bases of rim enhancement of breast masses demonstrated on dynamic contrast material-enhanced magnetic resonance (MR) images.Dynamic MR images of breast lesions (invasive carcinoma, n = 29; other, n = 6) in 35 women were reviewed. In each patient, subtraction images of the dynamic contrast-enhanced study were obtained, and early and delayed rim enhancement and delayed internal enhancement were evaluated. The MR findings were correlated with the ratio of microvessel density of the peripheral to the central portion of the lesion, fibrosis, and other histologic features, including expression of vascular endothelial growth factor (VEGF) and transforming growth factor ss1.Early rim enhancement was observed in 29% and delayed rim enhancement was noted in 60% of all patients. Small cancer nests, a high ratio of peripheral-to-central microvessel density, peripheral VEGF expression, and a low ratio of peripheral-to-central fibrosis were correlated with early rim enhancement. Delayed rim enhancement was correlated with a high degree of fibrosis and inflammatory changes. Delayed internal enhancement was correlated with a high degree of fibrosis.Rim enhancement of breast lesions at MR imaging is due to a combination of angiogenesis, distribution and degree of fibrosis, expression pattern of VEGF, and various histologic features.

Persistent trigeminal artery (PTA) variants are cerebellar arteries that originate directly from the precavernous portion of the internal carotid artery (ICA). The goal of our study was to determine the incidence and MR angiographic features of PTA variants. Between April 1996 and September 1999, 523 cranial MR angiographies were performed at our institution. Most of the patients examined had or were suspected of having cerebrovascular disease. We retrospectively reviewed these 523 MR angiograms. A 1.5-T scanner was used in all studies, and maximum intensity projection (MIP) images obtained using the three-dimensional time-of-flight (3D TOF) technique were displayed stereoscopically. Four PTA variants were detected on MR angiograms, at a rate of 0.76 %. At least three of the four PTA variants were anterior inferior cerebellar arteries (AICAs), small tortuous arteries arising from the precavernous portions of the ICAs and taking a posterior course. Although the clinical significance is not great, we found a relatively high incidence of PTA variants on MR angiograms. We stress that knowledge and recognition of these anomalous cerebellar arteries are useful and important in the interpretation of cranial MR angiograms.

Magnetic resonance (MR) imaging findings of two patients with Stewart-Treves syndrome are presented. MR imaging showed edematous changes in the subcutaneous fat and skin masses that proved to be angiosarcomas. MR signal intensity of the tumor was low compared with fat on T1-weighted images and intermediate and heterogeneous on T2-weighted images. In one patient, administration of intravenous Gd-DTPA showed marked enhancement in the early phase, which persisted until the delayed phase. These finding on dynamic MR imaging may reflect the abundant vascular spaces seen in these tumors.