Showing papers in "Japanese Journal of Radiology in 2013"

The role of 18F-fluoride PET-CT in the detection of bone metastases in patients with breast, lung and prostate carcinoma: a comparison with FDG PET/CT and 99mTc-MDP bone scan.

Abstract: We aimed to compare the role of 18F-fluoride PET/CT, FDG PET/CT and 99mTc-MDP bone scans in the detection of bone metastases in patients with lung, breast and prostate carcinoma This was a prospective study including patients for staging (S) and restaging (R) Seventy-two patients (23S, 49R) with infiltrating ductal breast carcinoma, 49 patients (25S, 24R) with prostate adenocarcinoma and 30 patients (17S, 13R) with non-small-cell lung carcinoma (NSCLC), without known bone metastases but with high risk/clinical suspicion for the same, underwent a 99mTc-MDP bone scan, FDG PET/CT and 18F-fluoride PET/CT within 2 weeks All scans were reviewed by two experienced nuclear medicine physicians, and the findings were correlated with MRI/thin-slice CT/skeletal survey Histological verification was done wherever feasible Sensitivity and negative predictive value (NPV) of 18F-fluoride PET/CT was 100 % in all three malignancies, while that of FDG PET/CT was 79 % and 73 % in NSCLC, 73 % and 80 % in breast cancer and 72 and 65 % in prostate cancer Specificity and positive predictive value (PPV) of FDG PET/CT were 100 % in NSCLC and prostate and 97 % and 96 % in breast cancer As compared to the 99mTc-MDP bone scan, all parameters were superior for 18F-fluoride PET/CT in prostate and breast cancer, but sensitivity and NPV were equal in NSCLC The MDP bone scan had superior sensitivity and NPV compared to FDG PET/CT but had low specificity and PPV To rule out bone metastases in cases where there is a high index of suspicion, 18F-fluoride PET/CT is the most reliable investigation 18F-fluoride PET/CT has the potential to replace the 99mTc-MDP bone scan for the detection of bone metastases

Diffusional kurtosis imaging of normal-appearing white matter in multiple sclerosis: preliminary clinical experience

Abstract: We evaluated diffusional changes in normal-appearing white matter (NAWM) regions remote from multiple sclerosis (MS) plaques by using diffusional kurtosis imaging (DKI) to investigate the non-Gaussian behavior of water diffusion. Participants were 11 MS patients and 6 age-matched healthy volunteers. DKI was performed on a 3-T MR imager. Fractional anisotropy (FA), apparent diffusion coefficient (ADC), and diffusional kurtosis (DK) maps were computed. Regions of interest (ROIs) were compared in 24 cerebral regions, including the frontal, parietal, and temporal lobe white matter (WM) in controls and NAWM in MS patients. The mean FA of all ROIs was 0.468 ± 0.014 (SD) (controls) or 0.431 ± 0.029 (MS group) (P = 0.016). Mean ADC was 0.785 ± 0.034 × 10−3 mm2/s (controls) or 0.805 ± 0.041 × 10−3 mm2/s (MS group). The mean DK of all ROIs was 0.878 ± 0.020 (controls) or 0.823 ± 0.032 (MS group) (P = 0.002). Analysis of individual ROIs revealed significant differences in DK in 3 ROIs between normal WM and NAWM, but significant differences in ADC and FA in only one ROI each. DKI may be a new sensitive indicator for detecting tissue damage in MS patients in addition to conventional diffusional evaluations, for example diffusion tensor imaging.

Preliminary report on virtual monochromatic spectral imaging with fast kVp switching dual energy head CT: comparable image quality to that of 120-kVp CT without increasing the radiation dose.

Abstract: Purpose This study aimed to evaluate whether the image quality of virtual monochromatic spectral imaging with fast kVp switching dual-energy CT (DECT) can be comparable to that of 120-kVp single-energy CT (SECT) without increasing the radiation dose.

Non-occlusive mesenteric ischemia (NOMI): utility of measuring the diameters of the superior mesenteric artery and superior mesenteric vein at multidetector CT.

Abstract: To investigate the diagnostic capability of multidetector computed tomography for detecting non-occlusive mesenteric ischemia (NOMI). We studied 11 NOMI patients and 44 controls. Radiologists evaluated the CT images for the presence of bowel ischemia and measured the diameters of the superior mesenteric artery and the superior mesenteric vein (D SMA and D SMV). We also performed linear discriminant analysis (LDA) using D SMA and D SMV. All NOMI patients presented with more than 2 CT findings of bowel ischemia. D SMA and D SMV were significantly smaller in NOMI patients than in the controls (p < 0.01). At the optimal cut-off values for D SMA (6.5 mm), D SMV (9.0 mm), and the Z value in LDA (0.93), sensitivity and specificity were 81.8 and 81.8; 81.8 and 88.6; and 81.8 and 97.7 %, respectively. D SMA and D SMV were significantly smaller in NOMI patients than in the controls and D SMV is a more significant parameter than D SMA.

F-18 FDG-PET/CT in evaluation of patients with fever of unknown origin

Abstract: Objectives This study was carried out to evaluate the diagnostic utility of FDG-PET/CT in patients with fever of unknown origin (FUO).

Guidelines on the use of iodinated contrast media in patients with kidney disease 2012: digest version

Abstract: Open image in new window What is the definition of CIN? Answer: CIN is defined as an increase in serum creatinine (SCr) levels by ≥0.5 mg/dL or ≥25 % from baseline within 72 h after a contrast radiography using iodinated contrast media. Open image in new window Because the risk for developing CIN increases as kidney function decreases, it is important to evaluate kidney function on the basis of the latest SCr levels prior to contrast radiography. According to the classification of the severity of CKD, which is based on the cause, GFR, and presence and severity of albuminuria (Table 1) [1], patients with a GFR of <60 mL/min/1.73 m2 (G3a–G5) are considered to have CKD in this guideline. In another words, CKD is also diagnosed in patients with a GFR of ≥60 mL/min/1.73 m2 and albuminuria, in the present guidelines only patients with a GFR of <60 mL/min/1.73 m2 are defined as having CKD. Table 1 Classification of severity of CKD (2012) Open image in new window Risks of ESKD requiring dialysis or transplantation, and risks for cardiovascular diseases such as stroke, myocardial infarction, and heart failure are coded with colors ranging from green (lowest), yellow, orange and red (highest) CKD chronic kidney disease, Cr creatinine, ESKD end-stage kidney disease, GFR glomerular filtration rate Adapted from KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter Suppl. 2013;3:19–62 [1], with permission from Nature Publishing Group., modified for Japanese patients The following formula is used to calculate estimated GFR (eGFR). Open image in new window CIN is a form of acute kidney injury (AKI) that occurs after exposure to iodinated contrast media, and is diagnosed on the basis of reducing kidney function after contrast radiography when other causes such as cholesterol embolism are ruled out. AKI due to CIN is generally reversible. Usually, SCr levels increase to a peak 3–5 days after onset, and return to normal in 7–14 days. However, kidney injury may worsen to the point that hemodialysis is required in some patients. The criteria for the diagnosis of CIN used in clinical research of this condition vary among studies. The minimum increment of SCr levels that defined CIN included 0.5 mg/dL, 1.0 mg/dL, and 25 % or 50 % from baseline, and the duration of monitoring for CIN included 24 h, 48 h, 72 h, 4 days, and 7 days after contrast radiography. The most commonly used criteria for CIN in clinical research is an increase in SCr levels by ≥0.5 mg/dL or ≥25 % from baseline within 72 h after contrast radiography. However, physicians in the clinical setting should not wait for 72 h, and should start close monitoring of SCr levels from an early stage when CIN is suspected. The incidence of CIN, and clinical characteristics such as patients’ baseline kidney function, vary depending on the criteria used for diagnosis. Standardized diagnostic criteria are necessary to promote clinical research of this condition and develop preventive procedures. Open image in new window Open image in new window

Imaging of vascular tumors with an emphasis on ISSVA classification

Abstract: The International Society for the Study of Vascular Anomalies (ISSVA) classification is becoming the international standard classification system for vascular tumors and vascular malformations. The ISSVA classification strictly distinguishes vascular tumors (neoplastic lesions) from vascular malformations (non-neoplastic lesions) based on whether there is a proliferation of vascular endothelial cells present, and it is an extremely useful classification system for determining therapeutic measures. For vascular tumors, it is clinically significant in terms of discriminating infantile hemangioma and rapidly involuting congenital hemangioma, which are expected to spontaneously regress, from other vascular tumors requiring treatment. Needless to say, clinical courses are important for diagnosis, and it is also important for radiologists to understand imaging findings on vascular tumors because such tumors have unique findings on diagnostic images. In this paper, vascular tumors are classified based on the ISSVA classification, and clinical and imaging findings are reviewed.

A case of refractory chylous ascites after nephrectomy successfully treated with percutaneous obliteration using adhesive glue.

Abstract: Here we report a case of uncontrollable chylous ascites that developed after nephrectomy and was successfully treated with percutaneous obliteration of the lymphocele-like extravasation using ethiodized oil during lymphangiography. Under computed tomographic and fluoroscopic guidance, an N-butyl cyanoacrylate-ethiodized oil mixture was used with metallic coils to obliterate the extralymphatic leakage site. The volume of intraperitoneal drainage decreased steadily over the next 5 days, and the tube was removed. Percutaneous obliteration can be characterized as filling of the leakage site from outside the lymph vessel with no flow disruption, which contrasts with the conventional embolization approach via the cisterna chyli.

MR imaging of ectopic pregnancy with an emphasis on unusual implantation sites

Abstract: Ectopic pregnancy (EP) is a life-threatening condition and remains the leading cause of death in the first trimester of pregnancy, although the mortality rate has significantly decreased over the past few decades because of earlier diagnoses and great improvements in treatment. EP is most commonly located in the ampullary portion of the fallopian tube and rarely in unusual sites such as the interstitium, cervix, cesarean scar, anomalous rudimentary horn of the uterus and peritoneal abdominal cavity. MRI may confirm or give additional information to ultrasonography, which is the most user-dependent imaging modality. Magnetic resonance imaging can accurately localize the site of abnormal implantation. It could be helpful for EP patient treatment by distinguishing the ruptured and unruptured cases before methotrexate treatment. MRI is quite sensitive to blood and can identify the hemorrhage phase.

Utility of (99m)Tc-MDP hybrid SPECT-CT for diagnosis of skull base osteomyelitis: comparison with planar bone scintigraphy, SPECT, and CT.

Abstract: To evaluate single photon emission tomography–computed tomography (SPECT-CT) for diagnosis of skull base osteomyelitis (SBO) and to compare this technique with planar bone scintigraphy (BS), SPECT, and CT. Data from 13 patients with known/suspected SBO were retrospectively analysed. Planar BS and SPECT images were evaluated by an experienced nuclear medicine physician, CT by and experienced radiologist, and SPECT-CT by the nuclear medicine physician and radiologist in consensus. On the basis of diagnostic confidence a score of 1–5 was given, with 1 being definitely osteomyelitis, 2 being probably osteomyelitis, 3 being equivocal, 4 being probably normal, and 5 being definitely normal. ROC analysis areas under the curves (AUC) were calculated. For diagnostic values a score of ≤2 was taken as positive. Clinical/imaging follow-up/microbiology was taken as reference standard. AUC was largest for SPECT-CT (0.977) followed by SPECT (0.909), CT (0.886), and planar BS (0.614). However, no significant difference was found between the techniques except for borderline significance between planar BS with SPECT-CT (P = 0.071) and CT (P = 0.072). Accuracy was 46 % for planar BS, 85 % for SPECT, 77 % for CT and 92 % for SPECT-CT. SPECT-CT seems to be useful, but not superior to planar BS, SPECT, or CT, for diagnosis of SBO.

Hypervascular hepatocellular carcinomas showing hyperintensity on hepatobiliary phase of gadoxetic acid-enhanced magnetic resonance imaging: a possible subtype with mature hepatocyte nature

Abstract: We evaluated molecular features of hypervascular hepatocellular carcinoma (HCC) that shows iso- or hyperintensity (hyperintense HCC) in the hepatobiliary phase (HB phase) of gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI). We investigated 89 surgically resected cases. Patients were divided into two groups according to the signal intensity in the HB phase of EOB-MRI: hyperintense HCCs (n = 18) and hypointense HCCs (n = 71). We performed immunohistochemical staining for uptake transporter of gadoxetic acid: organic anion transporter polypeptides (OATP8); tumor markers: alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist II (PIVKA-II); hepatic stem cell markers: epithelial cell adhesion molecule (EpCAM), cytokeratin 19 (CK19), and neural cell adhesion molecule (NCAM); biliary marker: CK7; hepatocyte marker: hepatocyte paraffin 1 (HepPar1); markers of HCC differentiation: glypican-3; signaling: beta-catenin, and the respective grade was semiquantitatively determined. Histopathologically, hyperintense HCCs showed significantly weaker expression of AFP (p < 0.05), PIVKA-II (p < 0.01), EpCAM (p < 0.005), glypican-3 (p < 0.005) relative to the hypointense HCCs, whereas OATP8 (p < 0.0001), HepPar1 (p < 0.05), and beta-catenin (p < 0.001) were overexpressed in hyperintense HCCs compared with hypointense HCCs. Hyperintense HCC expressed OATP8 and showed a feature of mature hepatocytes with a weak expression of stem cell characteristics immunohistochemically. In addition, this type of HCC demonstrated a weaker expression of the poorer prognosis markers including, AFP, PIVKA-II, EpCAM, CK19, and glypican-3.

MRI differentiation of cardiomyopathy showing left ventricular hypertrophy and heart failure: differentiation between cardiac amyloidosis, hypertrophic cardiomyopathy, and hypertensive heart disease

Abstract: To evaluate the capability of MRI to differentiate cardiac amyloidosis (CA), end-stage hypertrophic cardiomyopathy (HCM), and hypertensive heart disease (HHD), which are important etiologies of left ventricular hypertrophy (LVH) and heart failure. We enrolled 26 patients presenting with both LVH and heart failure: six with CA, nine with end-stage HCM, and 11 with HHD. Cardiac function, presence of pericardial or pleural effusion, and the extent and patterns of late gadolinium enhancement (LGE) were compared among the three diseases. Myocardial LGE was observed in all six CA patients, eight end-stage HCM patients, and six HHD patients. The number of LGE segments was significantly greater in CA than in HCM or HHD (p = 0.02 for both), and all patients with CA showed a global endocardial pattern of LGE. There were significant differences among CA, HCM, and HHD in ejection fraction and end-diastolic and end-systolic volume indices (p < 0.05 for all). Pericardial effusion was observed more frequently in CA than in HCM or HHD (p = 0.04 or 0.01, respectively). MRI is valuable for distinguishing among CA, end-stage HCM, and HHD, all of which present with LVH and heart failure.

Measurement consistency of MR elastography at 3.0 T: comparison among three different region-of-interest placement methods

Abstract: To test inter- and intraobserver consistency of liver stiffness measurement on MR elastography (MRE) at 3.0 T. Two abdominal radiologists independently measured stiffness of the liver on MRE in three volunteers and seven patients with chronic liver diseases using three different region-of-interest (ROI) placement methods. Methods 1 and 2 involved placing circular and free-hand-drawn ROIs, respectively, visually referring to anatomical (three-dimensional T1-weighted) and wave images. Method 3 involved placing ROIs on the fused images of MRE and anatomical images developed on a work station, visually referring to wave images. The inter- and intraobserver consistency was assessed with regression and Bland–Altman analysis. Thirty-eight images were available for measurement in total. As for interobserver consistency, method 3 showed the best regression coefficient, correlation coefficient, and y intercept. The absolute values of the interobserver differences for method 3 were significantly smaller than those of method 1 or method 2 (p < 0.05, each). Intraobserver consistency of method 3 was excellent for both observers. Stiffness measurement of the liver on MRE performed with the fusion method at 3.0 T provides the highest inter- and intraobserver consistency.

Neuroimaging of Langerhans cell histiocytosis: a radiological review.

Abstract: The neuroimaging of Langerhans cell histiocytosis (LCH), in most of the cases, is nonspecific and can vary depending on the location, especially as shown on magnetic resonance imaging (MRI). In the absence of a clinical history of LCH, isolated central nervous system (CNS) lesion presents a diagnostic challenge. LCH should be considered in the differential diagnosis of craniofacial tumors and neurodegenerative (ND) lesions of the brain. MRI is the modality of choice for investigating the CNS-LCH. Long-term follow-up with MRI is indicated in patients with ND-LCH. This retrospective study provides a comprehensive description of the spectrum of neuroimaging findings in patients with LCH, the underlying neuropathology, and follow-up study of the disease.

Midterm results of endovascular abdominal aortic aneurysm repair: comparison of instruction-for-use (IFU) cases and non-IFU cases

Abstract: Purpose To investigate the midterm results of abdominal aortic aneurysm repair (EVAR) and compare the endoleak (EL) and abdominal aortic aneurysm (AAA) prognoses between instruction-for-use (IFU) patients and non-IFU patients.

F18-FDG-PET/CT for evaluation of intraductal papillary mucinous neoplasms (IPMN): a review of the literature.

Abstract: Intraductal papillary mucinous neoplasms (IPMN) are intraductal mucin-producing neoplasms with tall columnar, mucin-containing epithelium, with or without papillary projections, involving the main pancreatic duct and/or major side branches. They account for approximately 25 % of all cystic neoplasms and can be subdivided into benign lesions, borderline lesions, and carcinoma. In this clinical scenario accurate preoperative diagnosis can eliminate unnecessary surgery, which is risky and potentially harmful, yet enable effective selection of patients who are candidates for surgery. In this review we try to provide a complete evaluation of the use of F18-FDG-PET/CT for diagnosis of this neoplasm on the basis of published papers. F18-FDG-PET/CT seems to be an useful technique for preoperative work-up of patients with suspected IPMN and is an improvement over conventional imaging in distinguishing benign from malignant lesions, especially for selecting patients for surgical treatment or for long-term follow-up.

IgG4-related inflammatory pseudotumors mimicking multiple meningiomas.

Abstract: IgG4-related disease is an emerging clinicopathologic entity. Hypophysitis, diffuse thickening of dura, and enlargement of the trigeminal nerve are well-known intracranial involvements of IgG4-related disease. This report of a case of systemic IgG4-related disease is the first to present neuroimaging of apparent supratentorial meningioma-like lesions and thickening and contrast enhancement of the walls of the intracranial internal carotid arteries. It is important to recognize IgG4-related intracranial pseudotumors so that patients do not undergo unnecessary surgical procedures.

Can we use CT pulmonary angiography as an alternative to echocardiography in determining right ventricular dysfunction and its severity in patients with acute pulmonary thromboembolism

Abstract: Purpose Our aim was to investigate the role of computed tomography pulmonary angiography (CTPA) in the diagnosis of right ventricular dysfunction (RVD) and massive pulmonary thromboembolism (PTE).

CT prediction of histological grade of hypervascular hepatocellular carcinoma: utility of the portal phase

Abstract: To elucidate whether the attenuation of hypervascular hepatocellular carcinoma (HCC) on the portal phase of dynamic CT is correlated with histological grade. This study group consisted of 66 patients with 74 surgically resected, hypervascular HCCs. On a preoperative dynamic study with a 64-multidetector row CT, the portal phase was scanned 60 s after injecting the contrast agent following the pre-contrast image and hepatic arterial phase. The tumor attenuation of each HCC on the portal phase was categorized into high, iso-, or low, and was compared with the predominant histological grade using Mann–Whitney’s U test. Twenty-nine, 29, and 16 HCCs showed high, iso-, and low attenuation on the portal phase, respectively. Tumors were classified into three well- (w-), 58 moderately (m-), or 13 poorly (p-) differentiated HCCs. The tumor attenuation of p-HCC on the portal phase was significantly lower than those of w-HCC and m-HCC (p < 0.05 and p < 0.00001). The tumor attenuation on the portal phase may help when diagnosing the histological grade of hypervascular HCC. p-HCC are considered to show a faster contrast washout than w-HCC and m-HCC.

Prediction of therapeutic effectiveness according to CT findings after therapeutic lymphangiography for lymphatic leakage

Abstract: To evaluate the correlation between computed tomography (CT) findings after therapeutic lymphangiography for lymphatic leakage and the clinical course of lymphatic leakage. Therapeutic lymphangiography for lymphatic leakage was performed in 14 patients. In all patients, CT was performed 0.5–26 h (mean 6.9 h) after lymphangiography and results were retrospectively evaluated. In 8 of the 14 patients (57 %), lymphatic leakage stopped after lymphangiography. Lymphatic leakage was detected on CT in 9 of the 14 patients (64 %) and had either a nodular (n = 4) or beaded appearance (n = 5). The amount of drainage had decreased the day after lymphangiography, and leakage finally stopped in all 4 patients in whom the leakage had a nodular appearance. However, leakage did not stop in 3 of the 5 patients having leakage with a beaded appearance. A nodular appearance of leakage might predict success of therapeutic lymphangiography.

Adenoid cystic carcinoma of the maxillary sinus: CT and MR imaging findings

Abstract: The purpose of this study was to determine whether adenoid cystic carcinomas (ACCs) of the maxillary sinus have features on CT and MR imaging. Nine patients with histopathologically proved maxillary sinus ACCs were included. The growth pattern was classified as expansile or destructive types on the basis of CT images. CT images were also reviewed for adjacent bony defects and MR images were reviewed for tumor extension. Fluid accumulation in the ipsilateral maxillary sinus was also assessed. The tumors had caused adjacent bony expansion with minimal bony defects in 4 patients whereas those in the remaining 5 patients had caused extensive destruction of adjacent bones comprising the maxillary sinus walls. Nasal cavity invasion was observed in 7 patients, retroantral fat pad invasion in 5, pterygopalatine fossa invasion in 4, and orbital invasion in 3. All 4 expansile ACCs were accompanied by accumulation of a small amount of fluid in the surroundings of the tumors, which was revealed as hyperintensity on T1-weighted images. The growth pattern of maxillary sinus ACCs can be classified into an expansile type with minimal bony defects and a destructive type with extensive bony defects.

Imaging spectrum and pitfalls of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with tuberculosis.

Abstract: Mycobacterium tuberculosis (TB) is one of the most prominant diseases frequently causing false positive lesions in oncologic surveys using (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT), since TB granulomas are composed of activated macrophages and lymphocytes with high affinity for glucose. These pitfalls of (18)F-FDG PET/CT are important for radiologists. Being familiar with (18)F-FDG images of TB could assist in preventing unfavorable clinical results based on misdiagnoses. In addition, (18)F-FDG PET/CT has the advantage of being able to screen the whole body, and can clearly detect harboring TB lesions as high uptake foci. This article details the spectrum and pitfalls of (18)F-FDG PET/CT imaging in TB.

Prediction of postoperative pulmonary function: preliminary comparison of single-breath dual-energy xenon CT with three conventional methods.

Abstract: To assess the use of xenon ventilation maps (Xe-images) for predicting postoperative pulmonary function. After study approval by the institutional review board, written informed consent was obtained from 30 patients with lung tumors who underwent pre- and postoperative spirometry, pulmonary perfusion SPECT and dual-energy CT (80 kV and 140 kV/Sn) after single-breath inspiration of 35 % xenon. Xe-images were calculated by three-material decomposition. Sum of pixel values of the part to be resected (A) and of the whole lung (B) on Xe-images or lung perfusion SPECT, and volumes or the number of segments of the part to be resected (A) and of the whole lung (B) on Xe-images were enumerated, respectively. We multiplied (1 − A/B) by each preoperative value from spirometry for prediction. Predictions by each of the four methods were compared with postoperative values. Predicted values for vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) by the four methods regressed significantly with measured values (R 2 = 0.56–0.77, p < 0.001 for all). Analysis of Xe-images can predict postoperative VC, FVC and FEV1 with accuracy comparable to that of CT volumetry.

MRI findings in fetuses with an abdominal wall defect: gastroschisis, omphalocele, and cloacal exstrophy

Abstract: Congenital abdominal wall defects include several entities such as gastroschisis, omphalocele, and cloacal exstrophy. It is important for perinatal management and parental counseling to understand the magnetic resonance (MR) imaging features essential for correctly diagnosing the clinical condition and predicting the prognosis of fetal patients. The purpose of this pictorial review is to demonstrate the MR imaging features of fetal cases with an abdominal wall defect and the pitfalls of image findings.

Intrahepatic periportal high intensity on hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI: imaging findings and prevalence in various hepatobiliary diseases.

Abstract: Purpose To reveal the incidence and degree of intrahepatic periportal high intensity (PHI) on hepatobiliary phase images of Gd-EOB-DTPA-enhanced MRI (EOB-MRI) in patients with or without various hepatobiliary diseases.

Diffusion-weighted imaging of patients with neonatal bilirubin encephalopathy

Abstract: Purpose The aim of the study is to evaluate neonatal bilirubin encephalopathy in the acute period by the DWI.

Adult midgut malrotation: multi-detector computed tomography (MDCT) findings of 14 cases.

Abstract: Purpose To describe MDCT findings in adult patients of midgut malrotation and to correlate the types of adult midgut malrotation with its complications.

Clinical results after the multidisciplinary treatment of spinal arteriovenous fistulas

Abstract: We retrospectively evaluated the clinical outcome after multidisciplinary treatment of spinal arteriovenous fistulas (AVFs) in terms of the Aminoff-Logue grading scale (ALS) to depict the outcome in a perspective pertinent to the quality of everyday living. Twenty-six spinal AVFs in 25 patients were angiographically diagnosed from April 1998 through April 2012 and treated by endovascular embolization or surgery. When both treatment procedures seemed feasible, embolization was undertaken as the initial treatment. Motor and gait disturbance at follow-up was retrospectively graded according to ALS. All lesions were localized at the thoracolumbar or sacral levels and include six epidural AVFs with intradural venous reflux, 14 dural AVFs, and six perimedullary AVFs. Embolization was performed as the initial treatment for 17 lesions, while open surgery was performed for the others as well as for residual or recurrent lesions after embolization. All lesions were completely occluded except three perimedullary AVFs. At clinical follow-up of 1–153 months (mean 53.3), amelioration of gait disturbance with reduction of ALS scores was noted for 13 lesions and amelioration of micturition for 13 lesions as well. Clinical functional status was improved for half of the lesions after the multidisciplinary treatment.

Confluent hepatic fibrosis in liver cirrhosis: possible relation with middle hepatic venous drainage.

Abstract: Our aim was to retrospectively analyze the location of confluent hepatic fibrosis in relation to the portal and hepatic venous anatomy using multidetector computed tomography (CT) and to clarify the influence of the hepatic venous drainage on confluent fibrosis. The study population consisted of 879 patients diagnosed with cirrhosis: 539 men and 340 women (65.9 ± 10.6 years) and 633 with Child-Pugh class A, 161 with class B, and 85 with class C. The cause of cirrhosis was hepatitis C (n = 528) and hepatitis B (n = 122) virus infection, alcoholism (n = 114), and others (n = 115). The confluent fibrosis was diagnosed using CT images according to previous reports and statistically analyzed (p < 0.05). Thirty-five confluent fibrosis lesions in 30 patients (3.4 %) were identified. The predictive factors were alcoholic cirrhosis [odds ratio (OR), 7.25; p < 0.0001], Child-Pugh class C (OR, 6.95; p < 0.0001), and Child-Pugh class B (OR, 2.91; p < 0.0023). Confluent fibrosis was most frequently seen in the middle hepatic venous drainage area (n = 21) or at the boundary between the medial and anterior segments (n = 17), and each distribution of the location of confluent fibrosis was significantly unequal (p < 0.0001). Confluent fibrosis was most commonly located in the middle hepatic venous drainage area.

A case of pseudoaneurysm of the deep femoral artery successfully treated by NBCA embolization under occlusion

Abstract: Transcatheter embolization of bleeding from distal branches of small arteries can be difficult. N-butyl cyanoacrylate (NBCA) was originally used as a tissue adhesive material, and recent evidence suggests that it can also be used as an embolic material. This report describes a case in which a pseudoaneurysm arising from the distal portion of a small branch of the deep femoral artery was successfully embolized with NBCA using a new technique with a microballoon catheter. Advantages of this technique include its safely, short treatment time, good control of the embolization range, absence of fragmentation, favorable polymerization dynamics, and absence of glue reflux or excessive distal spread of the glue.