[A Case of Early Detection of Hepatocellular Carcinoma using Abdominal Ultrasonography after Endoscopic Submucosal Dissection for Early Gastric Cancer].

We treated an 82-year-old man with early gastric cancer using endoscopic submucosal resection.Ultrasonography, which was performed to screen for metastasis, revealed hepatocellular carcinoma, and the tumor was curatively resected.Ultrasonography can be considered a useful examination tool to detect double cancer, even in cases of early cancer.

[A Case of Primary Squamous Cell Carcinoma of the Jejunum in the Ultra-Elderly].

We treated a 91-year-old man with squamous cell carcinoma that originated from his jejunum, which is very rare; only 8 cases have been reported previously.Surgery was performed because of the small bowel obstruction caused by the large cancerous mass, but he died 23 days later.Early detection and early treatment are important, especially for the ultra-elderly from a standpoint of tolerating surgery.

Preliminary experience with superparamagnetic iron oxide-enhanced dynamic magnetic resonance imaging and comparison with contrast-enhanced computed tomography in endoleak detection after endovascular aneurysm repair.

OBJECTIVE: Contrast-enhanced computed tomography (CE-CT) has been commonly used for follow-up imaging after endovascular aneurysm repair (EVAR), but it is difficult to use on patients with renal insufficiency. Superparamagnetic iron oxide (SPIO) particles, contrast medium for magnetic resonance imaging (MRI) that has been widely used for detection of the liver tumor, rarely affects renal function. The present study examined SPIO-enhanced dynamic MRI as a potential alternative to CE-CT for detection of endoleaks after EVAR. METHODS: Institutional review board approval was obtained for this prospective study. Twenty-three consecutive patients with normal renal function were evaluated using both CE-CT and SPIO-enhanced MRI within 2 weeks after EVAR. The median interval between the two modalities was 2 days. SPIO-enhanced MRI was performed at 1.5 T with T1-weighted, SPIO-enhanced dynamic, and postcontrast T1-weighted gradient echo sequences. The CE-CT protocol consisted of triple scans. Two experienced, blinded observers evaluated all images. Consensus reading of CE-CT and SPIO-MRI was defined as the reference standard. Interobserver, intraobserver, and intermodality agreement for endoleak detection was assessed by κ statistics. RESULTS: A total of 11 type II endoleaks originating from either the lumbar or inferior mesenteric artery were detected. Eight were able to be detected by CE-CT (8/11:73%) and 10 (10/11:91%) by SPIO-enhanced MRI. Interobserver (κ = 0.91; 95% CI, 0.74-1.00) and intraobserver agreement for MRI (κ = 1.00) were excellent. Intermodality agreement for endoleak detection was moderate (κ = 0.63; 95% CI, 0.32-0.94; and κ = 0.62; 95% CI, 0.29-0.95 for observers A and B, respectively). CONCLUSIONS: SPIO-enhanced MRI could represent a useful alternative to CE-CT, as it offers excellent interobserver, intraobserver agreement, and could detect more endoleaks than CE-CT.

Ectopic pregnancy: MRI findings and clinical utility.

PURPOSE: To assess the utility of magnetic resonance imaging (MRI) in patients with clinically suspected ectopic pregnancy (EP). METHODS: We retrospectively reviewed MRIs of 26 consecutive patients who were clinically suspected of having an EP. The diagnostic utility of MRI features of EP was analyzed retrospectively as follows: (1) Direct sign detection of ectopic gestational sac (GS); (2) Indirect signs tubal dilatation with hemosalpinx, adnexal hematoma, and hemorrhagic ascites. The diagnostic accuracy of each sign and their combination was compared to surgical records. The MRI findings of an ectopic GS were reviewed as follows: size, shape, signal intensity, and enhancement pattern. RESULTS: Of 26 patients, 24 had a tubal pregnancy; 22 of these 24 patients (92%) had a direct sign (sensitivity: 91.3%; specificity: 100%; positive predictive value: 100%). The diagnostic accuracy of the direct sign was 92%; this was more accurate than that of any single indirect sign (39%, 54%, and 50%, respectively). However, the diagnostic accuracy of EP increased to 100% when diagnostic criteria required the presence of a direct sign or at least two indirect signs. CONCLUSIONS: MRI is an effective modality for diagnosing EP with a high detection rate of extrauterine GSs. The combination of direct and indirect signs is useful for establishing the correct diagnosis.

Visualization of ovarian tumors using 3T MR imaging: diagnostic effectiveness and difficulties.

PURPOSE: We evaluated the diagnostic effectiveness of magnetic resonance (MR) imaging at 3 tesla to visualize ovarian tumors and problems associated with its use. MATERIALS AND METHODS: From the records of 423 consecutive women who underwent pelvic MR imaging using a 3T system from April 2009 to June 2010, we analyzed 50 continuous cases of ovarian tumors proved by histopathology. We evaluated visualization of these tumors for image quality and artifacts using 5-point scales. For qualitative assessment, we scored overall image quality (1, poor, to 5, excellent), degree of conviction regarding the diagnosis (1, undiagnosable, to 5, diagnosable with high certainty), and 4 representative artifacts (penetrating, chemical shift, motion, and susceptibility artifact) (1, severe, to 5, little degradation). We also retrospectively reviewed the diagnostic features of the ovarian tumors and preoperative diagnostic accuracy. For quantitative assessment, we determined tumor size and ADC value. RESULTS: Overall quality score was scored 4.9±0.5, and conviction regarding diagnosis was 4.9±0.3. Artifacts caused little degradation in most cases: penetrating, 4.8±0.5; chemical shift, 4.3±0.5; motion, 4.6±0.6; and susceptibility, 3.8±0.9. Preoperative diagnostic accuracy was 92% (sensitivity 94.7%, specificity 90.3%). Mean tumor diameter was 88.3±61 mm. The mean ADC value was 1.04±0.3 in malignant tumors and 1.15±0.5 (×10⁻6 mm²/s) in benign tumors. CONCLUSION: The quality of ovarian tumor images obtained with a 3T MR imaging system is adequate for diagnosis, with only slight degradation from penetrating or susceptibility artifacts.

Axillary lymph node accumulation on FDG-PET/CT after influenza vaccination.

OBJECTIVE: 2-[(18)F]fluoro-2-deoxy-D: -glucose (FDG) is known to accumulate in benign conditions such as infection and inflammation as well as in malignancy. Vaccination may cause transient inflammation of lymph nodes, which may induce false-positive findings on FDG-positron emission tomography (PET) imaging. This study investigated the influence of influenza vaccination on FDG-PET/CT imaging in normal subjects. METHODS: Between November 2008 and March 2009, a total of 172 examinees underwent FDG-PET/CT during an annual cancer-screening program at our hospital, 83 of whom had a history of recent non-adjuvanted seasonal influenza vaccination. They were asked the date and injection site of the vaccination. Examinees were divided into 2 groups based on the interval after vaccination using a cutoff value of 7 days (1 week). Two double board-certified nuclear medicine physicians and radiologists visually interpreted the FDG-PET/CT images with reference to PET/CT fusion and CT images and checked the location and the number of abnormal accumulations by consensus reading. RESULTS: Intervals between vaccination and FDG-PET were less than 7 days in 5 examinees, and 7 days or more in 78 examinees. Unexpected accumulations were visualized in 4 examinees in the axilla and medial upper arm, and all of them belonged to the group who underwent vaccination less than 7 days previously. In the second group there was no abnormal FDG accumulation. CONCLUSIONS: Recent influenza vaccination before FDG-PET/CT examination may cause ipsilateral axillary lymph node accumulations, especially within several days after vaccination. Questionnaires about vaccination can help to avoid false interpretation of FDG avid axillary lymph nodes.

Retained placental tissue: role of MRI findings in diagnosis and clinical assessment.

OBJECTIVE: To assess the role of MRI in diagnosis and predicting clinical outcome in women with retained placental tissue. PATIENTS AND METHODS: Eleven patients with pathologically proven RPT were retrospectively studied. All underwent MRI. The following MRI parameters of RPT were studied: size, signal intensity on T1- and T2-weighted images, enhancement pattern on dynamic study, extent of attachment to the uterine myometrium, and myometrial thickness at the attachment site. Clinical reports were reviewed and MRI findings were compared with respect to outcome. RESULTS: RPT diameter varied from 30 to 102 mm. On T2-weighted images, 10 cases showed high intensity, while on T1-weighted images, seven cases showed high intensity. Nine cases were hypervascular. The myometrium was thinner at the attachment side than at the opposite side. All five cases in which RPT was delivered spontaneously showed an attachment area of less than a semicircle, hence broad attachment appears to impede detachment and necessitate additional therapy. After uterine arterial embolization, two patients showed complete infarction of RPT on enhanced MRI. CONCLUSION: MRI is useful for diagnosis and follow-up of RPT. The evaluation of extent of RPT attachment to the myometrium and vascularity on MRI can help the clinical assessment.

Hepatocellular carcinoma of the iliac bone with unknown primary.

We report a case of hepatocellular carcinoma of the iliac bone in which the primary tumor was not detected. No malignant primary lesions such as hepatocellular carcinoma or hepatoid carcinoma were detected at the time or during 10 years' follow-up. In this case, transcatheter arterial chemo-embolization and radiation therapy resulted in complete regression of the iliac bone tumor and in long-term survival. We focus in particular on the clinical, histological, and therapeutic aspects of the presented case, as well as the imaging and diagnostic aspects.

Early detection of therapeutic response to hepatic arterial infusion chemotherapy of liver metastases from colorectal cancer using diffusion-weighted MR imaging.

The purpose of this study was to investigate whether diffusion-weighted magnetic resonance imaging (DWI) is useful for early detection of the response of hepatic colorectal metastases to hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil (5-FU). The subjects were 12 patients with hepatic colorectal metastases. The indwelling catheter for HAIC was placed in the hepatic artery, and 1000 mg/m(2) 5-FU was given repeatedly once a week. DWI was performed before and 9 days after HAIC. The minimum and mean apparent diffusion coefficient (ADC) values (minADC and meanADC) were measured. The relative change in ADC values (%ADC) and the relative change in tumor size on follow-up CT after 3 months (reduction ratio) were determined. Liver metastases were divided into two groups, responder and nonresponder. The correlation between %ADC and reduction ratio was determined, and %ADC was compared between the two groups. Eleven patients successfully completed HAIC over the 3-month period; 48 metastatic lesions were evaluated. Positive correlations were observed for relative change between %minADC and reduction ratio (r = 0.709) and between %meanADC and reduction ratio (r = 0.536). Both %minADC and %meanADC were significantly greater in the responder group than in the nonresponder group. With the threshold determined as < 3.5%, the receiver-operating curve analysis showed higher sensitivity and specificity values for %minADC (100% and 92.6%, respectively) than for %meanADC (66.7% and 74.1%, respectively). In conclusion, the relative change in minimum ADC values on DWI may be useful for early detection of the response of liver metastases to HAIC with 5-FU.

"Sukeroku sign" and "dent internal-capsule sign"--identification guide for targeting the subthalamic nucleus for placement of deep brain stimulation electrodes.

INTRODUCTION: The purpose of this study was to assess the usefulness of signs ("Sukeroku sign" and "dent internal-capsule sign") for the recognition of subthalamic nucleus (STN). MATERIALS AND METHODS: Five Parkinson's disease cases in which there was a successful placement of deep brain stimulation (DBS) electrodes at the STN were retrospectively reviewed. Five radiologists who were not engaged in localization of STNs in clinical practice were asked to locate the STNs before and after instructions on the signs. We evaluated the deviation between the reader-located points and the location of the DBS electrode for which there had been a successful installation. RESULTS: After instruction, there was a significant reduction in the deviation between the reader-located points and the DBS electrode. The time required for localization was also reduced after the instructions. CONCLUSION: Sukeroku sign and dent internal-capsule sign are feasible indicators of STN and seem to be useful in helping to identify the STN.

Prominent signal intensity of T1/T2 prolongation in subcortical white matter of the anterior temporal region on conventional screening MRI of late preterm infants with normal development.

PURPOSE: This study discusses prominent signal intensity of T(1)/T(2) prolongation of subcortical white matter within the anterior temporal region in premature infant brains that radiologists may encounter when interpreting conventional screening MRIs. MATERIALS AND METHODS: T(1)- and T(2)-weighted images of 69 preterm and term infants with no neurological abnormalities or developmental delays were evaluated retrospectively for areas of prominent signal intensity of T(1)/T(2) prolongation in white matter. We measured signal intensities of anterior temporal white matter, deep temporal white matter, frontopolar white matter and subcortical white matter of the precentral gyrus. We accessed chronological changes in signal intensity in the anterior and deep temporal white matter. We also analyzed variance tests among the signal intensity ratios to the ipsilateral thalamus of white matter areas by gestational age. RESULTS: There was high frequency of prominent signal intensity of T(1)/T(2) prolongation in the temporal tip, particularly at a gestational age of 36-38 weeks. Signal intensity ratio of the anterior temporal white matter was lower on T(1)-weighted images and higher on T(2)-weighted images, and the finding became less prominent with increasing gestational age. The signal intensity ratios of anterior temporal white matter at a gestational age of 36-37 weeks and 38-39 weeks were significantly different from other regions. CONCLUSION: Prominent signal intensity of T(1)/T(2) prolongation of subcortical white matter of the anterior temporal region is seen in normal premature infants, especially those at 36-39 gestational weeks. Although it is a prominent finding, radiologists should understand that these findings do not represent a pathological condition.

Polypoid endometriosis of the ureter mimicking fibroepithelial polyps.

We present a case of polypoid endometriosis of the ureter that showed bilateral polypoid intraluminal masses in the lower part of the ureter mimicking ureteral fibroepithelial polyps, arising with a background of pelvic endometriosis and a history of gonadotropin releasing hormone (GnRH) therapy. Magnetic resonance imaging revealed the masses to have high signal intensity on T2-weighted imaging. The location and bilaterality of the polypoid intraluminal masses are considered useful points in the differential diagnosis of fibroepithelial polyps.