[The use of an opect optic system in neurosurgical practice]. / Opyt ispol'zovaniia opticheskoi sistemy orest v praktike neirokhirurga.

INTRODUCTION: Modern neurosurgical practice is impossible without access to various information sources. The use of MRI and MSCT data during surgery is an integral part of the neurosurgeon's daily practice. Devices capable of managing an image viewer system without direct contact with equipment simplify working in the operating room. AIM AND OBJECTIVES: To test operation of a non-contact MRI and MSCT image viewer system in the operating room and to evaluate the system effectiveness. MATERIAL AND METHODS: An Opect non-contact image management system developed at the Tokyo Women's Medical University was installed in one of the operating rooms of the Novosibirsk Federal Center of Neurosurgery in 2014. In 2015, the Opect system was used by operating surgeons in 73 surgeries performed in the same operating room. The system effectiveness was analyzed based on a survey of surgeons. RESULTS: The non-contact image viewer system occurred to be easy-to-learn for the personnel to operate this system, easy-to-manage it, and easy-to-present visual information during surgery. CONCLUSIONS: Application of the Opect system simplifies work with neuroimaging data during surgery. The surgeon can independently view series of relevant MRI and MSCT scans without any assistance.

Hepatic falciform ligament artery in patients with chronic liver diseases: detection on computed tomography hepatic arteriography.

BACKGROUND: The detection rate of hepatic falciform ligament artery (FLA) has been reported as ranging from 2-25%. The rate of FLA on laparotomy, however, is reported to be higher, at 68%. PURPOSE: To compare the detection rate of FLA on computed tomography hepatic arteriography (CTHA) with that on angiography and dynamic CT, and to clarify the clinical significance of FLA in patients with chronic liver disease. MATERIAL AND METHODS: 126 consecutive patients underwent CTHA angiography and dynamic CT to evaluate suspected liver tumors. Liver function was classified as follows: normal, n=5; Child-Pugh class A, n=94; B, n=21; and C, n=6. All CT images were obtained using multidetector (MDCT) scanners (Aquilion; Toshiba, Tokyo, Japan). For CTHA, CT images were obtained during contrast material injection through the left hepatic, proper, or common hepatic artery. On CT, FLAs were retrospectively identified within the hepatic falciform ligament and the hepatic round ligament by the paging method on a workstation (TWS-5000; Toshiba, Tokyo, Japan). The detection rates were compared among the three modalities (hepatic arterial phase of dynamic CT, CTHA, and angiography). The calibers of FLA were also correlated with the hepatic function of the patients. RESULTS: The detection rates of FLA by angiography, dynamic CT, and CTHA were 37% (47/126), 10% (13/126), and 77% (97/126), respectively. The calibers of FLA increased as the hepatic function deteriorated (P=0.001). CONCLUSION: The detection rates of FLA with CTHA are far higher than those with angiography and dynamic CT. Careful interpretation with recognition of FLA on CTHA images is important, as inadvertent embolization or chemotherapeutic infusion of the FLA may result in supraumbilical skin rash.

Microcoil embolization through a downsized coaxial catheter system: an experimental study.

BACKGROUND: Most of the recently developed microcatheters for abdominal angiography still have large diameters at their trailing ends, and thus cannot be used for microcoil embolization in combination with a 3-French (F) system. PURPOSE: To evaluate the in vitro passage of microcoils through a newly developed 2-F microcatheter (Meister Cath Superselective Plus, MC6) that is compatible with a downsized coaxial catheter system (3-F system) in an experimental study. MATERIAL AND METHODS: We evaluated the passage of microcoils through MC6 within a blood vessel model using the saline flush technique. Six types of microcoils and 17 size variations (maximal curled diameter 2-10 mm, total length 20-140 mm) were used. We evaluated the passage and post-deployment shape of the microcoils as well as the volume of saline required to flush them. RESULTS: In the experimental study, all microcoils passed through the MC6 and deployed in a satisfactory manner without catheter occlusion. The mean volumes of saline required to flush the TORNADO (n=1), Reverse TORNADO (n=6), HILAL (n=1), Micronester (n=3), VortX (n=4), and C-Stopper Coil (n=2) were 0.7 ml, 0.58+/-0.20 ml, 0.5 ml, 0.57+/-0.058 ml, 3.5+/-1.5 ml, and 0.70+/-0.14 ml, respectively. There was a statistically significant difference in the mean volume of saline required between the VortX and Reverse TORNADO (P=0.029), and between the VortX and C-Stopper Coil (P=0.031). The VortX required the greatest volume of saline. CONCLUSION: Microcoil embolization through a 3-F system appears to be feasible for the coils examined in this study.

Portal vein occlusion or stenosis in patients with hepatolithiasis: observation by multiphasic contrast-enhanced CT.

AIMS: To analyze the dynamic findings of multiphasic contrast-enhanced CT in hepatolithiasis and to elucidate occlusive changes in portal veins and other associated abnormalities. METHODS: This was a retrospective study of 25 selected patients with hepatolithiasis who underwent various imaging examinations, including multiphasic contrast-enhanced CT. The following CT findings were evaluated in each of 71 hepatic segments: visualization of a calculus; biliary dilation or focal hepatic atrophy of the affected segment; areas that were abnormally enhanced in the hepatic arterial phase; degrees (normal, stenosis, occlusion) of portal vein calibre; and linear delayed enhancement along the bile-duct walls, suggesting cholangitis. RESULTS: On CT, calculi were depicted as a hyperdense structures in 61 of 71 segments (86%). Focal hepatic atrophy, which frequently accompanied CT findings suggesting compensatory hypertrophy of other segments, was seen in 50 of 71 segments (70%). Areas that were abnormally enhanced were recognized in 36 of 71 segments (51%). Stenosis or occlusion of portal venous branches was observed in 59 of 71 segments (83%), including 13 segments with occlusion. Findings indicating cholangitis were noted in 50 of 71 segments (70%). The degrees of portal vein calibre were significantly correlated with the presence of hepatic atrophy or cholangitis. CONCLUSION: Hepatolithiasis is associated with significant rates of stenosis or occlusion of adjacent portal veins as well as hepatic parenchymal changes in the affected area. Chronic deterioration of portal flow may cause these morphological changes.

Bilateral ovarian leiomyomas: CT and MRI features.

We recently treated a 21-year-old woman with leiomyomas arising from the bilateral ovaries, a very rare condition. On magnetic resonance imaging, more than half of the left adnexal mass showed low signal intensity on T2-weighted images and good enhancement by gadolinium-DTPA, and the remaining part showed high signal intensity on T2-weighted images, so the lesions initially were diagnosed as ovarian fibromas or as thecomas with a certain degree of degeneration. Pathologic examination of the excised tumors proved that they were bilateral ovarian leiomyomas; in addition, the tumor from the left side showed hemorrhagic and myxoid changes with torsion of 180 degrees.

Liver lesions of visceral larva migrans due to Ascaris suum infection: CT findings.

The purpose of this study was to analyze computed tomographic (CT) findings of hepatic lesions due to Ascaris suum infection. CT of the liver in three patients, all of whom had immunoserologically confirmed A. suum infection, were retrospectively reviewed. Twenty-five lesions were identified in total. Two radiologists analyzed CT findings in a consensus fashion, with particular interest in the margin, shape, and location of the lesions. Hepatic lesions were ill-defined (22 of 25), small (3-35 mm; average, 11 mm), and nodular (18 of 25) or wedge (three of 25) in shape. Most were located in periportal (16 of 25) or subcapsular (six of 25) regions. Hepatic nodules due to visceral larva migrans of A. suum were located mainly in periportal or subcapsular regions, which may represent periportal eosinophilic granuloma, its pathologic feature. The results were considered to represent the pathophysiology of this entity.

Gluteal muscular and sciatic nerve metastases in advanced urinary bladder carcinoma: case report.

We present a case of gluteal muscular and sciatic nerve metastases from urinary bladder carcinoma. T2-weighted magnetic resonance images demonstrated diffuse swelling and an increase in the signal of the right gluteus maximus muscle without destruction of the original arrangement of muscular fibers. Further, remarkable thickening of the right sciatic nerve showing a relatively hypointense signal was detected. Postcontrast T1-weighted images showed strong enhancement of these structures. Fine-needle aspiration biopsy with ultrasonographic guidance confirmed metastatic carcinoma cells in the right gluteal muscle and the sciatic nerve. These radiologic findings may represent a rare pattern of metastasis from urinary bladder carcinoma.

Fat in liver metastasis from renal cell carcinoma detected by chemical shift MR imaging.

A case with liver metastasis from papillary renal cell carcinoma (RCC) is presented, in which intratumoral fat was detected on dual-echo chemical shift magnetic resonance imaging (MRI). The preoperative chemical shift MR image of the primary RCC also suggested the presence of intratumoral fat. Liver metastasis from fat-containing RCC should be included in the differential diagnosis of fat-containing liver masses as observed on chemical shift MRI.

Fat detection in gallbladder carcinoma with extensive xanthogranulomatous change demonstrated by chemical shift MR imaging.

We present a case of gallbladder carcinoma, in which fat was detected on dual-echo chemical shift magnetic resonance imaging (MRI). Histologic analysis showed poorly differentiated adenocarcinoma associated with massive xanthogranulomatous change. Sudan IV staining successfully confirmed the presence of fat within the interstitial histiocytes. Although rare, gallbladder carcinoma with xanthogranulomatous change should be included in the differential diagnosis of fatty tumor involving the region of the liver as observed on chemical shift MRI.

Gallbladder torsion: case report.

Torsion of the gallbladder (GB) is a rare, acute abdominal condition. The treatment of choice is cholecystectomy. Even with recent advances in radiologic imaging modalities, it is difficult to make a correct preoperative diagnosis of GB torsion. We report a case of GB torsion with a retrospective review of the radiologic findings of magnetic resonance imaging, computed tomography, and ultrasonography. Those findings were compared with the histopathologic findings of the surgical specimen. The radiologic findings in our case were useful for making a preoperative diagnosis of GB torsion. We postulate the characteristic magnetic resonance findings and discuss discrepancies in the evaluations of the GB wall.

Measurement of the apparent diffusion coefficient in intraductal mucin-producing tumor of the pancreas by diffusion-weighted echo-planar MR imaging.

BACKGROUND: We investigated whether diffusion-weighted echo-planar magnetic resonance (MR) imaging can help differentiate intraductal mucin-producing tumors of the pancreas from other cystic lesions. METHODS: Diffusion-weighted echo-planar MR imaging was performed in patients with mucin-producing tumors (n = 19), pseudocysts (n = 9), chronic pancreatitis with diffuse main pancreatic dilatation (n = 5), and serous cystadenomas (n = 2). Images were obtained with diffusion sensitizing gradients of 30, 300, and 900 s/mm2. The apparent diffusion coefficient (ADC) was calculated. RESULTS: The mean (+/- standard deviation) ADCs of mucin-producing tumors (2.8 x 10(-3) mm2/s +/- 1.0 x 10(-3)), pseudocysts (2.9 x 10(-3) mm2/s +/- 1.2 x 10(-3)), dilated main pancreatic duct in chronic pancreatitis (3.3 x 10(-3) mm2/s +/- 1.2 x 10(-3)), serous cystadenomas (2.9 x 10(-3) and 2.6 x 10(-3) mm2/s), and cerebrospinal fluid (3.5 x 10A(-3) mm2/s +/- 1.1 x 10(-3)) were not statistically different. CONCLUSION: It is difficult to differentiate between mucin-producing tumors and other cystic lesions by ADC measurements when using diffusion-weighted echo-planar MR imaging.

[A safe and simple method of percutaneous transfemoral implantation of a port-catheter access system for hepatic artery chemotherapy infusion].

The purpose of this study was to perform a simple percutaneous transfemoral implantation of a portcatheter access system using a new catheter coating for hepatic artery chemotherapy infusion, and to evaluate the complications of transfemoral infusion port implantation. The methods of treatment for complications were also studied. The port-catheter system was percutaneously implanted via femoral artery access in 180 patients with malignant liver tumors. Blood flow redistribution was performed using embolization coils. An unfixed 5 Fr catheter was placed in a hepatic artery, and connected to a port implanted subcutaneously below the level of the inguinal ligament. The success rate of implantation was 99%. Complications after placement were observed as follows: port system obstruction (9.6%); dislocation of the catheter tip (8.4%); drug toxicity (4.5%); and infection (3.4%). Notable is the avoidance of cerebral infarcts. In 3 of 17 patients with port obstruction, recanalization of the port was achieved. In 11 of 15 patients with catheter dislocation, replacement of the catheter-port system was successful. In 5 patients with hepatic artery occlusion, the replacement of a microcatheter-port access system was achieved, and hepatic artery chemotherapy infusion was resumed. This percutaneous transfemoral implantation of a catheter-port access system would seem to be a very simple and useful method for many clinical doctors, and it may improve the quality of life in patients with an unresectable malignant liver tumor.

Radiologic diagnosis of adenomyomatosis of the gallbladder: comparative study among MRI, helical CT, and transabdominal US.

PURPOSE: The goal of this work was to evaluate the diagnostic accuracy of transabdominal ultrasound (US), helical CT, and MRI in the diagnosis of adenomyomatosis (ADM) of the gallbladder. METHOD: Twenty patients with surgically proven ADM were included, all of whom underwent preoperative US, helical CT with 3 mm collimation, and MRI with half-Fourier rapid acquisition with relaxation enhancement (RARE). All images were retrospectively reviewed by two radiologists, and the presence of ADM was assessed at three compartments (neck, body, and fundus) of the organ. Receiver operating characteristic analysis was performed, and sensitivity, specificity, and accuracy were calculated for each modality. RESULTS: The A z values (area under the curve) for MRI, helical CT, and US were 0.98, 0.85, and 0.72 for the Reader 1, respectively, showing no statistically significant interobserver difference in any of the three modalities. MRI showed a significantly higher A z value than helical CT or US (p < 0.1). The accuracies of MRI, helical CT, and US were 93, 75, and 66%, respectively. CONCLUSION: Among the three modalities tested, MRI with half-Fourier RARE sequence was the most accurate for diagnosing ADM.

Unusual hemodynamics and pseudolesions of the noncirrhotic liver at CT.

Recognition of pseudolesions of the liver at computed tomography (CT) is important because of their close resemblance to primary liver cancers or metastases. Two types of pseudolesion in the noncirrhotic liver include that due to transient extrinsic compression, typically caused by ribs or the diaphragm, and that due to a "third inflow" of blood from other than the usual hepatic arterial and portal venous sources: the cholecystic, parabiliary, or epigastric-paraumbilical venous system. Although the location of both types of pseudolesion are characteristic, their appearances at CT during arterial portography and CT during selective angiography vary from nonenhanced low-attenuation areas to well-enhanced high-attenuation areas, depending on the amount and timing of the inflow and presence or absence of focal metabolic alteration of the hepatocytes. Radiologists need to understand the underlying mechanism of these pseudolesions to better recognize the wide range of their appearances at CT.

Hepatic nodular hyperplasia in a boy with Alagille syndrome: CT and MR appearances.

A boy with Alagille syndrome complicated by hepatic nodular hyperplasia (HNH) is reported. During pre-transplantation evaluation, CT and MRI revealed a large hepatic lesion with multiple small nodular lesions. Angiography demonstrated a large hypervascular lesion and CT arterial portography (CTAP) showed a portal perfusion defect corresponding to the lesion. CTAP also revealed large portal vein branches running through the lesion. Although hepatocellular carcinoma is known to accompany Alagille syndrome, HNH should also be considered when large vessels running through the lesion are demonstrated.

Sclerosed hemangioma of the liver.

We report the radiologic findings of sclerosed hemangioma (SH), a rare variant of hepatic hemangioma. Dynamic contrast-enhanced computed tomography showed a hypodense mass in the liver with delayed enhancement. T2-weighted magnetic resonance imaging showed the mass as hypointense in relation to cerebrospinal fluid. The final diagnosis of SH was made pathologically. Although SH is rare, understanding its radiologic appearance is important to avoid unnecessary surgery and should be included in the differential diagnoses of hepatic lesion with delayed enhancement.

[Dynamic MR imaging of the upper abdomen: timing optimization and pulse sequence selection].

Since breath-hold gradient-echo MR imaging was introduced, dynamic MR study has played an important role in the MR investigation of the upper abdomen. In this article, the importance of tailoring imaging delay in each individual patient is stressed, with special attention given to a logical aspect of setting delay time based upon the bolus transfer time obtained by test injection. Also discussed is the importance of selecting types and parameters of pulse sequence to maximize the enhancement effect. It should be noted that alteration of gadolinium concentration in vivo following intravenous injection could result in a large change in signal intensity change on one sequence but little change on another. Double-dose 3DFISP with tailored delay time utilizing the test injection method, which is currently used for dynamic MR imaging in our institute, is presented.

Metastatic adrenal tumor from clear-cell renal cell carcinoma: a pitfall of chemical shift MR imaging.

We present a case of adrenal metastasis from clear-cell renal cell carcinoma in which presence of a small amount of fat was shown on chemical shift gradient-echo magnetic resonance imaging. Radiologists should be aware that signal loss of the adrenal tumor on out-of-phase gradient-echo images does not always suggest the diagnosis of benign adenoma, particularly in patients with a history of renal cell carcinoma.

Complications encountered with a transfemorally placed port-catheter system for hepatic artery chemotherapy infusion.

A port-catheter system was implanted via femoral artery access for hepatic artery chemotherapy infusion. Implantation was attempted in 90 patients and was successful in 88. Blood flow redistribution was performed using embolization coils. In the first ten patients a soft heparin-coated infusion catheter was used. For the following 78 patients we used a stiffer catheter coated with fluorine-acryl-styrene-urethane-silicone (FASUS) copolymer. The catheter was connected to a port implanted subcutaneously below the level of the inguinal ligament. Complications during the procedure and after placement were observed in 7 of 90 patients and 24 of 88 patients, respectively. These included catheter obstruction (11%), dislocation of the catheter tip (10%), drug toxicity (5.7%), and catheter infection (3.4%). In 6 of 10 patients with catheter obstruction, recanalization of the port system was achieved. In 7 of 9 patients with dislocation of the indwelling catheter tip, replacement of the port system was successful. Our complications appear to be comparable with those encountered with the subclavian/brachial approach when the new catheter coating is used. Notable is the avoidance of cerebral infarcts.