SUV navigator enables rapid [18F]-FDG PET/CT image interpretation compared with 2D ROI and 3D VOI evaluations.

PURPOSE: Positron emission tomography (PET) and the maximum standardized uptake value (SUVmax) is a useful technique for assessing malignant tumors. Measurements of SUVmax in multiple lesions per patient frequently require many time-consuming procedures. To address this issue, we designed a novel interface named SUV Navigator (SUVnavi), and the purpose of this study was to investigate its utility. MATERIALS AND METHODS: We measured SUVmax in 661 lesions from 100 patients with malignant tumors. Diagnoses and SUVmax measurements were made with SUVnavi, 2D, and 3D measurements. SUV measurement accuracy in each method were also evaluated. RESULTS: The average reduction in time with SUVnavi versus 2D was 53.8% and 3D was 37.5%; time required with SUVnavi was significantly shorter than with 2D and 3D (P < 0.001 and P < 0.001, respectively). The time reduction and lesion number had a positive correlation (P < 0.001 and P < 0.001, respectively). SUVmax agreed with precise SUVmax in all lesions measured with SUVnavi and 3D but in only 466 of 661 lesions (70.5%) measured with 2D. CONCLUSION: SUVnavi may be useful for rapid [18F]-fluorodeoxyglucose positron emission tomography/computed tomography ([18F]-FDG PET/CT) image interpretation without reducing the accuracy of SUVmax measurement.

Late gadolinium enhancement on cardiac magnetic resonance represents the depolarizing and repolarizing electrically damaged foci causing malignant ventricular arrhythmia in hypertrophic cardiomyopathy.

BACKGROUND: The presence of a myocardial scar detected by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) has been described as a predictor of all-cause mortality in hypertrophic cardiomyopathy (HCM). However, the detailed spatial relationship between LGE site and electrical abnormality is unclear in high-risk HCM with malignant arrhythmia. OBJECTIVE: The purpose of this study was to elucidate the detailed relationship between the site on CMR imaging and the electrically damaged site, a potential origin of ventricular arrhythmias in patients with HCM. METHODS: Fifty consecutive HCM patients underwent contrast-enhanced CMR. Of those patients, 18 patients with ventricular tachycardia underwent electrophysiology study including endocardial mapping of the left ventricle (LV). The LGE area was calculated at 12 different LV sites: anterior, lateral, posterior, and septal segments of the basal, middle, and apical portions. At each LV site, the bipolar electrogram, effective refractory period (ERP), and monophasic action potential were recorded. RESULTS: LGE-positive segments demonstrated a significantly lower amplitude (4.0 ± 2.8 mV vs 7.3 ± 3.6 mV; P < .001), longer duration (54.7 ± 17.8 vs 40.6 ± 7.8 ms; P < .001), longer ERP (320 ± 42 ms vs 284 ± 37 ms; P = .001), and longer monophasic action potential duration measured at 90% repolarization (321 ± 19 ms vs 283 ± 25 ms; P < .001) than did LGE-negative segments. The LGE area negatively correlated with the amplitude (r = -0.59; P < .001) and positively correlated with the duration (r = 0.64; P < .001), ERP (r = 0.44; P < .001), and action potential duration measured at 90% repolarization (r = 0.63; P < .001). All the observed VTs originated from LGE-positive segments. CONCLUSION: The spatial distribution of LGE significantly correlates with depolarizing and repolarizing electrical damage in high-risk HCM with malignant ventricular arrhythmia.

Dual-time-point F-18 FDG PET/CT imaging for differentiating the lymph nodes between malignant lymphoma and benign lesions.

PURPOSE: The purpose of the present study is to evaluate the clinical value of dual-time-point F-18 FDG PET/CT imaging to differentiate malignant lymphoma (ML) from benign lymph node (BLN). MATERIALS AND METHODS: The subjects were 310 lymph nodes in 84 patients (195 ML lesions in 30 patients and 115 BLN in 54 patients associated with various etiologies.). F-18 FDG PET/CT scan was performed at 50 min (early scan) and at 100 min (delayed scan) after the injection. First, the maximum standardized uptake value (SUVmax) of each lesion at early and delayed scans was calculated. Second, we estimated the difference between early and delayed SUVmax (D-SUVmax) and the retention index (RI-SUVmax) to evaluate the change of tracers in the lesions. Furthermore, proper cut-off values of them were evaluated using receiver operating characteristic analysis. The efficacy of each parameter was analyzed with ANOVA. RESULTS: Delayed SUVmax and D-SUVmax in ML were significantly higher than those in BLN. Proper cut-off value in delayed SUVmax was 4.0 and in D-SUVmax was 1.0. When the proper cut-off value in D-SUVmax was applied, the D-SUVmax yielded the role of diagnosis with sensitivity of 82.6%, specificity of 65.2%, positive predictive value of 80.1% and negative predictive value of 68.8%, respectively. CONCLUSIONS: The delayed SUVmax and D-SUVmax were useful indices to differentiate ML from BLN, regardless of histologic subtype. Dual-time-point F-18 FDG PET/CT imaging may help to consider whether there is any need to proceed to more invasive tests, such as biopsy, in individual patients.

"Hot" vertebra on (18)F-FDG PET scan: a case of vertebral hemangioma.

An F-FDG-PET with CT scan was performed to stage a tongue cancer, revealing the hypermetabolic region in the thoracic vertebra. This corresponded to a benign lesion seen on MRIs and CT.Although these findings suggested a vertebral hemangioma, "hot" vertebra in FDG-PET was atypical. The final diagnosis was confirmed capillary hemangioma by the scopic biopsy and this lesion was no change at 1 year later.Careful interpretation of metabolic (FDG-PET) and anatomic (CT and MRI) images should be performed to accurately characterize the foci of increased FDG uptake.

Pulmonary lymphatic drainage to the mediastinum based on computed tomographic observations of the primary complex of pulmonary histoplasmosis.

BACKGROUND: In the primary infection of pulmonary histoplasmosis, pulmonary lesions are commonly solitary and associated with hilar and/or mediastinal nodal diseases, which spontaneously resolve, resulting in calcifications in individuals with normal cellular immunity. PURPOSE: To assess the lymphatic drainage to the mediastinum from each pulmonary segment and lobe using computed tomographic (CT) observations of a calcified primary complex pulmonary histoplasmosis and predict which patients with N2 disease that would benefit from surgery. MATERIAL AND METHODS: We collected 585 CT studies of patients with primary complex histoplasmosis consisting of solitary calcified pulmonary lesions and calcified hilar and/or mediastinal nodal disease. Using the N stage criteria of non-small cell lung cancer, we assessed the distribution of the involved hilar and mediastinal nodes depending on the pulmonary segment of the lesion, with a focus on skip involvement. We also assessed the correlation between the incidence of N1 and skip N2 involvement and the mean number of involved mediastinal nodal stations in the non-skip N2 and skip N2 groups. RESULTS: Skip involvement was common in the apical segment (9/45, 20.0%), posterior segment (7/31, 22.6%), and mediolbasal segment (13/20, 65.0%) in the right lung, and in the apicoposterior segment (7/55, 12.7%), lateral basal segment (6/26, 23.1%), and posterobasal segment (16/47, 34.0%) in the left lung. The incidence of skip involvement in each segment showed a significant inverse correlation with that of N1 involvement (r = -0.51, P <0.05) in both lungs. The mean number of involved mediastinal nodal stations in the non-skip N2 and skip N2 groups in all segments of both lungs were 1.4 (434/301) and 1.2 (93/77), and the former was significantly greater than the latter (P <0.01). CONCLUSION: Our data showed a predictable pattern of segmental and lobar lymphatic drainage to the mediastinum and suggested that skip involvement could represent the initial mediastinal node involvement via direct lymphatic drainage.

Potential direct communication of the lung to the mediastinum: computed tomographic evaluation of pulmonary venous connections.

PURPOSE: We hypothesized that the remnant of the primitive pulmonary venous plexus in the embryo provides a pathway for direct communication from each lobe of the lung to the mediastinum. We assessed the presence and location of these connections by using 64-row multidetector computed tomography (CT). MATERIALS AND METHODS: This study was approved by the institutional ethics committee. First, we analyzed the multidetector row CT images of 120 normal lungs for the presence of septal structures between the pulmonary veins and the mediastinum and the extension of mediastinal fat into these septal structures. Second, we analyzed 62 patients with pneumothorax for the presence of cross-bridging structures in the pleural cavities. RESULTS: We frequently observed septal structures (36% to 77%) and the extension of mediastinal fat (8% to 56%) in the right apical segment, left apical posterior segment, both right and left anterior segments, right medial segment, and left inferior lingular segment. Cross-bridging structures were observed in 44% of right and 38% of left pneumothoraces and were noted in the right apical and posterior segments, left apical posterior segment, both anterior segments, right middle lobe, and left lingular segments. Septal and cross-bridging structures both showed a similar distribution pattern. CONCLUSIONS: Venous septal structures in normal lungs and cross-bridging structures in pneumothoraces visualized on CT images suggest the presence of direct pathways from each lobe of the lung to the mediastinum.

Effect of ageing and pulmonary inflammation on the incidence and number of cross-bridging structures in pneumothorax patients.

BACKGROUND: There is an improved prognosis for T4 non-small-cell lung cancer in patients who show particular patterns of direct mediastinal invasion. The particular patterns suggest the presence of direct pathways other than the pulmonary hilum between each of the lungs and the mediastinum/chest wall. PURPOSE: To determine the incidence and number of such direct pathways in pneumothorax patients as well as the factors that affect the development of these pathways. MATERIAL AND METHODS: Two radiologists independently analyzed multidetector computed tomographic images of 81 patients with pneumothorax to assess the incidence and distribution pattern of the cross-bridging structures in the pleural cavity. RESULTS: Cross-bridging structures were observed in the right pneumothorax in 34/54 (63%) patients and in the left pneumothorax in 19/32 (59%) patients. The number of cross-bridging structures was found to be positively correlated with ageing and pulmonary disease. The distribution patterns of cross-bridging structures were found to be specific in formation and often in repeated locations, regardless of the presence of pulmonary disease or the age of the patient. CONCLUSION: Cross-bridging structures in pneumothoraces were found more frequently in older patients and in patients with pulmonary disease. However, some of the cross-bridging structures may have been congenital because of their specific formations and repeated locations.

Absent skeletal uptake of (99m)Tc-hydroxymethylene diphosphonate in the presence of AL-type amyloidosis associated with multiple myeloma.

A 66-year-old woman with congestive heart failure suspected to have multiple myeloma underwent bone scintigraphy. The bone scintigraphy using technetium-99m hydroxymethylene-diphosphonate showed the following interesting findings: absent skeletal uptake; increased gastrointestinal, myocardial, and soft tissue uptake; migration of radionuclide to bilateral pleural effusions. Histopathological examination revealed that the patient suffered from AL-type amyloidosis associated with multiple myeloma. Extraosseous uptake is often observed on bone scintigraphy in amyloidosis patients, but in many cases skeletal uptake is preserved. The simultaneous presentation of these findings is rare.

Spinal metastasis from lung cancer fifteen years after surgery presenting a pseudohemangioma appearance of the vertebra: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To describe a case of solitary metastasis of the seventh thoracic vertebra (T7) from lung cancer 15 years after surgery. SUMMARY OF BACKGROUND DATA: Late recurrence of the bone over 5 years after curative surgery for lung cancer is highly exceptional. In addition, bone metastasis from lung cancer showing a coarse trabecular pattern of the vertebra on computed tomography (CT) is quite unusual. METHODS: A case of solitary metastasis of T7 from lung cancer 15 years after surgery showing a pseudohemangioma appearance of the vertebra on CT is presented. RESULTS: A 66-year-old man presented with a 2-month history of gradually progressed numbness and muscle weakness of the bilateral leg, with a more recently developed spastic gate. He had undergone a left lower lobectomy for lung cancer 15 years previously. Magnetic resonance imaging showed an ill-defined mass lesion involving the entire vertebral body of T7 with extension into the posterior element and surrounding soft tissue, which resulted in moderate spinal canal stenosis. CT showed a coarse trabecular pattern at T7 with a mild compression fracture. No other lesion was detected by whole-body CT and bone scintigraphy. Tumor resection and T5-T9 posterior spinal fusion had been performed, and a pathologic diagnosis of metastatic pulmonary adenocarcinoma of the bone was established. Additional radiation therapy (40 Gy) was added, and the patient recovered and continued to survive uneventfully at the 3-month follow-up. CONCLUSION: We have reported a rare case of solitary metastasis to T7 appearing 15 years after surgery for lung cancer. The incidence of lung cancer recurrence more than 5 years after surgery is exceedingly low; however, even in patients with lung cancer, late occurrence of bone metastasis should be considered and included in the differential diagnosis of a pseudohemangioma appearance of the vertebra.

Imaging a pancreatic carcinoma xenograft model with 11C-acetate: a comparison study with 18F-FDG.

PURPOSE: Pancreatic carcinoma is a malignant tumor with poor prognosis and its early detection is still a clinical problem. The aim of this study was to evaluate the efficacy of carbon-11-labeled acetate (11C-acetate)-positron emission tomography (PET) for the detection of pancreatic carcinoma in a BxPC-3 human pancreatic carcinoma xenograft-bearing immunodeficiency BALB/c-nu nude mice model. METHODS: Whole-body 11C-acetate and fluorine-18-labeled fluorodeoxyglucose (F-FDG) micro-PET imaging were performed weekly on BxPC-3 human pancreatic carcinoma xenograft-bearing BALB/c-nu nude mice from the 2nd week after tumor cell inoculation. Regions of interest method and tumor-to-nontumor ratio (T/N ratio) were used for semiquantitative evaluation. Tumor proliferation was evaluated by immunohistochemistry analysis of proliferating cell nuclear antigen. RESULTS: Radiotracer accumulation in the tumor xenografts could be detected 1 week earlier in 11C-acetate-PET than that in 18F-FDG-PET. Peak T/N ratio was obtained at the 5th week in 11C-acetate-PET and at the 4th week in 18F-FDG-PET. T/N ratio in 11C-acetate-PET was lower than that in 18F-FDG-PET during the same period. By visual evaluation, tumor xenografts were more easily observed in 11C-acetate-PET than in 18F-FDG-PET in most of the mice. Linear correlation analysis indicated T/N ratios in C-acetate-PET had no significant correlation with those in 18F-FDG-PET. Tumor size, T/N ratio in 11C-acetate-PET, and T/N ratio in 18F-FDG-PET were not found to be significantly correlated with tumor proliferating cell nuclear antigen expression. CONCLUSION: 11C-acetate-PET imaging can be used for the detection of pancreatic carcinoma. In the early stage of tumor growth, 11C-acetate-PET has better detectability than that of 18F-FDG-PET.

Transient brain hyperperfusion detected with I-123 IMP SPECT in a patient with neuropsychiatric systemic lupus erythematosus.

We report the case of a 25-year-old woman with systemic lupus erythematosus. She complained of headache and left hemiparesis and was admitted to our hospital. She was in a coma after admission. Brain MRI showed no abnormalities, but brain single photon emission computed tomography showed diffuse hyperperfusion in the right frontal and temporal lobes. The calculated measured regional cerebral blood flow in the right hemisphere was increased to 40 to 55 mL/100 g/min, and that in the left was within the normal range of 25 to 35 mL/100 g/min. Two months later, the hyperperfusion was disappeared. The hyperperfusion could be explained by inflammatory changes.

Cerebral control of bladder storage in patients with detrusor overactivity.

OBJECTIVE: To identify the brain areas that control bladder storage by technetium-99m hexamethylpropyleneamine oxime single-photon emission computed tomography (SPECT) with the Neurological Statistical Image Analysis software (NEUROSTAT) in patients with detrusor overactivity (DO). METHODS: SPECT scans were performed on 19 patients with DO. Eight patients with normal detrusor function, who had some storage symptoms of the lower urinary tract as the patients with DO, also had a SPECT scan, as controls. All the patients were male and right handed, and were scanned twice under two conditions: resting state and urine withholding state. NEUROSTAT was adopted to analyze the difference in brain--blood perfusion between groups and states. The results were displayed on Z score images at a significance threshold of P value of less than 0.05 with correction for multiple comparisons. RESULTS: No region reached the significant threshold in comparison with patients with DO and normal detrusor function in resting state. Significant increases in tracer activity in the right inferior frontal gyrus and the right middle temporal gyrus during urine withholding state as compared with resting state in patients with normal detrusor function were observed. Among the regions, the right inferior frontal gyrus was distinctly prominent at both Z score and the extent. The regions that were significantly activated in patients with normal detrusor function did not reach a significant threshold during urine withholding in patients with DO. CONCLUSION: The study indicated that the right inferior frontal gyrus and the right middle temporal gyrus, especially the right inferior frontal gyrus, played a role in the cerebral control of bladder storage, inhibiting the contraction of detrusor in urine storage.

VIBE MRI for evaluating the normal and abnormal gastrointestinal tract in fetuses.

OBJECTIVE: The great potential of MRI for assessing gastrointestinal abnormalities in fetuses has been described. T1-weighted images may add additional information to T2-weighted images in diagnosing fetal gastrointestinal abnormalities. The objective of this study was to assess the performance of a 3D volumetric interpolated breath-hold sequence (VIBE) in evaluating the normal and abnormal fetal gastrointestinal tract. CONCLUSION: VIBE provides high-quality T1-weighted and 3D MR colonography images for the evaluation of the normal and abnormal gastrointestinal tract in fetuses, and 3D MR colonography provides excellent delineation of the meconium.

A compartment model analysis for investigation of myocardial fatty acid metabolism in patients with hypertrophic cardiomyopathy.

OBJECTIVE: The purpose of this study was to investigate the myocardial fatty acid metabolism in patients with hypertrophic cardiomyopathy (HCM) from dynamic SPECT through a compartment model analysis. METHODS: Twenty-four normal controls, seven patients with left ventricular hypertrophy (LVH) due to essential hypertension (eHT), and 30 patients with HCM were studied. 123I-BMIPP and 99mTc-tetrofosmin SPECT were performed. All the myocardium was divided into 13 segments, and a total of 390 segments of HCM were categorized into early, moderately and severely advanced HCM segments, based on these SPECT imaging. By using the myocardial and blood pool time-activity curves, BMIPP pharmacokinetics were analysed through a two-compartment model. We defined k1 and k2 as influx and outflux rate constants between blood and myocardial reversible component, and k3 as the specific uptake rate constant between myocardial reversible and irreversible compartments. RESULTS: The averages of k3 in HCM were higher than in normal. In contrast, the averages of k1/k2 in HCM were lower than in normal, and gradually decreased with progression of HCM. There are no significant differences in these indexes between normal controls and patients with LVH due to eHT. CONCLUSION: k3 might be a sensitive predictor for early detection of HCM, and k1/k2 could be a useful index to evaluate its progression. A mathematical compartment model analysis with a BMIPP SPECT study might be useful not only for identification of HCM in very early stage, but also for evaluation of the progression of HCM.

Solitary fibrous tumor of the pleura: apparent diffusion coefficient (ADC) value and ADC map to predict malignant transformation.

Solitary fibrous tumors (SFTs) of the pleura are rare soft-tissue tumors that are presumed to be of mesenchymal origin. Most SFTs are histologically benign, but up to 20% of SFTs may be malignant. In addition, malignant transformation may occur within histologically benign SFTs, though it is rare. However, it is difficult to diagnose malignant SFTs of the pleura by means of conventional computed tomography and magnetic resonance imaging (MRI). In this article we present the first case of malignant SFT of the pleura in an 81-year-old man in which the apparent diffusion coefficient (ADC) value and ADC map based on diffusion-weighted MRI were very useful for identifying malignant transformation.

Acute rhabdomyolysis of the soleus muscle induced by a lightning strike: magnetic resonance and scintigraphic findings.

Among natural disasters, a lightning strike is a rare but potentially life-threatening phenomenon. If victims survive a cardiac arrest due to instantaneous passage of an exceptionally high voltage electric charge through the whole body, they may be afflicted with various complications such as muscle necrosis resulting in acute renal failure. In this article, we report a case of a 54-year-old man with acute rhabdomyolysis of the left soleus muscle associated with a lightning strike. T2-weighted and short-tau inversion recovery MR images showed a high signal intensity in the left soleus muscle. A whole-body bone scintigram showed abnormal uptakes in the left soleus muscle and the dorsal aspect of the left foot. MR and scintigraphic evaluations were very useful in depicting the site and extent of muscle damage. Since the patient showed a surprisingly high level of serum creatine kinase, the added information was very valuable for determining the patient's management.

Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging.

PURPOSE: To prospectively evaluate chemical shift magnetic resonance (MR) imaging for differentiating thymic hyperplasia from tumors of the thymus gland. MATERIALS AND METHODS: The institutional review board approved this study; informed consent was obtained and patient confidentiality was protected. The authors assessed 41 patients (17 male, 24 female; age range, 16-78 years) in whom thymic lesions were seen at chest computed tomography. Patients were assigned to a hyperplasia group (n=23) (18 patients with hyperplastic thymus associated with Graves disease and five with rebound thymic hyperplasia) and a tumor group (n=18) (seven patients with thymomas, four with invasive thymomas, five with thymic cancers, and two with malignant lymphomas). T2-weighted fast spin-echo and T1-weighted in-phase and opposed-phase MR images were obtained in all patients and visually assessed. A chemical shift ratio (CSR), determined by comparing the signal intensity of the thymus gland with that of the paraspinal muscle, was calculated for quantitative analysis. Mean CSRs for the patient groups and subgroups were analyzed by using Welch t and Newman-Keuls tests. P<.05 indicated a significant difference. RESULTS: The thymus gland had homogeneous signal intensity in all 23 patients in the hyperplasia group and in 12 of the 18 patients in the tumor group. The mean CSR (+/- standard deviation) was 0.614 +/- 0.130 in the hyperplasia group and 1.026 +/- 0.039 in the tumor group. Mean CSRs in the patients with a hyperplastic thymus and Graves disease, rebound thymic hyperplasia, thymoma, invasive thymoma, thymic cancer, and malignant lymphoma were 0.594 +/- 0.120, 0.688 +/- 0.154, 1.033 +/- 0.043, 1.036 +/- 0.040, 1.020 +/- 0.044, and 0.997 +/- 0.010, respectively. The difference in CSR between the hyperplasia and tumor groups was significant (P<.001). Mean CSRs in the hyperplasia subgroups were lower than those in the tumor subgroups (P<.001). All hyperplasia group patients had an apparent decrease in thymus gland signal intensity at chemical shift MR imaging; no tumor group patients had a decrease in thymus gland signal intensity. CONCLUSION: Chemical shift MR imaging can be used to differentiate thymic hyperplasia from thymic tumors.

Cerebral activation during withholding urine with full bladder in healthy men using 99mTc-HMPAO SPECT.

UNLABELLED: The aim of this study was to identify the brain areas that control urinary continence in healthy men by 99mTc-hexamethylpropyleneamine oxime (99mTc-HMPAO) SPECT. METHODS: SPECT scans were performed on 15 right-handed healthy male volunteers, 24-45 y old. Each subject was scanned twice without movement in a supine position, and 444 and 555 MBq 99mTc-HMPAO were separately injected intravenously during the following 2 conditions: resting state with an empty bladder and urine-withholding state with a full bladder. The final image during urine withholding was obtained by subtracting the first scan data from the second scan data. The images were analyzed by statistical image analysis software and displayed on Z-score images at a significance threshold of P < 0.05 with correction for multiple comparisons. RESULTS: In the urine-withholding state, as compared with resting, there was a significant increase in tracer activity in the bilateral inferior frontal gyri and the right superior and the middle temporal gyri. Among the regions, the right inferior frontal gyrus was distinctly prominent. When the threshold value was decreased to P < 0.005 without correction, there was a vast network of cortical and subcortical regions involved during urine withholding. CONCLUSION: Our results suggest that the right inferior frontal gyrus plays an important role in brain control of urinary continence. This study also suggests that brain control of continence can be confirmed by statistical image analysis software using SPECT.

[Survey and analysis of radiation safety management systems at medical institutions--second report: radiation measurement, calibration of radiation survey meters, and periodic check of installations, equipment, and protection instruments].

We carried out a questionnaire survey to determine the actual situation of radiation safety management measures in all medical institutions in Japan that had nuclear medicine facilities. The questionnaire consisted of questions concerning the evaluation of shielding capacity; radiation measurement; periodic checks of installations, equipment, and protection instruments; and the calibration of radiation survey meters. The analysis was undertaken according to region, type of establishment, and number of beds. The overall response rate was 60 percent. For the evaluation of shielding capacity, the outsourcing rate was 53 percent of the total. For the radiation measurements of "leakage radiation dose and radioactive contamination" and "contamination of radioactive substances in the air," the outsourcing rates were 28 percent and 35 percent of the total, respectively (p<0.001, according to region and establishment). For the periodic check of radiation protection instruments, the implementation rate was 98 percent, and the outsourcing rate was 32 percent for radiation survey meters and 47 percent for lead aprons. The non-implemented rate for calibration of radiation survey meters was 25 percent of the total (p<0.001, according to region and establishment). The outsourcing rate for calibration of radiation survey meters accounted for 87 percent of the total, and of these medical institutions, 72 percent undertook annual calibration. The implementation rate for patient exposure measurement was 20 percent of the total (p<0.001, according to number of beds), and of these medical institutions 46 percent recorded measurement outcome.

Three-dimensional magnetic resonance imaging after ultrasonography for assessment of fetal gastroschisis.

A 24-year-old woman (Gravida I, Para I) at estimated 32 weeks of pregnancy was referred to our department for evaluation of a suspected fetal gastroschisis. Ultrasound scan revealed multiple loops of dilated bowel outside the fetal abdomen and absence of membrane surrounding the herniated loops of the intestines. Three-dimensional (3D) magnetic resonance imaging was performed to obtain more information on the bowel both outside and inside the abdomen. Images were constructed with T1-weighted fat-suppressed 3D fast low-angle shot sequences using a maximum intensity projection algorithm. The 3D images made possible the realization of fetal bowel conditions with greater definition and accuracy.