Stent graft migration with massive hemorrhage following pancreaticoduodenectomy: A serious complication of endovascular pseudoaneurysm repair.

Highlight Endovascular pseudoaneurysm repair with a stent graft enables aneurysm treatment and vessel preservation; however, little is known about its complications. Sano and colleagues describe a case of massive intestinal bleeding associated with stent-graft migration. They used a multidisciplinary approach with endoscopic hemostasis and endovascular embolization to overcome this unprecedented difficulty.

Primary posterior mediastinal angiolipoma: a case report.

An angiolipoma is a benign tumor, and a primary mediastinal angiolipoma is extremely rare. Herein, we describe the presentation and management of a posterior mediastinal angiolipoma in a woman with loss of consciousness. Chest computed tomography (CT) revealed a contrast-enhancing mass in the right posterior mediastinum, with intercostal arterial blood supply identified on three-dimensional reconstruction CT (3D-CT). Magnetic resonance imaging revealed a fatty component. Pre-operative embolization of the supplying intercostal artery was performed to reduce intraoperative bleeding. Mass resection was performed using video-assisted thoracic surgery. Histopathology confirmed angiolipoma diagnosis. Although rare, a posterior mediastinum angiolipoma should be considered a possibility; 3D-CT and pre-operative embolization may be useful in the surgical treatment of hypervascular mediastinal tumors, such as angiolipomas.

Split-bolus injection protocol with optimized timings of contrast medium injection and CT scanning for 3D CT angio-venography before laparoscopic gastrectomy.

PURPOSE: To propose an optimization method of contrast medium injection for the split-bolus protocol based on the contrast medium pharmacokinetics and investigate the utility of the optimized split-bolus protocol in 3D CT angio-venography for laparoscopic gastrectomy. MATERIALS AND METHODS: A pharmacokinetic relationship between injection duration and time to the peak enhancement was taken into account in the protocol design. The first 20 consecutive patients underwent a multi-phase scan with a single-bolus injection (single-bolus protocol), and the next 20 underwent the proposed split-bolus protocol. CT attenuations of the arteries and veins and dose-length products (DLPs) were compared between the two protocols. Two radiologists visually assessed arterial and venous depictions and the misregistrations. RESULTS: Mean arterial CT attenuations were not significantly different between the two protocols. Though mean venous CT attenuations for the split-bolus protocol were 7-11% lower than those of the single-bolus protocol, they were visually evaluated as similar. The mean DLP of the split-bolus protocol was 46% lower than that of the single-bolus protocol. Misregistration between the arteries and veins occurred 35-80% during the single-bolus protocol, but was not indicated in the split-bolus protocol. CONCLUSION: The split-bolus protocol with optimized timing was more effective for providing improved image quality with reduced radiation dose compared with the single-bolus protocol in 3D CT angio-venography for laparoscopic gastrectomy.

New visual rating system for medial temporal lobe atrophy: a simple diagnostic tool for routine examinations.

AIM: We estimated the usefulness of our new scale to rate medial temporal atrophy with short inversion time inversion recovery images. METHODS: Alzheimer's disease (AD) subjects (n= 34) and non-demented subjects (n= 19) were recruited for this study. First, coronal short inversion time inversion recovery images were scanned vertical to the long axis of hippocampus. Next, the single image in which peduncles appeared widest was adopted for estimation. The parahippocampal cerebrospinal fluid space was divided into three parts: the outer, upper and inner parts. The hippocampus was defined as a structure being of equal intensity to grey matter. Two radiologists compared each part of the parahippocampal cerebrospinal fluid space with the hippocampus and rated them on a 0-3 scale. Interrater and intrarater kappa statistics and sensitivity/specificity for the diagnosis of AD were calculated using the scores of the right, left and both sides combined. RESULTS: There were no significant differences between AD and ND subjects with regards to sex. AD subjects had lower Mini-Mental State Examination scores and were older than non-demented subjects. Interrater and intrarater kappa statistics were 0.52-0.68 and 0.76-0.83, respectively. Sensitivity was 88.2% using the scores of both sides. CONCLUSIONS: Interrater and intrarater agreements were fair to good and good to excellent, respectively. Our new visual rating method detected medial temporal atrophy in AD patients at a highly sensitive rate. As such, we conclude that this visual rating scale is useful for judging medial temporal atrophy simply and objectively in clinical use, and it is helpful in establishing an AD diagnosis.

Interstitial brachytherapy and neck dissection for Stage III squamous cell carcinoma of the mobile tongue.

The purpose of this study is to describe the cause-specific survival rate, local control rate, salvage rate of neck metastasis, and post-treatment eating and speaking conditions for stage III mobile tongue squamous cell carcinomas and its subgroups. Between 1968 and 1999, 117 previously untreated patients with stage III mobile tongue carcinomas underwent mainly brachytherapy with external beam irradiation (EBRT) and neck dissection. A multivariate analysis was performed for the cause-specific survival rate on the various factors. The 1-, 3- and 5-year cause-specific survival rates for all patients were 76%, 54% and 54%, respectively. The 1-, 3- and 5-year primary control rates for all patients were 67.6%, 63.4% and 59.2%, respectively. There were statistically significant differences in cause-specific survival rates among stage III subgroups of T3N0, T1-2N1 and T3N1 (p = 0.0002). Our treatment method for patients with stage III mobile tongue squamous cell carcinoma was effective and acceptable.

Early ureteral luminal enhancement on computed tomography in a renal trauma patient: a characteristic sign of communication between artery and collecting system.

We report the case of a 65-year-old man with blunt abdominal trauma following a fall from a three-meter-high roof. Contrast-enhanced abdominal computed tomography (CT) obtained in early phase showed intense contrast enhancement in the urinary tract as dense as artery. This finding was considered characteristic of traumatic communication between artery and collecting system. In cases of blunt abdominal trauma, contrast-enhanced CT should be obtained in the early phase to diagnose this disorder. When the diagnosis is made, prompt treatment should be initiated.

Prominent laterality of the posterior cerebral artery at three-dimensional time-of-flight MR angiography in M1-segment middle cerebral artery occlusion.

BACKGROUND AND PURPOSE: Three-dimensional time-of-flight MR angiography (3D TOF MRA) often discloses prominent posterior cerebral artery (PCA) laterality in the setting of M1-segment middle cerebral artery (MCA) occlusion. We sought to analyze the implications of prominent PCA laterality at 3D TOF MRA. METHODS: We retrospectively reviewed 3D TOF MRA and digital subtraction angiography (DSA) findings in 25 patients (12 male, 13 female; mean age, 68.8 years [age range, 29-94 years]) with M1-segment occlusion. The observable laterality of the PCA, determined on the basis of 3D TOF MRA findings, was scored according to distal signal extent and compared with findings of collateral flow from the ipsilateral PCA via the leptomeningeal anastomosis (LMA) at DSA. Frequency of PCA laterality at 3D TOF MRA in patients and that in 56 healthy control subjects was also compared. RESULTS: The positive predictive value of PCA laterality for the existence of collateral flow was 99.9% and the negative predictive value 30.7%. The distal extent of ipsilateral PCA signal at 3D TOF MRA positively correlated with the grade of collateral flow from the PCA via the LMA (r = 0.802; P <.01). PCA laterality was significantly less common in control subjects (P <.01). CONCLUSION: Prominent PCA laterality at 3D TOF MRA in patients with M1-segment occlusion represents the existence of collateral flow from the PCA via the LMA.

Diffusion-weighted half-Fourier single-shot turbo spin echo imaging in breast tumors: differentiation of invasive ductal carcinoma from fibroadenoma.

PURPOSE: The purpose of this investigation is to evaluate the usefulness of diffusion-weighted half-Fourier single-shot turbo spin echo (DW-HASTE) imaging in differentiating invasive ductal carcinoma from fibroadenoma. METHOD: The DW-HASTE imaging was performed in patients with invasive ductal carcinoma (n = 16) and fibroadenoma (n = 6). Images were obtained with diffusion-sensitizing gradients of 0 and 700 mm(2)/s. The apparent diffusion coefficient (ADC) was calculated. RESULTS: The DW-HASTE imaging was not affected with susceptibility and chemical shift artifacts usually present in DW echo planar imaging. The DW-HASTE imaging had low tumor detectability (62%), however. The difference in mean ADC of invasive ductal carcinoma (1.216 +/- 0.189 x 10(-3)mm(2)/s) and fibroadenoma (1.495 +/- 0.181 x 10(-3)mm(2)/s) was statistically significant. CONCLUSION: Apparent diffusion coefficient measurement using DW-HASTE imaging is helpful in differentiating invasive ductal carcinoma from fibroadenoma. Nevertheless, DW-HASTE imaging has low detectability at present; therefore, more technologic improvement is desired.

Fat necrosis of breast: a potential pitfall in breast MRI.

Fat necrosis is a benign nonsuppurative inflammatory process of adipose tissue. Occasionally fat necrosis may mimic a breast cancer clinically, mammographically, and sonographically. There have been some previous reports on the MR imaging of the fat necrosis. In some MR findings of fat necrosis, it was difficult to distinguish it from malignant lesions. We report a case of fat necrosis presenting the irregular enhancement with the non-enhancing area of central areas on MRI.

Inflammatory intramammary lymph node mimicking the malignant lesion in dynamic MRI: a case report.

Enlarged intramammary lymph node (LN) may be caused by inflammation [Arch. Surg. 109 (1974) 759.], reaction to dermatitis [Radiology 137 (1980) 15.], tuberculosis [Histopathology 17 (1990) 91.], foreign body such as gold [Hum. Pathol. 19 (1988) 992.], neoplasm including metastasis [Arch. Surg. 109 (1974) 759; AJR, Am J Roentgenol 146 (1986) 133.], and malignant lymphoma [AJR, Am J Roentgenol 161 (1993) 779.]. It is difficult to distinguish benign enlarged LNs from malignant lesion clinically, mammographically, and sonographically. There have been a few reports on the magnetic resonance imaging (MRI) of enlarged intramammary LNs in the English literature. In this article, we present a case in which dynamic MRI indicated inflammatory LNs as highly suspicious of malignancy.

Hepatic involvement of visceral larva migrans due to Toxocara canis: a case report--CT and MR findings.

Imaging findings of hepatic lesions of visceral larva migrans are reported. A 44-year-old man presented with chills, eruptions, marked leukocytosis (31,400/microlitter), and eosinophilia (eosinophil, 72%). Multiple liver nodules were detected as low-density lesions on computed tomography (CT). They were visualized as high signal intensity lesions on T2-weighted, and as low signal intensity lesions on T1-weighted magnetic resonance imaging (MRI). The patient was diagnosed as having visceral larva migrans due to Toxocara canis, by Toxocara immnoserological test. After antihelmintic therapy, multiple liver nodules disappeared on CT. We consider that the differential diagnosis of multiple liver nodules should include visceral larva migrans.