Computed tomography findings of acute gastric peptic ulcer.

PURPOSE: To report the computed tomography (CT) findings of acute peptic ulcer disease (PUD) and to evaluate the usefulness of contrast media for diagnosis. METHODS: This retrospective study included 51 patients diagnosed with acute gastric peptic ulcer by endoscopy. Using a κ analysis, two radiologists independently reviewed contrast-enhanced emergency CTs performed within 24 h of endoscopy. Evaluation findings included low-attenuation wall thickening, focal wall thickening, focal luminal outpouching, perigastric fat stranding, ascites, adjacent lymphadenopathy, and high-density gastric contents. Of the 51 patients, 48 underwent both non-contrast-enhanced and contrast-enhanced CT, and two radiologists also evaluated the presence or absence of these findings on a non-contrast-enhanced CT. McNemar's test was used to evaluate the contrast media's usefulness. RESULTS: Interobserver variability of perigastric fat stranding revealed substantial agreement between evaluators, and other findings had almost perfect agreement. High-density gastric contents were the most recognized findings (60%). Low-attenuation focal wall thickening and focal luminal outpouching were observed in relatively large numbers (~50%) of the cases on contrast-enhanced CT. The CT examinations using contrast media provided significantly higher detectability of low-attenuation wall thickening and focal luminal outpouching than CT examinations without using contrast media. CONCLUSION: Acute PUD can be suspected in patients with nonspecific abdominal symptoms in whom emergency CT shows high-density gastric contents, focal low-attenuation wall thickening, and/or focal luminal outpouching. Our study showed that contrast media are useful for diagnosis.

Quantitative 3D Shape Analysis of CT Images of Thymoma: A Comparison With Histological Types.

OBJECTIVE. The purpose of this study is to differentiate between low- and high-risk types of thymoma using quantitative 3D shape analysis of CT images. MATERIALS AND METHODS. This retrospective study included 44 patients with a pathologic diagnosis of thymoma. Two radiologists semiautomatically contoured CT images of the tumors and evaluated 3D shape parameters-namely, quantitative indicators of surface smoothness, including sphericity, ellipsoidality, and discrete compactness. The visual CT findings that were analyzed included longest diameter, shape (round-oval, lobulated, or irregular), calcification, cystic or necrotic changes, and enhancement pattern (homogeneous or heterogeneous). The difference and discriminating performance between low-risk (types A, AB, and B1) and high-risk (types B2 and B3) thymomas were statistically assessed. Interobserver agreement was determined using the concordance correlation coefficient. RESULTS. Twenty-three low-risk and 21 high-risk thymomas were identified on the basis of pathologic findings. The median values of sphericity and ellipsoidality were significantly higher for low-risk thymomas than for high-risk thymomas (for sphericity, 0.566 vs 0.517; for ellipsoidality, 0.941 vs 0.875; p < 0.05 for both). The AUC values of sphericity and ellipsoidality were 0.704 and 0.712, respectively. The best cutoff values were 0.528 and 0.919 for sphericity and ellipsoidality, respectively. Risk assessment combining these cutoff values and the mode of tumor detection (incidental detection or detection based on the presence of symptoms) improved the AUC value to 0.856 (sensitivity, 81.0% [17 of 21 patients]; specificity, 82.6% [19 of 23 patients]). All 3D shape parameters showed almost perfect interobserver agreement (concordance correlation coefficient, > 0.90). The visual CT findings were not significantly different between low- and high-risk thymomas (p > 0.05 for all). CONCLUSION. Quantitative 3D shape analysis has excellent reproducibility, and combining this technique with information on the detection mode helps differentiate low- from high-risk thymomas.

[A Case of Squamous Cell Carcinoma with Negative Conversion of ER Status after Endocrine Therapy in an Elderly Woman].

We report the case ofan elderly patient with squamous cell carcinoma(SCC)ofthe breast, which showed negative conversion after endocrine therapy. An 82-year-old woman with a diagnosis ofER -positive SCC(cT1N0M0, StageⅠ)received primary endocrine therapy with 5 hormonal medicines. Following the endocrine therapy, she underwent mastectomy and axillary node resection. Histological examination confirmed a diagnosis of ER-negative SCC. At 10 months after the operation, she was doing well with no evidence ofdisease without postoperative adjuvant therapy. Thus, clinicians should be aware that the ER status may change after primary endocrine therapy. For elderly patients with breast cancer, it is important to be aware that primary endocrine therapy can become ineffective due to ER-negative conversion and aging due to prolonged treatment.