Resovist-Enhanced MRI for Preoperative Assessment of Colorectal Hepatic Metastases: A Case of Multiple Bile Duct Hamartomas Associated with Colon Cancer

Extensive preoperative assessment of hepatic metastases is required in colon cancer patients. We report a case in whom the preoperative investigation by ultrasound scan and contrast-enhanced computed tomography revealed numerous cystic lesions of the liver, suspicious of von Meyenburg complex. Magnetic resonance and magnetic resonance cholangiographic images demonstrated typical features of von Meyenburg complex. Further Resovist-enhanced magnetic resonance imaging detected two hemangiomas in addition to the multiple cystic lesions. So-called Kupffer cell imaging strongly helped the detection of these hemangiomas, and a combination of various magnetic resonance pulse sequences was of great value for the differential diagnosis of cystic lesions and hemangiomas. In cases in whom conventional imaging studies fail to give a definite diagnosis, such as in the present case, superparamagnetic iron oxide-enhanced magnetic resonance imaging is meaningful for adequate preoperative staging

Prognosis of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus:Assessment Based on Clinical and Computer Tomography Characteristics

Patients with hepatocellular carcinoma (HCC) complicated by portal vein tumor thrombus (PVTT) have an extremely poor prognosis. It is important to select adequate therapeutic options based on reliable prognostic factors using imaging studies and clinical data. Prognostic factors were analyzed in patients with HCC with PVTT in the first branch or main trunk of the portal vein. From 2000 to 2007, 107 consecutive patients with HCC with PVTT in the major portal vein were reviewed, and diagnostic images and clinical characteristics were retrospectively observed. Thirty-eight possible prognostic factors for survival were analyzed by the log-rank test and multivariate analysis using Coxʼs proportional hazards model. Median overall survival was 14 months following PVTT diagnosis. Survival rates at 6 months, 1, 2, and 3 years were 72.1%, 52.6%, 32.6%, and 29.6%, respectively. Independent prognostic factors for longer survival included:patient age ＜65 years, Child-Pugh classification A/B, PVTT treatment, accumulation of Lipiodol in the PVTT after TACE, initial radical treatment for HCC, HCC located in a single lobe of the liver, and no invasion of HCC to the hepatic vein or bile duct. Survival was associated with liver function, tumor extension, and treatment for HCC and PVTT

Lateral–Medial Dissociation in Orbitofrontal Cortex–Hypothalamus Connectivity

The orbitofrontal cortex (OFC) is involved in cognitive functions, and is also closely related to autonomic functions. The OFC is densely connected with the hypothalamus, a heterogeneous structure controlling autonomic functions that can be divided into two major parts: the lateral and the medial. Resting-state functional connectivity has allowed us to parcellate the cerebral cortex into putative functional areas based on the changes in the spatial pattern of connectivity in the cerebral cortex when a seed point is moved from one voxel to another. In the present high spatial-resolution fMRI study, we investigate the connectivity-based organization of the OFC with reference to the hypothalamus. The OFC was parcellated using resting-state functional connectivity in an individual subject approach, and then the functional connectivity was examined between the parcellated areas in the OFC and the lateral/medial hypothalamus. We found a functional double dissociation in the OFC: the lateral OFC (the lateral orbital gyrus) was more likely connected with the lateral hypothalamus, whereas the medial OFC (the medial orbital and rectal gyri) was more likely connected with the medial hypothalamus. These results demonstrate the fundamental heterogeneity of the OFC, and suggest a potential neural basis of the OFC-hypothalamic functional interaction

Nipple-centered Radiate M PR Images of M DCT for Evaluation of Breast Cancer Extent ― Correlation with M ammography and Pathologic Specimen ―

Background & Aims : Evaluation of the extent of breast cancer lesions is important for selecting the appropriate surgical procedure or to determine the surgical margin. We aimed to assess the diagnostic accuracy of nipple-centered radiate multiplanar reconstruction (NRMPR)images using multidetector row helical computed tomography (MDCT), comparing it with conventional mammography. M ethods : Our subjects were 26 breast cancer patients with a total of 29 lesions who sequentially received contrastenhanced MDCT imaging for preoperative evaluation. We measured the maximum diameter of the breast cancer in the direction toward the nipple on NRMPR images and mammography. All data were correlated with histopathological mapping of the specimens. Results : The tumor extent measured on NRMPR images and in pathological examinations ranged from 12.4 to 66.0mm (average, 28.0mm) and 10 to 70mm (average, 27.9 mm), respectively. The correlation coefficient of the two measurements was 0.898. On mammography, two lesions were not clearly identified. The correlation coefficient of mammography and pathological measurements was 0.554. Conclusions : The addition of NRMPR images to mammography provides more information to evaluate breast cancer extension toward the nipple. Potentially, it provides a clue for selecting the appropriate surgical procedure or surgical resection margin for breast cancer