Intrapulmonary lymph nodes: thin-section CT findings, pathological findings, and CT differential diagnosis from pulmonary metastatic nodules.

We compared the thin-section CT findings of 11 intrapulmonary lymph nodes with pathological findings and evaluated the possibility of CT scan differential diagnosis from pulmonary metastatic nodules. First, we retrospectively reviewed CT scan and pathological findings of intrapulmonary lymph nodes. The median size of these nodules was 6.2 mm. The nodules appeared round (n=3) or angular (n=8) in shape with a sharp border, and they were found below the level of the carina. The median distance from the nearest pleural surface was 4.6 mm, and 3 of the 11 nodules were attached to the pleura. On thin-section CT scan, linear densities extending from the intrapulmonary lymph nodes were frequently visualized, and were pathologically proven to be ectatic lymphoid channels. We then compared the thin-section CT findings of 8 metastatic nodules less than 1 cm in diameter with those of the 11 intrapulmonary lymph nodes. The median size of these nodules was 6.8 mm, and the median distance from the nearest pleural surface was 16 mm. All nodules appeared round in shape. None of the nodules had linear densities extending from the nodules. The linear densities on thin-section CT scan may be the most useful characteristic of intrapulmonary lymph nodes, when differential diagnosis from metastatic nodules is necessary.</p

Percutaneous sclerotherapy for venous malformations using polidocanol under fluoroscopy.

This retrospective study evaluated the safety and efficacy of using polidocanol with X-ray fluoroscopy for percutaneous sclerotherapy of venous malformations of the limbs, head, and neck. The subjects were 16 of 18 patients who presented to our department with venous malformations. Two patients were excluded because they were unlikely to benefit from the treatment. Of the 16 included in the study, 1 could not be treated because of inaccessibility, and another was lost to follow-up. Among the 14 cases that we were able to follow-up, 11 cases had had pain as their primary symptom. Following treatment, this symptom remained unchanged in 1 patient, was improved in 4, and had disappeared in 6; however, there was a recurrence of pain for 3 of these patients. Two patients had sought treatment for cosmetic purposes; following treatment, the lesion disappeared in one and showed a significant reduction in the other. The remaining patient presented with a primary symptom of mouth bleeding, which disappeared following treatment. There were no critical complications. Percutaneous sclerotherapy of venous malformations using polidocanol is safe and effective, and permits repeat treatments. The efficacy is especially good for resolving pain, and complications are minor. It is desirable to use fluoroscopy for these procedures</p

Recanalization 24 months after endovascular repair of a large internal iliac artery aneurysm with use of stent-graft.

An 83-year-old man with a large internal iliac artery aneurysm (IIAA) was treated with the use of stent-graft, suggesting successful results at 3, 6, and 12 months after treatment. However, 24-month follow-up computed tomography showed minor peripheral opacification of the IIAA. The patient underwent surgical endoaneurysmorrhaphy. No previous report of long-term recanalization of a satisfactorily thrombosed iliac artery aneurysm at 2 years or more after stent-grafting has been previously reported. Further follow-up studies need to be performed on the present procedure before anyone can confidently recommend it in regard to its long-term safety.</p

Dynamic contrast-enhanced MRI for the prediction of volumetric response of uterine leiomyomas following uterine artery embolization

　This study aimed to evaluate the utility of using contrast enhancement (CE) effects of uterine leiomyoma in dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) as a predictor of uterine leiomyoma volume reduction (VR) following uterine artery embolization (UAE). We retrospectively studied 22 women who underwent pre-UAE pelvic MRI with DCE-MRI and post-UAE pelvic MRI without DCE-MRI. The MRI sequences included conventional and fat-suppressed DCE-MRI. Percent volume response was determined using axial and sagittal T2-weighted imaging. The ratio between the signal intensity (SI) of the leiomyoma and that of the psoas major or iliopsoas muscle (SI ratio) was used to measure CE. In addition, the ratio of change in CE ratio during DCE-MRI was used to assess the CE pattern. We divided the target leiomyomas into two groups according to the volume reduction (VR) rate. Next, we examined whether there was a significant correlation between VR rate and SI ratio in each phase on DCE-MRI, we also assessed the ratio of change in CE ratio during DCE-MRI, age, and pre-UAE leiomyoma volume using the Mann–Whitney U test. We grouped leiomyomas in 10% increments from 50% to 90%, VR rates and decided to perform a total of five statistical tests. A total of 57 leiomyomas with preprocedural volumes ranging from 6.27 to 949.15 cm3 (135.20 ± 197.33 cm3 ) were included. The time between UAE and follow-up MRI was 3 - 14 months (mean, 9.09 months). The leiomyoma VR rate following UAE ranged from -85.51% to 99.94% (55.3 ± 33.85%). We found that between leiomyomas with VR rate of ≥ 90% and those with VR rate of < 90%, there was a significant difference in SI ratio at 35 sec after contrast material injection (CMI) (p = 0.0499), the ratio of change in CE ratio from 35 to 60 sec after CMI (p = 0.0153), and the ratio of change in CE ratio from 35 to 80 sec after CMI (p = 0.0185). Thus, DCE-MRI can be considered an effective and predictive tool for the therapeutic effect of UAE