Malignant transformation of diffuse infiltrating glial neoplasm after prolonged stable period initially discovered with hypothalamic hamartoma

We present a case of malignant transformation of diffuse infiltrating glial neoplasm after a prolonged stable period on magnetic resonance imaging (MRI) and spectroscopy (MRS) initially discovered with a hypothalamic hamartoma. Although MRI and MRS suggest the possibility of malignant transformation in future, they cannot precisely predict the timing of rapid growth

膵癌肝転移の画像的特徴の解明: 臨床病理組織学的検討との対比

画像診断で膵癌の肝転移と診断された53例が対象。男性28例、女性25例、年齢は平均66歳(43歳〜83歳)。【成績】画像上肝転移を認めた53例中50例(94%)は多発例であった。53例中31例(58%)ではすべての転移巣はダイナミックCTあるいはダイナミックMRIで腺癌に特徴的なリング状濃染を呈した。53例中18例(34%)では少なくとも1個以上の転移巣でリング状濃染を示す腫瘤に連続してAP shunt様の楔状濃染が認められた。4例(8%)では多発性のAP shunt様の楔状濃染のみが画像上描出された。この4例では単純なAP shuntであるか肝転移であるかが鑑別上問題となったが、経過観察で腫瘍の存在が明らかとなり肝転移と診断された。結局、楔状濃染の所見は53例中22例(42%)に認められた。【結論】膵癌の肝転移の多くは多発性であり、しかも高率にAP shunt様の楔状濃染を伴うことが明らかとなった。これは膵癌の肝転移が他の悪性腫瘍の肝転移と比べて肝内の末梢門脈枝に微小な腫瘍塞栓を形成したりあるいはグリソン鞘へ浸潤する傾向が強いためと推測される。特に膵癌患者で肝内にAP shuntを認めた場合には腫瘍自体が描出されなくとも肝転移の可能性があることを認識する必要がある。OBJECTIVE. We aimed to evaluate the imaging findings of hepatic metastases from pancreatic carcinomas, especially wedge-shaped enhancement and its etiology.MATERIALS AND METHOD. Dynamic CT and MR images were performed in 87 patients with liver metastases from pancreatic carcinomas, and CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) in 51 patients.RESULTS. In 37 patients, more than one metastatic lesions accompanied with wedge-shaped enhancement on dynamic studies and CHTA, and wedge shaped perfusion defect on CTAP. Six patients showed multiple wedge-shaped enhancement which was initially diagnosed as multiple arterioportal shunts (AP shunts). However, metastatic tumors appeared within the area of wedge-shaped enhancement on follow-up CT and/or MR images After all, 43 of 87 patients (49%) had AP shunt like contrast enhancement adjacent to liver metastases.CONCLUSION. Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as nontumorous arterioportal shunts.研究課題/領域番号:16591191, 研究期間(年度):2004-2005出典：「膵癌肝転移の画像的特徴の解明: 臨床病理組織学的検討との対比」研究成果報告書　課題番号16591191 (KAKEN：科学研究費助成事業データベース（国立情報学研究所）)　　　本文データは著者版報告書より作

膵癌に関する脂肪抑制法併用T1強調像ならびにダイナミックMRIの有用性の検討

取得学位 : 博士（医学）, 学位授与番号 : 医博乙第1334号, 学位授与年月日：平成7年3月1日,学位授与年：199

Radiologic manifestation of hepatic pseudolesions and pseudotumors in the third inflow area

金沢大学附属病院放射線科We sometimes encounter hepatic pseudolesions and pseudotumors of the third inflow area on imaging. Generally, to differentiate these lesions of true hepatic neoplasm on radiological examinations are easy with the knowledge of common site in the liver and characteristic findings of these lesions. However, it occasionally mimic hepatocellular carcinoma in various imaging modalities. In this article, we are going to provide current knowledge about pseudolesions and pseudotumors in the third inflow area on imaging. To have knowledge about pseudolesions and pseudotumors in the third inflow area can aid in correct diagnosis and avoid unnecessary treatment

Imaging diagnosis of hepatic metastases of pancreatic carcinomas: Significance of transient wedge-shaped contrast enhancement mimicking arterioportal shunt

金沢大学医薬保健研究域医学系We aimed to evaluate the imaging findings of hepatic metastases from pancreatic cancers, especially wedge-shaped enhancement and its etiology. Dynamic CT and MR images were performed in 87 patients with liver metastases from pancreatic carcinomas, and CT during arterial portography (CTAP) and CT during hepatic arteriography (CTHA) in 51 patients. Liver metastases were multiple in 84 patients (97%) and solitary in only three (3%). In 44 of 87 patients (51%), all liver metastases showed ring-like enhancement compatible with metastatic adenocarcinomas on dynamic CT and/or dynamic MR imaging. In 37 patients, more than one metastatic lesion showed wedge-shaped contrast enhancement on dynamic CT, dynamic MRI and CTHA, and wedge-shaped perfusion defect on CTAP adjacent to metastatic tumors. Six patients showed multiple wedge-shaped enhancements, which were initially diagnosed as multiple arterioportal shunts (AP shunts). However, metastatic tumors appeared within the area of wedge-shaped enhancement and increased in size on follow-up CT and/or MR images. After all, 43 of 87 patients (49%) had AP shunt like contrast enhancement adjacent to liver metastases. Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as nontumorous arterioportal shunts. © 2007 Springer Science+Business Media, LLC

IgG4-Related Perineural Disease

Aims. To elucidate characteristics of IgG4-related disease involving the peripheral nervous system. Methods. Retrospective review of 106 patients with IgG4-related disease identified 21 peripheral nerve lesions in 7 patients. Clinicopathological and radiological features were examined. Results. Peripheral nerve lesions were commonly identified in orbital or paravertebral area, involving orbital (n = 9), optic (n = 4), spinal (n = 7), and great auricular nerves (n = 1). The predominant radiological feature was a distinct perineural soft tissue mass, ranging 8 to 30 mm in diameter. Histologically, the epineurium was preferentially involved by massive lymphoplasmacytic infiltration rich in IgG4+ plasma cells. All lesions were neurologically asymptomatic and steroid-responsive at the first presentation, but one recurrent lesion around the optic nerve caused failing vision. Conclusion. IgG4-related disease of the peripheral nervous system is characterized by orbital or paravertebral localization, perineural mass formation, and rare neurologic symptoms. The term “IgG4-related perineural disease” seems appropriate to describe this entity

Confluent hepatic fibrosis in liver cirrhosis: Possible relation with middle hepatic venous drainage

Purpose: Our aim was to retrospectively analyze the location of confluent hepatic fibrosis in relation to the portal and hepatic venous anatomy using multidetector computed tomography (CT) and to clarify the influence of the hepatic venous drainage on confluent fibrosis. Materials and methods: The study population consisted of 879 patients diagnosed with cirrhosis: 539 men and 340 women (65.9 ± 10.6 years) and 633 with Child-Pugh class A, 161 with class B, and 85 with class C. The cause of cirrhosis was hepatitis C (n = 528) and hepatitis B (n = 122) virus infection, alcoholism (n = 114), and others (n = 115). The confluent fibrosis was diagnosed using CT images according to previous reports and statistically analyzed (p < 0.05). Results: Thirty-five confluent fibrosis lesions in 30 patients (3.4 %) were identified. The predictive factors were alcoholic cirrhosis [odds ratio (OR), 7.25; p < 0.0001], Child-Pugh class C (OR, 6.95; p < 0.0001), and Child-Pugh class B (OR, 2.91; p < 0.0023). Confluent fibrosis was most frequently seen in the middle hepatic venous drainage area (n = 21) or at the boundary between the medial and anterior segments (n = 17), and each distribution of the location of confluent fibrosis was significantly unequal (p < 0.0001). Conclusion: Confluent fibrosis was most commonly located in the middle hepatic venous drainage area. © 2013 Japan Radiological Society

Long-term predictive factors of the morphology based outcome in bare platinum coiled intracranial aneurysms: Evaluation by pre- and post-contrast 3D time-of-flight MR angiography

Purpose Our aim was to identify long-term predictive factors of the morphology-based outcome (MBO) of bare platinum coiled intracranial aneurysms. Materials and Methods A retrospective analysis of 96 bare platinum coiled intracranial aneurysms followed up from 1997 to 2016 using pre- and post-contrast 3D time-of-flight MR angiography (MRA) was performed. Logistic regression analysis was used to identify factors associated with a positive history of surrounding coil mass enhancement (SCME) and poor MBO. Spearman's rank correlation test was used to analyze the relationship between the initial angiographic result (IAR) class, sequential change of the SCME category, and MBO grade. Results Factors independently associated with poor MBO were incomplete IAR (OR=14.94, 95%CI: 2.46, 289.21, P=0.002) and a history of SCME (OR=4.13, 95% CI: 1.05, 18.65, P=0.043). The MBO grade strongly correlated with the IAR class (correlation coefficient [r]=0.84, P&lt;0.0001). MBO grade correlated with sequential change of the SCME category (r=0.56, P&lt;0.0001). The sequential change of the SCME category correlated with IAR class (r=0.53, P&lt;0.0001). Conclusion Although IAR and its class were strong long-term predictive factors of MBO, a history of SCME and upgrading of sequential change of SCME category were also long-term predictive factors of the MBO of bare platinum coiled intracranial aneurysms

Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging findings of borderline lesions at high risk for progression to hypervascular classic hepatocellular carcinoma

金沢大学医薬保健研究域保健学系OBJECTIVES: The objectives of the study were to assess the imaging features of hypovascular borderline lesions containing hypervascular foci on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) and to evaluate the ability of Gd-EOB-DTPA-enhanced MRI to diagnose high-risk borderline lesions possibly consistent with early hepatocellular carcinoma (HCC). METHODS: Institutional review board approval was obtained for this retrospective analysis of imaging findings, and informed consent was obtained from 217 consecutive patients undergoing Gd-EOB-DTPA-enhanced MRI and angiography-assisted computed tomography (CT) for examination of hepatocellular nodular lesions in cirrhotic livers. There were 73 nodules showing hypervascular foci in borderline lesions identified by angiography-assisted CT. Signal intensity patterns of the nodules were evaluated on hepatobiliary-phase Gd-EOB-DTPA-enhanced T1-weighted MRI obtained 20 minutes after intravenous injection of contrast media. RESULTS: Among 73 high-risk borderline lesions, 59 were hypointense (81%), and 14 were isointense (19%), compared with background liver parenchyma. There were 27 untreated lesions followed by CT and/or MRI. Almost half of these nodules transformed into hypervascular HCC, regardless of signal intensities seen on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI. CONCLUSIONS: Although many high-risk borderline HCC lesions are hypointense on hepatobiliary-phase Gd-EOB-DTPA-enhanced MRI, some high-risk borderline lesions are isointense and transform at the same rate into hypervascular HCC. © 2011 Lippincott Williams & Wilkins, Inc

MDCT findings of extrapancreatic nerve plexus invasion by pancreas head carcinoma: correlation with en bloc pathological specimens and diagnostic accuracy

金沢大学医薬保健研究域Objective: To elucidate the multi-detector row computed tomography (MDCT) findings of extrapancreatic nerve plexus (PLX) invasion by pancreas head carcinoma (PhC) by "point-by-point" correlation with en bloc pathological specimens and to assess their diagnostic accuracy. Methods: Each pathological section of PhC and adjusted double oblique multiplanar reconstruction MDCT images were correlated in 554 sections from 37 patients. The diagnostic accuracy of the MDCT patterns derived was assessed by blind reading. Results: PLX invasion with fibrosis showed mass or strand shape (85.6%) or coarse reticula (13.3%). The CT findings were divided into fine reticular and linear, coarse reticular, mass and strand, and nodular patterns. PLX invasion was revealed pathologically in 92% of the regions of investigation showing the mass and strand pattern and 63% of the coarse reticular pattern (all continuous with PhC), and they were highly suggestive of PLX invasion by PhC on MDCT images (p < 0.001). Sensitivity, specificity, accuracy, and positive and negative predictive values of these MDCT findings in the diagnosis of PLX invasion were 100% (25/25), 83.3% (10/12), 94.6% (35/37), 92.6% (25/27) and 100% (10/10), respectively. Conclusion: The mass and strand pattern and the coarse reticular pattern continuous with PhC on MDCT images were highly suggestive of PLX invasion by PhC. © 2010 European Society of Radiology