Comparison of CT Urography and MRI in Bladder Cancer Detection

A final diagnosis of bladder cancer is made based on a pathological assessment using cystoscopy and biopsy. Recently, computed tomography (CT) and magnetic resonance imaging (MRI) have become widely used as screening tests for hematuria, and there are scattered reports of new imaging modalities such as CT urography (CTU) and diffusion-weighted MRI being useful in the detection of bladder cancer. However, there are no reports comparing CTU and MRI in this context. In the present study, we compared the bladder cancer detection abilities of CTU and MRI. We analyzed 58 cases of bladder cancer that had been examined by both CTU and bladder MRI. The objects of comparison were T2-weighted images and diffusion-weighted images for MRI and contrast CT images of the renal parenchyma and excretory phases for CTU. Bladder cancer was confirmed histopathologically via either biopsy or surgery for all cases. For patients with multiple bladder cancer, up to three lesions per case were included in the analysis. Two independent readers assessed all cases. Out of 91 lesions from 58 cases, Reader 1 detected 72 (79.1%) and 65 cases (71.4%), and Reader 2 detected 69 (75.8%) and 70 (76.9%), using MRI and CTU, respectively. The κ-values for Reader 1 versus Reader 2 were 0.780 for MRI and 0.857 for CT, showing high diagnostic consistency. MRI showed a higher lesion detection rate than CTU, but this difference was not statistically significant. This study showed no significant difference in bladder cancer detection rate between CTU and MRI, confirming the value of MRI in the clinical diagnosis of bladder cancer

The Usefulness of C-arm CBCT-guided Abscess Drainage with A Flat-panel Detector

Herein we report our experience with a C-arm cone beam computed tomography (CBCT)-guided abscess drainage procedure. We retrospectively examined the medical records and imaging results of patients whose abscesses were drained between 2005 and 2010 employing this system. We analyzed the technical success rate and incidence of procedure-related complications. Percutaneous abscess drainage using C-arm CBCT was performed using a flat-panel detector digital subtraction angiography (DSA) system on 104 lesions in 97 patients (55 men, 42 women) with a mean age of 64.7 (30-88) years. The drainage procedure was performed twice in 6 patients and 3 times in 2 patients, and 6 patients received 2 or more punctures at the same time. The technical success rate with this procedure was 98.1% (102 of 104 lesions). Placement of the drainage tube was abandoned in 2 patients due to difficulty in inserting a wire into the abscess cavity in 1 case and difficulty looping the wire in the other. The incidence of procedure-related complications was 3.85% (4 of 104 lesions). Our retrospective study and review of the relevant literature revealed that the C-arm CBCT-guided abscess drainage procedure examined was generally safe for patient use, showed a high technical success rate and low incidence of procedure-related complications, and was useful for abscesses that were inaccessible using other instruments. Although C-arm CBCT has limited contrast resolution, this disadvantage is easily overcome by comparing images with those obtained using other modalities

Investigating of the Usefulness of Multidetector-row Computed Tomography for Diagnosing Abdominal Visceral Pseudoaneurysms

Abdominal visceral pseudoaneurysms are rare, but rapid diagnosis is clinically important because of the associated conditions that are often fatal. Multidetector-row computed tomography (MDCT) is important in the diagnosis and treatment of many human conditions. This study thus sought to investigate the usefulness of MDCT for diagnosing abdominal visceral pseudoaneurysms. We retrospectively assessed the MDCT diagnosis of pseudoaneurysms and identification of the responsible vessels or cases diagnosed with an abdominal visceral pseudoaneurysm via angiography. The study comprised 35 patients who underwent MDCT preoperatively and in whom angiography detected an abdominal visceral pseudoaneurysm over a 7-year period. Using the angiography findings as the gold standard, we investigated whether a pseudoaneurysm and the responsible vessel could be diagnosed using preoperatively imaged MDCT findings. For angiography and MDCT, diagnosis was reached on the basis of two radiologists\u27 agreement. Of 35 patients (28 males and 7 females), the median subject age was 67 years (range: 22–84 years). We found that MDCT could preoperatively detect abnormal findings such as hematomas in all patients. MDCT detected the presence of a pseudoaneurysm in 88.6% (31/35) of patients and identified the responsible vessel in 71% (25/35) of patients. In 6 patients, MDCT findings could successfully reveal both the pseudoaneurysm and the extravasation. MDCT was effective for diagnosing abdominal visceral pseudoaneurysms and it could be useful for determining treatment strategies and aiding treatment techniques in such patients

Clinical Outcomes and Prognostic Factors Associated with Survival after Balloon-occluded Retrograde Transvenous Obliteration of Gastric Varices

We evaluated clinical outcomes and prognostic factors associated with survival after balloon-occluded retrograde transvenous obliteration (B-RTO) of gastric varices in patients with portal hypertension. Of 50 patients with gastric varices who underwent B-RTO, 46 (94.0%) patients in whom B-RTO was technically successful were reviewed retrospectively. Gastric and esophageal varices after B-RTO were evaluated by contrast-enhanced computer tomography and endoscopy, respectively. Liver function parameters and Child-Pugh scores were estimated before and at 1 year after B-RTO. The cumulative survival rate was calculated, and univariate and multivariate analyses were used to assess the prognostic factors. No major complications occurred in any of the patients following B-RTO and no recurrence or bleeding of gastric varices was noted. Of the 42 patients who were followed up for the progression of esophageal varices, 13 (31.0%) had worsened varices and of these, 6 (14.3%) showed bleeding. Prothrombin activity had significantly improved at 1 year after B-RTO, although there were no changes in other liver function parameters. The overall cumulative survival rates at 1, 3, and 5 years after B-RTO were 91.6%, 70.9%, and 53.6%, respectively. Multivariate analysis identified the occurrence of advanced hepatocellular carcinoma (HCC) during the observation period as a prognostic factor for survival (hazard ratio = 4.1497, 95% CI = 1.32314-13.0319, P = 0.0148). B-RTO of gastric varices is an effective treatment ensuring lower recurrence and bleeding rates; however, these patients require careful observation for progression of esophageal varices. The management of HCC is crucial for achieving long-term survival after B-RTO

DDD Pacing Therapy Could Serve as a Dual Purpose Treatment in Hypertrophic Obstructive Cardiomyopathy —A Case Report Which Suggests the Importance of Lead Position and the Mechanism—

We treated a patient with hypertrophic obstructive cardiomyopathy (HOCM) who underwent DDD pacing therapy. He suffered from attacks of paroxysmal atrial fibrillation (PAF) complicated by sick sinus syndrome. Initially, we were unable to decrease the left ventricular outflow tract (LVOT) gradient by pacing from the mid-distal portion of the right ventricular (RV) septum. However, by changing the pacing site to the apical portion guided by right ventriculography, it was possible to decrease the LVOT gradient and at the same time reduce the mitral regurgitation. Tissue Doppler imaging (TDI) revealed a marked motion delay of the ventricular septum during DDD pacing. The mechanism of the therapy for HOCM provided by the DDD pacing was clearly confirmed by TDI. Furthermore, a dramatic effect of preventing symptomatic PAF with the use of overdrive pacing in the region of Bachmann's bundle was also observed. This case report provides new insight into DDD pacing therapy for patients with HOCM