Comparison of Magnetic Resonance Imaging Findings of Neuroendocrine and Non-neuroendocrine Ductal Carcinoma in Situ of the Breast

Neuroendocrine ductal carcinoma in situ of the breast（NE-DCIS）was recently recognized as a special subtype of DCIS, although the diagnostic criteria for NE-DCIS are yet to be established. DCIS is defined as the immunohistochemical expression of neuroendocrine markers chromogranin A and/or synaptophysin in over 50％ of tumor cells. Here, we investigated whether there are significant differences in magnetic resonance imaging（MRI）findings between NE-DCIS and non-NE-DCIS. The study sample comprised 8 lesions in 7 patients with breast NE-DCIS and 71 lesions in 69 patients with non-NE-DCIS who underwent preoperative MRI and histopathological diagnosis at our hospital from June 2010 to June 2012. The patients were females aged 34–85 years. We examined the lesion type, pattern of time-signal intensity curve（TIC）on dynamic contrast-enhanced MRI（DCE-MRI）, presence or absence of bloody duct ectasia delineation, and presence or absence of calcification on mammography（MMG）. Mass-type lesions were significantly more common in breast NE-DCIS than in non-NE-DCIS on MRI. On DCE-MRI, the TIC washout pattern was more commonly observed in NE-DCIS than in non-NE-DCIS, and although there was no significant difference in the rate of bloody duct ectasia delineation, it was relatively more common in NE-DCIS. MMG revealed a significant difference in calcification between non-NE-DCIS（60.1％）and NE-DCIS（0％）. Mass-type lesions and TIC washout pattern are significantly more common in patients with NE-DCIS than in those with non-NE-DCIS on MRI and DCE-MRI

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

Proton (1H) MR Spectroscopy of the Breast at 3.0T: Detectability of the Choline Peak of Breast Cancer in Comparison with a 1.5T Imager

1H-MR spectroscopy (MRS) of the breast demonstrated that choline could be detected in breast cancers. The purpose of this study was to evaluate the detectability of the choline peak (Tcho) in breast cancer using a 3.0T imager. A total of 52 female patients who underwent MR imaging were evaluated. Localization methods included the SVS and PRESS, with acquisition times of approximately 5 minutes. Correlations among tumor size, histological type, and the presence of Tcho were evaluated. Of 52 breast lesions that were pathologically diagnosed, 50 were malignant [45 invasive ductal carcinomas (IDC), five ductal carcinomas in situ (DCIS) ]and 2 were benign. The presence of Tcho was evaluated in 50 cases. The average diameter of malignant tumors was 2.2 cm and that of benign tumors was 1.9cm. Tcho was identified in 24 of 48 breast cancers (sensitivity 50%, specificity 100%). There was a significant difference between the identification in tumors according to tumor size. Tcho was identified in 76.9% of IDC cases with a diameter greater than the voxel size (1.5cm), while it was identified in only 17.6% of tumors less than 1.5cm in size. Tcho was identified in approximately 77% of breast cancer tumors overall with a diameter greater than the voxel size. The result was comparable with the detectability at 1.5T, although the acquisition times at 3.0T were much shorter than at 1.5T. The advantages at 3.0T include the ability to investigate smaller lesions within a shorter time frame

The Usefulness of Diffusion-weighted Imaging in Observing Localized Extension of Endometrial Cancer

Endometrial cancer is the seventh most common human malignancy and the most common form of cancer treated in women by obstetrics and gynecology departments. Until now, magnetic resonance imaging (MRI) has been used for pre-surgical evaluation of endometrial cancer and evaluating the depth of myometrial invasion, in addition to being a valuable diagnostic tool. Diffusion-weighted imaging (DWI) has been reported as useful in distinguishing between benign and malignant tumors when observing lesions in the endometrium. Subsequent reports suggest that DWI is also effective in identifying malignancy and diagnosing local extension in a range of tissues. Based on this, we implemented a study of the effectiveness of DWI in identifying local extension of endometrial cancer. This study enrolled patients undergoing surgery at this hospital for cancer of the uterine body during the six years from January 2008 to February 2014. Cases in which images were unclear or the lesions were too small to be described by MRI examination were excluded, leaving 61 patients in the study. Using the results from pre-surgical MRI, a sequence comprising a T2-weighted axial view alone and a T2-weighted axial view to which a diffusion-weighted axial view had been added was created for each patient. Two radiologists then independently examined the image sequence to determine localized extension. Following surgery, the pre-surgical assessment was compared to the localized extension determined by histopathology of post-surgical samples to evaluate the effectiveness of adding diffusion-weighted imaging to the process. The first radiographic interpreter\u27s rate of correct diagnosis using the T2-weighted axial view alone was 45 out of 55 cases (81.8%), while using the T2-weighted axial view to which a diffusion-weighted axial view had been added gave a correct diagnosis rate of 51 out of 55 cases (92.7%). The second radiographic interpreter\u27s rate of correct diagnosis using the T2-weighted axial view alone was 41 out of 55 cases (74.5%), while using the T2-weighted axial view with diffusion-weighted axial view added gave a correct diagnosis rate of 51 out of 55 cases (92.7%). These differences were statistically significant based on the McNemar testing. This study confirmed that DWI is an effective means of diagnosing localized extension from images. It is anticipated that DWI will be used in the future clinical workplace to provide more accurate pre-surgical diagnoses

Comparison of 1.5 T(Tesla) and 3.0 T(Tesla) Magnetic Resonance Imaging for Evaluating Local Extension of Endometrial Cancer

Magnetic resonance imaging (MRI) is an important means of evaluating local extension of endometrial cancer. The 3.0 Tesla (T) MRI system introduced in 2005 improved the diagnostic capabilities of this modality due to an increased signal to noise ratio; however, it was also susceptible to artifacts and debate remains regarding the clinical applicability of 3.0 T MRI in the pelvic region. A few reports have compared 1.5 T and 3.0 T MRI for determining the degree of progression of endometrial cancer. Therefore, we conducted a comparative study of the diagnostic capability of 1.5 T and 3.0 T MRI for the local extension of endometrial cancer. Over the 6 years and 8 months from 1 January 2008 to 30 August 2014, preoperative MRI has been conducted at our hospital including T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced MRI for cases of endometrioid adenocarcinoma requiring surgery. We investigated 60 subjects after excluding cases for which the tumor could not be imaged and cases that underwent surgery 2 months or more after undergoing MRI. Two radiologists used magnetic resonance images taken preoperatively to determine local extension using T2-weighted, diffusion-weighted, and dynamic-study images. Results for local extension were compared with those of postoperative histopathology. Results indicated no significant difference in accurate diagnosis rates between 1.5 T and 3.0 T MRI for any of the imaging modalities examined by both radiologists

A Study of Correlation between Gd-EOB-DTPA-enhanced MRI Using the 3T MRI System and Tc-99m-GSA Hepatic Scintigraphy / Hepatic Function Tests in Prehepatectomy Cases

This study compared results from Gd-EOB-DTPA on two different phases of 3T MRI with those from Tc-99m-GSA hepatic scintigraphy and hepatic function tests. Twenty-four patients with liver tumor were included in this study. All patients underwent Gd-EOB-DTPA-enhanced-MRI and Tc-99m-GSA hepatic scintigraphy. Clearance index (HH15) and receptor index (LHL15) were calculated for the Tc-99m-GSA, while signal intensities (SI) of liver at pre-injection and at 4/20min post-injection, and of spleen at 4 min/20min were measured (SIpre, SI4min, SI20min, SIsp4min, SIsp20min, respectively) for the Gd-EOB-DTPA-MRI. Liver activity at 15min by Tc-99m-GSA scintigraphy or biochemical liver function values were compared with liver spleen contrast at 4min (LSC4min = SI4min/SIsp4min) or 20min post-injection (LSC20min = SI4min/SIsp20min), and the increase in ratio at 4min (IR4min=SI4min/SIsp4min) or 20min (IR20min= SI20min/SIpre). Total bilirubin levels (T-bil), serum albumin levels (Alb), prothrombin activity, and the indocyanine green clearance test (ICG) results were also analyzed. There were statistically significant correlations in all comparisons between Gd-EOB-DTPA and Tc-99m-GSA. The highest coefficient of correlation was obtained in IR4min (LHL15: r = 0.795, P<0.001; HH15: r = -0.782, P<0.001), with IR20min (LHL15: r = 0.690, P<0.01; HH15: r = -0.528, P<0.05), LSC4min (LHL15: r = 0.458, P<0.05; HH15: r = -0.626, P<0.05), and LSC20min (LHL15: r = 0.443, P<0.05, HH15: r = -0.609, P<0.05) also significantly correlated. Correlations in hepatic function data were observed between IR4min and T-bil/Alb, and IR20min and Alb. In 3T-MRI using Gd-EOB-DTPA, the SI of liver at pre- to post-injection (especially at 4 min) significantly correlated with the corresponding Tc-99m-DTPA scintigraphy results, and with some biochemical liver function data

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

Clinical Significance of Reverse Redistribution Phenomenon for 201Tl Scintigraphy in Nonischemic Disease

The reverse redistribution phenomenon (RR) on 201Tl SPECT has been focused mainly on ischemic improvement regions after reperfusion therapy or vasospastic angina pectoris. However, RR analysis has not been used in the context of non-ischemic disease. The aim of this study was to evaluate the clinical role of RR on 201Tl SPECT in patients without a history of myocardial ischemia. We retrospectively enrolled 86 patients showing RR by myocardial perfusion SPECT and studied 75 other patients as a control group. For quantitative analysis, each 201Tl SPECT polar map was divided into 13 segments. Differences between the RR and control group were assessed with respect to patient characteristics and cardiac event-free survival using the Kaplan-Meier method. RR was detected frequently in the inferoposterior wall, septal portion of the anterior wall, and septum. The two groups showed signi_cant differences in rates of heart failure (P ＜ 0.01), hypertrophic cardiomyopathy (P ＜ 0.05), and wall motion abnormality (P ＜ 0.05), but not in the rate of event occurrence. The study demonstrated that RR on 201Tl SPECT could indicate the existence of myocardial damage ; however, it would not be a factor that determines the prognosis