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Atsukawa N, Nakai G, Omura S, Yamamoto K, Yamada T, Ohmichi M, Osuga K. Imaging features of mucinous carcinoma arising from mature teratoma showing cytokeratin 7+ and cytokeratin 20+ expression profile: A case report. Radiol Case Rep 2024; 19:1288-1293. [PMID: 38292777 PMCID: PMC10825558 DOI: 10.1016/j.radcr.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/01/2024] [Indexed: 02/01/2024] Open
Abstract
Ovarian mature teratomas are benign, but malignant transformation can occur infrequently, especially in women of advanced age. The tissue that undergoes malignant change is mostly squamous cell carcinoma, although adenocarcinoma has been reported in a small number of cases. The immunostaining results of adenocarcinoma usually show a cytokeratin (CK)7-/CK20+ expression profile, corresponding to lower gastrointestinal tract origin. In this report, we describe a case of mucinous carcinoma arising from an ovarian mature teratoma showing a CK7+/CK20+ profile and discuss its imaging features. A 40-year-old woman presented to her primary care physician with abdominal distension and poor oral intake, and she was referred to our hospital. She had been diagnosed with an ovarian mature teratoma at our institution 3 years earlier. At the current presentation, pelvic magnetic resonance imaging showed a large multilocular cystic mass with adipose tissue extending into the upper abdomen. Densely packed cysts were observed inside the mass, which showed weak contrast enhancement on contrast-enhanced imaging and a mildly high signal on diffusion-weighted imaging. A portion of the cysts also showed abnormal 18F-fluorodeoxyglucose uptake (maximum standardized uptake value, 13.2) on positron emission tomography/computed tomography. The patient was subsequently diagnosed with mucinous carcinoma showing a CK7+/CK20+ profile arising from a mature teratoma by pathologic examination. This mucinous carcinoma arising from a mature teratoma showed a CK7+/CK20+ profile and took the form of densely packed multilocular cysts. In this respect, it was similar to primary ovarian epithelial mucinous carcinoma on both magnetic resonance imaging and pathologic examination despite showing a much higher maximum standardized uptake value than that of primary ovarian mucinous carcinoma. When a large ovarian teratoma contains a large multilocular cyst, the presence of densely packed multilocular cysts should not be missed even in a mass without solid components. Clinicians should consider the possibility of mucinous carcinoma showing a CK7+/CK20+ profile arising from a mature teratoma in such cases.
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Affiliation(s)
- Natsuko Atsukawa
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Go Nakai
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Shoko Omura
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynaecology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
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Yamamoto K, Yamamoto K, Nakai G, Fujitani T, Omura S, Azuma H, Osuga K. Detection of the Vesical Arteries Using Three-dimensional Digital Subtraction Angiography Relevant to Intra-arterial Infusion Chemotherapy for Bladder Cancer Using Double-balloon Catheters. Interv Radiol (Higashimatsuyama) 2023; 8:64-69. [PMID: 37485483 PMCID: PMC10359176 DOI: 10.22575/interventionalradiology.2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 07/25/2023]
Abstract
Purpose This study aims to assess and measure the origin of the superior vesical artery and its distance from the anterior trunk of the internal iliac artery, to which the anticancer drug is infused via double-balloon-occluded arterial infusion bladder-preserving therapy for locally invasive bladder cancer. Material and Methods The 160 pelvic sides of 80 patients were analyzed. Double-balloon catheters were bilaterally introduced into the contralateral superior gluteal artery via the internal iliac arteries using a bilateral transfemoral approach. The proximal balloon is placed at the internal iliac artery, proximally from superior gluteal artery bifurcation, whereas the distal balloon at the origin of the superior gluteal artery to isolate the anterior trunk of the internal iliac artery discharging to the targeted vesical arteries between the balloons. The side hole between the distal and proximal balloons was adjusted at the origin of the anterior trunk of the internal iliac artery to allow clear visualization of the angiographic flow into the bladder. After the distal and proximal balloons were inflated, three-dimensional rotational digital subtraction angiography was performed by simultaneous contrast injection from one extension tube connected to bilateral catheters. The distance (X) between the origins of anterior trunk of the internal iliac artery and superior vesical artery was measured on three-dimensional digital subtraction angiography images, and the origin of the inferior vesical artery was investigated. Results All superior vesical artery originated from anterior trunk of the internal iliac artery. The mean x was 7.2 mm (range 1.0-22.0 mm). All inferior vesical arterys branched from anterior trunk of the internal iliac artery or its branches. Conclusions Superior vesical artery commonly originates from the proximal portion of anterior trunk of the internal iliac artery close to superior gluteal artery bifurcation.
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Affiliation(s)
- Kiyohito Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Go Nakai
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Tomohiro Fujitani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Shoko Omura
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
| | - Haruhito Azuma
- Department of Urology, Osaka Medical and Pharmaceutical University, Japan
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, Japan
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Funakoshi M, Nakai G, Yamada T, Ohmichi M, Yamamoto K, Osuga K. Acute cervicitis resembling gastric-type mucinous adenocarcinoma that was definitively diagnosed by cervical conization: A case report. Radiol Case Rep 2023; 18:1767-1771. [PMID: 36923387 PMCID: PMC10009334 DOI: 10.1016/j.radcr.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 03/06/2023] Open
Abstract
Although imaging studies are not typically performed for clinical diagnosis of cervicitis, in this case magnetic resonance imaging (MRI) was performed because a lesion with a tumor-like gross appearance was found in the uterine cervix. We present a case of cervicitis in which clinical, imaging and pathological features overlapped with those of gastric-type mucinous adenocarcinoma (GAS). The patient, a 30-year-old woman, was referred to a gynecologist with a complaint of watery vaginal discharge. On visual examination, the uterine cervix was irregularly enlarged and bled easily, suggesting cervical cancer. The next day, the patient had a fever of 39°C and blisters appeared on her vulva due to herpes simplex virus type II infection. MRI showed a diffusely enlarged cervix with poorly marginated high signal intensity on T2-weighted imaging (WI) and apparent diffusion coefficient map as well as strong enhancement on contrast-enhanced T1WI, which are findings consistent with GAS. Although a punch biopsy showed only mild atypia of the cervical glands, this was not enough to completely rule out GAS. Consequently, laser conization of the lesion was performed for definitive diagnosis, and the diagnosis of cervicitis was made. Acute cervicitis can be difficult to differentiate from GAS based on symptoms, results of cervical biopsy and MR imaging because of their overlapping features. Even when a patient presents with a lesion with tumor-like gross appearance, acute cervicitis should be included in the differential diagnosis if the result of cervical biopsy is negative, especially when accompanied by infection-like fever.
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Key Words
- ADC, apparent diffusion coefficient
- Adenocarcinoma
- DWI, diffusion-weighted imaging
- Diagnostic Imaging
- FDG, fluorodeoxyglucose
- G, gravida
- GAS, gastric-type mucinous adenocarcinoma
- HSV, herpes simplex virus
- MRI, magnetic resonance imaging
- Magnetic Resonance Imaging
- Mucinous
- P, para
- PET-CT, positron emission tomography-computed tomography
- Positron-Emission Tomography
- STD, sexually transmitted disease
- TE, echo time
- TR, repetition time
- Uterine Cervicitis
- WI, weighted imaging
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Affiliation(s)
- Mai Funakoshi
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Go Nakai
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
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Matsutani H, Nakai G, Fujiwara S, Takahashi S, Yamamoto K, Ohmichi M, Osuga K. Frequency of thoracic recurrence based on pathological features in patients with ovarian epithelial tumors in stage I versus higher stages. Jpn J Radiol 2022; 41:500-509. [PMID: 36575285 PMCID: PMC10147781 DOI: 10.1007/s11604-022-01374-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
PURPOSE The aim of this study was to clarify the frequency of thoracic recurrence and identify associated pathological features in postoperative patients with borderline or malignant ovarian epithelial tumors (BMOT) in stage I versus higher stages. MATERIALS AND METHODS A total of 368 consecutive patients with a single primary BMOT were treated at our hospital. This study included the 217 patients with no residual disease on the first CT after standard treatment. The timing and pattern of recurrence on follow-up CT images with a scan range from chest to pelvis were evaluated retrospectively. Patient characteristics, tumor histology, and stage were recorded from electronic medical records. RESULTS After a median follow-up period of 48 months, recurrence was detected by CT in 9 patients in stage I (n = 159) and 15 in stage II/III (n = 58) (p = 0.0001). Thoracic recurrence was detected in four patients in stage I and four in stage II/III (p = 0.15). Abdominal recurrence was identified as a factor associated with thoracic recurrence (P < 0.001). Clear cell carcinomas accounted for three out of four thoracic recurrences in stage I and two out of four in stage II/III, and had the highest rates of thoracic recurrence (7.7% in stage I and 22.2% in stage II/III) among all histological types associated with thoracic recurrence. Among patients with recurrence, thoracic recurrence-free probability (p = 0.38), median abdominal recurrence-free interval (18 vs 16 months; p = 0.55) and thoracic recurrence-free interval (16.5 vs 23 months; p = 0.89) did not differ significantly between stage I and stage II/III. CONCLUSION The frequency and timing of thoracic recurrence did not differ significantly in postoperative patients with BMOT in stage I versus stage II/III. Abdominal recurrence and a histological type of clear cell carcinoma were most often associated with thoracic recurrence in stage I.
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Affiliation(s)
- Hiroki Matsutani
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Go Nakai
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Satoe Fujiwara
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Satoru Takahashi
- Department of Radiology, Takatsuki General Hospital, 1-3-13 Kosobecho, Takatsuki, Osaka, 567-1192, Japan
| | - Kazuhiro Yamamoto
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Keigo Osuga
- Department of Diagnostic Radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
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Higashino M, Abe S, Sawada M, Yamada H, Ayani Y, Haginomori SI, Kawata R, Matsuoka T, Nakai G, Osuga K, Tanaka E. Development of the Sphenoid Sinus in Japanese Children: A Retrospective Longitudinal Study Using Three-Dimensional Computed Tomography. J Clin Med 2022; 11:jcm11216311. [PMID: 36362538 PMCID: PMC9656594 DOI: 10.3390/jcm11216311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/20/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The sphenoid sinus (SS) is located close to vital structures, such as the pituitary gland, and it has significant clinical relevance. This study aimed to clarify the growth pattern of the SS in Japanese children using three-dimensional computed tomography (CT). Methods: Seventy-eight participants with congenital, acquired, or external auditory canal cholesteatoma were recruited and underwent CT more than twice during their treatment. Using the volume-rendered images, the size and volume of the SS were measured. Furthermore, on the scout image, the morphological measurements of the cranial base were determined. Results: The size and volume of the SS increased with age, and peaked at the mean age of 15 years. For males, the volume of the SS was smaller than that of females aged <5 years. The growth rate of the SS was significantly higher in males than in females. The maximum growth rate was detected at the age of 12 years for males and 10 years for females. For females, the increase in the length of the anterior cranial base ceased at approximately 10 years of age and remained constant thereafter. In contrast, for males, the length of the anterior cranial base increased gradually until 15 years of age. Conclusions: Considering the similarity of the periods between the adolescent growth spurt and the maximum growth rate of the SS, changes in the size of the SS may be used as an indicator of the physical growth spurt.
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Affiliation(s)
- Masaaki Higashino
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Susumu Abe
- Department of Comprehensive Dentistry, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8504, Tokushima, Japan
| | - Masaki Sawada
- Yamada Orthodontic Office, Izumiotsu 595-0025, Osaka, Japan
| | - Hiroshi Yamada
- Yamada Orthodontic Office, Izumiotsu 595-0025, Osaka, Japan
| | - Yusuke Ayani
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Shin-Ichi Haginomori
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology, Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Toshihiro Matsuoka
- Department of Diagnostic Radiology, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Go Nakai
- Department of Diagnostic Radiology, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Keigo Osuga
- Department of Diagnostic Radiology, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Osaka, Japan
| | - Eiji Tanaka
- Department of Orthodontics and Dentofacial Orthopedics, Tokushima University Graduate School of Biomedical Sciences, Tokushima 770-8504, Tokushima, Japan
- Correspondence: ; Tel.: +81-88-633-7356
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Nakai G, Tanaka Y, Yamada T, Ohmichi M, Yamamoto K, Osuga K. Can addition of frozen section analysis to preoperative endometrial biopsy and MRI improve identification of high-risk endometrial cancer patients? BMC Cancer 2021; 21:1178. [PMID: 34736433 PMCID: PMC8569997 DOI: 10.1186/s12885-021-08910-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background Surgeons sometimes have difficulty determining which result to favor when preoperative results (MRI + preoperative endometrial biopsy [pre-op EB]) differ from intraoperative frozen section histology (FS) results. Investigation of how FS can complement ordinary preoperative examinations like MRI and pre-op EB in identification of patients at high risk of lymph node metastasis (high-risk patients) could provide clarity on this issue. Therefore, the aim of this study is to assess the utility of pre-op EB, MRI and FS results and determine how to combine these results in identification of high-risk patients. Methods The subjects were 172 patients with endometrial cancer. Patients with a histological high-grade tumor (HGT), namely, grade 3 endometrioid cancer, clear cell carcinoma or serous cell carcinoma, or with any type of cancer invading at least half of the uterine myometrium were considered high-risk. Tumors invading at least half of the uterine myometrium were classified as high-stage tumors (HST). We compared (a) detection of HGT using pre-op EB versus FS, (b) detection of HST using MRI versus FS, and (c) identification of high-risk patients using MRI + pre-op EB versus FS. Lastly, we determined to what degree addition of FS results improves identification of high-risk patients by routine MRI + pre-op EB. Results (a) Sensitivity, specificity, and accuracy for detecting HGT were 59.6, 98.4 and 87.8% for pre-op EB versus 55.3, 99.2 and 87.2% for FS (P = 0.44). (b) These figures for detecting HST were 74.4, 83.0 and 80.8% for MRI versus 46.5, 99.2 and 86.0% for FS (P < 0.001). (c) These figures for identifying high-risk patients were 78.3, 85.4 and 82.6% for MRI + pre-op EB versus 55.1, 99.0 and 81.2% for FS (P < 0.001). The high specificity of FS improved the sensitivity of MRI + pre-op EB from 78.3 to 81.2%, but this difference was not statistically significant (P < 0.16). Conclusion Frozen section enables identification of high-risk patients with nearly 100% specificity. This advantage can be used to improve sensitivity for identification of high-risk patients by routine MRI + pre-op EB, although this improvement is not statistically significant.
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Affiliation(s)
- Go Nakai
- The department of diagnostic radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
| | - Yoshikazu Tanaka
- The department of diagnostic radiology, Tesseikai Neurosurgical Hospital, Shijonawate City, Osaka, Japan
| | - Takashi Yamada
- The department of pathology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Masahide Ohmichi
- The department of Obstetrics and Gynecology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Kazuhiro Yamamoto
- The department of diagnostic radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Keigo Osuga
- The department of diagnostic radiology, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
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Tanaka Y, Nakai G, Tomiyama H, Kurisu Y, Narumi Y. A case report of ectopic pancreatitis in an isolated enteric duplication cyst. BMC Surg 2019; 19:64. [PMID: 31215413 PMCID: PMC6582472 DOI: 10.1186/s12893-019-0531-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 06/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Isolated enteric duplication cyst is an intestinal duplication cyst found in a distant location from the intestinal tract and it is said to have its own blood supply. Meckel's diverticulm is considered as an antimesenteric structure and has its own blood supply. However, there are some reported cases of Meckele's diverticum in the mesenteric side. Ectopic pancreas may be found in both entities. CASE PRESENTATION A 5-year-old girl presented with increasing abdominal pain around the umbilicus. On laboratory investigation serum pancreatic enzymes and C-reactive protein were elevated. Abdominal computed tomography (CT) revealed a normal pancreas but a cystic lesion in the mesentery of the ileum. A nodule with a marked enhancement was observed in the wall of the lesion. During the laparoscopy, the lesion was found at the root of the mesentery and was distant from the ileum. The lesion was resected suspecting an abscess. Pathologically, the wall of the lesion consisted of small bowel like tissue, and pancreatic tissue was seen beneath the mucosa. There were some post inflammatory changes in the pancreatic tissue. Retrospectively on thin slice enhanced CT, an independent blood supply was noted. Based on these findings, a diagnosis of ectopic pancreatitis in an iliac intestinal duplication cyst was made. CONCLUSION Isolated enteric duplication cyst in the root of ileal mesentery and mesenteric Meckel's diverticulum have similarities. In the present case, the diagnosis of isolated enteric duplication cyst was made since it was found distant from the ileum. It is important to consider the possibility of ectopic pancreatitis when serum pancreatic enzymes are elevated even when the pancreas appears normal.
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Affiliation(s)
- Yoshikazu Tanaka
- Department of Radiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, Japan.
| | - Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, Japan
| | - Hideki Tomiyama
- Department of Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, Japan
| | - Yoshitaka Kurisu
- Department of Pathology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, Japan
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Matsutani H, Nakai G, Yamada T, Yamamoto K, Ohmichi M, Narumi Y. Diversity of imaging features of ovarian sclerosing stromal tumors on MRI and PET-CT: a case report and literature review. J Ovarian Res 2018; 11:101. [PMID: 30572921 PMCID: PMC6302382 DOI: 10.1186/s13048-018-0473-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 12/04/2018] [Indexed: 12/02/2022] Open
Abstract
Background Sclerosing stromal tumors (SST) are rare, benign tumors classified as sex cord stromal tumors. To our knowledge, positron emission tomography with computed tomography (PET-CT) findings of SST have only been described in one report and imaging findings on diffusion-weighted imaging (DWI) have only been described in three reports. Characteristic imaging features of SST on PET-CT and DWI have not yet been identified. Here we report a case of multilocular SST with solid components showing mild FDG uptake and slight hyperintensity on DWI, and reviewed the literature. Case presentation Seventeen-year-old woman presented with a complaint of abdominal pain and was admitted due to infectious colitis. Ultrasonography incidentally revealed a multiseptated cystic mass in the pelvis. Magnetic resonance imaging (MRI) showed a large multilobulated cystic mass with irregularly thickened septa and solid components originating in the left adnexa. On T2WI, the cystic components had the same signal intensity (SI) as water, and the irregularly thickened septa and solid components showed intermediate SI higher than the SI of the uterine myometrium. The septa and solid components also showed early strong enhancement on contrast-enhanced T1WI and slight hyperintensity on DWI. The PET-CT showed mild FDG uptake in the solid components of the tumor (SUV: 2.11). According to previous articles, the morphology of SSTs are various; solid mass, well-circumscribed multilobular mass, well-demarcated mass, and multilocular cysticmass. According to the reports describing DWI findings of SST, the SI varies from significant hyperintensity to slightly hyperintensity like in this case. Only one report describing PET-CT findings of SST showed intense FDG uptake (SUV max: 7.0). Conclusion The findings on DWI and PET-CT of our case and the past reports describing PET and DWI findings of SSTs are not consistent. The wide variety of the signal intensity on MRI and FDG uptake on PET could be due to the pathological diversity caused by the cellular areas undergoing collagenous sclerosis, which transforms the tumor into admixture of the collagen and the densely fibrous components with edema.
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Affiliation(s)
- Hiroki Matsutani
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Inada Y, Nakai G, Yamamoto K, Yamada T, Hirose Y, Terai Y, Ohmichi M, Narumi Y. Rapidly growing juvenile granulosa cell tumor of the ovary arising in adult: a case report and review of the literature. J Ovarian Res 2018; 11:100. [PMID: 30547828 PMCID: PMC6293549 DOI: 10.1186/s13048-018-0474-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/06/2018] [Indexed: 12/23/2022] Open
Abstract
Background Ovarian granulosa cell tumors (GCTs) are divided into adult GCT (AGCT) and juvenile GCT (JGCT). The AGCT is more common type, conversely, less than 5% of tumors are the JGCT and occur in mainly premenarchal girls and in women younger than 30 years. Although JGCT have different histologic features compared to AGCT, the two types have similar imaging features because they have similar gross appearance. Therefore, it is difficult to distinguish two types by radiologic findings. In addition, it has not been described about the growth rate of JGCTs in past literatures. The aims of this report were to describe a case of rapidly growing JGCT arising in adult with difficulty in diagnosing and to review the literatures. Case presentation A 38-year-old woman, presented with abdominal distension and frequent urination, was found to have a pelvic mass measuring approximately 12 cm on ultrasonography. On magnetic resonance imaging (MRI), right ovarian multiloculated cystic mass accompanied with hemorrhagic foci was demonstrated. Although the presumptive diagnosis of GCT was made based on MR findings, the intraoperative differential diagnoses included GCT, yolk sac tumor or malignant mucinous tumor due to cytologic atypia and lack of the typical findings for AGCT such as nuclear grooves and Call-Exner bodies. As a result, abdominal simple total hysterectomy, bilateral oophoro-salpingectomy, partial omentectomy and appendectomy were performed. Moreover, she had a history of laparoscopic uterine myomectomy about one year before, and during that surgery bilateral ovaries were found to be macrospically normal. Therefore, it was suspected the tumor became enlarged within the short period of time. Conclusions Even though it is difficult to distinguish two types of GCT by imaging findings, in some cases without typical findings for AGCT pathologically, MRI could provide useful information in accurately diagnosing JGCT. Moreover, in this case, the tumor growth rate seemed to be rapid regardless of its borderline malignant potential. It may be related with nuclear atypia and high mitotic rate of the tumor.
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Affiliation(s)
- Yuki Inada
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan.
| | - Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, 569-8686, Japan
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Nakamoto A, Yamamoto K, Sakane M, Nakai G, Higashiyama A, Juri H, Yoshikawa S, Narumi Y. Reduction of the radiation dose and the amount of contrast material in hepatic dynamic CT using low tube voltage and adaptive iterative dose reduction 3-dimensional. Medicine (Baltimore) 2018; 97:e11857. [PMID: 30142778 PMCID: PMC6113013 DOI: 10.1097/md.0000000000011857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The purpose of this study was to prospectively evaluate the image quality and the diagnostic ability of low tube voltage and reduced contrast material dose hepatic dynamic computed tomography (CT) reconstructed with adaptive iterative dose reduction 3-dimensional (AIDR 3D).Eighty-nine patients underwent hepatic dynamic CT using one of the 2 protocols: tube voltage of 120 kVp, contrast dose of 600 mgI/kg, and filtered back projection in Protocol A (n = 46), and tube voltage of 100 kVp, contrast dose of 500 mgI/kg, and AIDR 3D in Protocol B (n = 43). The volume CT dose index (CTDIvol) and size-specific dose estimates (SSDEs) were compared between the 2 groups. Objective image noise and tumor to liver contrast-to-noise ratio (CNR) were also compared. Three radiologists independently reviewed image quality. The jackknife alternative free-response receiver-operating characteristic (JAFROC) analysis was performed to compare diagnostic performance.The mean CTDIvol and SSDE of Protocol B (14.3 and 20.2, respectively) were significantly lower than those of Protocol A (22.1 and 31.4, P < .001). There were no significant differences in either objective image noise or CNR. In the qualitative analysis, 2 readers assigned significant lower scores to images of Protocol B for at least one of the 3 phases regarding overall image quality (P < .05). There was no significant difference in the JAFROC1 figure of merit between protocols.Low tube voltage CT with AIDR 3D yielded a reduction in radiation dose and in the amount of contrast material while maintaining diagnostic performance.
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Affiliation(s)
- Atsushi Nakamoto
- Department of Radiology, Osaka Medical College, Takatsuki
- Department of Radiology, Osaka University Graduate School of Medicine, Suita
| | | | - Makoto Sakane
- Department of Radiology, Osaka Medical College, Takatsuki
| | - Go Nakai
- Department of Radiology, Osaka Medical College, Takatsuki
| | | | - Hiroshi Juri
- Department of Radiology, Osaka Medical College, Takatsuki
| | - Shushi Yoshikawa
- Central Radiology Department, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
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Nakai G, Yamada T, Yamamoto K, Hirose Y, Ohmichi M, Narumi Y. MRI appearance of ovarian serous borderline tumors of the micropapillary type compared to that of typical ovarian serous borderline tumors: radiologic-pathologic correlation. J Ovarian Res 2018; 11:7. [PMID: 29321056 PMCID: PMC5764013 DOI: 10.1186/s13048-018-0379-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022] Open
Abstract
Background Serous borderline tumor (SBT) of the micropapillary type (SBT-MP) became one of the major pathological SBT diagnoses in addition to typical SBT, and was also defined as “non-invasive” low-gradeserous carcinoma according to the World Health Organization (WHO) classification in 2014. In this study, we investigated the MRI appearance of SBT-MP compared to that of typical SBT in order to identify specific imaging features of SBT-MP that correspond to pathological findings. Methods MR images of 6 histologically proven ovarian SBT-MP in four patients and 14 typical SBT in ten patients were reviewed retrospectively. Images were evaluated for laterality, size and morphology of the lesion and the solid component (SC) and signal intensity (SI) of the SC. MRI findings were correlated with pathological findings. Results The patients with SBT-MP (mean 26.3 years) were younger than those with typical SBT (mean 44.5 years). Postoperative staging in patients with SBT-MP was II in two and III in two cases, while staging for typical SBT was I in seven, II in one and III in two cases. The morphologic patterns of SBT-MP were a unilateral cystic mass with intracystic mural nodules (CwMN) (n = 2), bilateral solid papillary masses (SM), and bilateral SM with CwMN. The pattern of typical SBT was CwMN (n = 13) in all but one lesion (SM with CwMN). All SCs showed inhomogeneous slight hyperintensity on T2 weighted images (WI) and high SI on diffusion-WI (DWI) except for in one typical SBT. Although diffuse proliferation of the tumor cells in micropapillary projections with little stroma seemed to correspond to inhomogeneous slightly hyperintense foci in SC on T2WI and high SI on DWI, similar MR findings were observed in typical SBT in all lesions on T2WI and 11 of 12 lesions on DWI. In typical SBT, inhomogeneous slightly hyperintense foci in SC on T2WI and high SI on DWI corresponded to highly cellular foci with densely branched papillae. Conclusion Pathological findings and clinical behavior of SBT-MP differed from those of typical SBT, but morphology and SI of SC on MRI were similar, with papillary projections demonstrating inhomogeneous slight hyperintensity on T2WI and high SI on DWI.
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Affiliation(s)
- Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan.
| | - Takashi Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Osaka, Takatsuki, 569-8686, Japan
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12
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Nakai G, Yamada T, Hamada T, Atsukawa N, Tanaka Y, Yamamoto K, Higashiyama A, Juri H, Nakamoto A, Yamamoto K, Hirose Y, Ohmichi M, Narumi Y. Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI. Abdom Radiol (NY) 2017; 42:1825-1831. [PMID: 28389786 PMCID: PMC5486831 DOI: 10.1007/s00261-017-1126-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose Venous infarction of a leiomyoma is known as red degeneration of leiomyoma (RDL) and can be a cause of acute abdomen. Although magnetic resonance imaging (MRI) is the only modality that can depict the inner condition of a leiomyoma, the typical MR findings of RDL are sometimes identified incidentally even in asymptomatic patients. The purpose of this study is to clarify common pathological findings of uterine tumors preoperatively diagnosed as RDL by MRI. Methods We diagnosed 28 cases of RDL by MRI from March 2007 to April 2015. The ten lesions subjected to pathological analysis after resection were included in the study and reviewed by a gynecological pathologist. The average time from MRI to operation was 4.7 months. Results The typical beefy-red color was not observed on the cut surface of the tumor except in one tumor resected during the acute phase. All lesions diagnosed as RDL by MRI had common pathological findings consistent with red degeneration of leiomyoma, including coagulative necrosis. Other common pathological features of RDL besides extensive coagulative necrosis appear to be a lack of inflammatory cell infiltrate or hemorrhage in the entire lesion. Conclusions Although RDL is known to cause acute abdomen, its typical MR findings can be observed even in asymptomatic patients in a condition that manifests long after red degeneration. The characteristic pathological findings in both the acute phase and the chronic phase that we found in this study, along with radiology reports, will be helpful references for gynecologists and pathologists in suspecting a history of red degeneration and confirming the diagnosis.
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Affiliation(s)
- Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Takashi Yamada
- The Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Takamitsu Hamada
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Natsuko Atsukawa
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshikazu Tanaka
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kiyohito Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Akira Higashiyama
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Hiroshi Juri
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Atsushi Nakamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshinobu Hirose
- The Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan
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Yamada T, Hattori K, Satomi H, Hirose Y, Nakai G, Daimon A, Hayashi A, Terai Y, Ohmichi M, Fukunaga M. Mitotically active cellular fibroma of the ovary: a case report and literature review. J Ovarian Res 2015; 8:65. [PMID: 26437718 PMCID: PMC4595272 DOI: 10.1186/s13048-015-0191-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022] Open
Abstract
Background The ovarian cellular fibrous tumor with mitotic figure >4 per 10 high power field without moderate to severe atypia is defined as mitotically active cellular fibroma according to the 2014 World Health Organization classification. As this category is new and rare now, we described here a case of MACF and reviewed the literature. Case We present a case of mitotically active cellular fibroma of the ovary with 10-year history that was treated with laparoscopic surgery. Methods We reviewed the relevant literature using PubMed search system and analyzed the previous cases. Results To date, only 5 cases of mitotically active cellular fibroma have been reported. Our patient is the first case of mitotically active cellular fibroma of the ovary treated with laparoscopic surgery. Conclusion MACF of the ovary is a newly defined category and few cases have been reported, while prognostic factors have also not yet been fully characterized. Long-term clinical follow-up is necessary.
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Affiliation(s)
- Takashi Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Kimiaki Hattori
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Hidetoshi Satomi
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Atsushi Daimon
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Atsushi Hayashi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Masaharu Fukunaga
- Department of Pathology, Jikei Daisan Hospital, 4-11-1, Izumihoncho, Komaeshi, Tokyo, 201-8601, Japan.
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Nakai G, Kitano R, Yoshimizu N, Yamamoto K, Higashiyama A, Juri H, Nakamoto A, Yamamoto K, Yamada T, Hirose Y, Ohmichi M, Narumi Y. A Case of Bilateral Decidualized Endometriomas during Pregnancy: Radiologic-pathologic Correlation. Kobe J Med Sci 2015; 61:E40-E46. [PMID: 26628013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Clinical differentiation between decidualized endometrioma and malignant transformation still poses difficulties as both are intracystic vascularized excrescences of an endometrial cyst and exhibit similar characteristics on color-flow Doppler sonography. This is a characteristic sonographic finding associated with ovarian cancer, but MRI can provide further information about mural excrescences that can aid in their differential diagnosis; for example, the signal of decidualized endometriomas is isointense with the placenta within the uterus on all sequences and the apparent diffusion coefficient is higher than that of malignant mural nodules. Thus, MRI should be an aid in deciding whether to intervene during pregnancy. However, considering that it is not yet possible to clearly differentiate decidualized endometriomas from ovarian cancer, surgery or watchful observation may still be needed to exclude the possibility of malignancy.
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Affiliation(s)
- Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Remi Kitano
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Natsuko Yoshimizu
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Kiyohito Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Akira Higashiyama
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Hiroshi Juri
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Atsushi Nakamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Kazuhiro Yamamoto
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Takashi Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
| | - Yoshifumi Narumi
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan
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Tatsugami F, Matsuki M, Nakai G, Inada Y, Kanazawa S, Takeda Y, Morita H, Takada H, Yoshikawa S, Fukumura K, Narumi Y. The effect of adaptive iterative dose reduction on image quality in 320-detector row CT coronary angiography. Br J Radiol 2012; 85:e378-82. [PMID: 22253355 DOI: 10.1259/bjr/10084599] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effect of adaptive iterative dose reduction (AIDR) on image noise and image quality as compared with standard filtered back projection (FBP) in 320-detector row CT coronary angiography (CTCA). METHODS 50 patients (14 females, mean age 68 ± 9 years) who underwent CTCA (100 kV or 120 kV, 400-580 mA) within a single heartbeat were enrolled. Studies were reconstructed with FBP and subsequently AIDR. Image noise, vessel contrast and contrast-to-noise ratio (CNR) in the coronary arteries were evaluated. Overall image quality for coronary arteries was assessed using a five-point scale (1, non-diagnostic; 5, excellent). RESULTS All the examinations were performed in a single heartbeat. Image noise in the aorta was significantly lower in data sets reconstructed with AIDR than in those reconstructed with FBP (21.4 ± 3.1 HU vs 36.9 ± 4.5 HU; p<0.001). No significant differences were observed between FBP and AIDR for the mean vessel contrast (HU) in the proximal coronary arteries. Consequently, CNRs in the proximal coronary arteries were higher in the AIDR group than in the FBP group (p<0.001). The mean image quality score was improved by AIDR (3.75 ± 0.38 vs 4.24 ± 0.38; p<0.001). CONCLUSION The use of AIDR reduces image noise and improves image quality in 320-detector row CTCA.
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Affiliation(s)
- F Tatsugami
- Department of Radiology, Osaka Medical College, Takatsuki City, Osaka, Japan.
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Nakai G, Matsuki M, Harada T, Tanigawa N, Yamada T, Barentsz J, Narumi Y. Evaluation of axillary lymph nodes by diffusion-weighted MRI using ultrasmall superparamagnetic iron oxide in patients with breast cancer: initial clinical experience. J Magn Reson Imaging 2011; 34:557-62. [PMID: 21761468 DOI: 10.1002/jmri.22651] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 04/07/2011] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To investigate the diagnostic performance and clinical feasibility of diffusion-weighted magnetic resonance imaging (MRI) using ultrasmall superparamagnetic iron oxide (USPIO) in the evaluation of axillary lymph nodes (ALNs) in patients with breast cancer. MATERIALS AND METHODS Sixteen patients with known breast cancer underwent 1.5 T MRI. Axial diffusion-weighted images (DWIs) and conventional T1- and T2*-weighted images (CIs) were acquired before and 24-36 hours after intravenous administration of USPIO. Detection of ALNs was evaluated on DWIs in comparison with CIs. The apparent diffusion coefficient values (ADCvs) of the nonmetastatic and metastatic nodes in precontrast DWIs were determined. The diagnostic performance of DWI using USPIO was compared with that of CIs using USPIO with pathological correlation. RESULTS Out of a total of 286 ALNs, 216/286 (76%) nodes were detected on DWIs and 238/286 (83%) on CIs. The differences in the ADCvs between metastatic and nonmetastatic nodes were not significant (P = 0.06). Sensitivity of CIs and DWIs using USPIO were respectively 70% and 83%, specificity 98% and 98%, and overall accuracy 93% and 95%. CONCLUSION Although the detection on DWIs of ALNs in patients with breast cancer was inferior compared to CIs, the sensitivity and accuracy of DWIs using USPIO were superior in the diagnosis of ALNs metastasis.
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Affiliation(s)
- Go Nakai
- Department of Radiology, Osaka Medical College, Takatsuki City, Osaka, Japan.
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Matsuki M, Kanazawa S, Inada Y, Nakai G, Tatsugami F, Narumi Y. [Utilization of multislice CT for the colorectal cancer-from screening to preoperative simulation]. Nihon Shokakibyo Gakkai Zasshi 2010; 107:718-725. [PMID: 20460845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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18
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Tatsugami F, Matsuki M, Inada Y, Kanazawa S, Nakai G, Takeda Y, Morita H, Takada H, Ashida K, Yoshikawa S, Fukumura K, Narumi Y. Feasibility of low-volume injections of contrast material with a body weight-adapted iodine-dose protocol in 320-detector row coronary CT angiography. Acad Radiol 2010; 17:207-11. [PMID: 19926497 DOI: 10.1016/j.acra.2009.09.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 09/16/2009] [Accepted: 08/19/2009] [Indexed: 01/24/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility of low-volume injections of contrast material with a body weight-adapted iodine-dose protocol in computed tomography coronary angiography (CTCA) using a 320-detector row scanner. MATERIALS AND METHODS Ninety-eight patients who underwent CTCA in a single heartbeat with electrocardiogram-gating were divided into two groups, receiving 0.8 mL/kg of contrast material injected at a fixed duration of 12 seconds (A; n = 48) or 0.7 mL/kg of contrast material injected at a fixed duration of 10 seconds (B; n = 50); all patients then received 20 mL of saline. Contrast densities were assessed for the ascending aorta, left ventricle, right coronary artery (RCA), and left main coronary artery (LMA). RESULTS The mean flow rate was 4.00 + or - 0.56 mL/second in group A and 4.06 + or - 0.57 mL/second in group B (P = .51). There were no significant differences in the mean enhancement values of the ascending aorta, LMA and proximal RCA between the two groups. Also, there was no significant difference between the mean enhancement values at the three different levels of the RCA (proximal, middle, and distal segments) (group A; P = .27, group B; P = .07). CONCLUSION The use of 0.7 mL/kg of contrast material injected at a fixed duration of 10 seconds was feasible for CTCA using 320-detector row CT, with a sufficient and reliable contrast enhancement in the ascending aorta and coronary artery.
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Tatsugami F, Kanamoto T, Nakai G, Takeda Y, Morita H, Morinaga I, Yoshikawa S, Narabayashi I. Reduction of the total injection volume of contrast material with a short injection duration in 64-detector row CT coronary angiography. Br J Radiol 2009; 83:35-9. [PMID: 19505968 DOI: 10.1259/bjr/23203690] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The ability of short injection duration of contrast material to reduce the total injection volume in 64-detector row CT coronary angiography was investigated. 45 patients were divided into three groups: (i) those receiving 0.8 ml kg(-1) of contrast material (350 mgI ml(-1)) injected with a fixed duration of 14 s (Group A; n = 16); (ii) those receiving 0.8 ml kg(-1) of contrast material injected with a fixed duration of 10 s (Group B; n = 15); and (iii) those receiving 0.7 ml kg(-1) of contrast material injected with a fixed duration of 10 s (Group C; n = 14). All patients then received 20 ml of saline. Contrast densities of the ascending aorta and proximal and distal coronary arteries were assessed where vessel diameters were >2.0 mm. The mean enhancement value in the ascending aorta for Group B was significantly higher than that for Groups A and C (p<0.05), whereas there was no significant difference between Groups A and C. All enhancement values in the coronary arteries were higher than 250 Hounsfield units. The mean enhancement value for each coronary artery in Group B was significantly higher than that for Group A (p<0.05), whereas there was no significant difference between Groups A and C. In conclusion, a short injection duration allows a reduction in the total volume of contrast material from 0.8 ml kg(-1) to 0.7 ml kg(-1) while a steady contrast enhancement is maintained in the ascending aorta and coronary arteries.
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Affiliation(s)
- F Tatsugami
- Department of Radiology, Osaka Medical College,Takatsuki City, Osaka 569-8686, Japan.
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Inada Y, Matsuki M, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Yamada T, Tsuji M. Body diffusion-weighted MR imaging of uterine endometrial cancer: is it helpful in the detection of cancer in nonenhanced MR imaging? Eur J Radiol 2008; 70:122-7. [PMID: 18182265 DOI: 10.1016/j.ejrad.2007.11.042] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2007] [Revised: 11/28/2007] [Accepted: 11/28/2007] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In this study, the authors discussed the feasibility and value of diffusion-weighted (DW) MR imaging in the detection of uterine endometrial cancer in addition to conventional nonenhanced MR images. METHODS AND MATERIALS DW images of endometrial cancer in 23 patients were examined by using a 1.5-T MR scanner. This study investigated whether or not DW images offer additional incremental value to conventional nonenhanced MR imaging in comparison with histopathological results. Moreover, the apparent diffusion coefficient (ADC) values were measured in the regions of interest within the endometrial cancer and compared with those of normal endometrium and myometrium in 31 volunteers, leiomyoma in 14 patients and adenomyosis in 10 patients. The Wilcoxon rank sum test was used, with a p<0.05 considered statistically significant. RESULTS In 19 of 23 patients, endometrial cancers were detected only on T2-weighted images. In the remaining 4 patients, of whom two had coexisting leiomyoma, no cancer was detected on T2-weighted images. This corresponds to an 83% detection sensitivity for the carcinomas. When DW images and fused DW images/T2-weighted images were used in addition to the T2-weighted images, cancers were identified in 3 of the remaining 4 patients in addition to the 19 patients (overall detection sensitivity of 96%). The mean ADC value of endometrial cancer (n=22) was (0.97+/-0.19)x10(-3)mm(2)/s, which was significantly lower than those of the normal endometrium, myometrium, leiomyoma and adenomyosis (p<0.05). CONCLUSION DW imaging can be helpful in the detection of uterine endometrial cancer in nonenhanced MR imaging.
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Affiliation(s)
- Yuki Inada
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan.
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Matsuki M, Inada Y, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Masuda D, Arisaka Y, Takaori K, Tanigawa N. Diffusion-weighed MR imaging of pancreatic carcinoma. ACTA ACUST UNITED AC 2008; 32:481-3. [PMID: 17431713 DOI: 10.1007/s00261-007-9192-6] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of this study was to demonstrate the feasibility of body diffusion-weighted (DW) MR imaging in the evaluation of a pancreatic carcinoma. MATERIAL AND METHODS In nine normal volunteers and in eight patients with pancreatic carcinoma, DW images were obtained on the axial plane scanning with a multisection spin-echo-type single-shot echo planar sequence with a body coil. Moreover, we measured the apparent diffusion coefficient (ADC) value in a circular region of interest (ROI) within the normal pancreas, pancreatic carcinoma, and tumor-associated chronic pancreatitis. RESULTS On the DW images, all eight carcinomas were clearly shown as high signal intensity relative to the surrounding tissue. The ADC value (x10(-3) mm(2)/s) in the carcinoma was 1.44 +/- 0.20, which was significantly lower compared to that of normal pancreas (1.90 +/- 0.06) and tumor-associated chronic pancreatitis (2.31 +/- 0.18). CONCLUSION Diffusion-weighted (DW) images can be helpful in detecting the pancreatic carcinoma and accessing the extent of the tumor.
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Affiliation(s)
- M Matsuki
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan.
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Tatsugami F, Matsuki M, Nakai G, Tanikake M, Yoshikawa S, Narabayashi I, Miyaji K, Asai A, Fujiwara S, Hongo Y, Katsu K. Hepatic computed tomography for simultaneous depiction of hepatocellular carcinoma, intrahepatic portal veins, and hepatic veins in real-time virtual sonography: initial experience. J Ultrasound Med 2007; 26:1065-9. [PMID: 17646368 DOI: 10.7863/jum.2007.26.8.1065] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to examine a double-step injection of contrast material in hepatic computed tomography (CT) for the simultaneous depiction of hepatocellular carcinoma (HCC), intrahepatic portal veins, and hepatic veins in real-time virtual sonography. METHODS This study consisted of 6 patients with solitary HCC nodules with early enhancement on dynamic contrast-enhanced CT. Computed tomographic scanning was performed in a combined late arterial/hepatic phase after 2 sequential contrast material injections. RESULTS In all 6 patients, the solitary HCC nodule, intrahepatic portal veins, and hepatic veins were simultaneously visualized with enhancement, for which CT values were appreciably higher than that of the liver parenchyma. In virtual sonography, HCC nodules and intrahepatic vessels were simultaneously shown, and the HCC lesions were treated by radio frequency ablation without vascular injury. CONCLUSIONS A double-step injection of contrast material in hepatic CT was helpful in the identification of the relationship between the HCC nodule and intrahepatic vessels under virtual sonography and contributed to the accurate and safe performance of radio frequency ablation for HCC.
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Affiliation(s)
- Fuminari Tatsugami
- Department of Radiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka, Japan.
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Tatsugami F, Matsuki M, Inada Y, Nakai G, Tanikake M, Yoshikawa S, Narabayashi I. Usefulness of saline pushing in reduction of contrast material dose in abdominal CT: evaluation of time–density curve for the aorta, portal vein and liver. Br J Radiol 2007; 80:231-4. [PMID: 17038409 DOI: 10.1259/bjr/60407135] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The effects of saline pushing after contrast material injection were investigated as well as the possibility for this technique to reduce contrast material doses in liver CT examinations. 52 patients were divided randomly into three groups: 100 ml of contrast material (300 mg I ml(-1)) only (A; n = 19), 100 ml of contrast material pushed with 50 ml of saline solution (B; n = 17), and 85 ml of contrast material pushed with 50 ml of saline solution (C; n = 16). Single-level images were obtained at the level of the main portal vein after the initiation of contrast material injection. There were no significant differences in the mean peak enhancement values (PE) and the mean time to peak enhancement values (TPE) of the aorta between the three groups. The mean PE of the portal vein in group B increased 21 HU over that in group A (p<0.05), and there was no significant difference between groups A and C. The mean PE of the liver in group B increased 7 HU over that in group A (p<0.05), and there was no significant difference between groups A and C. The mean TPE of the portal vein was shorter by 4 s (p<0.05), and that of the liver was shorter by 5 s (p<0.05) in group C compared with those in group A. In conclusion, saline pushing increases the enhancement values of the portal vein and liver, and allows a contrast material dose reduction of 15 ml without decreasing hepatic and vascular enhancement at adequate scan timing.
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Affiliation(s)
- F Tatsugami
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan.
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Matsuki M, Inada Y, Nakai G, Tatsugami F, Tanikake M, Narabayashi I, Nishimura H, Iwamoto M, Hiramatsu M, Tanigawa N, Kurisu Y, Tsuji M. CT and MR features of sclerosing mesenteritis mimicking a mesenteric metastasis from the carcinoid tumor. Radiat Med 2006; 24:220-3. [PMID: 16875311 DOI: 10.1007/s11604-005-1405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Sclerosing mesenteritis is a rare and benign inflammatory entity characterized by fibrofatty thickening of the mesentery. To our knowledge, there are only a few reports on the features of sclerosing mesenteritis on magnetic resonance (MR) imaging and computed tomography (CT). In this present case, MR imaging demonstrated tissue characterization of fibrosis, and partial maximum intensity projection (MIP) and three-dimensional angiography images obtained using multislice CT clearly revealed the extent of the tumor and the vascular appearance affected by the mass. However, a mesenteric metastasis from the carcinoid tumor may show such imaging features. Therefore, when encountering such a case, we suggest that a tentative diagnosis of sclerosing mesenteritis be made, followed by a biopsy for intraoperative histopathologic analysis to avoid aggressive surgery.
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Affiliation(s)
- Mitsuru Matsuki
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan.
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