Differentiation of bone metastases from benign red marrow depositions: utilizing qualitative and quantitative analysis of conventional T1-weighted imaging and fat-suppressed T2-weighted imaging

OBJECTIVES

To distinguish bone metastases (BMs) from benign red marrow depositions (BRMs) by qualitative and quantitative analyses of T1-weighted imaging and fat-suppressed T2-weighted imaging (T2 FS).

METHODS

For 75 lesions including 38 BMs and 37 BRMs, two radiologists independently evaluated magnetic resonance images by qualitative (signal intensity [SI] of lesions compared to that of normal muscle [NM] or normal bone marrow [NBM]) and quantitative (parameters of the region of interests in the lesions, including T1 ratio [T1 SI ratio of lesion and NM], T2FMu ratio [T2 FS SI ratio of lesion and NM], and T2FMa ratio [T2 FS SI ratio of lesion and NBM]) analyses.

RESULTS

Hyperintensity relative to NM or NBM on T2 FS was more frequent in BMs than in BRMs (100% vs 59.5%-78.4%, respectively; P ≤ 0.001) but also was present in more than half of BRMs. All quantitative parameters showed a significant difference between BMs and BRMs (T1 ratio, 1.075 vs 1.227 [P = 0.002]; T2FMu ratio, 2.094 vs 1.282 [P < 0.001]; T2FMa ratio, 3.232 vs 1.810 [P < 0.001]). The receiver operating characteristics areas under the curves of T2FMu and T2FMa ratios were clinically useful (0.781 and 0.841, respectively) and did not demonstrate statistically significant differences.

CONCLUSIONS

The quantitative analysis of T2 FS facilitates distinguishing between BMs and BRMs, regardless of whether the reference was NM or NBM.

ADVANCES IN KNOWLEDGE

Quantitative parameters derived from T2 FS facilitate differentiation of BMs BRMs without additional scans. The role of NBM as an internal standard for T2 FS to differentiate between BMs and BRMs is similar to that of NM.

Bone metastases with post-treatment intralesional fatty content of the spine: imaging features from T1-weighted imaging with CT finding correlations

BACKGROUND

Despite post-treatment intralesional fatty content (PIFAT) in bone metastases indicating a healing processes after treatment, the imaging features of PIFAT have not been studied in detail.

PURPOSE

To analyze imaging features from T1-weighted (T1W) imaging with computed tomography (CT) finding correlations in bone metastases with PIFAT of the spine.

MATERIAL AND METHODS

A total of 29 bone metastases with PIFAT were analyzed with T1W and CT images before and after treatment. On T1W imaging after treatment, the lesions were categorized into three types according to fat distribution patterns. CT attenuation changes after treatment were also evaluated. According to the MD Anderson (MDA) criteria, response types for all lesions were obtained on magnetic resonance (MR) and CT images.

RESULTS

The types from T1W imaging in bone metastases with PIFAT were as follows: 14 with a return to totally normal marrow signal intensity within the lesion; 13 with an inhomogeneous patchy pattern in the lesion; and two with a peripheral halo of fatty marrow or peripheral fat signal intensity foci in the lesion. Among bone metastases with PIFAT, 93.1% showed osteosclerotic changes in this study. According to the MDA criteria, the concordance between the response types of the MR and CT images was 57.2%.

CONCLUSION

Knowledge of imaging features from T1W imaging with CT correlation in bone metastases with PIFAT is important for the accurate interpretation of post-treatment MR and CT studies. Both MR and CT images have a complementary value regarding the post-treatment evaluation of bone metastases with PIFAT.

[Gallbladder Perforation after Transarterial Chemoembolization in a Patient with a Huge Hepatocellular Carcinoma]

Transarterial chemoembolization (TACE) is a common treatment for unresectable hepatocellular carcinoma (HCC). The most common complications after TACE are non-specific symptoms called post-embolization syndrome, such as abdominal pain or fever. Rare complications, such as liver failure, liver abscess, sepsis, pulmonary embolism, cholecystitis, can also occur. On the other hand, gallbladder perforation is quite rare. This paper reports a case of gallbladder perforation following TACE. A 76-year-old male with a single 9-cm-sized HCC underwent TACE. Five days after TACE, he developed persistent right upper quadrant pain and ileus. An abdomen CT scan confirmed gallbladder perforation with bile in the right paracolic gutter and pelvic cavity. Percutaneous transhepatic gallbladder drainage was performed with the intravenous administration of antibiotics. After 1 month, the patient underwent right hemihepatectomy and cholecystectomy. Physicians should consider the possibility of gallbladder perforation, which is a rare complication after TACE, when unexplained abdominal pain persists.

Spinal Enumeration by Morphologic Analysis of Spinal Variants: Comparison to Counting in a Cranial-To-Caudal Manner

Objective

To compare the spinal enumeration methods that establish the first lumbar vertebra in patients with spinal variants.

Materials and Methods

Of the 1446 consecutive patients who had undergone computed tomography of the spine from March 2012 to July 2016, 100 patients (62 men, 38 women; mean age, 47.9 years; age range, 19-88 years) with spinal variants were included. Two radiologists (readers 1 and 2) established the first lumbar vertebra through morphologic analysis of the thoracolumbar junction, and labeled the vertebra by counting in a cranial-to-caudal manner. Inter-observer agreement was established. Additionally, reader 1 detected the 20th vertebra under the assumption that there are 12 thoracic vertebra, and then classified it as a thoracic vertebra, lumbar vertebra, or thoracolumbar transitional vertebra (TLTV), on the basis of morphologic analysis.

Results

The first lumbar vertebra, as established by morphologic analysis, was labeled by each reader as the 21st segment in 65.0% of the patients, as the 20th segment in 31.0%, and as the 19th segment in 4.0%. Inter-observer agreement between the two readers in determining the first lumbar vertebra, based on morphologic analysis, was nearly perfect (κ value: 1.00). The 20th vertebra was morphologically classified as a TLTV in 60.0% of the patients, as the first lumbar segment in 31.0%, as the second lumbar segment in 4.0%, and as a thoracic segment in 5.0%.

Conclusion

The establishment of the first lumbar vertebra using morphologic characteristics of the thoracolumbar junction in patients with spinal variants was consistent with the morphologic traits of vertebral segmentation.

Doppler sonography of the penile cavernosal artery: comparison of intraurethral instillation and intracorporeal injection of prostaglandin E1

PURPOSE

We compared the Doppler sonographic findings in the penile cavernosal artery (arteria profunda penis) after intraurethral instillation and intracorporeal injection of prostaglandin E1 (PGE1) to evaluate the hemodynamic changes during drug-induced erection.

METHODS

Twenty healthy male volunteers were enrolled in the study. Ten subjects (intraurethral group) were examined with Doppler sonography of the penile cavernosal artery after intraurethral administration of 1 mg of PGE1. The remaining 10 subjects (intracorporeal group) underwent Doppler sonography of the cavernosal artery after intracorporeal injection of 5 microg of PGE1. The peak systolic velocity, minimal diastolic velocity, and resistance index were determined at 5-minute intervals for 30 minutes following administration of PGE1 in both groups. The results were compared between the 2 groups.

RESULTS

The peak systolic velocity in the intraurethral group increased progressively from a mean of 31.1 cm/second at 5 minutes to 65.6 cm/second at 30 minutes after intraurethral administration of PGE1. In the intracorporeal group, the mean peak systolic velocity ranged from 44.1 to 83.2 cm/second, reached a maximum at 10 minutes, and then decreased continuously through 30 minutes after intracorporeal injection of PGE1. The mean peak systolic velocities were significantly higher in the intracorporeal group at 10 and 15 minutes (p < or = 0.05); the mean minimal diastolic velocities were significantly lower in the intracorporeal group at 15, 20, and 25 minutes (p < or = 0.05); and the mean resistance indices were significantly higher in the intracorporeal group at all time points except 5 minutes (p < or = 0.05).

CONCLUSIONS

The intracorporeal injection of PGE1 produced a greater vasoactive response in the cavernosal artery than did intraurethral instillation.

Malignant gastroduodenal obstructions: treatment by means of a covered expandable metallic stent-initial experience

PURPOSE

To investigate the technical feasibility and clinical effectiveness of a polyurethane-covered expandable nitinol stent in the treatment of malignant gastroduodenal obstructions.

MATERIALS AND METHODS

The stent was constructed in-house by weaving a single thread of 0.2-mm nitinol wire in a tubular configuration and was covered with polyurethane solution by means of a dipping method. With fluoroscopic guidance, the stent was placed in 19 consecutive patients with malignant gastric outlet obstruction (n = 15) or duodenal obstruction (n = 4). All patients had severe nausea and recurrent vomiting, and their obstructions were inoperable.

RESULTS

Stent placement was technically successful in all but one patient. After stent placement, symptoms improved in all but one patient, who had another stenosis at the proximal jejunum. One patient with stent placement in the second portion of the duodenum became jaundiced. During the mean follow-up of 11 weeks, stent migration occurred in five patients 1-4 days after the procedure. All patients with stent migration were treated by means of placing a second, uncovered nitinol stent. Two of these five patients showed recurrence of stricture because of tumor ingrowth; they underwent coaxial placement of a third, covered nitinol stent with good results.

CONCLUSION

Placement of a polyurethane-covered expandable nitinol stent seems to be technically feasible and effective for palliative treatment of inoperable malignant gastroduodenal obstructions. Stent migration, however, is problematic and requires further investigation.

In vitro antigenotoxic activity of novel ginseng saponin metabolites formed by intestinal bacteria

Ginseng saponin metabolites produced by human intestinal bacteria were evaluated for antigenotoxic properties by testing their effects on benzo[a]pyrene (B[a]P)-induced mutagenicity and clastogenicity. They include 20-O-(beta-D-glucopyranosyl)-20(S)-protopanaxadiol (IH-901), 20-O-(alpha-D-arabinopyranosyl(1-->6)-beta-D-glucopyranosyl]- 20(S)-protopanaxadiol (IH-902) and 20-O-[alpha-D-arabinofuranosyl(1-->6)-beta-D-glucopyranosyl]-20(S)- protopanaxadiol (IH-903). IH-901, IH-902 and IH-903 inhibited the mutagenicity of B[a]P in a dose-dependent manner. In the chromosome aberration assay, IH-901 and IH-903 reduced the frequency of chromosome aberration induced by B[a]P. These results suggest that the ginseng saponin metabolites tested in the present study have potential as chemopreventive agents.

Synthesis and biological properties of new 1 beta-methylcarbapenems

The synthesis and biological activity of the novel series of 1 beta-methylcarbapenems, 1 and 2 were described. Most compounds displayed high potent antibacterial activity. The best compound in this series, 2a (IH201; R2 = NH2) showed an excellent and a broad spectrum as well as high renal DHP-I stability. It also possessed good in vivo efficacy and high safety.

Sparganosis in the spinal canal with partial block: an uncommon infection

A case of rare intraspinal sparganosis treated by surgical excision is described. In this 59-year-old male with paraparesis and voiding problem, an intradural mass was noted on myelogram. Magnetic resonance (MR) and computed tomographic appearance of spinal and associated cerebral lesion are illustrated and possible route of migration discussed. This represents, to our knowledge, the first MRI demonstration of intraspinal sparganosis reported in the literature.