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Tachibana Y, Takaji R, Shiroo T, Asayama Y. Deep-learning reconstruction with low-contrast media and low-kilovoltage peak for CT of the liver. Clin Radiol 2024; 79:e546-e553. [PMID: 38238148 DOI: 10.1016/j.crad.2023.12.015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 03/09/2024]
Abstract
AIM To compare images using reduced CM, low-kVp scanning and DLR reconstruction with conventional images (no CM reduction, normal tube voltage, reconstructed with HBIR. To compare images using reduced contrast media (CM), low kilovoltage peak (kVp) scanning and deep-learning reconstruction (DLR) with conventional image quality (no CM reduction, normal tube voltage, reconstructed with hybrid-type iterative reconstruction method [HBIR protocol]). MATERIALS AND METHODS A retrospective analysis was performed on 70 patients with liver disease and three-phase dynamic imaging using computed tomography (CT) from April 2020 to March 2022 at Oita University Hospital. Of these cases, 39 were reconstructed using the DLR protocol at a tube voltage of 80 kVp and CM of 300 mg iodine/kg while 31 were imaged at a tube voltage of 120 kVp with CM of 600 mg iodine/kg and were reconstructed by the usual HBIR protocol. Images from the DLR and HBIR protocols were analysed and compared based on the contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR), figure-of-merit (FOM), and visual assessment. The CT dose index (CTDI)vol and size-specific dose estimates (SSDE) were compared with respect to radiation dose. RESULTS The DLR protocol was superior, with significant differences in CNR, SNR, and FOM except hepatic parenchyma in the arterial phase. For visual assessment, the DLR protocol had better values for vascular visualisation for the portal vein, image noise, and contrast enhancement of the hepatic parenchyma. Regarding comparison of the radiation dose, the DLR protocol was superior for all values of CTDIvol and SSDE, with significant differences (p<0.01; max. 52%). CONCLUSION Protocols using DLR with reduced CM and low kVp have better image quality and lower radiation dose compared to protocols using conventional HBIR.
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Affiliation(s)
- Y Tachibana
- Graduate School of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - R Takaji
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - T Shiroo
- Radiology Department, Division of Medical Technology, Oita University Hospital, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan
| | - Y Asayama
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, 879-5593, Japan.
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2
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Miyamoto S, Takaji R, Kaneko N, Iwasaki T, Kawano M, Tanaka K, Daa T, Asayama Y. A case of plexiform schwannoma arising from the sciatic, tibial, and peroneal nerves. Radiol Case Rep 2024; 19:230-233. [PMID: 38028287 PMCID: PMC10651423 DOI: 10.1016/j.radcr.2023.10.009] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Plexiform schwannoma is a rare subtype of schwannoma. In this report, we present a case of plexiform schwannoma arising from the sciatic, tibial, and peroneal nerves. A 54-year-old man presented with a painful palpable mass extending from the left posterior thigh to the calf. Magnetic resonance imaging showed multiple bead-like nodular structures along the sciatic, tibial, and peroneal nerve pathway. The nodular lesions showed uniform signal intensity on T1-weighted imaging. On T2-weighted imaging, each nodule showed an eccentric area of relatively low signal intensity surrounded by an area of higher signal intensity and a low-intensity rim. Plexiform schwannoma or neurofibroma was considered as the preoperative diagnosis. Because of the patient's severe symptoms and strong desire for relief, tumor enucleation of the largest painful nodule was performed, and plexiform schwannoma was confirmed pathologically.
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Affiliation(s)
- Shuhei Miyamoto
- Departments of Radiology, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Ryo Takaji
- Departments of Radiology, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Norimasa Kaneko
- Departments of Radiology, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Tatsuya Iwasaki
- Departments of Orthopedic Surgery, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Masanori Kawano
- Departments of Orthopedic Surgery, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Kazuhiro Tanaka
- Departments of Orthopedic Surgery, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Tsutomu Daa
- Departments of Diagnostic Pathology, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
| | - Yoshiki Asayama
- Departments of Radiology, Oita University Faculty of Medicine, Yufu, Oita 879-5593, Japan
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Baba H, Yamada Y, Tada K, Kuboyama Y, Fukuzawa K, Iwaki K, Motomura M, Takaji R, Shimada R, Takaki H, Asayama Y. Pancreatic mixed acinar-neuroendocrine carcinoma with intraductal growth: A case report with radiologic-pathologic correlations. Radiol Case Rep 2023; 18:4422-4430. [PMID: 37929047 PMCID: PMC10624768 DOI: 10.1016/j.radcr.2023.09.032] [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: 06/13/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023] Open
Abstract
Pancreatic mixed acinar-neuroendocrine carcinomas are rare malignant tumors of the pancreas. They are composed histologically of both acinar and neuroendocrine cells. The pancreatic duct is known to be an important site of tumor growth for acinar cell carcinomas, neuroendocrine tumors, and intraductal tubulopapillary neoplasms. To the best of our knowledge, there has been only 1 report of a mixed acinar-neuroendocrine carcinoma growing into the pancreatic duct and no reports detailing imaging findings with this tumor. We here report a 69-year-old man who presented with worsening glycemic control. Multiphase contrast-enhanced computed tomography and magnetic resonance imaging revealed a well-circumscribed mass with poor contrast enhancement in the pancreatic tail region of the pancreatic duct. The intraductal mass showed diffusion restriction on magnetic resonance imaging. These imaging findings are consistent with the expansive, smooth-surfaced polypoid tumor of low vascularity and high cellularity that was diagnosed pathologically. Mixed acinar-neuroendocrine carcinomas should be included in the differential diagnosis of intraductal tumors of the pancreas with poor contrast enhancement and diffusion restriction.
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Affiliation(s)
- Hiroshi Baba
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Kazuhiro Tada
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Yusuke Kuboyama
- Department of Pathology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Kentaro Iwaki
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Mitsuteru Motomura
- Hepato-Biliary-Pancreatic Internal Medicine, Oita Red Cross Hospital, Chiyo-machi, Oita, 870-0033, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ryuichi Shimada
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Hajime Takaki
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
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Takaji R, Abe S, Shin T, Daa T, Shimada R, Asayama Y. A case of intrascrotal extratesticular schwannoma. Radiol Case Rep 2023; 18:3380-3385. [PMID: 37502485 PMCID: PMC10369397 DOI: 10.1016/j.radcr.2023.07.029] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023] Open
Abstract
Schwannomas are benign tumors arising from Schwann cells, which compose the myelin sheath covering peripheral nerves. Although schwannomas can develop in various locations throughout the human body, the scrotum is a rare site for development of a schwannoma. Furthermore, to the best of our knowledge, no study to date has focused on the detailed imaging findings of intrascrotal schwannoma.
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Affiliation(s)
- Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Satoki Abe
- Department of Urology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Toshitaka Shin
- Department of Urology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Ryuichi Shimada
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Hara A, Yamada Y, Fukuzawa K, Motomura M, Kuboyama Y, Sakata K, Takaji R, Asayama Y, Takaki H. “Honeycomb” appearance in large-duct type pancreatic ductal adenocarcinoma: Case report with radiologic–pathologic correlation. Radiol Case Rep 2022; 17:3439-3445. [PMID: 35909928 PMCID: PMC9334827 DOI: 10.1016/j.radcr.2022.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
Large-duct type pancreatic ductal adenocarcinoma (PDA) is a rare morphologic variant forming large duct elements. This case report, to our knowledge, is the first report of a large-duct type PDA with a “honeycomb” appearance resembling a serous cystic neoplasm (SCN) on CT and MRI. The patient is an 82-year-old woman who presented with upper abdominal pain. Dynamic contrast-enhanced CT revealed a multilocular cyst with honeycomb loculi, in which the cyst walls showed gradual enhancement. On T2-weighted MRI, the mass displayed inhomogeneous hyperintensity characterized by a honeycomb appearance with irregular and thick hypointense cyst walls. The patient underwent distal pancreatectomy; histopathological diagnosis was large-duct type PDA. Although the imaging features of large-duct type PDA may resemble those of SCN, this distinction between PDA and SCN is important because the treatment options are very different.
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Tachibana Y, Takaji R, Maruno M, Honda K, Endo M, Murakami K, Asayama Y. LI-RADS Classification and Outcomes of Hepatocellular Carcinoma Treated With Transcatheter Arterial Chemoembolization Plus Radiofrequency Ablation. Cancer Diagn Progn 2022; 2:471-481. [PMID: 35813008 PMCID: PMC9254100 DOI: 10.21873/cdp.10130] [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] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
AIM The aim of this study was to clarify the usefulness of the Liver Imaging Reporting and Data System (LI-RADS) for predicting a patient's prognosis after transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (TACE-RFA) for hepatocellular carcinoma (HCC) of Barcelona-Clinic Liver Cancer (BCLC) stage 0 or A. PATIENTS AND METHODS We retrospectively analyzed cases of patients with HCC who underwent TACE-RFA (Jan 2005 to Dec 2015). Nodules were categorized based on their LI-RADS v2018 core. The LI-RADS category was assigned to each nodule using dynamic contrast-enhanced computed tomography. LR-3, LR-4 and LR-5 nodules were extracted. The overall (OS) and recurrence-free (RFS) survival was assessed among patients with BCLC 0 and BCLC A disease. RESULTS Of the 64 nodules extracted, 22 were LR-3 or -4 (mean±standard deviation=14.8±6.7 mm) and 42 were LR-5 (17.1±6.9 mm). Regarding OS, there was no significant difference between those with LR-3 or -4 and LR-5 (p=0.278). In terms of RFS, there was a significant difference between those with LR-3 or -4 and those with LR-5 (p=0.03). In particular, patients with BCLC A with LR-5 nodules had significantly poorer RFS than those with LR-3 or -4 (p=0.016) nodules. CONCLUSION For patients with BCLC A, LR-3 or -4 nodules are associated with a better prognosis than LR-5 nodules.
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Affiliation(s)
- Yuji Tachibana
- Graduate School of Medicine, Oita University, Oita, Japan
| | - Ryo Takaji
- Department of Radiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Miyuki Maruno
- Department of Radiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Koichi Honda
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Mizuki Endo
- Medical Safety Management Center, Oita University Hospital, Oita, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Faculty of Medicine, Oita University, Oita, Japan
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Yoshida Y, Nagai S, Shibuta K, Miyamoto S, Maruno M, Takaji R, Hata S, Nishida H, Miyamoto S, Ozeki Y, Okamoto M, Gotoh K, Masaki T, Shin T, Mimata H, Daa T, Asayama Y, Shibata H. Adrenal vein sampling with gadolinium contrast medium in a patient with florid primary aldosteronism and iodine allergy. J Endocr Soc 2022; 6:bvac007. [PMID: 35155972 PMCID: PMC8826024 DOI: 10.1210/jendso/bvac007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
We describe a 35-year-old woman who was allergic to iodine contrast medium and was diagnosed with primary aldosteronism (PA) based on functional confirmatory tests. She was suspected to have unilateral PA because of marked hypertension, spontaneous hypokalemia, high plasma aldosterone, reduced plasma renin activity, and a right hypodense adrenal tumor. She wanted to become pregnant and requested adrenalectomy instead of medical treatment with mineralocorticoid receptor antagonists. Localization of PA by adrenal vein sampling (AVS) was necessary, but angiography with iodine contrast medium was not possible because of her allergy. AVS was performed using gadolinium contrast agent (gadoterate meglumine) instead of iodine, in combination with computed tomography angiography (CTA). In AVS, before and after adrenocorticotropin (ACTH) loading, 12 blood samples were drawn from the right adrenal vein, left adrenal central vein, left adrenal common duct, left and right renal veins, and the lower inferior vena cava with only 5 mL of gadolinium medium. There were no complications during AVS. Examination revealed an elevated aldosterone/cortisol ratio on the right side, lateralized ratio of 7.4, and contralateral ratio of 0.76; the patient was diagnosed with right unilateral PA. She underwent right adrenalectomy and showed improvements in aldosterone level from 312.4 pg/mL to 83.0 pg/mL, potassium from 3.0 mEq/L to 3.9 mEq/L, and systolic blood pressure from 138 mm Hg to 117 mm Hg. In PA patients with iodine allergy, AVS can be performed safely and precisely using gadolinium contrast combined with CTA.
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Affiliation(s)
- Yuichi Yoshida
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Satoshi Nagai
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Kanako Shibuta
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Shuhei Miyamoto
- Department of Radiology, Faculty of Medicine, Oita University
| | - Miyuki Maruno
- Department of Radiology, Faculty of Medicine, Oita University
| | - Ryo Takaji
- Department of Radiology, Faculty of Medicine, Oita University
| | - Shinro Hata
- Department of Urology, Faculty of Medicine, Oita University
| | - Haruto Nishida
- Department of Pathology, Faculty of Medicine, Oita University
| | - Shotaro Miyamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Yoshinori Ozeki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Mitsuhiro Okamoto
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Koro Gotoh
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Takayuki Masaki
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
| | - Toshitaka Shin
- Department of Urology, Faculty of Medicine, Oita University
| | | | - Tsutomu Daa
- Department of Pathology, Faculty of Medicine, Oita University
| | - Yoshiki Asayama
- Department of Radiology, Faculty of Medicine, Oita University
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University
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Mori H, Tanoue S, Takaji R, Ueda S, Okahara M, Ueda SS. Arterial Administration of DNA Crosslinking Agents with Restraint of Homologous Recombination Repair by Intravenous Low-Dose Gemcitabine Is Effective for Locally Advanced Pancreatic Cancer. Cancers (Basel) 2022; 14:cancers14010220. [PMID: 35008384 PMCID: PMC8750330 DOI: 10.3390/cancers14010220] [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: 11/11/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Pancreatic cancer is considered incurable, and most cases are detected in the advanced stages. Establishing a new, effective interventional treatment for advanced pancreatic cancer is a pressing issue. Pretreatment with gemcitabine had a restraining effect on the homologous DNA recombination repair (HRR) of DNA crosslinking, inhibiting the function of Rad51, of which expression is found to be increased in pancreatic cancer. The aim of our prospective study was to assess the potential value of the arterial administration of DNA crosslinking agents after intravenous administration of low-dose gemcitabine for patients with advanced pancreatic cancer. We confirmed, among forty-five patients with unresectable advanced pancreatic cancer, that a patient subgroup of locally advanced pancreatic cancer (LAPC, 10 patients) who underwent these treatment courses successively more than twice in the first 6 months had 33 months of overall survival, 31 months of local progression free survival, and a complete response of 40%. This treatment can be a new treatment option for LAPC. Abstract (1) Background: Pretreatment by Rad51-inhibitory substances such as gemcitabine followed by arterial chemotherapy using antineoplastic agents causing DNA crosslink might be more beneficial for patients with locally advanced pancreatic cancers than conventional treatments. The efficacy of arterial administration of DNA crosslinking agents with pretreatment of intravenous low-dose gemcitabine for patients with unresectable locally advanced or metastatic pancreatic cancer (LAPC or MPC) is evaluated. (2) Methods: A single-arm, single-center, institutional review board-approved prospective study was conducted between 2005 and 2015. Forty-five patients (23 LAPC, 22 MPC) were included. Patients received a weekly low dose of gemcitabine intravenously for three weeks followed by arterial administration of mitomycin C and epirubicin hydrochloride at tumor-supplying arteries on the fifth or sixth week. This treatment course was repeated at 1.5-to-2-month intervals. Overall survival (OS), local progression-free survival (LPFS), and therapeutic response were evaluated. LAPC or MPC were divided according to treatment compliance, excellent or poor (1 or 2), to subgroups L1, L2, M1, and M2. (3) Results: OS of LAPC and MPC were 23 months and 13 months, respectively. The OS of LAPC with excellent treatment compliance (subgroup L1, 10 patients) was 33 months with 31 months of LPFS, and four patients (40%) had a complete response (CR). The OS of the L1 subgroup was significantly longer than those of other subgroups L2, M1, and M2, which were 17 months, 17 months, and 8 months, respectively. As Grade 3 adverse effects, severe bone marrow suppression, interstitial pneumonitis, and hemolytic uremic syndrome were observed in six (13.0%), three (6.5%), and three (6.5%) patients, respectively. (4) Conclusions: Arterial DNA crosslinking with the systemic restraint of homologous recombination repair can be a new treatment option for LAPC.
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Affiliation(s)
- Hiromu Mori
- Department of Radiology, Nagato Memorial Hospital, Saiki 876-0835, Japan;
- Department of Radiology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (S.T.); (R.T.); (M.O.)
- Correspondence: ; Tel.: +81-80-4270-0753
| | - Shuichi Tanoue
- Department of Radiology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (S.T.); (R.T.); (M.O.)
- Department of Radiology, School of Medicine, Kurume University, Kurume 830-0011, Japan
| | - Ryo Takaji
- Department of Radiology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (S.T.); (R.T.); (M.O.)
| | - Shinya Ueda
- Department of Radiology, Nagato Memorial Hospital, Saiki 876-0835, Japan;
- San-Ai Medical Center, Department of Radiology, Oita 870-1151, Japan
- Department of Radiology, Shin-Beppu Hospital, Beppu 874-8538, Japan
| | - Mika Okahara
- Department of Radiology, Faculty of Medicine, Oita University, Yufu 879-5593, Japan; (S.T.); (R.T.); (M.O.)
- Department of Radiology, Shin-Beppu Hospital, Beppu 874-8538, Japan
| | - Saori Sugi Ueda
- Department of Gastroenterology, Shin-Beppu Hospital, Beppu 874-8538, Japan;
- San-Ai Medical Center, Department of Gastroenterology, Oita 870-115, Japan
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Takaji R, Kiyosue H, Maruno M, Hongo N, Shimada R, Ide S, Tokuyama K, Okamoto M, Kawano Y, Asayama Y. Angiographic features and transarterial embolization of retained placenta with abnormal vaginal bleeding. CVIR Endovasc 2021; 4:77. [PMID: 34727271 PMCID: PMC8563979 DOI: 10.1186/s42155-021-00265-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives To clarify characteristic angiographic features and clinical efficacy of selective transarterial embolization (TAE) of retained placenta with abnormal vaginal bleeding. Methods The study cohort comprised 22 patients (mean age, 33.5 years; range, 22–24 years) who underwent selective TAE for retained placenta with abnormal bleeding between January 2018 and December 2020 at our institution. Angiographic images were reviewed by two certified radiologists with consensus. Medical records were reviewed to evaluate the efficacy of TAE. Angiographic features of retained placenta, technical success (disappearance of abnormal findings on angiography), complications, clinical outcomes (hemostatic effects and recurrent bleeding) were evaluated. Results Pelvic angiography showed a dilated vascular channel mimicking arteriovenous fistulas or an aneurysm contiguous with dilated uterine arteries in the mid-arterial–capillary phase in 20 patients; it showed contrast brush in the remaining two patients. TAE technical success was achieved in all patients. No major complications were observed in any patients. Fifteen patients were followed up with expectant management after TAE; all but one patient showed no re-bleeding during the follow-up period (mean follow-up interval, 3.4 months; range, 1–17 months). One patient showed minor rebleeding, which resolved spontaneously. Seven patients underwent scheduled hysteroscopic resection within 1 week after TAE, and no excessive bleeding was observed during or after the surgical procedure in all seven patients. Conclusions The characteristic angiographic feature of retained placenta is “dilated vascular channel that mimic low flow AVM.” TAE is a safe and effective treatment to manage retained placenta with abnormal bleeding.
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Affiliation(s)
- Ryo Takaji
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan.
| | - Hiro Kiyosue
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan
| | - Miyuki Maruno
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan
| | - Norio Hongo
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan
| | - Ryuichi Shimada
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan
| | - Satomi Ide
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan
| | - Kohei Tokuyama
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan
| | - Mamiko Okamoto
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Yasushi Kawano
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Yoshiki Asayama
- Departments of Radiology, Oita University Faculty of Medicine, Yufu City, Oita, 879-5593, Japan
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Takaji R, Yamada Y, Shimada R, Matsumoto S, Daa T, Endo Y, Inomata M, Asayama Y. Retrospective evaluation of venous phase contrast-enhanced computed tomography images in patients who developed pancreatic adenocarcinomas after treatment for nonpancreatic primary cancer. BJR Open 2021; 3:20200069. [PMID: 34381945 PMCID: PMC8320134 DOI: 10.1259/bjro.20200069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/25/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives: To clarify venous phase contrast-enhanced CT findings in early pancreatic adenocarcinomas by retrospectively evaluating CT images of pancreatic adenocarcinomas that developed during follow-up after treatment for non-pancreatic cancers. Methods: The study cohort comprised six patients who developed pancreatic adenocarcinomas between April 2005 and April 2020 during follow-up after treatment for non-pancreatic primary cancers. Two radiologists retrospectively evaluated CT images and reached consensus on previously reported CT findings that were suggestive of small pancreatic adenocarcinomas; namely pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, focal hypoattenuated areas, and appearance of cystic lesions. Time intervals between the first CT with these suggestive findings and the latest pre-operative CT were recorded. Doubling times were calculated in patients with hypoattenuated areas on initial CT scans. Results: Small (<10 mm) focal hypoattenuated areas with (n = 2) or without rim enhancement (n = 1) were identified on initial CT images of three patients. Pancreatic duct interruption and dilatation, pancreatic parenchymal atrophy, and cystic lesion were identified in two, one and one patient, respectively. Time intervals between initial and latest preoperative CT examination were 6–19 months (median, 14.5 months). Tumor doubling time according to CT findings was calculated as 46–407 days (median 106 days). Conclusion: Venous phase contrast-enhanced CT can provide findings that are suggestive of early pancreatic adenocarcinoma. Pancreatic phase contrast-enhanced CT should therefore be performed in patients with such findings with the aim of early detection of pancreatic adenocarcinoma. Advances in knowledge: Pancreatic adenocarcinoma can develop subsequently in patients with non-pancreatic malignancies. Patients with non-pancreatic cancers are often followed up with monophasic contrast-enhanced CT in venous phase timing. Venous phase contrast-enhanced CT can provide some findings suggestive of early pancreatic adenocarcinoma. Knowledge of these findings is important for early detection of pancreatic adenocarcinoma.
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Affiliation(s)
- Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita Red Cross Hospital, Oita, Japan
| | - Ryuichi Shimada
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
| | | | - Tsutomu Daa
- Department of Diagnostic Pathology, Oita University Faculty of Medicine, Oita, Japan
| | - Yuichi Endo
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Oita, Japan
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Silman C, Matsumoto S, Yamada Y, Sena Y, Hongo N, Takaji R, Kiyonaga M, Ogawa R, Okamoto K, Murakami K. Evaluation of juxtapapillary duodenal diverticula using multiplanar reformation in MDCT: correlation with ERCP findings. Jpn J Radiol 2020; 38:968-972. [PMID: 32488500 DOI: 10.1007/s11604-020-00995-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/26/2020] [Accepted: 05/25/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the ability of multidetector computed tomography (MPR-MDCT) to identify and classify the juxtapapillary duodenal diverticulum (JPDD), with ERCP findings as the gold standard. METHODS We retrospectively reviewed all ERCP examinations (n: 455) performed between January 2010 to December 2018 and selected 105 patients with JPDD as the inclusion criteria. Of those, 28 patients were excluded because of advanced pancreatic carcinoma, incomplete MDCT examinations and biliary catheter insertion. Finally, MDCT examinations of 77 patients with JPDD were assessed for the presence and type of JPDD. RESULTS MPR-MDCT was able to identify 71 (92.2%) JPDD in 77 cases with 88.9% accuracy, 83.3% sensitivity, and 91.6% specificity in classifying the type of JPDD. MPR-MDCT performed best in determining type 1 JPDD, with accuracy of 95.4% compared with type 2 (83.3%) and type 3 (87.8%). There was no significant difference between age, gender, incidence of biliary stones and pancreatitis between each type of JPDD. No correlation of sizes with types of JPDD was found. CONCLUSIONS MPR-MDCT can accurately identify and classify JPDD. This information will be useful in determining the difficulty of ERCP.
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Affiliation(s)
- Christopher Silman
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Shunro Matsumoto
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yankel Sena
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Norio Hongo
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Maki Kiyonaga
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Ryo Ogawa
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazuhisa Okamoto
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
| | - Kazunari Murakami
- Department of Gastroenterology, Oita University Faculty of Medicine, Oita, Japan
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Kamei N, Yamada Y, Hijiya N, Takaji R, Kiyonaga M, Hongo N, Ohta M, Hirashita T, Inomata M, Matsumoto S. Invasive intraductal papillary mucinous neoplasms of the pancreas: relationships between mural nodules detected on thin-section contrast-enhanced MDCT and invasive components. Abdom Radiol (NY) 2019; 44:3139-3147. [PMID: 31168723 DOI: 10.1007/s00261-019-02084-2] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To elucidate the relationships between mural nodules (MNs) and invasive components in patients with invasive intraductal papillary mucinous neoplasm (IPMN) on the basis of thin-section contrast-enhanced multidetector CT (CE-MDCT) and pathologic findings. METHODS This retrospective study included 28 patients with surgically confirmed invasive IPMN. Two radiologists independently evaluated the thin-section (1-mm section thickness, no overlap) triple-phase CE-MDCT images for MNs, invasive components, and the continuity between them using a five-point scale (confidence scores of 1-3 as negative, 4 and 5 as positive). Kappa statistic was used to evaluate interobserver agreement. The CE-MDCT findings were correlated with pathologic findings. RESULTS Interobserver agreement was good or excellent. MNs consisting of tumor cells were recognized in 12 (42.9%) of 28 patients with no discrepancy between the two radiologists. Invasive components were detected in 85.7% and 82.1% in the pancreatic parenchymal phase for radiologist 1 and 2, respectively, and recognized as hypoattenuating areas. Pathologic continuities between MNs and invasive components were confirmed in five (41.7%) of 12 patients with MNs and these were detected on CE-MDCT. When combined seven patients without continuities between MNs and invasive components and 16 patients without MNs, the invasive components pathologically derived from non-nodular low-height papillary epithelium in 23 (82.1%) of 28 patients. CONCLUSIONS The invasive components derived more often from low-height papillary epithelium without MN appearance on CE-MDCT than from MN. Careful attention should be paid to the existence of an invasive component even in the absence of an enhancing MN.
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Affiliation(s)
- Noritaka Kamei
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan.
| | - Naoki Hijiya
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Maki Kiyonaga
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Norio Hongo
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Department of Gastrointestinal and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Teijiro Hirashita
- Department of Gastrointestinal and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastrointestinal and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Shunro Matsumoto
- Department of Radiology, Oita University Faculty of Medicine, 1-1 Hasama-machi, Yufu, Oita, 879-5593, Japan
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Takaji R, Yamada Y, Matsumoto S, Kiyonaga M, Hongo N, Mori H, Hijiya N, Ohta M, Inomata M, Takaki H, Fukuzawa K, Yonemasu H. Small pancreatic ductal carcinomas on triple-phase contrast-enhanced computed tomography: enhanced rims and the pathologic correlation. Abdom Radiol (NY) 2018; 43:3374-3380. [PMID: 29796845 DOI: 10.1007/s00261-018-1645-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To reveal the prevalence of small (≤ 20 mm) pancreatic ductal carcinomas with enhanced rims on triple-phase contrast-enhanced CT and correlate the CT images with the pathologic findings. MATERIALS AND METHODS Between April 2005 and April 2016, 45 patients underwent preoperative triple-phase contrast-enhanced CT and were pathologically diagnosed with small pancreatic ductal carcinoma. CT images were independently reviewed by two radiologists. The attenuation values of the enhanced rims, internal areas of the tumors, and surrounding pancreatic parenchyma were compared using Mann-Whitney U test. These areas were also correlated with the pathologic findings. Tumor invasiveness was compared between the tumors with and without enhanced rims using Fisher's exact test. RESULTS Enhanced rims were identified in 18 tumors (40%) by consensus between the two reviewers. The enhanced rims showed significantly higher mean attenuation values compared with the internal areas of the tumors (p < 0.001) and surrounding pancreatic parenchyma (p < 0.0086), and were most clearly visualized on equilibrium phase. The enhanced rims pathologically reflected the abundant fibrotic stroma with cancer cells in all tumors. There was no statistically significant difference in tumor invasiveness between the tumors with and without enhanced rims (anterior peripancreatic invasion, p = 0.137; posterior peripancreatic invasion, p = 0.758; portal vein invasion, p = 0.639; and lymph node metastases, p = 0.359). CONCLUSIONS Enhanced rims were detected at a rate of 40% in small pancreatic ductal carcinomas and could be an important finding for diagnosis on CT images, but did not suggest a less aggressive nature.
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Affiliation(s)
- Ryo Takaji
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan.
| | - Yasunari Yamada
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Shunro Matsumoto
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Maki Kiyonaga
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Norio Hongo
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Hiromu Mori
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Naoki Hijiya
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Hajime Takaki
- Department of Radiology, Oita Red Cross Hospital, Oita, 870-0033, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, 870-0033, Japan
| | - Hirotoshi Yonemasu
- Department of Anatomic Pathology, Oita Red Cross Hospital, Oita, 870-0033, Japan
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Yamada Y, Matsumoto S, Mori H, Takaji R, Kiyonaga M, Hijiya N, Tanoue R, Tomonari K, Tanoue S, Hongo N, Ohta M, Seike M, Inomata M, Murakami K, Moriyama M. Periportal lymphatic system on post-hepatobiliary phase Gd-EOB-DTPA-enhanced MR imaging in normal subjects and patients with chronic hepatitis C. Abdom Radiol (NY) 2017; 42:2410-2419. [PMID: 28444420 DOI: 10.1007/s00261-017-1155-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We sought to evaluate visualization of periportal lymphatics and lymph nodes (lymphatic system) on Gd-EOB-DTPA-enhanced magnetic resonance (MR) images using a fat-suppressed T2-weighted sequence with 3-dimensional (3D) volume isotropic turbo spin echo acquisition (VISTA) at 3.0 T in normal subjects and patients with chronic hepatitis C. METHODS MR imaging was performed in 254 subjects between June 2013 and May 2016. After applying inclusion and exclusion criteria, the final population was 31 normal subjects and 34 patients with chronic hepatitis C. Images were acquired after the hepatobiliary phase following intravenous administration of Gd-EOB-DTPA, which causes signal loss in the bile ducts, to facilitate the visualization of the periportal lymphatic system. Two radiologists assessed the visualization of the periportal lymphatic system in 31 normal subjects. The axial dimensions of the main periportal lymphatic system in normal subjects were measured and compared with those of 34 patients with chronic hepatitis C using the Mann-Whitney U-test, and their correlation with a hepatic fibrosis marker, the Fibrosis-4 (FIB-4), was assessed using Spearman's rank correlation test. RESULTS The periportal lymphatic system was detected as high signal intensity areas surrounding the portal vein up to the third branches by each reader in all normal subjects. The axial dimensions of the main periportal lymphatic system in patients with chronic hepatitis C were significantly larger than those in normal subjects (p < 0.0001), and showed a significantly positive correlation with the FIB-4 score (ρ = 0.73, p < 0.001). CONCLUSIONS Fat-suppressed T2-weighted MR imaging with 3D-VISTA acquired after the hepatobiliary phase on Gd-EOB-DTPA-enhanced imaging may be a useful noninvasive method for evaluating the periportal lymphatic system and the degree of hepatic fibrosis.
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Affiliation(s)
- Yasunari Yamada
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Shunro Matsumoto
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan.
| | - Hiromu Mori
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Maki Kiyonaga
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Naoki Hijiya
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Rika Tanoue
- Oita Diagnostic Imaging Center, Beppu, Oita, 874-0023, Japan
| | | | - Shuichi Tanoue
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Norio Hongo
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masataka Seike
- Gastroenterology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Kazunari Murakami
- Gastroenterology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Masatsugu Moriyama
- Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
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Omeri AK, Matsumoto S, Kiyonaga M, Takaji R, Yamada Y, Ando Y, Mori H, Uchida H, Iwashita Y, Ohta M, Inomata M. Fusion anomaly of the pancreatic tail and spleen: a case report. J Med Case Rep 2017; 11:238. [PMID: 28843273 PMCID: PMC5572307 DOI: 10.1186/s13256-017-1391-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 01/29/2017] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Splenopancreatic fusion is a rare anomaly that is often associated with trisomy 13. Its diagnosis can be important in patients scheduled to undergo distal pancreatectomy or splenectomy, to avoid possible intraoperative or postoperative complications. CASE PRESENTATION An 82-year-old Japanese man was referred to our hospital for further evaluation and treatment for a solitary hepatocellular carcinoma based on liver cirrhosis. Triple-phase contrast-enhanced multidetector-row computed tomography and magnetic resonance imaging showed a splenopancreatic fusion as well as a solitary hepatocellular carcinoma in segment VIII of his liver. CONCLUSIONS Fusion of the pancreatic tail and spleen is a rare and asymptomatic anomaly. Its detection can be improved by the use of multidetector computed tomography or magnetic resonance imaging.
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Affiliation(s)
- Ahmad Khalid Omeri
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, 879-5593, Oita, Japan
| | - Shunro Matsumoto
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, 879-5593, Oita, Japan.
| | - Maki Kiyonaga
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, 879-5593, Oita, Japan
| | - Ryo Takaji
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, 879-5593, Oita, Japan
| | - Yasunari Yamada
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, 879-5593, Oita, Japan
| | - Yumiko Ando
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, 879-5593, Oita, Japan
| | - Hiromu Mori
- Department of Radiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu city, 879-5593, Oita, Japan
| | - Hiroki Uchida
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Yukio Iwashita
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
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Sadanaga Y, Takaji R, Ishiyama A, Nakajima K, Matsuki A, Bandow H. Thermal dissociation cavity attenuated phase shift spectroscopy for continuous measurement of total peroxy and organic nitrates in the clean atmosphere. Rev Sci Instrum 2016; 87:074102. [PMID: 27475571 DOI: 10.1063/1.4958167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A thermal dissociation cavity attenuated phase shift spectroscopy (TD-CAPS) instrument was developed for measuring total peroxy nitrates (PNs) and organic nitrates (ONs) concentrations in the clean atmosphere. This instrument is easy to operate and can be applied to continuous measurement of PNs and ONs. A continuously measurable system is convenient to perform observations, especially in remote areas. Three lines (NO2, PNs, and ONs lines) were used for thermal dissociation. The NO2 line contains a quartz tube that is not heated, while the PN and ON lines contain quartz tubes that are heated at 433 K and 633 K, respectively. The concentrations of NO2, NO2 + PNs, and NO2 + PNs + ONs can be obtained from the NO2, PN, and ON lines, respectively. The lower limit values of the detection limit (3σ) for PNs and ONs were estimated to be 21 parts per trillion by volume with an integration time of 2 min. PNs were selectively thermally decomposed in the PNs line and formed NO2 quantitatively. In the ONs line, both PNs and ONs were thermally decomposed to produce NO2 quantitatively, but partial decomposition of HNO3 at 633 K interfered with the ONs measurement. Therefore, a HNO3 scrubber is required before the ONs line. Continuous observations were conducted with the TD-CAPS instrument in a remote area, and the instrument performed well for obtaining PNs and ONs concentrations.
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Affiliation(s)
- Yasuhiro Sadanaga
- Department of Applied Chemistry, Graduate School of Engineering, Osaka Prefecture University, 1-1 Gakuen-cho, Naka-ku, Sakai, Osaka 599-8531, Japan
| | - Ryo Takaji
- Department of Applied Chemistry, Graduate School of Engineering, Osaka Prefecture University, 1-1 Gakuen-cho, Naka-ku, Sakai, Osaka 599-8531, Japan
| | - Ayana Ishiyama
- Department of Applied Chemistry, Graduate School of Engineering, Osaka Prefecture University, 1-1 Gakuen-cho, Naka-ku, Sakai, Osaka 599-8531, Japan
| | - Kazuo Nakajima
- Department of Applied Chemistry, Graduate School of Engineering, Osaka Prefecture University, 1-1 Gakuen-cho, Naka-ku, Sakai, Osaka 599-8531, Japan
| | - Atsushi Matsuki
- Institute of Nature and Environmental Technology, Kanazawa University, Kakuma-machi, Kanazawa, Ishikawa 920-1192, Japan
| | - Hiroshi Bandow
- Department of Applied Chemistry, Graduate School of Engineering, Osaka Prefecture University, 1-1 Gakuen-cho, Naka-ku, Sakai, Osaka 599-8531, Japan
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Matsumoto S, Mori H, Kiyonaga M, Yamada Y, Takaji R, Sato F, Mimata H, Hijiya N, Moriyama M, Tanoue R, Tomonari K, Matsumoto T, Hasebe T. Perirenal lymphatic systems: Evaluation using spectral presaturation with inversion recoveryT2-weighted MR images with 3D volume isotropic turbo spin-echo acquisition at 3.0T. J Magn Reson Imaging 2016; 44:897-905. [DOI: 10.1002/jmri.25244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/06/2016] [Indexed: 02/06/2023] Open
Affiliation(s)
- Shunro Matsumoto
- Department of Radiology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Hiromu Mori
- Department of Radiology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Maki Kiyonaga
- Department of Radiology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Yasunari Yamada
- Department of Radiology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Ryo Takaji
- Department of Radiology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Fuminori Sato
- Department of Urology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Hiromitsu Mimata
- Department of Urology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Naoki Hijiya
- Department of Molecular Pathology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Masatsugu Moriyama
- Department of Molecular Pathology; Oita University Faculty of Medicine; Yufu Oita Japan
| | - Rika Tanoue
- Oita Diagnostic Imaging Center; Beppu Oita Japan
| | | | - Tomohiro Matsumoto
- Department of Radiology; Tokai University Hachioji Hospital; Tokai University School of Medicine; Hachioji Tokyo Japan
| | - Terumitsu Hasebe
- Department of Radiology; Tokai University Hachioji Hospital; Tokai University School of Medicine; Hachioji Tokyo Japan
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Takaji R, Mori H, Yamada Y, Kiyonaga M, Matsumoto S. Medial pathway patterns of the right retromesenteric plane: anatomical investigation using MDCT in patients with acute pancreatitis and pyelonephritis. Br J Radiol 2016; 89:20150471. [DOI: 10.1259/bjr.20150471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Kiyonaga M, Matsumoto S, Mori H, Yamada Y, Takaji R, Hijiya N, Yoshizumi F, Aramaki M. Pancreatic neuroendocrine tumor with extensive intraductal invasion of the main pancreatic duct: a case report. JOP 2014; 15:497-500. [PMID: 25262720 DOI: 10.6092/1590-8577/2741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
CONTEXT Pancreatic neuroendocrine tumors account for only 1-3% of all pancreatic neoplasms and the intraductal invasion of the main pancreatic duct (MPD) is rare. CASE REPORT We report a case of a 26-year-old woman with an endocrine tumor of the pancreas extensively invading into the MPD. She presented abdominal pain and her laboratory data showed abnormal liver function. Contrast-enhanced computed tomography demonstrated a well-enhanced mass on the arterial dominant phase in the head of the pancreas. The mass grew within the lumen of the MPD in the body of the pancreas, with dilatation of the upstream MPD. The contrast-enhancement pattern between the main tumor of the head and the intraductal lesion of the body was different. On T2-weighted magnetic resonance (MR) imaging, the pancreatic head lesion showed non homogeneously low signal intensity, while the intraductal lesion of the pancreatic body showed high signal intensity. MR cholangiopancreatography showed obstruction of the MPD in the pancreatic head to body, with dilatation of the upstream MPD. An endocrine tumor or acinar cell carcinoma of the pancreas was considered as preoperative diagnosis, and pancreaticoduodenectomy was performed. As a result, pancreatic endocrine tumor (G2) was confirmed pathologically. CONCLUSION A rare case of pancreatic neuroendocrine tumor with extensive growth within the MPD was presented. The intraductal extension is a unique growth pattern of nonfunctioning pancreatic neuroendocrine tumor, and the desmoplastic reaction in this tumor may reflect the increased invasiveness.
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Affiliation(s)
- Maki Kiyonaga
- Department of Radiology, Faculty of Medicine, Oita University. Oita, Japan.
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Yamada Y, Mori H, Hijiya N, Matsumoto S, Takaji R, Kiyonaga M, Ohta M, Kitano S, Moriyama M, Takaki H, Fukuzawa K, Yonemasu H. Extrahepatic bile duct cancer: invasion of the posterior hepatic plexuses--evaluation using multidetector CT. Radiology 2012; 263:419-28. [PMID: 22447852 DOI: 10.1148/radiol.12111024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the utility of axial and coronal reformatted multidetector computed tomographic (CT) images in the evaluation of the invasion of posterior hepatic plexuses by extrahepatic bile duct cancer. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and informed consent was waived. Forty-three patients (22 men, 21 women; age range, 40-80 years; mean age, 65 years) with surgically resected cancer involving the extrahepatic bile duct between December 2004 and September 2010 were included. Posterior hepatic plexus 1 runs from the superior and middle bile duct to the right celiac ganglion, and posterior hepatic plexus 2 runs between the lower bile duct and right celiac ganglion behind the portal vein. Invasion of the posterior hepatic plexuses was elucidated by using pathologic and postoperative multidetector CT findings. Three radiologists independently evaluated the preoperative axial and coronal reformatted images with a separate viewing session for the invasion of posterior hepatic plexuses that was detected on the basis of the presence of increased attenuation of fat tissue along the nerve routes. Receiver operating characteristic analysis was performed to compare the diagnostic performance of the two image interpretations. RESULTS Invasion of posterior hepatic plexus 1 and of posterior hepatic plexus 2 was recognized in 10 (23%) and nine (21%) of 43 patients, respectively. The diagnostic performance of coronal reformatted image interpretation was significantly greater than that for axial image interpretation (mean area under the curve, 0.99 vs 0.89, P = .04; mean accuracy, 95% vs 82%, P = .003). In all reviewers, one false-positive diagnosis of the invasion of posterior hepatic plexus occurred on axial and/or coronal image display types because of fibrosis and inflammatory cell infiltration along these plexus routes. CONCLUSION Coronal reformatted images can be useful for accurate diagnosis of the invasion of posterior hepatic plexuses and may facilitate surgical decision making in regard to the resection of celiac ganglion.
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Affiliation(s)
- Yasunari Yamada
- Departments of Radiology, Oita University Faculty of Medicine, Oita, Japan.
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Abstract
As less-invasive treatments for small bowel obstruction, such as laparoscopic surgery or small incision therapy, have become common, there is a growing demand for preoperative assessment of the cause and location of the small bowel obstruction. Thus, the role of computed tomography (CT) in the evaluation of small bowel obstruction is expanding. CT imaging of internal hernias (IHs) has been extensively described and is well established; however, CT imaging of IH after abdominal surgeries is not well recognized because of their anatomical complexity. The aims of this pictorial review are (1) to evaluate the causes of internal IHs in relation to previous abdominal surgery (e.g., IH associated with Roux-en-Y reconstruction, Billroth II reconstruction, peritoneal adhesive band, perineal hernia, and IH after gynecological procedures), (2) to demonstrate the spectrum of imaging findings on multidetector CT (MDCT), and (3) explain the key features for CT diagnosis of IHs related to previous surgical procedures, with emphasis on the multi-planar reformation (MPR) image. We also demonstrate the dynamic changes in the progression of mesenteric strangulation revealed by CT. Understanding the imaging appearance on MDCT can help radiologists guide therapy for patients with a small bowel obstruction after abdominal surgery.
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Affiliation(s)
- Norio Hongo
- Department of Radiology, Faculty of Medicine, Oita University, Hasama-machi, Japan.
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Okino Y, Kiyosue H, Matsumoto S, Takaji R, Yamada Y, Mori H. Hepatocellular carcinoma: prediction of blood supply from right inferior phrenic artery by multiphasic CT. J Comput Assist Tomogr 2003; 27:341-6. [PMID: 12794596 DOI: 10.1097/00004728-200305000-00007] [Citation(s) in RCA: 16] [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: 02/07/2023]
Abstract
OBJECTIVE Recurrent hepatocellular carcinoma (HCC) often occurs with extrahepatic arterial supply (parasitic supply), essentially due to liver intraarterial chemoembolization, which could potentially hamper retreatment. The right inferior phrenic artery (RIPA) is the most frequent extrahepatic feeding artery. We investigated computed tomography (CT) findings of parasitic supply by the RIPA, and discuss the utility of multiphasic CT for prediction of parasitic supply from RIPA. METHOD Medical records, CT scans, and angiograms in 20 patients with HCC fed by RIPA were reviewed. Forty-two patients with HCC but without parasitic supply were enrolled as the control group. After injection of contrast medium (300 mg I/mL) at a rate of 3 mL/s (total amount, 100 mL), CT images were obtained at 30 seconds, 60 seconds, and 150 seconds with scanning parameters of 7-mm collimation, 1:1 pitch, and 3.5-mm reconstruction. Two radiologists evaluated the previous treatment, patency of the hepatic arteries, location of tumors, and detectability and diameter of the RIPA. RESULTS CT demonstrated at least one portion of RIPA in all patients in both groups. The distal portions of RIPA were detected on CT more frequently in the parasitic group (75%) than in the control group (7.1%). The mean diameter of the RIPA in the parasitic group was 2.3 mm (range; 1.6-3.8), and was larger than that of the control group (mean; 1.3 mm and range; 0-4.1mm) with statistical significance (P < 0.01). CONCLUSIONS Multiphasic CT could demonstrate the presence of parasitic supply to HCCs from RIPA. Visualization of RIPA at the distal portion on CT would be a clue of parasitic supply from RIPA.
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Affiliation(s)
- Yuriko Okino
- Department of Radiology, Oita medical University, Oita, Japan.
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