18F-FDG PET/CT Findings of G-CSF-Producing Gallbladder Cancer

ABSTRACT

We report a case of granulocyte colony-stimulating factor (G-CSF)-producing gallbladder cancer in a 64-year-old man. Contrast-enhanced CT showed an exophytic hypoattenuation mass with peripheral enhancement in the gallbladder. 18F-FDG PET/CT showed avid FDG uptake in the gallbladder mass and diffuse FDG uptake in the bone marrow. The patient was diagnosed with G-CSF-producing gallbladder cancer based on an elevated serum level of G-CSF and histological findings. G-CSF-producing tumors are associated with a poor prognosis because of rapid progression. Early and accurate diagnosis of G-CSF-producing tumors based on characteristic PET/CT findings is important to determine treatment strategies and improve prognosis of patients.

Neuroendocrine carcinoma of uterine cervix findings shown by MRI for staging and survival analysis - Japan multicenter study

Objectives: To investigate neuroendocrine carcinoma (NEC) of the uterine cervix cases for MRI features and staging, as well as pathological correlations and survival.

Results: FIGO was I in 42, II in 14, III in 1, and IV in 5 patients. T2-weighted MRI showed homogeneous slightly high signal intensity and obvious restricted diffusion (ADC map, low intensity; DWI, high intensity) throughout the tumor in most cases, and mild enhancement in two-thirds. In 50 patients who underwent a radical hysterectomy and lymphadenectomy without neoadjuvant chemotherapy (NAC), intrapelvic T staging by MRI overall accuracy was 88.0% with reference to pathology staging, while patient-based sensitivity, specificity, and accuracy for metastatic pelvic lymph node detection was 38.5%, 100%, and 83.3%, respectively. During a mean follow-up period of 45.6 months (range 4.3–151.0 months), 28 patients (45.2%) experienced recurrence and 24 (38.7%) died. Three-year progression-free and overall survival rates for FIGO I, II, III, and IV were 64.3% and 80.9%, 50% and 64.3%, 0% and 0%, and 0% and 0%, respectively.

Materials and Methods: Sixty-two patients with histologically surgery-proven uterine cervical NEC were enrolled. Twelve received NAC. Clinical data, pathological findings, and pretreatment pelvic MRI findings were retrospectively reviewed. Thirty-two tumors were pure NEC and 30 mixed with other histotypes. The NECs were small cell type (41), large cell type (18), or a mixture of both (3).

Conclusions: Homogeneous lesion texture with obvious restricted diffusion throughout the tumor are features suggestive of cervical NEC. Our findings show that MRI is reliable for T staging of cervical NEC.

Invasive solid papillary carcinoma with neuroendocrine differentiation of the breast: a case report and literature review

Background

Solid papillary carcinoma (SPC) of the breast is a rare breast cancer that accounts for less than 1% of all breast cancers. The optimal clinical management of SPC remains controversial. Here, we report a case of invasive SPC with neuroendocrine differentiation in addition to review of the current literature.

Case presentation

A premenopausal 46-year-old female presented with a mass in her left breast that tended to increase in size over a 10-month period. Mammography and ultrasonography revealed a mass in the left upper-inner quadrant. The resulting images suggested a category 3 breast tumor according to the Breast Imaging Reporting and Data System (BI-RADS). A core needle biopsy (CNB) was performed, and the pathological findings showed a solid papillary pattern and atypical cells suggestive of noninvasive SPC. After a left partial mastectomy and sentinel lymph node biopsy (SLNB), the specimens were sent for histopathological analysis for further investigation. Postoperative pathological findings suggested invasive SPC. Whole-breast radiation therapy and adjuvant hormonal therapy were performed as postoperative treatments. Three years after surgery, multiple lung metastases were detected, and the patient was treated with a gonadotropin-releasing hormone agonist and an aromatase inhibitor. Five months later, multiple liver metastases and bone metastases appeared, and oral 5-fluorouracil was chosen for the subsequent treatment. The patient has been treated for 5 years to date, and she is continuing to take oral 5-fluorouracil and is alive without any further disease progression.

Conclusions

We report a rare case of premenopausal invasive SPC with multiple metastases. Further study is needed to clarify the molecular characteristics and clinical behaviors of SPC and to explore the optimal treatment strategy.

Prediction of clinical outcome after stereotactic body radiotherapy for non-small cell lung cancer using diffusion-weighted MRI and (18)F-FDG PET

PURPOSE/OBJECTIVES

To evaluate the use of diffusion-weighted magnetic resonance imaging (DW-MRI) and (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) for predicting disease progression (DP) among patients with non-small cell lung carcinoma (NSCLC) treated with stereotactic body radiotherapy (SBRT).

MATERIALS/METHODS

Fifteen patients with histologically confirmed stage I NSCLC who underwent pre-treatment DW-MRI and PET and were treated with SBRT were enrolled. The mean apparent diffusion coefficient (ADC) value and maximum standardised uptake value (SUVmax) were measured at the target lesion and evaluated for correlations with DP.

RESULTS

The median pre-treatment ADC value was 1.04×10(-3) (range 0.83-1.29×10(-3))mm(2)/s, and the median pre-treatment SUVmax was 9.9 (range 1.6-30). There was no correlation between the ADC value and SUVmax. The group with the lower ADC value (≤1.05×10(-3)mm(2)/s) and that with a higher SUVmax (≥7.9) tended to have poor DP, but neither trend was statistically significant (p=0.09 and 0.32, respectively). The combination of the ADC value and SUVmax was a statistically significant predictor of DP (p=0.036).

CONCLUSION

A low ADC value on pre-treatment DW-MRI and a high SUVmax may be associated with poor DP in NSCLC patients treated with SBRT. Using both values in combination was a better predictor.

"Early esophageal rim enhancement": a new sign of esophageal cancer on dynamic CT

OBJECTIVE

To retrospectively assess a new CT finding of esophageal cancer, "early esophageal rim enhancement".

MATERIALS AND METHODS

Sixty-two patients with pathological proven esophageal squamous cell carcinoma who underwent dual phase CT imaging (arterial and venous phases) were enrolled. Two blinded observes independently evaluated presence of partial or circumferential enhancement of the esophageal periphery on arterial (early esophageal rim enhancement) and venous phase CT images. The radiological assessment was compared with the pathological T-stages. Agreement between the observers was also evaluated with a Cohen' kappa value.

RESULTS

Pathologic results found 19, 12, 30 and 1 lesions, respectively for T1, T2, T3 and T4 stages. Agreement between two readers was substantial (κ=0.71). Esophageal rim enhancement was observed in 0, 4, 24 and 1 lesions respectively for T1, T2, T3 and T4 stages at the arterial phase, whereas no esophageal rim enhancement could be detected at the venous phase. Early esophageal rim enhancement was more frequently observed in T3/T4 lesions than T1/T2 lesions with statistical significance (p<0.0001). The sensitivity, specificity and accuracy for the diagnosis of T3 or T4 lesion were 80.6%, 87.1% and 83.9%, respectively.

CONCLUSION

Early esophageal rim enhancement may be helpful for assessing invasion into the adventitia.

Diffusion tensor MRI of the kidney at 3.0 and 1.5 Tesla

BACKGROUND

Diffusion tensor imaging (DTI) at 3 T provides information on the microstructure and pathophysiology of tissues that is not available from conventional imaging with an advantage of high signal to noise ratio (SNR).

PURPOSE

To evaluate the feasibility of DTI of the normal kidney at 3.0 T compared to results obtained at 1.5 T.

MATERIAL AND METHODS

DTI of the normal kidney of 15 healthy volunteers obtained with 3.0 and 1.5 T scanners using respiration-triggered acquisition was examined. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of both the renal cortex and the medulla and SNRs were measured (b-values 0 and 400 s/mm², diffusion direction of 6). The image quality of FA and ADC maps was also compared subjectively.

RESULTS

The FA values of the renal cortex were 0.15 ± 0.03 at 3.0 T and 0.14± 0.03 at 1.5 T on average. This difference was not significant. The FA values of the renal medulla were 0.49 ±0.04 at 3.0 T and 0.42 ± 0.05 at 1.5 T. ADC values of the renal cortex were 2.46 x 10⁻³± 0.09 mm<²/s at 3.0 T and 2.20 x 10⁻³±0.11 mm²/s at 1.5 T. The ADC values of the renal medulla were 2.08 x 10⁻³ ± 0.08 mm²/s at 3.0 T and 1.90 x 10⁻³± 0.11 mm²/s at 1.5 T. These FA and ADC values were consistent with previous publications. The difference was significant for the FA value of the medulla (P< 0.01) and ADC values in both cortex and medulla (P < 0.01). The subjective image quality of the FA map with the 3.0 T scanner was significantly superior to that with the 1.5 T scanner (P< 0.01), but not significant for the ADC map (P = 0.18). There was a significant difference in SNR between 3.0 T (48.8 ± 6.6) and 1.5 T images (32.8 ± 5.0).

CONCLUSION

The feasibility of renal DTI with a 3.0 T magnet resulting in improved SNR was demonstrated.

Identification of early interstitial lung disease in smokers from the COPDGene Study

RATIONALE AND OBJECTIVES

The aim of this study is to compare two subjective methods for the identification of changes suggestive of early interstitial lung disease (ILD) on chest computed tomographic (CT) scans.

MATERIALS AND METHODS

The CT scans of the first 100 subjects enrolled in the COPDGene Study from a single institution were examined using a sequential reader and a group consensus interpretation scheme. CT scans were evaluated for the presence of parenchymal changes consistent with ILD using the following scoring system: 0 = normal, 1 = equivocal for the presence of ILD, 2 = highly suspicious for ILD, and 3 = classic ILD changes. A statistical comparison of patients with early ILD to normal subjects was performed.

RESULTS

There was a high degree of agreement between methods (kappa = 0.84; 95% confidence interval, 0.73-0.94; P < .0001 for the sequential and consensus methods). The sequential reading method had both high positive (1.0) and negative (0.97) predictive values for a consensus read despite a 58% reduction in the number of chest CT evaluations. Regardless of interpretation method, the prevalence of chest CT changes consistent with early ILD in this subset of smokers from COPDGene varied between 5% and 10%. Subjects with early ILD tended to have greater tobacco smoke exposure than subjects without early ILD (P = .053).

CONCLUSIONS

A sequential CT interpretation scheme is an efficient method for the visual interpretation of CT data. Further investigation is required to independently confirm our findings and further characterize early ILD in smokers.

Diffusion tensor imaging of kidneys with respiratory triggering: optimization of parameters to demonstrate anisotropic structures on fraction anisotropy maps

PURPOSE

To demonstrate the feasibility of diffusion tensor imaging (DTI) of kidneys with respiratory triggering, and determine the optimal imaging parameters for fraction anisotropy (FA) maps.

MATERIALS AND METHODS

DTI of kidneys from 16 healthy volunteers was performed using a 1.5T scanner. Five different sequences with different parameters including respiration-triggered acquisition or multiple breath-holding, slice thicknesses of 3 or 5 mm, and different numbers of signal averaging and b values were compared. FA and apparent diffusion coefficients (ADCs) of the cortex and medulla were measured. Measurement error within the same and repeated examination was examined using within-individual standard deviation (Sw).

RESULTS

FAs of the renal cortex were lower than the medulla (mean value of a sequence ranging 0.148-0.224, 0.433-0.476) and the ADCs of the cortex were higher than the medulla (2.26-2.69x10(-3) mm2/s, 1.77-2.19x10(-3) mm2/s) in all sequences (P<0.001). The renal cortex-medulla difference was the largest, with respiratory trigger- ing including a 3-mm slice thickness, three signal averages,and a b-value=0, 200, or 400 s/mm2 (P<0.001). Sw tended to be smaller in the sequence with a b-value of 400 s/mm2.

CONCLUSION

DTI of kidneys with respiratory triggering is feasible with excellent cortex-medulla differentiation.

Pictorial review of tuberous sclerosis in various organs

Tuberous sclerosis is a rare autosomal dominant neurocutaneous syndrome characterized by the presence of benign congenital tumors in multiple organs. The diagnosis is usually established on the basis of diagnostic criteria applied to physical or radiologic findings. Because the classical triad of epilepsy, mental retardation, and adenoma sebaceum is uncommonly seen at clinical examination, radiologic examinations can play an important role in the diagnosis of tuberous sclerosis and in treatment. Cardiac rhabdomyoma, renal angiomyolipoma, and neurologic involvement encompassing cortical or subependymal tubers and white matter abnormalities are the common radiologic findings. Detection of these entities can be strong evidence for suspecting tuberous sclerosis. The presence of pulmonary lymphangioleiomyomatosis, multifocal micronodular pneumocyte hyperplasia, or multiple renal cysts also raises suspicion of tuberous sclerosis. Moreover, tuberous sclerosis can involve bone, liver, and the alimentary tract. The clinical course and patient prognosis depend on the sites of manifestations. Familiarity with the clinical and radiologic findings in various organs is crucial in diagnosis and treatment.

Diffusion-weighted MR imaging of uterine endometrial cancer

PURPOSE

To determine the feasibility of diffusion-weighted (DW) MRI of uterine endometrial cancer and to investigate whether the apparent diffusion coefficient (ADC) values of endometrial cancer differ from those of normal endometrium and whether they differ according to the histologic grade of the tumor.

MATERIALS AND METHODS

Study population included 18 consecutive females with surgically proven endometrial cancer and 12 females with pathologically confirmed normal endometrium in cervical cancer patients. Visual evaluation and ADC measurement were performed in endometrial cancer and normal endometrium.

RESULTS

All endometrial cancer and the normal endometrium appeared hyperintense on DW images. The mean ADC value (10(-3) mm(2)/second) of endometrial cancer was 0.88 +/- 0.16, which was significantly lower (P < 0.01) than that of normal endometrium (1.53 +/- 0.10). The mean ADC value for each histologic grade was 0.93 +/- 0.16 (G1), 0.92 +/- 0.13 (G2), and 0.73 +/- 0.09 (G3).

CONCLUSION

The present study showed that DW imaging is feasible in demonstrating uterine endometrial cancer and ADC measurement has a potential ability to differentiate between normal and cancerous tissue of the endometrium. The ADC values of endometrial cancers of higher grade show tendency to decrease compared to those of lower grade, although estimation of histologic grade based on ADC values seems difficult because of considerable overlap.

MRCP imaging at 3.0 T vs. 1.5 T: preliminary experience in healthy volunteers

PURPOSE

To evaluate the impact of magnetic resonance cholangiopancreatography (MRCP) imaging at 1.5T and 3.0T on image quality.

MATERIALS AND METHODS

Fourteen volunteers were examined at both 1.5T and 3.0T using MRCP imaging performed with a breath-held two-dimensional (2D) half-Fourier acquired single-shot turbo spin-echo (HASTE) thick-slab sequence, a free-breathing navigator-triggered three-dimensional (3D) turbo spin-echo (TSE) sequence with prospective acquisition correction, and a heavily T2-weighted (T2W) sequence with breath-held multislice HASTE. All images were scored for visualization of the biliary and pancreatic ducts, severity of artifacts, image noise, and overall image quality.

RESULTS

MRCP imaging at 3.0T yielded a significant improvement in overall image quality compared to 1.5T. We found a trend for superior visualization of the biliary and pancreatic ducts at 3.0T. Heavily T2W imaging with thin sections (1.4 mm) at 3.0T provided diagnostic images and better visualization of the biliary and pancreatic ducts than heavily T2W imaging with standard sections (2.8 mm) at 3.0T.

CONCLUSION

Our experience suggests that MRCP imaging at 3.0T has the potential to provide excellent images. High-resolution heavily T2W imaging with a small voxel size (1.3 x 1.3 x 1.4 mm) at 3.0T can provide diagnostic images and allow evaluation of small pathologies of the bile and pancreatic ducts, which 1.5T MRI cannot sufficiently visualize.

MRI of the female pelvis at 3T compared to 1.5T: Evaluation on high-resolution T2-weighted and HASTE images

PURPOSE

To evaluate the feasibility of MRI of the female pelvis using high-resolution T2-weighted imaging (T2WI) and the half-Fourier acquisition single-shot turbo spin-echo (HASTE) technique at 3 Tesla (T) compared to 1.5T, while focusing on the uterine body and cervical anatomy.

MATERIALS AND METHODS

A total of 19 healthy women underwent pelvic MR scans on 3T and 1.5T scanners. Axial and sagittal T2W (voxel size of 0.6 x 0.8 x 2 mm) and sagittal HASTE images were obtained. The images were evaluated qualitatively for overall image quality, contrast in the uterine zonal appearance and cervical structure, image inhomogeneity, and artifacts. A quantitative evaluation was performed regarding zonal contrast and image inhomogeneity.

RESULTS

On T2WI, the image contrast in the uterine cervix and vagina were significantly higher at 3T than at 1.5T, although there was no significant difference in the overall image quality or contrast in the uterine zonal appearance. Image inhomogeneity was more prominent at 3T, and motion artifact was more severe at 1.5T.

CONCLUSION

Our results suggest that MRI of the female pelvis at 3T may potentially provide excellent images of the uterine cervix on high-resolution T2WI. New techniques to reduce inhomogeneity are thus called for.

Spectrum of MR features in adenomyosis

Magnetic resonance (MR) imaging is a highly accurate non-invasive technique for the diagnosis of adenomyosis. Typical MR features include either diffuse or focal thickening of the junctional zone or an ill-defined area of low signal intensity in the myometrium on T2-weighted MR images. Occasionally, the islands of ectopic endometrial tissue can be identified as punctate foci of high signal intensity. Less commonly, adenomyosis can present as a well-circumscribed form known as adenomyoma, adenomyotic cyst characterized by the presence of haemorrhagic cyst, or adenomyomatous polyp protruding into the uterine cavity. The MR appearances of adenomyosis may occasionally fluctuate in response to hormonal stimulation and treatment. MR imaging is helpful not only in monitoring the treatment effect of hormonal therapy, but also in predicting therapeutic effect. In cases of endometrial cancer in the uterus with adenomyosis, evaluation of myometrial invasion may become difficult. Rarely, endometrial cancer may arise directly from adenomyosis resulting from malignant transformation of endometrial glands, creating diagnostic challenges. Differential diagnosis of adenomyosis on MR imaging include physiological myometrial contraction and almost all myometrial lesions, and they should be carefully differentiated from adenomyosis by identifying typical clinical and MR features in these lesions. Precise knowledge of the spectrum of MR features in adenomyosis greatly helps in determining an accurate diagnosis and appropriate management of the patients.

Evaluation of esophageal peristalsis in patients with esophageal tumors: initial experience with cine MR imaging

We evaluated esophageal peristalsis in patients with esophageal tumors by cine MR using steady-state free precession (SSFP) sequence and correlated the alteration of the esophageal peristalsis with clinical symptoms and tumor stages. Thirteen patients with pathologically proven esophageal tumors, including 12 esophageal cancers and one submucosal leiomyoma, underwent cine MRI using true fast imaging with steady precession (trueFISP) sequence, which is one SSFP sequence, after contrast-enhanced MR scanning for clinical purposes. A total of 120 serial images were obtained within 60 s through the plane along the long axis of the esophagus while patients chewed gum. The serial trueFISP images were evaluated for the presence, frequency, speed of progression, and passage of peristalsis through the tumor. The data from cine MRI were compared with clinical symptoms and tumor stages. Peristalsis was clearly identified in all patients. Seven patients with complete interruption of peristalsis had dysphagia; one with partially impaired peristalsis could intake solid foods with discomfort; and two with partially impaired peristalsis and three with preserved peristalsis remained asymptomatic. Patients with complete or partial interruption of peristalsis had Stage T3 or T4 esophageal cancer. In conclusion, trueFISP cine MR imaging enables direct visualization of esophageal peristalsis in relation to esophageal tumors. Complete interruption of peristalsis causes dysphagia, whereas partial interruption of and preserved peristalsis usually do not cause digestive problems. Interruption of peristalsis may indicate impaired muscle function caused by invasion of advanced esophageal cancers.

MR features of physiologic and benign conditions of the ovary

In reproductive women, various physiologic conditions can cause morphologic changes of the ovary, resembling pathologic conditions. Benign ovarian diseases can also simulate malignancies. Magnetic resonance imaging (MRI) can play an important role in establishing accurate diagnosis. Functional cysts should not be confused with cystic neoplasms. Corpus luteum cysts typically have a thick wall and are occasionally hemorrhagic. Multicystic lesions that may mimic cystic neoplasms include hyperreactio luteinalis, ovarian hyperstimulation syndrome, and polycystic ovary syndrome. Recognition of clinical settings can help establish diagnosis. In endometrial cysts, MRI usually provides specific diagnosis; however, decidual change during pregnancy should not be confused with secondary neoplasm. Peritoneal inclusion cysts can be distinguished from cystic neoplasms by recognition of their characteristic configurations. Ovarian torsion and massive ovarian edema may mimic solid malignant tumors. Recognition of normal follicles and anatomic structures is useful in diagnosing these conditions. In pelvic inflammatory diseases, transfascial spread of the lesion should not be confused with invasive malignant tumors. Radiologic identification of abscess formation can be a diagnostic clue. Many benign tumors, including teratoma, Brenner tumor, and sex-cord stromal tumor, frequently show characteristic MRI features. Knowledge of MRI features of these conditions is essential in establishing accurate diagnosis and determining appropriate treatment.

Esophageal cancer: evaluation with triple-phase dynamic CT--initial experience

PURPOSE

To prospectively assess which phase of a triple-phase dynamic contrast material-enhanced multi-detector row computed tomography (CT) protocol is optimal for visualization of esophageal cancer.

MATERIALS AND METHODS

The study was supported by the local ethical committee; all patients gave written informed consent. Thirty-one lesions in 28 consecutive patients (26 men, two women; mean age, 65 years; range, 53-87 years) with histopathologically confirmed esophageal cancer were evaluated with triple-phase dynamic CT performed at 5, 35, and 65 seconds (first arterial, second arterial, and venous phases) after attenuation of 200 HU was obtained at the descending aorta. Qualitative image analysis was performed to assess appearance and conspicuity of the tumor. Appearances of all 31 lesions were classified into three categories-not identifiable, focal enhancement with or without minimal (<1 cm) wall thickening, and focal mass lesion or obvious (>1 cm) wall thickening. Results were compared with surgical or endoscopic ultrasonographic findings. Quantitative assessment included regions-of-interest measurement of the tumor and normal esophageal wall and the difference between those measurements. A paired t test was used to determine which phase showed the highest tumor attenuation and tumor-to-normal esophageal wall attenuation differences.

RESULTS

At visual assessment, 30 lesions were identified in the second arterial phase. Of these 30 lesions, eight were focal enhancements; the best conspicuity was during the second arterial phase. Furthermore, seven of these eight lesions were T1 cancers. The remaining 22 lesions were enhanced masses or wall thickening. Twenty-one of these 22 tumors also showed best conspicuity in the second arterial phase. The greatest attenuation of tumors in the second arterial phase was 130.0 HU, and the difference in attenuation between tumor and normal esophageal wall was 50.6 HU in the second arterial phase, which were significantly higher than those in the other two phases (P<.01, each).

CONCLUSION

The second arterial phase of dynamic CT is the optimal phase for visualization of esophageal cancer.

Posttransplant Lymphoproliferative Disorder in a Lung Transplant Recipient

The authors describe a case of posttransplant lymphoproliferative disorder (PTLD) in a 38-year-old Japanese male patient who had undergone bilateral lung transplantation. Chest CT performed on day 109 revealed multiple lung nodules measuring approximately 1cm in the left lower lobe. Despite administration of anti-fungal agents, follow-up CT performed on day 138 showed bilateral lung nodules increased in size and number. Transcutaneous lung biopsy was performed, yielding a diagnosis of polymorphic PTLD positive for Epstein-Barr virus (EBV)-encoded RNA (EBER) and CD20. Treatment with rituximab was successful, resulting in decreased size and number of lung nodules. FDG-PET showed no increased metabolic activity in the residual nodules. In this case, CT and FDG-PET were useful for initial diagnosis and evaluation of treatment response. To the best of our knowledge, this is the first report of PTLD in a lung transplant recipient in Japan documented in the English literature.

Ectopically located gonads in a patient with mixed gonadal dysgenesis: detection by diffusion-weighted MRI

We report a case of mixed gonadal dysgenesis in which diffusion-weighted magnetic resonance imaging played a major role in the detection of ectopically located gonads. Magnetic resonance imaging may have a potential in detecting ectopically located gonads and may provide important information for the management of patients with mixed gonadal dysgenesis.

Contrast-enhanced volumetric interpolated breath-hold examination compared with spin-echo T1-weighted imaging of head and neck tumors

OBJECTIVE

Volumetric interpolated breath-hold examination (VIBE) is a relatively new gradient-echo MR sequence that is capable of shortening acquisition times and is reported to be useful in abdominal and brain imaging. The purpose of this study was to evaluate the feasibility of using VIBE images as a substitute for conventional postcontrast spin-echo T1-weighted images in the assessment of head and neck tumors.

SUBJECTS AND METHODS

The subjects were 33 consecutive patients referred for MRI for preoperative assessment of head and neck tumors. After administration of gadodiamide hydrate, images were obtained using postcontrast fat-saturated VIBE sequence for a 35-sec acquisition time and then a postcontrast fat-saturated spin-echo T1-weighted sequence for a 269-sec acquisition time ( approximately 4.5 min). Quantitative comparisons of the two methods were made by calculating signal-to-noise and contrast-to-noise ratios for both methods, and qualitative comparisons were made on the basis of the scoring of three independent reviewers concerning image quality and tumor conspicuity.

RESULTS

No significant difference was detected quantitatively between the two sequences. However, in qualitative assessments, the degree of image degradation by artifacts was significantly smaller for VIBE images than for spin-echo T1-weighted images (p = 0.029).

CONCLUSION

In preoperative evaluations of head and neck tumors, the postcontrast VIBE sequence is capable of decreasing acquisition time without degrading image quality or tumor conspicuity; thus, it is an acceptable alternative to postcontrast spin-echo T1-weighted imaging.

High 18F-fluorodeoxyglocose uptake in adrenal histoplasmosis; a case report

Adrenal histoplasmosis is one of the most common adrenal granulomatous infections in endemic areas. Although CT or MRI findings of adrenal histoplasmosis have been documented, there are no reports regarding 18F-fluorodeoxyglocose (FDG) positron emission tomography (PET) findings. We report a case of bilateral adrenal histoplasmosis showing a significantly high uptake of 18F-fluorodeoxyglocose on PET study. Adrenal histoplasmosis should be considered as one of the differential diagnoses in cases of adrenal tumors with intense FDG uptake, even in non-endemic areas.

Radiologic manifestations of sarcoidosis in various organs

Sarcoidosis is a systemic disorder of unknown cause with a wide variety of clinical and radiologic manifestations. The diagnosis is usually made on the basis of these manifestations supported by histologic findings. Systemic manifestations (eg, Löfgren syndrome, Heerfordt syndrome) are commonly seen at clinical examination. Bilateral hilar lymphadenopathy is the most common radiologic finding-frequently with associated pulmonary infiltrates-and typically has a characteristic perivascular distribution at high-resolution chest computed tomography. Radiologic findings in the short tubular bones of the hands and feet and magnetic resonance imaging findings of nodular involvement of muscle are often sufficient to raise suspicion for sarcoidosis. In the liver, spleen, kidneys, and scrotum, coalescing granulomas form nodules whose imaging features may occasionally be nonspecific, although familiarity with the relevant clinical settings will be helpful in recognizing the presence of sarcoidosis. Radiologic recognition of cardiac and central nervous system involvement is also important because patients may be only mildly symptomatic. The clinical course and prognosis of sarcoidosis are highly variable, often correlating with the mode of onset. Familiarity with the clinical and radiologic features of sarcoidosis in various anatomic locations plays a crucial role in diagnosis and management.

Vascular Dilatation in the Pelvis: Identification with CT and MR Imaging

Focal or diffuse dilatation of pelvic vessels is observed occasionally on computed tomographic or magnetic resonance images. Two major mechanisms may account for dilatation. The first mechanism is development of collateral channels as a result of venous obstruction or stenosis. Symptoms associated with vessel dilatation vary according to the level of obstruction. Portal hypertension also may result in the formation of numerous collateral vessels. In addition, left renal venous compression between the aorta and the superior mesenteric artery, which results in blood flow from the left renal vein toward the left gonadal vein, causes a variety of symptoms. The second major mechanism for dilatation is increased blood flow through collateral vessels associated with a neoplasm or vascular lesion. Hypervascular pelvic tumors such as uterine leiomyomas, gestational trophoblastic neoplasms, ovarian solid tumors, and mesenteric tumors may be associated with a marked increase in the number of draining vessels. The assessment of such vessels can assist in identification of tumor origins. Visual recognition of abnormal pelvic vasculature and abnormal hemodynamics is clinically important because it helps to improve diagnosis of a wide variety of pelvic and systemic diseases. Moreover, recognition of abnormal hemodynamics facilitates understanding of the physiology of such conditions. Recognition of the pattern of collateral channels also assists in identification of the level of narrowing even when the level is not readily apparent and is dependent on postural position.

[Early effect of intra-arterial chemotherapy combined with degradable starch microspheres for malignant hepatic tumors]

The hepatic artery-embolizing effect of degradable starch microspheres (DSM) was assessed by dynamic CT scanning soon after embolization in patients with malignant hepatic tumors. Using the Seldinger method, DSM with a mixture of contrast medium, MMC, ADM or Epi-ADM was manually injected. The subjects were 32 patients with metastatic carcinoma of the liver (62 treatments) and 15 patients with hepatocellular carcinoma(19 treatments) (47 patients received 81 treatments in all). Dynamic CT scanning was performed within 2 weeks of each embolization procedure, and the percent reduction in the area visualized (necrotic effect) was calculated to assess the efficacy of embolization. The necrotic effect of embolization was classified as CR, PR, NC, and PD after 9, 41, 10, and 2 treatments, respectively, in the patients with metastatic carcinoma of the liver and after 4, 6, 6, and 3 treatments, respectively, in the patients with hepatocellular carcinoma. Although there was no patient in whom the tumor showed 50% or more reduction, the contrast enhanced area showed 50% or more decrease in 60 out of 81 treatments. Therefore, blocking of blood flow seemed to contribute more to the response than enhancement of the efficacy of the anticancer agents. Adverse reactions were all transient and controllable. Based on our results, intra-arterial chemotherapy plus DSM embolization seems to be useful for treating malignant hepatic tumors.

Expression of an embryonic intermediate filament protein in amygdaloid kindled rats

Amygdaloid kindling is well known as an experimental model of temporal lobe epilepsy. However, the mechanism of kindling epileptogenesis remains unclear. To examine the remodelling process in kindling, we performed immunohistochemistry of nestin, an embryonic intermediate neurofilament protein, in amygdaloid kindled rats. In rats expressing focal seizures (kindling stage C3), nestin immunoreactive cells (NIC) were detected at ipsilateral piriform cortex (PC) and ipsilateral perirhinal cortex (PRh), and at PC bilaterally in fully kindled rats expressing secondary generalized seizures (kindling stage C5). Double staining with glial fibrillary acidic protein revealed that almost all reactive astrocytes at PC express nestin immunoreactivity. These results suggest that glial NIC may participate in the remodelling process at the PC and PRh areas. This is the first report of nestin expression in kindling and suggests that glial nestin at PC and PRh may play a significant role in permanent epileptogenesis in kindling.

Appearance and alteration of TUNEL positive cells through epileptogenesis in amygdaloid kindled rat

To evaluate the role of neural cell death during and after kindling epileptogenesis, apoptotic cells were analyzed in amygdaloid kindled rat using TUNEL staining as a marker of programmed cell death. TUNEL positive cells (TPC) were stained and counted as apoptotic cells in hippocampus, white matter, diencephalon, and cortex at three stages; C0 (before kindling), C3 (during kindling) and C5 (fully kindled). The animals were studied 2 h after the last stimulation. In all regions except cortex, apoptotic cells in stage C3 were significantly increased as compared to those in stage C0. Especially, in white matter significantly more apoptotic cells in stage C3 were detected than in stage C5. The present data showed that in the course of getting the epileptogenesis, apoptosis had already occurred and this type of cell death may play a significant role in reaching stage C5 through kindling.