Usefulness of LacdiNAc-glycosylated Prostate-specific Antigen Density for Predicting Pathological Findings of Magnetic Resonance Imaging-transrectal Ultrasound Fusion Image-guided Prostate Biopsy for the Patients With Highest Prostate Imaging Reporting and Data System Category ≥3.

PURPOSE: This study aimed to evaluate the usefulness of the LDN-PSA (LacdiNAc-glycosylated-prostate specific antigen) in detecting clinically significant prostate cancer in patients suspected of having clinically significant prostate cancer on multiparametric magnetic resonance imaging. MATERIALS AND METHODS: Patients with prostate specific antigen levels ranging between 3.0 ng/mL and 20 ng/mL and suspicious lesions with PI-RADS (Prostate Imaging-Reporting and Data System) category ≥3 were included prospectively. The LDN-PSA was measured using an automated 2-step Wisteria floribunda agglutinin lectin-anti-prostate specific antigen antibody sandwich immunoassay. RESULTS: Two hundred four patients were included. Clinically significant prostate cancer was detected in 105 patients. On multivariable logistic regression analysis, prostate specific antigen density (OR 1.61, P = .010), LDN-PSAD (OR 1.04, P = .012), highest PI-RADS category (3 vs 4, 5; OR 14.5, P < .0001), and location of the lesion with highest PI-RADS category (transition zone vs peripheral zone) (OR 0.34, P = .009) were significant risk factors for detecting clinically significant prostate cancer. Among the patients with the highest PI-RADS category 3 (n=113), clinically significant prostate cancer was detected in 28 patients. On multivariable logistic regression analysis to predict the detection of clinically significant prostate cancer in patients with the highest PI-RADS category 3, age (OR 1.10, P = .026) and LDN-PSAD (OR 1.07, P < .0001) were risk factors for detecting clinically significant prostate cancer. CONCLUSIONS: LDN-PSAD would be a biomarker for detecting clinically significant prostate cancer in patients with prostate specific antigen levels ≤20 ng/mL and suspicious lesions with PI-RADS category ≥3. The use of LDN-PSAD as an adjunct to the use of prostate specific antigen levels would avoid unnecessary biopsies in patients with the highest PI-RADS category 3. Multi-institutional studies with large population are recommended.

Analysis of oncological outcomes of whole-gland therapy with high-intensity focused ultrasound for localized prostate cancer in clinical and technical aspects: a retrospective consecutive case-series analysis with a median 5-year follow-up.

PURPOSE: This study aimed to analyze technical and clinical factors related to oncological outcomes in patients with localized prostate cancer (PC) who were treated with whole-gland high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: From 2007-2014, patients diagnosed with localized PC who underwent whole-gland HIFU were consecutively included retrospectively. Biochemical failure was defined according to the Phoenix ASTRO guidelines. The relationship between oncological outcomes and technical and clinical factors was evaluated. RESULTS: The study cohort included 428 patients. The median age was 67 years, and the median prostate-specific antigen level was 7.61 ng/mL. Patient risk classifications were low (n = 102), intermediate (n = 240), and high (n = 86). Biochemical disease-free survival rates of patients with HIFU for localized PC in the total, low-, intermediate-, and high-risk groups according to D'Amico risk groups over a median follow-up period of 5 years (range 9-144) were 68.4%, 80.4%, 65.6%, and 61.6%, respectively. In multivariate logistic regression analyses to predict biochemical failure of the treatment, neoadjuvant hormonal therapy (NHT) in the high-risk group (OR 0.225, p = 0.015), and compression method in the low- (OR 0.178, p = 0.030), intermediate- (OR0.291, p < 0.0001), and high-risk (OR 0.316, p = 0.049) groups were significant factors that reduced the risk of biochemical failure after treatment. There were no significant differences in complications between patients treated with compression and those treated conventionally. CONCLUSIONS: NHT may potentially improve oncological outcomes for patients in the high-risk group, and compression methods can improve the oncological outcomes of whole-gland therapy with HIFU.

Current status and future prospective of focal therapy for localized prostate cancer: development of multiparametric MRI, MRI-TRUS fusion image-guided biopsy, and treatment modalities.

Multiparametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPC) because of its usefulness in combination with anatomic and functional data. MRI-targeted biopsy, such as MRI-transrectal ultrasound (TRUS) fusion image-guided prostate biopsy, has high accuracy in the detection and localization of csPC. This novel diagnostic technique contributes to the development of tailor-made medicine as focal therapy, which cures the csPC while preserving the anatomical structures related to urinary and sexual function. In the early days of focal therapy, TRUS-guided systematic biopsy was used for patient selection, and treatment was performed for patients with low-risk PC. With the introduction of mpMRI and mapping biopsy, the treatment range is now determined based on individualized cancer localization. In recent prospective studies, 87.4% of treated patients had intermediate- and high-risk PC. However, focal therapy has two main limitations. First, a randomized controlled trial would be difficult to design because of the differences in pathological features between patients undergoing focal therapy and radical treatment. Therefore, pair-matched studies and/or historical controlled studies have been performed to compare focal therapy and radical treatment. Second, no long-term (≥ 10-year) follow-up study has been performed. However, recent prospective studies have encouraged the use of focal therapy as a treatment strategy for localized PC because it contributes to high preservation of continence and erectile function.

Focal therapy with high-intensity focused ultrasound for the localized prostate cancer for Asian based on the localization with MRI-TRUS fusion image-guided transperineal biopsy and 12-cores transperineal systematic biopsy: prospective analysis of oncological and functional outcomes.

BACKGROUND: We evaluated clinical outcomes of region target focal therapy with high-intensity focused ultrasound (HIFU) for the localized prostate cancer (PCa) based on magnetic resonance imaging-based biopsy and systematic prostate biopsy for Asian. METHODS: We prospectively recruited patients with localized PCa, located their significant tumors using MRI-transrectal ultrasound (TRUS) elastic fusion image-guided transperineal prostate biopsy and 12-cores transperineal systematic biopsy, and focally treated these regions in which the tumors were located in the prostate using HIFU. Patients' functional and oncological outcomes were analyzed prospectively. RESULTS: We treated 90 men (median age 70 years; median PSA level 7.26 ng/ml). Catheterization was performed within 24 h after the treatment in all patients. Biochemical disease-free rate was 92.2% during 21 months follow-up when use of Phoenix ASTRO definition. In follow-up biopsy, significant cancer was detected in 8.9% of the patients in un-treated areas. Urinary functions, including international prostate symptom score (IPSS) (P < 0.0001), IPSS quality of life (QOL) (P = 0.001), overactive bladder symptom score (OABSS) (P < 0.0001), EPIC urinary domain (P < 0.0001), maximum urinary flow rate (P < 0.0001), and IIEF-5 (P = 0.001), had significantly deteriorated at 1 month after treatment, but improved to preoperative levels at 3 or 6 months. Rates of erectile dysfunction and ejaculation who had the functions were 86% and 70%, respectively, at 12 months after treatment. CONCLUSIONS: The present treatment for Asian would have similar oncological and functional outcomes to those in previous reports. Further large studies are required to verify oncological and functional outcomes from this treatment for patients with localized PCa.

Microballoon-related interventions in various endovascular treatments of body trunk lesions.

Occlusion balloon catheters of 5.2- or 6-French have been used for a few decades in various endovascular treatments of body trunk vascular lesions. However, these catheters may be difficult to place in cases of excessive vessel tortuosity, small vessels, and anatomic complexity. Recently, the introduction of the double lumen microballoon catheters for body trunk vascular lesions has allowed operators to advance them into more distal, smaller, and more tortuous vessels. Since the launch of the first generation microballoon catheters onto the market in Japan in 2011, the microballoon catheters have evolved and are now generally available for clinical use. The purpose of this article is to review the evolution and current clinical applications of the microballoon catheters in the field of interventional radiology.

Accuracy of real-time magnetic resonance imaging-transrectal ultrasound fusion image-guided transperineal target biopsy with needle tracking with a mechanical position-encoded stepper in detecting significant prostate cancer in biopsy-naïve men.

OBJECTIVE: To evaluate the accuracy of real-time elastic fusion image-guided transperineal prostate biopsy with needle tracking involving a mechanical position-encoded stepper in detecting clinically significant prostate cancer for biopsy-naïve men. METHODS: We prospectively recruited patients with serum prostate-specific antigen levels of 4.0-20 ng/mL and suspicious of prostate cancer on multiparametric magnetic resonance imaging. They underwent targeted biopsies for cancer-suspicious lesions and 12-core systematic biopsies. Pathological findings from biopsy cores and whole-mount specimens (for those who underwent radical prostatectomy) were analyzed. RESULTS: A total of 250 patients were included, in whom targeted and systematic biopsies detected significant cancers in 55% and 25%, respectively (P < 0.001). The targeted biopsy cores (n = 527) showed significantly greater biopsy-proven significant cancer detection rates (P < 0.001), cancer core length (P < 0.0001), cancer core percentage (P < 0.001) and Gleason scores (P < 0.001) than did the systematic biopsies. The significant cancer detection rate for targeted lesions (those with Prostate Imaging and Reporting and Data System classification scores of 5) was 80%. Biopsy-proven significant cancer detection rates for targeted lesions ≤10 mm and >10 mm were similar for Prostate Imaging and Reporting and Data System scores of 4 (P = 0.707) and 5 (P = 0.386). In whole-mount specimens (n = 30), locations for 95% of significant cancers were diagnosed preoperatively. Targeted biopsies alone diagnosed 79% of significant cancers. CONCLUSIONS: Although targeted biopsies are superior to systematic biopsies in detecting significant cancers, systematic biopsies maintain an important role in the diagnosis of prostate cancer in biopsy-naïve men.

Balloon-occluded retrograde transvenous obliteration using a new microballoon for gastric varices.

We here present a case involving a complicated type of gastric fundal varices treated by balloon-occluded retrograde transvenous obliteration. A newly developed 1.8-Fr tip coaxial microballoon catheter was successfully advanced into narrow and tortuous varices, and a sclerosant could be infused in a reasonable manner, avoiding reflux into collaterals. Divided injections of sclerosant were performed over two days, via a microballoon catheter that remained inserted overnight with balloon inflation, and the sclerosant could be infused sufficiently in the entirety of the varices. The varices were completely thrombosed and prominently reduced.

Balloon-occluded arterial stump pressure before balloon-occluded transarterial chemoembolization.

OBJECTIVE: To evaluate balloon-occluded arterial stump pressure (BOASP), which is responsible for effective balloon-occluded transarterial chemoembolization (B-TACE), at each hepatic arterial level before B-TACE using a 1.8-French tip microballoon catheter for unresectable hepatocellular carcinoma (HCC). MATERIAL AND METHODS: The BOASP at various embolization portions was retrospectively investigated. "Selective" and "non-targeted" BOASP was defined as the BOASP at the subsegmental or segmental artery and the lobar artery, respectively. RESULTS: The measurement of the BOASP was carried out in 87 arteries in 47 patients. BOASP > 64 mmHg was revealed in the caudate lobe artery (A1) and the left medial segmental (A4), right anterior superior segmental (A8), anterior segmental, right and left hepatic arteries. Significant difference was noted in the incidence of BOASP above 64 mmHg between "non-targeted" and "selective" BOASP (p = 0.01). "Non-targeted" BOASP was significantly greater than "selective" BOASP (p = 0.0147). In addition, the BOASP in A1, 4, 8 and the anterior segmental arteries were significantly greater than in the other subsegmental and segmental arteries (p = 0.0007). CONCLUSION: "Non-targeted" B-TACE should be avoided to perform effective B-TACE and "selective" B-TACE at A1, 4, 8 and the anterior segmental arteries may become less effective than at the other segmental or subsegmental arteries.

Manually controlled targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: an early experience.

OBJECTIVES: To report our early experience with manually controlled targeted biopsy with real-time multiparametric magnetic resonance imaging and transrectal ultrasound fusion images for the diagnosis of prostate cancer. METHODS: A total of 20 consecutive patients suspicious of prostate cancer at the multiparametric magnetic resonance imaging scan were recruited prospectively. Targeted biopsies were carried out for each cancer-suspicious lesion, and 12 systematic biopsies using the BioJet system. Pathological findings of targeted and systematic biopsies were analyzed. RESULTS: The median age of the patients was 70 years (range 52-83 years). The median preoperative prostate-specific antigen value was 7.4 ng/mL (range 3.54-19.9 ng/mL). Median preoperative prostate volume was 38 mL (range 24-68 mL). The number of cancer-detected cases was 14 (70%). The median Gleason score was 6.5 (range 6-8). Cancer-detected rates of the systematic and targeted biopsy cores were 6.7 and 31.8%, respectively (P < 0.0001). In six patients who underwent radical prostatectomy, the geographic locations and pathological grades of clinically significant cancers and index lesions corresponded to the pathological results of the targeted biopsies. CONCLUSION: Prostate cancers detected by targeted biopsies with manually controlled targeted biopsy using real-time multiparametric magnetic resonance imaging and transrectal ultrasound fusion imaging have significantly higher grades and longer length compared with those detected by systematic biopsies. Further studies and comparison with the pathological findings of whole-gland specimens have the potential to determine the role of this biopsy methodology in patients selected for focal therapy and those under active surveillance.

Balloon-occluded transarterial chemoembolization using a 1.8-French tip coaxial microballoon catheter for hepatocellular carcinoma: technical and safety considerations.

OBJECTIVE: To evaluate the technical feasibility and safety considerations of balloon-occluded transarterial chemoembolization (B-TACE) using a newly developed 1.8-French (Fr) tip microballoon catheter for hepatocellular carcinoma (HCC). MATERIAL AND METHODS: Between February 2013 and May 2013, 31 patients (20 males, 11 females; age range 56-85 years) underwent B-TACE using a 1.8-Fr tip microballoon catheter for unresectable HCC. The technical success rate, procedural complications, and adverse events of B-TACE were retrospectively investigated. RESULTS: A total of 31 patients were subjected to 70 sessions of B-TACE using a 1.8-Fr tip microballoon catheter. The level of B-TACE was sub-subsegmental in 11, subsegmental in 35, segmental in 14, lobar in five, and right inferior phrenic artery in five sessions. The overall technical success rate was 99% (69 out of 70 sessions). As procedural complications, rupturing of the microballoon (n = 3) and aneurysmal dilatation at the site of balloon occlusion (n = 2) were encountered. There were no significant differences in any parameters between blood biochemical examination before and between two to four weeks after the procedure. CONCLUSION: A 1.8-Fr tip microballoon catheter enables selective catheterization in patients with HCC and B-TACE using the 1.8-Fr tip microballoon catheter is a safe procedure.

Transnodal lymphangiography and post-CT for protein-losing enteropathy in Noonan syndrome.

Noonan syndrome, which is a multiple congenital disorder, may be associated with lymphatic abnormalities. Protein-losing enteropathy (PLE) developing in Noonan syndrome is rare. We performed transnodal lymphangiography by directly accessing bilateral inguinal nodes under ultrasound guidance in a 17-year-old female with PLE developing in Noonan syndrome to assess detailed anatomical findings regarding lymphatic vessels. There have been no reports on transnodal lymphangiography for Noonan syndrome. Post-lymphangiographic CT images revealed multiple lymphatic abnormalities and lipiodol extravasation into the duodenum and the proximal jejunum. Transnodal lymphangiography was easy and safe for PLE developing in Noonan syndrome, and post-lymphangiographic CT provided invaluable information.

First experience of efficacy and radiation exposure in 320-detector row CT fluoroscopy-guided interventions.

OBJECTIVE: We investigated the efficacy and exposure to radiation in 320-detector row computed tomography fluoroscopy-guided (CTF-guided) interventions. METHODS: We analysed 231 320-detector row CTF-guided interventions (207 patients over 2 years and 6 months) in terms of technical success rates, clinical success rates, complications, scanner settings, overall radiation doses (dose-length product, mGy*cm), patient doses of peri-interventional CT series, and interventional CT (including CTF), as a retrospective cohort study. The relationships between patient radiation dose and interventional factors were assessed using multivariate analysis. RESULTS: Overall technical success rate was 98.7% (228/231). The technical success rates of biopsies, drainages, and aspirations were 98.7% (154/156), 98.5% (66/67), and 100% (8/8), respectively. The clinical success rate of biopsies was 93.5% (146/156). All three major complications occurred in chest biopsies. The median total radiation dose was 522.4 (393.4-819.8) mGy*cm. Of the total radiation dose, 87% was applied during the pre- and post-interventional CT series. Post-interventional CT accounted for 24.4% of the total radiation dose. Only 11.4% of the dose was applied by CTF-guided intervention. Multilinear regression demonstrated that male sex, body mass index, drainage, intervention time, and helical scan as post-interventional CT were significantly associated with higher dose. CONCLUSION: The 320-detector row CTF interventions achieved a high success rate. Dose reduction in post-interventional CT provides patient dose reduction without decreasing the technical success rates. ADVANCES IN KNOWLEDGE: This is the first study on the relationship between various interventional outcomes and patient exposure to radiation in 320-detector row CTF-guided interventions, suggesting a new perspective on dose reduction.

Right Aortic Arch with Mirror-image Branching in Adults: Evaluation Using CT.

OBJECTIVE: We evaluated radiological findings and clinical significance of right aortic arch with mirror-image branching (RAMI) in adults using data from computed tomography (CT) examinations. MATERIAL AND METHODS: We reviewed recorded reports and CT images obtained from university and branch hospitals for RAMI in adults. The RAMI incidence in adults found on CT was assessed. Associated congenital and acquired cardiovascular diseases were evaluated. RESULTS: A total of 27 cases (14 men, 13 women; mean age, 59.4 ± 18.3 years) of RAMI were found. Among 107,014 cases in three hospitals, the RAMI incidence in the first, second, and third Tokai University hospitals were 0.018%, 0.012%, and 0.012%, respectively. Eight cases had high aortic arches and four cases had aortic diverticulum (AD) in proximal descending aorta. Three cases had a history of tetralogy of Fallot. One case with an absent left pulmonary artery and three cases with an aberrant left brachiocephalic vein were found incidentally. Two cases were associated with AD aneurysm and vascular ring formation. One case had stenosis of the left subclavian artery due to injury. CONCLUSION: Cases of RAMI found in CT examinations in adults were extremely rare. Some cases were associated with congenital anomalies and/or acquired cardiovascular disease.

[FOCAL THERAPY WITH HIGH-INTENSITY FOCUSED ULTRASOUND FOR THE LOCALIZED PROSTATE CANCER BASED ON THE LOCALIZATION WITH MRI-TRUS FUSION IMAGE-GUIDED BIOPSY: 1-YEAR PROSPECTIVE STUDY].

(Objective) To evaluate the efficacy and invasiveness of focal therapy with transrectal high-intensity focused ultrasound (HIFU) for localized prostate cancer based on spatial location of significant cancer with magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion image-guided biopsy. (Methods) Patients with low- and intermediate-risk significant prostate cancer who were followed-up at least 1 year, were prospectively recruited. The spatial localization of the significant cancer was determined by MRI-TRUS fusion image-guided transperineal prostate biopsy. Focal therapy targeting the regions of significant cancer was performed by transrectal HIFU using a Sonablate® 500 (SonaCare Medical, Indianapolis, IN, USA). Serum prostate-specific antigen (PSA) kinetics, multi-parametric MRI, and MRI-TRUS fusion image-guided prostate biopsy were analyzed to determine the treatment efficacy. Questionnaires and uroflowmetry were performed to evaluate the invasiveness. (Results) Ten men with median age of 67 years (range, 48-79), median PSA level of 7.07 ng/ml (range, 4.67-15.99), median prostate volume of 25 ml (range, 19-36) were treated. Median operative time was 29.5 minutes (range, 14-85). Catheterization was performed within 24 hours after the treatment in all patients. The median PSA concentration significantly decreased to 1.35 ng/ml (p<0.0001) at 3 months after the treatment. Contrast-enhanced T1-weighted MRI showed the disappearance of blood flow in all targeted regions of the prostate. MRI-TRUS fusion image-guided prostate biopsy detected the significant cancer out of the treated region in 1 patient. In urinary function, residual urine was significantly increased at 3 months after the treatment (p=0.007), but improved to the preoperative level (p=0.411). There was no significant deterioration in IPSS, IPSS QOL, OABSS, and the urinary function domain of EPIC between before and 3, 6, 9, and 12 months after the treatment. In sexual function, there was no significant difference in IIEF-5 and the sexual domain of EPIC between before and 3, 6, 9, and 12 months after the treatment. In quality of life, there was no significant difference in EPIC and SF-36 between before and 3, 6, 9, and 12 months after the treatment. The proportion of men with erections sufficient for penetration and ejaculation remained unchanged at 100% (5 of 5 patients). No serious adverse events were recorded. (Conclusions) The focal therapy with HIFU has the potential to provide accurate treatment with low morbidity in patients with localized prostate cancer. Further large studies are required to investigate the effects of the focal therapy with HIFU for analysis of oncological and functional outcomes in patients with localized prostate cancer.

Assessment of renal shape of horseshoe kidney with multidetector row CT in adult patients: relationship between urolithiasis and renal isthmus.

OBJECTIVE: The aim of this study was to evaluate the relationship between urolithiasis and characteristics of renal shape in adult patients with horseshoe kidney (HSK) diagnosed on multidetector row computed tomography (MDCT). METHODS: We evaluated 36 patients with HSK and urolithiasis (Group A) and 70 patients with HSK without urolithiasis (Group B) whose disease was diagnosed on non-contrast MDCT. Two radiologists measured minimum width of the renal isthmus and maximum length of the renal pelvis and evaluated coexisting neoplastic diseases on axial computed tomographic (CT) images with 5-mm reconstruction, and we compared those measurements between the Groups A and B. RESULTS: The overall mean maximum length of the renal pelvis, 12.7±9.2 mm, did not differ significantly between the 2 groups. Minimum isthmus width was larger in patients with HSK and urolithiasis (11.0±5.6 mm), than those without urolithiasis (9.5±5.1 mm). No patient in either groups had a urological renal tumor. CONCLUSIONS: Patients of HSK might have tendency of a high incidence of stone formation. Because urolithiasis is a risk factor for tumors of the renal pelvis, monitoring of patients with HSK requires careful attention to isthmus width on CT images.

Diffusion magnetic resonance imaging with gadofosveset trisodium as a negative contrast agent for lymph node metastases assessment.

PURPOSE: The aim of this study was to assess the feasibility of using intravenously administered gadofosveset trisodium as a negative contrast agent for lymph node (LN) assessment with diffusion-weighted imaging (DWI) using a VX2 tumor model in rabbits. MATERIALS AND METHODS: VX2 cells were injected in the right hind limb of five Japanese white rabbits to induce ipsilateral popliteal LN metastasis. DWI was performed before and every 7.5 min (until 1 h) after intravenous gadofosveset trisodium administration, at 1.5 T. Signal intensities (SIs) of right (metastatic) and left (nonmetastatic) popliteal LNs at each time point were measured and compared to each other using two-sided unpaired t-tests. RESULTS: The SIs of metastatic lymph nodes were significantly higher (P < 0.05) than those of nonmetastatic LNs at each time point after intravenous gadofosveset trisodium administration. Although the SI of metastatic LNs was significantly higher (P = 0.0237) than that of nonmetastatic LNs before contrast injection, this difference became even more significant (P ≤ 0.0105) after gadofosveset trisodium administration. CONCLUSION: The SI of metastatic LNs at DWI is less suppressed than that of nonmetastatic LNs after the intravenous administration of gadofosveset trisodium. Therefore, intravenously administered gadofosveset trisodium shows promise for use as a negative contrast agent for discriminating metastatic from nonmetastatic LNs at DWI.

CT features of juxtapapillary duodenal diverticula with complications.

OBJECTIVE: We evaluated the computed tomography (CT) features of juxtapapillary duodenal diverticula (JPDD) with complications in patients who had acute abdomen. MATERIALS AND METHODS: Nineteen JPDD were evaluated in 14 patients (mean age: 50 years), who had acute abdomen on contrast-enhanced helical CT with a diagnosis of complicated JPDD by endoscopic retrograde cholangiopancreatography (ERCP). The size, number, and contents of the JPDD, pacreticobiliary ductal dilation, biliary stones, and other associated findings were evaluated on CT scans. RESULTS: Eighteen of the 19 JPDD (94.4%) containing air were demonstrated by CT. Their diameter ranged from 20 to 40 mm (mean: 30 mm). Common bile duct dilation was visualized in 12 patients and biliary stones were found in 8 patients. The other findings were cholecystitis, cholangitis, pancreatitis, and liver abscess. The most serious complication was perforation into the retroperitoneal space caused by diverticulitis associated with an enterolith. CONCLUSION: Complicated JPDD were well depicted on CT scans, and various findings were revealed. CT evaluation of complicated JPDD was useful for management of these patients.

Visualization of azygos arch valves using computed tomography: comparison of scanning delay times.

OBJECTIVE: To evaluate the frequency and appearance of azygos arch valves after short and long scanning delays and high injection rates of contrast material (CM) using a 64-slice multi-detector-row computed tomography (MDCT). METHODS: We retrospectively reviewed the findings from 264 contrast-enhanced MDCT chest examinations. The rate of injection for 300 mg I/ml CM was 3.0 ml/sec; the short and long scanning delays were 20 and 180 sec, respectively. The presence of residual CM in the azygos arch valves and reflux of CM into the azygos arch were recorded. A chi-square test was used to compare the frequency of residual CM in azygos arch valves and reflux of CM into the azygos arch in both groups. RESULTS: Of the 132 examinations with short scanning delays, 91 (68.9%) demonstrated residual CM in azygos arch valves and 103 (78.0%) demonstrated reflux of CM into the azygos arch. A significantly higher frequency of reflux of CM into the azygos arch and residual CM in azygos arch valves was seen with short scanning delays than with long scanning delays (P<0.05). However, no reflux of CM into azygos arch was seen with long scanning delays. CONCLUSIONS: Both reflux of CM into azygos arch valve and residual CM in the azygos arch were frequently seen using short scanning delays.