Preoperative CT Findings for Predicting Acute Exacerbation of Interstitial Pneumonia After Lung Cancer Surgery: A Multicenter Case-Control Study.

BACKGROUND. Acute exacerbation (AE) is a life-threatening complication of inter-stitial pneumonia (IP). Thoracic surgery may trigger AE. OBJECTIVE. The purpose of this study is to explore the role of preoperative CT findings in predicting postoperative AE in patients with IP and lung cancer. METHODS. This retrospective case-control study included patients from 22 institutions who had IP and underwent thoracic surgery for lung cancer. AE was diagnosed on the basis of symptoms and imaging findings noted within 30 days after surgery and the absence of alternate causes. For each patient with AE, two control patients without AE were identified. After exclusions, the study included 92 patients (78 men and 14 women; 31 with AE [the AE group] and 61 without AE [the no-AE group]; mean age, 72 years). Two radiologists independently reviewed preoperative thin-slice CT examinations for pulmonary findings and resolved differences by consensus. The AE and no-AE groups were compared using the Fisher exact and Mann-Whitney U tests. Multivariable logistic regression was performed. Interreader agreement was assessed by kappa coefficients. RESULTS. A total of 94% of patients in the AE group underwent segmentectomy or other surgery that was more extensive than wedge resection versus 75% in the no-AE group (p = .046). The usual IP pattern was present in 58% of the AE group versus 74% of the no-AE group (p = .16). According to subjective visual scoring, the mean (± SD) ground-glass opacity (GGO) extent was 6.3 ± 5.4 in the AE group versus 3.9 ± 3.8 in the no-AE group (p = .03), and the mean consolidation extent was 0.5 ± 1.2 in the AE group versus 0.1 ± 0.3 in the no-AE group (p = .009). Mean pulmonary trunk diameter was 28 ± 4 mm in the AE group versus 26 ± 3 mm in the no-AE group (p = .02). In a model of CT features only, independent predictors of AE (p < .05) were GGO extent (odds ratio [OR], 2.8), consolidation extent (OR, 9.4), and pulmonary trunk diameter (OR, 4.2); this model achieved an AUC of 0.75, a PPV of 71%, and an NPV of 77% for AE. When CT and clinical variables were combined, undergoing segmentectomy or more extensive surgery also independently predicted AE (OR, 8.2; p = .02). CONCLUSION. The presence of GGO, consolidation, and pulmonary trunk enlargement on preoperative CT predicts AE in patients with IP who are undergoing lung cancer surgery. CLINICAL IMPACT. Patients with IP and lung cancer should be carefully managed when predictive CT features are present. Wedge resection, if possible, may help reduce the risk of AE in these patients. TRIAL REGISTRATION. University Hospital Medical Information Clinical Trial Registry UMIN000029661.

2D-shear wave elastography in the prediction of type II endoleaks after endovascular aneurysm repair.

PURPOSE: To evaluate the usefulness of 2D-shear wave elastography (2D-SWE) in the prediction of type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAA). MATERIAL AND METHODS: Twenty-nine patients underwent EVAR for AAA, and 2D-SWE was performed after EVAR. Follow-up contrast-enhanced CT and ultrasonography were performed to evaluate endoleaks in all patients. The median follow-up period was 12 months (range, 3-12 months). Patients were divided into two groups: one with an endoleak (endoleak group) and another without it (control group). We compared the elasticity index (EI) of intraluminal thrombus (ITL) and fresh thrombus (FT) between the two groups. RESULTS: Type II endoleaks were confirmed in five of the 29 patients (endoleak group), and there were no endoleaks in the other 24 (control group). ILT was observed in 21 patients of the control group and in all patients of the endoleak group. There was a difference only in EI of ILT; the mean EI (± standard deviation) of ILT was 89 ± 16 kPA in the control group and 113 ± 25 kPA in the endoleak group (p=.037). CONCLUSIONS: High EI of ILT may predict the occurrence of type II endoleaks after EVAR of AAA.

Triaxial system for embolization of type II endoleak after endovascular aneurysm repair.

PURPOSE: To demonstrate the utility of a triaxial catheter system for embolization of type II endoleak after endovascular aneurysm repair. TECHNIQUE: The technique is illustrated in 2 patients with sac enlargement owing to persistent type II endoleak of lumbar artery origin. In both cases, the access to the iliolumbar and lumbar arteries was very long and tortuous. For selective catheterization in this situation, a 4-F catheter is advanced through the access site, and 2.7-F microcatheter is inserted into the iliolumbar artery, followed by a 1.9-F untapered microcatheter. The latter is advanced along with a 0.014-inch microguidewire into the feeding artery. Supported by the 2.7-F microcatheter, the no-taper microcatheter is then navigated through the endoleak to the draining vessel for embolization. CONCLUSION: This simple-to-use triaxial catheter system seems well suited for superselective embolization of type II endoleaks with very long and tortuous access routes. If glue is used and multiple doses are required, access to the feeding artery is not lost if the smaller microcatheter has to be replaced.

Clinical Outcomes of Intraoperative Radiotherapy, Postoperative Radiotherapy, and Definitive Radiotherapy for Non-metastatic Pancreatic Cancer.

OBJECTIVE: The aim of this study is to evaluate the utility of adjuvant radiotherapy (intraoperative radiotherapy, IORT; postoperative radiotherapy, PORT), and definitive radiotherapy for non-metastatic pancreatic cancer. METHODS: Ninety-nine patients were analyzed. Thirty patients underwent IORT with surgery, 31 underwent PORT after surgery, and 38 underwent definitive radiotherapy. Tumor stage [Union for International Cancer Control (UICC) 2009] was as follows: Stage I, 7; IIA, 16; IIB, 31; III, 45. The doses for IORT, PORT, and definitive radio therapy were 20 to 30, 40 to 64.6, and 50.4 to 61.2 Gy, respectively. Associations between clinical parameters including age, gender, tumor site, stage, performance status, surgical margin, and use of chemotherapy and local control (LC) or overall survival (OS) were analyzed. RESULTS: Follow-up periods for all patients were 1.1-145 months (median, 11). OS rate in the IORT, PORT, and definitive radiotherapy groups was 22%, 16%, and 6%, respectively, at 2 years. The 5-year OS rate was 13%, 3.2%, and 0%, respectively. Local control rate at 2 years was 33%, 35%, and 0%, respectively. No Grade ≥ 3 tox icities were observed. Distant metastasis was less common in the IORT group. Stage and surgical margin were sig nificant factors for OS after IORT. Performance status and chemotherapy were significant factors for OS after PORT and definitive radiotherapy. CONCLUSIONS: The present study showed the safety of the three treatment modalities, but the outcomes were not satisfactory. More intensive strategies including radiotherapy should be investigated.

Triaxial system in stent-graft placement for traumatic renal artery dissection: A case report.

Stent-graft placement is an important treatment for traumatic renal artery dissection, but it may occasionally be technically difficult to advance a catheter through the lesion of the dissection due to severe stenosis of the true rumen. A triple-coaxial (triaxial) system, which consists of a small microcatheter, a large microcatheter, and a 4-Fr. catheter, has recently become available, and it contributes to super-selective catheterization. We thought this system may be useful for passing catheters through the dissection. We herein report a 30-year-old male patient with traumatic renal artery dissection, who was successfully treated by stent-graft placement using the triaxial system.

Is targeted reconstruction necessary for evaluating contrast-enhanced chest computed tomography using a liquid crystal display monitor?

PURPOSE: The aim of this study was to examine whether 20-cm field-of-view (FOV) targeted reconstruction (TR) on contrast-enhanced (CE) chest computed tomography (CT) might improve the diagnostic value compared with simple zooming (SZ) from whole-thorax FOV images using a 2 million (2M)-pixel liquid crystal display (LCD) monitor. MATERIALS AND METHODS: We prospectively evaluated 44 patients. SZ images were magnified from a FOV of 26-34 cm (mean 29.7 cm). Parameters were 512 x 512 matrix and 3 mm thickness and interval. Images were reconstructed using a soft-tissue kernel. Three radiologists evaluated contour, spiculation, notch, pleural tag, invasion, and internal characteristics of the lesions using 5-scale scores. We also performed a phantom study to evaluate the spatial resolution of images. RESULTS: The diagnostic value of the TR images was similar to that of the SZ images, with the findings identified in 88%-100% of the cases. Artifacts from high-density structures deteriorated the image quality in six (14%), and the SZ images were judged to be preferable in five of them. In the phantom study, there was little difference in spatial resolution between the two images. CONCLUSION: The SZ images from whole-thorax FOV on CE chest CT were similar in quality to TR images using a 2M-pixel LCD monitor.

Correction to: Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations.

The article "Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations," written by Masashi Shimohira, Tatsuya Kawai, Takuya Hashizume, Masahiro Muto, Masanori Kitase and Yuta Shibamoto, was originally published electronically on the publisher's Internet portal (currently SpringerLink) on January 17, 2018, without open access.

Usefulness of Hydrogel-Coated Coils in Embolization of Pulmonary Arteriovenous Malformations.

PURPOSE: To evaluate the usefulness of hydrogel-coated coils for preventing recanalization after coil embolization of pulmonary arteriovenous malformations (PAVMs). MATERIALS AND METHODS: Thirty-seven consecutive patients with 57 untreated PAVMs underwent coil embolization with hydrogel-coated coils between January 2013 and Jun 2017. The mean age was 49 years (range 9-83 years), and there were seven male patients and 30 female patients. The median size of the feeding artery was 3.7 mm (range 1.5-6.1 mm), and the median size of the venous sac was 9.3 mm (range 2.6-36.6 mm). For all PAVM, embolization was attempted using 0.018-in. hydrogel-coated coils with or without other coils (0.0135-0.018-in. bare platinum coils and fibered platinum coils). Technical success rate, recanalization rate, and complications were evaluated. Technical success was defined as completion of embolization using hydrogel-coated coils. Recanalization was evaluated with time-resolved magnetic resonance angiography and/or pulmonary angiography. RESULTS: In 56 of 57 PAVMs, embolization was successfully performed with hydrogel-coated coils. Therefore, the technical success rate was 98% (56/57). The number of PAVMs at risk was 56, 42, 18, and 12 at 0, 12, 24, and 36 months, respectively. There was no recanalization with a mean follow-up period of 19 months (range 2-47 months) in 56 PAVMs embolized with hydrogel-coated coils. There were no major complications. As a minor complication, local pain was observed in 8 of 43 sessions (19%) after embolization. CONCLUSIONS: Hydrogel-coated coils may be useful for preventing recanalization after the embolization of PAVMs.

Internal mammary lymph node metastases in breast cancer: what should radiologists know?

The internal mammary lymph node (IMLN) chain is a pathway through which breast lymphatic drainage flows. The internal mammary lymphatic vessel runs around the internal mammary artery and veins with IMLN in the parasternal intercostal spaces. IMLN metastasis, which forms a part of clinical TNM staging, may negatively affect the prognosis of primary breast cancer patients. IMLN metastasis is clinically detected using ultrasound, computed tomography, magnetic resonance imaging, and 18F-deoxyglucose positron emission tomography computed tomography. The uptake of radioactive tracers in IMLN with clinically negative axillary lymph nodes is often identified using sentinel lymph node mapping (SLNM) in primary breast cancer patients. The indication for IMLN biopsy or resection that is clinically detected or visualized using SLNM is controversial. The clinically suspicious IMLN may be considered for ultrasound-guided fine-needle aspiration. First IMLN recurrence needs to be biopsied. Irradiation of the breast, chest wall, and/or regional nodal irradiation, including IMLN, following lumpectomy or postmastectomy is recommended. Although radiation therapy for IMLN recurrence may improve clinical outcomes, it is also associated with pulmonary and cardiac toxicities. This review covers the local anatomy of IMLN, lymph drainage and image findings of IMLN with a discussion.

Congenital pulmonary airway malformation: CT-pathologic correlation.

OBJECTIVES: Congenital pulmonary airway malformation (CPAM) is classified into 5 subtypes (types 0 to 4). We attempted to correlate computed tomography (CT) findings with those of pathologic examination and evaluated the predictability of the CPAM subtype. SUBJECTS AND METHODS: We retrospectively reviewed CT findings in 13 pathologically proven cases of CPAM seen between 1981 and 2005. Patient's age ranged from 4 days to 5 years and 10 months. Six were boys and 7 were girls. According to CT findings, lesions with a cyst larger than 2.5 cm, lesions with cysts 2.5 cm or less and solid lesions were classified into groups A, B, and C, respectively. We assumed that Stocker's types 1 and 4, type 2, and types 0 and 3 would correspond to CT groups A, B, and C, respectively. Then, we assessed whether this assumption is correct or not. RESULTS: Eight, 3, and 2 cases were diagnosed as groups A, B, and C, respectively. All of the 8 cases diagnosed as group A were Stocker's type 1. One of the 3 cases diagnosed as group B was type 2, but the remaining 2 were type 1 and type 4, respectively. One of the 2 cases diagnosed as group C was type 3 but the other was type 2. CONCLUSIONS: Lesions with the largest cyst being larger than 2.5 cm was type 1. It seemed, however, difficult to distinguish among types 1, 2, and 4 when they consisted of small cystic components and between types 2 and 3 when they appeared as a solid lesion.

[The frontiers of diagnostic radiology--PET/CT, 3DCT--].

Recently, positron-emission tomography (PET) systems have been introduced in many institutions around Japan and their clinical importance should increase in the management of many malignant diseases particularly systems using 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG). Since March 2004, we have been using the first PET/computed tomography (CT) scanner in Japan with 4-slice multidetector CT (MDCT) and now have introduced a second PET/CT scanner with 8-slice MDCT because of its excellent diagnostic capability and higher throughput capacity than that of the ordinal PET scanner. MDCT was a landmark in the history of CT in 1998. Subsequently, 8-, 16-, 32-, and 40-slice MDCT was developed in rapid succession. Finally, 64-slice MDCT became commercially available in 2005. In the future, 256-slice MDCT and flat-panel CT will appear in the clinical setting. Using these MDCT systems, we can now obtain multidimensional CT images very easily. These multidimensional images are less-invasive methods that are gradually phasing out the use of invasive angiography including digital subtraction angiography. In this article we describe the current features of PET/CT and multidimensional CT using MDCT.

Radiological findings of tailgut cyst in a fetus.

Tailgut cyst, or retrorectal cystic hamartoma, is a rare congenital lesion found in the presacral space. The lesion has not been adequately reported in the literature. In this article, we describe a case of tailgut cyst that was demonstrated as a large cystic lesion within a fetal pelvis using ultrasonography and magnetic resonance imaging.