Detectability of T1a lung cancer on digital chest radiographs: an observer-performance comparison among 2-megapixel general-purpose, 2-megapixel medical-purpose, and 3-megapixel medical-purpose liquid-crystal display (LCD) monitors.

BACKGROUND: There has been no comparison of detectability of small lung cancer between general and medical LCD monitors or no comparison of detectability of small lung cancer between solid and part-solid nodules. PURPOSE: To compare the detectabilities of T1a lung cancer on chest radiographs on three LCD monitor types: 2-megapixel (MP) for general purpose (General), 2-MP for medical purpose (Medical), and 3-MP-Medical. MATERIAL AND METHODS: Radiographs from forty patients with T1aN0M0 primary lung cancer (27 solid nodules, 13 part-solid nodules) and 60 patients with no abnormalities on both chest X-ray and computed tomography (CT) were consecutively collected. Five readers assessed 100 cases for each monitor. The observations were analyzed using receiver operating characteristic (ROC) analysis. A jackknife method was used for statistical analysis. A P value of <0.05 was considered significant. RESULTS: The average AUC for all T1a lung cancer nodule detection using the 2-MP-General, 2-MP-Medical, and 3-MP-Medical LCD monitors were 0.86, 0.89, and 0.89, respectively; there were no significant differences among them. The average AUC for part-solid nodule detection using a 2-MP-General, 2-MP-Medical, and 3-MP-Medical LCD monitors were 0.77, 0.86, and 0.89, respectively. There were significant differences between the 2-MP-General and 2-MP-Medical LCD monitors (P = 0.043) and between the 2-MP-General and 3-MP-Medical LCD monitors (P = 0.027). There was no significant difference between the 2-MP-Medical and 3-MP-Medical LCD monitors. The average AUC for solid nodule detection using a 2-MP-General, 2-MP-Medical, and 3-MP-Medical LCD monitors were 0.90, 0.90, and 0.88, respectively; there were no significant differences among them. The mean AUC values for all and part-solid nodules of the low-experienced readers were significantly lower than those of the high-experienced readers with the 2 M-GP color LCD monitor (P < 0.05). CONCLUSION: Detectability of part-solid nodules using a general-purpose LCD monitor was significantly lower than those using medical-purpose LCD monitors.

Quantitative analysis of 1.5-T whole-heart coronary MR angiograms obtained with 32-channel cardiac coils: a comparison with conventional quantitative coronary angiography.

PURPOSE: To develop a method to determine significant stenosis at whole-heart coronary magnetic resonance (MR) angiography and to evaluate the accuracy and reproducibility of this approach. MATERIALS AND METHODS: The institutional review board approved the study, and all participants provided written informed consent. Sixty-two patients who were suspected of having coronary artery disease (CAD) and were scheduled for conventional coronary angiography were included. Coronary MR angiography was performed by using a 1.5-T imager with 32-channel coils. Luminal narrowing was evaluated with quantitative analysis (QA) of coronary MR angiograms on the basis of the signal intensity profile along the vessel. Percentage stenosis with QA of coronary MR angiograms was calculated as [1 - (SI(min)/SI(ref))] × 100, where SI(min) is minimal signal intensity and SI(ref) is corresponding reference signal intensity. Diagnostic performance of QA of coronary MR angiograms for predicting at least a 50% reduction in diameter was evaluated by using quantitative coronary angiography (QCA), with conventional angiography findings serving as the reference standard. Receiver operating characteristic (ROC) analysis, Spearman rank correlation, Bland-Altman analysis, and Cohen κ analysis were used. RESULTS: The areas under the ROC curve in a segment-based analysis for detecting significant CAD were 0.96 (95% confidence interval [CI]: 0.94, 0.98) with QA of coronary MR angiograms and 0.93 (95% CI: 0.88, 0.98) with visual assessment. The correlation coefficients between percentage stenosis with QA of coronary MR angiograms and percentage stenosis with QCA were 0.84 (P < .001), 0.80 (P < .001), and 0.66 (P < .001) in the patient-, vessel-, and segment-based analyses, respectively. CONCLUSION: QA of coronary MR angiograms with use of a signal intensity profile along the vessel permits detection of CAD. This method had a diagnostic performance approximately equal to that of visual analysis of coronary MR angiograms with high inter- and intraobserver reliability, allowing for more objective interpretation of coronary MR angiography findings.

Quantitative assessment of right ventricular function and pulmonary regurgitation in surgically repaired tetralogy of Fallot using 256-slice CT: comparison with 3-Tesla MRI.

OBJECTIVES: To compare 256-slice cardiac computed tomography (CCT) with cardiac magnetic resonance (CMR) imaging to assess right ventricular (RV) function and pulmonary regurgitant fraction (PRF) in patients with repaired tetralogy of Fallot (TOF). METHODS: Thirty-three consecutive patients with repaired TOF underwent retrospective ECG-gated CCT and 3-Tesla CMR. RV and left ventricular (LV) end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV) and ejection fraction (EF) were measured using CCT and CMR. PRF-CCT (%) was defined as (RVSV - LVSV)/RVSV. PRF-CMR (%) was measured by the phase-contrast method. Repeated measurements were performed to determine intra- and interobserver variability. RESULTS: CCT measurements, including PRF, correlated highly with the CMR reference (r = 0.71-0.96). CCT overestimated RVEDV (mean difference, 17.1 ± 2.9 ml), RVESV (12.9 ± 2.1 ml) and RVSV (4.2 ± 2.0 ml), and underestimated RVEF (-2.6 ± 1.0%) and PRF (-9.1 ± 2.0%) compared with CMR. The limits of agreement between CCT and CMR were in a good range for all measurements. The variability in CCT measurements was lower than those in CMR. The estimated effective radiation dose was 7.6 ± 2.6 mSv. CONCLUSIONS: 256-slice CCT can assess RV function and PRF with relatively low dose radiation exposure in patients with repaired TOF, but overestimates RV volume and underestimates PRF. KEY POINTS: 256-slice CT assessment of RV function is highly reproducible in repaired TOF. Pulmonary regurgitation can be evaluated by biventricular systolic volume difference. CT overestimates RV volume and underestimates pulmonary regurgitation, compared with MRI.

Geometrical characteristics of left ventricular dyssynchrony in advanced heart failure. Myocardial strain analysis by tagged MRI.

The aims of this study were to quantify the geometrical differences in left ventricular (LV) dyssynchrony in patients with heart failure (HF) using cine-tagged MRI, and to investigate the relationship between dyssynchrony and major adverse cardiac events (MACE) in HF.In 67 patients with HF [mean LV ejection fraction (LVEF), 34%], cardiac MRI using a 3-Tesla scanner was performed. The dyssynchrony time between septal and lateral segments (SL-DT) and between basal and apical segments (BA-DT) was computed by cross-correlation analysis of the strain time-curves from the cine-tagged MRI. After receiving optimal medical treatment, all patients were followed-up for a mean period of 27 months. The primary endpoint was MACE that consisted of cardiac death or HF hospitalization or a left ventricular assist device due to refractory pump failure. Multivariate logistic regression analysis was performed to determine the ability of SL-DT, BA-DT, and HF biomarkers to predict MACE.Multivariate logistic regression analysis showed that the odds ratio to predict MACE was 0.935 for LVEF (P = 0.021), 1.016 for BA-DT (P = 0.026), and 0.971 for systolic blood pressure (P = 0.126).The results show that basal-apical dyssynchrony is an independent predictor of MACE in HF patients.

Relationship between impaired cardiac sympathetic activity and spatial dyssynchrony in patients with non-ischemic heart failure: assessment by MIBG scintigraphy and tagged MRI.

BACKGROUND: Impairment of cardiac sympathetic activity has various detrimental effects on cardiac function. The purpose was to investigate the relationship between left ventricular (LV) dyssynchrony and cardiac sympathetic activity in non-ischemic heart failure (HF). METHODS: Twenty-seven patients with non-ischemic HF were enrolled. Cardiac sympathetic activity was assessed by heart-to-mediastinum ratio (H/M ratio) on (123)I-Metaiodobenzylguanidine scintigraphy. LV dyssynchrony was assessed by cross-correlation analysis of time curves of myocardial circumferential strains delivered from cine-tagging MR images. Temporal dyssynchrony was defined as contraction delay between septal and lateral segments >110 milliseconds. Spatial dyssynchrony was defined as the negative value of the maximum correlation for the two strain time curves. RESULTS: H/M ratio was significantly lower for patients with spatial dyssynchrony compared to patients without (1.8 ± 0.3 vs 2.1 ± 0.3, P < .05). There was no difference between patients with and without temporal dyssynchrony (2.0 ± 0.2 vs 2.0 ± 0.3). The incidence of spatial dyssynchrony was significantly higher in patients with H/M ratio <2.0 than those whose ratios were ≥2.0 (75% vs 20%, P = .001). There was no difference in the incidence of temporal dyssynchrony between the two groups (17% vs 20%). CONCLUSION: Impairment of cardiac sympathetic activity was found to be associated with spatial dyssynchrony in patients with non-ischemic HF.

Protein-protein interaction analysis by C-terminally specific fluorescence labeling and fluorescence cross-correlation spectroscopy.

Here, we describe novel puromycin derivatives conjugated with iminobiotin and a fluorescent dye that can be linked covalently to the C-terminus of full-length proteins during cell-free translation. The iminobiotin-labeled proteins can be highly purified by affinity purification with streptavidin beads. We confirmed that the purified fluorescence-labeled proteins are useful for quantitative protein-protein interaction analysis based on fluorescence cross-correlation spectroscopy (FCCS). The apparent dissociation constants of model protein pairs such as proto-oncogenes c-Fos/c-Jun and archetypes of the family of Ca2+-modulated calmodulin/related binding proteins were in accordance with the reported values. Further, detailed analysis of the interactions of the components of polycomb group complex, Bmi1, M33, Ring1A and RYBP, was successfully conducted by means of interaction assay for all combinatorial pairs. The results indicate that FCCS analysis with puromycin-based labeling and purification of proteins is effective and convenient for in vitro protein-protein interaction assay, and the method should contribute to a better understanding of protein functions by using the resource of available nucleotide sequences.

DNA display for in vitro selection of diverse peptide libraries.

We describe the use of a DNA display system for in vitro selection of peptide ligands from a large library of peptides displayed on their encoding DNAs. The method permits completely in vitro construction of a DNA-tagged peptide library by using a wheat germ in vitro transcription/translation system compartmentalized in water-in-oil emulsions. Starting with a library of 10(9)-10(10) random decapeptides, 21 different peptide ligands were isolated for monoclonal antibody anti-FLAG M2. DNA display selected more diverse peptides with a DYKXXD consensus motif than previously reported phage display systems. Binding and recovery rates of three peptides were significantly higher than those of the original FLAG peptide, implying that these peptides would be superior to the FLAG peptide for purification of tagged proteins. The simplicity of DNA display enables two selection rounds per day to be conducted. Further, DNA display can overcome the limitations of previous display technologies by avoiding the use of bacterial cells and RNA tags. Thus, DNA display is expected to be useful for rapid screening of a wide variety of peptide ligands for corresponding receptors.

Prediction of post-operative pulmonary function after lobectomy for primary lung cancer: A comparison among counting method, effective lobar volume, and lobar collapsibility using inspiratory/expiratory CT.

PURPOSE: To compare the predictabilities of postoperative pulmonary function after lobectomy for primary lung cancer among counting method, effective lobar volume, and lobar collapsibility. METHODS: Forty-nine patients who underwent lobectomy for primary lung cancer were enrolled. All patients underwent inspiratory/expiratory CT and pulmonary function tests 2 weeks before surgery and postoperative pulmonary function tests 6-7 months after surgery. Pulmonary function losses (ΔFEV1.0 and ΔVC) were calculated from the pulmonary function tests. Predictive postoperative pulmonary function losses (ppoΔFEV1.0 and ppoΔVC) were calculated using counting method, effective volume, and lobar collapsibility. Correlations and agreements between ΔFEV1.0 and ppoFEV1.0 and those between ΔVC and ppoΔVC were tested among three methods using Spearman's correlation coefficient and Bland-Altman plots. RESULTS: ΔFEV1.0 and ppoΔFEV1.0insp-exp were strongly correlated (r=0.72), whereas ΔFEV1.0 and ppoΔFEV1.0count and ΔFEV1.0 and Pred. ΔFEV1.0eff.vol. were moderately correlated (r=0.50, 0.56). ΔVC and ppoΔVCeff.vol. (r=0.71) were strongly correlated, whereas ΔVC and ppoΔVCcount, and ΔVC and ppoΔVC insp-exp were moderately correlated (r=0.55, 0.42). CONCLUSIONS: Volumetry from inspiratory/expiratory CT data could be useful to predict postoperative pulmonary function after lobectomy for primary lung cancer.

Feeding Arteries of Primary Tongue Cancers on Intra-arterial Infusion Chemotherapy.

PURPOSE: To evaluate the frequency and the predictive factor of each feeding artery on intra-arterial infusion chemotherapy (IAIC) in primary tongue cancer. MATERIALS AND METHODS: We retrospectively evaluated 20 patients who received IAIC for primary tongue cancer. The main and accompanying feeding arteries were identified on super-selective angiography of the branches of the external carotid artery. Tumor diameter, and extension to the contralateral side, tongue extrinsic muscles (TEMs), and lateral mesopharyngeal wall were determined based on magnetic resonance imaging or computed tomography findings. RESULTS: The main feeding artery was the ipsilateral lingual artery (LA) in 15 of the 20 examined tumors and the contralateral LA in the other 5. Ten cancers had only one feeding artery, and multiple feeding arteries were detected in the remaining 10. Tumors >4 cm (n = 9), those with extension to the contralateral side (n = 13), and those with extension to TEMs (n = 15) were supplied by significantly larger numbers of feeding arteries compared to tumors without these features (P = 0.01, 0.049, and 0.02, respectively). The frequency of feeding from the contralateral LA was 64 % (9/14) and 17 % (1/6) in tumors with and without extension to the contralateral side, respectively. Feeding from a facial artery (FA) was not detected in tumors ≤4 cm, while 5 of the 9 (56 %) tumors >4 cm were supplied by a FA (P = 0.01). CONCLUSION: A careful search for feeding arteries is required, especially in large tumors with extension to the contralateral side or to TEMs.

Prediction of adverse cardiac events in dilated cardiomyopathy using cardiac T2* MRI and MIBG scintigraphy.

Iron deficiency and cardiac sympathetic impairment play a role in the worsening of heart failure, and these two conditions may be linked. The present study aimed to clarify the relationship between myocardial iron deficiency, cardiac sympathetic activity, and major adverse cardiac events (MACE) in patients with dilated cardiomyopathy (DCM). Cardiac T2* MRI for iron deficiency and (123)I-Metaiodobenzylguanidine (MIBG) imaging for cardiac sympathetic activity were performed in 46 patients with DCM. Myocardial T2* value (M-T2*) was calculated by fitting signal intensity data for mid-left ventricular septum to a decay curve using 3-Tesla scanner. (123)I-MIBG washout rate (MIBG-WR) was calculated using a polar-map technique with tomographic data. We analyze the ability of M-T2* and MIBG-WR to predict MACE. MIBG-WR and M-T2* were significantly greater in DCM patients with MACE than in patients without MACE. Receiver-operating-characteristics curve analysis showed that the optimal MIBG-WR and M-T2* thresholds of 35 % and 28.1 ms, and the two combination predict MACE with C-statics of 0.69, 0.73, and 0.82, respectively. Patients with MIBG-WR <35 % and M-T2* <28.1 ms had significantly lower event-free rates than those with MIBG-WR ≥35 % or M-T2* ≥28.1 ms (log-rank value = 4.35, p < 0.05). Cox hazard regression analysis showed that χ(2) and the hazard ratio were 3.99 and 2.15 for development of MACE in patients with MIBG-WR ≥35 % or M-T2* ≥28.1 ms (p < 0.05). Iron deficiency, expressed by a high M-T2*, and MIBG-WR were both independent predictors of MACE in patients with DCM. The two combination was a more powerful predictor of MACE than either parameter alone.

Volumetric measurement of artificial pure ground-glass nodules at low-dose CT: Comparisons between hybrid iterative reconstruction and filtered back projection.

PURPOSE: To compare hybrid iterative reconstruction (HIR) with filtered back projection (FBP) in the volumetry of artificial pure ground-glass nodules (GGNs) with low-dose computed tomography (CT). MATERIALS AND METHODS: Artificial GGNs (10 mm-diameter, 523.6 mm(3), -660 HU) in an anthropomorphic chest phantom were scanned by a 256-row multi-slice CT with three dose levels (10, 30, 100 mAs). Each scan was repeated six times. Each set was reconstructed by FBP and HIR at 0.625-mm thickness. The volumes of artificial GGNs placed at the lung apex and middle lung field of the chest phantom were measured by two observers. Semi-automated measurements were performed by clicking the cursor in the center of GGNs, and manual measurements were performed by tracing GGNs on axial section. Modification of the trace was added on a sagittal or coronal section if necessary. Measurement errors were calculated for both the FBP and HIR at each dose level. We used the Wilcoxon signed rank test to identify any significant difference between the measurement errors of the FBP and HIR. Inter-observer, intra-observer, and inter-scan variabilities were evaluated by Bland Altman analysis with limits of agreements given by 95% confidence intervals. RESULTS: There were significant differences in measurement errors only at the lung apex between FBP and HIR with 10 mAs in both the semi-automated (observer 1, -37% vs. 7.2%; observer 2, -39% vs. 1.9%) and manual methods (observer 1, -29% vs. 7.5%; observer 2, -30% vs. 1.1%), respectively (P<0.05). HIR provided each variability equal to or less than one half of that of FBP at 10 mAs in both methods. In the semi-automated method, the inter-observer and intra-observer variabilities obtained by HIR at 10 mAs were -11% to 17% and -6.7% to 6.7%, whereas those for FBP at 10 mAs were -29% to 30% and -38% to 20%, respectively. The inter-scan variability for FBP at 100 mAs vs. HIR at 10 mAs was -9.5% to 11%, and that for FBP at 100 mAs vs. FBP at 10 mAs was -73% to 32%. In the manual method, the inter-observer and intra-observer variabilities for HIR at 10 mAs were -14% to 22% and -9.8% to 22%, and those for FBP at 10 mAs were -45% to 36% and -31% to 28%, respectively. The inter-scan variability for FBP at 100 mAs vs. HIR at 10 mAs was -7.4% to 23%, and that for FBP at 100 mAs vs. FBP at 10 mAs was -52% to 26%. CONCLUSION: HIR is superior to FBP in the volumetry of artificial pure GGNs at lung apex with low-dose CT.

Interventricular Dyssynchrony Using Tagging Magnetic Resonance Imaging Predicts Right Ventricular Dysfunction in Adult Congenital Heart Disease.

PURPOSE: Right ventricular (RV) failure and ventricular dyssynchrony are strong determinants of prognosis in patients with adult congenital heart disease (ACHD). The aim of this study was to investigate the relationship between interventricular dyssynchrony (IVD) using cine-tagged magnetic resonance imaging (MRI) and RV dysfunction in ACHD patients. MATERIALS AND METHODS: Sixty-seven patients with ACHD (38 with repaired tetralogy of Fallot; 22 with atrial septal defect; seven with ventricular septal defect) underwent tagging MRI. Time curves of myocardial circumferential strains for RV and left ventricular (LV) free walls were delivered from short-axis cine-tagging images. Contraction delay between RV and LV free walls was computed by cross-correlation analysis of the two strain time curves and was defined as the IVD time (msec). RESULTS: IVD was significantly greater for patients with RV ejection fraction (RVEF) <40% (116 ± 58 msec) than for patients with RVEF ≥ 40% (65 ± 54 msec) and was significantly greater for patients with RV systolic pressure ≥ 40 mm Hg (112 ± 59 msec) than for patients with RV systolic pressure <40 mm Hg (49 ± 28 msec). Receiver operating characteristic analysis revealed optimal IVD thresholds for detecting patients with RVEF <40% with C-statistics of 0.76 and patients with RV systolic pressure ≥ 40 mm Hg with C-statistics of 0.81. CONCLUSION: Quantification of IVD was possible using RV and LV strains derived from tagging MRI. IVD, represented as the time difference between LV and RV contractions, correlates with RV dysfunction. IVD may thus offer an indicator for RV failure in ACHD.

Mediastinal paraganglioma.

We present a case of mediastinal paraganglioma with radiologic-pathologic correlation. A 48-year-old woman was found incidentally to have a middle mediastinal mass on CT. The mass showed iso-signal intensity compared to that of muscle on T1-weighted images and high signal intensity on T2-weighted images. The lesion showed intermediate intensity on diffusion-weighted imaging, and its apparent diffusion coefficient was 1.72 × 10(-3) mm(2)/s. A contrast-enhanced dynamic study revealed a rapid peak and washout enhancement pattern. (18)F-FDG-PET revealed abnormal uptake in the mediastinal tumor with a maximal standardized uptake value of 7.88. (123)I-meta-iodobenzylguanidine scintigraphy also showed abnormal uptake in the tumor. These findings corresponded to the hypervascularity, rich stroma, low nuclear/cytoplasmic ratio, and nest-forming proliferation of tumor cells with positive neuroendocrine markers.

DNA display of biologically active proteins for in vitro protein selection.

In vitro display technologies are powerful tools for screening peptides with desired functions. We previously proposed a DNA display system in which streptavidin-fused peptides are linked with their encoding DNAs via biotin labels in emulsion compartments and successfully applied it to the screening of random peptide libraries. Here we describe its application to functional and folded proteins. By introducing peptide linkers between streptavidin and fused proteins, we achieved highly efficient (>95%) formation of DNA-protein conjugates. Furthermore, we successfully enriched a glutathione-S-transferase gene by a factor of 20-30-fold per round on glutathione-coupled beads. Thus, DNA display should be useful for rapidly screening or evolving proteins based on affinity selection.

Treatment of chondroblastoma of the calcaneus with a secondary aneurysmal bone cyst using endoscopic curettage without bone grafting.

Chondroblastoma is a relatively rare benign bone tumor. Approximately 7% of chondroblastomas occur in the calcaneus, and 17% of chondroblastoma associated with cystic lesions. We report a case of a chondroblastoma in the calcaneus with a secondary aneurysmal bone cyst treated successfully by endoscopic curettage without bone grafting. New bone formation is facilitated by minimal damage to the bone and soft tissue. The cosmetic results of this procedure are good. Two years later, the patient is asymptomatic with no radiographic evidence of recurrence. Endoscopic curettage without bone grafting is a promising new treatment for chondroblastoma.

Improvement of automated right ventricular segmentation using dual-bolus contrast media injection with 256-slice coronary CT angiography.

RATIONALE AND OBJECTIVES: To investigate the effect of dual-bolus contrast media injection (dual-CM) on the accuracy of automated right ventricular (RV) segmentation on coronary computed tomography angiography (CCTA). MATERIALS AND METHODS: A total of 104 patients with suspected and known coronary artery disease underwent 256-slice CCTA with retrospective electrocardiographic (ECG) gating. The patients were divided into 51 patients who underwent single-bolus CM injection (single-CM) and 53 patients who underwent dual-CM. The dual-CM method consisted of an initial bolus of CM followed by an injection of dilute CM with saline (CM:saline, 1:9). Three-dimensional CCTA images were automatically segmented into the RV, left ventricle (LV), and myocardium using commercially available software (Comprehensive Cardiac Analysis; Philips Medical Systems, Cleveland, OH). Prevalence and locations of segmentation errors were compared between single-CM and dual-CM. Segmentation errors were defined as segment deviation of >1 cm from the actual ventricular margin. RESULTS: Prevalence of segmentation errors was significantly lower with dual-CM than with single-CM in the diastolic phase (4/41 vs. 20/41, respectively; P < .01), and there was no difference between the two methods in the systolic phase (2/12 vs. 2/10, respectively). With dual-CM and single-CM, the locations of segmentation errors were mostly the RV wall (4/53 and 18/51, respectively) and secondly the LV wall (2/53 and 9/51, respectively). CONCLUSIONS: Dual-CM improved the accuracy of automated ventricular segmentation using diastolic data from 256-slice CCTA.

Apparent diffusion coefficient is a prognostic factor of head and neck squamous cell carcinoma treated with radiotherapy.

PURPOSE: To evaluate the correlation between apparent diffusion coefficient (ADC) and prognosis in head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy. MATERIALS AND METHODS: We retrospectively studied 41 patients (38 male and 3 female, ages 37-85 years) diagnosed with HNSCC (14 oropharynx, 22 hypopharynx, 4 larynx, 1 oral cavity) and treated with radiotherapy, with radiation dose to gross tumor volume over 60 Gy. The association between age, gender, performance status, tumor location, T stage, N stage, stage, dose, overall treatment time, treatment method, adjuvant therapy, or ADC and prognosis was analyzed using a Cox proportional hazard test. RESULTS: ADC calculated with b-values of 300, 500, 750, and 1,000 s/mm(2) (ADC 300-1,000) alone showed a significant correlation with all of the analyses (p = 0.022 for local control, p = 0.0109 for regional control, p = 0.0041 for disease-free survival, and p = 0.0014 for overall survival). ADC calculated with b-values of 0, 100, and 200 s/mm(2) (ADC 0-200) showed a significant correlation with overall survival (p = 0.0012). N stage showed a significant correlation with regional control (p = 0.0241). Performance status showed significant association with local control (p = 0.0459), disease-free survival (p = 0.023), and overall survival (p = 0.0151), respectively. CONCLUSION: ADC is an independent predictor of prognosis in HNSCC treated with radiotherapy.

Differentiation between benign phyllodes tumors and fibroadenomas of the breast on MR imaging.

PURPOSE: The purpose of this study was to determine the factors that contribute to the differentiation between phyllodes tumors (PTs) and fibroadenomas (FAs) on MR imaging. MATERIALS AND METHODS: This retrospective study included 19 PTs and 18 FAs with ≥ 2 cm diameter. The presence or absence of a capsule and internal septum, the extent of lobulation, and the apparent diffusion coefficient (ADC) values were determined. The presence or absence of a cystic component, the time-intensity curve, and the signal intensity on delayed-phase contrast-enhanced T1WI were also evaluated in 31 patients (16 PTs and 17 FAs) who underwent a contrast-enhanced study. RESULTS: Cystic components were seen in 10 of the 16 PTs (63%) and in 4 of the 17 FAs (24%; P=0.03). The PTs showed strong lobulation more frequently compared to the FAs (14/19 [74%] vs. 7/18 [39%], respectively; P=0.04). Though there was no significant difference, PT tended to be heterogeneous more frequently on the delayed phase of the contrast-enhanced T1WI compared to the FA (11/16 [69%] vs. 7/17 [41%], respectively). No significant difference was found in the other findings. CONCLUSIONS: Although PTs and FAs show similar MR findings, the presence of a cystic component, strong lobulation, and heterogeneity on delayed-phase contrast-enhanced T1WI suggests a PT.

Quantification of myocardial iron deficiency in nonischemic heart failure by cardiac T2* magnetic resonance imaging.

The aim of this study was to use T2* cardiac magnetic resonance (CMR) imaging to quantify myocardial iron content in patients with heart failure (HF) and to investigate the relation between iron content, cardiac function, and the cause of HF. CMR data were analyzed from 167 patients with nonischemic and 31 with ischemic HF and 50 patients with normal ventricular function. Short-axis T2* imaging was accomplished using 3-T scanner and multiecho gradient-echo sequence. Myocardial T2* value (M-T2*) was calculated by fitting the signal intensity data for the mid-left ventricular (LV) septum to a decay curve. Patients with nonischemic HF were categorized into patients with LV ejection fraction (LVEF) <35% or ≥35%. The relation between nonischemic HF with LVEF <35% and the risk for major adverse cardiac events was analyzed by multivariate logistic regression analysis using M-T2* and HF biomarkers. M-T2* was significantly greater for patients with nonischemic HF (LVEF <35%: 29 ± 7 ms, LVEF ≥35%: 26 ± 5 ms) than for patients with normal LV function (22 ± 3 ms, p <0.0001) or ischemic HF (22 ± 4 ms, p <0.001). The odds ratio was 1.21 for M-T2* (p <0.0001) and 1.0015 for brain natriuretic peptide (p <0.0001) in relation to nonischemic HF with LVEF <35%. Furthermore, this value was 0.96 for systolic blood pressure (p = 0.012) and 1.02 for M-T2* (p = 0.03) in relation to the risk for major adverse cardiac events in patients with nonischemic HF. In conclusion, T2* CMR demonstrated the robust relation between myocardial iron deficiency and nonischemic HF. M-T2* is a biomarker that can predict adverse cardiac function in patients with nonischemic HF.

Spindle-cell carcinoma of the hypopharynx presenting with a pedunculated appearance: CT and MR features.

Spindle-cell carcinoma (SPCC) is a rare tumor that presents biphasic components: squamous-cell carcinoma and sarcomatous features without any differentiation. We present a case of SPCC of the hypopharynx in a 60-year-old man. A well-demarcated mass occupying the hypomesopharynx and presenting a pedunculated appearance was observed originating from the lateral wall of left piriform sinus. High signal intensity on T2-weighted magnetic resonance (MR) images corresponded to the myxoid matrix of the tumor on MR pathologic correlation.