Utility of multi-detector computed tomography scans after colorectal endoscopic submucosal dissection: a prospective study.

BACKGROUND AND AIMS: Several reports have described major adverse events after endoscopic submucosal dissection (ESD), such as perforation or bleeding. However, few studies have discussed the occurrence of post-ESD electrocoagulation syndrome (PEECS) after colorectal ESD. In addition, the occurrence of fever without abdominal pain in patients requires postoperative management similar to that required for PEECS. Therefore, we have defined post-ESD inflammatory syndrome (PEIS) composed of both PEECS and fever without abdominal pain. This study aimed to evaluate the correlation between the findings of multi-detector computed tomography (MDCT) imaging and PEIS in patients. METHODS: Between January 2015 and October 2015, we performed colorectal ESD in 100 patients; after this, all patients underwent abdominal examinations by MDCT scans. Nine patients who experienced intraoperative perforations or penetrations were excluded; 91 patients were enrolled in our prospective study. MDCT findings in patients were classified according to the amount of extraluminal gas. The patients were divided into 2 groups based on the presence or absence of extraluminal gas and were assessed for co-occurring PEIS. RESULTS: Among the 91 patients, extraluminal gas was observed in 31 (34%); of these, PEIS occurred in 14 (15%) patients. Patients with extraluminal gas had increased incidence of PEIS compared with patients without extraluminal gas (29% vs 8%, P = .014). CONCLUSIONS: Extraluminal gas was detected by MDCT in many cases and significantly correlated with the occurrence of PEIS, even in cases without obvious intraoperative perforation or penetration. MDCT findings after ESD may be useful for predicting PEIS and appropriate perioperative management.

Prediction of Time to Castration-Resistant Prostate Cancer Using Bone Scan Index in Men with Metastatic Hormone-Sensitive Prostate Cancer.

INTRODUCTION: We evaluated bone scan index (BSI) as a predictive biomarker for time to castration-resistant prostate cancer (CRPC) in patients with metastatic hormone-sensitive prostate cancer (mHSPC). MATERIALS AND METHODS: We identified 85 consecutive mHSPC patients treated with first-line androgen deprivation therapy. We analyzed the correlations between time to CRPC and clinicopathological characteristics, including age, prostate-specific antigen (PSA) level, Gleason score, clinical TNM stage, hemoglobin, lactate dehydrogenase, C-reactive protein, and BSI. RESULTS: The median BSI was 2.7%. Progression to CRPC occurred in 55 (64.7%) patients and the median time to CRPC was 12.9 months. In multivariate analysis, 3 significant risk factors for time to CRPC were identified: age (>73 vs. ≤73 years; hazard ratio [HR] 0.53), p = 0.038, PSA level (>270 vs. ≤270 ng/mL; HR 0.53, p = 0.038), and BSI (>2.7 vs. ≤2.7%; HR 2.97, p < 0.001). CONCLUSION: Age, PSA level, and BSI were found to be significant predictive factors for time to CRPC in patients with mHSPC.

Prognostic value of the bone scan index using a computer-aided diagnosis system for bone scans in hormone-naive prostate cancer patients with bone metastases.

BACKGROUND: The bone scan index (BSI) using a computer-aided diagnosis system for bone scans is expected to be an objective and quantitative clinical tool for evaluating bone metastatic prostate cancer. This study aimed to evaluate the pretreatment BSI as a prognostic factor in hormone-naive prostate cancer patients with bone metastases. METHODS: The study included 60 patients with hormone-naive, bone metastatic prostate cancer that was initially treated with combined androgen blockade therapy. The BONENAVI system was used for calculating the BSI. We evaluated the correlation between overall survival (OS) and pretreatment clinicopathological characteristics, including patients' age, initial prostate-specific antigen (PSA) value, Gleason scores, clinical TNM stage, and the BSI. Cox proportional hazards regression models were used for statistical analysis. RESULTS: The median follow-up duration was 21.4 months. Clinical or PSA progression occurred in 37 (61.7%) patients and 18 (30.0%) received docetaxel. Death occurred in 16 (26.7%) patients. Of these deaths, 15 (25.0%) were due to prostate cancer. The median OS was not reached. In multivariate analysis, age and the BSI were independent prognostic factors for OS. We evaluated the discriminatory ability of our models, including or excluding BSI by quantifying the C-index. The BSI improved the C-index from 0.751 to 0.801 for OS. Median OS was not reached in patients with a BSI ≤ 1.9 and median OS was 34.8 months in patients with a BSI >1.9 (p = 0.039). CONCLUSIONS: The pretreatment BSI and patients' age are independent prognostic factors for patients with hormone-naive, bone metastatic prostate cancer.

Prognostic value of a computer-aided diagnosis system involving bone scans among men treated with docetaxel for metastatic castration-resistant prostate cancer.

BACKGROUND: The bone scan index (BSI), which is obtained using a computer-aided bone scan evaluation system, is anticipated to become an objective and quantitative clinical tool for evaluating bone metastases in prostate cancer. Here, we assessed the usefulness of the BSI as a prognostic factor in patients with metastatic castration-resistant prostate cancer (mCRPC) treated using docetaxel. METHODS: We analyzed 41 patients who received docetaxel for mCRPC. The Bonenavi system was used as the calculation program for the BSI. The utility of the BSI as a predictor of overall survival (OS) after docetaxel was evaluated. The Cox proportional hazards model was used to investigate the association between clinical variables obtained at docetaxel treatment, namely PSA, patient age, liver metastasis, local therapy, hemoglobin (Hb), lactase dehydrogenase (LDH), albumin (Alb), PSA doubling time, and BSI and OS. RESULTS: The median OS after docetaxel therapy was 17.7 months. Death occurred in 22 (53.7%) patients; all deaths were caused by prostate cancer. In multivariate analysis, three factors were identified as significant independent prognostic biomarkers for OS after docetaxel; these were liver metastases (yes vs no; HR, 3.681; p = 0.026), Alb (<3.9 vs ≥ 3.9; HR, 3.776; p = 0.020), and BSI (>1% vs ≤ 1%; HR, 3.356; p = 0.037). We evaluated the discriminatory ability of our models including or excluding the BSI by quantifying the c-index. The BSI improved the c-index from 0.758 to 0.769 for OS after docetaxel. CRPC patients with a BSI >1 had a significantly shorter OS than patients with a BSI ≤ 1 (p = 0.029). CONCLUSIONS: The BSI, liver metastases and Alb were independent prognostic factors for OS after docetaxel. The BSI might be a useful tool for risk stratification of mCRPC patients undergoing docetaxel treatment.

Effect of transarterial embolization for post-partum hemorrhage on subsequent pregnancy.

Although pregnancy after transarterial embolization (TAE) has occasionally been reported, gelatin sponge was used as the embolic agent in most of these cases. Reports on the effect of TAE with permanent embolic agents such as N-butyl cyanoacrylate or coil on subsequent pregnancies are rare. We describe placenta accreta associated with difficult hemostasis in two patients who became pregnant after TAE with permanent embolic agents. In pregnancy after TAE with permanent embolic agents, placenta accreta occurs frequently and well-developed collateral vessels are highly likely, resulting in difficult hemostasis. Although the acceptability of pregnancy after TAE with permanent embolic agents is controversial, patients should be informed that pregnancy is extremely high risk.

Renal perfusional cortex volume for arterial input function measured by semiautomatic segmentation technique using MDCT angiographic data with 0.5-mm collimation.

OBJECTIVE: The purpose of this study was to evaluate the usefulness of renal perfusional cortex volume for arterial input function. MATERIALS AND METHODS: This retrospective study included 45 potential kidney donors--33 patients with aortic dissection and 12 patients with renovascular hypertension--who underwent both MDCT angiography with 0.5-mm collimation and renal (99m)Tc-diethylenetriamine pentaacetic acid (DTPA) scanning using the modified Gates method. Each perfusional cortex volume for the arterial input function and parenchymal volume was measured by semiautomatic segmentation using the region-growing technique. Linear regression analysis and correlation coefficients were used to assess the impact of the cortical volume, parenchymal volume, and renal scanning glomerular filtration rate (GFR) on estimated GFR (eGFR) using a modified Modification of Diet in Renal Disease (MDRD) equation. RESULTS: The correlation coefficient was higher for the total renal DTPA GFR adjusted for body surface area, weight-adjusted perfusion cortex volume, and adjusted total parenchyma volume in rank (r = 0.712, 0.642, 0.510, respectively, p< 0.0001 for each). The coefficient of the right renal perfusional cortex volume percent with a mean value of 52.1% ± 10.1% was 0.826 (p < 0.0001) for the right renal DTPA GFR percent with a mean value of 51.0% ± 12.1% (range, 22.0-89.5%), although the value for the right renal parenchymal volume percent with a mean value of 49.5% ± 5.5% was 0.764 (p < 0.0001). CONCLUSION: Weight-adjusted perfusional cortex volume for arterial input function can be measured clinically and may replace renal DTPA scanning using the modified Gates method.

Use of vessel patterns on contrast-enhanced ultrasonography using a perflubutane-based contrast agent for the differential diagnosis of regenerative nodules from early hepatocellular carcinoma or high-grade dysplastic nodules in patients with chronic liver disease.

OBJECTIVE: We evaluated the use of tumor vessel patterns observed during arterial-phase contrast-enhanced ultrasonography (US) to differentiate regenerative nodules (RN) from early hepatocellular carcinoma (HCC) or high-grade dysplastic nodules (HGDN) in patients with chronic liver disease. SUBJECTS AND METHODS: Pathologically confirmed lesions (83 early HCC, 6 HGDN, and 13 RN with mean maximal diameters of 15.4, 15.3, and 16.2 mm, respectively) were enrolled in this retrospective study. We performed contrast-enhanced US using a perflubutane-based contrast agent. We then classified the tumor vessels observed during the arterial phase of contrast-enhanced US into two patterns: peripheral vessels (centripetal pattern) and central vessels (centrifugal pattern). RESULTS: Eighty-one (97.6%) of the 83 early HCC exhibited various enhancement patterns (hypovascular, 44.6%; isovascular, 25.3%; and hypervascular, 27.7%) and a peripheral vessel pattern, while the remaining 2 lesions (2.4%) exhibited hypovascular enhancement and a central vessel pattern. All 6 HGDN lesions were hypovascular with a peripheral vessel pattern. Twelve (92.3%) of the 13 RN were hypovascular with a central vessel pattern, and the remaining one (7.7%) was hypervascular with a central vessel pattern. When lesions exhibiting a central vessel pattern during arterial-phase contrast-enhanced US were diagnosed as RN, the sensitivity, specificity, and accuracy of these diagnoses were 100%, 97.8%, and 98.0%, respectively. CONCLUSION: The tumor vessel patterns observed during arterial-phase contrast-enhanced US may be useful for differentiating RN from early HCC or HGDN in patients with chronic liver disease.

Fibromuscular dysplasia associated with simultaneous spontaneous dissection of four peripheral arteries in a 30-year-old man.

A 30-year-old man had a sudden bout of severe abdominal pain. An enhanced computed tomographic scan revealed dissections of the celiac artery, superior mesenteric artery, left renal artery, and right external iliac artery; stenosis of the right renal artery; and left kidney infarction. After careful evaluation, the patient was diagnosed with fibromuscular dysplasia (medial dysplasia), based on the findings obtained from the enhanced computed tomographic scan. This case is extremely rare because fibromuscular dysplasia occurred concurrently with simultaneous spontaneous dissections of four peripheral arteries in a young man.

C-arm cone beam CT for hepatic tumor ablation under real-time 3D imaging.

OBJECTIVE: We describe our experience with the application of a novel technology in which fluoroscopy and 3D imaging from C-arm cone beam CT systems are combined with integrated navigation software. CONCLUSION: We applied this technology to five cases in which radiofrequency ablation was performed for hepatocellular carcinoma. Technical success was achieved without treatment-related complications in all cases. We conclude that this novel technology is potentially useful for targeting hepatic lesions.

Focal liver tumors: characterization with 3D perflubutane microbubble contrast agent-enhanced US versus 3D contrast-enhanced multidetector CT.

PURPOSE: To investigate the potential application of contrast material-enhanced three-dimensional (3D) ultrasonography (US), as compared with contrast-enhanced 3D computed tomography (CT), for characterization of focal liver tumors. MATERIALS AND METHODS: Institutional review board approval and informed patient consent were obtained. One hundred thirty-nine patients with focal liver tumors-77 hepatocellular carcinomas (HCCs), 33 metastases, 23 hemangiomas, and six focal nodular hyperplasias (FNHs)-who were examined at 3D US enhanced with a perflubutane microbubble contrast agent and at 3D contrast-enhanced multidetector CT were retrospectively identified. Two readers blindly reviewed the multiplanar images and angiograms reconstructed with both modalities and classified the depicted lesions according to diagnostic criteria based on their experience and published findings. Sensitivity, specificity, positive predictive value (PPV), area under the receiver operating characteristic curve (A(z)), intermodality agreement, and interreader agreement were assessed. RESULTS: Readers 1 and 2 had concordant US and CT findings for 115 (83%) and 116 (83%) of the 139 lesions, respectively, with moderate to excellent (kappa = 0.55-0.81) intermodality agreement. There were no significant differences between the two modalities: Sensitivity was 83% or greater with both modalities, specificity was 87% or greater with contrast-enhanced US and 92% or greater with contrast-enhanced CT, the PPV was 71% or greater with both modalities, and the A(z) was at least 0.89 with US and at least 0.92 with CT. Interreader agreement was good to excellent (kappa > or = 0.76) with both modalities. CONCLUSION: Contrast-enhanced 3D US potentially can be used to characterize focal liver tumors.

Anemia and hypertension are risk factors for both renal prognosis and survival in patients with diabetes mellitus.

BACKGROUND: Diabetic nephrosclerosis is the most common cause of renal failure in the industrialized countries. At the same time, the mortality rate of patients with diabetes mellitus is high. METHODS: To clarify the factors influencing the prognosis and survival of patients with diabetic nephrosclerosis, we carried out a retrospective follow-up study of 166 cases (age, 55.6 +/- 1.0 years; male/female, 110/56) by simple and multifactorial analyses of clinical data recorded at time of renal biopsy, including survival after diagnosis of diabetic mellitus (months), body mass index (BMI) (kg/m(2)) [body weight/(body height)(2)], age (years), mean blood pressure (mBP) (mmHg) [diastolic BP + (systolic BP - diastolic BP)/3], serum levels of albumin (mg/dl), urea nitrogen (BUN) (mg/dl), serum creatinine (s-Cr) (mg/dl), total cholesterol (mg/dl), triglyceride (mg/dl), and fasting blood sugar (FBS) (mg/dl), hematocrit (%), HbA1c (%), urinary protein secretion (g/day), insulin resistance, BP control (good, <140/90 mmHg or poor, > or =140/90 mmHg) after biopsies, and pathomorphological parameters at the biopsy. RESULTS: We found a significant association between renal prognosis and several factors, e.g., hypoalbuminemia, anemia, high levels of BUN and s-Cr, hypercholesteremia, hypertriglyceridemia at biopsy, poor control of BP after biopsies, Kimmelstiel-Wilson nodule, and severe glomerular and tubulointerstitial damages at the biopsy. In addition, associations between survival and factors such as low value of BMI, elderly age at the biopsy, and poor control of BP after biopsies were significant. By multivariate analysis we also found a significant association of renal prognosis with anemia, BUN, severe glomerular damage at the biopsy, and poor control of BP after biopsies. At the same time, poor control of BP after biopsies had a significant association with survival. On Kaplan-Meier analysis, anemia at biopsy and hypertension after biopsies are risk factors for both renal prognosis and survival in diabetes mellitus patients. CONCLUSIONS: Our data strongly suggest that good control of BP after biopsies and anemia at the biopsy play pivotal roles in the prognosis and survival of patients with diabetic glomerulosclerosis.

Aortic and Internal Carotid Atherosclerosis in Patients with Carotid Stenosis: Semiautomatic Volumetric Analysis of Low-Attenuation Plaque on Curved Planar Reformations Using MDCT Angiographic Data.

This retrospective study included 65 patients who underwent multidetector computed tomography (MDCT) carotid angiography; 28 patients were <70 years old (group 1), and 37 were ≥70 years old (group 2). Each low-attenuation (<30 Hounsfield units [HU]) plaque volume (LPV) and total uncalcified plaque volume ([TUPV] ≤150 HU) were semiautomatically measured on each aortic arch and internal carotid artery (ICA) curved planar reformations (CPR), using MDCT angiographic data. Correlation coefficients were employed to assess the impact of each plaque volume on various factors including ICA stenosis. The correlations (r > 0.5) were observed between aortic LPV and each ICA stenosis ratio and >30% stenosis in group 1, between aortic TUPV and male gender in group 1, and between ICA-TUPV and each aortic TUPV or the largest plaque thickness in group 2. Marginal correlations were observed between hyperlipidemia and aortic LPV and ICA-TUPV in group 1. There was no association between cerebral infarction and the aortic and ICA plaques. Both the aortic arch and ICA plaque volumes can be measured clinically. The increasing aortic LPV may be a significant factor associated with the development of ICA stenosis in patients younger than 70 years old.

Impact of Isolated Cerebral Perfusion Technique for Aortic Arch Aneurysm Repair in Elderly Patients.

BACKGROUND: In aortic surgery, a severely atherosclerotic aorta is a known risk factor for perioperative stroke. The authors adopted a novel procedure of selective cerebral perfusion, named isolated cerebral perfusion (ICP), for the prevention of stroke during aortic arch operations. METHODS: Between January 2010 and June 2016, 48 patients (mean age, 80 ± 3 years) at Yokohama City University Medical Center, Yokohama, Japan underwent total aortic arch replacement, which included nine emergency cases with rupture. ICP was routinely performed for extracorporeal circulation during total arch replacement. The ICP procedure included the following steps: First, 9-mm Dacron grafts were anastomosed to the bilateral axillary arteries for systemic perfusion. Next, the left common carotid artery (LCCA) was clamped just before starting systemic perfusion. Dissection of the LCCA and insertion of a balloon-tipped cannula into the LCCA were performed. Extracorporeal circulation through the bilateral axillary arteries and selective cerebral perfusion to the LCCA were simultaneously started. Finally, at a bladder temperature of 25°C, clamping of the brachiocephalic and left subclavian arteries was performed. RESULTS: Preoperative evaluation by enhanced computed tomography confirmed that 62.2% of patients had severely atherosclerotic aortas and 37.8% had shaggy aortas. The overall 30-day mortality rate was 2.1%, whereas that for elective cases was 0%. Neurologic deficits developed in 3 patients (6.3%), 1 patient (2.6%) after an elective procedure. The 1-year and 3-year survival rates were 85.3% and 69.5% overall and 87.0% and 70.4% in elective cases, respectively. CONCLUSIONS: ICP during total aortic arch replacement presents an acceptable procedure for elderly patients with severely atherosclerotic aortas.

Semiautomatic Volumetry of Low Attenuation of Thoracic Aortic Plaques on Curved Planar Reformations Using MDCT Angiographic Data with 0.5 mm Collimation.

To evaluate the relationship of aortic low attenuation plaque volume (LAPV) on multidetector computed tomography (MDCT) with the abdominal aortic aneurysm (AAA), the coronary arterial disease (CAD, ≥50% stenosis), severe (≥90% stenosis) CAD, hypertension, and long-term (≥10 years) hypertension. Curved planar reformations (CPR) of three segments (the ascending, the arch, and the upper descending aorta) of the thoracic aorta were generated with attenuation-dependent color codes to measure LAPV with 0~29 HU and total noncalcified plaque volume (TNPV) with 0~150 HU in 95 patients. Correlation coefficients were employed to assess the impact of each LAPV and TNPV on AAA, CAD, severe CAD, hypertension, and long-term hypertension. Each Mean LAPV/cm and TNPV/cm was statistically greater in the aortic arch than the ascending (p < 0.001 on each) or the proximal descending segment (p < 0.001 on each). LAPV in the aortic arch has moderate correlations with AAA, severe CAD, and long-term hypertension (r = 0.643, 0.639, 0.662, resp.). Plaque volumes in each aortic segment can be measured clinically and the increasing LAPV in the arch may be a significant factor associated with the development of severe atherosclerosis underlying AAA, severe CAD, and long-term hypertension.

Efficacy of continuous versus intermittent subglottic secretion drainage in preventing ventilator-associated pneumonia in patients requiring mechanical ventilation: A single-center randomized controlled trial.

OBJECTIVE: Aspiration of subglottic secretion is a widely used intervention to prevent ventilator-associated pneumonia (VAP). This study aimed to compare the efficacy of continuous and intermittent subglottic secretion drainage (SSD) in preventing VAP. METHODS: A single-center randomized controlled trial was conducted on adult postoperative patients who were expected to undergo mechanical ventilation for more than 48 hours. Primary outcome measure was incidence of VAP and secondary outcome measures were length of mechanical ventilation and intensive-care unit (ICU) stay. RESULTS: Fifty-nine patients received continuous SSD, while 60 patients received intermittent SSD. Of these 119 patients, 88 (74%) were excluded and 15 and 16 patients were allocated to receive continuous and intermittent SSD, respectively. VAP was detected in 4 (26.7%) and 7 (43.8%) patients in the continuous and intermittent groups, respectively, (p=0.320). The length of mechanical ventilation was significantly shorter (p=0.034) in the continuous group (99.5±47.1 h) than in the intermittent group (159.9±94.5 h). The length of ICU stay was also shorter (p=0.0097) in the continuous group (6.3±2.1 days) than the intermittent group (9.8±4.8 days). CONCLUSIONS: Although continuous SSD did not reduce the incidence of VAP, it reduced the length of mechanical ventilation and ICU stay when compared to intermittent SSD.

A new device for fiducial registration of image-guided navigation system for liver RFA.

PURPOSE: Radiofrequency ablation for liver tumors (liver RFA) is widely performed under ultrasound guidance. However, discriminating between the tumor and the needle is often difficult because of cavitation caused by RFA-induced coagulation. An unclear ultrasound image can lead to complications and tumor residue. Therefore, image-guided navigation systems based on fiducial registration have been developed. Fiducial points are usually set on a patient's skin. But the use of internal fiducial points can improve the accuracy of navigation. In this study, a new device is introduced to use internal fiducial points using 2D US. METHODS: 3D Slicer as the navigation software, Polaris Vicra as the position sensor, and two target tumors in a 3D abdominal phantom as puncture targets were used. Also, a new device that makes it possible to obtain tracking coordinates in the body was invented. First, two-dimensional reslice images from the CT images using 3D Slicer were built. A virtual needle was displayed on the two-dimensional reslice image, reflecting the movement of the actual needle after fiducial registration. A phantom experiment using three sets of fiducial point configurations: one conventional case using only surface points, and two cases in which the center of the target tumor was selected as a fiducial point was performed. For each configuration, one surgeon punctured each target tumor ten times under guidance from the 3D Slicer display. Finally, a statistical analysis examining the puncture error was performed. RESULTS: The puncture error for each target tumor decreased significantly when the center of the target tumor was included as one of the fiducial points, compared with when only surface points were used. CONCLUSION: This study introduces a new device to use internal fiducial points and suggests that the accuracy of image-guided navigation systems for liver RFA can be improved by using the new device.

Extensive lipomatosis of the small bowel and mesentery: CT and MRI findings.

We report a patient with extensive lipomatosis involving both the ileum and mesentery. Axial computed tomographic images showed that diffuse and multiple intramural masses of fat densities compressed the ileum interior and abundant mesenteric fat compressed the retroperitoneum. Coronal magnetic resonance images showed thumbprinting of fluid containing ileum caused by fat-intensity masses.

Central vascular structures as a characteristic finding of regenerative nodules using hepatobiliary phase gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid-enhanced MRI and arterial dominant phase contrast-enhanced US.

OBJECTIVE: We investigated the characteristic findings of regenerative nodules (RNs) for differentiating early hepatocellular carcinoma (HCC) from high-grade dysplastic nodules (HGDNs) using magnetic resonance imaging (MRI) with gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA; EOB-MRI) and contrast-enhanced ultrasonography (CEUS) in patients with chronic liver disease. SUBJECTS AND METHODS: Pathologically confirmed lesions (100 early HCCs, 7 HGDNs, and 20 RNs with a maximum diameter of more than 1 cm and mean maximal diameters of 15.5, 15.1, and 14.8 mm, respectively) were enrolled in this retrospective study. The signal intensities of these lesions during the hepatobiliary phase of EOB-MRI were investigated, and findings characteristic of RNs using this modality were also evaluated using CEUS. RESULTS: Ninety-eight of the 100 early HCCs that were hypo-intense (n = 95), iso-intense (n = 2), or hyper-intense (n = 1) and the seven HGDNs that were hypo-intense (n = 6) or hyper-intense (n = 1) during the hepatobiliary phase of EOB-MRI exhibited centripetal vessels during the arterial dominant phase of CEUS, although one early HCC that was hypo-intense exhibited both centrifugal and centripetal vessels. Eighteen of the 20 RNs and one early HCC that were hyper-intense with a small central hypo-intensity and the remaining two RNs that were hyper-intense on EOB-MRI exhibited centrifugal vessels during the arterial dominant phase of CEUS. The small central hypo-intense area corresponded to central vascular structures in the lesion, such as the hepatic artery and portal vein running from the center to the periphery, when viewed using CEUS. CONCLUSION: Central vascular structures may be a characteristic finding of RNs when observed during the hepatobiliary phase of EOB-MRI and the arterial dominant phase of CEUS.

Emergent Uterine Arterial Embolization Using N-Butyl Cyanoacrylate in Postpartum Hemorrhage with Disseminated Intravascular Coagulation.

Although it is widely accepted that uterine artery embolization (UAE) is an effective therapeutic strategy for postpartum hemorrhage (PPH), no consensus has been reached regarding the efficacy of UAE in patients with PPH with disseminated intravascular coagulation (DIC). This single-center retrospective cohort study included patients treated with UAE using NBCA for PPH between 2010 and 2015. The patients were divided into DIC and non-DIC groups, according to the obstetrical DIC score and the overt DIC diagnostic criteria issued by the International Society of Thrombosis and Haemostasis (ISTH), and their clinical outcomes were compared. There were 28 patients treated with UAE using NBCA. Complete hemostasis was achieved by UAE in 19 of 28 patients. In eight of nine patients with unsuccessful hemostasis, surgical hemostatic interventions were performed after UAE, and hemostasis was achieved in seven patients. UAE using NBCA showed no significant intergroup differences in complete hemostasis according to the presence or absence of DIC based on obstetrical DIC score (70% versus 62.5%, P = 1.000) or ISTH DIC score (54.5% versus 76.5%, P = 0.409). UAE using NBCA may be a useful first-choice treatment for PPH with DIC.