Capillary hemangioma arising from the lesser omentum in an adult: A case report.

RATIONALE: Although capillary hemangiomas, common lesions involving the proliferation of small capillary vessels and a single layer of endothelial cells, can arise in any organ, they are rarely reported in the greater or lesser omentum. Here in, we report a case of capillary hemangioma arising from the lesser omentum in an adult with interesting diagnostic imaging findings, including changes in tumor size over time on computed tomography (CT), that was resected using laparoscopic surgery. To our knowledge, this is the first English report to describe a capillary hemangioma arising from the lesser omentum. PATIENT CONCERNS: A 63-year-old Japanese man received hemodialysis for chronic renal failure due to diabetic nephropathy, and a small, gradually enlarging tissue mass was found near the lesser curvature of the stomach on plain CT performed annually, without any associated complaints. Diagnostic imaging revealed an 18 × 15-mm tumor with a homogenous, highly enhanced effect in the early phase that was attenuated but prolonged in the delayed phase. Magnetic resonance imaging showed a mass with low signal intensity on T1-weighted imaging and relatively high signal intensity on T2-weighted imaging. DIAGNOSIS: The patient was diagnosed with capillary hemangioma arising from the lesser omentum according to the pathological and immunohistological findings. INTERVENTIONS: The patient underwent laparoscopy for excision of the tumor from the lesser omentum. OUTCOMES: At the 1 year follow-up, the patient had no recurrence of the tumor. LESSONS: We describe the first case worldwide of capillary hemangioma that was a true vascular tumor arising from the lesser omentum. Although capillary hemangioma arising from the lesser omentum is extremely rare, it should be considered in the differential diagnosis of patients presenting with a highly enhanced lesser omental tumor, and laparoscopy can be safely applied for the excision of this tumor.

Winged scapula in patients with myotonic dystrophy type 1.

We report two patients with myotonic dystrophy type 1 (DM1) showing winged scapula in a single family. Genomic analysis revealed a marked expansion of CTG repeats in the 3' untranslated region; 1100 in patient 1 and 667 in patient 2. Muscle MRI revealed marked atrophy in the serratus anterior muscle in both patients. Muscle biopsy findings showed central nuclei and variations in fiber size. One of the patients showed ragged red fibers in muscles of the biceps brachii. To our knowledge, this is the first report of typical winged scapula in DM1.

Tissue characterization of glioma by proton magnetic resonance spectroscopy and perfusion-weighted magnetic resonance imaging: glioma grading and histological correlation.

BACKGROUND AND PURPOSE: Our intent was to clarify the usefulness of proton magnetic resonance spectroscopy (MRS) and perfusion-weighted magnetic resonance imaging (PW-MRI) in the grading of glioma. METHODS: Twenty-three consecutive patients with gliomas were investigated by both proton MRS and PW-MRI. For quantitative analysis, the metabolite data of the gliomas were estimated using the LCModel software. Receiver operating characteristic (ROC) curve analyses were also performed to assess which metabolite parameter was optimal for discrimination of glioma grade. From the PW-MRI data, the value of blood volume was measured on the parametric map corresponding to the location of MRS analysis. We then compared tumor blood volume with the amount of choline (Cho). RESULTS: The mean Cho/creatine (Cre) ratio was useful to discriminate between Grades II and III, and the mean lactate (Lac)/Cre ratio was found to be significantly different between Grades III and IV. ROC curve analysis showed that measurements involving Cho were superior indices for grading glioma compared with blood volume information. Furthermore, the correlation between tumor blood volume and the amount of choline was statistically significant. CONCLUSION: MRS may provide valuable information for glioma grading.

Apparent diffusion coefficient in pancreatic cancer: characterization and histopathological correlations.

PURPOSE: To clarify the components primarily responsible for diffusion abnormalities in pancreatic cancerous tissue. MATERIALS AND METHODS: Subjects comprised 10 patients with surgically confirmed pancreatic cancer. Diffusion-weighted (DW) echo-planar imaging (b value = 0, 500 s/mm(2)) was employed to calculate the apparent diffusion coefficient (ADC). ADC values of cancer and noncancerous tissue were calculated. Furthermore, ADC values of the cancer were compared with histopathological results. RESULTS: The mean (+/-standard deviation) ADC value was significantly lower for tumor (1.27 +/- 0.52 x 10(-3) mm(2)/s) than for noncancerous tissue (1.90 +/- 0.41 x 10(-3) mm(2)/s, P < 0.05). Histopathological examination showed similar proportions of fibrotic area, cellular component, necrosis, and mucin in each case. Regarding the density of fibrosis in cancer, three cases were classified in the loose fibrosis group and the remaining seven cases were classified in the dense fibrosis group. The mean ADC value was significantly higher in the loose fibrosis group (1.88 +/- 0.39 x 10(-3) mm(2)/s) than in the dense fibrosis group (1.01 +/- 0.29 x 10(-3) mm(2)/s, P < 0.05). In quantitative analysis, ADC correlated well with the proportion of collagenous fibers (r = -0.87, P < 0.05). CONCLUSION: Collagenous fibers may be responsible for diffusion abnormalities in pancreatic cancer.

Rare causes of hematuria associated with various vascular diseases involving the upper urinary tract.

Hematuria is a commonly encountered symptom of a wide spectrum of diseases, including calculi, tumors, and vascular abnormalities. In rare cases, hematuria is caused by life-threatening vascular diseases. When hematuria is encountered, physicians sometimes fail to include vascular diseases in the differential diagnosis because of their rare association with hematuria. Likewise, radiologists often fail to do so because of the low frequency of occurrence of these diseases. Multidetector computed tomography performed with the bolus injection technique should be the first-line diagnostic test when vascular disease is suspected. Radiologists should be familiar with the various imaging findings of hematuria caused by vascular disease. They should also be familiar with the management options (including endovascular techniques) for hematuria caused by vascular disease, since in some cases affected patients can be treated with interventional procedures.

18F-FDG PET of common enhancing malignant brain tumors.

OBJECTIVE: The purpose of our study was to determine whether (18)F-FDG PET can be used to differentiate among common enhancing brain tumors such as lymphoma, high-grade glioma, and metastatic brain tumor. MATERIALS AND METHODS: We evaluated 34 patients with an enhancing brain tumor on MRI, including seven lymphomas, nine high-grade gliomas, and 18 metastatic tumors. All patients also underwent FDG PET. For PET image analysis, regions of interest were placed over the tumor (T), contralateral cortex (C), and white matter (WM). Average and maximum pixel values were determined at each site. On the basis of these measurements, average and maximum standard uptake values (SUV(avg) and SUV(max)) were calculated, along with activity ratios (T/C(avg), T/WM(avg), T/WM(max), and T/C(max)), and comparisons among lesions were then made. RESULTS: All parameters were significantly higher for lymphoma than for other tumors (p < 0.01). High-grade gliomas showed significantly higher SUV(avg) and SUV(max) than metastatic tumors (p < 0.05). Other parameters did not differ between lesion types. SUV(max) was the most accurate parameter for distinguishing lymphomas. Using an SUV(max) of 15.0 as a cutoff for diagnosing CNS lymphoma, only one high-grade glioma was found as a false-positive (SUV(max), 18.8). CONCLUSION: FDG PET may be useful for differentiating common enhancing malignant brain tumors, particularly lymphoma versus high-grade glioma and metastatic tumor. FDG PET can provide useful information for distinguishing between lymphoma and other malignant enhancing brain tumors and is recommended when differential diagnoses are difficult to narrow using MRI alone.

Assessment of the vascularity of uterine leiomyomas using double-echo dynamic perfusion-weighted MRI with the first-pass pharmacokinetic model: correlation with histopathology.

OBJECTIVES: To retrospectively evaluate the feasibility of perfusion-weighted MRI (PWI) in uterine leiomyomas. MATERIALS AND METHODS: : Eighteen uterine leiomyomas in 15 patients were evaluated. PWI was performed using a double-echo T2*-weighted spoiled gradient-recalled acquisition sequence, and the first-pass pharmacokinetic model was applied to calculate relative blood volume (rBV). Histopathologic analysis was performed to measure vascular area (VA). RESULTS: PWI was successful in 13 of 15 patients. On quantitative analysis, mean (+/-SD) rBV calculated from PWI was 0.17 +/- 0.13 (range, 0.06-0.55), whereas mean VA was 3.3% +/- 1.6% (range, 1.7-8.5%). A significant correlation was identified between rBV and VA (r = 0.87, P < 0.001). CONCLUSIONS: The rBV determined at PWI correlates with histologic vascular area in uterine leiomyomas.

Double-echo perfusion-weighted MR imaging: basic concepts and application in brain tumors for the assessment of tumor blood volume and vascular permeability.

Perfusion-weighted magnetic resonance (MR) imaging using contrast agents plays a key role in characterizing tumors of the brain. We have shown that double-echo perfusion-weighted MR imaging (DEPWI) is potentially useful in assessing brain tumors. Quantitative indices, such as tumor blood volume, are obtained using DEPWI, which allows correction of underestimation of tumor blood volume due to leakage of contrast agents from tumor vessels, in addition to simultaneous acquisition of tumor vessel permeability. This article describes basic concepts of DEPWI and demonstrates clinical applications in brain tumors.

Solitary plasmacytoma of the sacrum. Radiologic findings of three cases.

We report the radiologic findings from three cases of solitary plasmacytoma (SP) of the sacrum. Common findings included lytic changes on computed tomography (CT) and relatively low signal intensity on T2-weighted magnetic resonance (MR) images, with intense enhancement after contrast administration. All cases showed infiltrating and slightly expansive growth, but the sacral structure was generally maintained. These radiologic findings may be of utility when generating a differential diagnosis of a solitary sacral tumor.

Yamanouchi magnetic compression anastomosis for bilioenteric anastomotic stricture after living-donor liver transplantation.

Yamanouchi magnetic compression anastomosis (YMCA) is a novel interventional method that creates an anastomosis between the bile duct and small intestine. The method uses two magnets to compress the stricture transmurally, causing gradual ischemic necrosis of the stricture. This ischemic necrosis creates an anastomosis between the two magnets. The present report describes two cases in which YMCA was successfully applied to treat bilioenteric anastomotic stricture after living-donor liver transplantation. These two patients exhibited good long-term clinical courses.

Dynamic MR imaging: value of differentiating subtypes of peripheral small adenocarcinoma of the lung.

PURPOSE: To determine the utility of dynamic magnetic resonance imaging (MRI) in the differential subtyping of small adenocarcinomas of the lung. MATERIALS AND METHODS: Twenty-nine pathologically diagnosed peripheral adenocarcinomas (less than 20 mm in diameter) underwent dynamic contrast-enhanced MRI. Maximum relative enhancement ratio, slope of enhancement, and corrected start time of enhancement were calculated from signal intensity-time curve of pulmonary lesion for each subject, and were statistically compared among bronchioloalveolar carcinoma (BAC) group (7 cases), mixed BAC group (10 cases), and adenocarcinoma group (12 cases). RESULTS: Maximum relative enhancement ratio (P<0.001) and slope of enhancement (P<0.001) of BAC group were significantly higher than those of mixed BAC and adenocarcinoma groups. Start times of BAC group were significantly earlier than those of mixed BAC (P=0.0001) and adenocarcinoma groups (P<0.0001). Adapting the thresholds values of MR indexes from the positive tests, sensitivity, specificity, positive predictive value, negative predictive value and accuracy for differentiating BAC from other subtypes were 85.7, 100.0, 100.0, 95.7, and 96.6%, respectively. CONCLUSIONS: Dynamic MRI is useful for differentiating subtypes of small peripheral adenocarcinoma.

Dynamic T1 estimation of brain tumors using double-echo dynamic MR imaging.

PURPOSE: To assess the clinical utility of a new method for real-time estimation of T1 during the first pass of contrast agent by using this method to examine brain tumors. MATERIALS AND METHODS: The multi-phase spoiled gradient-echo pulse sequence using the double-echo magnetic resonance (MR) technique was modified. In the first half of the pulse sequence, the flip angle was varied systematically. Then, static T1 values were calculated using differences in MR signal intensities between different flip angles. In the latter half of this sequence, changes in absolute T1 were calculated using differences in signal intensities before and after injection of contrast agent. The double-echo MR data were used to minimize the T2* effect. Five cases of neurinoma and seven cases of meningioma were examined. Changes in T1 during the first pass of contrast agent were compared between neurinoma and meningioma. RESULTS: Changes in absolute T1 were clearly demonstrated on the parametric map. Although the changes in absolute T1 during the first pass of contrast agent did not allow differentiation between the two types of tumors, the mean gradient after the first pass was statistically higher for neurinoma than for meningioma (P < 0.05; meningioma, 0.011 +/- 0.012 second(-1)/second; neurinoma, 0.034 +/- 0.020 second(-1)/second). CONCLUSION: The present method appears to be useful for estimation of dynamic T1 changes in brain tumors in clinical settings.

Peritumoral brain edema in intracranial meningiomas evaluated by dynamic perfusion-weighted MR imaging: a preliminary study.

Our objective was to semi-quantitatively evaluate the cerebral perfusion in the peritumoral brain edema of meningiomas using dynamic perfusion-weighted MR imaging. Six patients with intracranial meningiomas accompanied by peritumoral brain edema were prospectively examined by perfusion-weighted MR imaging. One patient was examined twice, once before and once 5 months after the surgical resection. The relative regional cerebral blood volume (rrCBV), the relative regional cerebral blood flow (rrCBF), and the relative regional mean transit time (rrMTT) were calculated for peritumoral brain edema and the contralateral white matter. These parameters were compared between peritumoral brain edema and the contralateral white matter. The time-concentration curve of the peritumoral brain edema was less prominent than that of the contralateral white matter, resulting in a significantly lower rrCBV (mean 46%) and rrCBF (mean 45%) in peritumoral brain edema than those of contralateral white matter. The serial perfusion-weighted MR imaging also demonstrated the recovery of these parameters after the removal of meningioma by means of surgical resection. Perfusion-weighted MR imaging can demonstrate significantly decreased rrCBV and rrCBF in peritumoral brain edema compared with those in normal white matter.

[Dynamic contrast-enhanced T(1) measuring MRI using variable flip angle SPGR].

We modified the multi-phase spoiled gradient recalled echo (SPGR) pulse sequence using the double-echo MR technique for estimation of T(1) during the first pass of contrast agent, and examined its precision. In the first half of the pulse sequence, the flip angle was varied systematically to calculate static T(1) values. It was necessary to choose optimal flip angles to minimize the calculation error of static T(1) values. In the latter half of this sequence, changes in absolute T(1) were calculated using differences in signal intensities before and after the injection of contrast agent. The optimal flip angle was 20 degrees for precise conversion to T(1) values under the short TR (33.3 ms) condition. Double echo MR data were used to minimize the T(2)* effect. The present method appears to be useful for quantitative estimation of dynamic contrast-enhanced MRI.

Susceptibility-induced changes in signal intensity from spin-echo versus gradient-echo sequences.

This manuscript describes a study of the evaluation of T2 and T2* changes in a hypervascular tumor model (hemodialyzer phantom) under conditions simulating dynamic perfusion study. The measured 1/T2* was strongly dependent on the compartmentalization of contrast material within the model, whereas the observed 1/T2 was not. Gradient-echo magnetic resonance (MR) imaging may be more suitable than a spin-echo MR imaging for the evaluation of tumor vascularity.

Measurement of the vascularity and vascular leakage of gliomas by double-echo dynamic magnetic resonance imaging: a preliminary study.

RATIONALE AND OBJECTIVE: To evaluate the vascularity and vascular leakage of well-enhanced gliomas by double-echo dynamic magnetic resonance (MR) imaging. MATERIALS AND METHODS: Eight patients with glioblastoma multiforme (GBM) and two patients with juvenile pilocytic astrocytoma (JPA) were studied. Double-echo dynamic MR imaging was utilized to separate the T2* shortening effect and the T1 shortening effect. The former was represented by the vascularity index, and the latter was represented by the leakage index. These indexes were compared with histopathologic data. RESULTS: The mean vascularity index of the GBM was higher than that of the JPA (mean +/- SD, 3.48 +/- 1.57 [GBM] versus 0.51 +/- 0.29 [JPA]), and the mean leakage index of the JPA was higher than that of the GBM (1.35 +/- 0.87 [JPA] versus 0.27 +/- 0.15 [GBM]). Abundant vascularity was noted in the tight interstitial space in the pathologic specimen of GBM. Conversely, sparse vasculature was observed in the wide interstitial space in the pathologic specimen of JPA. CONCLUSION: This method may enable better characterization of grade in well-enhanced glioma by providing the information on the vascularity and leakage indexes.

Differentiation of prostate cancer from benign prostate hypertrophy using dual-echo dynamic contrast MR imaging.

OBJECTIVE: To investigate the usefulness of dynamic contrast magnetic resonance (MR) imaging in the differentiation of prostate cancer (PC) from benign prostate hypertrophy (BPH). MATERIALS AND METHODS: Eleven PC patients and 13 BPH patients were entered into the analysis. The mean gradient (MG) was calculated from the T2* term-eliminated time-signal intensity curve obtained from dynamic contrast MR data, and the MG of PC and that of BPH were compared. RESULTS: The MG of PC was significantly higher than that of BPH. When the threshold value was set to 1.88% per s for discriminating PC from BPH, the sensitivity, specificity, and accuracy were 100, 85, and 92%, respectively. CONCLUSION: The MG, which is derived from the T2* term-eliminated time-signal intensity curve, may be a useful index for differentiating PC from BPH.

H(2) (15)0 positron emission tomography validation of semiquantitative prostate blood flow determined by double-echo dynamic MRI: a preliminary study.

PURPOSE: Information regarding prostate blood flow as determined by positron emission tomography (PET) with H 0 may provide useful information about tumor diagnosis; however, PET requires a cyclotron for the production of an extremely short half-life (2 minutes) tracer. Therefore, the aim of this study was to propose a complementary index for blood flow as determined by MRI to validate the results and compare them with PET, especially for prostate tissue. METHODS: Six consecutive patients with prostate disease were studied. The two semiquantitative indices for tumor blood flow were calculated from the time-concentration curve measured from double-echo MR images. The theory of nondiffusible tracers by means of indicator dilution theory was applied to MR data. The relative regional blood flow (rrBF) was calculated as the ratio of the relative regional blood volume to relative regional mean transit time. Another proposed index was the maximum height of the time-concentration curve. PET studies were also performed, and absolute blood flow values were calculated for each subject. These indices calculated from different modalities were then compared. RESULTS: A significant correlation was found between the rrBF and the absolute blood flow as determined by PET (r = 0.69, p < 0.005). A significant correlation was also found between the maximum height of the time-concentration curve and the absolute blood flow (r = 0.85, p < 0.0001). CONCLUSIONS: The semiquantitative tumor blood flow indices measured with MRI have a good correlation with the corresponding measurements by PET; therefore, these indices may provide useful information about tumor diagnosis in clinical settings.