[Usefulness of Radiation Protection Cloths in Fluoroscopy with Clean Areas].

Lowering the dose limit for the lens of the eye incorporated into the Regulation on Prevention of Ionizing Radiation Hazards, effective on April 2021, and dose reduction will become more and more important in the field of radiation. Radiation protective cloth is used as a protective equipment in fluoroscopy rooms. Although it is usually used to protect staff from radiation exposure during endoscopic retrograde cholangiopancreatography, we investigated whether there is a way to use it for procedures in clean areas. Assuming ureterostomy fistula replacement in urology, the protective cloth was suspended on the side of the patient's head and posterior aspect of the tube, and the distance between the anterior aspect of the X-ray tube and the patient's foot was 55 cm. As a result of measuring the dose rate, a 10% dose reduction was obtained for the lens of the eye of the surgeon, and the distribution of air dose rate in the examination room was significantly reduced. Although scattered radiation from the radiation protection cloth appeared in some areas, the radiation dose to the patient was reduced throughout the body, and a high degree of radiation protection was obtained, especially for the lens of the eye. It is expected that the radiation protection cloths may be useful even when the length of the cloths is limited due to the cleanliness of the area.

Unexpected discovery of a diffuse astrocytoma of the conus medullaris in an elderly NF1 patient.

Neurofibromatosis type 1 (NF1) is one of the most common genetic neurocutaneous disorders, and it is well known to be associated with peripheral or central nervous system malignancies. The most common malignant tumors are malignant peripheral nerve sheath tumors (MPNSTs); MPNSTs are the most common cause of death in patients with NF1. Central nervous system malignancies rarely occur. So far, the occurrence of spinal cord malignancies is exceedingly rare. Herein, we report a rare case of a 69-year-old male with NF1 following tumor resection twice for cutaneous MPNSTs developing intramedullary diffuse astrocytoma in the conus medullaris, which initially presented with traumatic spinal cord injury associated with a compression fracture from fall. Contrast-enhanced magnetic resonance imaging and biopsy of the spinal cord were required to establish the final diagnosis.

Osteointegration of a Biocomposite Suture Anchor After Arthroscopic Shoulder Labral Repair.

PURPOSE: To evaluate osteoconductivity of a poly-L-lactide co-glycolide (PLG)-calcium sulfate (CS)-ß-tricalcium phosphate (ß-TCP) biocomposite suture anchor after arthroscopic shoulder labral repair. METHODS: The subjects of this study were patients who participated in a clinical trial for acquisition of marketing approval of a PLG-CS-ß-TCP biocomposite anchor in Japan. They underwent arthroscopic labral repair using the anchor, and computed tomographic (CT) images of the glenoid were obtained 2 years after surgery. Osteoconductivity at the anchor sites was evaluated with the CT images using the established ossification quality score. Shoulder function scores including the Rowe score and Japanese Shoulder Society shoulder instability score were also assessed 2 years after surgery. RESULTS: CT images and functional scores were obtained from 37 patients, comprising 29 men and 8 women with a mean age of 29 years (range, 25-33 years) at surgery. A total of 148 anchors were implanted in the 37 shoulders. Osteoconductivity was seen in 133 of 148 anchor sites (90.0%) 2 years after implantation. No significant differences in osteoconductivity were found by anchor diameter or position. The Rowe score significantly improved from 39.9 points (95% confidence interval [CI], 33.8-45.9 points) preoperatively to 96.6 points (95% CI, 95.1-98.1 points) at 2 years postoperatively (P < .001). The Japanese Shoulder Society shoulder instability score also significantly improved, from 63.1 points (95% CI, 58.4-67.7 points) preoperatively to 96.3 points (95% CI, 94.7-97.8 points) at 2 years postoperatively (P < .001). CONCLUSIONS: Biocomposite suture anchors made of PLG, CS, and ß-TCP exhibited some osteoconductivity 2 years after arthroscopic labral repair, as well as good clinical outcomes. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Transient Ischemic Attack: Which Determines Diffusion-Weighted Image Positivity?

AIM OF THE STUDY: Diffusion-weighted image (DWI) of magnetic resonance imaging (MRI) can reveal high signal lesion in up to 50% of transient ischemic attack (TIA) patients. However, it is not well-known which factors determine developing DWI positivity. In order to answer this question, we analyzed factors relevant to DWI positivity in TIA patients. METHODS: We had 257 stroke patients at a university emergency/neurology wards. They were 140 men, 117 women, mean age 72 (45-88) years. Among them, 24 (9.3%) had TIA (14 men, 10 women, mean age 71 [58-82] years). All patients underwent a 1.5T MRI. In 24 TIA patients, we investigated the following parameters in relation with stroke maturation: ABCD2 score, smoking habits, blood profile, HbA1C, dyslipidemia, coagulation factors, carotid echography, electrocardiography, cardiac echography, chest X-ray, neurological symptom/signs, imaging, and recurrence of neurological symptom on follow-up. RESULTS: In 24 TIA patients, 13 (54%) were DWI positive and 11 (46%) were DWI negative. After an extensive analysis, all parameters were not relevant to DWI positivity except for plasma osmolarity, i.e., plasma osmolarity in DWI positive cases (305.3 mOsm/l) is significantly higher than that in DWI negative cases (301.3 mOsm/l) (P = .0064). As for recurrence, 4 of 24 TIA patients recurred. They were 1 (9.0%) of 11 DWI negative cases and 3 (23.1%) of 13 DWI positive cases. Therefore, DWI positive cases recurred more frequently than DWI negative cases did, although it did not reach statistical significance. CONCLUSIONS: TIA with DWI positivity in our institute was 54%, closely associated with initial dehydration and might predict stroke recurrence.

Superior graft maturation after anatomical double-bundle anterior cruciate ligament reconstruction using the transtibial drilling technique compared to the transportal technique.

PURPOSE: To evaluate and compare the femoral tunnel aperture position, graft bending angle and the magnetic resonance imaging (MRI) graft signal intensity after anatomical double-bundle anterior cruciate ligament (ACL) reconstruction between transtibial and transportal drilling techniques of the femoral tunnel. METHODS: Eighty-seven patients who underwent anatomic double-bundle ACL reconstruction with hamstring tendon autograft between January 2012 and December 2014 were included in this retrospective study. Forty-one patients underwent reconstruction using a transportal technique (TP group) and 46 patients underwent reconstruction using a transtibial technique (TT group). The anteromedial (AM) femoral aperture position and the graft bending angle were assessed using transparent three-dimensional CT 2 weeks postoperatively. MRI assessment was performed with proton density-weighted images in an oblique coronal plane 6 and 12 months postoperatively. Signal/noise quotient was calculated for two specific graft sites (femoral tunnel site and mid-substance site). Femoral aperture position, the graft bending angle and signal/noise quotient were compared between the TP and TT groups. RESULTS: There was no significant difference in the aperture position between the two groups. The graft bending angle of the AM tunnel in the axial plane was significantly greater in the TP group (p < 0.001). On the other hand, the TP group had a significantly more acute angle in the coronal plane (p < 0.001). There was no significant difference at either site in the signal/noise quotient of the graft between the two groups at 6 months. However, the TT group had a lower signal/noise quotient at 12 months at both sites (femoral aperture: p = 0.04, mid-substance: p = 0.004). CONCLUSION: There was a significant difference in signal/noise quotient between the two drilling techniques 12 months postoperatively. There was no significant difference in femoral tunnel aperture position between the two groups. However, graft bending angle at the femoral tunnel aperture was significantly different between the two groups, indicating the possibility that graft bending angle is a factor that influences graft maturation. This indicates that the TT technique has an advantage over the TP technique in terms of graft maturation.

Quantitative evaluation of the relative apparent diffusion coefficient values on multiparametric magnetic resonance imaging to predict higher Gleason score prostate cancer.

INTRODUCTION: Apparent diffusion coefficient (ADC) values on multiparametric magnetic resonance imaging (mpMRI) have been reported to correlate with high-Gleason score (GS) prostate cancer. However, the relative ADC values between tumor lesions and normal tissue have been suggested as more suitable than the absolute ADC values for evaluation of diffusion abnormalities, because absolute ADC values are susceptible to differences in scanners or scanner settings. The present study evaluated the usefulness of the relative assessment of ADC values between tumor lesions and normal tissue on preoperative mpMRI for the prediction of high-risk prostate cancer on radical prostatectomy specimens. MATERIALS AND METHODS: A retrospective analysis of 48 men who underwent radical prostatectomy between January 2013 and December 2014 was conducted. MpMRI was performed with a 3.0-T scanner using b-values of 0 and 1500 s/mm2. ADC values of the tumor (ADCTUMOR) and normal prostate and the relative ADC tumor/normal ratio (ADCTNR) were evaluated by two radiologists. RESULTS: The inter-rater reliability between two radiologists for ADCTUMOR measurement was high, with Pearson's r = 0.982. There was no difference in ADCTUMOR between GS ≤7 and GS ≥8. In contrast, ADCTNR was significantly lower in GS ≥8 than in GS ≤7. ROC curves of ADCTNR to predict higher GS (≥8) showed better classification performance (AUC = 0.8243, p = .0012 by radiologist A and AUC = 0.7961, p = .0031 by radiologist B) than of ADCTUMOR. CONCLUSIONS: The relative assessment of ADC values between tumor lesions and normal tissue could improve the detection rate of high-risk prostate cancers.

Bladder recovery relates with increased mid-cingulate perfusion after shunt surgery in idiopathic normal-pressure hydrocephalus: a single-photon emission tomography study.

AIMS OF STUDY: It is reported that severe bladder disorder in idiopathic normal-pressure hydrocephalus (iNPH) is predicted by right frontal hypoperfusion. However, it is not known whether bladder recovery is predicted by brain perfusion change after shunt surgery. To address this issue, we compared bladder and brain function before and after shunt surgery in iNPH. METHODS: We enrolled 75 patients in the study. Before and 12 months after shunt surgery, we analyzed brain perfusion by SPECT and bladder disorder by a specialized grading scale. The scale consisted of grade 0, none; grade 1, urinary urgency and frequency; grade 2, urinary incontinence 1-3 times a week; grade 3, urinary incontinence >daily; and grade 4, loss of bladder control. More than one grade improvement is defined as improvement, and more than one grade decrement as worsening; otherwise no changes. RESULTS: Comparing before and after surgery, in the bladder-no-change group (32 cases) there was an increase in blood flow which is regarded as reversal of enlargement in the Sylvian fissure and lateral ventricles (served as control). In contrast, in the bladder-improved group (32 cases) there was an increase in bilateral mid-cingulate, parietal, and left frontal blood flow (p < 0.05). In the bladder-worsened group (11 cases) no significant blood flow change was observed. CONCLUSION: The present study showed that after shunt surgery, bladder recovery is related with mid-cingulate perfusion increase in patients with iNPH. The underlying mechanism might be functional restoration of the mid-cingulate that normally inhibits the micturition reflex.

IgG4-related inflammatory pseudotumors mimicking multiple meningiomas.

IgG4-related disease is an emerging clinicopathologic entity. Hypophysitis, diffuse thickening of dura, and enlargement of the trigeminal nerve are well-known intracranial involvements of IgG4-related disease. This report of a case of systemic IgG4-related disease is the first to present neuroimaging of apparent supratentorial meningioma-like lesions and thickening and contrast enhancement of the walls of the intracranial internal carotid arteries. It is important to recognize IgG4-related intracranial pseudotumors so that patients do not undergo unnecessary surgical procedures.

Round cell liposarcoma arising in the left foot: MRI and PET findings.

Liposarcomas are one of the most common soft-tissue sarcomas and commonly arise in the deep soft tissues of the extremities and retroperitoneum; however, the occurrence of liposarcomas in the foot or ankle is exceedingly rare. In this article, we present a 52-year-old man with round cell liposarcoma arising in the left foot. This tumor presented unusual manifestations of secondary osseous involvement in the metatarsal and tarsal bones of the left foot and solitary lymph node metastasis at the para-aortic region. Magnetic resonance imaging (MRI) and [(18)F]-fluoro-deoxy-glucose positron emission tomography computed tomography (FDG PET-CT) evaluation was considered to be useful for tumor grading and staging in this case.

Spinal metastasis from lung cancer fifteen years after surgery presenting a pseudohemangioma appearance of the vertebra: a case report.

STUDY DESIGN: Case report. OBJECTIVE: To describe a case of solitary metastasis of the seventh thoracic vertebra (T7) from lung cancer 15 years after surgery. SUMMARY OF BACKGROUND DATA: Late recurrence of the bone over 5 years after curative surgery for lung cancer is highly exceptional. In addition, bone metastasis from lung cancer showing a coarse trabecular pattern of the vertebra on computed tomography (CT) is quite unusual. METHODS: A case of solitary metastasis of T7 from lung cancer 15 years after surgery showing a pseudohemangioma appearance of the vertebra on CT is presented. RESULTS: A 66-year-old man presented with a 2-month history of gradually progressed numbness and muscle weakness of the bilateral leg, with a more recently developed spastic gate. He had undergone a left lower lobectomy for lung cancer 15 years previously. Magnetic resonance imaging showed an ill-defined mass lesion involving the entire vertebral body of T7 with extension into the posterior element and surrounding soft tissue, which resulted in moderate spinal canal stenosis. CT showed a coarse trabecular pattern at T7 with a mild compression fracture. No other lesion was detected by whole-body CT and bone scintigraphy. Tumor resection and T5-T9 posterior spinal fusion had been performed, and a pathologic diagnosis of metastatic pulmonary adenocarcinoma of the bone was established. Additional radiation therapy (40 Gy) was added, and the patient recovered and continued to survive uneventfully at the 3-month follow-up. CONCLUSION: We have reported a rare case of solitary metastasis to T7 appearing 15 years after surgery for lung cancer. The incidence of lung cancer recurrence more than 5 years after surgery is exceedingly low; however, even in patients with lung cancer, late occurrence of bone metastasis should be considered and included in the differential diagnosis of a pseudohemangioma appearance of the vertebra.

VIBE MRI for evaluating the normal and abnormal gastrointestinal tract in fetuses.

OBJECTIVE: The great potential of MRI for assessing gastrointestinal abnormalities in fetuses has been described. T1-weighted images may add additional information to T2-weighted images in diagnosing fetal gastrointestinal abnormalities. The objective of this study was to assess the performance of a 3D volumetric interpolated breath-hold sequence (VIBE) in evaluating the normal and abnormal fetal gastrointestinal tract. CONCLUSION: VIBE provides high-quality T1-weighted and 3D MR colonography images for the evaluation of the normal and abnormal gastrointestinal tract in fetuses, and 3D MR colonography provides excellent delineation of the meconium.

Solitary fibrous tumor of the pleura: apparent diffusion coefficient (ADC) value and ADC map to predict malignant transformation.

Solitary fibrous tumors (SFTs) of the pleura are rare soft-tissue tumors that are presumed to be of mesenchymal origin. Most SFTs are histologically benign, but up to 20% of SFTs may be malignant. In addition, malignant transformation may occur within histologically benign SFTs, though it is rare. However, it is difficult to diagnose malignant SFTs of the pleura by means of conventional computed tomography and magnetic resonance imaging (MRI). In this article we present the first case of malignant SFT of the pleura in an 81-year-old man in which the apparent diffusion coefficient (ADC) value and ADC map based on diffusion-weighted MRI were very useful for identifying malignant transformation.

Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging.

PURPOSE: To prospectively evaluate chemical shift magnetic resonance (MR) imaging for differentiating thymic hyperplasia from tumors of the thymus gland. MATERIALS AND METHODS: The institutional review board approved this study; informed consent was obtained and patient confidentiality was protected. The authors assessed 41 patients (17 male, 24 female; age range, 16-78 years) in whom thymic lesions were seen at chest computed tomography. Patients were assigned to a hyperplasia group (n=23) (18 patients with hyperplastic thymus associated with Graves disease and five with rebound thymic hyperplasia) and a tumor group (n=18) (seven patients with thymomas, four with invasive thymomas, five with thymic cancers, and two with malignant lymphomas). T2-weighted fast spin-echo and T1-weighted in-phase and opposed-phase MR images were obtained in all patients and visually assessed. A chemical shift ratio (CSR), determined by comparing the signal intensity of the thymus gland with that of the paraspinal muscle, was calculated for quantitative analysis. Mean CSRs for the patient groups and subgroups were analyzed by using Welch t and Newman-Keuls tests. P<.05 indicated a significant difference. RESULTS: The thymus gland had homogeneous signal intensity in all 23 patients in the hyperplasia group and in 12 of the 18 patients in the tumor group. The mean CSR (+/- standard deviation) was 0.614 +/- 0.130 in the hyperplasia group and 1.026 +/- 0.039 in the tumor group. Mean CSRs in the patients with a hyperplastic thymus and Graves disease, rebound thymic hyperplasia, thymoma, invasive thymoma, thymic cancer, and malignant lymphoma were 0.594 +/- 0.120, 0.688 +/- 0.154, 1.033 +/- 0.043, 1.036 +/- 0.040, 1.020 +/- 0.044, and 0.997 +/- 0.010, respectively. The difference in CSR between the hyperplasia and tumor groups was significant (P<.001). Mean CSRs in the hyperplasia subgroups were lower than those in the tumor subgroups (P<.001). All hyperplasia group patients had an apparent decrease in thymus gland signal intensity at chemical shift MR imaging; no tumor group patients had a decrease in thymus gland signal intensity. CONCLUSION: Chemical shift MR imaging can be used to differentiate thymic hyperplasia from thymic tumors.

Primary clear cell sarcoma (malignant melanoma) in the right radius.

Clear cell sarcoma (malignant melanoma) originating in bone is an extremely rare occurrence, which has been reported twice previously. It is challenging to differentiate this neoplasm from skeletal metastasis of malignant melanoma because it shows no specific imaging, pathological or immunohistochemical features. However, this differentiation is clinically important due to significant differences in patient management. In this article, we present the case of a 55-year-old man with primary clear cell sarcoma arising in the right radius.

The growing teratoma syndrome secondary to immature teratoma of the ovary.

The growing teratoma syndrome (GTS) secondary to a testicular nonseminomatous germ cell tumor has been well described since the first case was reported in 1982. In addition, radiological findings of male GTS have also reported in several studies; however, its occurrence secondary to an ovarian germ cell tumor is extremely rare. We experienced a 5-year-old girl who had GTS secondary to immature teratoma of the right ovary. In this article we present radiological findings of female GTS with clinical and pathological correlation.