Magnetic resonance imaging characteristics of polypoid endometriosis and review of the literature.

AIM: Polypoid endometriosis is a rare variant of endometriosis and may mimic malignancy. The purpose of this study is to evaluate magnetic resonance (MR) imaging characteristics of polypoid endometriosis for the differential diagnosis with malignancy. METHODS: MR imaging findings of four histologically proven polypoid endometriosis were retrospectively evaluated with the review of the literature. RESULTS: All polypoid endometriosis exhibited high signal intensity on T2-weighted images reflecting abundant dilated endometrial glands. Peritoneal lesions were surrounded by low signal intensity rim represented the "black rim sign" reflecting endometriotic fibrous adhesion. Two cases arising from endometriotic cysts showed transmural extension (peritoneal extension and myometrial infiltration). Endometriotic hemorrhagic foci were demonstrated in four lesions as high signal intensity on T1-weighted images and/or susceptibility-induced signal voids on susceptibility-weighted MR sequence. Diffusion-weighted images showed high signal intensity with relatively high apparent diffusion coefficient (ADC) due to T2 shine-through effect but no diffusion restriction, and dynamic contrast-enhanced (DCE) MR imaging showed gradually increasing contrast-enhancement pattern like benign pathologies. CONCLUSIONS: Polypoid endometriosis may mimic malignancy; however, black rim sign may be a characteristic MR imaging finding for the peritoneal lesions, and no diffusion restriction and gradually increasing contrast-enhancement pattern may reflect its benign nature.

[An Anastomotic Aneurysm Thirty Years After Open Surgery of the Descending Thoracic Aorta:Report of a Case].

An 86-year-old man was hospitalized urgently to our department because of his worsening hemoptysis. He had undergone open thoracic aortic grafting for the Stanford type B chronic aortic dissecting aneurysm 30 years earlier. Contrast enhanced computed tomography (CT) revealed the distal anastomotic aneurysm, leakage of the contrast medium around the distal anastomotic site. We urgently performed thoracic endovascular aneurysm repair( TEVAR) for the distal anastomotic aneurysm. TEVAR was done under local anesthesia because of his poor respiratory condition due to hemoptysis. He recovered well without hemoptysis. Patients after open aortic surgery are expected to survive longer. Thus, special attention should be paid to the occurrence of anastomotic aneurysms.

Performance of real-scale anaerobic baffled reactor-swim bed tank system in treating fishmeal wastewater.

This study evaluates the process performance of a real-scale anaerobic baffled reactor (ABR) coupled with swim bed tank (SBT) as an aerobic post-treatment process in treating fishmeal wastewater discharged from an actual fishmeal processing factory in Bali, Indonesia. The industrial wastewater released from the aforementioned factory contains high concentrations of organic COD (more than 10 g COD·L-1) and ammonia (100 to 200 mg-N·L-1). During the study period, ABR demonstrated a high organic removal of 95.7 ± 2.9%, with an organic loading rate of 2.1 ± 1.3 kg COD·m-3·day-1. Furthermore, the average total COD influent and effluent of the proposed system were 37,800 ± 15,000 mg COD·L-1 and 435 ± 113 mg COD·L-1, respectively, during the entire experimental period. Based on the determination of volatile fatty acids (VFAs) and microbial community analysis of the ABR-retained sludge, the first and second columns of the ABR were utilized as hydrolysis zones and the third column functioned as an acidification zone. The remaining columns were used for methane production and as final removal zones. The results concluded that this system has the potential to treat fishmeal wastewater under onsite industrial conditions.

Mid-Pleistocene climate transition drives net mass loss from rapidly uplifting St. Elias Mountains, Alaska.

Erosion, sediment production, and routing on a tectonically active continental margin reflect both tectonic and climatic processes; partitioning the relative importance of these processes remains controversial. Gulf of Alaska contains a preserved sedimentary record of the Yakutat Terrane collision with North America. Because tectonic convergence in the coastal St. Elias orogen has been roughly constant for 6 My, variations in its eroded sediments preserved in the offshore Surveyor Fan constrain a budget of tectonic material influx, erosion, and sediment output. Seismically imaged sediment volumes calibrated with chronologies derived from Integrated Ocean Drilling Program boreholes show that erosion accelerated in response to Northern Hemisphere glacial intensification (∼ 2.7 Ma) and that the 900-km-long Surveyor Channel inception appears to correlate with this event. However, tectonic influx exceeded integrated sediment efflux over the interval 2.8-1.2 Ma. Volumetric erosion accelerated following the onset of quasi-periodic (∼ 100-ky) glacial cycles in the mid-Pleistocene climate transition (1.2-0.7 Ma). Since then, erosion and transport of material out of the orogen has outpaced tectonic influx by 50-80%. Such a rapid net mass loss explains apparent increases in exhumation rates inferred onshore from exposure dates and mapped out-of-sequence fault patterns. The 1.2-My mass budget imbalance must relax back toward equilibrium in balance with tectonic influx over the timescale of orogenic wedge response (millions of years). The St. Elias Range provides a key example of how active orogenic systems respond to transient mass fluxes, and of the possible influence of climate-driven erosive processes that diverge from equilibrium on the million-year scale.

[Infected Thoracic Aortic Aneurysm Secondary to the Purulent Pericarditis;Report of a Case].

A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/µl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography( CT). As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair (TEVAR). The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.

Carcinosarcoma of the uterus: MRI findings including diffusion-weighted imaging and MR spectroscopy.

BACKGROUND: Recently carcinosarcoma has become regarded as a subset of endometrial carcinoma. Because the clinical course of carcinosarcoma is aggressive with poor prognosis, it should be differentiated from endometrial carcinomas for the appropriate surgical management and adjuvant therapy. PURPOSE: To clarify the magnetic resonance imaging (MRI) characteristics of uterine carcinosarcoma including diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement and MR spectroscopy (MRS) with quantitative metabolite evaluation. MATERIAL AND METHODS: MRI findings of 12 pathologically diagnosed uterine carcinosarcomas obtained on 3T MRI were retrospectively evaluated. The mean and minimum ADCs, and the lipid and choline concentration levels were compared with those of pathologically diagnosed 38 endometrial carcinomas. RESULTS: The mean and minimum ADCs in carcinosarcomas and endometrial carcinomas were not significantly different. The mean ADC of carcinosarcomas was significantly higher than that of higher grade (G2 and G3) endometrial carcinomas. The choline concentration in carcinosarcomas was significantly lower than that in endometrial carcinomas. High lipid peak was observed in 91% of carcinosarcomas and in 24% of endometrial carcinomas. CONCLUSION: Large, exophytic heterogeneous endometrial mass containing strongly enhanced areas, which may exhibit "tumor delivery", is a suggestive of carcinosarcoma. Relatively high mean ADC and low choline concentration considering its highly malignant nature due to intra-tumoral heterogeneity with necrosis and epithelial cystic components, and the presence of necrosis-associated high lipid peak may be compatible with carcinosarcoma.

MR manifestations of uterine polypoid adenomyoma.

PURPOSE: Polypoid adenomyoma (PA) is an uncommon benign tumor of the uterus appearing as a submucosal polypoid mass, or rarely as a subserosal polypoid mass. PA should be differentiated from atypical polypoid adenomyoma or malignant uterine tumors. The purpose of our case series is to evaluate magnetic resonance (MR) manifestations of PA for the differential diagnosis. METHODS: Seven cases with surgically proven PA, five submucosal, and two subserosal, were evaluated. MR imaging findings including contrast enhancement in six cases (four cases with dynamic contrast-enhanced MR study), diffusion-weighted imaging (DWI) in five cases, and susceptibility weighted imaging (SWI) in two cases were retrospectively reviewed. RESULTS: All seven lesions exhibited isointensity compared with the myometrium and 4 of 7 lesions (57%) contained high signal intensity hemorrhagic areas on T1-weighted images. On T2-weighted images, signal intensity was variable and all seven lesions contained cysts. None of five lesions with DWI exhibited high signal intensity compared with the normal myometrium. All six lesions showed intense contrast enhancement similar to that of the myometrium on post-contrast T1-weighted images. Punctate low intensity areas reflecting blood contents were revealed in all two lesions with SWI. CONCLUSIONS: Submucosal or subserosal polypoid masses containing hemorrhagic areas, and cysts reflecting functional endometrium and dilatation of endometrial glands are suggestive for PA. Intense contrast enhancement similar to that of the myometrium may be another characteristic finding for PA.

Susceptibility-weighted MRI of extra-ovarian endometriosis: preliminary results.

PURPOSE: Extra-ovarian endometriosis (EOE) usually appears as solid masses mimicking neoplasms both clinically and radiologically. Detection of blood products within a lesion may be suggestive of its endometriotic nature. We present a descriptive study of MR imaging findings that include susceptibility-weighted imaging (SWI) for patients with EOE. METHODS: Eight pathologically proven EOE (3 bowel, 2 bladder and 3 abdominal wall) were evaluated. Fat-saturated T1-weighted images (fsT1WI) and SWI were obtained using 1.5T MR imaging. Images were reviewed for the presence of signal voids on SWI and of high-intensity foci on fsT1WI. RESULTS: High-intensity foci reflecting subacute hemorrhage were detected in 4 of 8 lesions (50%) on fsT1WI, whereas signal voids reflecting acute to chronic hemorrhage were detected in all 8 lesions (100%) on SWI. CONCLUSIONS: SWI is a sensitive MRI technique which demonstrates hemorrhage of varying chronicity in patients with EOE and may improve future MRI characterization of EOE.

Endometriosis, a common but enigmatic disease with many faces: current concept of pathophysiology, and diagnostic strategy.

Endometriosis is a benign, common, but controversial disease due to its enigmatic etiopathogenesis and biological behavior. Recent studies suggest multiple genetic, and environmental factors may affect its onset and development. Genomic analysis revealed the presence of cancer-associated gene mutations, which may reflect the neoplastic aspect of endometriosis. The management has changed dramatically with the development of fertility-preserving, minimally invasive therapies. Diagnostic strategies based on these recent basic and clinical findings are reviewed. With a focus on the presentation of clinical cases, we discuss the imaging manifestations of endometriomas, deep endometriosis, less common site and rare site endometriosis, various complications, endometriosis-associated tumor-like lesions, and malignant transformation, with pathophysiologic conditions.

MR Imaging Findings of Uterine Adenomatoid Tumors.

PURPOSE: Adenomatoid tumor is a rare benign genital tract neoplasm of mesothelial origin. Uterine adenomatoid tumors occur in the outer myometrium and may mimic leiomyomas. Because hormonal treatment is not applicable to adenomatoid tumors and laparoscopic enucleation is not easy as myomectomy, it is important to differentiate adenomatoid tumors from leiomyomas for the adequate treatment. The purpose of this study is to evaluate the MRI findings of adenomatoid tumor for the differentiation from leiomyoma. METHODS: MRI findings of surgically proven 10 uterine adenomatoid tumors in 9 women were retrospectively evaluated with correlation to histopathological findings. RESULTS: All 10 tumors appeared as solid myometrial masses and showed heterogeneous signal intensity with admixture of partially ill-defined slight high-intensity areas containing abundant tubular tumor cells and well-defined myoma-like low-intensity areas reflecting smooth muscle hypertrophy on T2WI including 4 lesions with peripheral ring-like high intensity. High-intensity areas on T2WI tended to show high intensity on diffusion-weighted imaging (DWI) with relatively high apparent diffusion coefficient (ADC), suggesting T2 shine-through effect due to abundant tubules. Intra-tumoral hemorrhage revealed on MRI was rare. Early intense contrast-enhanced areas on dynamic contrast-enhanced study were observed dominantly within the high-intensity areas but rarely within the low-intensity areas on T2WI. CONCLUSION: The outer myometrial mass with the admixture of well-defined low- and ill-defined high-intensity areas on T2WI may be suggestive of adenomatoid tumor. Peripheral ring-like high intensity on T2WI and DWI may also be suggestive. Dynamic contrast-enhanced MR study may be helpful for the differentiation from leiomyoma.

In vivo proton MR spectroscopy in uterine abscesses.

It is important to make a rapid diagnosis to provide appropriate treatment, however, specific diagnosis of causative organisms of pelvic abscesses on conventional MR imaging is difficult. MR spectroscopy provides metabolic information noninvasively, and has the potential to characterize etiology of the abscesses. The presence of acetate (Ac) peak with or without succinate (Suc) peak may suggest anaerobic bacterial infection, whereas the absence of Ac and Suc peaks in the spectra may suggest aerobic infection. This report describes two cases of uterine pyogenic abscesses, which showed Ac and Suc peaks on in vivo MR spectroscopy.

Preliminary observations and clinical value of lipid peak in high-grade uterine sarcomas using in vivo proton MR spectroscopy.

OBJECTIVE: To retrospectively evaluate the clinical significance of the lipid peak in in vivo proton magnetic resonance spectroscopy (MRS) for the diagnosis of high-grade uterine sarcomas. METHODS: MRS was performed in patients with 38 pathologically diagnosed uterine corpus tumours (26 leiomyomas and 12 sarcomas) at 3 T. Single-voxel MRS data were collected from a single square volume of interest that encompassed the tumours. The concentrations of lipid and total choline compounds (tCho) were classified as high, low or none. RESULTS: High lipid peaks were observed in all 12 sarcomas and not in benign leiomyomas except for 1 lipoleiomyoma. All 26 leiomyomas and 10 of the 12 sarcomas showed tCho peaks, whereas 2 sarcomas with massive necrosis showed no tCho peak. The presence of a high lipid peak for the diagnosis of sarcoma had a sensitivity of 100 %, specificity of 96 %, positive predictive value of 92 % and negative predictive value of 100 %. CONCLUSIONS: The high lipid peaks in high-grade malignant tumours may be observed in both viable and necrotic areas, and may be useful in distinguishing uterine sarcomas from benign leiomyomas. KEY POINTS: • High lipid peak on MR spectroscopy is suggestive of uterine sarcomas. • Lipid peak is observed in both viable and necrotic areas in sarcomas. • MR spectroscopy may be useful in distinguishing uterine sarcomas from benign leiomyomas.

Ovarian adenofibromas and cystadenofibromas: magnetic resonance imaging findings including diffusion-weighted imaging.

BACKGROUND: Ovarian adenofibromas (AF) and cystadenofibromas (CAF) belong to the surface epithelial-stromal tumors, and may appear as solid, or solid and cystic masses mimicking ovarian cancers. PURPOSE: To evaluate the capability of magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) measurement for the diagnosis of ovarian AF/CAF. MATERIAL AND METHODS: Magnetic resonance manifestations of 13 cases of ovarian AF/CAF were retrospectively evaluated. DWI was obtained in all 13 lesions, and mean ADC values in 11 lesions were compared with those in solid portions of 27 ovarian cancers. Results Neither case with AF/CAF revealed high signal intensity on DWI, whereas all ovarian cancers showed high signal intensity on DWI. The ADC values in the solid portions of AF/CAF were significantly higher than those of ovarian cancers (P < 0.001). A cut-off value of 1.20 × 10(-3) mm(2)/s for AF/CAF had a sensitivity of 82%, specificity of 93%, positive predictive value of 82%, and negative predictive value of 93%. CONCLUSION: DWI with ADC measurement may be helpful in differentiating AF/CAF from ovarian cancers.

Dynamic contrast-enhanced MR imaging of uterine endometrial carcinoma with/without squamous differentiation.

PURPOSE: Endometrial carcinoma with strong enhancement on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is suggestive of high-grade type II endometrial carcinoma. However, low-grade type I endometrial carcinoma may also sometimes show strong enhancement. We hypothesized that squamous differentiation would contribute to the strong enhancement at the early phase on DCE-MRI-like uterine cervical squamous cell carcinoma and compared the DCE-MRI findings of endometrial carcinoma with and without squamous differentiation. METHODS: DCE-MRI of endometrial carcinoma including 41 low-grade type I endometrial carcinomas without squamous differentiation (LG), 39 low-grade type I endometrial carcinomas with squamous differentiation (LGSD), and 20 high-grade type II endometrial carcinomas (HG) was retrospectively evaluated. RESULTS: Significant difference in the time-intensity curves was found between LG and HG and LG and LGSD, whereas no significant difference was seen between HG and LGSD. Curve type 3 (initial signal rise which is steeper than that of the myometrium) was more frequent in HG (60%) and LGSD (77%) than in LG (34%). CONCLUSION: It should be recognized as a pitfall that high-grade type II endometrial carcinoma and low-grade type I endometrial carcinoma with squamous differentiation may show similar early strong enhancement on DCE-MRI.

Middle Pleistocene re-organization of Australian Monsoon.

The sensitivity of the Australian Monsoon to changing climate boundary conditions remains controversial due to limited understanding of forcing processes and past variability. Here, we reconstruct austral summer monsoonal discharge and wind-driven winter productivity across the Middle Pleistocene Transition (MPT) in a sediment sequence drilled off NW Australia. We show that monsoonal precipitation and runoff primarily responded to precessional insolation forcing until ~0.95 Ma, but exhibited heightened sensitivity to ice volume and pCO2 related feedbacks following intensification of glacial-interglacial cycles. Our records further suggest that summer monsoon variability at the precessional band was closely tied to the thermal evolution of the Indo-Pacific Warm Pool and strength of the Walker circulation over the past ~1.6 Myr. By contrast, productivity proxy records consistently tracked glacial-interglacial variability, reflecting changing rhythms in polar ice fluctuations and Hadley circulation strength. We conclude that the Australian Monsoon underwent a major re-organization across the MPT and that extratropical feedbacks were instrumental in driving short- and long-term variability.

Preliminary observations and diagnostic value of lipid peak in ovarian thecomas/fibrothecomas using in vivo proton MR spectroscopy at 3T.

PURPOSE: To retrospectively evaluate the significance of lipid peak in in vivo proton magnetic resonance (MR) spectroscopy for the diagnosis of ovarian thecomas/fibrothecomas in patients with solid gynecologic tumors exhibiting totally or partially low signal intensity on T2-weighted images. MATERIALS AND METHODS: MR spectroscopy was performed in patients with pathologically diagnosed gynecologic tumors at 3T MRI. Single-voxel MR spectroscopy data were collected from a single square volume of interest that encompassed the gynecologic masses. The lipid concentration level was classified into three classes (high; low; none). RESULTS: A total of 20 gynecologic tumors in 20 patients were evaluated in this study. High lipid peak was observed in all seven thecomas/fibrothecomas, whereas low lipid peak was observed in only one fibroma in 13 nonthecomatous tumors (six benign ovarian tumors and seven subserosal uterine leiomyomas). The presence of lipid peak for the diagnosis of thecomas/fibrothecomas had a sensitivity of 100%, specificity of 92%, positive predictive value of 88%, and negative predictive value of 100%. CONCLUSION: The high lipid peak reflecting abundant intracellular lipid contents is considered a specific metabolite concentration for thecomas/fibrothecomas. Demonstration of high lipid peak may contribute to the diagnosis of thecomas/fibrothecomas in distinguishing from other benign ovarian fibrous tumors or subserosal uterine leiomyomas.

Weakened pacific overturning circulation, winter monsoon dominance and tectonism re-organized Japan Sea paleoceanography during the Late Miocene global cooling.

The Late Miocene global cooling (LMGC; approximately 7.9-5.8 Ma) was associated with remarkable changes in monsoon dynamics, biogenic bloom in the global oceans, and the rise of modern ecosystems at the expense of old biota. However, the possible linkage between the environmental changes and ecosystem shifts during the LMGC is still debated. In this paper, we show the high-resolution changes in the fluxes of selected radiolarian species, suggesting a drastic reorganization in the paleoceanography and ecosystem in the Japan Sea during the LMGC. The endemic radiolarian Cycladophora nakasekoi dominated the Japan Sea until 7.4 Ma when the Japan Sea sediment changed from dark radiolarian-rich sediment to organic-poor diatom ooze. Changes in the fluxes of C. nakasekoi and Tricolocapsa papillosa, the latter related to changes in the Pacific central water (PCW), show 100, 200, and ~ 500 ka cycles with their high flux mostly within the darker sediment intervals during the low-eccentricity period until 7.4 Ma, suggesting that orbitally paced PCW inflow might have been the major nutrient source into the Japan Sea. At about 7.4 Ma, these species decreased at the expense of increased Larcopyle weddellium, a radiolarian related to the North Pacific intermediate water (NPIW), and Cycladophora sphaeris, a subarctic radiolarian species, implying a decrease in PCW inflow and an increase in the inflow of NPIW and subarctic shallow water. Such a change would have been related to the LMGC-induced weakening in the Pacific Meridional overturning circulation and the southward shift of the subarctic front due to intensified East Asian winter monsoon. Such a drastic reorganization in the hydrography in the Japan Sea probably caused changes in nutrient provenance from the PCW to the NPIW and resulted in faunal turnover, marked by the disappearance of the old regional and endemic faunal components, such as C. nakasekoi.

The feasibility of reduced field-of-view diffusion-weighted imaging in evaluating bladder invasion of uterine cervical cancer.

OBJECTIVES: Uterine cervical cancer with bladder mucosal invasion is classified as FIGO stage IVA with poor prognosis. MRI can rule out the bladder invasion and skipping cystoscopy may be possible; however, high false-positive rate may be problematic. The purpose of this study is to evaluate the diagnostic performance of reduced field-of-view (FOV) diffusion-weighted imaging (DWI) in evaluating bladder mucosal invasion of cervical cancer. METHODS: 3T MRI including T2WI and reduced FOV DWI in 15 women with histologically proven cervical cancer (two stage IIIB, six stage IVA, seven stage IVB) were retrospectively evaluated compared with cystoscopic findings. RESULTS: Cystoscopy revealed mucosal invasion in 13 of 15 cases. The border between the tumor and the bladder wall was unclear on T2WI and clear on reduced FOV DWI in all 15 cases. The diagnosis of mucosal invasion on reduced FOV DWI had a sensitivity of 100%, specificity of 50%, accuracy of 93%, PPV of 93%, and NPV of 100%. CONCLUSIONS: Addition of reduced FOV DWI may improve the staging accuracy of MRI for cervical cancer in assessing the bladder mucosal invasion. ADVANCES IN KNOWLEDGE: Reduced FOV DWI may improve the staging accuracy of cervical cancer in assessing bladder mucosal invasion with high NPV and PPV, which may be helpful for avoiding unnecessary cystoscopy.