Impact of MRI on the post-therapeutic diagnosis of T4 esophageal cancer.

BACKGROUND: Opportunities for T4b esophageal cancer patients to receive curative surgery are increasing with the development of multidisciplinary treatments. However, the best modality to accurately diagnose infiltration to the organs surrounding T4b esophageal cancer is still unknown. The aim of this study was to determine the performance of CT and MRI in diagnosing T stage in T4b esophageal cancer, with reference to the pathological diagnosis. METHODS: A retrospective medical records review of patients with T4b esophageal cancer patients from January 2017 to December 2021 was conducted. Among 125 patients who were treated for cT4b esophageal cancer in Osaka University Hospital, 30 patients were diagnosed with cT4b esophageal cancer by CT, ycT staging with CT (contrast-enhanced images) and MRI (T2-FSE images), and curative R0 resection was performed. Preoperative MRI staging was independently performed by two experienced radiologists. The diagnostic performance of CT and MRI were examined using McNemar's test. RESULTS: Nineteen and 12 patients were diagnosed with ycT4b by CT and MRI, respectively. Combined T4b organ resection was performed in 15 patients. A pathological diagnosis of ypT4b was made in 11 cases. In comparison to CT, MRI showed a higher diagnostic performance, specificity (47% vs. 89%, p = 0.013), and accuracy (60% vs. 90%, p = 0.015) for CT vs. MRI. CONCLUSIONS: Our results-with reference to the pathological diagnosis-revealed that MRI had a superior diagnostic performance to CT for diagnosing T4b esophageal cancer invading the surrounding organs. An accurate diagnosis of T4b esophageal cancer may facilitate the implementation of appropriate treatment strategies.

Trends in dietary intakes of vitamins A, C and E among Japanese men and women from 1974 to 2001.

OBJECTIVE: To investigate long-term trends in dietary intakes of vitamins A, C and E in Japanese adults. DESIGN: Time series by community-based nutrition survey. SETTING: Two rural communities (Ikawa and Kyowa) between 1974 and 2001 in Japan. SUBJECTS: A total of 3713 men and 3726 women aged 40-69 years. METHODS: Dietary intake data were collected by the 24 h dietary recall. RESULTS: In Ikawa, mean intake of vitamin A (beta-carotene and retinol) increased by 13-40%; vitamins C and E increased by approximately 23-33% among men and women from 1974-1977 to 1998-2000. In Kyowa, mean intake of vitamin A, primarily retinol, increased by 13-21% among men and women; vitamin C from fruits decreased by 16% among men; and vitamin E increased by 29% among women from 1982-1986 to 1998-2001. Mean intake of vitamin E in the latest survey period was lower than the Adequate Intake among men and women in both communities. Generally, there were increased intakes of beta-carotene and vitamin C from green/yellow and other vegetables; increased retinol intake from fish/shellfish, eggs, milk/dairy products and fats/oils; and increased vitamin E intake from green/yellow and other vegetables, fish/shellfish, eggs, milk/dairy products and fats/oils. CONCLUSIONS: Mean intakes of the antioxidant vitamins A, C and E increased among middle-aged Japanese men and women between the 1970s and the 1990s except for decreased vitamin C among Kyowa men. The lower mean intake of vitamin E than the Adequate Intake should be considered a potential public health issue for the prevention of CVD.

The reproducibility of 24-h dietary recall for estimating mineral intakes and their food sources among middle-aged Japanese men and women.

The objective of the present study was to examine reproducibility for mineral intakes estimated by single 24-h dietary recall for middle-aged Japanese men and women. We conducted repeated cross-sectional study between 1973 and 1999. The subjects were 262 Japanese people (132 men and 130 women) aged 40-69 years. The median Spearman correlation coefficients (range) for mineral intakes were 0.43 (0.31-0.55) for men and 0.39 (0.32-0.50) for women. The correlation coefficients stratified by the survey periods 1973-1984 and 1985-1999 were 0.42 (0.31-0.53) for men and 0.44 (0.34-0.53) for women during the earlier period, and 0.43 (0.22-0.62) for men and 0.29 (0.21-0.65) for women during the later period. In conclusion, the reproducibility of single 24-h dietary recall was fairly good for estimating mineral intakes by middle-aged Japanese men and women, although the reproducibility for some minerals tended to decline from the mid-1980s.

Evaluation of the usefulness of color digital summation radiography in temporally sequential digital radiographs: a phantom study.

PURPOSE: The purpose of this study was to assess the usefulness of color digital summation radiography (CDSR) for detection of nodules on chest radiographs by observers with different levels of experience. MATERIALS AND METHODS: A total of 30 radiographs of chest phantoms with abnormalities and 30 normal ones were arranged at random. Set A was conventional radiographs only. Set B consisted of both conventional radiographs and CDSR images, which were colored with magenta. Five chest radiologists and five residents evaluated both image sets on a TFT monitor. The observers were asked to rate each image set using a continuous rating scale. The reading time for each set was also recorded. RESULTS: In set A, the performance of chest radiologists was significantly superior to that of the residents (P < 0.05). However, in set B, there was no significant difference in the performance of the chest radiologists and the residents. In both observer groups, the mean reading time per case in set B was significantly shorter than that in set A (P < 0.01). CONCLUSION: By using CDSR, the detection capability of observers with little experience improves and is comparable to that of experienced observers. Moreover, the reading time becomes much shorter using CDSR.

Evaluation of coronary artery bypass grafts using multidetector-row CT with Japanese patients.

PURPOSE: To evaluate the patency of coronary artery bypass grafting (CABG) with multidetector-row computed tomography (MDCT) in Japanese patients, who have narrower coronary arteries than Caucasians. MATERIALS AND METHODS: Nineteen patients (12 men and 7 women, mean age: 63 +/- 12 years) with 33 coronary bypass grafts were examined with three-dimensional volume rendering (3D-VR) and curved multiplanar reconstruction (MPR) of MDCT. All grafts were compared with those obtained with selective graft angiography. RESULTS: For the 19 patients with 33 grafts, the overall sensitivity and specificity, compared with those for selective bypass angiography, were 96.7% and 100%, respectively. CONCLUSION: The patency of CABG in Japanese patients can be effectively evaluated with 3D-VR and curved MPR of MDCT.

MR imaging of thymic epithelial tumors: correlation with World Health Organization classification.

PURPOSE: The aim of this study was to determine magnetic resonance imaging (MRI) features of various subtypes of thymic epithelial tumors based on the World Health Organization classification. MATERIALS AND METHODS: The study included 64 patients with histologically proven thymic epithelial tumors. Two observers evaluated the MRI findings in terms of tumor size, contour, lobulation, shape, homogeneity, the presence of intratumor high- and low-signal foci, enhancement degree and pattern, the presence of capsule and septum, and associated mediastinal lymphadenopathy and pleural effusion. RESULTS: Type A tumors were more likely to have a smooth contour, round shape, distinct capsule, and smaller size compared to any other type of thymic epithelial tumor. Thymic carcinomas demonstrated a higher prevalence of low-signal foci within the mass on T2-weighted images and mediastinal lymphadenopathy than any other types. The frequency of heterogeneous intensity on T2-weighted images increased from type A tumors to thymic carcinomas. CONCLUSION: The presence of a smooth contour, round shape, and capsule is highly suggestive of a type A tumor. Foci of low signal intensity in the mass on T2-weighted images and mediastinal lymphadenopathy are highly suggestive of thymic carcinomas.

Evaluation of usefulness of color digital summation radiography for solitary pulmonary nodules on chest radiographs.

PURPOSE: The aim of this study was to evaluate the usefulness of novel color digital summation radiography (CDSR) for detecting solitary pulmonary nodules on chest radiographs by observers with different levels of experience. MATERIALS AND METHODS: A total of 30 healthy controls and 30 patients with newly detected solitary pulmonary nodules were evaluated. Six radiologists and five residents evaluated three image sets: set A, current and prior radiographs only; set B, set A with temporal subtraction images; and set C, set A with CDSR. The observers were asked to rate each image set using a continuous rating scale. In addition, the reading time required for each set was recorded. RESULTS: The radiologists showed no significant differences in the mean A(z) value between set A, set B, and set C. However, the residents showed significant differences between set A and set B and between set A and set C. In addition, for set B and set C, the mean reading time per case of all readers was significantly shorter than that for set A. CONCLUSION: The detection capability of observers with little experience is comparable to that of experienced observers when reading radiographs with temporal subtraction images or with CDSR. The usefulness of CDSR is comparable to that of temporal subtraction.

Image quality of high-resolution CT with 16-channel multidetector-row CT: comparison between helical scan and conventional step-shoot scan.

OBJECTIVE: The aim of this study was to evaluate the image quality of high-resolution CT (HRCT) reconstructed from volumetric data with 16-channel multidetector-row CT (MDCT). SUBJECTS AND METHODS: Eleven autopsy lungs that were diagnosed histopathologically were scanned by 16-channel MDCT with the step-and-shoot scan mode and three helical scan modes. Each helical mode had each size of focal spot, pitch, and time of gantry rotation. HRCT images were reconstructed from the volumetric data with each helical mode and axial sequence data. Two observers evaluated the image quality and noted the most appropriate diagnosis for each imaging. RESULTS: Visualization of abnormal structures with one helical mode was equal to those with axial mode, whereas those with the other two helical modes were inferior to those with axial mode (Wilcoxon signed rank test; p<0.0001). There was no significant difference in diagnostic efficacy between modes. CONCLUSION: The image quality of HRCT with appropriate helical mode is equal to that with axial mode and diagnostic efficacy is equal among all modes. These results may indicate that sufficient HRCT images can be obtained by only one helical scan without the addition of conventional axial scans.

Aortic compliance in patients with aortic regurgitation: evaluation with magnetic resonance imaging.

PURPOSE: To assess by means of cine magnetic resonance imaging (MRI) aortic compliance before and after aortic valve replacement (AVR with SJM valve) in patients with aortic regurgitation (AR). MATERIALS AND METHODS: Two groups (healthy controls and patients with severe isolated AR) of 10 subjects each were included in this study. Cine MRI was performed at three locations of the aorta, and aortic compliance was calculated by dividing the maximum change in the aortic area by pulse pressure. RESULTS: Cine MRI is useful to assess abnormalities of aortic compliance in patients with AR. Compared with the control group, aortic compliance in the AR group was significantly less in the ascending aorta (p<0.05), decreasing in order of aortic location. After AVR, aortic compliance improved for all locations. CONCLUSION: Cine MRI enables assessment of aortic biophysical properties such as a compliance for evaluating the progression of AR and the efficacy of treatment.

Full-size digital storage phosphor chest radiography: effect of 4K versus 2K matrix size on observer performance in detection of subtle interstitial abnormalities.

PURPOSE: To compare observer performance in the detection of subtle interstitial abnormalities on 3,520 x 3,520 (4K) matrix and 1,760 x 1,760 (2K) matrix full-size digital storage phosphor (DSP) chest radiographs. MATERIALS AND METHODS: Thirty-five 4K DSP chest radiographs with subtle interstitial abnormalities (n=27) or normal lungs (n=8) were processed with a half-band low-pass filter to produce 2K DSP radiographs. Although the actual matrix size of the 2K DSP radiographs remained 4K, the effective matrix size was reduced to 2K. Four chest radiologists independently evaluated full-sized hard-copy of the 4K and 2K DSP radiographs, and scored the presence of interstitial abnormalities for both right and left lungs on a five-point confidence scale. With findings on high-resolution computed tomography as the reference standard, observer performance was evaluated using multireader-multicase receiver operating characteristic (ROC) analysis. RESULTS: The average area under the ROC curve (Az) values for 4K and 2K DSP radiographs were 0.791+/-0.055 and 0.804+/-0.050, respectively. Both individual and averaged Az values showed no statistically significant differences (p>0.05) between 4K and 2K DSP radiographs. CONCLUSION: Observer performance in the detection of subtle interstitial abnormalities on 4K full-size DSP chest radiographs was equivalent to that on 2K full-size DSP chest radiographs.

Voxel dimensions required for micromorphologic evaluation of ground-glass opacity on lung high-resolution CT.

PURPOSE: To clarify the appropriate voxel dimensions required for pathologic evaluation of areas with ground-glass opacity on lung high-resolution computed tomography (HRCT). MATERIALS AND METHODS: Synchrotron radiation CT (SRCT) images of autopsied lung speci-mens (n=25) that showed ground-glass opacity on HRCT were reconstructed with 12 different voxel dimensions ranging from 0.006 to 0.6 mm. The specimens were micromorphologically categorized into one of three pathologic groups: alveolar, interstitial, and mixed abnormalities. Each SRCT image was independently diagnosed as one of three pathologic groups by six chest radiologists. The diagnostic accuracy required to estimate the appropriate voxel dimensions was compared among different voxel dimensions by means of the Tukey test. RESULTS: Diagnostic accuracy with voxel dimensions less than or equal to 0.06 mm was significantly higher than that with voxel dimensions of 0.18 mm or more (p<0.01). There was, however, no significance of difference in diagnostic accuracy with voxel dimensions of less than or equal to 0.06 mm. In addition, no significant difference in diagnostic accuracy was found with voxel dimensions of 0.18 mm or more. CONCLUSION: The appropriate voxel dimensions are approximately 0.06 mm for pathologic differentiation of areas with ground-glass opacity on HRCT.

Evaluation of major aortopulmonary collateral arteries (MAPCAs) using three-dimensional CT angiography: two case reports.

Pulmonary atresia (PA) and ventricular septal defect (VSD) are usually associated with major aortopulmonary collateral arteries (MAPCAs). Preoperative evaluation of MAPCAs is essential for effective planning of unifocalization. Multidetector-row computed tomography (MDCT) with three-dimensional volume rendering (3D-VR) demonstrates MAPCAs as well as conventional angiography. We report two cases of PA and VSD associated with MAPCAs examined pre- and postoperatively by means of angiography and MDCT with the 3D-VR technique. MDCT with the 3D-VR technique had the potential to elucidate all MAPCAs demonstrated by invasive angiography. This technique is useful with preoperative conventional angiography as a standard examination for the planning of staged surgery.

Coronal multiplanar reconstruction view from whole lung thin-section CT by multidetector-row CT: determination of malignant or benign lesions and differential diagnosis in 68 cases of solitary pulmonary nodule.

PURPOSE: The purpose of this study was to evaluate the usefulness of the coronal multiplanar reconstruction (MPR) view in comparison with transverse helical thin-section CT for both the determination of malignant or benign lesions and the differential diagnosis of solitary pulmonary nodules. MATERIALS AND METHODS: Sixty-eight cases of pathologically proved solitary pulmonary nodule less than 3 cm in diameter were enrolled in this study. For the routine study, transverse helical thin-section CT (1.25 mm collimation, FOV 20 cm) covering the areas with solitary pulmonary nodules as well as whole lung helical thin-section CT (2.5 mm collimation, 1.25 mm reconstruction interval, FOV 34.5 cm, pitch 6:1, high-spatial frequency algorithm) were scanned with a multidetector-row CT (MDCT) scanner. From the whole lung thin-section CT data, coronal MPR views (2.5 mm slice thickness) were reconstructed on a workstation. ROC analysis was used for an observer performance study, in which three observers indicated their confidence level for the determination of malignant or benign lesion for the nodules by means of transverse thin-section CT and coronal MPR. In addition, the observers recorded appropriate disease entities as the final diagnosis of each case. Accuracies of the final diagnosis based on the two sets of images were compared with McNemer' s test. RESULTS: In terms of the determination of malignant or benign lesion, there was no significant difference between the two sets of images (coronal MPR and transverse thin-section CT; mean Az=0.853 and 0.854, respectively). In addition, accuracy of the final diagnosis based on coronal MPR views (74%) was almost equal to that based on transverse thin-section CT (71%) (p=0.3). CONCLUSIONS: The diagnostic efficacy of the coronal MPR view is comparable to that of transverse thin-section CT for the evaluation of solitary pulmonary nodules.

[Technical application of three-dimensional visualization and measurement for breast cancer using multidetector-row CT scanner].

This paper describes an integrated methodology that addresses the operation of 3D imaging and measurement for the diagnosis and surgical operation of breast cancer. The main system for breast CT imaging used a multi-slice CT scanner and 3D-workstation. The clinical sequence was performed in three phases with non-contrast and biphasic contrast-enhanced studies that were performed with multi-slice helical CT scanning. Acquired DICOM images were directly sent to the 3D workstation that implemented our developed functions. Four types of transfer functions (mammary skin, vessel, lymph node, and tumor) were set based on region-of-interest (ROI) measurements. After that, two types of segmentation were prepared with volumetry and measurement of the size of breast cancer. Batch processing for 3D visualization and the measurement of breast tumors was helpful for diagnosis and surgical planning.

Pathologic subgroups of nonspecific interstitial pneumonia: differential diagnosis from other idiopathic interstitial pneumonias on high-resolution computed tomography.

OBJECTIVE: To determine whether the subtypes of nonspecific interstitial pneumonia (NSIP) could be differentiated from other idiopathic interstitial pneumonias (IIPs) on the basis of findings on high-resolution computed tomography (CT). METHODS: Two observers evaluated the high-resolution CT findings in 90 patients with IIPs. The patients included 36 with NSIP, 11 with usual interstitial pneumonia (UIP), 8 with cryptogenic organizing pneumonia (COP), 10 with acute interstitial pneumonia (AIP), 14 with desquamative interstitial pneumonia (DIP) or respiratory bronchiolitis-associated interstitial lung disease (RB-ILD), and 11 with lymphoid interstitial pneumonia (LIP). The NSIP cases were subdivided into group 1 NSIP (n = 6), group 2 NSIP (n = 15), and group 3 NSIP (n = 15). RESULTS: Observers made a correct diagnosis with a high level of confidence in 65% of NSIP cases, 91% of UIP cases, 44% of COP cases, 40% of AIP cases, 32% of DIP or RB-ILD cases, and 82% of LIP cases. Group 1 NSIP was misdiagnosed as AIP, DIP or RB-ILD, and LIP in 8.3% of patients, respectively. Group 2 NSIP was misdiagnosed as COP in 10% of patients, LIP in 6.7%, AIP in 3.3%, and DIP or RB-ILD in 3.3%. Group 3 NSIP was misdiagnosed as UIP in 6.7% of patients, COP in 6.7%, and DIP or RB-ILD in 3.3%. CONCLUSIONS: In most patients, NSIP can be distinguished from other IIPs based on the findings on high-resolution CT. Only a small percentage of patients with predominantly fibrotic NSIP (group 3 NSIP) show overlap with the high-resolution CT findings of UIP.