Concordance of clinical diagnosis of T classification among physicians for locally advanced unresectable thoracic esophageal cancer.

BACKGROUND: We conducted a multicenter phase II trial assessing chemoselection with docetaxel plus 5-fluorouracil and cisplatin induction chemotherapy and subsequent conversion surgery for locally advanced, unresectable esophageal cancer. The aim of this study was to validate the concordance of clinical T diagnosis among physicians in the cases of this trial. METHODS: Computed tomography scans and esophagoscopic images of 48 patients taken at baseline were centrally reviewed by 6 senior physicians with experience in esophageal oncology. Individual reviewers voted for definitive T4, relative T4, relative T3, or definitive T3. Discordant diagnoses between reviewers were resolved by the majority opinion. The reviewers were blinded to patient clinical outcome data and to the vote of the other reviewers. RESULTS: Ninety percent of cases were diagnosed as clinical T4 by investigators, while 33.3-75.0% (median 70.8%) of cases were judged to be T4 by 6 reviewers. Discordant diagnosis between investigators and reviewers occurred in 33% (16/48) of all cases (Cohen's kappa coefficient 0.0519), including 12 cases where curative resection was considered possible (48%, n = 25) and 4 cases where curative resection was considered impossible (17%, n = 23). Critical discordance (one reviewer voted for definitive T3 but the other voted for definitive T4, and vice versa) between reviewers occurred in 0-12.5% of cases (median 2.1%). CONCLUSIONS: There were inter-observer variations in clinical diagnosis of the T category of locally advanced, unresectable esophageal cancer. Accurate clinical diagnosis of T classification is required for determining the optimum treatment for each patient.

Single focus on breast magnetic resonance imaging: diagnosis based on kinetic pattern and patient age.

Background Because of its small size, a focus in breast magnetic resonance imaging (MRI) must be evaluated on the basis of characteristics other than morphologic features. Patient-related factors including patient age, in conjunction with lesion-related factors, could be useful for decision-making. Purpose To assess the probability of malignant foci based on both lesion- and patient-related factors, and to propose a relevant decision-making method. Material and Methods Foci in our breast MRI database dating from April 2006 to June 2013 were retrospectively identified and analyzed. A Fisher's exact test or a Mann-Whitney U test were performed for univariate analyses, and factors that showed a significant association with outcome in the univariate analyses were subjected to multivariate analysis using a logistic regression model. A decision tree was then drawn using the significant predictors confirmed by multivariate analysis. Results In total, 184 foci (168 benign, 16 malignant) in 184 patients were analyzed in our study. The presence of a washout pattern and older age were found to be significant predictors of malignancy ( P < 0.0001; odds ratio [OR], 17.8; P = 0.021; OR, 1.1, respectively). The main decisive node on the decision tree was the presence of a washout pattern, followed by whether the patient's age was >63 years. Conclusion An enhancing focus showing a washout pattern, especially in older patients, may warrant immediate biopsy rather than short-interval follow-up.

Diffusion-weighted MRI as an adjunct to mammography in women under 50 years of age: an initial study.

PURPOSE: To evaluate diffusion-weighted magnetic resonance (DW) imaging as an adjunct to mammography for the detection of small invasive breast cancer. MATERIALS AND METHODS: Institutional review board standards were followed for this retrospective study. We performed both breast DW imaging and mammography on 25 women under 50 years of age with pathologically proven T1 breast cancer and on 21 healthy women under 50 years of age. Four offsite radiologists blind to the clinical information independently interpreted the mammograms and DW images and then classified their confidence level regarding the presence of breast cancer. The composite area under receiver operating characteristic curve (AUC), of mammography alone, DW imaging alone, and the combination of DW imaging and mammography (DWI/Cal) were calculated. RESULTS: The AUC of composite ROC curves of mammography, DW imaging, DWI/Cal combination, was 0.79 (95% CI, 0.72-0.87), 0.86 (95% CI, 0.84-0.87), and 0.96 (95% CI, 0.92-1.00), respectively. CONCLUSION: DW imaging may be a useful adjunct to mammography in the detection of small invasive breast cancer in women under 50 years of age.

Diffusion-weighted imaging of surgically resected hepatocellular carcinoma: imaging characteristics and relationship among signal intensity, apparent diffusion coefficient, and histopathologic grade.

OBJECTIVE: The objective of our study was to determine the relationship between the signal intensity of hepatocellular carcinoma (HCC) assessed with diffusion-weighted imaging (DWI) and T2-weighted imaging and the apparent diffusion coefficient (ADC) with the histopathologic grade of each nodule. MATERIALS AND METHODS: MR examinations including DWI and T2-weighted imaging of 125 surgically resected hypervascular HCCs in 99 patients were retrospectively reviewed. Pathologic examinations revealed 25 well-, 61 moderately, and 39 poorly differentiated HCCs. Two radiologists reviewed the images and classified the signal intensity of each tumor on DWI and T2-weighted imaging by mutual agreement. The incidence of each signal intensity and the relationship between signal intensity and histopathologic grade were assessed for each sequence. The relationship between the ADC and histopathologic grade was also evaluated. RESULTS: On DWI, 11 of 125 HCCs appeared hypo- to isointense, 27 tumors appeared slightly hyperintense, and the remaining 87 tumors appeared obviously hyperintense to the surrounding liver. Overall, 91.2% (114/125) of HCCs showed hyperintensity to the surrounding hepatic parenchyma. Statistical analysis showed that this rate on DWI was significantly higher than that on T2 turbo spin-echo (TSE) imaging (p < 0.001). On DWI, the tumors tended to show a brighter signal with rising histopathologic grade (p = 0.031), but this trend was not observed on T2-weighted imaging. ADC measurements revealed that the mean ADCs of well-, moderately, and poorly differentiated HCCs were approximately 1.45, 1.46, and 1.36 x 10(-3) mm(2)/s, respectively. There was no significant correlation between ADC and histopathologic grade. CONCLUSION: The histopathologic grade of HCC had no correlation with the ADC, but HCC tumors tended to show a higher signal on DWI as the histopathologic grade rose. However, predicting the correct histopathologic grade of each HCC before surgery on the basis of DWI findings was difficult because of the large overlap among histopathologic grades.

Tumor staging of advanced esophageal cancer: combination of double-contrast esophagography and contrast-enhanced CT.

OBJECTIVE: The objective of this study was to compare the diagnostic accuracy of tumor staging in patients with advanced esophageal cancer based on contrast-enhanced CT findings alone with that based on a combination of CT and double-contrast esophagography and to evaluate the relevance of tumor stage to survival rate. MATERIALS AND METHODS: In 94 patients who underwent surgery as the primary treatment for esophageal cancer and had a diagnosis of postoperative T stage 3 (pT3) or pT4 disease based on pathologic examination, T stage was evaluated using CT alone and using a combination of CT and double-contrast esophagography. The diagnostic criterion for T4 disease using CT alone was tumor strongly displacing or deforming adjacent organs. The diagnostic criterion for T4 disease using the combined method was tumor displacing or deforming adjacent organs in the direction that corresponded to the direction of the location of the tumor or the deepest ulcer as diagnosed by barium esophagography. Concordance of T staging based on imaging with postoperative T staging based on pathology results, the gold standard, and survival rate were assessed for CT alone and for the combined method. RESULTS: The concordance rate with postoperative T staging pathology results was 78% for CT alone and 84% for CT and double-contrast esophagography combined, with a significant difference between the two diagnostic methods. For patients with a diagnosis of T3 and those with a diagnosis of T4 using CT alone, the 3-year survival rate was 42% and 26%, respectively, with no significant difference between the two. For patients with a diagnosis of T3 and those with a diagnosis of T4 using the combined method, the 3-year survival rate was 42% and 21%, respectively, with a significant difference between the two. CONCLUSION: The diagnostic performance of contrast-enhanced CT and double-contrast esophagography combined in staging advanced esophageal tumors is better than that of CT alone and thus has potential for estimating prognosis.

Detecting breast cancer with non-contrast MR imaging: combining diffusion-weighted and STIR imaging.

We combined diffusion-weighted (DWI) and short TI inversion recovery (STIR) imaging to evaluate the diagnostic capability of non-contrast magnetic resonance (MR) imaging to detect breast cancer. Seventy women patients underwent mammography and MR imaging with combined DWI (b factor: 1000) and STIR that revealed malignancy, and postoperative pathological examination confirmed breast cancer. Interpreted images were evaluated for sensitivity, false negative rate (FN), sensitivity by pT, and sensitivity by background density of the mammary gland. Of the 70 cases, 68 were diagnosed as cancer by DWI and STIR (sensitivity, 97% [68/70]; FN, 2.9% [2/70]). Sensitivities by pT were: pTis, 67% (4/6); pT1, 100% (33/33); and pT2-4, 100% (31/31). No significant differences were observed in sensitivity between pT1 and pT2-4 (P<0.001). Sensitivities by background density of mammary gland were: fatty/scattered fibroglandular tissue, 95% (20/21) and heterogeneous fibroglandular tissue/mostly fibroglandular tissue, 98% (48/49). No significant differences were observed (P<0.001). Two cases, an intraductal and an apocrine carcinoma, were incorrectly diagnosed by MR imaging. Precise diagnosis of breast cancer is possible with combined DWI and STIR, even in non-contrast MR imaging, regardless of the diameter or background density of mammary gland. It is hoped that non-contrast MR imaging that combines DWI and STIR will become an established clinical screening method.

Measurement of the apparent diffusion coefficient in the liver: is it a reliable index for hepatic disease diagnosis?

PURPOSE: The aim of this study was to determine the validity of the hepatic apparent diffusion coefficient (ADC) measurement. The influence of differences in measured location and administration of Buscopan (hyoscine butylbromide) for ADC were assessed. MATERIALS AND METHODS: SENSE-DWI (b = 0, 500) was obtained before and after Buscopan administration to 30 patients suspected of having a liver tumor. In this sequence, respiration gating was employed, but cardiac triggering was not. ADC measurement was performed in the hepatic parenchyma of both right and left lobes in selected slices. A statistical analysis was performed to estimate the correlation among ADC, measured location, Buscopan, and pulse rate. The images were visually evaluated to categorize the subcardiac signal loss in the left lobe. RESULTS: The ADC showed higher values in the left lobe than in the right lobe in both pre- and postloaded studies (P < 0.001). In a comparison between ADCs in the pre- and postloaded studies, the differences were not significant in the left lobe (P = 0.93) or the right lobe (P = 0.41). No correlation was noted between ADCs and the pulse rate. Visual evaluation revealed that the subcardiac signal loss was more prominent in the postloaded study. CONCLUSION: ADC measurement of the left hepatic lobe was far more incorrect than that of the right lobe if cardiac gating was not employed. The administration of Buscopan worsened the image quality of the left lobe and made visual evaluation difficult.

The effect of simultaneous use of respiratory triggering in diffusion-weighted imaging of the liver.

OBJECTIVE: To determine the effect of simultaneous use of respiratory triggering in hepatic diffusion-weighted imaging (DWI), we compared DWI with respiratory triggering (RT-DWI) and DWI under free breathing (FB-DWI) in terms of relative contrast between hepatic tumor and surrounding liver parenchyma, apparent diffusion coefficient (ADC) measurement, and frequency of respiratory misregistration. MATERIALS AND METHODS: Thirty patients (21 men, 9 women, aged 25 to 80 years) with liver metastasis or hepatocellular carcinoma in the right hepatic lobe were examined with RT- and FB-DWI. In patients having multiple tumors, up to 3 lesions were selected by mutual agreement of 2 diagnostic radiologists. Finally, 59 nodules were selected for evaluation. Relative contrast ratio (RCR) between the lesions and surrounding parenchyma and ADC were measured in each hepatic lesion in each sequence. The differences in RCR and ADC between RT- and FB-DWI were statistically analyzed using Wilcoxon's signed rank test. The frequency of respiratory misregistration advents in each sequence was visually evaluated by the 2 diagnostic radiologists and assessed using McNemar's test. RESULTS: RCRs were significantly higher in RT- than in FB-DWI (P<0.001). The difference in ADC between the 2 sequences was not significant. However, ADCs tended to be more scattered in FB- than in RT-DWI. The frequency of respiratory misregistration advents was significantly higher in FB- than in RT-DWI. CONCLUSION: FB- was inferior to RT-DWI in both contrast between tumors and surrounding liver parenchyma and in accuracy of ADC measurement as far as the numbers of excitation in each sequence were the same. For preoperative examination of hepatic resection, RT- is more suitable than FB-DWI.

Descriptors of Malignant Non-mass Enhancement of Breast MRI: Their Correlation to the Presence of Invasion.

RATIONALE AND OBJECTIVES: This study aims to investigate the clinical significance of malignant non-mass enhancement (NME) descriptors in breast magnetic resonance images by assessing their correlation to the presence of invasion or lymph node metastasis. MATERIALS AND METHODS: Three radiologists independently reviewed magnetic resonance images with malignant NMEs between January 2008 and December 2009. Distribution was assessed first, and then each of four internal enhancement patterns-clumped, clustered ring, branching, and hypointense area-was evaluated dichotomously (yes or no). Because clustered rings and hypointense areas were thought to be major structural elements of heterogeneous NMEs, they were also evaluated by integrating them into one collective descriptor we called the "heterogeneous structures." Chi-square test, Fisher exact test, or Student t test was used to analyze differences of variables by each reviewer. Positive predictive values (PPVs) of descriptors in predicting presence of invasion or lymph node metastasis were calculated. P < 0.05 was considered significant. RESULTS: We included 131 malignant NMEs (76 in situ and 55 invasive) in 129 patients (two bilateral). All three observers' results showed clustered rings (PPVs 54.5%, 54.5%, 50.0%) (P = 0.0005, 0.038, 0.029) and hypointense areas (PPVs 63.6%, 61.5%, 73.9%) (P = 0.004, 0.024, 0.0006) to be significantly associated with invasion. When clustered rings and hypointense areas were integrated into heterogeneous structures, they were significantly associated with invasion (PPVs 54.3%, 53.3%, 51.8%) (P = 0.0003, 0.016, 0.003). CONCLUSIONS: The NME descriptors clustered rings, hypoechoic areas, and heterogeneous structures, assessed collectively, were associated with invasive breast cancer.

Phase II trial of panitumumab with irinotecan as salvage therapy for patients with advanced or recurrent colorectal cancer (TOPIC study).

Little is known about the clinical impact of salvage panitumumab with irinotecan for metastatic colorectal cancer (mCRC) patients. The present study conducted a single-arm, multicenter phase II trial for mCRC with skin toxicity prevention program. The subjects were mCRC patients with wild-type KRAS, who showed resistance to fluoropyrimidine, oxaliplatin and irinotecan. Panitumumab was administered at a dose of 6 mg/kg every 2 weeks by intravenous infusion over 60 min, and irinotecan was administered at a dose of 100-180 mg/m2 every 2 weeks by intravenous infusion over 90 min, depending on the preceding treatment dose. To prevent skin toxicities, a moisturizer was applied and oral antibiotics (100 mg minocycline twice daily) were initiated for 6 weeks. The primary endpoint was the response rate (RR) determined by independent reviewers. Secondary endpoints were the disease control rate (DCR), progression-free survival (PFS) time, overall survival (OS) time and adverse events. A total of 35 patients were enrolled between October 2010 and March 2012. The median age was 61 years (range, 41-76 years), with 25 male and 10 female patients. The initial irinotecan dose was 150 mg/m2 in 19 patients and 180 mg/m2 in 1 patient. The remaining patients were treated with ≤120 mg/m2. A central review indicated a partial response in 8 patients (22.9%) and stable disease in 6 patients (17.1%), with an RR of 22.9% (95% confidence interval, 12.1-39.0) and a DCR of 40%. The RR of the patients with standard-dose irinotecan (150 or 180 mg/m2) was 30%, although that of low-dose irinotecan (100-120 mg/m2) was 13%. The median PFS time was 2.7 months, and the median OS time was 6.3 months. A grade 3 or above acne-like rash developed in 25.7% of patients. In conclusion, panitumumab and irinotecan as salvage therapy for mCRC KRAS wild-type patients with skin toxicity prevention exhibits limited efficacy. In particular, the effect of low-dose irinotecan with panitumumab appears to be clinically insignificant. Routine use of skin toxicity prevention is currently under evaluation.

Thymic MALT lymphoma: MR imaging findings and their correlation with histopathological findings on four cases.

There has been no report on the MRI findings of primary thymic MALT lymphoma. We report the correlation between MRI findings and histopathology in four cases of this entity. While primary thymic MALT lymphomas exhibited diverse characteristics, the cystic components inside, which were clearly depicted on T2-weighted images, were considered to be pathognomonic. Primary thymic MALT lymphoma should be considered as one of the differential diagnoses of anterior mediastinal tumors having multilocular cysts that arise in patients with immunological abnormalities.

Optimization of Gd-DTPA-enhanced balanced turbo field echo sequence in abdominal imaging: a basic study.

PURPOSE: To determine the optimum imaging conditions for the balanced turbo field echo (bTFE) sequence in abdominal imaging, we performed phantom experiments and scanning of a normal volunteer while noting the correlation among signal intensity, k-space ordering, flow velocity and Gd-DTPA concentration. MATERIALS AND METHODS: Initially, the abdomen of a healthy volunteer and some samples (water, blood and bovine albumin solutions with various Gd-DTPA concentrations, and olive oil) were examined with the bTFE sequence under various conditions to define the correlation among signal intensity, k-space ordering and Gd-DTPA concentration. Another experiment was performed to assess the correlation between the flow velocity and Gd-DTPA concentration. With the centric-bTFE sequence, we measured the signal intensity of water samples having various Gd-DTPA concentrations flowing in a long tube with an internal diameter of 4 mm. RESULTS: The experiments revealed the following issues: (i) The contrast of bTFE images was much influenced by k-space ordering; (ii) Gd-DTPA did not exhibit an overt enhancement effect in water and blood under stable conditions; (iii) The signal intensity of moving water decreased in centric-bTFE images, and this signal drop became more significant as the fluid speed increased; and (iv) Gd-DTPA decreased the range of signal loss in the moving fluid; however, this effect had no correlation with Gd-DTPA concentration. CONCLUSION: When the bTFE sequence was employed for abdominal imaging, centric view ordering, fat suppression and Gd-DTPA contrast enhancement were assumed to be necessary.

Optimization of Gd-DTPA-enhanced balanced turbo field echo sequence in abdominal imaging: clinical application.

PURPOSE: We performed MRI examinations of patients in order to confirm the enhancement effect of the balanced turbo field echo (bTFE) sequence with centric view ordering and SPIR (SPIR-centric-bTFE) as mentioned in the prior paper, and to evaluate the actual image quality of this sequence. MATERIALS AND METHODS: The upper abdomens of 30 patients with various abdominal disorders were examined with the SPIR-centric-bTFE sequence before and after Gd-DTPA administration. To assess the enhancement effect of Gd-DTPA, ROI measurements were taken in the aorta, superior mesenteric artery, portal vein, liver and bile juice in the common bile duct in each patient both in pre- and postcontrast images. Visual evaluations were also carried out in order to depict the peripheral vessels in the peritoneal fat and the apparent brightness of the soft-tissue organs. RESULTS: In all patients, the signal of the arteries after Gd-DTPA administration increased by about 50% compared with precontrast images. On the other hand, the veins and the liver showed a signal gain of less than 20% in postcontrast images. Consequently, only the signal of the arteries appeared enhanced in the postcontrast images. The visual evaluation revealed that postcontrast SPIR-centric-bTFE acquisition can depict the thin vessels clearly and the abdominal soft-tissue organs brightly. CONCLUSION: The balanced turbo field echo sequence with centric view ordering and SPIR after Gd-DTPA injection was considered the most appropriate protocol when this sequence was employed for abdominal imaging.

Diffusion-weighted imaging of breast cancer with the sensitivity encoding technique: analysis of the apparent diffusion coefficient value.

PURPOSE: The usefulness of diffusion-weighted imaging (DWI) in the field of neuroradiology has been established. Despite its high contrast resolution, DWI has the disadvantages of susceptibility artifact and chemical shift artifact. We performed DWI of breast cancer with the sensitivity encoding (SENSE) technique. METHODS: The subjects were 60 female patients with breast mass. All patients underwent MRI including SENSE-DWI and were diagnosed histologically. Of these patients, 55 were diagnosed with breast cancer and the remaining five were diagnosed with benign mass. The histological diagnoses of breast cancer were as follows: 39 cases of invasive ductal carcinoma (IDC); 11 cases of IDC with a predominant intraductal component and non IDC (pure or predominant NIDC); and five cases of special types of cancer. The MR system used was a Gyroscan Intera 1.5T (Philips Medical Systems). In addition to routine MRI for breast cancer, including contrast-enhanced dynamic, SENSE-DWI was obtained. The accuracy of the positional information of SENSE-DWI was visually compared with that of conventional images. The apparent diffusion coefficient (ADC) values of breast mass were analyzed with SENSE-DWI. RESULTS: The accuracy of positional information was adequate for diagnosing of all patients. The mean ADC value of breast cancer was 1.021x10(-3) mm2/s and that of benign mass was 1.488x10(-3) mm2/s (p=0.0002). The mean ADC value of IDC was 0.968x10(-3) mm2/s and that of pure or predominant NIDC was 1.218x10(-3) mm2/s (p=0.0011). CONCLUSION: SENSE-DWI was of sufficient quality to support diagnosis of breast mass. SENSE-DWI may permit the acquisition of more detailed information about lesions, including tumor cellularity, that is difficult to obtain with conventional techniques.

Efficacy of MR mammography (MRM) in providing preoperative locoregional information on breast cancer: correlation between MRM and histological findings.

RATIONALE AND OBJECTIVES: To assess the efficacy of MRM in providing preoperative locoregional information on patients with breast cancer. METHODS: MRI was performed on 62 female breast cancer patients. A 1.5T MR-system was used to acquire fat-suppressed T(1)WI, T(2)WI and dynamic-contrast-enhanced images with an SPGR pulse sequence. The extent of the cancer measured with MRM was confirmed histologically in all patients. RESULTS: The size obtained from MRM correlated well with the size obtained histologically, including intraductal spread of cancer (R: 0.853). As for shape, the round/oval type evident from MRM correlated more accurately (R: 0.934) than the ill-defined type associated with a linear and/or clumped enhanced area (R: 0.744). The difference between the size obtained from MRM and the size obtained histologically, including IDS, was less than 15 mm in the majority of patients (93.5%). CONCLUSIONS: MRM accurately reveals the extent of cancer, including IDS, and is effective at providing preoperative locoregional information for breast-conserving therapy for breast cancer.

Diffusion-weighted imaging findings of mucinous carcinoma arising in the ano-rectal region: comparison of apparent diffusion coefficient with that of tubular adenocarcinoma.

PURPOSE: To determine the diffusion-weighted imaging (DWI) characteristics of ano-rectal mucinous carcinoma. Apparent diffusion coefficient (ADC) and DWI findings for mucinous and tubular adenocarcinomas were retrospectively compared. MATERIALS AND METHODS: Eight-one consecutive surgically resected ano-rectal adenocarcinomas were evaluated. The patient group consisted of 15 mucinous and 66 tubular adenocarcinomas. The DWI signal intensity (SI) pattern of each tumor was visually classified into one of three groups. Differences in the proportions in each group were statistically compared for the two types of tumor. The ADCs of each tumor, calculated from two different b-factors (0 and 1500 s/mm(2)) were compared statistically. RESULTS: Visual evaluation revealed ten mucinous carcinomas as predominantly hypointense lesions, and the remaining five as mixed SI lesions. Sixty-one of 66 tubular adenocarcinomas had hyperintensities; the remaining five had mixed SI. The different proportions in each group were statistically significant. The mean ADC for mucinous carcinomas was 1.49 ± 0.34 × 10(-3) mm(2)/s whereas that for tubular adenocarcinomas was 0.80 ± 0.15 × 10(-3) mm(2)/s. The difference between those figures was statistically significant. CONCLUSION: In DWI, mucinous carcinomas had higher ADCs and lower SI than tubular adenocarcinomas. DWI and ADC measurements were useful for differentiating these two tumors.

Pancreatic cancer screening employing noncontrast magnetic resonance imaging combined with ultrasonography.

PURPOSE: We have conducted an initial evaluation on the potential of combining noncontrast magnetic resonance imaging (MRI) and ultrasonography (US) to screen for pancreatic cancer. MATERIALS AND METHODS: An independent ethics committee approved this study. A total of 2511 patients who underwent US were enrolled. Among them, noncontrast MRI was performed in patients in whom the entire pancreas was difficult to depict or in those with US-suspected pancreatic lesions. In total, using 1.5-T MRI, T1- and T2-weighted imaging, magnetic resonance cholangiopancreatography, and diffusion-weighted imaging, we acquired a variety of images. The efficacy of US and MRI in screening for pancreatic lesions, including pancreatic cancer, was evaluated. RESULTS: Of 2511 patients, 184 underwent MRI, and the pancreas was demonstrated in all of them. Among the 2511, five pancreatic cancers were detected by MRI combined with US (detection rate 0.20%). Of the five pancreatic cancers, three were detected by US (detection rate 0.12%) and two by MRI. Four of the five pancreatic cancers were resectable. CONCLUSION: By combining noncontrast MRI with US, pancreatic cancer can be detected with high accuracy. Other pancreatic lesions that require follow-up, including intraductal papillary mucinous neoplasms, can also be detected. Thus, pancreatic cancer screening with a combination of US and MRI is suggested.

Preoperative diagnosis of the axillary arch with multidetector row computed tomography and the axillary arch in association with anatomical problems of sentinel lymph node biopsy.

BACKGROUND: The purpose of this study was to describe the preoperative diagnosis of the axillary arch with multidetector row computed tomography (MDCT) in patients who underwent sentinel lymph node (SLN) biopsy. In addition, we investigated anatomical problems of SLN biopsy in the cases that diagnosed this anomaly. METHODS: From 2003 to 2008, combined procedures with blue dye SLN biopsy and MDCT-assisted axillary node sampling were performed in 550 clinically axilla-negative patients with primary operable breast cancer. We use MDCT for not only the diagnosis of the axillary arch, but also the planning and navigation of SLN biopsy. RESULTS: The axillary arches were preoperatively diagnosed with MDCT in 59 patients (10.8%) as follows: a single ordinary axillary arch (n = 44), another anomalous muscle besides the ordinary axillary arch (n = 13), and other rare axillary arches (n = 2). The SLN identification failure rate was 1.8% (9/491) for patients without the axillary arch and 5.1% (3/59) for patients with the axillary arch (chi-square test, P = 0.11). Three patients with an axillary arch in whom a SLN could not be identified were observed in 13 patients who had another anomalous muscle besides the ordinary axillary arch (3/13, 23.1%). In the examination of 56 patients with an axillary arch in whom a SLN was identified, variations of the SLN location and/or anomalous muscles covering a SLN were observed in 16 patients (28.5%). CONCLUSIONS: MDCT is useful for a diagnosis of the axillary arch. The axillary arch should be kept in mind during SLN biopsy because this anomaly would be related to anatomical variations that affect SLN biopsy.