Diffusion-weighted imaging (b value = 1500 s/mm(2)) is useful to decrease false-positive breast cancer cases due to fibrocystic changes.

BACKGROUND: We aimed to evaluate the application of apparent diffusion coefficient (ADC) values calculated from diffusion-weighted imaging (DWI) (b value = 1500 s/mm(2)) in the breast imaging reporting and data system (BI-RADS). METHODS: For 104 cases of breast lesions with definitive histology diagnosis (45 benign cases, 59 malignant cases) in which breast magnetic resonance imaging was performed, ADC values were compared between benign and malignant cases, between ductal carcinoma in situ (DCIS) and fibrocystic changes, and between DCIS and ductal hyperplasia (one type of fibrocystic change). Diagnostic accuracy was compared for a total of 101 images and for 34 images including only nine DCIS and 25 fibrocystic changes between BI-RADS alone (with categories 4a, 4b, and 5 defined as malignancies) and BI-RADS plus ADC. RESULTS: There were significant differences in mean ADC values between malignant and benign cases (p < 0.0001) and between DCIS and fibrocystic changes (p < 0.002), but not between DCIS and ductal hyperplasia. Positive predictive values were significantly greater for BI-RADS plus ADC than for BI-RADS alone in all cases (70.5% for BI-RADS alone, 81.3% for BI-RADS plus ADC) and in cases of DCIS versus fibrocystic changes (40.9% for BI-RADS alone, 64.3% for BI-RADS plus ADC), resulting in a significant improvement in diagnostic accuracy with the addition of ADC. CONCLUSION: Adding ADC values calculated from DWI (b value = 1500 s/mm(2)) to BI-RADS is a useful way to improve differential diagnostic accuracy for malignant tumors and benign lesions, especially for DCIS versus fibrocystic changes, except in cases of ductal hyperplasia.

Postoperative pulmonary embolism including asymptomatic cases in gynecologic oncology.

INTRODUCTION: So far, there has been no report addressing the actual rate of asymptomatic pulmonary embolism (PE). The present study was conducted to clarify the incidence and the characteristics of postoperative PE including asymptomatic cases in gynecologic oncology. METHODS: A total of 2107 gynecologic surgery cases that were performed from January 1996 to December 2006 at the National Kyushu Cancer Center were included. Pulmonary embolism was diagnosed using a lung scan, multi-detector row computed tomography, or pulmonary angiography. The clinical factors, including prophylaxis, were analyzed by univariate and multivariate analyses. RESULTS: PE was diagnosed in 45 patients (2.14%). Six (13.3%) of the 45 patients had respiratory symptoms or signs, and 16 patients (35.6%) had no symptoms or signs except for a SpO2 level decrease. PE was diagnosed within 4 days after the surgery in 42 patients (93.3%). There were 1 massive, 2 recurrent, and no fatal PEs. A multivariate analysis demonstrated the incidence of PE to be associated with age (odds ratio, 1.957; 95% confidence interval, 1.497-2.559), operation time (1.664; 1.180-2.346), body mass index (2.457; 1.735-3.479), surgical position (2.253; 1.468-3.458), and the use of a perioperative intermittent pneumatic compression device (0.389; 0.229-0.659). CONCLUSIONS: A substantial number of postoperative PEs were occult, and identification of high-risk patients and routine SpO2 level monitoring would reduce the diagnostic delay of PE after gynecologic surgery. Increasing age, longer operation time, and obesity were risks. The use of a perioperative intermittent pneumatic compression device in multimodal conditions might thus prevent PE.

CT and MRI findings of human herpesvirus 6-associated encephalopathy: comparison with findings of herpes simplex virus encephalitis.

OBJECTIVE: It is important to differentiate human herpesvirus 6 (HHV-6)-associated encephalopathy from herpes simplex encephalitis (HSE). Although these conditions are similar with regard to involvement of the mesial temporal lobe, HSE is sensitive to acyclovir but HHV-6 encephalopathy is not. We compared the imaging findings of the two conditions. MATERIALS AND METHODS: We encountered eight cases of HHV-6 encephalopathy and nine cases of HSE. We divided an observation time into early, middle, and late periods defined as 0-2, 3-30, and more than 30 days from the onset of neurologic symptoms. Differences between HHV-6 encephalopathy and HSE on CT scans in the early period and in distribution and temporal changes in the affected regions on MR images in the three periods were analyzed. RESULTS: At MRI in the early and middle periods, all eight patients with HHV-6 encephalopathy had exclusive involvement of the mesial temporal lobes, and all nine patients with HSE had involvement of both the mesial temporal lobes and the extratemporal regions (p < 0.01). Among patients who underwent head MRI, six of six with HHV-6 encephalopathy but none of six with HSE had resolution of high signal intensity on T2-weighted and FLAIR images (p < 0.01). Among patients who underwent head CT in the early period, none of the four with HHV-6 encephalopathy and six of the seven with HSE had abnormal findings, including parenchymal swelling, decreased attenuation of affected regions, and abnormal gyral enhancement (p < 0.05). CONCLUSION: Serial MRI showed transient abnormal signal intensity in the mesial temporal lobes in patients with HHV-6 encephalopathy but persistent abnormal signal intensity in both the mesial temporal lobes and the extratemporal regions in patients with HSE. CT in the early period showed no abnormality in patients with HHV-6 encephalopathy but definite abnormal findings in patients with HSE. These differences may be useful in the differential diagnosis of the two conditions.

Efficacy of intra-arterial infusion chemotherapy for head and neck cancers using coaxial catheter technique: initial experience.

The aim of this study was to evaluate the efficacy of intra-arterial infusion chemotherapy for head and neck cancers using a coaxial catheter technique: the superficial temporal artery (STA)-coaxial catheter method. Thirty-one patients (21 males and 10 females; 37-83 years of age) with squamous cell carcinoma of the head and neck (maxilla, 2; epipharynx, 4; mesopharynx, 8; oral floor, 4; tongue, 10; lower gingiva, 1; buccal mucosa, 2) were treated by intra-arterial infusion chemotherapy. Four patients were excluded from the tumor-response evaluation because of a previous operation or impossibility of treatment due to catheter trouble. Forty-eight sessions of catheterization were performed. A guiding catheter was inserted into the STA and a microcatheter was advanced into the tumor-feeding artery via the guiding catheter under angiographic guidance. When the location of the tumor or its feeding artery was uncertain on angiography, computed tomographic angiography was performed. The anticancer agent carboplatin (CBDCA) was continuously injected for 24 h through the microcatheter from a portable infusion pump attached to the patient's waist. The total administration dose was 300-1300 mg per body. External radiotherapy was administered during intra-arterial chemotherapy at a total dose of 21-70.5 Gy. The initial response was complete response in 15 patients, partial response in 7 patients, and no change in 5 patients; the overall response rate was 81.5% (22/27). Complication-related catheter maintenance was observed in 15 of 48 sessions of catheterization. Injury and dislocation of the microcatheter occurred 10 times in 7 patients. Catheter infection was observed three times in each of two patients, and catheter occlusion and vasculitis occurred in two patients. Intra-arterial infusion chemotherapy via the STA-coaxial catheter method could have potential as a favorable treatment for head and neck tumors.

Incidentally detected lesions on contrast-enhanced MR imaging in candidates for breast-conserving therapy: correlation between MR findings and histological diagnosis.

PURPOSE: To investigate the correlation between MR findings and the histological diagnosis of incidentally detected lesions in candidates for breast-conserving therapy. MATERIALS AND METHODS: MR images of 299 patients with breast cancer were reviewed. Incidentally detected lesions were noted in 59 of 299 (20%) patients, and a histological diagnosis was obtained in 48 of 59 (81%) patients. There were 25 benign and 23 malignant lesions. The number, size, location, morphologic character, and kinetic curve assessment of the MR findings were analyzed. Statistical analyses were performed to determine whether any differences could be observed between benign and malignant lesions. RESULTS: Lesions of over 10 mm tended to be malignant (11/16; 69%), whereas those equal or less than 5 mm tended to be benign (12/17; 71%; P < 0.05). Lesions in the same quadrant as the main lesion tended to be malignant (20/27.5; 73%), whereas those in a different quadrant tended to be benign (17.5/20.5; 85%; P < 0.001). Lesions with early peak of enhancement tended to be malignant (20/25; 80%), whereas those with persistent enhancement tended to be benign (20/23; 87%; P < 0.001). CONCLUSION: Incidentally detected lesions that are found in a different quadrant from the main lesion, are smaller than 10 mm in diameter, and show persistent enhancement on MR imaging suggest benign lesions. Therefore, patients with such lesions should avoid unnecessary surgical procedures unless lesions are proved to be malignant by cytology or biopsy.

Feasibility study of ambulatory continuous infusion of 5-fluorouracil followed by cisplatin through hepatic artery for metastatic colorectal cancer.

PURPOSE: A great synergy has been reported in a number of preclinical studies when 5-fluorouracil (5-FU) precedes cisplatin (CDDP). The objective of this study was to determine the feasibility of ambulatory continuous infusion of 5-FU followed by CDDP through hepatic artery for metastatic colorectal cancer. PATIENTS AND METHODS: Seventeen patients with unresectable liver metastases, who underwent primary tumor resection, were treated with 5-FU (450 mg/m2/day) for seven consecutive days followed by CDDP (100 mg/body/week) for seven consecutive days, each administered continuously by using a balloon pump via Infuse-A-Port catheter inserted into common hepatic artery. The doses of drugs were reduced 20% in patients older than 70 years. The treatment was repeated every 4-6 weeks until disease progression. RESULTS: Of 17 assessable patients, nine patients showed PR (53%; 95% CI, 29.3-76.7%) and eight patients had SD (47%; 95% CI, 23.3-70.7%), with disease control rate of 100%. The median overall survival was 26 months (95% CI: 17.5-41 months) and TTP 14 months (95% CI: 11-20.3 months). Two patients (11.8%), who showed progression due to collateral feeding arteries, responded to HAI again after occlusion. Grade 3 toxicity included leukopenia (12%) and anemia (24%). Grade 4 toxicity was absent. Four patients (23.5%) progressed at extrahepatic sites. CONCLUSIONS: This sequential combination of 5-FU followed by CDDP through hepatic artery is active and safe in an outpatient setting, and warrants further multi-institutional study, although prevention of micrometastasis would be mandatory to further prolong overall survival.

Traumatic neuroma and recurrent lymphadenopathy after neck dissection: comparison of radiologic features.

PURPOSE: To retrospectively evaluate the ultrasonographic (US), computed tomographic (CT), and magnetic resonance (MR) imaging features that differentiate traumatic neuroma from recurrent lymphadenopathy after neck dissection. MATERIALS AND METHODS: Imaging findings of 10 patients with a traumatic neuroma and 17 with recurrent lymphadenopathy were reviewed. US and CT were performed in all patients; MR imaging was performed in 16 patients. Findings analyzed at US included the diameter of the long and short axes, the short-axis-to-long-axis ratio, and the presence of a central hyperechoic area. Findings analyzed at CT were contiguity with common or internal carotid artery, lesion location in correlation with carotid artery, and the presence of a hyperattenuating rim. Findings analyzed at MR imaging included signal intensity on T1- and T2-weighted images, the presence of ring enhancement, and the presence of a hypointense rim on T2-weighted images. RESULTS: Statistically significant differences were found between traumatic neuroma and recurrent lymphadenopathy in the short-axis-to-long-axis ratio (mean, 0.47 vs 0.72; P < .001), the short-axis diameter (mean, 5.7 vs 12.2 mm; P < .001), the presence of a central hyperechoic area (five of 10 patients [50%] vs one of 17 patients [6%]; P < .05), the frequency of contact with carotid artery (two of 10 patients [20%] vs 13 of 17 patients [76%]; P < .01), and the presence of a hypointense rim on T2-weighted MR images (three of six patients [50%] vs zero of 10 patients [0%]; P < .05). Findings in other parameters were not statistically significant. CONCLUSION: Several imaging findings can differentiate traumatic neuroma from recurrent lymphadenopathy after neck dissection.

Efficacy of intra-arterial infusion therapy using a combination of cisplatin and docetaxel for recurrent head and neck cancers compared with cisplatin alone.

AIMS: To compare the initial effect and toxicity, response duration and survival time of intra-arterial infusion therapy using a combination of cisplatin (CDDP) and docetaxel (DXT) with those using CDDP alone for treatment of recurrent head and neck cancers. MATERIALS AND METHODS: Twenty-nine patients with recurrent head and neck cancers were treated using intra-arterial infusion chemotherapy. The chemotherapeutic regimens consisted of CDDP alone (n=12) or a combination of CDDP and DTX (n=17). In the CDDP-DTX group, both CDDP 70 mg/m2 and DTX 60 mg/m2 were administrated via the external carotid artery (ECA) or via branches of the ECA or subclavian artery. In the CDDP-alone group, CDDP 70 mg/m2 was infused. The tumour response (response rate = complete response + partial response) and toxicities (World Health Organization [WHO] classification grades 3 and 4) were evaluated in both groups and compared by Fisher's exact probability test. RESULTS: The response rates in the CDDP-DTX group and the CDDP-alone group were 71% (12/17) and 50% (6/12), respectively (P=0.44). Leucocytopenia and neutropenia (grades 3 and 4) were significantly more prevalent in the former than in the latter group (11/17 vs 1/12; 10/17 vs 1/12) (P<0.01). However, there were no infectious diseases in any of the patients. CONCLUSION: Combined cisplatin-docetaxel intra-arterial infusion therapy was shown to be effective and safe for recurrent head and neck cancers.

Thoracic malignant peripheral nerve sheath tumour mimicking a pleural tumour: a rare pedunculated appearance.

A malignant peripheral nerve sheath tumour (MPNST) generally occurs in adults and often in patients with neurofibromatosis-1 (NF-1). We present a rare case of a huge thoracic MPNST arising from the intercostal nerve in a 12-year-old girl without NF-1. In addition to the unusual occurrence in a child without NF-1, MRI demonstrated a unique pedunculated appearance mimicking a pleural tumour. In this report, we present the CT and MRI findings of our case, together with the histopathological findings, and review previous reports.

Optimal multi-phase three-dimensional fast imaging with steady-state free precession dynamic MRI and its clinical application to the diagnosis of hepatocellular carcinoma.

PURPOSE: To determine the appropriate acquisition parameters for three-dimensional fast imaging with steady-state free precession (3D-FISP), to clarify the superiority of 3D-FISP to two-dimensional fast low-angle shot (2D-FLASH) on phantom study, and to clarify the clinical usefulness of 3D-FISP in diagnosing hepatocellular carcinoma (HCC). MATERIALS AND METHODS: 3D-FISP images with varying flip angles were compared by using a phantom. Signal-to-noise ratios (SNRs) and contrast-enhancement ratios (CERs) were compared for the four two-dimensional fast low-angle shot (2D-FLASH) sequences and 3D-FISP sequences in a phantom. The optimal 3D-FISP dynamic study was compared with plain, postcontrast MR sequences used to study 78 HCC cases and analyzed according to histological grade. The 3D-FISP image obtained 30 sec after gadopentetate dimeglumine (Gd) administration was also compared with CT hepatic angiography (CTHA). RESULTS: A 25 degrees flip angle and double-dose Gd administration were appropriate for 3D-FISP dynamic study. CER was the highest with 3D-FISP, and SNR was higher in 3D-FISP than in 2D-FLASH images in a phantom with high Gd concentration. Among the 105 lesions, 103 (98%) were depicted on 3D-FISP images. The detection rate of HCC on 3D-FISP was higher than 95% for each histological grade. The vascularity of the tumors as determined by CTHA findings was correctly diagnosed on 3D-FISP in 80% of cases. CONCLUSION: In phantom study, 3D-FISP with double-dose Gd injection showed higher contrast than 2D-FLASH as a sequence for liver dynamic study. In clinical study, 3D-FISP is useful in the detection of HCC, regardless of tumor vascularity and histological grade.

Helical CT of the local spread of carcinoma of the gallbladder: evaluation according to the TNM system in patients who underwent surgical resection.

OBJECTIVE: Our aim was to evaluate the performance of helical CT as an aid in the preoperative diagnosis of the spread of carcinomas of the gallbladder. MATERIALS AND METHODS: Two radiologists retrospectively reviewed both hard-copy and soft-copy (on a monitor with multiplanar reconstruction capability) versions of helical CT scans (3-mm collimation and 3-mm reconstruction) of 21 patients who had undergone surgical resection for carcinomas of the gallbladder. The local spread of the disease was evaluated according to the TNM system, and the results were correlated to the pathologic findings. Inter- and intraobserver differences were checked with kappa statistics. Results of the consensus interpretations were used to calculate sensitivity, specificity, and accuracy of helical CT. RESULTS: No significant inter- or intraobserver differences were found in any T category evaluation. The sensitivities of the hard-copy consensus interpretations in the diagnosis of T1, T2, T3, and T4 lesions were 33%, 64%, 80%, and 100%, respectively; specificities of hard-copy interpretations were 94%, 80%, 81%, and 95%, respectively. For soft-copy (monitor) consensus interpretations, the sensitivities for the diagnosis of T1, T2, T3, and T4 lesions were 33%, 73%, 80%, and 100%, respectively; the specificities of soft-copy interpretations were 94%, 80%, 88%, and 95%, respectively. Overall accuracy of the hard-copy interpretation was 83%; the overall accuracy of the soft-copy interpretation was not significantly different-86%. CONCLUSION: Helical CT provided 83-86% accuracy in the diagnosis of the local extent of carcinomas of the gallbladder, showing acceptable sensitivity and specificity for the T2 and more advanced lesions but poor sensitivity for the T1 lesions. Use of a monitor with multiplanar reconstructions of the CT data did not significantly improve the diagnostic accuracy.

[Catheter placement in the right gastroepiploic artery without fixation using a W spiral catheter for implantable reservoir therapy of malignant liver tumors].

Intra-arterial infusion chemotherapy using a percutaneously implanted port-catheter system was performed in 21 patients with liver tumors. We developed a new procedure, the gastroepiploic method, using a W Spiral Catheter without embolization around/within the catheter and embolization for the right gastroepiploic artery distal to the catheter tip. After embolizing the gastroduodenal arterial branches, right gastric artery, or aberrant hepatic arteries, we mainly inserted the catheter tip into the right gastroepiploic artery. There were no complications such as peptic ulcer, hepatic artery obstruction, or catheter dislocation (observation time, 5.3 months). This method seemed to be feasible for implantable reservoir therapy of patients with malignant liver tumors.