Screening and follow-up of chronic liver diseases with understanding their etiology in clinics and hospitals.

BACKGROUND AND AIM: Considering the increasing prevalence of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis (NASH), the development of an effective screening and follow-up system that enables the recognition of etiological changes by primary physicians in clinics and specialists in hospitals is required. METHODS: Chronic hepatitis B (HBV) and C (HCV), NASH, and alcoholic steatohepatitis (ASH) patients who were assayed for Mac-2-binding protein glycosylation isomer (M2BPGi) (n = 272) and underwent magnetic resonance elastography (MRE) (n = 119) were enrolled. Patients who underwent MRE were also tested by ultrasound elastography (USE) (n = 80) and for M2BPGi (n = 97), autotaxin (ATX) (n = 62), and platelet count (n = 119), and their fibrosis-4 (FIB-4) index was calculated (n = 119). RESULTS: FIB-4 index >2, excluding HBV-infected patients, M2BPGi >0.5, ATX >0.5, and platelet count <20 × 104/µL were the benchmark indices, and we took into consideration other risk factors, such as diabetes mellitus and age, to recommend further examinations, such as USE, based on the local situation to avoid overlooking hepatocellular carcinoma (HCC) in the clinic. During specialty care in the hospital, MRE exhibited high diagnostic ability for fibrosis stages >F3 or F4; it could efficiently predict collateral circulation with high sensitivity, which can replace USE. We also identified etiological features and found that collateral circulation in NASH/ASH patients tended to exceed high-risk levels; moreover, these patients exhibited more variation in HCC-associated liver stiffness than the HBV and HCV patients. CONCLUSIONS: Using appropriate markers and tools, we can establish a stepwise, practical, noninvasive, and etiology-based screening and follow-up system in primary and specialty care.

Effects of menstrual cycle on background parenchymal enhancement and detectability of breast cancer on dynamic contrast-enhanced breast MRI: A multicenter study of an Asian population.

PURPOSE: To evaluate the effect of the menstrual cycle on BPE and cancer detectability in an Asian population. MATERIAL AND METHODS: 266 premenopausal patients with regular menstrual cycles from 24 centers were included, and 176 of them were diagnosed by pathology as having breast cancer. Thirty-five patients were examined in the menstrual phase (days 1-4), 105 in the proliferative phase (days 5-14), and 126 in the secretory phase (days 15-30). Measurement of the following signal intensities (SIs) were obtained: breast tissue on the unaffected side on a pre-contrast image (SI1) and an early-phase image (SI2); the SIs of breast tissue on the affected side on a pre-contrast image (SI3) and an early-phase image (SI4); and the SIs of breast cancer on a pre-contrast image (SI5) and an early-phase image (SI6). We calculated the BPE ratio, i.e., (SI2- SI1)/SI1 and the cancer/background enhancement ratio (C/B) ratio, i.e., (SI6- SI5) / (SI4- SI3). The BPE was classified as minimal, mild, moderate, or marked, and the cancer detectability was classified as excellent, good, or poor independently by two radiologists. RESULTS: The average C/B ratio was 20.1, 15.7, and 9.1 at the menstrual, proliferative, and secretory phases (p < 0.001). BPE was determined as moderate or marked in 0% and 5.4% at the menstrual phase, 10.3% and 11.0% at the proliferative phase, and 17.5% and 21.7% at the secretory phase by the two observers, respectively (p = 0.01, p = 0.01). The detectability of breast cancer was classified as poor in 0% and 0%, 1.4% and 13.0%, and 8.0% and 22.1% at the menstrual, proliferative, and secretory phases by the two observers, respectively (p = 0.07, p = 0.02). CONCLUSION: The menstrual phase and the proliferative phase seem to be suitable for breast MRI of Asian women.

Correction to: The sternalis muscle: radiologic findings on MDCT.

In the original publication of the article, the seventh author name was incorrectly published as Hidehumi Aoyama. The correct author name should read as Hidefumi Aoyama.

Contrast-enhanced multidetector-row computed tomography can predict pathological findings of acute appendicitis in children.

Aims: To retrospectively evaluate the correlation between multidetector-row computed tomography findings of acute appendicitis and the pathological status of acute appendicitis, and evaluate the capability of multidetector-row computed tomography to predict the pathological status of acute appendicitis in children. Methods: The presence of a distended appendix (>6 mm in transverse diameter) was used as a primary sign to indicate the presence of appendiceal inflammation. The presence of appendiceal wall thickening (>1 mm) and enhanced appendiceal wall continuity were also used as predictive findings to reflect the degree of progression of acute appendicitis on multidetector-row computed tomography findings. The findings of each individual case were classified into four grades. The final pathological diagnosis was classified into four groups: normal findings, only mucosal inflammation, inflammation with intramural spreading, and gangrenous. The relationship between the pathological grades and computed tomography grades was analyzed using Spearman's rank correlation test. Results: Four of six cases in Grade 0 reflected normal appendiceal findings (66.7%) and 3 of 5 cases in Grade I reflected only mucosal inflammation status (60.0%). Forty-four of 51 cases in Grade II reflected intramural inflammation status (86.3%), and 40 of 57 cases in Grade III reflected gangrenous status (70.2%). The multidetector-row computed tomography grade was significantly correlated to the pathological grade with Spearman's rank correlation coefficient of 0.689 (P < 0.001). Conclusions: There was a close relationship between the multidetector-row computed tomography imaging findings and the pathological findings. This preoperative information is extremely useful for decision-making in the treatment strategy for acute appendicitis in children.

Localized air foci in the lower thorax in the patients with pneumothorax: skip pneumothoraces.

PURPOSE: To investigate the characteristics and imaging features of localized air foci in the lower thorax in patients with pneumothorax using thin-section multidetector computed tomography. MATERIALS AND METHODS: Of 10,547 consecutive CT examinations comprising the chest, the CT scans of 146 patients with ordinary pneumothoraces were identified and retrospectively evaluated. The study group included 110 male and 36 female patients (mean age, 50 years; range, 1-93 years). All examinations were performed at our institution between January 2009 and December 2009. Cause of pneumothorax was classified as traumatic or non-traumatic. Localized air foci in the lower thorax were defined as being localized air collections in the lower thorax that did not appear to be adjacent to the lung. If these criteria were met, the shape, size, location laterality, and number of foci were evaluated. Associations with trauma, sex, severity of the pneumothorax, and laterality were evaluated using the χ(2) test. All P values <0.05 were considered significant. RESULTS: Localized air foci in the lower thorax presented as slit-like or small ovoid air collections in the lowest part of the pleural space. These foci were observed in 79/146 (54.1%) patients. The traumatic pneumothoraces group showed a higher prevalence of these features than the non-traumatic group. Some foci that were situated in the anterior part mimicked the appearance of free intraperitoneal air. CONCLUSION: Patients with pneumothorax commonly had localized air foci in the lower thorax. Because such foci can mimic pneumoperitoneum, accurate recognition of them is required to avoid confusion with free intraperitoneal air, especially in traumatic cases.

The sternalis muscle: radiologic findings on MDCT.

PURPOSE: The purpose of this study was to characterize and determine the prevalence of the sternalis muscle using 64-row multidetector computed tomography (MDCT). MATERIALS AND METHODS: We retrospectively reviewed MDCT chest scans that were performed in a hospital during the course of a month. The study population consisted of 948 consecutive patients (511 males and 467 females). On the MDCT scans the sternalis muscle was defined as the longitudinal muscle lying on and superficial to the pectoralis major muscle. RESULTS: The prevalence of the sternalis muscle was 10.5 %. The muscle was present more frequently in females (13.0 %) compared to males (8.4 %) (P = 0.02). In the majority of patients, the muscle was located longitudinally in the parasternal position; however, in two patients it was positioned across the sternum. One hundred twenty were flat types, while the remaining five had oblique shapes. The muscle mean height, width and depth were 77.9 ± 25.1, 19.4 ± 12.2 and 2.8 ± 1.3 mm, respectively. The muscle was wider in males compared to females (P < 0.001). CONCLUSION: Using MDCT, its prevalence was shown to be 10.5 %. This variant muscle can be differentiated from other pathological structures using its specific characteristic appearance.

[Utility of serum human epidermal growth factor receptor-2 extracellular domain(HER2 ECD)assessment in patients with advanced or recurrent breast cancer and those who received neoadjuvant therapy].

Levels of serum human epidermal growth factor receptor-2 extracellular domain(HER2ECD )were measured in breast cancer patients. Fifty-six patients had advanced or recurrent disease, and 21 others were preoperation patients who received neoadjuvant therapy. In the tissue HER2-positive group of advanced or recurrent patients, levels of serum HER2ECD at first recurrence were high(≥15. 3 ng/mL)in 75%of patients, and significantly higher(p=0. 03)than in the tissue HER2-negative group. In neoadjuvant therapy patients, the levels of serum HER2ECD were high in 50% of the tissue HER2-positive group, and within the normal limit in all the tissue HER2-negative group(p=0. 015). The levels of serum HER2ECD were closely correlated with treatment efficacies in both recurrent and neoadjuvant patients. In this study, the levels of serum HER2 ECD appeared to be useful for diagnosis of recurrence in HER2-positive breast cancer and for estimation of therapy in recurrent and neoadjuvant patients as a secondary bio-marker.

Main bronchial diverticula in the subcarinal region: their relation to airflow limitations.

BACKGROUND: To date, bronchial diverticula have generally been treated as a pathological condition associated with chronic obstructive pulmonary disease (COPD), although only a limited amount of published information is available on the relationship between bronchial diverticula as depicted by multidetector computed tomography (MDCT) and airflow limitations. PURPOSE: To evaluate the relationship between airflow limitations and main bronchial diverticula in the subcarinal region using spirometry and thin-section MDCT. MATERIAL AND METHODS: A total of 189 consecutive adult patients were retrospectively evaluated based on spirometry and thin-section MDCT of the chest. All examinations were performed at our institution between June and October 2008. The study group included 70 women and 119 men with a mean age of 65 years (range 19-86 years). The relationship between the FEV(1)% and bronchial diverticula in the subcarinal region was analyzed (Student's t-test). RESULTS: The indications for conducting the examinations were pulmonary diseases (82 patients), cardiovascular diseases (22), extrapulmonary malignancies (74), and other conditions (11). A total of 84/189 (44.4%) patients showed bronchial diverticula, and the FEV(1)% of 70/84 (83.3%) patients was above 70. The FEV(1)% of patients with lesions ranged from 26.0 to 97.8 (mean 76.8), whereas the range was 28.1-94.4 (mean 73.7) in those without lesions. There was no significant association between the FEV(1)% and the presence of subcarinal bronchial diverticula (P > 0.05). CONCLUSION: Our data demonstrate that thin-section chest CT commonly demonstrates main bronchial diverticula in the subcarinal region in patients without airflow limitations. We propose that the presence of a small number of tiny bronchial diverticula under the carina may not be a criterion for the diagnosis of COPD.

The effectiveness of postmortem multidetector computed tomography in the detection of fatal findings related to cause of non-traumatic death in the emergency department.

OBJECTIVES: To investigate the diagnostic performance of postmortem multidetector computed tomography (PMMDCT) for the detection of fatal findings related to causes of non-traumatic death in the emergency department (ED). METHODS: 494 consecutive cases of clinically diagnosed non-traumatic death in ED involving PMMDCT were enrolled. The fatal findings were detected on PMMDCT and classified as definite or possible findings. These findings were confirmed by autopsy in 20 cases. RESULTS: The fatal findings were detected in 188 subjects (38.1%) including 122 with definite (24.7%) and 66 with possible finding (13.4%). Definite findings included 21 cases of intracranial vascular lesions, 84 with intra-thoracic haemorrhage, 13 with retroperitoneal haemorrhage and one with oesophagogastric haemorrhage. In three patients who had initially been diagnosed with non-traumatic death, PMMDCT revealed fatal traumatic findings. Two definite findings (two haemopericardiums) and seven possible findings (two intestinal obstructions, one each of multiple liver tumours central pulmonary artery dilatation, pulmonary congestion, peritoneal haematoma, and brain oedema) were confirmed by autopsy. The causes of death were not determined in cases with possible findings without autopsy. CONCLUSIONS: PMMDCT is a feasible tool for detecting morphological fatal findings in non-traumatic death in ED. It is important to know the ability and limitation of PMMDCT.

Effectiveness of a worksheet for diagnosing postmortem computed tomography in emergency departments.

PURPOSE: The aim of this study was to evaluate the effectiveness of a worksheet for diagnosing postmortem computed tomography (PMCT) in emergency departments (EDs). MATERIALS AND METHODS: A total of 49 cases of clinically diagnosed nontraumatic deaths in the ED who underwent total body PMCT were enrolled. PMCT images were prospectively evaluated by four radiologists: two radiologists with 1.5 and 3.5 years of residency and two board-certified radiologists with >20 years of experience. Readers were independently instructed to detect and interpret findings with reference to fatal findings, postmortem features, changes caused by cardiopulmonary resuscitation, and other pathological findings according to a worksheet that was composed of the possible findings previously reported. Agreement on detection and interpretation of findings between each reader was measured using Cohen's kappa coefficients. RESULTS: For the detection of findings, there was substantial agreement among the four readers (kappa > 0.60, P < 0.0001). There was substantial (kappa > 0.60, P < 0.0001) and near-substantial (kappa = 0.60, P < 0.0001) agreement in the interpretation of the finding. CONCLUSION: Results of our study suggest equivalency on diagnosing PMCT regardless of the reader's level of experience. We conclude that the worksheet is useful for diagnosing PMCT in emergency departments.

Quantitative analysis of intracranial hypostasis: comparison of early postmortem and antemortem CT findings.

OBJECTIVE: The purpose of this study was to quantitatively analyze postmortem hypostasis in the intracranial venous sinus on head CT scans compared with the antemortem CT findings in the same patients with the aim of evaluating sedimentation in the heart and great vessels. MATERIALS AND METHODS: A total of 50 patients on whom head CT was performed before and after death were enrolled. Attenuation in the dorsal part of the superior sagittal sinus was measured at the level of the basal ganglia on both antemortem and postmortem CT scans. Increased attenuation in the transverse sinus and cerebellar tentorium and sedimentation in the heart and great vessels were evaluated visually. RESULTS: Attenuation in the dorsal part of the superior sagittal sinus increased significantly (p < 0.0001) between antemortem (42.77 ± 6.23 HU) and postmortem (49.72 ± 10.58 HU) CT in 80% of cases. Increased attenuation of the transverse sinus or cerebellar tentorium was observed in 48% of cases and sedimentation in the heart or great vessels in 62% of cases. Increased attenuation in the superior sagittal sinus was clearly evident in patients with sedimentation in the heart or great vessels (antemortem, 43.81 ± 6.17 HU; postmortem, 54.65 ± 8.51 HU) compared with the patients without evidence of sedimentation (antemortem, 41.06 ± 6.10 HU; postmortem, 41.66 ± 8.57 HU) (p < 0.0001). CONCLUSION: Intracranial hypostasis is a common postmortem CT finding. Radiologists and physicians who interpret postmortem neurologic images should be aware of intracranial hypostasis and differentiate this phenomenon from intracranial hemorrhage.

Quantitative analysis of brain edema and swelling on early postmortem computed tomography: comparison with antemortem computed tomography.

PURPOSE: The aim of this study was quantitatively to analyze brain edema and swelling due to early postmortem changes using computed tomography (CT) scans of the head. MATERIALS AND METHODS: Review board approval was obtained, and informed consent was waived. A total of 41 patients who underwent head CT before and shortly after death were enrolled. Hounsfield units (HUs) of gray matter (GM) and white matter (WM) were measured at the levels of the basal ganglia, centrum semiovale, and high convexity area on both antemortem and postmortem CT. The length of the minor axis of the third ventricle at the level of the basal ganglia and the width of the central sulcus at the level of high convexity were measured. RESULTS: At each level tested, the HUs of GM and the GM/WM ratios on postmortem CT were significantly lower than those on antemortem CT (P < 0.001). HUs of WM on postmortem CT were slightly higher than those on antemortem CT but without significant difference (P > 0.1). Postmortem CT showed subtle loss of distinction between GM and WM. The size of the third ventricle and the width of the central sulcus did not vary before and after death (P > 0.1). CONCLUSION: Early postmortem CT shows mild brain edema but does not show brain swelling.

Characteristics and CT features of subcarinal air collections/main bronchial diverticula.

The aim of this study was to evaluate the characteristics and CT features of subcarinal air collections on thin-section multidetector-row computed tomography (MDCT). Two hundred asymptomatic adult subjects without a history of pulmonary disease underwent MDCT. The CT appearances and characteristics of foci of extraluminal air contiguous to the main bronchus in the subcarinal region were retrospectively analysed. Subcarinal air collections were found in 81 of 200 subjects (41%) and were spotty or microtubular in 67 of 81 subjects and rounded or oval in the other 14. Each subcarinal air focus communicated, or seemed to communicate, with the adjacent bronchus in 76 of 81 cases. Our data demonstrate that extraluminal air foci in the subcarinal region are common CT findings and routinely depicted on thin-section MDCT, and that most of these lesions seem to be main bronchial diverticula. Cystic air foci in the subcarinal region should be called subcarinal air cysts. The precise recognition of these cysts improves the ability to avoid misidentification, such as pneumomediastinum.

Multiple lung tumors as the cause of death in a patient with subarachnoid hemorrhage: postmortem computed tomography study.

A 77-year-old woman who had been in the hospital suffering from a subarachnoid hemorrhage suddenly died after undergoing a cerebral aneurysmal operation. Postmortem whole-body computed tomography (CT) demonstrated multiple lung tumors with abnormal masses in the bronchus with no evidence of complications in the cranium. The patient was estimated to have died from asphyxia caused by metastatic lung and endobronchial tumors. Although a traditional autopsy was not performed, postmortem CT provided strong evidence for detecting the cause of death. In this case, postmortem CT played an important role in hospital risk management.

Intrahepatic gas at postmortem multislice computed tomography in cases of nontraumatic death.

PURPOSE: The purpose of this study was to investigate the cause and significance of intrahepatic gas (IHG). MATERIALS AND METHODS: There were 208 nontraumatically deceased individuals retrospectively investigated concerning the occurrence and location of IHG by postmortem multislice computed tomography (MSCT) imaging. The location of IHG was graded on a scale from 0 to 3: 0, no gas; 1, gas only in the left lobe; 2, gas in the left lobe and anterior segment of the right lobe; 3, gas in the left lobe and the anterior and posterior segments of the right lobe). We also assessed and noted the occurrence of intestinal distention, airway management, the interval between cardiopulmonary arrest (CPA) and subsequent examination, and the postmortem interval. RESULTS: IHG was found in 66 cases (31.7%): grade 1, 15 (7.2%); grade 2, 21 (10.1%); grade 3, 30 (14.4%). The presence of IHG was strongly related to intestinal distention and the period between the time of CPA and the examination. CONCLUSION: IHG is a frequent finding on postmortem CT in cases of nontraumatic death. The presence of IHG is related to intestinal distention and the interval between the time of CPA and examination.