Gallbladder hernia into the foramen of Winslow: CT findings.

We present a case of gallbladder hernia into the foramen of Winslow. During the diagnosis of hernia, ultrasonography, computed tomography and intravenous computed tomography, cholangiography of the abdomen were performed. Ultrasonography detected gallstone, but did not provide sufficient information to diagnose gallbladder hernia. Computed tomography yielded the correct diagnosis. At laparoscopic cholecystectomy, the diagnosis was confirmed.

REG Ialpha is a reliable marker of chemoradiosensitivity in squamous cell esophageal cancer patients.

BACKGROUND: A reliable marker of chemoradiosensitivity that would enable appropriate and individualized treatment of thoracic squamous cell esophageal cancer has long been sought. We investigated whether regenerating gene (REG) Ialpha is such a marker. METHODS: We assessed expression of REG Ialpha in untreated endoscopic biopsy specimens and examined the correlation between REG Ialpha expression and the clinical responses to definitive chemoradiotherapy and prognosis. We also examined the relationship between REG Ialpha expression in the resected tumor and the prognosis of patients who received esophagectomy for thoracic squamous cell esophageal cancer. RESULTS: Among the 42 patients treated with definitive chemoradiotherapy, 8 of the 23 REG I-positive patients (35%) showed complete responses to chemoradiotherapy, while only one of the 19 REG I-negative patients did so. The survival rate among the REG I-positive patients was significantly better than among the REG I-negative patients. For the 76 patients treated surgically, there was no significant difference in the survival rates among the REG I-positive and REG I-negative patients. CONCLUSIONS: REG Ialpha expression in squamous cell esophageal carcinoma may be a reliable marker of chemoradiosensitivity. We anticipate that it will enable us to provide more appropriate and individualized treatment to patients of advanced esophageal squamous cell carcinoma.

Thallium-201 SPECT in the evaluation of early effects on brain tumors treated with stereotactic irradiation.

PURPOSE: To determine whether thallium-201 SPECT can predict response to stereotactic irradiation (STI) earlier than magnetic resonance imaging (MRI), the change in tumor size measured by MRI was compared with the change in tumor activity measured by Tl-201 SPECT before and after STI. MATERIALS AND METHODS: Twenty-one tumors in 16 patients with intracranial tumors were treated by STI. Tl-201 SPECT was performed within 1 week before the beginning of STI and within 1 week after the end of STI in all patients. All patients underwent MRI within 1 week before the beginning of STI, and 14 patients (19 tumors) underwent MRI within 1 week after the end of STI. Follow-up MRI was performed 1 to 2 months after the end of STI in 14 patients (16 tumors). The activity of Tl-201 in the tumor divided by that of the uninvolved symmetric area was defined as the Tl-index. The change in tumor size immediately and 1 to 2 months after STI was compared with the change in Tl-index immediately after STI. RESULTS: No significant relationship between the ratio of tumor size immediately after STI and the ratio of Tl-index immediately after STI was found. A significant correlation (r = 0.69, P <0.05) between the ratio of tumor size 1 to 2 months after STI and the ratio of Tl-index immediately after STI was found. CONCLUSIONS: This study suggests that Tl-201 SPECT immediately after STI can predict treatment response 1 to 2 months after STI, and that Tl-201 SPECT can be an early indicator of treatment response.

Multi-shot echo-planar Flair imaging of brain tumors: comparison of spin-echo T1-weighted, fast spin-echo T2-weighted, and fast spin-echo Flair imaging.

Multi-shot echo-planar fluid-attenuated inversion-recovery (EPI-Flair) was compared with spin-echo T1-weighted (SE-T1W), fast SE T2-weighted (FSE-T2W), and fast Flair (F-Flair) in imaging brain tumors. In 32 patients with various different brain tumors, three reviewers independently evaluated image quality. Two reviewers evaluated the image quality of precontrast EPI-Flair to be significantly better than that of precontrast SE-T1W. Two reviewers evaluated the image quality of postcontrast EPI-Flair as superior to that of postcontrast SE-T1W. Artifacts on postcontrast EPI-Flair were significantly more prominent than those on postcontrast F-Flair. Multi-shot EPI-Flair appeared to be superior to SE-T1W, and almost equivalent to FSE-T2W in terms of image quality.

Computed tomography findings of spontaneous perforation of pyometra.

We report herein a case of spontaneous perforation of pyometra leading to diffuse peritonitis. This pathological condition is rare, and preoperative diagnosis is difficult. We were able to make the correct diagnosis preoperatively using contrast-enhanced abdominopelvic computed tomography. Both intrauterine and extrauterine fluid collections and defects of the uterine fundus were key findings, and reconstructed sagittal and coronal images were useful. In elderly female patients presenting with acute abdomen, ruptured pyometra should be considered as a possibility.

Tumor-liver contrast and subjective tumor conspicuity of respiratory-triggered T2-weighted fast spin-echo sequence compared with T2*-weighted gradient recalled-echo sequence for ferucarbotran-enhanced magnetic resonance imaging of hepatic malignant tumors.

PURPOSE: To compare respiratory-triggered T2-weighted fast spin-echo (RTT2W-FSE) and gradient T2*-weighted recalled-echo (T2*W-GRE) images for visualization of malignant hepatic tumors using ferucarbotran-enhanced magnetic resonance (MR) imaging. MATERIALS AND METHODS: Ferucarbotran-enhanced RTT2W-FSE and breath-hold long-TE 2D-fast spoiled gradient recalled acquisition in the steady state (FSPGR) images as T2*W-GRE were used to evaluate 128 malignant hepatic tumors (77 metastases, 37 hepatocellular carcinomas, 14 other) in 62 patients. Tumor-to-liver contrast (TLC) was quantitatively compared using the paired Student's t-test, and the score of lesion conspicuity was qualitatively compared using Wilcoxon's signed rank test. RESULTS: The mean TLC of RTT2W-FSE was significantly higher than that of FSPGR (1.10 +/- 0.82 vs. 2.54 +/- 1.42) in all malignant tumors. The score of lesion conspicuity of RTT2W-FSE was significantly higher than that of FSPGR (4.84 +/- 0.52 vs. 4.52 +/- 0.99) in all malignant tumors. CONCLUSION: For ferucarbotran-enhanced MR imaging, compared to FSPGR images, RTT2W-FSE images provide greater TLC and subjective conspicuity for malignant tumors.

Diffusion changes in a tumor and peritumoral tissue after stereotactic irradiation for brain tumors: possible prediction of treatment response.

OBJECTIVE: Changes in apparent diffusion coefficient (ADC) in a tumor and peritumoral tissue after stereotactic irradiation (STI) were evaluated, and then the therapeutic efficacy of ADC measurement was assessed. METHODS: In 20 tumors, diffusion-weighted imaging within 1 week before and 2-4 weeks after STI was performed. The normalized ADC (nADC) was measured. The nADCs in the tumor and peritumoral region before STI were compared with those after STI and the change in tumor nADC compared with the change in tumor size. RESULTS: The nADC of the tumors was significantly higher 2-4 weeks after STI compared with that before STI. The nADC of the peritumoral regions 2-4 weeks after STI did not differ significantly from that before STI. A significant difference in the nADC at 2-4 weeks after STI was observed between the responder and nonresponder groups. CONCLUSIONS: Changes in nADC as measured by diffusion-weighted imaging can predict response to STI.