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Introduction: We have often encountered high signal intensity (SI) of the cingulate gyrus and insula during diffusion-weighted magnetic resonance imaging (DW-MRI) on neurologically healthy adults. To date, cortical signal heterogeneity on DW images has not been investigated systematically. The purpose of our study was to determine whether there is regional signal variation in the brain cortices of neurologically healthy adults on DW-MR images., Methods: The SI of the cerebral cortices on DW-MR images at 1.5 T was evaluated in 50 neurologically healthy subjects (34 men, 16 women; age range 33-84 years; mean age 57.6 years). The cortical SI in the cingulate gyrus, insula, and temporal, occipital, and parietal lobes was graded relative to the SI of the frontal lobe. Contrast-to-noise ratios (CNRs) on DW-MR images were compared for each cortical area. Diffusion changes were analyzed by visually assessment of the differences in appearance among the cortices on apparent diffusion coefficient (ADC) maps., Results: Increased SI was frequently seen in the cingulate gyrus and insula regardless of patient age. There were no significant gender- or laterality-related differences. The CNR was significantly higher in the cingulate gyrus and insula than in the other cortices (p< .01) , and significant differences existed among the cortical regions (p< .001). There were no apparent ADC differences among the cortices on ADC maps., Conclusion: Regional signal variation of the brain cortices was observed on DW-MR images of healthy subjects, and the cingulate gyrus and insula frequently manifested high SI. These findings may help in the recognition of cortical signal abnormalities as visualized on DW-MR images.

Purpose: The aim of this study was to investigate how accurately we could diagnose the level of gastrointestinal (GI) tract perforation using multidetector computed tomography (MDCT)., Materials and Methods: We reviewed 155 patients with surgically confirmed GI tract perforation. MDCT scans were obtained with eight-detector CT; 5 mm thick axial images and 2.5 mm thick coronal multiplanar reconstruction (MPR) images were generated for all patients. Contrast enhancement was performed in 44 of the 155 patients. Two board-certified radiologists reviewed the images for direct findings (free air, ruptured GI tract wall) and indirect findings (inflammatory changes, fluid collection, focal thickening of the GI tract wall) and attempted to identify the perforation site in each patient., Results: Free air was seen in more than 95% of the patients with perforation at sites other than the appendix; free air was seen in 44% of patients with appendicitis. On contrast-enhanced CT performed in 44 patients, rupture of the wall of the GI tract was directly visualized in 14 (32%) on axial images only and in 23 (52%) on axial or MPR images, respectively. The perforation site was correctly diagnosed in 90% of the patients when the radiologists referred to both direct and indirect findings., Conclusion: MDCT was valuable for identifying the presence and level of GI tract perforation.

On T2-weighted MR images, the pontine tegmentum frequently shows a signal of high intensity in neurologically healthy individuals. We examined whether the signal intensity of the pontine tegmentum normally differs from that of the pontine base. We evaluated the signal intensity of the pontine tegmentum and pontine base on T2-weighted images from 38 neurologically healthy subjects. The subjects included 29 adults (16 males and 13 females, age range 23-48 years, mean age 39.5 years) and 9 children (4 boys and 5 girls (age range 4-9 years mean age 6.5 years). We compared the contrast-to-noise ratio (CNR) between the tegmentum and the base in the upper pons, midpons and lower pons, and evaluated the signal intensity ratio of the tegmentum to the base. The CNR was significantly higher for the tegmentum than the base at each level of the pons (P<0.0001), and the signal intensity ratio of the tegmentum to the base in the upper pons was significantly higher in children than in adults (P<0.005). On T2-weighted images, a high signal intensity of the pontine tegmentum is frequently seen in neurologically healthy subjects. This finding should not be considered abnormal, particularly in children.

Background and Purpose: Differentiation between tumor recurrence and treatment-related brain injury is often difficult with conventional MRI. We hypothesized that the diffusion-weighted imaging (DWI) could help differentiate these 2 conditions, because water diffusion may be greater for necrotic tissues in the treatment-related brain injury than for tumor tissues in recurrence. Our aim was to analyze whether DWI findings of recurrent tumor are distinct from those of radiation necrosis., Methods: Seventeen patients were examined prospectively. Two readers assessed the images by consensus for homogeneity and signal intensity of the lesions. Five regions of interest were drawn within the lesions on trace DWI images and apparent diffusion coefficient (ADC) maps. The minimal, maximal, and mean values of each lesion were compared between the 2 groups. Findings in 12 of 17 patients were verified histologically by surgery or biopsy; the diagnoses in the remaining 5 patients were made on the basis of follow-up MRI findings and clinical follow-up., Results: There were a total of 20 lesions; 12 lesions were due to radiation necrosis and 8 lesions to tumor recurrence. In the radiation necrosis group, 8 lesions had marked hypointensity. In the recurrence group, however, no marked hypointensity was seen. The maximal ADC values within each lesion were significantly smaller for the recurrence group than for the necrosis group (P = .039)., Conclusion: Radiation necrosis usually showed heterogeneity on DWI images and often included spotty, marked hypointensity. Significant difference was found in the maximal ADC values between radiation necrosis and tumor recurrence. DWI was useful in differentiating recurrent neoplasm from radiation necrosis.

Background: Bone metastases from breast carcinoma are frequently observed as postoperative pathologic conditions; however, in many cases, diagnosis and treatment are difficult. Although most diagnoses of bone metastases are made by plain radiography (X-P) or bone scintigraphy, the use of magnetic resonance imaging (MRI) has enabled detailed imaging of foci, and many more lesions have become detectable. In the current study, the authors evaluated the relation between the diagnosis of bone metastases of breast carcinoma and clinicopathologic factors, especially those of proliferative activity and effects of treatment., Methods: The subjects consisted of 51 breast carcinoma patients (mean age, 51.2 years) with vertebral metastases diagnosed by plain radiography, bone scintigraphy, or MRI. Twenty-eight of the 51 patients were premenopausal and 27 of the 51 had bone metastases only. The patients were classified into the following groups: Group A, 24 patients who showed similar findings in plain radiography, bone scintigraphy, and MRI; Group C, 14 who showed no abnormalities on radiography or bone scintigraphy but whose lesions were diagnosed by MRI only; and Group B, 13 patients with findings intermediate between Groups A and C. The proliferative activity of tumors was evaluated by determining the level of DNA polymerase alpha., Results: Regarding the relation to clinicopathologic factors, a significant number of patients with estrogen receptor (ER) negative tumors who had a high level of DNA polymerase alpha, short disease free intervals (DFI), and metastases to other organs were included in Group C. Prognoses of patients in Group C were poor., Conclusions: For the diagnosis of breast carcinoma with bone metastasis, different correlations were noted among the various biologic characteristics, such as ER status and proliferative activity. That is, bone scintigraphy sufficiently reflected foci in patients with ER positive tumors or tumors with low proliferation, whereas bone scintigraphy was false-negative in patients with ER negative or highly proliferative tumors, showing that MRI was useful in diagnosing such patients. Therefore, consideration of malignant features, such as proliferative activity and ER status, is believed necessary during the postoperative follow-up of breast carcinoma patients.

A 78-year-old man was admitted to hospital with heart failure and chronic bronchitis. A computed tomographic scan of the chest incidentally demonstrated bilateral abnormal vessels near the left atrium. Selective angiography showed that both internal mammary arteries and bronchial arteries communicated with the pulmonary arteries bilaterally. The patient refused surgery and was discharged on medical therapy. This is the first reported case of bilateral fistulas between the internal mammary arteries and bronchial arteries and the pulmonary arteries.

MR imaging of a patient with cortical blindness revealed areas of abnormal signal bilaterally in the lateral putamen and the striate cortices. The coronal T2-weighted image clearly demonstrated the selective involvement of the bilateral striate cortices. The differential diagnosis and the vulnerability of the striate cortex are discussed.

Purpose: To evaluate magnetic resonance (MR) signal intensities of orbital pseudotumors on short inversion time inversion-recovery (STIR) images and to predict the effect of treatment., Materials and Methods: Sequential MR examinations were performed in 17 patients with orbital pseudotumors, before and after treatment. All patients underwent MR imaging with T1- and T2-weighted spin-echo or fast spin-echo sequences, and STIR sequences with two 0.5-T systems. Quantitatively and qualitatively, the differences in signal intensities among three therapeutic response groups (good, mild, and no responses) were analyzed for each pulse sequence., Results: Quantitatively, both contrast and contrast-to-noise ratio on STIR images corresponded well to the results of response to therapy for all background markers; contrast and contrast-to-noise ratio values in the good response group were the largest, while those in the no response group were the smallest (P < .0001). Qualitatively, the signal intensities of the lesions in the good response group were interpreted as hyperintense to the cerebral cortex in 14 (93%) or 11 (73%) of 15 lesions by two observers, respectively, while in the no response group, both observers assessed 16 (89%) of 18 lesions as hypo- or isointense to the muscle (P < .0001)., Conclusion: STIR images showed a variety of signal intensities in the lesions, and the signal intensities on the STIR images helped predict the response to the therapy in orbital pseudotumors.