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Background: The critical role of radiographic assessment at the time of castration-resistant prostate cancer (CRPC) diagnosis is underscored by this study. We performed a retrospective analysis of radiographic changes in metastasis from the time of diagnosis of metastatic hormone-sensitive prostate cancer (mHSPC) to CRPC diagnosis. We also explored its impact on prognosis post-CRPC., Materials and Methods: We retrospectively analyzed 98 men who underwent radiographic examinations (bone scans and computed tomography [CT]) at the time of CRPC diagnosis. When radiographic studies demonstrated progression at CRPC diagnosis, patients were assigned to the radiographic progressive disease (rPD) group. The remaining patients were placed in the "non-rPD" group. The overall survival (OS) post-CRPC was compared between the 2 groups., Results: The median OS post-CRPC was significantly shorter in the rPD group (n = 50) compared to the non-rPD group (n = 48) (32 months vs. not reached, P = .0124). Multivariate analysis showed that radiographic progression and shorter time to CRPC were associated with a shorter OS post-CRPC (hazard ratio [HR] = 3.14; 95% confidence interval [CI], 1.21-8.12, P = .019)., Conclusion: Radiographic progression at the point of CRPC diagnosis independently predicts a shorter OS post-CRPC in patients with mHSPC. Therefore, assessing radiographic changes at the time of CRPC diagnosis could be instrumental in managing CRPC in patients with mHSPC., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Abstract: Although differentiating benign and malignant thymic epithelial lesions is important to avoid unnecessary treatment and predict prognosis, it is challenging because of overlaps in the chest computed tomography (CT) findings. In this study, we investigated whether the diameter of the thymic vein and other CT findings could differentiate between benign (thymoma and thymic cysts) and malignant (thymic carcinoma, [TCa]) lesions.We conducted a retrospective study across two tertiary referral hospitals in Japan between November 2009 and June 2018. We included 12 patients with TCa, 34 patients with thymomas, and 17 patients with thymic cysts. We analyzed the receiver operating characteristic (ROC) curve to determine the best cut-off values and performed univariate and multivariate analyses of CT findings to distinguish TCa from other benign lesions. Post-hoc analysis was performed for the maximum short axis of the thymic vein using the Mann-Whitney U test, and the number of the maximum short axis of the thymic vein ≥ the cutoff was determined using the Fisher exact test with a family-wise error-correction using Bonferroni's method.ROC analysis showed that a maximum short axis of the thymic vein ≥2 mm was considerably more frequent in TCa than in the other lesions (P < .001 for both), with 83% sensitivity and 86% specificity. Univariate and multivariate analyses revealed the association with TCa of the number of the maximum short axis of the thymic vein ≥2 mm (P = .005, multivariate generalized linear model analysis), ill-defined margin (P = .001), and mediastinal lymphadenopathy (P < .001). Thymic vein diameter was in descendimg order of TCa > thymoma > thymic cysts with statistically significant differences between the groups (Ps < .05).Thymic vein diameter was significantly longer in TCa than in thymoma and thymic cysts. Measurement of the maximum short axis of the thymic vein could be a powerful diagnostic tool to differentiate TCa from thymoma and thymic cysts., Competing Interests: The authors have no funding and conflicts of interests to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Accurate gluteus medius (GMd) volume evaluation may aid in the analysis of muscular atrophy states and help gain an improved understanding of patient recovery via rehabilitation. However, the segmentation of muscle regions in GMd images for cubic muscle volume assessment is time-consuming and labor-intensive. This study automated GMd-region segmentation from the computed tomography (CT) images of patients diagnosed with hip osteoarthritis using deep learning and evaluated the segmentation accuracy. To this end, 5250 augmented pairs of training data were obtained from five participants, and a conditional generative adversarial network was used to identify the relationships between the image pairs. Using the preserved test datasets, the results of automatic segmentation with the trained deep learning model were compared to those of manual segmentation in terms of the dice similarity coefficient (DSC), volume similarity (VS), and shape similarity (MS). As observed, the average DSC values for automatic and manual segmentations were 0.748 and 0.812, respectively, with a significant difference (p < 0.0001); the average VS values were 0.247 and 0.203, respectively, with no significant difference (p = 0.069); and the average MS values were 1.394 and 1.156, respectively, with no significant difference (p = 0.308). The GMd volumes obtained by automatic and manual segmentation were 246.2 cm3 and 282.9 cm3, respectively. The noninferiority of the DSC obtained by automatic segmentation was verified against that obtained by manual segmentation. Accordingly, the proposed GAN-based automatic GMd-segmentation technique is confirmed to be noninferior to manual segmentation. Therefore, the findings of this research confirm that the proposed method not only reduces time and effort but also facilitates accurate assessment of the cubic muscle volume., Competing Interests: The authors have declared that no competing interests exist.

Background: Legionella spp. can cause severe pneumonia and most Legionella pneumonia (LP) cases are diagnosed using the urine antigen test (UAT). However, diagnosis of LP with negative UAT results (LPNUAT) is challenging. We investigated the clinical and radiological features of LPNUAT., Methods: We retrospectively collected LP cases with positive UAT (LPPUAT) and cases of suspected LP with negative UAT that were examined by Legionella culture between July 2014 and March 2020. We investigated the clinical and CT findings for LP that showed negative UAT results and was diagnosed by culture and compared these findings with those for other pneumonias suspicious for LP with negative results in UAT and Legionella culture (OPSLP)., Results: Eight LPNUAT, 20 LPPUAT, and 19 OPSLP cases were included in this study. There were no significant differences in the clinical and CT findings between LPPUAT and LPNUAT when examined by UAT. In LPNUAT, dyspnea, renal dysfunction, liver dysfunction, and bilateral lesions were more commonly observed and inflammatory changes and the number of affected lobes were significantly higher when examined by culture than when examined by UAT. Comparison to OPSLP, LPNUAT did not show such differences, but rather showed disturbances in consciousness, hyponatremia and rhabdomyolysis. Furthermore, lobar consolidation was observed more frequently and bronchial wall thickening and centrilobular nodules were observed less frequently in LPNUAT., Conclusions: LP characteristics such as disturbance of consciousness, hyponatremia, rhabdomyolysis, lobar consolidation, and less bronchial wall thickening and centrilobular nodule contribute to the diagnosis of LP in patients with negative UAT results., Competing Interests: Conflict of Interest The authors declared no conflict of interest., (Copyright © 2020 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Background: No study has investigated the capability of high-resolution computed tomography (HRCT) to detect a lateral bronchus abnormality, degree of air bronchogram, and distribution of affected lesions in the diagnosis of Mycoplasma pneumoniae pneumonia (MPP)., Methods: We prospectively enrolled patients with serologically-confirmed MPP or culture-confirmed other bacterial pneumonia (OBP). The distribution of affected areas, abnormalities in lateral bronchial lesions, the degree of air bronchogram, and previously reported findings on HRCT were evaluated for MPP and OBP. Predictive HRCT findings for MPP were determined by logistic regression analysis. We provisionally designed our HRCT criteria (negative, probable, or highly suspected) for diagnosing MPP and investigated the diagnostic yield of the HRCT criteria., Results: Sixty-three MPP and 126 OBP patients were included in this study. Logistic regression analysis showed that the absence of peripheral predominance, bronchial wall thickening, lateral bronchial wall thickening, intralobular or lobular ground-glass opacities, intralobular ground-glass opacities connected to a lateral bronchus, and less air bronchogram in infiltrates were significant predictors of MPP. Our HRCT criteria showed that the sensitivity and specificity in negative, probable, and highly suspected MPP were 0.0 and 0.33, 1.0 and 0.69, and 0.5 and 0.98, respectively., Conclusions: HRCT had considerable ability to detect a lateral bronchial abnormality and to diagnose or rule out MPP based on the distribution of affected areas, abnormalities in lateral bronchial lesions, and the degree of air bronchogram in the infiltrates., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2020 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

We reviewed six cases suspected of having fish bones in the bile ducts on follow-up CT following pancreaticoduodenectomy. The period from surgery to CT examination in which fishbone migration was first suspected ranged from 282 to 1157 days with a median of 517 days. The fish bone in the bile duct disappeared in five out of six cases on subsequent CT. One case was complicated by hepatolithiasis, and the other five cases showed no biliary complications. In two cases, wandering of fish bones in the jejunal limb was observed on CT images before their migration into the bile ducts. Asymptomatic migration of fish bones to the bile ducts following pancreaticoduodenectomy is not rare, but serious complications can occasionally occur. Indications of intervention may be controversial in asymptomatic cases, but once fish bones are observed in the biliary tree or the jejunal limb, dietary instructions advising not to swallow fish bones may be a good option to prevent complications.

Enophthalmos is caused by an increase of orbital volume after blowout fracture and is one of the most critical complications of such fractures, but is often masked by swelling soon after injury. If surgery is performed after swelling resolves, it becomes more difficult to treat enophthalmos because of atrophy and fibrosis. Accordingly, it is important to estimate the severity of enophthalmos soon after injury. We developed a new criterion for determining whether orbital fractures are indicated for surgery in Asian patients using analysis of orbital volume. We retrospectively calculated the orbital volume of patients treated surgically or conservatively and analyzed the correlation between changes of orbital volume and the severity of enophthalmos. Regression analysis of the correlation between enophthalmos and increased orbital volume (y = 0.8x + 0.2; correlation coefficient: 0.92) showed that enophthalmos of 2.0 mm corresponded to an increase in orbital volume of 2.25 cm 3 . This result is similar to data reported previously for Caucasian patients - enophthalmos of 2.0 mm is a common surgical indication worldwide. Our results suggest that an increase of orbital volume of >2.25 cm 3 could be a new criterion for surgical treatment of blowout fractures in Asians., (Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Dermatofibrosarcoma protuberans (DFSP) is a cutaneous tumor of intermediate-grade malignant potential, and it rarely shows dedifferentiation to high-grade fibrosarcoma, which is called "fibrosarcomatous DFSP." We present the enhanced MRI and PET/MRI findings and our comparison with pathological findings in a case of fibrosarcomatous DFSP with various histological features.

Objective: We describe herein two tumor-induced osteomalacia (TIO) cases for whom the causative lesions, located in their popliteal fossa, that were not identified in the standard field of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT), which usually images only the head, trunk, and proximal parts of the extremities., Clinical Presentation and Intervention: A 47 years old Japanese man with multiple pathological fractures due to osteomalacia, accompanied by muscle weakness, hypophosphatemia, and an elevation of alkaline phosphatase (ALP) was referred to our hospital. A (18)F-FDG PET/CT scan was performed, but no (18)F-FDG uptake was detected in the standard field of imaging. Magnetic resonance imaging revealed a small subcutaneous tumor (1.9×1.2×0.6cm) of the left posteriomedial knee, displaying uniform enhancement on gadolinium-enhanced T1-weighted fat-suppression imaging. The tumor was resected widely and diagnosed as phosphaturic mesenchymal tumor, mixed connective tissue variant (PMTMCT). The other patient was a 31 years old Japanese woman with multiple pathological fractures, hypophosphatemia and elevated of ALP and was referred to our hospital on suspicion of TIO. Although the causative lesion was not identified in the standard field of (18)F-FDG PET/CT, (18)F-FDG uptake (SUVmax 2.9) was detected on the right knee in the additional whole-body (18)F-FDG PET/CT. Magnetic resonance imaging revealed a soft-tissue tumor (6.4×4.1×2.9cm) in the right posterior knee. Following biopsy, the tumor was marginally resected, and was pathologically diagnosed as PMTMCT., Conclusion: Once patients are suspected to have TIO, a whole-body nuclear imaging study such as (18)F-FDG PET/CT should be performed, in order not to miss the hidden causative tumor, especially occurring in the distal extremities.

Purpose: To evaluate the usefulness of metabolic parameters obtained by (18)F-FDG PET/CT for preoperative stratification of high-risk and low-risk endometrial carcinomas., Methods: Preoperative (18)F-FDG PET/CT was performed in 56 women with endometrial cancer. Maximum standardized uptake values (SUVmax), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of primary tumours were compared with clinicopathological features of surgical specimens. Diagnostic performance in terms of differentiation of low-risk disease (endometrioid histology, histological grade 1 or 2, invasion of less than half of the myometrium, and FIGO stage I) from high-risk disease was assessed., Results: MTV and TLG were significantly higher in patients with higher histological grade (p = 0.0026 and p = 0.034), larger tumour size (p = 0.002 and p = 0.0017), lymphovascular space involvement (LVSI; p = 0.012 and p = 0.0051), myometrial invasion (p = 0.027 and p = 0.031), cervical stromal invasion (p = 0.023 and p = 0.014), ovarian metastasis (p = 0.00022 and p = 0.00034), lymph node metastasis (p < 0.0001 and p < 0.0001), and higher FIGO stage (p = 0.0011 and p = 0.00048). SUVmax was significantly higher in patients with larger tumour size (p = 0.0025), LVSI (p = 0.00023) and myometrial invasion (p < 0.0001). The areas under the ROC curves (AUCs) for distinguishing high-risk from low-risk carcinoma were 0.625, 0.829 and 0.797 for SUVmax, MTV and TLG, respectively. AUCs for both MTV and TLG were significantly larger than that for SUVmax (p = 0.0049 and p = 0.021). The optimal TLG cut-off value of 70.2, determined by ROC analysis, was found to have 72.0% sensitivity and 74.2% specificity for risk stratification., Conclusion: MTV and TLG of primary endometrial cancer show better correlations with clinicopathological features and are more useful for differentiating high-risk from low-risk carcinoma than SUVmax.

Objective: To assess the efficacy of ultrasonography (US) for the detection of ureteral stone using non-contrast-enhanced computed tomography (NCCT) as a standard reference., Materials and Methods: From January 2009 to September 2011, 428 patients underwent both NCCT and US on the same day. The sensitivity and specificity of US to detect ureteral stone was evaluated. The detection rates using US imaging were examined according to location and stone size. The sizes of stones determined in the longest axis of NCCT and US were compared. We also performed group classification based on size to examine whether stone sizes measured by NCCT and US were similar. Moreover, the factors that may affect the detection of ureteral stone by US were analyzed., Results: Out of 856 ureters, NCCT could detect 171 stones in 169 patients, whereas US could detect 98 stones, yielding a sensitivity of 57.3% and a specificity of 97.5%. Expectedly, detection rate of US increased with stone size but was lower for distal ureter. With hydronephrosis, the sensitivity of US improved from 57.3% to 81.3%. Stone sizes measured by US correlated positively with those by computed tomography, and were concordant with those of NCCT in 68 of 98 patients (69.4%). Interestingly, stone size and the presence of hydronephrosis were factors that independently affected ureteral stone detection by US., Conclusion: These results indicate that US may be useful as an initial imaging modality for detecting ureteral stone., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Purpose: To investigate the fusion of pelvic magnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography (PET) for assessment of locoregional extension and nodal staging of cervical cancer., Methods: PET/computed tomography (CT), MRI, and non-fused and fusion of PET and MRI for assessing the extent of the primary tumor and metastasis to nodes were evaluated., Results: Accuracy for T-status was 83.3% for fused and non-fused PET/MRI and MRI proved significantly more accurate than PET/CT (53.3%) (P=.0077). Sensitivity, specificity, and accuracy for nodal metastasis were 92.3%, 88.2%, and 90.0% for fused PET/MRI and PET/contrast-enhanced CT; 84.6%, 94.1%, and 90.0% for non-fused PET/MRI; and 69.2%, 100%, and 86.7% for MRI., Conclusion: Fused PET/MRI combines the individual advantages of MRI and PET., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: Infants with congenital cytomegalovirus infection (CCMVI) may develop brain abnormalities such as ventricular dilatation, which may potentially associate with sensorineural hearing loss. There is currently no recognized method for quantitative evaluation of ventricle size in infants with CCMVI. Our objectives were to establish a method for quantitative evaluation of ventricle size using computed tomography (CT) in infants with CCMVI, and determine a cut-off value associated with abnormal auditory brainstem response (ABR) early in life., Design/subjects: This study enrolled 19 infants with CCMVI and 21 non-infected newborn infants as a control group. Infants with CCMVI were divided into two subgroups according to ABR at the time of initial examination: normal ABR (11 infants) or abnormal ABR (8 infants). Ventricle size was assessed by calculating Evans' index (EI) and lateral ventricle width/hemispheric width (LVW/HW) ratio on brain CT images, and was compared among groups. A cut-off ventricle size associated with abnormal ABR was determined., Results: EI and LVW/HW ratio were significantly higher in the CCMVI with abnormal ABR group than the control and CCMVI with normal ABR groups. Cut-off values of 0.26 for EI and 0.28 for LVW/HW ratio had a sensitivity of 100% and 100%, respectively, and a specificity of 73% and 91%, respectively, for association with abnormal ABR., Conclusions: We established a method for quantitative evaluation of ventricle size using EI and LVW/HW ratio on brain CT images in infants with CCMVI. LVW/HW ratio had a more association with abnormal ABR in the early postnatal period than EI., (Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)

Purpose: To investigate the diagnostic value of retrospective fusion of pelvic MRI and (18)F-fluorodeoxyglucose ((18)F-FDG) PET images for assessment of locoregional extension and nodal staging of endometrial cancer., Materials and Methods: Thirty patients with biopsy-proven endometrial cancer underwent preoperative contrast-enhanced PET/CT (PET/ceCT) and pelvic dynamic contrast-enhanced MRI for initial staging. Diagnostic performance of PET/ceCT, contrast-enhanced MRI, and retrospective image fusion from PET and MRI (fused PET/MRI) for assessing the extent of the primary tumor (T stage) and metastasis to regional LNs (N stage) was evaluated by two experienced readers. Histopathological and follow-up imaging results were used as the gold standard. The McNemar test was employed for statistical analysis., Results: Fused PET/MRI and MRI detected 96.7% of the primary tumors, whereas PET/ceCT detected 93.3%. Accuracy for T status was 80.0% for fused PET/MRI, and MRI proved significantly more accurate than PET/ceCT, which had an accuracy of 60.0% (p=0.041). Patient-based sensitivity, specificity and accuracy for detecting pelvic nodal metastasis were 100%, 96.3% and 96.7% for both fused PET/MRI and PET/ceCT, and 66.7%, 100% and 96.7% for MRI, respectively. These three parameters were not statistically significant (p=1)., Conclusion: Fused PET/MRI, which complements the individual advantages of MRI and PET, is a valuable technique for assessment of the primary tumor and nodal staging in patients with endometrial cancer., (Crown Copyright © 2013. Published by Elsevier Ireland Ltd. All rights reserved.)

Objective: To evaluate low-dose non-enhanced CT (ldCT) and full-dose contrast-enhanced CT (ceCT) in integrated 18F-fluorodeoxyglucose (FDG)-PET/CT studies for restaging of ovarian cancer., Materials and Methods: One hundred and twenty women who had undergone treatment for ovarian cancer underwent a conventional PET/CT scans with ldCT, and then ceCT. Two observers interpreted and decided in consensus on the PET/ldCT and PET/ceCT images by a 3-point scale (N: negative, E: equivocal, P: positive) per patient and lesion site. Final diagnoses were obtained by histopathological examinations, or clinical follow-up for at least 6 months., Results: Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/ceCT was 86.9% (40/46), 95.9% (71/74), and 92.5% (111/120), respectively, whereas those of PET/ldCT were 78.3% (36/46), 95.0% (70/74), and 88.3% (106/120), respectively. All sensitivity, specificity, and accuracy significantly differed between two methods (McNemar test, p<0.0005, p=0.023, and p<0.0001, respectively). The scales of detecting 104 recurrent lesion sites were N:14, E:6, P:84 for PET/ceCT, and N:15, E:17, P:72 for PET/ldCT, respectively. Eleven equivocal and one negative regions by PET/ldCT were correctly interpreted as positive by PET/ceCT., Conclusion: PET/ceCT is a more accurate imaging modality with higher confidence for assessing ovarian cancer recurrence than PET/ldCT., (Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.)

Microscopically, ovarian malignant Brenner tumor shows components of malignant transitional cell tumor intermixed with benign and borderline elements. We report a case of this tumor with components that transition from benign to malignant on diffusion-weighted images (DWI) and in histologic findings. The benign component showed low signal intensity on T(2)-weighted images, whereas the malignant component showed high signal intensity on T(2)-weighted images and high signal intensity on DWI with low apparent diffusion coefficient (ADC) value.

Purpose: The implementation of in-line x-ray phase contrast imaging (PCI) for soft-tissue patient imaging is hampered by the lack of a bright and spatially coherent x-ray source that fits into the hospital environment. This article provides a quantitative characterization of the phase-contrast enhancement of a PCI system based on the miniature synchrotron technology MIRRORCLE-6X., Methods: The phase-contrast effect was measured using an edge response of a plexiglass plate as a function of the incident angle of radiation. We have developed a comprehensive x-ray propagation model based on the system's components, properties, and geometry in order to interpret the measurement data. Monte-Carlo simulations are used to estimate the system's spectral properties and resolution., Results: The measured ratio of the detected phase-contrast to the absorption contrast is currently in the range 100% to 200%. Experiments show that with the current implementation of the MIRRORCLE-6X, a target smaller than 30-40 μm does not lead to a larger phase-contrast. The reason for this is that the fraction of x-rays produced by the material (carbon filament and glue) that is used for mounting the target in the electron beam is more than 25% of the total amount of x-rays produced. This increases the apparent source size. The measured phase-contrast is at maximum two times larger than the absorption contrast with the current set-up., Conclusions: Calculations based on our model of the present imaging system predict that the phase-contrast can be up to an order of magnitude larger than the absorption contrast in case the materials used for mounting the target in the electron beam do not (or hardly) produce x-rays. The methods described in this paper provide vital feedback for guiding future modifications to the design of the x-ray target of MIRRORCLE-type system and configuration of the in-line PCI systems in general.

Study Design: A prospective study using a newly developed imaging diagnosis method to examine the patients with L5 radiculopathy., Objective: To confirm the efficacy of a new 3-dimensional computed tomography (3D CT) imaging method to diagnose extraforaminal stenosis at the lumbosacral junction., Summary of Background Data: The lack of recognition of extraforaminal stenosis at the lumbosacral junction is a cause of failed back surgery syndrome. A clear method to diagnose this condition is essential., Methods: The participants were 75 consecutive patients (mean age 69.5 y) with or without cauda equina symptoms who were treated by microendoscopic spinal surgery for L5 radiculopathy. The lesion responsible for the symptoms was identified by a combination of neurologic findings, selective radiculography, (3D MRI), and intraoperative neurophysiological findings. Multislice CT scanning was carried out preoperatively from the L1 vertebral body to the sacrum in all patients. The CT scan images were transferred to a remote computer workstation, and the reconstructed images were examined after surgery by an investigator blinded to the clinical diagnoses. In the reconstructed plane, we measured the minimum cross-sectional area of the de novo bony tunnel formed by the L5 transverse process, sacral ala, and L5 vertebral body, that is, lumbosacral bony tunnel (LSBT) and determined a cutoff value to diagnose extraforaminal stenosis. The shape of the LSBT was also evaluated in relation to the diagnosis., Results: In 3D CT analysis, the LSBT was found on the ipsilateral side in 51 of the 75 patients. The bony tunnel was outside the foramen in all patients diagnosed clinically with extraforaminal stenosis, but in only 60% of the patients without extraforaminal stenosis. The minimum cross-sectional area of the bony tunnel was significantly smaller in patients with an extraforaminal stenosis than in those without extraforaminal stenosis. The cutoff value was set at 0.8 cm2. The cross-sectional area was <0.8 cm2 in all patients with extraforaminal stenosis. The specificity of this diagnostic procedure was 89.6%, and the sensitivity was 100%. All true-positive cases had the spur-type shape of the bony tunnel, and all false-positive cases had the round-type shape., Conclusions: All patients with extraforaminal stenosis had an LSBT. The minimum cross-sectional area of the bony tunnel was significantly smaller in patients with an extraforaminal lesion than in those without an extraforaminal lesion. 3D CT is a useful tool for diagnosing extraforaminal stenosis at the lumbosacral junction.

Negative product value for coronary artery disease is 98% to 99%. Therefore, the number of unnecessary cardiac catheterization procedures is reduced as the usefulness of CT systems for examination of the coronary arteries improves. In the bolus-tracking method, in which an ROI is placed in the ascending aorta to trigger scanning, scanning may not be performed at the optimal time of contrast enhancement depending on the patient. In addition to identifying the causes of this problem, we have developed a new method in which ROIs are placed in the right ventricle and left atrium to trigger scanning when the concentrations of contrast medium in the right ventricle and left atrium become equal. The two methods were then compared and evaluated. In the scan method, in which an ROI is placed in the ascending aorta, the reason for non-optimal scan timing is considered to be that the time required for contrast medium injected via an antecubital vein to reach the heart varies depending on the individual patient(approximately 3 times the variation of our method)followed by a delay of approximately 5 seconds between the scan trigger time and the actual scan start time. In the scan method in which scanning is triggered when the concentrations of contrast medium in the right ventricle and left atrium become equal, scanning can be performed at the time of peak enhancement regardless of differences in the time required for the injected contrast medium to reach the target region or differences in the injection rate, demonstrating the usefulness of this method.

Multidetector-row computed tomography (MDCT) studies were performed in three adult patients with pulmonary atresia with a ventricular septal defect. In all patients, the native pulmonary arteries were absent, and the pulmonary circulation was totally supplied by major aortopulmonary collateral arteries (MAPCAs). MDCT studies with 1-mm collimation provided detailed information on MAPCAs and bronchial collaterals, such as the numbers and sites of origin, their varying diameters, their courses, and the areas of the lungs they supply. MDCT studies may provide an efficient road map for safe and successful selective catheterization and may substitute for conventional angiography in patients with considerable risks.

Objective: To report a case of sciatic endometriosis diagnosed by computerized tomography (CT)-guided biopsy in combination with CD10 immunohistochemical staining., Design: Case report., Setting: University hospital., Patient(s): A 33-year-old Japanese woman complaining of right-sided sciatica., Intervention(s): Transgluteal computerized tomography (CT)-guided needle biopsy of a mass in the course of the right sciatic nerve was conducted for a histologic diagnosis., Main Outcome Measure(s): Histologic study with hematoxylin and eosin staining and CD10 immunohistochemical staining was performed., Result(s): Computerized tomography-guided biopsy was performed without any complication. CD10 staining distinguished endometrial stromal cells., Conclusion(s): Computerized tomography-guided biopsy followed by CD10 immunohistochemical staining is a minimally invasive procedure for accurate diagnosis of sciatic endometriosis.

Gastroesophageal varices are the major complication of portal hypertension. Ectopic varices develop in various organs such as the duodenum, colon, and gallbladder. However, varices other than at gastroesophageal or rectal sites is a rare entity. We report a 53-year-old patient with primary biliary cirrhosis complicated by sigmoid colonic varices. Computed tomographic angiography was useful to understand the entire status of the varices.

Unlabelled: We describe serial computed tomographic (CT) findings of methotrexate (MTX)-induced pulmonary injury., Materials and Methods: The cases of 8 patients (3 men and 5 women; mean age 58.6 years, range 16 to 75 years) of clinically diagnosed MTX-induced pulmonary injury were reviewed. Six patients had rheumatoid arthritis, 1 had lupus erythematosus profundus, and 1 had juvenile rheumatoid arthritis. CT findings on admission and at follow-up were evaluated., Results: The most common CT features were diffuse and patchy bilateral ground-glass opacity with (n = 3) or without reticulation (n = 4) and consolidation (n = 1). These opacities showed no predilection for any particular lung zone in 6 patients but did show dependent predilection in 1 patient and upper lobe predilection in 1. Diffuse centrilobular ill-defined nodules were noted in 1 patient, which disappeared on follow-up. During the average post-treatment follow-up period of 31.0 days (range 3 to 76 days), the opacities quickly improved after treatment in 6 patients; however, in 2 patients with pre-existing interstitial pneumonitis the opacities were refractory., Conclusion: CT features of MTX-induced pulmonary injury were variable and included diffuse parenchymal opacification, reticular opacities, and centrilobular nodules. These opacities usually responded quickly to treatment; however, those patients with lung fibrosis at presentation may have worse prognosis.

Study Objectives: We described the features seen on serial high-resolution CT scans of nonspecific interstitial pneumonia (NSIP) that was associated with polymyositis (PM) and dermatomyositis (DM), and we correlated the changes in the CT scan findings with those of pulmonary function test results., Design, Setting and Patients: Serial CT scans of 14 patients with histologically proven NSIP and PM/DM from two university hospitals were evaluated retrospectively (follow-up period, 3 to 61 months; mean follow-up period, 27.6 months). Using initial and follow-up CT scan findings, the extent of each type of opacity and the total area of increased opacity were calculated and correlated with the results of pulmonary function tests., Measurements and Results: The predominant findings on the initial CT scans were of reticular and/or ground-glass opacities with or without consolidation. Reticular and ground-glass opacities predominated in the lower zone of each lung, and consolidation predominated at the lung periphery. Thirteen patients showed significant improvement of the total area of increased opacity (p < 0.05), and this decrease in extent inversely correlated with changes in FVC (r = -0.650; p = 0.031). Ground-glass and reticular opacities also were improved significantly in 11 and 13 patients, respectively. The decrease in the extent of ground-glass opacity correlated inversely with the changes in FVC (r = -0.758; p = 0.0119) and diffusion capacity for carbon monoxide (r = -0.669; p = 0.0448). In one patient, ground-glass opacity progressed, and death occurred after 3 months. Traction bronchiectasis was seen in 12 patients, and it improved in four patients after treatment. Honeycomb lung was not noted in any patient during follow-up., Conclusions: With treatment, serial CT scans of PM/DM patients with NSIP showed significant improvement in the abnormal opacities, and radiographic progression of lung fibrosis was limited. The CT scan features and clinical course of NSIP in PM/DM patients were relatively uniform, and this constitutes a subset of NSIP.

Purpose: To characterize thin-section computed tomographic (CT) findings of pathologic subgroups of nonspecific interstitial pneumonia (NIP) in a sizeable number of patients., Materials and Methods: The study included 55 cases of pathologically proven NIP. The 55 cases were categorized histologically into four grades: grade 1, interstitial inflammation without fibrosis (n = 6); grade 2, interstitial inflammation predominating over fibrosis (n = 16); grade 3, fibrosis predominating over inflammation (n = 5); and grade 4, fibrosis only (n = 28). Two independent observers evaluated the presence, extent, and distribution of various CT findings. Thin-section CT findings and histologic grades were compared by using the Spearman rank correlation coefficient. Observer agreement was assessed., Results: Areas with ground-glass attenuation and architectural distortion were present in all 55 patients. Traction bronchiectasis and intralobular reticular opacities were seen in 52 and 48 patients, respectively. The extent of traction bronchiectasis (r = 0.68; P <.001) and intralobular reticular opacities (r = 0.35; P <.05) correlated with the histologic grade. Honeycombing was seen in 12 (43%) of 28 patients with grade 4 NIP and in three (11%) of the remaining 27 patients (chi(2) test, P <.001). There was good agreement between the observers for the presence (kappa = 0.7-1.0) and extent (Spearman rank correlation; r = 0.87-0.98; P <.001) of various abnormalities., Conclusion: The extent of traction bronchiectasis and intralobular reticulation at thin-section CT correlates with increased fibrosis in NIP. Honeycombing is seen almost exclusively in patients with fibrotic NIP.

Situs solitus refers to the normal arrangement of body organs. Situs inversus totalis is a complete mirror image or reverse isomeric form of the thoracic and abdominal viscera. Any arrangement of organs between these two extremes is designated by heterotaxia. Several patterns of vascular and visceral abnormalities are associated with heterotaxia, and two loosely defined syndromes of splenic anomalies (asplenia and polysplenia) are most common. We present the case of a 71-year-old woman with situs inversus totalis and polysplenia syndrome who developed synchronous double cancer originating from the stomach and rectum. Abdominal manifestations were situs inversus totalis combined with multiple lobulated spleen, azygous continuation of the interrupted inferior vena cava, direct drainage of hepatic vein to left atrium, preduodenal portal vein, short pancreas, incomplete rotation of the colon, and malrotation of the intestine. Histologically, gastric cancer was diagnosed as papillary adenocarcinoma and rectal cancer, as moderately differentiated adenocarcinoma. The patient was successfully treated with total gastrectomy for gastric cancer and low-anterior resection of the rectum for rectal cancer.

We report a case of agnathia-holoprosencephaly which was prenatally diagnosed based on helical computed tomography (CT) images obtained at 23 weeks of gestation. Ultrasound examination first showed the presence of alobar holoprosencephaly, but the facial structures were not clearly detailed. However, three-dimensional imaging by helical CT precisely demonstrated the most striking feature of agnathia: absence of the mandible. This technique provided us valuable information that contributed to the in utero diagnosis. In utero helical CT is a useful examination tool for the diagnosis of osteogenic abnormalities., (Copyright 2001 John Wiley & Sons, Ltd.)

Purpose: To investigate the age and sex dependence of the bone mineral status of human lumbar vertebrae with special regard to differences between cortical and trabecular bone., Material and Methods: The study group comprised 125 normal Japanese healthy volunteers (54 males and 71 females), and was subdivided into adult male and female groups (subjects younger than 40 years), intermediate male and female groups (ages ranging between 41 and 64 years) and old male and female groups (subjects older than 65 years). The cortical bone mineral status was estimated using a single-energy quantitative CT (SE-QCT) technique, whereas trabecular bone mineral density (BMD) was estimated using a dual-energy (DE-QCT) technique., Results: A considerable gender difference in the age-related cortical bone status was found. There was a significant reduction of the mean values of the cortical volume and BMD in the old female group compared with those obtained in the old male group., Conclusion: The results suggest that in men, cortical and trabecular bone volume decrease very little with age. In women, cortical volume and BMD and trabecular BMD decrease with age while trabecular bone volume does not. The study showed that all variables had higher values in men than in women and that the difference increased with age.

A dog with a bronchocutaneous fistula is described. Contrast enhanced computed tomography was useful for diagnosis and treatment of the fistula in this dog.

A 48-year-old female was stabbed by her husband with a chopstick made of wood in the left temporal region during a quarrel. She suffered laceration of the left temporal scalp. At initial examination, she concealed the assault with a chopstick. Radiography showed no abnormality, so the wound was sutured. One month after the injury, a painless subcutaneous mass appeared in the left temporal region which grew rapidly for 3 months. She was then admitted to our department. Computed tomography (CT) on admission showed a hyperdense area at the center of the mass. This area was hypointense on both T1- and T2-weighted magnetic resonance (MR) images. Temporalis muscle tumor with accompanying central necrosis, old hematoma, and inflammatory granuloma was considered. The mass was totally resected for cosmetic purposes and was found to be wooden foreign body granuloma. High density on CT and hypointensity on both T1- and T2-weighted MR images are characteristic of a chronically retained wooden foreign body in the living body and are useful for detecting wooden foreign bodies in the chronic granulomatous phase.

We compared CT and MRI obtained within the first 3 h of onset of a cerebral infarct. Echo-planar diffusion-weighted MRI delineated the infarcted areas most clearly, and subtle low-density areas on CT were consistent with those shown to be abnormal by diffusion-weighted MR. The signal changes of affected areas on fast spin-echo proton-density, T2-weighted and fast FLAIR images were subtler than the low density on CT.

Objectives: To analyze the plain film and CT findings of rheumatoid arthritis (RA)-associated lung diseases and to correlate them with clinical manifestations., Methods/materials: We retrospectively reviewed the plain chest and CT findings of 51 RA patients with lung diseases. Sixteen CT findings were separately corded as present or absent, and drew up our classification of lung diseases as follows; 1. interstitial pneumonia/pulmonary fibrosis (IP/PF), 2. airway disease (AD), 3. parenchymal disease (PD), and 4. mixed. Four plain film findings were also recorded, and classified in IP/PF or AD group. This classification was analyzed with reference to clinical parameters and courses., Results: Fifty-one patients were classified as follows; 1. IP/PF (n = 32, 62.6%), 2. AD (n = 15, 29.4%), 3. PD (n = 3, 5.9%), 4. mixed (n = 1, 2.0%). CT findings of PD were compatible with bronchiolitis obliterans organizing pneumonia with rapid improvement. IP/PF diagnosed with CT was depicted by the plain chest in 25 patients (78.1%). There is no false positive of the plain chest diagnosis in terms of IP/PF. As compared with IP/PF, AD consisted of significantly higher prevalence in female patients and patients with severe articular involvement and sinusitis. In spite of variable outcome in patients with AD, those with IP/PF showed the progression of honeycombing, and 4 of them were died from respiratory failure., Conclusions: CT based classification of rheumatoid lung diseases correlates with clinical manifestations and prognosis and is useful for clinical management in patients of RA. CT diagnosis is useful especially when plain chest does not demonstrate typical IP/PF pattern.

A dual-energy (DE) quantitative computed tomography (QCT) method, the four-equation four-unknown method (DEQCT 4E-4U), was assessed and compared to single-energy (SE) QCT and standard DEQCT (two-line method). The results of this study indicate that bone mineral density (BMD) was more accurately estimated by the present method than by the SEQCT or standard DEQCT techniques on the basis of a phantom study when a large fat content was present. The results of both the phantom study and a human study also showed that the present method corrected for fat in estimating BMD in the presence of high-fat content. These findings suggest that use of this method for estimating BMD can provide useful information in studies assessing the metabolic state of bone. We propose that CT numbers estimated from excised vertebral bone marrow can serve as a soft-tissue correction for the present method.

Three cases of symptomatic cavernous angioma occurring in the 1st year of life are presented. All three patients were treated with radical extirpation. Postoperatively, two of them improved, but the third died due to cerebral herniation secondary to recurrence of bleeding of the lesion. The clinical characteristics of cavernous angioma in the 1st year of life are briefly discussed and a review of the literature presented, including 16 previous cases operated on directly.

A rare case of intracranial primary chondroid chordoma is reported with special reference to neuroradiological findings. A precontrast computed tomographic (CT) scan revealed an isodense mass with multiple flecks in the right cerebellopontine region. A postcontrast CT scan showed slight ring enhancement. A delayed postcontrast CT scan demonstrated marked homogeneous enhancement extending from the middle cranial fossa to the cerebellopontine region on the right. Magnetic resonance (MR) imaging demonstrated a well-defined lesion as a high-intensity mass on T2-weighted image and a low-intensity mass on T1-weighted image. A MR image 5 minutes after gadolinium-diethylenetriaminepenta-acetic acid administration showed heterogeneous enhancement. A MR image 30 minutes after the contrast administration showed more marked, homogeneous enhancement. Such delayed postcontrast CT and MR imaging are useful in the differentiation of chondroid chordoma from classical chordoma.

A follow-up study by CT and MR of a case of Wernicke encephalopathy is reported. In the early stages, CT and MR revealed a characteristic topographical distribution of lesions in the midbrain, pons, and thalami. In the later stages, MR showed atrophy of the mamillary bodies and midbrain tegmentum and dilatation of the third ventricle. Both CT and MR are useful tools for the diagnosis of Wernicke encephalopathy in the early stages.

Williams-Campbell syndrome is a rare type of cystic bronchiectasis that is due to defective cartilage of fourth-to sixth-order bronchi. The diagnosis has been made either at autopsy or by bronchographic findings. The article describes an adult case of this syndrome with CT findings that are characteristic of this entity. CT showed areas of emphysematous lung parenchyma distal to the dilated bronchi, suggesting bronchiolitis obliterans secondary to proximal cystic bronchiectasis. These findings are useful in differentiating Williams-Campbell syndrome from other causes of cystic bronchiectasis, thus obviating bronchography.

We experienced five cases of gold pneumonitis. CT findings of four cases and pathological findings of an autopsy case were discussed. CT findings of gold pneumonitis could be classified as follow; (1) high density shadow of subpleural zone-BOOP suspected- (2) high density shadow along the broncho-vascular bundle (3) small cystic shadow of subpleural zone-UIP. Histological findings of an autopsy case revealed the fibrosis along the broncho-vascular bandle. A variety of radiologic and pathologic feature on the gold pneumonitis were seen.

Computed tomographic findings in a 71-year-old patient with an infiltrative right ventricular myxoma are described. The findings included multiple lesions in the right ventricle and stenosis of the trunk of the pulmonary artery.

The correlation between EEG and CT scan was studied in 57 full-term newborn infants with various neurological abnormalities, in order to clarify pathological processes underlying EEG abnormalities during the neonatal period. The relation between EEG and CT findings changes with the time elapsing after the acute phase of the perinatal brain insult. The same EEG pattern was associated with different CT findings of perinatal brain injury were usually associated with complete obliteration of cerebrospinal fluid spaces, a phenomenon considered to reflect severe brain swelling. Milkdly and minimally depressed EEGs in the acute phase were usually associated with localized decreased brain density, which is thought to represent localized edema. Moderately depressed background EEGs in the first week were associated with normal CT scans in most cases, although mild localized edema did not produce significant changes in the background EEG in some cases. In contrast to perinatal brain lesions, CT scans were not always well correlated with background EEGs in congenital cerebral dysplasia and intracranial hemorrhage, although the EEG was an useful adjunct to the CT scan in the diagnosis and prognostication of these disorders.

We reported a case of hypereosinophilic syndrome with an apical thrombus obstructing left ventricular cavity near the apex and apical hypertrophy of the left ventricle demonstrated by echocardiography and computed tomography. Abnormal laboratory findings included a white blood cell count of 22,800/mm3 with 64 per cent of eosinophils, high serum IgE level, and eosinophilic abscess formation in the lymph node specimen. The electrocardiogram showed left precordial high voltage and giant negative T waves in leads V4-5. Two-dimensional echocardiograms revealed an abnormal mass obstructing the left ventricular cavity. Computed tomography demonstrated marked apical hypertrophy of the left ventricle and a filing defect of 24 X 31 mm, which attached to the interventricular septum. Because of the lack of its movement on echocardiograms and significant differences in CT numbers from various portions of the myocardium, the abnormal mass in the left ventricle was considered to be a thrombus. In this case, both echocardiography and computed tomography were very useful to understand structural relationship among the thrombus, interventricular septum and surrounding left ventricular walls, and to assess myocardial thickness of the apex. In addition, it is of particular interest that hypereosinophilic syndrome was associated with marked apical hypertrophy of the left ventricle.

Clinical evaluation of aortic atherosclerosis has been most commonly performed by visual analysis of aortic calcification on conventional radiographs or X-ray CT. However, precise evaluation of the degree of calcification or mild changes with increasing age can be difficult by these methods of visual analysis. A new quantitative method of evaluating the abdominal aortic atherosclerosis using CT is reported. Target CT scans of the abdominal aorta were performed at the level of the 1st, 3rd and 4th lumbar vertebrae. Two circular regions of interest (ROI) were selected along the outer margin and inner margin of the abdominal aortic wall on CT images, since it was difficult to precisely trace the aortic wall. Histograms of CT value for each pixel were made from two ROIs. A histogram at the ROI of the outer margin was depicted using class values over the maximum CT value in histogram at the ROI of inner margin which indicated flowing blood. A sum of products of the value in each class by the number in that class was divided by the aortic diameter. The value thus obtained was defined as the atherosclerotic index (S.I.). Forty-five cases were studied with this method. Six cases were excluded because of artifacts. The remaining 39 cases (16 males, 23 females) were analyzed. S.I. increased with aging and was higher in men than in women. However, it increased more rapidly in women (8.68/year) than in men (2.73/year). Because this new method employed the CT value, it is more objectively quantitative than previous methods of visual analysis in evaluating abdominal aortic atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Five patients with thoracic aortic aneurysms, two saccular and three dissecting aneurysms, were examined by dynamic computed tomographic (CT) scanning. A Siemens Somatom 2 was employed. Dynamic scanning is the method by which plural serial images can be obtained in single operation. We used three serial images in a 5-second scan following a 3-second interval. After rapid manual injection of 30 ml of 76% megluminc amidotrizoate sodium into the right antecubital vein, scans of 4 mm section were performed three times and subsequently conventional scans four times. Serial changes in the same section and changes in the CT number against time in regions of interest in the image were investigated. Saccular aneurysms was difficult to distinguish from mediastinal tumors on the plain chest X-ray films. However, it was confirmed by the dynamic CT scanning demonstrating free communication between the aorta and the abnormal lumen, because the latter was filled with contrast medium, and the time of appearance, and the peak and washout of a contrast medium were almost the same between two lumens. In dissecting aneurysms, it was able to recognize both the false and true lumens as double channels in the aorta. We observed the different mode of dissection between the ascending and descending aorta in one case, and observed the twisting of an intimal flap in variable parts of the aorta in another case. Furthermore, it was possible to confirm the difference of blood flow pattern between the false and true lumens by dynamic CT. Because CT has a high quality image resolution, and especially, dynamic CT provides the serial changes in the same section after injection of contrast medium, both CT and dynamic CT are useful non-invasive imaging techniques for evaluating thoracic aortic aneurysms.