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Background To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP. Purpose To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas. Study type Retrospective. Population A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs. Field strength/sequence 3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality. Statistical tests Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P Results Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients. Data conclusion 3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern. Level of evidence 4 TECHNICAL EFFICACY: Stage 2.

To evaluate the feasibility of High-resolution (HR) magnetic resonance imaging (MRI) of the liver using deep learning reconstruction (DLR) based on a deep learning denoising technique compared with standard-resolution (SR) imaging.This retrospective study included patients who underwent abdominal MRI including both HR imaging using DLR and SR imaging between April 1 and August 31, 2019. DLR was applied to all HR images using 12 different strength levels of noise reduction to determine the optimal denoised level for HR images. The mean signal-to-noise ratio (SNR) was then compared between the original HR images without DLR and the optimal denoised HR images with DLR and SR images. The mean image noise, sharpness and overall image quality were also compared. Statistical analyses were performed with the Friedman and Dunn-Bonferroni post-hoc test.In total, 49 patients were analyzed (median age, 71 years; 25 women). In quantitative analysis, the mean SNRs on the original HR images without DLR were significantly lower than those on the SR images in all sequences (p 0.01). Conversely, the mean SNRs on optimal denoised HR images were significantly higher than those on the SR images in all sequences (p 0.01). In the qualitative analysis, the mean scores for the image noise and overall image quality were significantly higher on optimal denoised HR images than on the SR images in all sequences (p 0.01) except for the mean image noise score in in-phase (IP) images.The use of a deep learning-based noise reduction technique substantially and successfully improved the SNR and image quality in HR imaging of the liver. Denoised HR imaging using the DLR technique appears feasible for use in liver MR examinations compared with SR imaging.

To compare the occurrence of transient respiratory motion artifacts (TRMAs) in multiple arterial phases on abdominal magnetic resonance (MR) images between those obtained using gadobutrol and gadoxetate disodium. Two hundred and fourteen abdominal MR examinations (101 with gadoxetate disodium, 113 with gadobutrol) were evaluated. Dynamic three-dimensional contrast-enhanced T1-weighted imaging (CAIPIRINHA-Dixon-TWIST-VIBE) including single-breath-hold six arterial phase acquisitions was performed on a 3.0-T MRI scanner. The TRMAs frequency and the mean TRMA scores were compared between patients assessed with gadoxetate disodium and those assessed with gadobutrol. In addition, the timing of TRMAs appearing for the first time was also recorded and compared between the two groups. The mean TRMA scores in all arterial phases using gadoxetate disodium were significantly worse than in those using gadobutrol (1.49 ± 0.78 vs. 1.18 ± 0.53, P

There is wide agreement that morphologic features and enhancement kinetics should be evaluated for MRI of the breast, although there has been no clear consensus concerning optimal temporal resolutions. The objective of this study was to investigate the optimal temporal resolution for the kinetic analysis of breast cancers.Thirty-four patients with 34 enhancing lesions of breast cancer who underwent dynamic contrast-enhanced MRI (DCE-MRI) on a 3.0-T scanner were included in this retrospective study. DCE-MRI was performed with an original temporal resolution of 10-s, and the values of pharmacokinetic parameters (Ktrans, Ve, Kep, and area under the curve (AUC)) were compared with selected data of 30-s and 60-s time intervals.Among the 34 lesions, 10 showed a wash out pattern, 16 showed a plateau pattern, and 8 showed a persistent enhancement pattern. The Ktrans value in the wash-out pattern was significantly higher than that of other time-intensity curve patterns (p 0.01). The Kep and AUC also showed significant differences between the wash-out pattern and other types (p 0.01). On comparing the perfusion parameters among different temporal resolutions, simulations showed that only the AUC differed significantly between the data acquired at a 10-s temporal resolution and that acquired at a 60-s time interval (p 0.01). Although the comparison of the AUC between the 30-s and 60-s data also showed significant differences (p = 0.01), there was no significant difference between the 10-s and 30-s data (p = 0.17).DCE-MRI with a temporal resolution of 30-s preserves the kinetic information. Further prospective studies will be needed to investigate the trade-off between temporal and spatial resolution in DCE-MRI.

Purpose To evaluate the association of the pancreatic exocrine function estimated by cine-dynamic magnetic resonance cholangiopancreatography (MRCP) using a spatially selective inversion-recovery (IR) pulse with the pancreatic endocrine function estimated by the T1 relaxation time of the pancreatic parenchyma and HbA1c values. Materials and methods Forty-three patients with suspected hepatobiliary or pancreatic diseases were included. Patients were classified into three groups: HbA1c U tests. Results Both the mean secretion grade and frequency of the pancreatic secretory inflow had a significant negative correlation with the T1 relaxation time of the pancreatic parenchyma (r = − 0.335, p = 0.028 and r = − 0.305, p = 0.047, respectively) and HbA1c values (r = − 0.308, p = 0.044 and r = − 0.313, p = 0.041, respectively). Both the mean secretion grade and frequency of the pancreatic secretory inflow in the elevated HbA1c (prediabetes and diabetes) group were significantly lower than those in the normal group (p = 0.030 and p = 0.029, respectively). Conclusion The pancreatic exocrine function estimated by cine-dynamic MRCP was significantly lower in patients with prediabetes and diabetes than in controls. Cine-dynamic MRCP with a spatially selective IR pulse may be useful for the early diagnosis of pancreatic exocrine insufficiency in patients with pancreatic endocrine insufficiency.

To determine imaging findings of pancreatic adenocarcinomas incidentally detected on contrast-enhanced multiphasic dynamic computed tomography (CT) obtained during the follow-up for other diseases. From January 2007 to December 2018, 14 patients with pancreatic adenocarcinomas incidentally detected on CT obtained during the follow-up for other diseases (incidental group) and 105 patients with pancreatic adenocarcinomas symptomatically detected on ultrasound or CT (non-incidental group) were included. Imaging characteristics of the tumor were compared between the two groups. Additionally, imaging findings prior to the detection of a tumor on previous CT images in the incidental group were also assessed. In cancers of the pancreas body/tail, there was a significantly smaller tumor size (median, 17 mm vs. 42 mm, p

To determine the consistency of major hepatocellular carcinoma (HCC) features between CT and MRI based on Liver Imaging Reporting and Data System (LI-RADS) v2018 and to investigate the additional value on gadoxetic acid-enhanced MRI.Patients who underwent dynamic CT and gadoxetic acid-enhanced MRI within 1 month were investigated. Two radiologists evaluated the presence of major HCC features and categorized observations using LI-RADS v2018 algorithm. In addition, each observation was recorded as hyper-, iso-, or hypo-intensity on hepatobiliary-phase (HBP) images.Sixty-one patients with 110 observations were identified. Among 88 observations classified as LR-3, 4 or 5, arterial phase hyper-enhancement and washout appearance showed higher frequencies on CT than on MRI (75.0% vs. 58.0%, P 0.001, and 60.2% vs. 44.3%, P = 0.014, respectively). Of the 59 LR-3 observations categorized on MRI, 70.0% of observations with hypo-intensity on HBP images were HCCs, whereas 89.5% of observations with iso- or hyper-intensity on HBP images were non-HCCs (P 0.001) CONCLUSION: The frequencies of arterial phase hyper-enhancement and washout appearances were higher on CT than on gadoxetic acid-enhanced MRI. For LR-3 observations, adding the hepatobiliary-phase hypo-intensity to major features improved the diagnostic performance of MRI in distinguishing HCCs from non-HCC lesions.

To resolve drawbacks of navigator triggering (NT) three-dimensional (3D) magnetic resonance cholangiopancreatography (MRCP), several approaches were proposed to obtain 3D MRCP within a single breath-hold (BH). However, reduced field-of-view technique in the phase-encoding direction combined with two-dimensional spatially selective radiofrequency excitation pulses has not yet been applied to 3D BH MRCP.To investigate the feasibility and the complementary value of 3D BH zoomed MRCP to conventional 3D NT MRCP in patients with branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) of the pancreas.Retrospective.A total of 221 patients (116 male and 105 female, median age 73 years) with BD-IPMNs.3.0 T/3D turbo spin echo ASSESSMENT: MR images were analyzed by three radiologists (R.M., H.O., M.T., with 1, 13, and 17 years of experience) to compare blurring and motion artifacts, background suppression, visualization of main pancreatic duct (MPD), conspicuity of BD-IPMN, and overall image quality.Wilcoxon-signed rank, Mann-Whitney U, chi-squared or Fisher's exact tests (P 0.05).Image quality was significantly higher on 3D NT MRCP images than on 3D BH zoomed MRCP (median (interquartile range); background suppression, 4 (4-4) vs. 3 (3-4); visualization of MPD, 4 (3-4) vs. 4 (3-4), conspicuity of BD-IPMN, 4 (3-4) vs. 3 (3-4); and overall image quality, 3 (3-4) vs. 3 (3-3)). However, in 32 (14%) patients, 3D NT MRCP showed a score of 1 or 2 in overall image quality. Regarding the conspicuity of BD-IPMN, a conspicuity score of 1 or 2 was rendered in 31 (14%) patients in 3D NT MRCP group. Conversely, 3D BH zoomed MRCP showed a score of 3 or 4 in 29 (94%) of these 31 patients.3D BH zoomed MRCP plays a complementary role to 3D NT MRCP, and may improve the conspicuity of BD-IPMNs in patients with irregular breathing pattern.4 TECHNICAL EFFICACY: Stage 2.

Although it is important to quantify the degree of fatty degeneration of the pancreas, it is difficult to make such a quantification using conventional computed tomography (CT). The present study evaluated the feasibility of pancreatic fat quantification by dual-energy CT (DECT) compared with T2*-corrected six-point Dixon magnetic resonance imaging (MRI). Twenty-eight patients who underwent both DECT (100 and 150 kVp) and Dixon MRI without the use of contrast agents were analyzed. The region of interest (ROI) was placed at the head and body/tail of the pancreas on fat volume fraction (FVF) maps generated using the multi-material decomposition (MMD) algorithm on DECT. The FVF (%) of pancreatic parenchyma measured by DECT (CT-FVF) was compared with that measured on FVF maps calculated using Dixon MRI (MR-FVF) using the Spearman rank correlation coefficient. The median CT-FVF (%) values of the head and body/tail of the pancreas on DECT were 14.2% (range 0.1–81.2%) and 9.4% (range 0–40.8%), respectively. The median MR-FVF (%) values of the head and body/tail of the pancreas on Dixon MRI were 12.2% (range 1.2–80.9%) and 8.1% (range 0.3–43.7%), respectively. CT-FVF (%) measured by DECT showed a significant correlation with the MR-FVF (%) measured by Dixon MRI in the head of the pancreas (ρ = 0.631, P

To compare the image quality of multiphasic (arterial, portal, and equilibrium phases) dynamic computed tomography (CT) of the abdomen obtained by a low tube voltage (70kVp) in combination with a half-dose iodine load using low-concentration contrast agent in high tube output dual-source CT with a standard tube voltage (120kVp) and full-dose iodine load using the same group of adult patients. Fifty-five patients who underwent both low-tube-voltage (70kVp) abdominal CT with a half-dose iodine load and standard-tube-voltage (120kVp) CT with a full-dose iodine load were analyzed. The mean CT values and signal-to-noise ratio (SNR) of the liver, aorta and portal veins were quantitatively assessed. In addition, the contrast enhancement of the abdominal organs and overall image quality were qualitatively evaluated. The mean CT values and SNR of the liver parenchyma were significantly higher in 70-kVp protocol than in 120-kVp protocol in all 3 phases (p = 0.018 ~

Purpose To investigate the clinical value of measuring the ECV fraction of the pancreas by DECT in association with an impaired glucose tolerance (IGT) estimated by the hemoglobin A1C (HbA1C) value in patients with or without cirrhosis. Materials and Methods This retrospective study included patients who underwent contrast-enhanced dynamic CT with dual-energy mode between March 2018 and February 2019. The ECV fraction of the pancreas was calculated from iodine map images created from equilibrium-phase contrast-enhanced DECT images. The cross-sectional areas of the pancreas were also measured. Results In total, 51 patients were analyzed (median age, 69 years old; 22 women). The ECV fraction of the pancreas showed a significant negative correlation with the HbA1c value in the cirrhotic group (ρ=-0.346, p = 0.048), while there was no significant correlation in the non-cirrhotic group (ρ=-0.086, p = 0.734). In the elevated HbA1C group, the ECV fraction of the pancreas in the cirrhotic patients (median, 0.247; interquartile range [IQR], 0.098) was significantly lower than that in the non-cirrhotic patients (0.332, IQR 0.113) (p = 0.024). In the elevated HbA1C group, the cross-sectional area of the pancreas was significantly larger in the cirrhotic patients than that in the non-cirrhotic patients (median [IQR]; 2945 [904] vs. 1885 [909] mm2, p = 0.019). Conclusion A reduction in the ECV fraction of the pancreas measured by DECT as well as the enlargement of the pancreatic parenchyma was observed in cirrhotic patients with IGT. These findings suggest that the measurement of the pancreatic ECV fraction by DECT may help clarify the pathophysiology of IGT in patients with cirrhosis.

To evaluate clinical safety and efficacy of percutaneous transhepatic hybrid biliary prostheses for palliative treatment in patients with common bile duct obstruction caused by advanced malignancies. A total of 13 consecutive patients was treated with percutaneous transhepatic biliary endoprostheses concurrently using both plastic and metallic stents. Serum total bilirubin levels before and after stent placement were evaluated. The technical success rate, the period with no obstructive jaundice, patient survival and complications were also assessed. Median bilirubin levels decreased from 3.8 mg/dL before to 1.2 mg/dL after stent placement, and this difference was statistically significant. The median no-jaundice period after bile duct stent placement was 6.0 months (range: 2-11 months), and overall survival time was 7.0 months. Of the 13 patients, nine did not have recurrent jaundice by the time of death, whereas four (31%) had recurrent jaundice. A second intervention was performed in these four patients. A new plastic stent was placed and jaundice did not recur up to the time of death. No serious complications such as cholangitis, pancreatitis or bile duct perforation developed. Percutaneous transhepatic hybrid biliary endoprostheses using both plastic and metallic stents can be useful as non-invasive palliative treatment to relieve jaundice in patients with malignant obstructive jaundice.

The aim of this study was to evaluate the clinical effectiveness of covered Niti-S stent placement under multidetector CT and fluoroscopy guidance for the palliation of dysphagia in patients with cervical esophageal cancer. Under radiological imaging guidance using axial and sagittal CT scans, and fluoroscopy, Niti-S esophageal stents were placed in ten consecutive patients with complete obstruction caused by cervical esophageal cancer (9 men and 1 woman; age range = 54–79 years; mean age = 68.1 years) between February 2010 and December 2011. The procedure time and technical success rate were evaluated. Swallowing improvement was assessed by the following items: ability to eat and/or swallow (graded as follows: 3 = ability to eat normal diet, 2 = ability to eat semisolids, 1 = ability to swallow liquids, 0 = complete obstruction). Procedural and post-procedural complications were also evaluated. Survival (mean ± SD) was examined. The mean (±SD) procedure time was 40 ± 19 min (range = 21–69 min). Stent placement was technically successful in all patients; inadequate stent deployment did not occur in any case. Ability to eat and/or swallow was improved and scored 2.4 (score 3 in 5 cases, score 2 in 4 cases, score 1 in 1 case, and score 0 in no case) after stent placement. No major or post-procedural complications were encountered. The mean survival time was 131 ± 77 days (range = 31–259 days). Niti-S stents appeared to be a safe and effective device for the palliation of dysphagia caused by advanced cervical esophageal cancer. Multidetector CT and fluoroscopy image guidance helped the operators accurately place the stents in the cervical esophagus.

Giant cell tumours (GCTs) are benign tumours commonly found in the long bones. Rarely, they may occur in the larynx, often resulting in hoarseness and anterior neck swelling. Since Wessely reported the first case of laryngeal GCT in 1940, 35 cases have been identified. Herein, we present a case of a 53-year-old male with GCT of the larynx that showed T1 and T2 hypointense signal on MRI, presumably owing to abundant haemosiderin deposition. We also discuss the imaging findings of CT and 18F-fludeoxyglucose positron emission tomography scans, as well as the pathological correlation.

BACKGROUND Patients with head and neck cancer frequently require gastrostomy feeding. The aim of this study was to evaluate the safety and feasibility of percutaneous radiologic gastrostomy with push-type gastrostomy tubes using a rupture-free balloon (RFB) catheter under computed tomography (CT) and fluoroscopic guidance in patients with head and neck cancer with swallowing disturbance or trismus. METHODS Percutaneous CT and fluoroscopic gastrostomy placement of push-type gastrostomy tubes using a RFB catheter was performed in consecutive patients with head and neck cancer between April 2007 and July 2010. The technical success, procedure duration, and major or minor complications were evaluated. RESULTS Twenty-one patients (14 men, 7 women; age range, 55-78 years; mean age, 69.3 years) underwent gastrostomy tube placement. The tumor location was the pharynx (n = 8), oral cavity (n = 7), and gingiva (n = 6). Gastrostomy was performed in 15 patients during treatment and 6 patients after treatment. Percutaneous radiologic gastrostomy was technically successful in all patients. The median procedure time was 35 ± 19 (interquartile range) minutes (range, 25-75). The average follow-up time interval was 221 days (range, 10-920 days). No major complications related to the procedure were encountered. No tubes failed because of blockage, and neither tube dislodgement nor intraperitoneal leakage occurred during the follow-up periods. CONCLUSION Percutaneous CT and fluoroscopic-guided gastrostomy with push-type tubes using a RFB catheter is a relatively safe and effective means of gastric feeding, with high success and low complication rates in patients with head and neck cancer in whom endoscopy was not feasible.

There has been concern regarding the usefulness of diffusion-weighted imaging (DWI) to evaluate the ischemic lesions associated with carotid artery stent placement (CAS). Some small lesions may be detected not by standard DWI but by thin-slice DWI alone, since most of the cerebral lesions are very small in size and clinically silent. The purpose of this study is to compare the detectability of the small ischemic lesions after CAS by standard and thin-slice DWI. Both standard DWI with slice thickness of 6 mm and thin-slice DWI with slice thickness of 2 mm were obtained at the same MR examination within 2 to 7 days after 20 procedures of CAS in 17 patients. Number and measured diameter size of the detected lesions on both DWI were compared. All CAS procedures in 17 patients were successfully completed. The focal ischemic lesions were detected in 14 of 20 on thin-slice DWI and seven examinations on standard DWI. The total numbers of hyperintense lesions were 31 on thin-slice DWI and ten on standard DWI (p

The aim of this study was to investigate the usefulness of diffusion-weighted magnetic resonance imaging (DWI MRI) for the diagnosis and evaluation of autoimmune pancreatitis (AIP). A total of 4 consecutive patients with AIP, 5 patients with chronic alcoholic pancreatitis (CP), and 13 patients without pancreatic disease (controls) were studied. DWI was performed in the axial plane with spin-echo echo-planar imaging single-shot sequence. Apparent diffusion coefficients (ADCs) were measured in circular regions of interest in the pancreas. In AIP patients, abdominal MRI was performed before, and 2–4 weeks after steroid treatment. Follow-up study was performed chronologically for up to 11 months in two patients. The correlation between ADCs of the pancreas and the immunoglobulin G4 (IgG4) index (serum IgG4 value/serum IgG4 value before steroid treatment) was evaluated. In the AIP patients, DWI of the pancreas showed high signal intensity, and the ADCs of the pancreas (mean ± SD: 0.97 ± 0.18 × 10−3 mm2/s) were significantly lower than those in patients with CP (1.45 ± 0.10 × 10−3 mm2/s) or the controls (1.45 ± 0.16 × 10−3 mm2/s) (Mann-Whitney U-test, P < 0.05). In one AIP patient with focal swelling of the pancreas head that appeared to be a mass, DWI showed high signal intensity throughout the pancreas, indicating diffuse involvement. The ADCs of the pancreas and IgG4 index were significantly inversely correlated (Spearman’s rank correlation coefficient, r s = −0.80, P < 0.05). Autoimmune pancreatitis showed high signal intensity on DWI, which improved after steroid treatment. ADCs reflected disease activity. Thus, diffusion-weighted MRI might be useful for diagnosing AIP, determining the affected area, and evaluating the effect of treatment.

We present a rare case of bilateral parotid oncocytoma with spontaneous intratumoral hemorrhage. Magnetic resonance imaging revealed multiple, bilateral, well-defined masses within the parotid glands with increased vascularity based on arterial spin labeling Magnetic Resonance (MR) perfusion imaging and restricted diffusion on diffusion-weighted imaging. During the clinical follow-up, the patient developed extensive hemorrhage from the largest tumor, presumably due to a combination of the hypervascular nature of oncocytoma and hemodialysis.

To develop a novel percutaneous radiologic gastrostomy using a large-bore, rupture-free, balloon (RFB) catheter in patients with a swallowing disturbance due to a neurological disorder.Consecutive patients underwent percutaneous gastrostomy placement using a balloon catheter with a 5.0-cm 5.0-cm, large-bore, rupture-free balloon on the tip between August 2010 and December 2011. The large balloon in the stomach was percutaneously punctured by the needle, the guide wire was inserted through the abdominal wall, and the push-type gastrostomy tube was finally inserted over the guide wire via the oral cavity. Technical success and complications were evaluated.Fifteen patients (10 men, 5 women; age range, 47-82 years; mean age, 71.7 years) who had cerebral infarction (n=8), intracerebral hemorrhage (n=4), and subarachnoid hemorrhage (n=3) underwent percutaneous radiologic gastrostomy. The procedures were technically successful in all patients. The mean procedure time was 34+- 9 (SD) min (range, 20-47 min). The average follow-up was 158 days (range, 14 - 655 days). No major complications related to the procedure were encountered.Image-guided gastrostomy using a large-bore RFB catheter is an effective method of gastric feeding in patients with swallowing disturbance due to a neurological disorder.

We compared intermediate-weighted fast spin-echo (IW-FSE) images with intermediate-weighted fast-recovery FSE (IW-FRFSE) images in the diagnosis of meniscal tears. First, 64 patients were recruited, and the arthroscopic findings (n = 40) and image analysis (n = 19) identified 59 torn menisci with 36 patients. Both the diagnostic performance and image quality in assessing meniscal tears was evaluated for IW-FSE and IW-FRFSE images using a four-point scale. Signal-to-noise ratio (SNR) calculation was performed for both sets of images. IW-FRFSE image specificity (100 %) for diagnosing the posterior horn of the medial meniscus (MM) tear with reader 1 was significantly higher than that of IW-FSE images (90 %). Mean ratings of the contrast between the lesion and normal signal intensity within the meniscus were significantly higher for the IW-FRFSE image ratings than the IW-FSE images in most meniscal tears. Mean SNRs were significantly higher for IW-FSE images than for IW-FRFSE images (P

Objective: The purpose of our study was to elucidate the relationship between arterial perfusion in advanced maxillary sinus cancer which was opacified by superselective intra-arterial computed tomographic arteriography (IA-CTA) and the tumor response to intra-arterial chemotherapy. Methods: Superselective IA-CTA was performed to identify the feeding arteries and their perfusion in advanced maxillary sinus cancer in 10 patients. Cisplatin was selectively infused into these feeding arteries, except for the internal carotid artery. Results: The results were assessed in 9 of the 10 patients, and a complete response was achieved in 5 patients in whom either the entire tumor, or most of the tumor, was perfused by the branches of the external carotid artery. In 4 patients with a partial response, the residual tumors were seen in the territory of the perfusion defect or in the perfusion territory of the internal carotid artery. Conclusion: Superselective IA-CTA is a useful technique to correctly identify the intratumoral perfusion and to predict tumor response to the intra-arterial chemotherapy of advanced maxillary sinus cancer.

Background Percutaneous endoscopic gastrostomy (PEG) is often performed for alimentation and to prevent weight loss in patients with feeding problems due to central neurologic diseases such as cerebral infarction or intracranial hemorrhage. Although infection at the skin site after PEG placement is a typical late complication of PEG, a ruptured infectious pseudoaneurysm caused massive bleeding adjacent to the tract is rare. Prompt treatment is required to avoid the hemorrhage shock, however surgical ligation is difficult to obtain the arrest of bleeding in damaged skin due to the infection. Case presentation A 70-year-old male was bedridden due a cerebral infarction suffered 1 year previously. APEG was placed because of feeding problems, and a push-type, 20-Fr gastrostomy tube was inserted through the anterior abdominal wall. On day 16 after PEG placement, the patient had massive bleeding from the PEG site due to the rupture of infectious pseudoaneurysm and developed a decreased level of consciousness and hypotension. Treatment by percutaneous direct injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol was performed and achieved good hemostasis is obtained. Conclusions A rare case of an infectious pseudoaneurysm that developed in the abdominal wall and caused massive bleeding at a PEG placement site was described. Percutaneous injection of a mixture of n-butyl-cyanoacrylate (NBCA)-lipiodol under ultrasound guidance is an effective treatment in this case.