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Microvascular invasion (MVI) is recognized as a risk factor for early recurrence of hepatocellular carcinoma (HCC) within the Milan criteria after curative treatment.One hundred eleven consecutive patients with HCC within the Milan criteria who underwent hepatic resection were retrospectively reviewed. Independent preoperative predictors of MVI were identified, and a scoring system was developed using significant predictors.MVI was identified in 51 of 111 patients (46%). Multivariate analysis identified the following independent predictors of MVI: alpha-fetoprotein (AFP) of 95 ng/mL (odds ratio [OR], 9.87; 95% confidence interval [95% CI], 2.24-56.8; P = 0.002), des-γ-carboxy prothrombin (DCP) of 55 mAU/mL (OR, 5.50; 95% CI, 2.09-15.4; P 0.001), tumor size of 2.8 cm (OR, 6.10; 95% CI, 2.07-20.0; P 0.001), and non-smooth tumor margin in the hepatobiliary phase of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) (OR, 5.34; 95% CI, 1.84-16.9; P = 0.002). A clinical scoring system was developed using these four variables. Within a total possible score of 0 to 4, the prevalence of MVI with a score of 0, 1, 2, 3, and 4 was 4.5%, 24.0%, 45.5%, 91.7%, and 100%, respectively (P 0.001). The area under the curve of the scoring system was 0.865 based on the receiver operating characteristic curve analysis of the prediction score.Our clinical scoring system, consisting of AFP, DCP, tumor size, and tumor margin in Gd-EOB-DTPA-enhanced MRI, can be valuable for predicting MVI in HCC within the Milan criteria before curative treatment.

A 51-year-old woman underwent endoscopic biliary drainage with a plastic stent for obstructive jaundice due to unresectable pancreatic head cancer. During chemotherapy following heavy ion therapy for the cancer, she presented with acute cholangitis and massive rectal bleeding. The massive hemorrhage was caused by rupture of the biliary duct due to a pseudoaneurysm in the right hepatic artery. The position of the aneurysm coincided with the liver-side end of the plastic stent. Sustained irritation of the arterial and bile duct walls by the stent was considered to have contributed to formation of the aneurysm.

OBJECTIVE. The purpose of this article is to describe CT findings of miscellaneous pulmonary conditions that mimic lung cancers, especially primary cancers, to improve diagnosis of pulmonary lesions. Brief descriptions of patient clinical information and pathologic findings will be included and correlated with imaging findings in actual cases. CONCLUSION. A wide variety of pulmonary conditions present imaging features that mimic those of primary lung cancers and are difficult to differentiate from cancer. Awareness of these conditions with an understanding of their pathologic background and careful attention to the clinical information will help achieve correct diagnoses.

Purpose: We tested the hypothesis that patients with carotid pseudo-occlusion (PO) have a different prognosis from those with carotid artery stenosis (CS) without PO. Materials and Methods: 500 patients were examined for CS by cerebral angiography; those with severe CS ≧70% (CS group) or with PO (PO group) were enrolled in this study. The primary endpoint was defined as the combined endpoint of the occurrence of stroke, myocardial infarction, or death. Patients without any events were censored at 60 months. We followed patients for the occurrence and date of primary endpoints and compared clinical characteristics and outcomes between the PO group and the CS group. Results: We enrolled 337 patients (281 men, 56 women, mean age: 70.4 years, mean follow-up period: 32.0 months), of whom 303 (89.9%) were allocated to the CS group while 34 (10.1%) were allocated to the PO group. The rate of diabetes mellitus in the PO group (55.9%) tended to be higher than in the CS group (39.9%). According to Kaplan-Meier analysis, the PO group suffered from the primary outcome more frequently than the CS group. The occurrence of the primary outcome was also associated with older age, peripheral arterial disease and a history of myocardial infarction. Multivariate analysis indicated that patients in the PO group had a significantly poorer outcome compared with those in the CS group (p = 0.013). Conclusion: Patients in the PO group more frequently had neurological and cardiac events or died compared with those in the CS group.

Purpose This study was designed to determine whether, among Japanese patients receiving medical treatment for carotid stenosis, symptomatic carotid stenosis was more strongly associated with subsequent neurological events than asymptomatic carotid stenosis. Methods We consecutively registered Japanese patients with carotid stenosis of 50% or more as evaluated by digital subtraction angiography who were treated medically. We reviewed medical records regarding previous neurological events as well as other stroke risk factors and underlying diseases at admission. We monitored the occurrence and date of stroke and death after the first evaluation. We also attempted to obtain information from patients or their family members by means of a questionnaire or telephone survey. Results Among 67 patients with carotid stenosis of 50% or more who were treated medically, follow-up was completed in 62 subjects (56 men, 6 women; median age, 72 years; mean follow-up period, 37.3 months). The number of patients with subsequent stroke with symptomatic carotid stenosis was five, while that with asymptomatic stenosis was four. A significantly higher rate of subsequent stroke was observed in patients with symptomatic carotid stenosis compared with those with asymptomatic stenosis (p=0.012). Cox proportional hazards model indicated that symptomatic carotid stenosis was significantly correlated with future neurologic events (p=0.019). Conclusion In a Japanese population with carotid stenosis treated medically, symptomatic carotid stenosis is associated with future stroke more frequently than asymptomatic carotid stenosis.

Background:Development of retrograde blood flow may be observed in the vertebral artery and is associated with progressive ipsilateral proximal subclavian or innominate artery stenosis. The subclavian steal phenomenon is more prevalent in the left subclavian artery (LSA). The purpose of this study was to analyze the correlation between the degree of LSA stenosis and pulse Doppler waveforms of the left vertebral artery (LVA). Methods:A retrospective analysis of LVA waveforms was performed in 22 cases with LSA proximal stenosis before the origin of the LVA in conventional angiograms. The degree of LSA stenosis was classified into 5 groups (Results:A statistically significant correlation (R2 = 0.646, p < 0.0001) was found between the degree of LSA stenosis and the LVA waveform. Conclusions:The pattern analysis of LVA pulse Doppler waveforms seems to be useful in determining the degree of LSA stenosis.

Purpose This study aimed to clarify the angiographic characteristics of radiation-induced carotid stenosis. Methods We evaluated 11 carotid arteries of patients after radiotherapy (radiotherapy group) and 26 carotid arteries of age- and gender-matched patients without a history of radiotherapy (control group). All patients had carotid stenosis detected by digital subtraction angiography (DSA). We developed an original coordinate system on the DSA to determine the accurate length and location of the carotid lesion. Results Radiation-induced carotid lesions were significantly longer than carotid lesions caused by atherosclerosis. The maximal stenosis of radiation-induced carotid lesions tended to be at the end of the stenotic area and within a wider range than the nonradiation-induced lesions, including in the proximal common carotid artery (CCA). Conclusions Radiation-induced stenotic lesions seem to exist in a wide range of carotid artery, including the CCA, along the vessel, and show maximal stenosis near the end of the stenotic area.

Objective Restenosis of the carotid artery after carotid endarterectomy (CEA) is a major complication. The frequency, time of occurrence, and tissue characteristics of carotid restenosis were assessed with sonography. Methods Two hundred sixteen patients who had CEA for carotid stenosis were studied; follow-up sonography and magnetic resonance angiography were done 2 weeks, 3 months, and then every year after CEA. On sonography, restenosis was defined as an internal carotid artery (ICA) with a peak systolic velocity of 170 cm/s or greater or a maximum area of stenosis of 90% or greater. Results During 605 artery-years of follow-up, 18 patients (7.5%) were found to have restenosis on sonography: 4 at 3 months, 11 at 1 year, and 3 at 2 years after CEA. At the time that restenosis was detected, in all 18 ICAs the peak systolic velocity exceeded 200 cm/s and had more than doubled since the last measurement (mean +/- SD, 103 +/- 27 to 321 +/-107 cm/s), whereas the area of stenosis exceeded 90% in 6 patients, and magnetic resonance angiography revealed stenosis of 60% or greater in 8 patients. On sonography, all of the restenotic plaques were isoechoic and concentric. The restenosis was asymptomatic in 17 patients. Vascular risk factors or the severity of initial carotid stenosis before CEA were not associated with development of restenosis. Eleven patients had successful endovascular therapy, and the others received medical treatment. Conclusions A marked increase in the flow velocity through an operated ICA is a good indication of restenosis. The isoechogenicity and concentricity of the restenotic plaques suggest that the restenosis is primarily the result of intimal hyperplasia.

Background The assessment of intracranial arterial communication is important to prevent a stroke from occurring during an aortic arch operation. Bilateral axillary artery perfusion was used with the left common carotid artery perfusion for selective cerebral perfusion. A preoperative left carotid artery compression test with measurement of the left middle cerebral artery (LMCA) flow was performed to determine how safe it was to interrupt the perfusion to the left common carotid artery. Methods Eighteen patients who were scheduled for an aortic arch operation underwent the test. Before surgery, the LMCA flow was detected using transcranial Doppler ultrasonography. During manual compression of the left carotid artery, the flow velocity of the LMCA was measured and expressed as a percent in comparison to the precompression value. Results During carotid artery compression, flow velocity of the LMCA was reduced to 56% ± 36% (median, 63%; range, 0% to 100%) of the precompression value. The communication to the LMCA assessed with magnetic resonance angiography showed a weak relationship to the functional flow reserve of the LMCA based on a transcranial Doppler study. The results indicated that morphologic observation with magnetic resonance angiography did not reflect the dynamic nature of the intracranial collaterals. Conclusions A preoperative left carotid artery compression test with a measurement of the flow of the LMCA is useful to assess the feasibility of interrupting perfusion to the left carotid artery during aortic arch surgery with bilateral axillary artery perfusion.

Background: The cerebral hemodynamics in unilateral moyamoya disease have not been clarified. The present study was done to clarify the clinical characteristics of patients with unilateral moyamoya disease compared to those with typical moyamoya disease or occlusive lesions of the internal carotid artery, terminal portion or middle cerebral artery. Methods: We retrospectively analyzed patients who had unilateral or bilateral steno-occlusive lesions at the internal carotid artery terminal portion or proximal middle cerebral artery. We divided the patients into 3 groups: typical moyamoya (n = 25), unilateral moyamoya (n = 12) and nonmoyamoya (n = 44). Atherosclerotic risk factors and frequency of ischemic and hemorrhagic stroke were compared among the 3 groups. We also examined the extent of cerebral collateral vessels by angiography and used single-photon emission computed tomography to measure the regional cerebral blood flow (rCBF) at rest and after acetazolamide injection. Results: The data on age, sex, hyperlipidemia and smoking habits in the unilateral moyamoya group fell in between those of the typical moyamoya and nonmoyamoya groups. Stroke was less frequent in the unilateral moyamoya group compared to the typical moyamoya or nonmoyamoya groups (p < 0.05). The rCBF at rest and after acetazolamide injection were significantly higher in the unilateral moyamoya group than in the typical moyamoya and nonmoyamoya groups (p < 0.05). Conclusions: Patients with unilateral moyamoya disease appear to have the lowest frequency of stroke and a reduced rCBF, despite the fact that they have more atherosclerotic risk factors than patients with bilateral lesions.

Using transcranial color-coded sonography (TCCS), we evaluated the acute changes in the hemodynamics of cerebral hyperperfusion in two cases. The mean flow velocity of the cerebral arteries increased at the onset of clinical symptoms, together with an increase in the regional cerebral blood flow (rCBF). In serial follow-up studies, the flow velocity gradually returned to normal in parallel with the normalization of the rCBF values. TCCS can be useful for evaluation of acute cerebral hyperperfusion.

Background: To investigate the accuracy of conventional carotid ultrasonography (CCU) combined with transoral carotid ultrasonography (TOCU) for distinguishing pseudo-occlusion from total occlusion of the internal carotid artery (ICA). Methods: This study included 95 patients who were suspected of having an occlusion of the ICA on magnetic resonance angiography (MRA) and underwent both CCU and conventional digital subtraction angiography (DSA) in order to confirm the diagnosis. TOCU was also performed to observe the cervical portion of the ICA distal to the stenosis. We compared the ultrasonographic findings with the DSA findings. Results: Twelve of the 95 patients were defined as having an ICA pseudo-occlusion on DSA. On B-mode images with CCU color Doppler, slight residual flow signals in the ICA lumen were shown in 20 patients. Among them, 2 patients had a pulsed Doppler waveform of the distal ICA occlusion pattern. Among the remaining 18 patients, 4 had a pulsed Doppler waveform of the to and fro flow pattern, and 14 had a weak antegrade flow pattern in the ICA lumen. The conventional ultrasonographic method showed 100% sensitivity with 93% specificity for diagnosing an ICA pseudo-occlusion. The addition of TOCU findings increased the specificity to 98%. In 2 patients, who were overdiagnosed as having an ICA pseudo-occlusion even using TOCU, DSA revealed an occlusion of the ICA distal to the ophthalmic artery with a severe stenosis of the proximal ICA. Conclusions: Using conventional and transoral carotid ultrasonography, an ICA pseudo-occlusion can be diagnosed with higher accuracy.

Background and Methods: We studied changes in brain volume on magnetic resonance imaging in 10 patients with and without extracranial-intracranial (EC-IC) bypass surgery who met the inclusion criteria for the Japanese EC-IC Bypass Trial, a multicenter, randomized, prospective study of patients with hemodynamic brain ischemia due to cerebral artery occlusive disease. We also examined the association of cerebral hemodynamics on single-photon emission computed tomography with the changes in brain volume. Results: The affected/unaffected ratio of the percent brain volume declined in patients without EC-IC bypass surgery (p < 0.02, n = 4), and the affected/unaffected percent regional cerebral blood flow ratio increased in patients with the surgery (p < 0.03, n = 6). Acetazolamide reactivity increased in the affected hemisphere of patients with surgery (p < 0.01). Two-year increase (decrease) in acetazolamide reactivity of the affected hemisphere showed a significant positive correlation with 2-year changes in the affected/unaffected percent brain volume ratio (R2 = 0.737, p = 0.0007). Conclusions: Change in acetazolamide reactivity might be a good predictor for brain atrophy in cerebral artery occlusive disease.

A 54-year-old Japanese woman with a 6-year history of systemic lupus erythematosus (SLE) was admitted to our hospital suffering from acute blindness in her right eye. Her condition recovered after steroid pulse therapy, however, 18 months later she suffered from nuchal pain for 2 weeks after which right hemiparesis with urinary incontinence developed. A spinal magnetic resonance imaging (MRI) revealed cord swelling from C2 to C7. She was diagnosed with neuromyelitis optica (NMO) and intravenous steroid administrations were immediately commenced. Her condition promptly improved. This case was unique because the steroid treatment was quite effective for this case of myelitis, which had passed the acute phase. We supposed that, because most of the lesion was not necrotic or demyelinated, but rather showed edematous change caused by vasculitis based on autoimmune pathogenesis, the symptoms progressed rather gradually and improved promptly in response to glucocorticoid treatment.

Advanced systemic atherosclerotic disease is increasing in Japan. The patients with severe carotid steno-tic lesion have frequently (30-40%) associated with coronary artery disease, especially in those with diabetes mellitus and peripheral arterial disease. The new concept of acute neurovascular syndrome is similar to that of acute coronary syndrome, and both are based on the therapeutic standpoint. It becomes more important to protect the advanced atherosclerotic patients from both cerebral and myocardial ischemia/infarction, although the technology and safety of the surgery and stenting for carotid and coronary artery is remarkably improving. Clinical evidence from Japanese large clinical research should be clarified near future. The various approaches to carotid and coronary atherosclerosis tend to be less invasive.

Background: To investigate the utility of superficial temporal artery (STA) duplex ultrasonography (STDU) for evaluating the improvement of the cerebral hemodynamics after extracranial-intracranial (EC-IC) bypass. Methods: This study included 40 consecutive patients who underwent EC-IC bypass for occlusive disease of cerebral arteries. STDU was performed to measure the flow velocity, pulsatility index, and diameter of the operated STA before and 14 days after EC-IC bypass. Regional cerebral blood flow (rCBF) and acetazolamide (ACZ) reactivity of the ipsilateral middle cerebral artery (MCA) territory were evaluated by quantitative single-photon emission computed tomography with the ACZ challenge test. We investigated the correlation between STA flow velocity/diameter and rCBF/ACZ reactivity in the ipsilateral MCA territory. Results: Mean flow velocity (MFV; 26.3 ± 8.8 to 55.3 ± 16.3 cm/s, p < 0.0001) and diameter (1.57 ± 0.24 to 2.26 ± 0.29 mm, p < 0.0001) of the STA, and rCBF (29.1 ± 3.1 to 35.0 ± 6.4 ml/100 g/min, p < 0.0001) and ACZ reactivity (–0.02 ± 0.10 to 0.28 ± 0.21, p < 0.0001) of the MCA territory increased after EC-IC bypass compared with the baseline values. STA MFV was significantly correlated with the rCBF 14 days after EC-IC bypass (R = 0.70, p < 0.0001). A cutoff value of postsurgical STA MFV greater than 48.5 cm/s yielded the highest diagnostic accuracy (sensitivity 86%; specificity, 82%) for rCBF ≧32 ml/100 g/min after EC-IC bypass. Conclusions: STDU was available for evaluating postsurgical patency of the bypass flow and the rCBF of the ipsilateral MCA territory. The mean blood flow velocity of the operated STA is a highly sensitive parameter for predicting rCBF in the ipsilateral MCA territory after EC-IC bypass.

Background and Purpose— The purpose of the present study was to evaluate availability of transcranial color-coded real-time sonography (TCCS) to detect hyperperfusion after carotid endarterectomy (CEA). Methods— This prospective study included 105 consecutive patients who underwent CEA for severe carotid stenosis. TCCS with echo contrast agents was performed serially to evaluate flow velocity of the middle cerebral artery (MCA). Regional cerebral blood flow (rCBF) and vasodilatory capacity of the MCA territory were evaluated using single-photon emission computed tomography. We compared the changes in MCA flow velocity with rCBF. Results— Using echo contrast agents, we could evaluate the MCA flow in 95 (90%) of 105 patients. Twelve patients showed hyperperfusion syndrome. Changes in the MCA mean flow velocity (MFV) before and 4 days after CEA were significantly correlated with those in rCBF ( r =0.48; P 50% in MCA MFV was observed within 4 days after CEA in all 12 patients with hyperperfusion syndrome. Multivariate analysis revealed that reduced vasodilatory capacity (odds ratio, 0.14; 95% CI, 0.04 to 0.46) was an independent risk factor for a 1.5-fold increase in the MFV of MCA ipsilateral to CEA. Conclusions— Findings of a 1.5-fold increase in the MCA MFV can accurately identify those patients with high risk of developing post-CEA hyperperfusion syndrome. TCCS with echo contrast agents is available for the evaluation of hyperperfusion after CEA.

Here, we report two cases with rapidly progressive renal failure, caused by cholesterol crystal embolism (CCE), after an angiography for carotid artery stenosis. The diagnosis was determined by histological examination and from clinical symptoms, including livedo reticularis and eosinophilia. Neurologists and neuroradiologists tend to underdiagnose CCE, which results from the same atherosclerotic risk factors as cerebrovascular disease. We need to understand more about CCE and identify its unique clinical symptoms to enable an early diagnosis and treatment.

We report a patient who developed reversible posterior leukoencephalopathy syndrome (RPLS) in puerperium without preeclampsia-eclampsia or chronic hypertension. The woman suddenly complained of visual loss and headache 10 days after delivery caused by edematous lesions mainly distributed in the bilateral occipital lobe. Apparent diffusion coefficient map was useful for distinction of this vasogenic edema from cytotoxic edema due to brain infarction. Under the diagnosis of RPLS, we successfully treated her disease using a trinitroglycerin as an antihypertensive, a hyperosmolar agent, methylprednisolone, and a free radical scavenger. Postpartum women may have the risk of development of RPLS even without preeclampsia-eclampsia. Vascular endothelial dysfunction may trigger RPLS, in addition to acute and modest increase in systemic pressure.

The objective of this study was to identify the clinical features associated with neurological deterioration within 30 days of ischemic stroke patients with spontaneous cevicocranial dissection (SCCD) and clarify the effect on outcomes. We retrospectively identified 18 patients with SCCD (1.6%, 3 women, 52 ± 16 years old) among 1,112 patients with acute ischemic stroke within 7 days after onset. Of the 18 patients, 13 (72%) had vertebrobasilar arterial dissection. Neurological deterioration was present in 4 patients (22%), and 2 patients (11%) died. All of them became worse within 3 days after onset. Their initial blood pressures were high. All of them had dominant side vertebral artery or basilar artery dissection. Subarachnoid hemorrahage (SAH) were not seen although the agressive anticoagulant therapy were performed except for a case who had aneurysmal change. The patients with neurological deterioration had poor outcome, but the patients without neurological deterioration had good outcome. Recurrent ischemic event or SAH did not occurred in 3 months if they had not neurological deterioration. When we see acute stroke patients with dissection at the dominant side vertebral artery or the basilar artery, we should observe carefully for neurological deterioration especially within three days of onset.

Computed tomography (CT) plays a leading role in the evaluation of nonmalignant disease of the adrenal gland. CT is highly accurate in the localization of adrenal masses in patients with diseases associated with hyperfunctioning adrenal glands such as Cushing syndrome and Cushing disease, Conn syndrome, adrenal tumors leading to virilization or feminization, and pheochromocytomas. CT permits a specific diagnosis of acute or subacute adrenal hematoma and myelolipoma. Hematomas are round to oval and have increased attenuation (50-90 HU) that decreases on follow-up CT scans. Myelolipomas typically manifest as a well-defined suprarenal mass with an attenuation of-30 to -115 HU. Adrenal cysts are usually round to oval and manifest as a hypoattenuating mass with a smooth, thin wall. CT is useful in the evaluation of patients with Addison disease, particularly the subacute form secondary to tuberculosis or disseminated histoplasmosis. Findings typically include bilateral adrenal enlargement with a central necrotic area of hypoattenuation and peripheral enhancement. Thin-section unenhanced CT permits accurate measurement of attenuation and can be used to differentiate adrenal adenoma from metastasis in a cancer patient with an indeterminate mass: Attenuation of 10 HU or less usually indicates adenoma rather than cancer. If the mass is found incidentally at contrast material-enhanced CT, delayed scans obtained as early as 5-15 minutes after intravenous administration of contrast material appear to have comparable accuracy.

An unruptured intracranial aneurysm is an uncommon but possible embolic source to the brain. We report a young patient who developed recurrent ischemic strokes occurring mainly in the left internal carotid arterial territory within a short interval; the first stroke occurred midway through a long-distance race, and the second stroke occurred immediately following a bowel movement. The angiographical contrast deficit indicated a thrombus in the left anterior cerebral artery as a result of the embolism. A saccular aneurysm of the left distal internal carotid artery was the only detectable potential embolic source. Initially anticoagulant therapy was given, and then surgical clipping of the aneurysm was performed. The patient has been free from stroke recurrence. As a cause of ischemic stroke in young adults, a carotid saccular aneurysm should be considered. Hard exercise and a Valsalva maneuver may be important triggers of thrombus detachment from the aneurysm.

Image processing of gastric ulcer scars was conducted using a computer-equipped electronic endoscope in order to quantitatively classify the quality of gastric ulcer scars. Frontal images of 66 gastric ulcer scars (red scar stage), in 60 patients, obtained by electronic endoscopy were fed into a desktop computer system. Ulcer scars were classified according to the standard deviation of green signal intensity and unevenness of the scar surface, following repeated application of smoothing, into three groups. Group I: ulcer scars with a standard deviation of green signal intensity less than or equal to 15 and a flat surface after smoothing had been carried out 10 times. Group II: ulcers other than Group I or III. Group III: ulcers with a standard deviation greater than or equal to 25 and markedly uneven features after smoothing had been carried out 20 times. Follow-up gastroscopy examinations were performed at 2-week intervals and the cumulative recurrence rate, as well as the transition from red scar stage to white scar phase, were determined 7 months after initial healing. There were 15 Group I, 28 Group II and 23 Group III ulcer scars. The proportion of ulcer relapse was 6.7% in Group I, 35.7% in Group II and 47.5% in Group III. Regarding the relationship between the transition rate from red scar to white scar and the scar classification, 66.7% of Group I, 28.6% of Group II and 17.4% of Group III ulcer scars progressed to the white scar stage. This classification of gastric ulcer scars provides a representative index of the quality of ulcer healing, which is potentially useful for planning maintenance treatment.

Objectives To determine the incidence of antegrade internal carotid artery collateral flow in patients with common carotid artery occlusion, which artery supplies blood to the internal carotid artery, and whether the flow affects regional cerebral blood flow in the middle cerebral artery territory. Methods We determined the incidence of antegrade internal carotid artery collateral flow and identified its arterial origins using carotid sonography in 10 patients with common carotid artery occlusion and evaluated middle cerebral artery territory regional cerebral blood flow by single-photon emission computed tomography in these patients and 30 age- and sex-matched patients with internal carotid artery occlusion. Results Six (60%) of the 10 patients with common carotid artery occlusion had antegrade internal carotid artery collateral flow, which was supplied through the carotid bifurcation from retrograde flow of the external carotid artery in 5 and by a small artery directly into the internal carotid artery in 1. The regional cerebral blood flow ipsilateral to the occlusion at rest was higher in patients with common carotid artery occlusion than those with internal carotid artery occlusion (mean ± SD, 40.4 ± 8.5 versus 34.3 ± 6.2 mL/100 g/min; P = .02). The regional cerebral blood flow was significantly higher in the 6 patients with antegrade internal carotid artery flow than those with internal carotid artery occlusion at rest (42.2 ± 7.2 versus 34.3 ± 6.2 mL/100 g/min; P = .02) but not in the other 4 patients without antegrade internal carotid artery flow. Conclusions Antegrade collateral internal carotid artery flow was found in 60% of patients with common carotid artery occlusion and was mainly supplied by retrograde external carotid artery flow. It contributes to maintenance of middle cerebral artery territory regional cerebral blood flow.

Thirty-six cancer patients with symptomatic tracheobronchial stenoses received Gianturco tracheobionchial stents over a 9-year period. Symptoms improved in 28 patients (78%). The overall median survival was 1 month 3 weeks (range, 4 days to 35 months). The median survival for patients who showed improvement after receiving stents was 3 months compared with 1 week for those who did not respond. Complications were minimal. The Gianturco stent may palliate symptoms of tracheobronchial compression in selected cancer patients.

Object This study describes clinicopathological characteristics of pseudo-occlusion of the internal carotid artery with regard to its possible mechanisms. Methods The authors retrospectively reviewed 17 patients with pseudo-occlusion and 23 with high-grade stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria ≥ 90%, but no collapsed distal internal carotid artery) who underwent carotid endarterectomy. Atherosclerotic risk factors, clinical presentation, angiographic findings, and histological features of plaque obtained from the carotid endarterectomy were investigated and comparisons were made between groups. Results Plaques obtained in the pseudo-occlusion group were significantly more fibrous and less atheromatous than those in the high-grade stenosis group. Old, organized thrombi were more frequently found in pseudo-occlusion group plaques than in high-grade stenosis group plaques. Plaques acquired in the pseudo-occlusion group had 2 different histological features: the presence or absence of the original lumen. The pseudo-occlusion plaques with total occlusion and recanalization (8 patients) were composed of thrombotic total occlusion with lumen recanalization by large neovascular channels, whereas those with severe stenosis (9 patients) were fibrous or fibroatheromatous and had severe stenosis of the original lumen. In patients with pseudo-occlusion and total occlusion and recanalization, the authors observed a significantly higher incidence of transient ischemic attack and anterior communicating artery–posterior communicating artery collateral flow than those with high-grade stenosis and pseudo-occlusion with severe stenosis. Conclusions Plaques of the pseudo-occlusion group were more fibrous than those of the high-grade stenosis group and had 2 different histological features: pseudo-occlusion with total occlusion and recanalization or pseudoocclusion with severe stenosis. This difference in plaque histology may be related to the clinical features of pseudoocclusion, such as symptoms and collateral flow patterns.

Purpose. To investigate the correlation of Apperent Diffusion Coefficient (ADC) values in invasive ductal breast carcinomas with detailed histologic features and enhancement ratios on dynamic contrast-enhanced MRI.Methods and Materials. Dynamic MR images and diffusion-weighted images (DWIs) of invasive ductal breast carcinomas were reviewed in 25 (26 lesions) women. In each patient, DWI, T2WI, T1WI, and dynamic images were obtained. The ADC values of the 26 carcinomas were calculated with b-factors of 0 and 1000 s/ using echoplanar DWI. Correlations of the ADC values were examined on dynamic MRI with enhancement ratios (early to delayed phase: E/D ratio) and detailed histologic findings for each lesion, including cellular density, the size of cancer nests, and architectural features of the stroma (broad, narrow, and delicate) between cancer nests.Results. The mean ADC was /sec. Cellular density was significantly correlated with ADC values () and E/D ratios (). The ADC values were also significantly correlated to features of the stroma (broad to narrow, ).Conclusion. The findings suggest that DWIs reflect the growth patterns of carcinomas, including cellular density and architectural features of the stroma, and E/D ratios may also be closely correlated to cellular density.

Well-differentiated fetal adenocarcinoma is a rare primary adenocarcinoma originating in the lung. We present an early phase case that was followed up for 2 years with chest roentgens and high-resolution computed tomography. Multicentric origin was suspected in the sequential high-resolution computed tomography study findings.

Neuronal migration disorders include various anomalies of the brain, and cortical heterotopia is the most common type. In this report, we present the radiological findings of two adults with unusually large cortical heterotopia associated with fused-lip schizencephaly that caused extensive ventricular indentation. The lesion showed density on a computed tomographic scan and signal intensity on a magnetic resonance imaging scan similar to normal gray matter. Perifocal edema, contrast enhancement, and calcification were not seen. An abnormally decreased volume of the ipsilateral cerebral hemisphere, the presence of adjacent microgyri, and deep fissures that contained blood vessels were also characteristic findings, indicating abnormal development. Knowledge of this entity is important in differentiating true intracerebral neoplasms.

A unique case of hypogenetic lung syndrome is demonstrated with contrast-enhanced multidetector row computed tomography images. This is the first report of hypogenetic lung syndrome with anomalous venous return to the left inferior pulmonary vein.

A 56-year-old-man was admitted to our hospital because of acute brain infarction with symptoms of consciousness disturbance and left hemiparesis. After admission, the symptoms disappeared rapidly. MRI diffusion-weighted image on day one revealed high intensity area at the right insular cortex and MRA showed stenosis of the right middle cerebral artery. MRA on the next day demonstrated that the stenotic lesion improved, but another stenosis appeared at the petrous portion of the right internal carotid artery (ICA). Brain angiography on day eight showed improvement of the stenosis of the right ICA petrous portion and stenosis of bilateral ICAs extracranial distal portion. The transoral carotid ultrasonography (TOCU) on day nine showed clearly true lumen and false lumen at the bilateral extracranial distal ICAs, which indicated spontaneous dissection of the bilateral extracranial distal ICAs. TOCU seems very useful in evaluating the extracranial carotid arterial dissection.