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Eriko Takeda,1 Yota Katsuyama,2,3 Daichi Sogai,1,3 Li Yu,1,4 Yasuyo Kumagae,1 Daiki Yokokawa,4 Yasushi Shinohara,1 Kiyoshi Shikino3,4 1Department of General Medicine, Sanmu Medical Center, Chiba, Japan; 2Sambunomori Clinic, Chiba, Japan; 3Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan; 4Department of General Medicine, Chiba University Hospital, Chiba, JapanCorrespondence: Kiyoshi Shikino, Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba Pref, Japan, Tel +81-43-222-7171 (Ext. 6438) ; +81-43-224-4758, Email kshikino@gmail.comPurpose: This study aimed to investigate cancer screening rates and the reasons for not undergoing screening among patients who regularly visited the Sanmu Medical Center.Patients and Methods: This prospective observational study recruited patients aged ≥ 40 years with regular clinic visits to Sanmu Medical Center during October 2019. We conducted a self-administered survey to determine the patient’s sex and whether they underwent cancer screening in 2019, and if not, the reason for the same. The primary outcome measure was the percentage of people who did not undergo cancer screening.Results: A total of 198 responses (108 male respondents) were obtained. Among them, 189 were valid responses (valid response rate 94.5%). One hundred and twenty-nine patients (68.2%, 76 male) had not undergone screening. The most common reasons provided were “I have regular regular clinic visits and do not think they are necessary” (N = 65, 50.3%), “I underwent a gastroscopy within 2 years, a colorectal camera examination within a few years, and a chest radiography within a year” (42.5%), and “I have a separate complete medical checkup” (N = 15, 11.6%). Of the 65 patients who responded that their cancer screenings were unnecessary, 42 patients (64.6%) had not undergone a gastroscopy within 2 years, a colorectal camera examination within a few years, or a chest radiography or examination within a year.Conclusion: Roughly half of the respondents who did not undergo cancer screening elected to abstain because they believed that regular hospital visits were sufficient. Encouraging patients who regularly visit medical institutions to receive cancer screening is therefore necessary.Keywords: cancer screening, internal medicine, non-consultation, rural medicine

Objective: The aim of the study is to evaluate the usefulness of virtual monoenergetic imaging (VMI) generated from dual-energy computed tomography (DECT) in detecting small pancreatic ductal adenocarcinomas (PDACs)., Methods: This study included 82 patients pathologically diagnosed with small PDAC (≤30 mm) and 20 without pancreatic tumors who underwent triple-phase contrast-enhanced DECT. To assess diagnostic performance for small PDAC detection via a receiver operating characteristic analysis, 3 observers reviewed 2 image sets (conventional computed tomography [CT] set and combined image set [conventional CT + 40-keV VMI from DECT]). The tumor-to-pancreas contrast-to-noise ratio was compared between conventional CT and 40-keV VMI from DECT., Results: The area under the receiver operating characteristic curve of the 3 observers were 0.97, 0.96, and 0.97 in conventional CT set and 0.99, 0.99, and 0.99 in combined image set (P = 0.017-0.028), respectively. The combined image set yielded a better sensitivity than the conventional CT set (P = 0.001-0.023), without a loss of specificity (all P > 0.999). The tumor-to-pancreas contrast-to-noise ratios of 40-keV VMI from DECT were approximately threefold higher than those of conventional CT at all phases., Conclusions: The addition of 40-keV VMI from DECT to conventional CT had better sensitivity for detecting small PDACs without compromising specificity., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Several retrospective studies have reported spine-femur discordance in bone mineral density (BMD) values. However, the average age of individuals in these studies was the mid-50s, which is younger than the typical age of individuals requiring treatment for primary osteoporosis. Therefore, we aimed to investigate factors associated with discordance in the percentage of young adult mean (YAM) between the lumbar spine and femoral neck in the elderly population., Methods: We evaluated 4549 dual-energy X-ray absorptiometry (DXA) measurements obtained from 2161 patients (269 men and 1892 women) between January 2014 and December 2017 at our hospital. For individuals with more than one eligible set of measurements, the first record was used. We investigated each patient's age, sex, body mass index, current smoking status, alcohol consumption, use of steroids, presence of diabetes mellitus, and presence of rheumatoid arthritis., Results: The mean age of the patients was 76.4 ± 8.9 years. Older age (p <  0.001), male sex (p <  0.001), and diabetes mellitus (p = 0.007) were significantly associated with spine-femur discordance in the percentage of YAM., Conclusion: The frequency and magnitude of spine-femur discordance in the percentage of YAM from DXA scans increased with age. Notably, more than 77.4% of patients in their 90s had spine-femur discordance > 10% of YAM. Furthermore, the frequency of spine-femur discordance was higher in men and in patients with diabetes mellitus, suggesting that the percentage of YAM at the lumbar spine may not be reliable for diagnosis of osteoporosis in patients with these factors., (© 2022. The Author(s).)

Background: It is quite rare for breast cancer to metastasize to the kidney with a tumor thrombus in the inferior vena cava., Case Presentation: A Japanese woman in her forties was diagnosed with cancer of the left breast and underwent left mastectomy with sentinel lymph node biopsy. The final pathological diagnosis was pT1aN0M0, stage IA (ER positive, PgR positive, HER2 negative). Thirteen years later, she presented for care with the complaint of abdominal pain. By imaging findings, right renal carcinoma with a tumor thrombus in the inferior vena cava and lung metastases was suspected. However, her tumors were refractory to molecular targeted therapy. In addition, CT-guided needle biopsy of the kidney and lung lesions was done and it was revealed that lesions of the left lung and the right kidney was breast cancer metastases (ER positive, PgR positive, HER2 negative). The patient started combination therapy consisting of abemaciclib, tamoxifen and leuprorelin. Six months later, she died from progression of her metastatic disease., Conclusions: It is sometimes difficult to differentiate between primary renal cancer and kidney metastases from breast cancer on imaging. Renal biopsy is recommended before commencing treatment., (© 2022. The Author(s).)

BACKGROUND . Accurate nodal staging is essential to guide treatment selection in patients with non-small cell lung cancer (NSCLC). To our knowledge, measurement of electron density (ED) using dual-energy CT (DECT) is unexplored for this purpose. OBJECTIVE . The purpose of our study was to assess the utility of ED from DECT in diagnosing metastatic mediastinal lymph nodes in patients with NSCLC in comparison with conventional CT and FDG PET/CT. METHODS . This retrospective study included 57 patients (36 men, 21 women; mean age, 68.4 ± 8.9 [SD] years) with NSCLC and surgically resected mediastinal lymph nodes who underwent preoperative DECT and FDG PET/CT. The patients had a total of 117 resected mediastinal lymph nodes (33 metastatic, 84 nonmetastatic). Two radiologists independently reviewed the morphologic features of nodes on the 120-kVp images and also measured the iodine concentration (IC) and ED of nodes using maps generated from DECT data; consensus was reached for discrepancies. Two different radiologists assessed FDG PET/CT examinations in consensus for positive node uptake. Diagnostic performance was evaluated for individual and pairwise combinations of features. RESULTS . The sensitivity, specificity, and accuracy for nodal metastasis were 15.2%, 98.8%, and 75.2% for the presence of necrosis, respectively; 54.5%, 85.7%, and 76.9% for short-axis diameter greater than 8.5 mm; 63.6%, 73.8%, and 70.9% for long-axis diameter greater than 13.0 mm; 51.5%, 79.8%, and 71.8% for attenuation on 120-kVp images of 95.8 HU or less; 87.9%, 58.3%, and 66.7% for ED of 3.48 × 10 23 /cm 3 or less; and 66.7%, 75.0%, and 72.6% for positive FDG uptake. Among pairwise combinations of features, accuracy was highest for the combination of ED and short-axis diameter (accuracy, 82.9%; sensitivity, 54.5%; specificity, 94.0%) and the combination of ED and positive FDG uptake (accuracy, 82.1%; sensitivity, 60.6%; specificity, 90.5%); these accuracies were greater than those for the individual features ( p < .05). The remaining combinations exhibited accuracies ranging from 74.4% to 77.8%. Interobserver agreement analysis showed an intraclass correlation coefficient of 0.90 for ED. IC was not significantly different between metastatic and nonmetastatic nodes ( p = .18) and was excluded from the diagnostic performance analysis. CONCLUSION . ED derived from DECT may help diagnose metastatic lymph nodes in NSCLC given decreased ED in metastatic nodes. CLINICAL IMPACT . ED may complement conventional CT findings and FDG uptake on PET/CT in diagnosing metastatic nodes.

Purpose: To assess the feasibility of extracellular volume (ECV) fraction determined with equilibrium contrast-enhanced MRI for prediction of treatment response to chemotherapy in pancreatic ductal adenocarcinoma (PDAC) in comparison with dynamic contrast-enhanced MRI (DCE-MRI), and to clarify the association between ECV fraction and DCE-MRI-derived pharmacokinetic parameters., Methods: This retrospective study included 58 consecutive patients with histologically confirmed PDAC who underwent DCE-MRI before systemic chemotherapy. Tumor pharmacokinetic parameters, including the volume transfer coefficient (K trans ), rate constant (k ep ), and extracellular extravascular volume fraction (v e ) of DCE-MRI, and ECV fraction determined with equilibrium contrast-enhanced MRI were compared between the response and non-response groups. The correlation of tumor ECV fraction with each DCE-MRI-derived pharmacokinetic parameter was examined using Spearman's rank correlation coefficient., Results: Tumor K trans , v e , and ECV fraction were significantly higher in the response group than in the non-response group (all, P < 0.001), whereas no significant difference was found in k ep (P = 0.119). Tumor ECV fraction showed the highest area under receiver operating characteristic curve of 0.918, with a sensitivity of 89.3%, specificity of 90.0%, and accuracy of 89.7% (cut off, >37.6%). The ECV fraction showed a significant positive correlation with K trans (Spearman's coefficient = 0.66, P < 0.001) and v e (Spearman's coefficient = 0.79, P < 0.001)., Conclusions: ECV fraction determined with equilibrium contrast-enhanced MRI was as useful as DCE-MRI-derived pharmacokinetic parameters for predicting treatment response to chemotherapy in patients with PDAC., (Copyright © 2021 Elsevier B.V. All rights reserved.)

BACKGROUND. Contrast-enhanced CT performed for pancreatic ductal adeno-carcinoma (PDAC) detection traditionally uses a dual-phase (pancreatic and portal venous) protocol. However, PDAC may exhibit isoattenuation in these phases, hindering detection. OBJECTIVE. The purpose of this study was to assess the impact on diagnostic performance in detection of small PDAC when a delayed phase is added to dual-phase contrast-enhanced CT. METHODS. A database of 571 patients who underwent triple-phase (pancreatic, portal venous, and delayed) contrast-enhanced MDCT between January 2017 and March 2020 for suspected pancreatic tumor was retrospectively reviewed. A total of 97 patients had pathologically confirmed small PDAC (mean size, 22 mm; range, 7-30 mm). Twenty control patients had no pancreatic tumor suspected on CT, on initial MRI and follow-up CT, or on MRI after 12 months or longer. Three radiologists independently reviewed dual-phase and triple-phase images. Two additional radiologists assessed tumors' visual attenuation on each phase, reaching consensus for differences. Performance of dual- and triple-phase images were compared using ROC analysis, McNemar test, and Fisher exact test. RESULTS. AUC was higher ( p < .05) for triple-phase than dual-phase images for all observers (observer 1, 0.97 vs 0.94; observer 2, 0.97 vs 0.94; observer 3, 0.97 vs 0.95). Sensitivity was higher ( p < .001) for triple-phase than dual-phase images for all observers (observer 1, 74.2% [72/97] vs 59.8% [58/97]; observer 2, 88.7% [86/97] vs 71.1% [69/97]; observer 3, 86.6% [84/97] vs 72.2% [70/97]). Specificity, PPV, and NPV did not differ between image sets for any reader ( p ≥ .05). Seventeen tumors showed pancreatic phase visual isoattenuation, of which nine showed isoattenuation and eight hyperattenuation in the delayed phase. Of these 17 tumors, 16 were not detected by any observer on dual-phase images; of these 16, six were detected by at least two observers and five by at least one observer on triple-phase images. Visual attenuation showed excellent interob-server agreement (κ = 0.89-0.96). CONCLUSION. Addition of a delayed phase to pancreatic and portal venous phase CT increases sensitivity for small PDAC without loss of specificity, partly related to delayed phase hyperattenuation of some small PDACs showing pancreatic phase isoattenuation. CLINICAL IMPACT. Addition of a delayed phase may facilitate earlier PDAC detection and thus improved prognosis.

Purpose: To evaluate the usefulness of dual-energy analyses using dual-layer spectral CT (DLSCT) for diagnosing recurrent lesions of head and neck squamous cell carcinoma (HNSCC)., Materials and Methods: The study population comprised 62 patients with a history of HNSCC. Attenuation values on conventional 120-kVp images and 40-keV virtual monochromatic images (VMIs) and iodine concentration (IC) were compared between recurrent lesions and post-treatment changes or non-recurrent nodes using the Mann-Whitney U test. Receiver-operating characteristic (ROC) analysis was used to assess the ability of attenuation values and IC to diagnose recurrent lesions., Results: Attenuation values for 120-kVp and 40-keV images and IC of local recurrent lesions were significantly higher than those of post-treatment changes (p < 0.001), whereas recurrent nodes showed significantly lower attenuation values for both 120 kVp and 40 keV and IC than non-recurrent nodes (p < 0.001). Area under the ROC curves for 120-kVp images, 40-keV images, and IC to diagnose local recurrences were 0.912, 0.992, and 0.984, respectively, and those to diagnose recurrent nodes were 0.819, 0.922, and 0.934, respectively., Conclusions: Dual-energy images using DLSCT, particularly 40-keV VMIs and IC, may help in diagnosing recurrent lesions of HNSCC.

The purpose of this study is to determine whether multiparametric non-contrast MR imaging including diffusion-weighted imaging (DWI), arterial spin labeling (ASL), and amide proton transfer (APT) weighted imaging can help differentiate malignant from benign salivary gland lesions. The study population consisted of 42 patients, with 31 benign and 11 malignant salivary gland lesions. All patients were evaluated using DWI, three-dimensional pseudo-continuous ASL, and APT-weighted imaging on 3 T MR imaging before treatment. Apparent diffusion coefficient (ADC), tumor blood flow (TBF), and APT-related signal intensity (APTSI) values within the lesion were compared between the malignant and benign lesions by Mann-Whitney U test. For each parameter, optimal cutoff values were chosen using a threshold criterion that maximized the Youden index for predicting malignant lesions. The performance of ADC, TBF, APTSI, individually and combined, was evaluated in terms of diagnostic ability for malignant lesions. Diagnostic performance was compared by McNemar test. APTSI was significantly higher in malignant lesions (2.18 ± 0.89%) than in benign lesions (1.57 ± 1.09%, p = 0.047). There was no significant difference in ADC or TBF between benign and malignant lesions (p = 0.155 and 0.498, respectively). The accuracy of ADC, TBF, and APTSI for diagnosing malignant lesions was 47.6%, 50.0%, and 66.7%, respectively; whereas the accuracy of the three parameters combined was 85.7%, which was significantly higher than that of each parameter alone (p = 0.001, 0.001, and 0.008, respectively). Therefore, the combination of ADC, TBF, and APTSI can help differentiate malignant from benign salivary gland lesions.

Purpose: To determine whether combined signal averaging and compressed sensing (CS averaging) improves the image quality of contrast-enhanced fat-suppressed T1-weighted three-dimensional turbo field-echo (FS T1W 3D-TFE) for evaluation of pharyngolaryngeal squamous cell carcinoma (PLSCC)., Methods: This retrospective study included 27 patients with PLSCC. In all patients, contrast-enhanced FS T1W 3D-TFE imaging with CS averaging (number of excitations, 7) and that without CS averaging (number of excitations, 1) were obtained during the same acquisition time. Overall image quality, mucosal enhancement, vessel clarity, motion artifact, lesion conspicuity, and lesion edge sharpness were qualitatively evaluated using a 5-point scale. Images with and without CS averaging were compared using the Wilcoxon signed-rank test. Signal-to-noise ratio (SNR) of the lesion and the muscle structure were compared between the two imaging methods using a paired t-test., Results: Compared with the images without CS averaging, those with CS averaging showed significantly better overall image quality (p = 0.002), mucosal enhancement (p = 0.009), vessel clarity (p = 0.003), muscle edge clarity (p = 0.002), lesion conspicuity (p = 0.002), and lesion edge sharpness (p = 0.001); and less motion artifact (p < 0.001). The SNRs of the lesion and of the muscle structure were significantly higher for images with CS averaging than those without CS averaging (p < 0.001)., Conclusion: CS averaging improves the image quality of contrast-enhanced FS T1W 3D-TFE MR images for evaluation of PLSCC without requiring additional acquisition time.

Background: Pancreatic ductal adenocarcinoma (PDAC) has substantial heterogeneity in biophysical features and in outcomes of patients. Identifying reliable pretreatment imaging biomarkers for PDAC with distant metastases (stage IV) is a key imperative. Our objective was to determine whether visual tumor enhancement pattern on enhanced computed tomography (CT) can be used as a prognostic factor in stage IV PDAC treated with chemotherapy., Methods: This is a retrospective cohort study of 133 patients with stage IV PDAC who underwent multiphasic enhanced CT before systemic chemotherapy. The enhancement pattern of PDAC was qualitatively categorized as hypoattenuation, isoattenuation, or hyperattenuation on each of the pancreatic, portal venous, and delayed phases. The effects of clinical prognostic factors and the visual tumor enhancement pattern on progression-free survival (PFS) and overall survival (OS) were assessed in univariate and multivariate analyses using Cox proportional hazards models., Results: On univariate analysis, the number of metastatic organs and the visual tumor enhancement pattern during the delayed phase were significantly associated with PFS (p = 0.003 and < 0.001, respectively) and OS (p = 0.005 and < 0.001, respectively). Multivariate analysis identified the number of metastatic organs (PFS, p = 0.021; OS, p = 0.041) and visual tumor enhancement pattern during the delayed phase (PFS, p < 0.001; OS, p < 0.001) as independent predictors of PFS and OS., Conclusion: Visual enhancement pattern of PDAC on delayed phase enhanced CT appears to be associated with outcomes and could be a useful prognostic factor in stage IV PDAC, despite the need to add the delayed phase to CT protocol for pancreatic disease., Competing Interests: Declaration of competing interest The authors have no conflicts of interest directly relevant to the content of this article., (Copyright © 2020 IAP and EPC. Published by Elsevier B.V. All rights reserved.)

Objectives: To evaluate the feasibility of equilibrium contrast-enhanced dual-energy CT (DECT), as compared with single-energy CT (SECT) and to calculate extracellular volume (ECV) fraction to predict the survival outcomes of pancreatic ductal adenocarcinoma (PDAC) patients with distant metastases (stage IV) treated with chemotherapy., Methods: The study cohort included a total of 66 patients with stage IV PDAC who underwent DECT before systemic chemotherapy between July 2014 and March 2017. Unenhanced and 120-kVp equivalent images during the equilibrium phase were used to calculate tumor SECT-derived ECV fractions, and iodine density images were obtained from equilibrium-phase DECT for DECT-derived ECV fractions. Correlations between SECT- and DECT-derived ECV fractions were identified using the Pearson correlation coefficient and Bland-Altman analysis. The effects of clinical prognostic factors and tumor SECT- and DECT-derived ECV fractions on progression-free survival (PFS) and overall survival (OS) were assessed by univariate and multivariate analyses using Cox proportional hazards models., Results: The correlation between SECT- and DECT-derived ECV fractions was strong (r = 0.965; p < 0.001). The Bland-Altman plot between SECT- and DECT-derived ECV fractions showed a small bias (- 3.4%). Increasing tumor SECT- and DECT-derived ECV fractions were associated with a positive effect on PFS (SECT, p = 0.002; DECT, p = 0.007) and OS (DECT, p = 0.014; DECT, p = 0.015). Only tumor DECT-derived ECV fraction was an independent predictor of PFS (p = 0.018) and OS (p = 0.022) in patients with stage IV PDAC treated with chemotherapy on multivariate analysis., Conclusions: The ECV fraction determined by equilibrium contrast-enhanced DECT can potentially predict the survival of patients with stage IV PDAC treated with chemotherapy., Key Points: • Extracellular volume fraction of stage IV pancreatic ductal adenocarcinoma determined by dual-energy CT was strongly correlated to that with single-energy CT (r = 0.965, p < 0.001). • Tumor extracellular volume fraction was an independent predictor of progression-free survival (p = 0.018) and overall survival (p = 0.022). • Extracellular volume fraction determined by dual-energy CT could be a useful imaging biomarker to predict the survival of patients with stage IV pancreatic ductal adenocarcinoma treated with chemotherapy.

Objective: This study aimed to determine whether extracellular volume (ECV) fraction with routine equilibrium contrast-enhanced computed tomography (CT) can predict outcomes in patients with stage IV pancreatic ductal adenocarcinoma (PDAC) treated with chemotherapy., Methods: This is a retrospective cohort study of 128 patients with stage IV PDAC who underwent multiphasic pancreatic CT before systemic chemotherapy. Contrast enhancement and ECV fraction of the primary lesion were calculated using region-of-interest measurement within the PDAC and aorta on unenhanced and equilibrium phase-enhanced CT. The effects of clinical prognostic factors and ECV fractions on progression-free survival (PFS) and overall survival (OS) were assessed by univariate and multivariate analyses using Cox proportional hazards models., Results: The number of metastatic organs and tumor ECV fraction were significant for PFS (P = 0.005 and 0.001, respectively) and OS (P = 0.012 and 0.007, respectively). On the multivariate analysis, multiple metastatic organs (PFS, P = 0.046; OS, P = 0.047) and lower tumor ECV fraction (PFS, P = 0.010; OS, P = 0.026) were identified as independent predictors of poor PFS and OS., Conclusion: Extracellular volume fraction with routine equilibrium contrast-enhanced CT may potentially predict survival in patients with stage IV PDAC treated with chemotherapy.

Purpose: To describe CT features of parathyroid carcinomas (PCs) by comparison with benign parathyroid lesions (BPs)., Methods: This retrospective study comprised 82 patients with 76 BPs (62 adenomas and 14 hyperplastic lesions) and 6 PCs. CT features (size, short-to-long axis ratio, shape, peritumoral infiltration, homogeneity, calcification, attenuation values on unenhanced CT, and contrast enhancement during arterial and venous phases) were compared between PCs and BPs. The diagnostic performance of CT features for diagnosing PCs was calculated for these individual parameters., Results: Short-to-long axis ratio was significantly larger in PCs (0.7 ± 0.1) than in BPs (0.5 ± 0.1, p = 0.004). Irregular shape (33%), the presence of peritumoral infiltration (50%), and calcification (33%) were significantly more common in PCs than BPs. The contrast enhancement value was significantly lower in PCs than BPs during arterial (p = 0.004) and venous phases (p = 0.044). The 100% sensitivity criterion for the short-to-long axis ratio (≥ 0.53), enhancement during arterial phase (≤ 56.6HU), and venous phase (≤ 59.5HU) yielded accuracies (62.1%, 71.9%, and 75.4%, respectively). Irregular shape, peritumoral infiltration, and calcification showed high specificity (98.7%) and accuracy (93.9%, 95.1%, and 93.9%, respectively)., Conclusions: CT features of high short-to-long axis ratio, irregular shape, the presence of peritumoral infiltration and calcification, and low contrast enhancement may aid in distinguishing PCs from BPs.

Purpose: The purpose of this case series was to describe computed tomography (CT) and magnetic resonance imaging (MRI) features of undifferentiated carcinoma with osteoclast-like giant cells of the pancreas., Methods: Institutional ethics review board approval was obtained, and informed consent was waived for this case series. We reviewed CT and MRI of patients with pathologically confirmed undifferentiated carcinoma with osteoclast-like giant cells of the pancreas found in the medical records of our hospital between 2006 and 2016., Results: Seven patients (3 males and 4 females; age, 59-82 years (mean, 71)) with confirmation by surgical resection (n = 3) or biopsy (n = 4) were identified. They underwent CT (n = 7) and MRI (n = 6). The tumors 26-83 mm in diameter (mean, 44 mm) were located in the head (n = 4) or body (n = 3) of the pancreas. They were demonstrated as lower attenuation areas relative to the adjacent pancreas on CT images obtained in both pancreatic and portal vein phases (n = 7) with a well-defined smooth margin (n = 5). They were demonstrated as hypointense areas relative to the pancreas on T2-weighted images (n = 4) and T2*-weighted images (n = 4) and diffusion-weighted images (n = 3). They contained hemosiderin deposits on histology (n = 7)., Conclusions: Undifferentiated carcinoma with osteoclast-like giant cells of the pancreas might be present as low attenuation areas with a well-defined smooth margin on CT images obtained in pancreatic and portal vein phases, and hypointense areas on T2-, T2*-, and diffusion-weighted images caused by hemosiderin deposits.

Amide proton transfer (APT) imaging is an emerging molecular magnetic resonance imaging technique based on chemical exchange saturation transfer (CEST). APT imaging has shown promise in oncologic imaging, especially in the imaging of brain tumors. This review article illustrates the theory of CEST/APT imaging and describes the clinical utility, pitfalls, and potential for future development of APT imaging.

Background: Diffusion-weighted imaging (DWI) has been used for the detection and characterization of liver tumors because it has excellent contrast resolution. DWI using short tau inversion recovery (STIR) can improve tumor-to-liver contrast after gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) administration that shortens the T 1 relaxation of liver parenchyma., Purpose: To quantitatively and qualitatively compare the conspicuity of malignant liver tumors on DWI after Gd-EOB-DTPA administration between STIR and chemical shift selective (CHESS) sequences., Study Type: Single-institution retrospective study., Subjects: Fifty-seven patients with histologically confirmed malignant liver tumors were evaluated., Field Strength/sequence: Low b-value DWIs with STIR and CHESS sequences 18-20 minutes after Gd-EOB-DTPA administration were acquired at 1.5T., Assessment: Tumor contrast-to-noise ratio (CNR) and visual grade of tumor conspicuity on DWI between STIR and CHESS sequences were compared., Statistical Tests: Paired Student's t-test and the Wilcoxon signed rank-test were applied. P < 0.05 was considered statistically significant., Results: The mean tumor CNR and visual grade of tumor conspicuity on DWI were significantly higher for STIR than for CHESS (both P < 0.001). Regardless of the presence of chronic liver disease, the mean CNR (normal liver 33.5 ± 19.8 vs. 15.7 ± 12.2, P < 0.001; chronic liver disease 19.6 ± 11.0 vs. 9.2 ± 7.8, P < 0.001) and the visual conspicuity grade (normal liver 3.36 ± 0.64 vs. 2.56 ± 0.77, P < 0.001; chronic liver disease 2.94 ± 0.80 vs. 2.25 ± 0.84, P = 0.001) were significantly higher for STIR than for CHESS. Mean CNR and the visual conspicuity grade were also significantly higher for STIR than for CHESS in patients with hepatocellular carcinomas (CNR 18.1 ± 10.5 vs. 8.8 ± 7.2, P < 0.001; visual grade 2.88 ± 0.83 vs. 2.22 ± 0.87, P = 0.001) or metastases (CNR 35.0 ± 19.3 vs. 16.2 ± 13.1, P < 0.001; visual grade 3.45 ± 0.51 vs. 2.59 ± 0.73, P < 0.001)., Data Conclusion: DWI using STIR may be more helpful for depicting malignant liver tumors after Gd-EOB-DTPA administration compared with DWI using CHESS., Level of Evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:565-573., (© 2018 International Society for Magnetic Resonance in Medicine.)

Objectives: To assess whether extracellular volume (ECV) fraction with equilibrium contrast-enhanced multidetector computed tomography (MDCT) predicts outcomes for unresectable pancreatic adenocarcinoma patients treated with chemotherapy METHODS: Sixty-seven patients (42 men, 25 women; mean age, 67.5 years; range, 45-83 years) with histologically confirmed surgically unresectable pancreatic adenocarcinoma underwent contrast-enhanced MDCT before systemic chemotherapy. Tumour contrast enhancement (CE) and ECV fraction were calculated using region-of-interest measurement within the pancreatic adenocarcinoma and aorta on unenhanced and equilibrium phase-enhanced CT. The effect on survival variables including age, sex, tumour location, tumour size, TNM stage, carbohydrate antigen (CA) 19-9, carcinoembryonic antigen (CEA), tumour CE and tumour ECV fraction was determined on univariate and multivariate analyses using Cox proportional hazards regression model., Results: Median overall survival was 10.5 months. On univariate analysis, elevated serum CA19-9 (hazard ratio (HR), 1.00; p = 0.006) and CEA (HR, 1.02; p = 0.011) levels were found to be associated with a negative effect on overall survival. Increasing tumour CE (HR, 0.98; p < 0.001) and ECV fraction (HR, 0.97; p = 0.001) were associated with a positive effect. Multivariate analysis revealed that only tumour ECV fraction was an independent predictor of overall survival (HR, 0.97; p = 0.012)., Conclusions: ECV fraction with equilibrium contrast-enhanced MDCT could be a useful imaging biomarker for predicting patient survival after chemotherapy for unresectable pancreatic adenocarcinoma., Key Points: • Tumour aggressiveness and response to therapy are influenced by the extravascular extracellular space. • Extracellular volume (ECV) fraction can be quantified with equilibrium contrast-enhanced CT. • Patients with higher tumour ECV fraction had better prognosis after chemotherapy.

Oxidative stress, demonstrated by an accumulation of 8-hydroxy-2'-deoxyguanosine (8-OHdG), results in DNA damage, which is normally repaired by base excision repair enzymes including 8-OHdG DNA glycosylase (OGG1) and human MutY homolog (MUTYH), in addition to nucleotide pool sanitizing enzymes including MutT Homolog 1 (MTH1). Abnormalities of this repair system are present in various cancer types. The present study aimed to elucidate the clinicopathological significance of altered expression levels of inducible nitric oxide synthase (iNOS), 8-OHdG, OGG1, MTH1 and MUTYH in ulcerative colitis (UC) and UC-associated neoplasms. Immunohistochemical staining for these markers and p53 in 23 cases of UC-associated neoplasm (Group A, 14 carcinomas and nine dysplasias), 16 cases of UC without neoplasm (Group B) and 17 cases of normal colon specimens (Group C) was performed. Mutation analyses was conducted for KRAS proto-oncogene, GTPase ( K-ras) , tumor protein P53 ( TP53) and isocitrate dehydrogenase (NADP (+)) 1, cytosolic ( IDH1) genes. Immunohistochemically, the iNOS, 8-OHdG, OGG1 and MTH1 expression levels were increased in Groups A and B compared with Group C. The OGG1 and MTH1 expression levels in Group A were also increased compared with Group B. Group A and Group B exhibited increased cytoplasmic expression and decreased nuclear expression of MUTYH compared with Group C. Mutations of K-ras and TP53 were detected in 2/21 (9.5%) and 10/22 (45.5%) cases of Group A, respectively. IDH1 mutation was not detected in any cases. These findings suggest that, as a response to oxidative damage, OGG1 and MTH1 may be upregulated in UC through an inflammatory condition that progresses to cancer formation. Persisting oxidative damage stress may play a role in the pathogenesis of UC-associated tumors.

Aim: Previous studies have reported a 10.2%-22% rate of silent cerebral infarction and a 0.1%-1% rate of symptomatic cerebral infarction after coronary angiography (CAG). However, the risk factors of cerebral infarction after CAG have not been fully elucidated. For this reason, we investigated the incidence and risk factors of CVD complications within 48 h after CAG using magnetic resonance imaging (MRI) (Diffusion-weighted MRI) at Kagoshima University Hospital., Methods: From September 2013 to April 2015, we examined the incidence and risk factors, including procedural data and patients characteristics, of cerebrovascular disease after CAG in consecutive 61 patients who underwent CAG and MRI in our hospital., Results: Silent cerebral infarction after CAG was observed in 6 cases (9.8%), and they should not show any neurological symptoms of cerebral infarction. Only prior coronary artery bypass grafting (CABG) was more frequently found in the stroke group (n=6) than that in the non-stroke group (n=55); however, no significant difference was observed (P=0.07). After adjusting for confounders, prior CABG was a significant independent risk factor for the incidence of stroke after CAG (odds ratio: 11.7, 95% confidence interval: 1.14-129.8, P=0.04)., Conclusions: We suggested that the incidence of cerebral infarction after CAG was not related to the catheterization procedure per se but may be caused by atherosclerosis with CABG.

Purpose: To evaluate whether diffusion tensor imaging (DTI) can be used to differentiate malignant parotid gland tumors from the benign ones., Materials and Methods: The study population comprised 59 parotid gland tumors (24 Warthin's tumors, 19 pleomorphic adenomas, seven other benign tumors, and nine malignant tumors). Single-shot echo-planar DTI was performed with motion-probing gradients along 30 noncollinear directions (b=1000s/mm 2 ) at 3.0T. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values for benign and malignant tumors were compared using the Mann-Whitney U test. Receiver-operating characteristic (ROC) curve analysis was performed to assess the ability of the ADC and FA values to differentiate malignant tumors from the benign ones., Results: ADC values showed no significant difference between malignant (0.93±0.21×10 -3 mm 2 /s) and benign tumors (1.19±0.50×10 -3 mm 2 /s) (p=0.225). FA values of malignant tumors were significantly higher than those of benign tumors (0.26±0.06 vs. 0.17±0.05, p<0.001). The area under the ROC curve of FA was significantly greater than that under the curve of ADC (0.884 vs. 0.628, p=0.010)., Conclusions: DTI, particularly FA, can help differentiate malignant parotid gland tumors from the benign ones., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To assess the feasibility of computed diffusion-weighted imaging (cDWI) in comparison with directly acquired DWI for visualizing pancreatic adenocarcinomas., Materials and Methods: Patients with pancreatic adenocarcinoma underwent DWI at b-values of 0, 1000 (DWI 1000 ), 1500 (DWI 1500 ) and 2000 (DWI 2000 ) s/mm 2 . From DWIs at b-values of 0 and 1000s/mm 2 , we generated cDWIs at b-values of 1500 (cDWI 1500 ) and 2000 (cDWI 2000 ) s/mm 2 . DWI findings of pancreatic adenocarcinomas (clear hyperintensity; hyperintensity with an unclear distal border; and isointensity), the image quality and the tumor to pancreas contrast ratio (CR) were compared between directly acquired DWI and cDWI., Results: Among the 63 included patients, clear hyperintense tumors were seen in 35 on DWI 1000 , 50 on DWI 1500 , 50 on cDWI 1500 , 53 on DWI 2000 and 44 on cDWI 2000 . Incidence of clear hyperintense tumors was significantly higher on cDWI 1500 than on DWI 1000 (P=0.013). There was no significant difference in the incidence of clear hyperintense tumors between DWI 1500 and cDWI 1500 (P>0.999), but a lower incidence was seen on cDWI 2000 than on DWI 2000 (P=0.028). Image quality was lower on cDWI than on DWI at b-values of 1500 (P=0.002) and 2000s/mm 2 (P<0.001). The tumor to distal pancreas CR was significantly higher on cDWI 2000 than on cDWI 1500 (P<0.001), and on cDWI 1500 than on DWI 1000 (P<0.001). The cDWI showed a significantly higher tumor to distal pancreas CR than DWI at b-values of 1500 (P=0.004) and 2000s/mm 2 (P<0.001)., Conclusions: cDWI 1500 generated from b-values of 0 and 1000s/mm 2 should be considered more effective than DWI 1000 and at least as effective as DWI 1500 ., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Purpose: To determine the diagnostic performance of apparent diffusion coefficient (ADC) histogram analysis in diffusion-weighted (DW) magnetic resonance imaging (MRI) for differentiating adrenal adenoma from pheochromocytoma., Materials and Methods: We retrospectively evaluated 52 adrenal tumors (39 adenomas and 13 pheochromocytomas) in 47 patients (21 men, 26 women; mean age, 59.3 years; range, 16-86 years) who underwent DW 3.0T MRI. Histogram parameters of ADC (b-values of 0 and 200 [ADC 200 ], 0 and 400 [ADC 400 ], and 0 and 800 s/mm 2 [ADC 800 ])-mean, variance, coefficient of variation (CV), kurtosis, skewness, and entropy-were compared between adrenal adenomas and pheochromocytomas, using the Mann-Whitney U-test. Receiver operating characteristic (ROC) curves for the histogram parameters were generated to differentiate adrenal adenomas from pheochromocytomas. Sensitivity and specificity were calculated by using a threshold criterion that would maximize the average of sensitivity and specificity., Results: Variance and CV of ADC 800 were significantly higher in pheochromocytomas than in adrenal adenomas (P < 0.001 and P = 0.001, respectively). With all b-value combinations, the entropy of ADC was significantly higher in pheochromocytomas than in adrenal adenomas (all P ≤ 0.001), and showed the highest area under the ROC curve among the ADC histogram parameters for diagnosing adrenal adenomas (ADC 200 , 0.82; ADC 400 , 0.87; and ADC 800 , 0.92), with sensitivity of 84.6% and specificity of 84.6% (cutoff, ≤2.82) with ADC 200 ; sensitivity of 89.7% and specificity of 84.6% (cutoff, ≤2.77) with ADC 400 ; and sensitivity of 94.9% and specificity of 92.3% (cutoff, ≤2.67) with ADC 800 ., Conclusion: ADC histogram analysis of DW MRI can help differentiate adrenal adenoma from pheochromocytoma., Level of Evidence: 3 J. Magn. Reson. Imaging 2017;45:1195-1203., (© 2016 International Society for Magnetic Resonance in Medicine.)

The effects of oxidative stress in adenocarcinomas of gastric cardia (AGCs) have not been fully elucidated. With a strict definition of AGC, we examined the immunohistochemical expressions of inducible nitric oxide synthase; 8-hydroxy-deoxyguanosine; and the base excision repair enzymes such as MUTYH, MTH1, and OGG1, and TP53 mutational status. Sixty-three cases of AGC were characterized by younger patient age (P = .0227) and more frequent venous invasion (P = .0106) compared with the adenocarcinomas of pylorus (APs). 8-hydroxy-deoxyguanosine was accumulated (P = .0011), whereas MUTYH (P = .0325) and OGG1 (P = .0007) were decreased, in the AGCs compared with the adjacent mucosa, but these differences were not detected in the APs. Among the AGCs, lower expressions of MUTYH (P = .0013) and MTH1 (P = .0059) were each significantly associated with diffuse-type histology. A lower expression of OGG1 was correlated with higher T-stage (P = .0011), lymphatic invasion (P = .004), and lymph node metastasis (P = .0094). In addition, the presence of TP53 mutation was associated with diffuse-type histology (P = .0153) and a lower level of MUTYH (P = .0221). The AGCs also showed a relatively high rate of a transversion-type mutation of TP53 (50%), whereas all TP53 mutations in the APs were transition type. Age 62years or older (P = .0073), diffuse-type histology (P = .0020), and TP53 mutation (P = .0066) were each associated with worse survival in the AGC patients. Our results indicate that oxidative stress accumulation and a downregulation of base excision repair enzymes may play an important role in the pathogenesis of AGC, in particular diffuse-type AGCs. Diffuse-type AGC might involve molecular pathways different from those of other subsets of gastric cancer., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Our study aim was to clarify the characteristics of hemangiomas with pseudo washout sign (PWS) by comparing their features with those of hemangiomas without PWS on gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) imaging., Methods: We evaluated the features of hemangiomas on Gd-EOB-DTPA-enhanced MR imaging of 70 hepatic hemangiomas in 31 patients, investigating the presence of peripheral or central nodular enhancement, diffuse enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and PWS, which is low signal intensity during the late phase. We visually assessed the intensity of contrast enhancement of the lesion during the arterial, portal venous, late, and hepatobiliary phases using a 4-grade scale and used the Fisher exact and Mann-Whitney U tests to compare hemangiomas with and without PWS., Results: We observed PWS in 33 (47%) of 70 hemangiomas, which were significantly smaller than the hemangiomas without PWS (17.4 mm ± 20.3 versus 30.1 mm ± 28.5; P = 0.005); more frequent diffuse enhancement in hemangiomas with PWS than those without (21.2% versus 2.7%; P = 0.026); and no significant differences in nodular enhancement (P = 0.231), arterioportal shunt (P = 0.403), or fill-in enhancement (P = 0.357) between hemangiomas with and without PWS. Visually determined grades of tumor contrast enhancement were significantly lower in hemangiomas with PWS during the portal venous (P = 0.007) and late (P < 0.001) phases., Conclusions: Small hemangiomas tend to decrease in signal intensity during the portal venous phase and show PWS during the late phase.

Purpose: To evaluate whether the reduction rate of T1 relaxation time of the liver (T1 relaxation time index) before and 20 minutes after gadolinium-ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) injection has the potential to serve as an magnetic resonance imaging (MRI)-based liver function test in comparison with signal intensity-based indices., Materials and Methods: Ninety-nine patients with suspected liver lesions underwent Gd-EOB-DTPA-enhanced MRI. T1 maps using 3D T1-weighted gradient-echo volumetric interpolated examination with two different flip angles were also performed before and 20 minutes after Gd-EOB-DTPA administration. T1 relaxation time index was compared with four signal intensity-based indices in terms of the ability to discriminate Child-Pugh A (CPA) and Child-Pugh B (CPB) from normal liver function (NLF), and in terms of its correlation with indocyanine green (ICG) clearance., Results: Twenty-four patients were classified as NLF, 64 patients were classified as CPA, and 11 were classified as CPB group. The T1 relaxation time index was significantly lower for CPA (0.62 ± 0.08 vs. 0.68 ± 0.07, P = 0.021) and CPB (0.55 ± 0.15 vs. 0.68 ± 0.07, P < 0.001) than for NLF. All signal intensity-based indices showed significant differences only when comparing NLF and CPB. The correlation coefficient with ICG clearance was the highest for T1 relaxation time index (r = -0.605, P < 0.001)., Conclusion: The T1 relaxation time index has the potential to serve as an MRI-based liver function test, and is most strongly correlated with ICG clearance among the Gd-EOB-DTPA MRI-based indices investigated., (© 2013 Wiley Periodicals, Inc.)

We evaluated the effects of an injectable complex of β-tricalcium phosphate (β-TCP) granules, hyaluronate, and recombinant human fibroblast growth factor-2 (rhFGF-2) on repair of unstable intertrochanteric fractures in elderly patients. Twenty-five patients (range, 76-91 years) having 31.A2 fractures (AO classification) were treated with injection of the complex followed by intramedullary nails. Bone regeneration and β-TCP resorption, unions of intertrochanteric fractures and displaced lesser trochanters to the shaft, and varus deformity of the femoral neck were assessed by X-ray and CT scans. Fracture union occurred in all cases and union of the displaced lesser trochanter to the shaft was obtained in 24 cases by 12 weeks. It is of interest that β-TCP granules were completely resorbed and marked new bone formation around the lesser trochanter was observed in all cases compared to cases not treated with the complex. Based on the results of intertrochanteric fractures, we applied this technique to two patients with subtrochanteric or humeral fractures in elderly patients, and obtained bone union. This complex is a paste-like material that is easy to handle, and it may be of considerable use in treatment of both unstable intertrochanteric fractures and other cortical bone defects with minimal surgical invasion.

Aim: To clarify features of hepatic hemangiomas on gadolinium-ethoxybenzyl-diethylenetriaminpentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) compared with enhanced computed tomography (CT)., Methods: Twenty-six patients with 61 hepatic hemangiomas who underwent both Gd-EOB-DTPA-enhanced MRI and enhanced CT were retrospectively reviewed. Hemangioma appearances (presence of peripheral nodular enhancement, central nodular enhancement, diffuse homogenous enhancement, and arterioportal shunt during the arterial phase, fill-in enhancement during the portal venous phase, and prolonged enhancement during the equilibrium phase) on Gd-EOB-DTPA-enhanced MRI and enhanced CT were evaluated. The degree of contrast enhancement at the enhancing portion within the hemangioma was visually assessed using a five-point scale during each phase. For quantitative analysis, the tumor-muscle signal intensity ratio (SIR), the liver-muscle SIR, and the attenuation value of the tumor and liver parenchyma were calculated. The McNemar test and the Wilcoxon's signed rank test were used to assess the significance of differences in the appearances of hemangiomas and in the visual grade of tumor contrast enhancement between Gd-EOB-DTPA-enhanced MRI and enhanced CT., Results: There was no significant difference between Gd-EOB-DTPA-enhanced MRI and enhanced CT in the presence of peripheral nodular enhancement (85% vs 82%), central nodular enhancement (3% vs 3%), diffuse enhancement (11% vs 16%), or arterioportal shunt (23% vs 34%) during arterial phase, or fill-in enhancement (79% vs 80%) during portal venous phase. Prolonged enhancement during equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than on enhanced CT (52% vs 100%, P < 0.001). On visual inspection, there was significantly less contrast enhancement of the enhancing portion on Gd-EOB-DTPA-enhanced MRI than on enhanced CT during the arterial (3.94 ± 0.98 vs 4.57 ± 0.64, respectively, P < 0.001), portal venous (3.72 ± 0.82 vs 4.36 ± 0.53, respectively, P < 0.001), and equilibrium phases (2.01 ± 0.95 vs 4.04 ± 0.51, respectively, P < 0.001). In the quantitative analysis, the tumor-muscle SIR and the liver-muscle SIR observed with Gd-EOB-DTPA-enhanced MRI were 0.80 ± 0.24 and 1.28 ± 0.33 precontrast, 1.92 ± 0.58 and 1.57 ± 0.55 during the arterial phase, 1.87 ± 0.44 and 1.73 ± 0.39 during the portal venous phase, 1.63 ± 0.41 and 1.78 ± 0.39 during the equilibrium phase, and 1.10 ± 0.43 and 1.92 ± 0.50 during the hepatobiliary phase, respectively. The attenuation values in the tumor and liver parenchyma observed with enhanced CT were 40.60 ± 8.78 and 53.78 ± 7.37 precontrast, 172.66 ± 73.89 and 92.76 ± 17.92 during the arterial phase, 152.76 ± 35.73 and 120.12 ± 18.02 during the portal venous phase, and 108.74 ± 18.70 and 89.04 ± 7.25 during the equilibrium phase, respectively. Hemangiomas demonstrated peak enhancement during the arterial phase, and both the SIR with Gd-EOB-DTPA-enhanced MRI and the attenuation value with enhanced CT decreased with time. The SIR of hemangiomas was lower than that of liver parenchyma during the equilibrium and hepatobiliary phases on Gd-EOB-DTPA-enhanced MRI. However, the attenuation of hemangiomas after contrast injection was higher than that of liver parenchyma during all phases of enhanced CT., Conclusion: Prolonged enhancement during the equilibrium phase was observed less frequently on Gd-EOB-DTPA-enhanced MRI than enhanced CT, which may exacerbate differentiating between hemangiomas and malignant tumors.

Objective: To compare the quality of contrast enhancement and hepatic CT images acquired using bolus tracking technique at two different time points and those acquired with fixed scan delay technique using a previous bolus tracking data., Materials and Methods: Fifty patients who underwent 3 different hepatic CT exams (25-s fixed injection of 600 mg iodine (I)/kg or 100mL of 370 mg I/mL nonionic contrast medium) were enrolled. The first and second exams were performed with a bolus tracking technique. The third exam was performed with a fixed scan delay technique using the first exam data. Differences in attenuation values in the abdominal organs were examined and evaluated visually on hepatic arterial phase images., Results: There was no significant difference in the mean 50-HU threshold times between the first and second bolus tracking exams with intra-patient differences between them (1.3±0.9 s). No significant intra-patient differences were noted in organ attenuation and visual evaluation on hepatic arterial phase images between the 3 exams., Conclusion: The fixed scan delay technique using a previous bolus tracking data is feasible for hepatic CT exams to follow up hepatocellular carcinoma., (Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.)

Purpose: The aims of this study were to review published data on pedicle dimensions and bony spinal canal diameters calculated from CT examinations of the cervical spine through the English-language literature and analyze these data for ethnic disparities and similarities., Materials and Methods: The authors reviewed the literature on "pedicle" and "spinal canal" by conducting a bibliographic search using PubMed, Ovid MEDLINE, and Science Direct from January 1985 to December 2010. After evaluating all of the selected abstracts, we ultimately selected 19 studies involving living subjects: 12 studies on pedicle dimensions and 7 on spinal canal diameters. The four parameters, pedicle width (PW), pedicle transverse angle (PTA), anterior-posterior diameter of the spinal canal (APD), and transverse diameter of the spinal canal (TD), were analyzed at the relevant levels from C3 to C7. In addition, the values for pedicle dimensions and spinal canal diameters in the European/American populations were compared using the data from Asian populations as a baseline., Results: The smallest mean PW was found at C4 in the male (5.1 mm) and female populations (4.1 mm); the largest mean PW was found at C7 in both male (7.7 mm) and female populations (7 mm). The PW in males was greater than in females at the majority of levels. The smallest mean PTA was found at C7 in both male (33.4°) and female populations (33°); the largest mean PTA was found at C4 in both male (53.2°) and female populations (52.1°). The overall PW, PTA, APD, and TD ratio of European/American to Asian populations was 91.4-98.8, 99.6-106.2, 110.7-122, and 100-108.3 %, respectively., Conclusion: Although our cervical spine CT data were suggestive of possible ethnic differences in spinal canal morphology, our analysis failed to identify significant ethnic disparity in pedicle dimensions despite potential differences in physique between populations.

Purpose: To compare the apparent diffusion coefficients (ADCs) of pancreatic adenocarcinomas that appear hyperintense with clearly defined borders (clear hyperintense) with those that do not show clear hyperintense borders on diffusion-weighted magnetic resonance (MR) images., Materials and Methods: Institutional review board approval was obtained and informed consent was waived. Eighty patients with histologically confirmed pancreatic adenocarcinoma (mean tumor size, 32 mm) underwent fat-suppressed single-shot echo-planar 3.0-T diffusion-weighted MR imaging with diffusion gradients (b = 1000 sec/mm(2)). ADC values of the pancreatic adenocarcinomas (n = 80) and proximal (n = 51) and distal (n = 70) pancreas were compared by using the Friedman test, followed by the Wilcoxon signed-rank test, and the difference in serum amylase levels between pancreatic adenocarcinomas with and without clear hyperintensity was evaluated by using the x(2) test., Results: In 38 of 80 patients, pancreatic adenocarcinomas showed clear hyperintensity relative to the surrounding pancreas; 26 were hyperintense with unclear distal borders; 12, isointense; and four, hypointense. In all patients, the mean ADC (± standard deviation) of the tumors (1.16 × 10(-3) mm(2)/sec ± 0.22) was significantly lower than those of the proximal pancreas (1.33 × 10(-3) mm(2)/sec ± 0.16, P < .001) and the distal pancreatic parenchyma (1.24 × 10(-3) mm(2)/sec ± 0.23, P = .004). No significant difference in ADC was seen between the pancreatic adenocarcinomas without clear hyperintensity and the distal pancreas. The frequency of serum amylase levels greater than 120 U/L (2.00 μkat/L) was significantly higher than in those with clear hyperintense pancreatic adenocarcinomas (P < .001)., Conclusion: Diffusion-weighted MR imaging was not useful for delineating 47% of pancreatic adenocarcinomas, because of hyperintensity of the pancreatic parenchyma distal to the cancer.

An obesity-induced diabetes model using genetically normal mouse strains would be invaluable but remains to be established. One reason is that several normal mouse strains are resistant to high-fat diet-induced obesity. In the present study, we show the effectiveness of gold thioglucose (GTG) in inducing hyperphagia and severe obesity in mice, and demonstrate the development of obesity-induced diabetes in genetically normal mouse strains. GTG treated DBA/2, C57BLKs, and BDF1 mice gained weight rapidly and exhibited significant increases in nonfasting plasma glucose levels 8-12 weeks after GTG treatment. These mice showed significantly impaired insulin secretion, particularly in the early phase after glucose load, and reduced insulin content in pancreatic islets. Interestingly, GTG treated C57BL/6 mice did not become diabetic and retained normal early insulin secretion and islet insulin content despite being as severely obese and insulin resistant as the other mice. These results suggest that the pathogenesis of obesity-induced diabetes in GTG-treated mice is attributable to the inability of their pancreatic β-cells to secrete enough insulin to compensate for insulin resistance. Mice developing obesity-induced diabetes after GTG treatment might be a valuable tool for investigating obesity-induced diabetes. Furthermore, comparing the genetic backgrounds of mice with different susceptibilities to diabetes may lead to the identification of novel genetic factors influencing the ability of pancreatic β-cells to secrete insulin.

The aim of this study was to determine the effects of alendronate (ALN) on osteoclastic resorption of beta-tricalcium phosphate (beta-TCP) and bone formation. beta-TCP blocks of 75% porosity, with or without ALN treatment, were implanted into cavities drilled in rabbit femoral condyles. New bone formation, residual amount of beta-TCP, and the number of tartrate-resistant acid phosphatase-positive cells were evaluated 2 weeks after surgery. The results show that local application of ALN at a concentration of 10(-2) to 10(-6)M reduced the number of osteoclasts on the surface of beta-TCP. New bone formation was also inhibited by ALN in a dose-dependent manner. Thus, inhibition of osteoclast formation resulted in reduced beta-TCP resorption and bone formation. These results suggest that osteoclast-mediated resorption plays an important role in bone formation and a coupling-like phenomenon could occur in beta-TCP-filled bone defects., (Copyright 2009 Wiley Periodicals, Inc.)

A 14-year-old Japanese man was diagnosed with Crohn's disease in October 2001. Four years later, the patient was referred to our institution because of neck pain, fever and asymmetrical blood pressure. Magnetic resonance angiography, computed tomography and ultrasonography revealed findings compatible with Takayasu's arteritis. In March 2006, the patient developed purpura over bilateral hands and lower extremities, arthralgia, lower abdominal pain and microhematuria. The patient was diagnosed with Henoch-Schönlein purpura. This is the first reported case of Crohn's disease associated with two types of vascular complications.

For experimental research on type 2 diabetes mellitus, a diet-induced obesity-dependent diabetes model developed using genetically normal animals is essential. However, attempts at feeding a high-fat diet (HFD) to major inbred strains of mice have not resulted in the establishment of an ideal model. Here, we show that BDF1 mice, the F(1) hybrids of C57BL/6 and DBA/2 normal strains, develop HFD-induced obesity-dependent diabetes. BDF1 mice fed a HFD gained weight rapidly and developed severe diabetes characterized by hyperglycemia, glucosuria, and elevation of hemoglobin A(1C) levels in 3 to 4 months. The glucose tolerance of the diabetic mice was significantly impaired, and the elevation of plasma insulin after a glucose load was significantly reduced. Isolated pancreatic islets of HFD-fed BDF1 mice showed decreased insulin content and a reduced insulin secretory response to higher concentrations of glucose. Immunohistochemical analysis of the pancreas showed reduced staining intensity to insulin and aberrant distribution of glucagon-positive cells in diabetic BDF1 mice. These observations suggest the cause of the diabetes in HFD-fed BDF1 mice to be dysfunction of the pancreatic beta-cells, which do not produce or secrete enough insulin to compensate for insulin resistance. BDF1 mice fed a HFD showing obesity-dependent diabetes are suggested to be an appropriate animal model of type 2 diabetes mellitus. This model would be useful for exploring the mechanism of obesity-dependent type 2 diabetes mellitus and evaluating antiobesity and antidiabetic drugs.

Most of the implanted porous beta-tricalcium phosphate (beta-TCP) can be resorbed. However, beta-TCP block with 75% porosity is inadequate for weight-bearing sites until bone incorporation occurs. Thus, the authors have recently developed beta-TCP block with 60% porosity, which is approximately sevenfold greater in terms of compressive strength than that of beta-TCP with 75% porosity. The authors investigated bone formation and resorption of beta-TCP after implantation in patients of beta-TCP blocks with two different porosities. From May 2003 to November 2004, medial opening high tibial osteotomy was performed in 25 patients with a mean age of 66 years. The opened defect was fixed with a Puddu plate. Then 6-8 cm(3) of beta-TCP block with 75% porosity was used to fill the cancellous bone defect, except on the medial side where 2.83-3.18 cm(3) of wedge-shaped beta-TCP block with 60% porosity was implanted. At least 2 years after surgery, the 25 patients had no correction loss, and bone formation was noted in all cases. Complete or nearly complete resorption of beta-TCP with 60 and 75% porosity was obtained within 3.5 years. Thirteen biopsy samples obtained from the 60% porosity implantation sites showed good lamellar bone formation, and the percentage of beta-TCP remaining relative to the newly formed bone plus beta-TCP ranged from 0.3 to 14.5%, with a mean of 6.7%. The authors suspect that mechanical stress loading to the medial side of the tibia facilitated bone formation and resorption of beta-TCP with 60% porosity., ((c) 2007 Wiley Periodicals, Inc.)

The term tracheal bronchus encompasses a variety of bronchial anomalies originating from the trachea or main bronchus and directed to the upper lobe, and a true tracheal bronchus is any bronchus originating from the trachea. In most cases, it is found incidentally during bronchoscopy or tomography. It is often unilateral, and bilateral true tracheal bronchi are very rare. We report a case of a 54-year-old woman who had bilateral true tracheal bronchi associated with hemoptysis.

A dual inhibitor of acetylcholinesterase (AChE) and serotonin transporter (SERT), RS-1259 (4-[1S)-methylamino-3-(4-nitrophenoxy)]propylphenyl N,N-dimethylcarbamate (fumaric acid)(1/2)salt), was newly synthesized. RS-1259 simultaneously inhibited AChE and SERT in the brain following an oral administration in mice and rats. Actual simultaneous elevation of extracellular levels of 5-HT and ACh in the rat hippocampus was confirmed by microdialysis. The compound was as effective as SERT inhibitors such as fluoxetine and fluvoxamine in a 5-hydroxytryptophan-enhancing test in mice. Spatial memory deficits in the two-platform task of a water maze in aged rats were ameliorated by RS-1259 as well as donepezil. Both RS-1259 and donepezil increased the awake episodes in the daytime electroencephalogram of rats. Although RS-1259 was weaker than donepezil in enhancing central cholinergic transmission, as observed by ACh elevation in the hippocampus and memory enhancement in aged rats, the efficacy of RS-1259 on the consciousness level, which reflects the whole activity in the brain, was almost the same as that of donepezil. These results suggest that both cholinergic and serotonergic systems are involved in maintaining brain arousal and that a dual inhibitor of AChE and SERT may be useful for the treatment of cognitive disorders associated with reduced brain activity such as in Alzheimer's disease.

Oligomeric and fibrillar beta-amyloid (Abeta) may be toxic in Alzheimer disease (AD), especially after post-translation modification cumulative over time. Racemization of Ser and Asp residues of Abeta in senile plaques (SPs) occurs as an age-dependent process in AD. We previously reported that Abeta1-40 racemized at Ser26 is soluble and susceptible to proteolysis yielding toxic [D-Ser26]Abeta25-35/40 fragments in vitro and in vivo. Here, we focus on the localization of racemized Ser26 residues in AD brains within the limbic system, the earliest site of AD histopathology. We developed antisera (20.1 and 22.7). each with epitopes within [D-Ser26]Abeta25-40. Two forms of truncated [D-Ser26]Abeta were detected either in SPs or within neurons in all 11 AD-affected brains, but not in age-matched controls. [D-Ser26]Abeta25/26-35 (detected by 20.1) was localized to plaque cores, extracellular neurofibrillary "ghost" tangles and vascular amyloid deposits. In contrast, [D-Ser26]Abeta25-40 (detected by 22.7) was observed in most neurons containing intracellular neurofibrillary tangles, but not in SPs. These results suggest [D-Ser26]Abeta]1-40, formed during aging, becomes soluble and diffuses from SPs. It is then proteolyzed to [D-Ser26]Abeta25-35/40, which is toxic and may contribute to the neurodegeneration. This hypothesis may explain the long lag between SP formation and neurofibrillary degeneration in AD brains.