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Objectives To evaluate the detection rates of clinically significant prostate cancer classified according to the prostate imaging reporting and data system scoring system using magnetic resonance imaging/ultrasound rigid fusion targeted biopsy. Methods A total of 339 patients underwent transperineal magnetic resonance imaging/ultrasound rigid fusion targeted biopsy in our institution between January 2015 and July 2017. Patients with prostate imaging reporting and data system category 1 or 2 and those with a pre‐biopsy prostate‐specific antigen value of >30 ng/mL were excluded from this study. Finally, 310 patients were recruited. Results The detection rates of clinically significant prostate cancer with prostate imaging reporting and data system category 3, 4, and 5 were 1.0% (1/98), 35.1% (47/134) and 73.1% (57/78), respectively. The factors affecting the detection of clinically significant prostate cancer with prostate imaging reporting and data system categories 4 and 5 were: (i) prostate imaging reporting and data system category 5; (ii) prostate volume 0.35 ng/mL/mL. Conclusions The detection rate of clinically significant prostate cancer on magnetic resonance imaging/ultrasound rigid fusion targeted biopsy is very low in patients with prostate imaging reporting and data system category 3; therefore, patients with this classification should not undergo targeted biopsy. Prostate‐specific antigen density, prostate volume, locations of suspected cancer and history of biopsy should be considered to predict the detection rate of clinically significant prostate cancer with prostate imaging reporting and data system categories 4 and 5.

To determine the utility of high-resolution MR imaging for hepatocellular carcinoma.High-resolution MR images with a 512 matrix in a right to left frequency encoding direction were obtained in 20 consecutive patients with known or suspected hepatocellular carcinoma (HCC). Six series of breath-hold images of the entire liver [T1- and T2-weighted fast spin echo sequences, T1-weighted fast low-angle shot gradient echo sequence and three-phased contrast-enhanced dynamic study using the latter) were obtained using a phased-array multicoil.HCC was depicted in 15 patients on the MR images, and the diagnosis was confirmed at pathology in 13 and at imaging in the other two. In the remaining five patients, HCC was correctly ruled out with MR imaging.High-resolution MR imaging is a promising method in the evaluation of HCC.

We report a rare case of a bronchogenic cyst presenting as a pleural nodule. CT and MRI demonstrated a well circumscribed, homogeneous lesion located on the pleural surface apart from the mediastinum. It was proven to be a bronchogenic cyst localized between the parietal and visceral pleurae and connected with the mediastinum only through fibrous tissue. Radiologists should be aware that a mediastinal bronchogenic cyst may be located apart from the mediastinum.

A 54-year-old male case with multiple, diffuse hemangiomas of the large intestine is described. Large diffuse hemangiomas were located at the rectosigmoid and the ascending colon. Some polypoid lesions were located on the transverse colon. Tiny calcifications representing phleboliths were detected in those lesions. No skin hemangiomas were present. Although he did not manifest systemic bleeding tendency, blood examinations demonstrated the presence of mild consumption coagulopathy.

The computed tomographic (CT) and magnetic resonance appearance of pseudotumorous enlargement of the paracaval portion (PCP) of the caudate lobe of the liver are presented in two cirrhotic patients. The enlarged PCP was hyperattenuated on precontrast CT and hyperintense on T1-weighted images. The middle and right hepatic veins were displaced around the PCP. The presence of a portal vein branch penetrating the center of the enlarged PCP was important to distinguish it from other hepatic masses in the two patients.

We studied gastric function in patients with functional dyspepsia, using capsules containing contrast medium. We were able to estimate intragastric capsule movement by this method. Here, we report gastric functions in patients with esophagitis. We were able to recognize gastric dysfunction (delayed gastric emptying) in these patients.

Goals: To assess the efficacy of transcatheter arterial chemoembolization using autologous blood clot as an embolizing agent (short-TAE |S-TAE|) for the treatment of unresectable hepatocellular carcinoma less than 2 cm. Study: Twenty-eight consecutive patients with unresectable hepatocellular carcinoma less than 2 cm in diameter were treated by S-TAE alone. All patients had documented cirrhosis (Child class B:C = 20:8). S-TAE was performed by injecting a mixture of iodized oil and anticancer drugs followed by embolization of hepatic arteries with autologous blood clot. Results: A total of 147 sessions of embolization with clots were performed. S-TAE maintained patency of hepatic arteries. The overall survival rates at 1, 3, 5, and 8 years were estimated to be 89%, 52%, 34%, and 17%, respectively, which were better compared with prior records for the gelfoam method. The survival rates for Child class B patients were significantly better than that for Child class C patients (P < 0.05). The Cox proportional hazard model also demonstrated that Child staging of cirrhosis was the sole factor significantly predicting the survival (P < 0.05). Conclusions: The long-term outcomes of S-TAE for unresectable hepatocellular carcinoma less than 2 cm are satisfactory. Prognosis of these patients was significantly dependent on clinical stages of coexisting liver cirrhosis.

A retroperitoneal cystic mass compressing the right psoas muscle was found incidentally by ultrasonography in a 67-year-old woman. The radiological findings and a history of costal caries led us to suspect a psoas cold abscess. Ultrasound-guided needle aspiration was done to establish the diagnosis and to drain the content, but only a small amount of sterile fluid was obtained. The patient complained of neuralgia in her right leg at the time of puncture. Under the preoperative diagnosis of a neurogenic tumor, the mass was surgically resected, and found to be filled with old blood. The solid region consisted of a proliferation of fusiform cells, leading to a diagnosis of benign schwannoma. Retroperitoneal schwannoma is often misdiagnosed as an adjacent anatomical structure. Thus, we conclude that both microbiological and cytological examination of an aspiration specimen is important when psoas abscess is considered in a differential diagnosis.

Ninety-two consecutive patients with unresectable hepatocellular carcinoma (HCC) greater than 2 cm and less than 5 cm in diameter were treated by transcatheter arterial chemoembolization using autologous blood clot as an embolizing agent (Short-TAE; S-TAE). Survival, patency of hepatic arteries and side effects were retrospectively analyzed. The median follow-up interval was 42 months. The median size of the main tumor was 3.4 cm in diameter. All tumors were determined to be inoperable because of intrahepatic spread of tumors and/or poor hepatic functional reserves. S-TAE was performed by injecting a mixture of iodized oil and anticancer drugs followed by embolization of hepatic arteries with autologous blood clot. Embolization with clots maintained patency of hepatic arteries in all the patients. The overall survival rates for 92 HCC patients at 1, 3, 5, 7 and 8 years were estimated by the Kaplan-Meier method to be 100, 52, 34, 12 and 6%, respectively, which were better compared with prior records for conventional method with gelfoam. S-TAE was successfully performed in 16 patients with Childs class C liver cirrhosis presenting icterus and ascitis. The survival rates for Childs class C patients at 1, 2 and 3 years were 100, 66 and 32%, respectively. The Cox proportional hazard model was used to assess influence of each pretreatment parameter (age, gender, virus marker, stage of cirrhosis, number of tumor) on survival. The univariate analysis demonstrated that both the stage of cirrhosis and the multiplicity of tumor were significant factors predicting survival (p=0.003 and 0.046, respectively). The multivariate analysis showed the stage of cirrhosis to be the sole factor which significantly affected prognosis of HCC patients (p=0.005). In conclusion, chemoembolization with autologous blood clot is an effective and safe therapeutic option for unresectable HCC smaller than 5 cm. The hepatic functional reserves play a key role in determining prognosis of HCC patients.

A case of hepatocellular carcinoma is reported in which a calculated T2 value of the tumor was exceptionally long and differentiation from cavernous hemangioma based on T2 signal intensity was difficult. Pathologically, the mass consisted of dense, homogeneous acinar formation (pseudoglandular type). The T2 prolongation of the mass was probably due to abundant fluid in the acini.

Purpose : To evaluate a coaxial catheter method to sequentially acquire spiral-computed tomography (CT) during arterial portography (CTAP) and hepatic arteriography (CTA) at a single transfer. Patients and methods : Sixteen patients with malignant hepatic tumours (12 patients with hepatocellular carcinoma, four with metastases) were studied using spiral CT. Depending upon the vascular anatomy revealed by conventional coeliac and superior mesenteric arteriography, an outer and inner catheter were selectively placed to perform CTA and CTAP, respectively. CTAP images were obtained first, while injecting contrast material through an inner catheter followed by the acquisition of the CTA images during injection through an outer catheter. In three patients, the resected specimens were available for comparison with the imaging findings. Results : In 12 patients with standard hepatic arterial anatomy, high quality images of CTAP and CTA were obtained. More lesions were detected by the combination of CTAP and CTA than by CTAP or CTA alone in five patients. In one patient with breast carcinoma and a left hepatic artery arising from the left gastric artery, numerous hepatic metastases were delineated on both sets of images. In three patients with replaced or accessory right hepatic arteries, evaluation of the whole liver was difficult on CTA. These procedures were well tolerated by all 16 patients and no complication or technical failure was experienced. Conclusion : These preliminary data support this new technique as a promising method of performing CTA and CTAP in patients with standard hepatic arterial anatomy with a single catheter insertion.

Postaortic left innominate vein (PALIV) is a rare venous anomaly and the findings on plain chest radiographs have not been well described. Plain chest radiographs, CT and MR of nine adults known to have PALIV were reviewed. They all showed a high aortic arch, including four with a right-sided aortic arch and one with a double aortic arch, in postero-anterior radiographs, and seven showed curved shadows in the left upper mediastinum. On all lateral chest radiographs ( n =5), the superior retrosternal region was opacified by the high aortic arch. CT or MR images confirmed the aortic arch and/or innominate artery to be in that part of the retrosternal space, normally occupied by the left innominate vein, in all cases. Association of a curved shadow in the superior mediastinum with a high aortic arch on plain chest radiographs is therefore suggestive of, though not diagnostic for, PALIV. This entity was well documented by CT or MR and the radiological findings were considered to imply that developmentally PALIV is secondary to a high position of the aortic arch.

Twenty-two patients with hepatocellular carcinoma were treated by a new method of transcatheter arterial chemoembolization using an autologous blood clot as an embolizing agent. All had underlying advanced cirrhosis (14 Child's class B and 8 Child's class C patients). The median follow-up interval was 11 mo (range = 2 to 30 mo). The results of the treatment were compared with those of conventional chemoembolization using gelatin sponge particles for 19 Child's class B patients as historical controls. The survival rate for Child's class B patients treated by the new procedure estimated by the Kaplan-Meier method was 100% at 2 yr, whereas the survival rate for Child's class B patients treated by conventional chemoembolization was 89% at 1 yr and 72% at 2 yr. The survival rate for Child's class C patients was 75% at 1 yr and 50% at 2 yr. Side effects such as pyrexia of more than 38 degrees C or an elevation of the serum bilirubin level of more than 1.5-fold were less common in patients treated by the new method than in those treated by conventional chemoembolization, and thus the new procedure could be performed even for Child's class C patients. The autologous blood clot did not collapse the hepatic arteries even when the embolization was performed repeatedly, and thus fine collateral vessels feeding recurrent hepatocellular carcinoma did not develop. The results suggest that the new chemoembolization using an autologous blood clot is a promising therapeutic procedure in the management of hepatocellular carcinoma associated with advanced cirrhosis.

Figure 1. A 22-year-old woman had had hypertension for one year. Her only symptom was an occasional headache. Examination revealed a blood pressure of 148/110 mm Hg, a vascular bruit on the left-hand side of the upper abdomen, and no cardiomegaly. The electrocardiogram was normal. Renal scanning with [99mTc]pentetic acid (DTPA) showed less uptake of the tracer in the left kidney than in the right, with a similar time to peak uptake (Panel A). The patient was then given 25 mg of captopril orally, and renal scanning was repeated one hour later. The curve for the left kidney was . . .