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The purpose of this study was to evaluate the association between the breast tumor strain ratio and axillary lymph node metastasis in patients with invasive breast cancer.The records of 284 patients with invasive breast cancer who underwent ultrasound elastography before surgery between March 2013 and May 2014 were reviewed retrospectively. For women with multifocal or bilateral cancer, the largest tumor was included. An experienced radiologist performed ultrasound elastography and measured the strain ratio, which is defined as the fat-to-lesion ratio and is indicative of the relative stiffness of the breast lesion, using dedicated software within the ultrasound equipment. The associations between axillary lymph node metastasis with the tumor strain ratio and clinical and biologic variables were evaluated using univariate and multivariate logistic regression analyses.Among 284 tumors, 85 (29.9%) showed axillary lymph node metastasis by surgical histopathologic analysis. The strain ratio was statistically significantly higher in tumors with axillary lymph node metastasis than in those without axillary lymph node metastasis (mean ± SD, 5.19 ± 1.28 vs 4.17 ± 1.30, respectively; p0.001). On univariate analysis, a higher strain ratio (3.89), larger tumor size (2 cm), higher histologic grade (grade 3), presence of lymphovascular invasion, palpability, and higher expression of Ki-67 (≥ 14%) were statistically significantly associated with axillary lymph node metastasis. On multivariate analysis, a higher strain ratio (3.89) (odds ratio [OR], 14.208; p0.001), presence of lymphovascular invasion (OR, 17.437; p0.001), and higher expression of Ki-67 (≥ 14%) (OR, 3.744; p = 0.002) maintained independent significance for predicting axillary lymph node metastasis.The breast tumor strain ratio on ultrasound elastography is associated independently with axillary lymph node metastasis in patients with invasive breast cancer.

Background With regard to clinicopathological findings and disease prognosis, breast cancer in young women is different from that in older women. However, few studies have investigated magnetic resonance imaging (MRI) characteristics of young age-onset breast cancer. Purpose To retrospectively evaluate and compare the MR images and clinicopathological characteristics of invasive breast cancer in young women (aged Material and Methods A total of 270 invasive breast cancers in 266 premenopausal women aged 45 years and younger who underwent preoperative breast MRI and curative surgery were identified between 2009 and 2013. The subjects were divided into a young group (Results The young group had more positive axillary lymph nodes, higher histologic grade, negative estrogen receptor (ER), negative progesterone receptor (PR), and higher p53 and Ki-67 expression compared to the older group. Using MRI, the young group was more likely to display a round/oval or lobular mass shape, a smooth mass margin, and a high signal intensity on T2-weighted images when compared to the older group. In multivariate analysis, positive axillary nodal status (adjusted odds ratio [OR], 4.070; P = 0.002), higher expression of p53 (adjusted OR, 2.902; P = 0.038), lobular mass shape (adjusted OR, 4.979; P = 0.028), and smooth mass margin (adjusted OR, 5.123; P = 0.048) were independently associated with the young group. Conclusion MR morphologic features, including lobular mass shape and smooth mass margin, were independently associated with breast cancer in young women, in addition to positive axillary nodal status and higher p53 expression status.

A variety of pathologic conditions and pseudolesions occur at the capsular and subcapsular regions of the liver and are detected with cross-sectional abdominal imaging. These entities are related to anatomic and hemodynamic characteristics of the liver such as negative subdiaphragmatic pressure, connection with other viscera and extraperitoneal sites by the perihepatic ligaments, and a "third inflow" of blood from sources other than the usual hepatic arterial and portal venous sources. Pathologic conditions can affect the hepatic capsular and subcapsular regions by way of peritoneal, hematogenous, biliary, and perihepatic ligamentous routes. Pseudolesions or benign conditions may also be identified on the basis of altered hemodynamics of the liver. Computed tomography and magnetic resonance imaging with a multiphasic approach can be used to identify and characterize these entities. Familiarity with the wide spectrum of pathologic conditions and pseudolesions at the hepatic capsular and subcapsular regions and precise knowledge of the anatomic and hemodynamic characteristics of the liver will aid the radiologist in diagnosing pathologic conditions and differentiating pseudolesions from true lesions.

To evaluate the association between tumour FDG uptake on preoperative PET/CT and axillary lymph node metastasis (ALNM) according to breast cancer subtype.The records of 671 patients with invasive breast cancer who underwent (18) F-FDG PET/CT and surgery were reviewed. Using immunohistochemistry, tumours were divided into three subtypes: oestrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative, HER2-positive, and triple-negative. Tumour FDG uptake, expressed as maximum standardized uptake value (SUVmax), and clinicopathological variables were analysed.ALNM was present in 187 of 461 ER-positive/HER2-negative, 54 of 97 HER2-positive, and 38 of 113 triple-negative tumours. On multivariate analysis, high tumour SUVmax (≥4.25) (P 0.001), large tumour size (2 cm) (P = 0.003) and presence of lymphovascular invasion (P 0.001) were independent variables associated with ALNM. On subset analyses, tumour SUVmax maintained independent significance for predicting ALNM in ER-positive/HER2-negative (adjusted odds ratio: 3.277, P 0.001) and HER2-positive tumours (adjusted odds ratio: 14.637, P = 0.004). No association was found for triple-negative tumours (P = 0.161).Tumour SUVmax may be an independent prognostic factor for ALNM in patients with invasive breast cancer, especially in ER-positive/HER2-negative and HER2-positive subtypes, but not in those with triple-negative subtype.• Tumour SUVmax could be an imaging biomarker for predicting ALNM • Tumour SUVmax predicting ALNM is effective in ER-positive/HER2-negative and HER2-positive subtypes • Tumour SUVmax predicting ALNM is inaccurate in triple-negative subtypes • Accurate prognostic prediction based on molecular subtype may facilitate individualized management.

Background Previous studies have correlated the maximum standardized uptake value (SUVmax) of breast cancer lesions with histological and biological characteristics such as tumor size, histologic grade, or hormonal receptor expression status. However, controversy remains concerning the prognostic value of SUVmax in breast cancer. Purpose To determine if the SUVmax of a tumor on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is associated with disease-free survival in patients with primary invasive ductal breast cancer. Material and Methods The institutional review board of our hospital approved this retrospective study. From 2009 to 2011, 508 women (mean age, 53.6 years; age range, 26–85 years) with newly diagnosed invasive ductal breast cancer who had undergone preoperative 18F-FDG PET/CT followed by surgery were identified. Clinicopathological variables and FDG uptake quantified by SUVmax were analyzed. The Cox proportional hazards model was used to evaluate the association between SUVmax and disease-free survival after controlling for clinicopathological parameters. Results There were 21 recurrences at a median follow-up of 46 months. The mean SUVmax of the primary tumor was significantly higher in patients with a recurrence than those who remained disease-free (9.5 ± 3.5 vs. 6.6 ± 4.2, P max of 5.95 was the optimal cut-off value to predict disease-free survival. Multivariate analysis identified a high SUVmax (≥5.95) and high T stage as independent significant variables associated with worse disease-free survival. Conclusion A high primary tumor SUVmax on 18F-FDG PET/CT was an independent factor associated with worse disease-free survival in patients with primary invasive ductal breast cancer.

A variety of pathologic conditions can cause abnormalities of the ampulla of Vater. A bulging papilla is frequently encountered at computed tomography (CT) and can be seen in healthy individuals as well as in patients with various pathologic conditions such as papillitis, ampullary cancer, and intraductal papillary mucinous tumor. Mural thickening and certain attenuation patterns seen at contrast material-enhanced CT can help differentiate pathologic papilla from normal papilla. Increased targetlike enhancement of the papilla is likely to represent a benign condition such as papillitis, whereas an enhancing polypoid mass or focal asymmetric or irregular thickening with prolonged enhancement in the ampulla of Vater indicates a malignant condition such as ampullary or periampullary carcinoma. Although CT often does not clarify the exact cause of bulging, adequate duodenal distention may allow detection of an abnormal papilla, thereby providing additional information about other abnormalities in the pancreaticobiliary system. Thus, CT findings may prove useful for subsequent imaging studies such as magnetic resonance (MR) cholangiography or endoscopy. MR cholangiography may be equivalent to CT for identifying a bulging papilla and superior for distinguishing the underlying cause. However, endoscopy with or without biopsy is the best method for making a definitive diagnosis in patients with a bulging papilla. Familiarity with the normal imaging anatomy of the periampullary region and with the imaging features of the various pathologic causes of a bulging papilla may be useful in making the diagnosis.

The liver is covered by visceral peritoneum except at the bare area, bed of the gallbladder, and porta hepatis. The investing peritoneum becomes contiguous with the adjacent structures such as the diaphragmatic peritoneum, lesser omentum, and ligamentum teres. An inflammatory process or tumors involving the perihepatic space are usually affected by intraperitoneal flow dynamics, which depend on the anatomy of the recess as well as gravity and negative subdiaphragmatic pressure. Pathologic conditions that occur in the perihepatic space include abnormal air, fatty masses, conditions producing fluid attenuation at computed tomography (CT), and soft-tissue masses. Enhancement of the hepatic capsule indicates inflammation, as is seen in Fitz-Hugh-Curtis syndrome. The perihepatic ligaments may be invaded by various conditions by means of direct invasion, subperitoneal extension, or extension along the lymphatic vessels. Knowledge of the normal anatomy of the perihepatic space together with the clinical history and characteristic features at CT can assist the radiologist in making the correct diagnosis.

The CT findings of adenocarcinoma of the urachus in three patients were reviewed and correlated with pathologic features. The tumor was composed of two parts: supravesical and intravesical. The supravesical portion showed a cystic appearance with a capsule in the space of Retzius. The intravesical portions invading the dome of the bladder were polypoid and unencapsulated. These findings were consistent with pathologic findings in all three patients.

Purpose: To evaluate the clinical usefulness of 3D volume-rendering (VR) CT laryngography during quiet breathing, Valsalva, and modified Valsalva maneuvers, in those with laryngeal and pyriform sinus lesions. Materials and Methods: Twenty-seven patients with various laryngeal and hypopharyngeal lesions were examined by means of four-channel multidetector-row helical CT (LightSpeed QX/i; GE Medical Systems, Milwaukee, Wis., U.S.A.) during quiet breathing, Valsalva, and modified Valsalva maneuvers. The protocol included 1.25-mm slice thickness, 3.75-mm rotation, 1.25 mm interval, and a pitch ratio of 3:1. Using an Advantage Windows 3.1 workstation (GE Medical Systems), 3D VR was generated in regions of interest, including all structures with a CT attenuation of between -1022 and -125 HU. Visual assessment of the findings of 3D CT laryngography, including the images obtained during the three different breathing maneuvers, were analyzed by three radiologists, who reached a consensus. These results were then compared with the findings of axial CT. The lesions discovered, in descending order of frequency, included laryngeal cancer (n=12), pyriform sinus cancer with an intact apex (n=6), pyriform sinus cancer with apex involvement (n=6), laryngeal papilloma (n=2), and hypopharyngeal obstruction with (n=1) and without (n=2) associated vocal cord palsy. In each case, the findings were confirmed by surgical biopsy, direct laryngoscopy, or CT. Results: 3D CT laryngography using the VR technique can supplement the information provided by axial images, and in the assessment of subglottic invasion and pyriform sinus apical invasion, its findings are consistent. In many of our cases, its use during quiet breathing was able to determine whether or not glottic cancer involved subglottic invasion. In laryngeal cancer cases, furthormore, modified Valasalva can be used to clarify the condition of the pyriform sinus apex. Dynamic-phase 3D CT laryngography can be used to elucidate the condition of a patient with vocal cord palsy. Conclusion: 3D CT laryngography is a new method for the visual diagnosis of vocal cord and laryngeal cancer. When employed after dynamic diagnosis, it is useful for the evaluation of subglottic extension, pyriform sinus apical invasion and vocal cord palsy, important indicators in the staging of cancer.

Purpose: To predict the therapeutic efficacy of transcatheter oily chemoembolization(TOCE) in the treatment Materials and Methods: We reviewed the findings of 24 dynamic CT or MR scans examined for the purpose of diagnosis before TOCE, and follow-up CT scans obtained after this procedure. In 24 patients (M:F=20:4) with a mean age of 52.2 years, 43 nodular HCCs with a diameter of 5 cm or less were present. The patients under-went double dynamic CT or MR imaging as one arterial phase 30 seconds after the intravenous injection of contrast media, and this was followed by a delayed phase 5 minutes fter injection. HCCs were then classified as one of four types: Type I, high and low attenuation or intensity during the arterial and delayed phase, re-spectively; Type II, iso- and low; Type III, iso- and high; and Type IV, high and iso-. In addition, we classified the degree of lipiodol accumulation by HCC nodules as either Grade 5 (fullmoon-like lipiodolization), Grade 2 (about 40%), or Grade 1 (about 20%), as seen on follow-up CT scans after TOCE. Results: Type I provided an accuracy of 72.1% considering to more than 50% lipiodol accumulation. However, a single finding demonstrating high atenuation or intensity during the arterial phase gave an accura-cy of 79.1% better than that of Type I. Conclusion: A finding of high attenuation or intensity during the arterial phase, as seen on dynamic CT or MR images, provides the best information about the therapeutic efficacy of HCCs treated by means of with TOCE.

Purpose: To investigate the correlation between the MRI findings of cerebral fat embolism induced by injecting linoleic acid into ten cats, and pathologic diagnosis. Materials and Methods: Using a microcatheter, 30 μl of linoleic acid was injected into the internal carotid artery of ten cats. MR T2-weighted (T2WI), diffusion-weighted (DWI), and Gd-enhanced T1-weighted images (Gd-enhanced T1WI) were obtained after 30 minutes and after 2 hours of embolization. We pathlogically ex-amined endothelial cell damage, cellular change, perivascular abnormality and fat vacuoles, and then determined the correlation between MRI and the pathologic findings. Results: After 30 minutes of embolization, lesions of very high signal intensity were detected by T2WI in six cats, and of slightly high signal intensity in two; in the remaining two, signal intensity was normal. DWI showed lesions of very high intensity in nine animals and of slightly high intensity in one, while Gd-enhanced T1WI showed well-enhanced lesions in nine and a minimally enhanced lesion in one. After 2 hours of em-bolization, T2WI revealed lesions of very high signal intensity in nine cats, and of slightly high signal intensity in one, while DWI detected lesions of very high signal intensity in all cats. On Gd-enhanced T1WI, lesions in all cats were well enhanced. According to the findings of light microscopic examination, infarcted lesions mainly involved the gray matter, but also some white matter. In the lesions, neurophil matrix edema, neuronal degeneration, perivascular swelling, the widening of extracellular space, extravascular hemorrhage, and fat vacuoles were evident. Conclusion: During the initial two hours following injection, MR imaging of cerebral fat embolism induced by linoleic acid through the internal carotid artery in cats showed high signal intensity on T2WI and DWI, and clear enhancement on Gd-enhanced T1WI. In cases involving cellular edema, cerebrovascular injury and extracellular space widening, the pathologic evidence suggested the coexistence of cytotoxic and vasogenic edema.

Purpose : To evaluate the findings and differential points of ovarian fibroma and subserosal leiomyoma, as seen on MR images. Materials and Methods : The MR imaging findings of 31 surgically confirmed cases of ovarian fibroma(n=6) and subserosal leiomyoma (n=25;28 lesions) were evaluated. Multiplanar T1- and T2-weighted and postcon-trast T1-weighted images were obtained using a 1.5T MR unit, and histologic examination was also performed. The MR findings were analyzed in terms of signal intensity, the presence and definition of margin, the histo-logic finding of hyperintense lesion on T2-weighted images, the presence of the bridging vessel sign, degree of enhancement, and the presence of ipsilateral ovary and ascites. Results : Both fibromas and leiomyomas showed hypo-or isointensity compared with uterine myometrium on T1-weighted images and compared with skeletal muscle on T2-weighted images. The latter revealed intratu-moral hyperintense lesions in most cases of ovarian fibroma and subserosal leiomyoma. Three of four ovarian fibromas had a well defined margin after cystic change, but in 24 of 26 subserosal leiomyomas the margin was ill defined. The “bridging vessel sign ”was visible only in subserosal leiomyomas (22/28), and in all cases the enhancement of ovarian fibromas were less than that of myomtetrium. Subserosal leiomyomas (12/28), seen on enhancement as isointense or hyperintense to myometrium, showed a greater degree of enhancement than ovarian fibromas (0/6). Ipsilateral ovary was rarely seen in ovarian fibromas (1/6), but commonly seen in sub-serosal leiomyomas (20/25). Ascites was present in one case of ovarian fibroma. Conclusion : A defined margin of an intratumoral hyperintense lesion, as seen on T2-weighted images, and the presence or absence of the “bridging vessel sign ”and ipsilateral ovary are useful signs when differentiating be-tween ovarian fibromas and subserosal leiomyomas.

Purpose : To correlate the serial findings obtained by diffusion- and T2-weighted imaging with histologicfind-ings obtained from 30 minutes to 31 days after the development of cerebral infarction in rabbits. Materialsand Methods : Nineteen male New Zealand white rabbits were subjected to intracerebral embolic in-farction.Diffusion- and T2-weighted imagings were performed at 30 min, 2, 4 and 6 hours, and 1, 3, 5, 7, 11, 21 and 31days. Apparent diffusion coefficient (ADC) ratios and T2 signal intensity ratios of infarcted and nor-mal brainwere calculated. Microphotographic or electron microscopic (EM) examinations were performed during hyperacute,acute and chronic infarctions. Results : During hyperacute infarction, diffusion-weighted images showed highsignal intensity in the infarct-ed area, and ADC ratios ranged from 0.81 to 0.56. High signal intensity ondiffusion-weighted images contin-ued until day 3, decreasing thereafter. The ADC ratio increased continuouslyafter day 1. High signal intensity on T2-weighted images was noted from 6 hours and continued until day 7,decreasing thereafter. Microphotographic findings at 6 hours were normal, but EM examination revealed cellularswelling with in-tact basement membrane, suggesting cytotoxic edema. During acute infarction, abnormal dilatationof the per-ineural space, cell destruction, and loosening of the neuropil matrix were revealed bymicrophotography. During chronic infarction, microphotographic and EM findings revealed liquefaction necrosis.Conclusion : These data indicate that in cases of hyperacute infarction, diffusion-weighted images reflectcy-totoxic edema more accurately than do T2-weighted images. A gradually increasing ADC ratio during the course ofinfarction may be associated with vasogenic edema and cell lysis.