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Matching the diameter of the deep inferior epigastric artery (DIEA) and perforating branch (PB) of the internal thoracic artery (ITA) is important for arterial anastomosis during breast reconstruction using the DIEA flap. An anatomic investigation of these arteries was performed using multidetector row computed tomography (MDCT).Contrast-enhanced MDCT data of 50 women (aged 18-90 years) covering the neck to the groin were analyzed. The diameter of the PBs of the ITA at their origins from the first to the sixth intercostal space and of the DIEA 20 mm from the bifurcation of the external iliac artery were measured.The mean diameters of the right and left DIEAs were 1.53 ± 0.263 mm and 1.53 ± 0.306 mm, respectively. The diameter of the PBs in the second and third intercoastal spaces was the same as the diameter of the DIEA, bilaterally.It is suggested that anastomosis of the DIEA with PBs of the ITA in the second and third intercoastal spaces is optimal for DIEA flap grafting. Our results could contribute to making vascular anastomosis easier, thereby reducing the burden on both surgeons and patients.

Supplemental digital content is available in the text., Background/Objective Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary arterial pressure and pulmonary vascular resistance that can lead to right-sided heart failure. Connective tissue disease–associated PAH (CTD-PAH) often has poorer outcomes than idiopathic or hereditary PAH, suggesting the presence of non-PAH factors that could affect the prognoses. This cohort study aimed to identify prognostic factors for CTD-PAH management. Methods Medical records from April 1999 to November 2014 were reviewed to determine the time from treatment initiation to the occurrence of a clinically worsening event and the time elapsed until death. Data at baseline and the final assessment were used to identify prognostic factors associated with events using univariate and multivariate analyses by the stepwise Cox regression method. Results In 36 patients with CTD-PAH analyzed, the proportions with no clinically worsening events at 1, 2, and 3 years after treatment initiation were 62%, 52%, and 45%, respectively, with survival rates of 88%, 77%, and 77%, respectively. The regression model showed that reduced hemoglobin at baseline, reduced qR pattern in electrocardiogram lead V1, increased 60-minute erythrocyte sedimentation rate, and increased mean pulmonary arterial pressure at the final assessment were risk factors that were significantly associated with clinical worsening. For survival, no prognostic factor was identifiable. Conclusions Hemodynamic and non-PAH factors, such as anemia, nutritional status, and inflammatory activity of the underlying CTD, which are not listed in the risk assessment table of PAH guidelines, should be strictly controlled to improve the prognosis of patients with CTD-PAH. A more multifactorial treatment strategy should be developed.

Mammography is the only screening method with evidence in support of reduced breast cancer mortality, but yields poor accuracy outcomes in women with dense breast tissue. The Japan Strategic Anti-cancer Randomized Trial (J-START) was conducted as part of the measures implemented to deal with women with dense breast tissue. Although the sensitivity was increased, the specificity was significantly lower in the intervention group because further examination was required in all positive cases classified by either mammography or ultrasound in the J-START. To address the issue, an overall assessment system of combined mammography and adjunctive ultrasound for breast cancer screening has been developed in Japan. The basic concept is based on a comprehensive assessment that includes a mammography assessment followed by an adjunctive assessment for ultrasound similar to the clinical setting. Currently, mammography alone is recommended for population-based breast cancer screening in Japan, but additional ultrasonography is extensively available for women, especially for women with dense breasts with shared decision-making for personalized breast cancer screening. The overall assessment system is recommended for use in Japan when breast cancer screening is conducted using both mammography and ultrasonography. In this article, we summarize the advantages of the overall assessment and the simultaneous mammography/ultrasound method, the basic approach used in Japan to assign the overall assessment category for breast cancer screening, and we outline the future directions of adjunctive screening ultrasound.

Background The superficial musculoaponeurotic system (SMAS) is an important structure to understand for face-lift surgeries. However, the detailed distribution and imaging findings of the SMAS have not been established yet. Objectives The aim of this study was to establish the accurate distribution and computed tomography (CT) imaging findings of the SMAS based on cadaveric studies. Methods This study was designed in a 3-step procedure. First, 7 cadaver faces were utilized to understand the distribution and histology of the SMAS. Second, the SMAS findings from the cadaveric studies were compared with the CT images. Third, CT images were enrolled for the SMAS interpretation. Results In 7 cadaveric studies, the SMAS was observed as a subcutaneous fibro-membranous structure extending from the galea aponeurotica to the platysma muscle and laterally connected to the parotid fascia. On the medial side, it also connects with major and minor zygomatic muscles. The SMAS consisted of muscular fibers, collagen fibers, and elastic fibers histologically. Eighteen CT images (all females; age range, 21-82 years) showed the thin linear structures corresponding to the fibro-membranous structures in the cadaveric studies. CT density of the SMAS was similar with that of the muscle, and the SMAS was recognizable in all 18 subjects. Conclusions The SMAS is a definite anatomical structure that can be demonstrated as a thin membranous structure on CT. This clinical application could be applicable to the development the cosmetic surgical procedures.

Mammography is the only screening method with evidence in support of reduced breast cancer mortality, but yields poor accuracy outcomes in women with dense breast tissue. The Japan Strategic Anti-cancer Randomized Trial (J-START) was conducted as part of the measures implemented to deal with women with dense breast tissue. Although the sensitivity was increased, the specificity was significantly lower in the intervention group because further examination was required in all positive cases classified by either mammography or ultrasound in the J-START. To address the issue, an overall assessment system of combined mammography and adjunctive ultrasound for breast cancer screening has been developed in Japan. The basic concept is based on a comprehensive assessment that includes a mammography assessment followed by an adjunctive assessment for ultrasound similar to the clinical setting. Currently, mammography alone is recommended for population-based breast cancer screening in Japan, but additional ultrasonography is extensively available for women, especially for women with dense breasts with shared decision-making for personalized breast cancer screening. The overall assessment system is recommended for use in Japan when breast cancer screening is conducted using both mammography and ultrasonography. In this article, we summarize the advantages of the overall assessment and the simultaneous mammography/ultrasound method, the basic approach used in Japan to assign the overall assessment category for breast cancer screening, and we outline the future directions of adjunctive screening ultrasound.

To determine the predictive value of 3-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction to evaluate the short-term effect of therapy for facial palsy. We included 97 patients with idiopathic facial palsy (52 male, 45 female; aged 50.7 ± 19.4 years) who underwent MR imaging with a contrast agent after starting therapy. The mean interval between onset and therapy was 1.55 ± 1.69 days, between therapy and MR imaging was 3.19 ± 2.78 days, and between MR imaging and assessment of the therapeutic effect was 3.50 ± 0.71 days. The degree of therapeutic effect was determined using a 4-grade scale based on the House-Brackmann scale for grading facial nerve function. Two radiologists reviewed VIBE with pre- and postcontrast subtraction using the 4-point scale. We evaluated the diagnostic performance and compared the degree of therapeutic effect and enhancement of facial nerves that were divided into 5 segments bilaterally. We identified 98 facial palsy initially and significant enhancement in 55 facial nerves after the start of therapy and residual palsy in 87. Sensitivity for all facial palsy was 62.0 %, specificity was 90.9 %, positive predictive value was 98.2 %, negative predictive value was 23.3 %, and accuracy was 65.3 %. Eleven patients recovered completely, 1 showed significant enhancement, and the remaining 10 did not show significant enhancement of the facial nerve. VIBE has a potential to predict the prognostic outcome and assess facial palsy after the start of therapy. · Three-dimensional spoiled gradient-echo volumetric interpolated breath-hold examination (VIBE) using subtraction can be useful to predict residual facial palsy after initial therapy.. · Strong enhancement of the facial nerve on VIBE using subtraction was associated with residual facial palsy after the start of therapy.. · Patients with a favorable prognosis did not show strong enhancement..· Tomita H, Detmar K, Nakajima Y et al. Predictive Value of VIBE using Subtraction to Evaluate Idiopathic Facial Palsy after Starting Therapy. Fortschr Röntgenstr 2020; 192: 1183 - 1189.ZIEL: Prognostische Aussagekraft der 3D-VIBE-Subtraktionen (Spoiled Gradientenecho Volumetric Interpolated Breath-Hold-Examination) zur Bestimmung des Therapie-Kurzzeiteffektes bei Patienten mit Gesichtslähmung. Eingeschlossen wurden 97 Patienten mit idiopathischer Gesichtslähmung (52 Männer, 45 Frauen; Alter 50,7 ± 19,4 Jahre), bei denen ein MRT mit Kontrastmittel nach Therapiebeginn durchgeführt wurde. Das mittlere Intervall zwischen Erkrankung und Beginn der Therapie betrug 1,55 ± 1,69 Tage, zwischen Therapie und MRT-Bildgebung betrug das Intervall 3,19 ± 2,78 Tage und zwischen MRT-Bildgebung und der Bewertung der therapeutischen Wirkung 3,50 ± 0,71 Tage. Der Grad des therapeutischen Effekts wurde mittels einer 4-Punkte-Skala, basierend auf der House-Brackmann-Skala für die Einstufung der Gesichtsnervenfunktion, bestimmt. 2 Radiologen werteten die Subtraktionen aus der VIBE-Sequenz (vor und nach KM-Gabe) unter Verwendung der 4-Punkte-Skala aus. Wir beurteilten die diagnostische Aussagekraft und verglichen den Grad des therapeutischen Effekts sowie die Anreicherung der Fazialisnerven, welche in 5 Segmenten bilateral eingeteilt wurde. Wir fanden 98 Fazialisparesen vor und eine signifikante Anreicherung in 55 nach Therapiebeginn sowie eine Restlähmung in 87 Fazialisnerven. Die Sensitivität für die Gesichtslähmung betrug 62,0 %, die Spezifität 90,9 %, der positive prädiktive Wert 98,2 %, der negative prädiktive Wert 23,3 % und die Genauigkeit 65,3 %. 11 Patienten hatten eine komplette Remission, 1 Patient zeigte ein signifikantes Enhancement und die verbliebenen 10 Patienten zeigten keine signifikante Anreicherung des Fazialisnerven. VIBE hat das Potenzial, das therapeutische Ergebnis prognostisch einzuschätzen und den Grad der Gesichtslähmung nach Therapiebeginn zu beurteilen. · Subtraktionen aus 3D-VIBE (Spoiled Gradientenecho Volumetric Interpolated Breath-Hold Examination) können für die Prognose bei idiopathischer Fazialisparese nach Therapiebeginn verwendet werden.. · Eine kräftige Anreicherung der Fazialisnerven in Subtraktionen aus VIBE-Sequenzen war mit einer unvollständigen Rückbildung der Fazialisparese assoziiert.. · Patienten mit gutem klinischem Verlauf zeigen kein starkes Enhancement..

To prospectively correlate the preoperative vessel anatomy in three-dimensional computed tomographic angiography with computed tomographic colonography (3D-CTA with CTC) with that in laparoscopic surgery for colorectal cancer. The study protocol was approved by our institutional review board. The study population consisted of 101 patients with colon cancer who underwent 3D-CTA with CTC between June 2016 and January 2018. Two radiologists assessed the branching patterns of sigmoid arteries (SAs) and right colonic artery (RCA), the position between the ileocolic artery (ICA) and superior mesenteric vein (SMV), and the existence of an accessory middle colonic artery (aMCA). The vessel anatomy on 3D-CTA with CTC was correlated with that of intraoperative findings. Ninety-eight examinations (97.0%) were technically successful. Between preoperative and intraoperative vessel anatomy, the branching patterns of SAs were concordant in all 29 cases with rectosigmoid and descending colon cancer. The branching patterns of RCA and the position between the ICA and SMV were completely concordant in 32 cases of cecal and ascending colon cancer. No aMCA was identified either intraoperatively or by imaging analysis. 3D-CTA with CTC guided the surgeons to determine the resection margin of the relevant vessels for laparoscopic colorectal surgery.

The purpose of this study is to analyze the association between the probability of malignancy and breast mass descriptors in the BI-RADS 5th edition and to devise criteria for grading mass lesions, including subcategorization of category 4 lesions with or without apparent diffusion coefficient (ADC) values.A total of 519 breast masses in 499 patients were selected. Breast MRI was performed with a 1.5-T MRI scanner using a 16-channel dedicated breast radiofrequency coil. Two radiologists determined the morphologic and kinetic features of the breast masses. Mean ADC values were measured on ADC maps by placing round ROIs that encircled the largest possible solid mass portions. An optimal ADC threshold was chosen to maximize the Youden index. Corresponding pathologic diagnoses were obtained by either biopsy or surgery.A total of 472 masses were malignant. Multivariate model analysis showed that shape (irregular, p0.001), margin type (not circumscribed, p0.001), internal enhancement (rim enhancement and heterogeneous enhancement, p = 0.0001), and delayed phase (washout, p = 0.0003) were the significant explanatory variables. The 3-point scoring system for findings suspicious for malignancy and the proposed classification system for breast mass descriptors (with points for category designation ranging from 0 to4) were significant with respect to malignancy (p0.01). The inclusion of ADC values improved the positive predictive values for categories 3, 4A, and 4B.The 3-point scoring system for findings suspicious for malignancy and the proposed classification system for breast mass descriptors would be valid as a categorization system. ADC values may be used to downgrade benign lesions in categories 3, 4A, and 4B.

To investigate the global variation in radiologist potential workload for CT and MRI examinations, and the regional variation in potential workload and extent of radiologists' involvement in CT and MRI examinations in Japan."Radiologist potential workload" was defined as the annual number of CT plus MRI examinations divided by the total number of diagnostic radiologists. The extent of radiologists' involvement was measured as the proportion of CT and MRI examinations to which "Added-fees for Radiological Managements on Imaging-studies (ARMIs)" were applied among eligible examinations. Maximum variation was computed as the ratio of the highest-to-lowest values among the countries or Japanese prefectures.The radiologist potential workload in Japan was 2.78-4.17 times higher than those in other countries. A maximum prefecture-to-prefecture variation was 3.88. The average percentage of CT plus MRI examinations with ARMI applied was 43.3%, with a maximum prefecture-to-prefecture variation of 3.97. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement.Japan had a far greater radiologist potential workload compared with other countries, with a large regional variation among prefectures. Prefectures with more radiologists tended to have a higher extent of radiologists' involvement in CT and MRI examinations.

In this study, we evaluate the analgesic effect of strontium-89 (Sr-89) for patients with breast cancer having multiple bone metastases and identify positive predictive factors. We retrospectively evaluated 15 patients who were administered Sr-89 for painful bone metastases from breast cancer at St. Marianna University Hospital between January 2010 and April 2014. For patients receiving multiple doses, only the first dose was evaluated. Pain relief was defined as a decrease in the score of the Numeric Rating Scale (NRS) or requirement of reduced doses of pain medication 1 - 2 months after being on Sr-89 administration. The associations between pain relief owing to Sr-89 and that owing to bone scan index, interval from bone metastasis onset to Sr-89 administration, zoledronate and denosumab treatment history, hormone therapy/aromatase inhibitor history, and chemotherapy history were assessed. A logistic model was used for statistical analysis. Pain relief was observed in 11 (73.3%) of 15 patients. No statistically significant value was observed between pain relief and bone scan index, interval from bone metastasis onset to Sr-89 administration, zoledronate and denosumab treatment history, hormone therapy/aromatase inhibitor history, and chemotherapy. Thus, Sr-89 was effective for 70% of patients with breast cancer bone metastases, although positive predictive factors for pain relief could not be determined.

Objective: We evaluated early and mid-term results of endovascular aortic repair (EVAR) using crossed-limb and non-crossed-limb techniques. Material and Methods: From December 2011 to October 2013, 37 patients (31 men; mean age 75.4 years) were treated with EVAR (crossed-limb, 21 and non-crossed-limb, 16). We compared technical success, maximum short-axis diameter of abdominal aortic aneurysm, iliac angulation, time for catheterization of the short contralateral limb gate of the main body (SCT), and complications between the groups. Results: The mean follow-up period was 810±230 days. The technical success rate was 100%. There was no significant difference between the groups in terms of mean short-axis diameter. Iliac angulation was significantly wider in the crossed-limb group (53.3±14.6 vs. 39.4±13.0, p=0.0049). There was no significant difference between the groups in terms of SCT. Limb occlusion occurred in two cases (one crossed-limb and one non-crossed-limb). There were no aneurysm-related deaths. Conclusion: There were no differences between the crossed-limb and non-crossed-limb techniques in terms of early and mid-term results of EVAR. A crossed-limb technique can be performed safely without prolonged SCT even in severely splayed iliac angulation cases.

To analyze the association of breast non-mass enhancement descriptors in the BI-RADS 5th edition with malignancy, and to establish a grading system and categorization of descriptors. This study was approved by our institutional review board. A total of 213 patients were enrolled. Breast MRI was performed with a 1.5-T MRI scanner using a 16-channel breast radiofrequency coil. Two radiologists determined internal enhancement and distribution of non-mass enhancement by consensus. Corresponding pathologic diagnoses were obtained by either biopsy or surgery. The probability of malignancy by descriptor was analyzed using Fisher’s exact test and multivariate logistic regression analysis. The probability of malignancy by category was analyzed using Fisher’s exact and multi-group comparison tests. One hundred seventy-eight lesions were malignant. Multivariate model analysis showed that internal enhancement (homogeneous vs others, p

The objective of this study was to investigate the relationship between the extent of emphysema and heart size in patients with chronic obstructive pulmonary disease (COPD) using inspiratory and expiratory chest computed tomography (CT). This retrospective study was approved by the institutional review board and informed consent was waived. We measured lung volume (LV), low attenuation area percent (%LAA; less than or equal to −950 HU), maximum cardiac area, and maximum transverse cardiac diameter on inspiratory/expiratory chest CT in 60 patients with COPD. Spearman rank correlation analysis was used to determine the correlations between the heart and lung CT measurements, and the correlations between these measurements and spirometric values. On inspiratory CT, the maximum transverse cardiac diameter was negatively correlated with LV ( ρ = −0.42; p < 0.01) and %LAA ( ρ = −0.43; p < 0.001). Furthermore, on expiratory CT, the maximum cardiac area was negatively correlated with LV ( ρ = −0.35; p < 0.01) and %LAA ( ρ = −0.37; p < 0.01), and there was a negative correlation between transverse cardiac diameter and %LAA ( ρ = −0.34; p < 0.01). Although inspiratory cardiac size was not correlated with any of the spirometric values, the maximum cardiac area and transverse diameter on expiratory scans were significantly correlated with the reduced airflow values on spirometry ( p < 0.01). In patients with COPD, the transverse cardiac diameter decreased as the emphysema progressed. A smaller cardiac area on expiratory CT suggested the presence of large LVs, emphysema, and airflow limitation in COPD.

The anterior bundle of the longitudinal muscle in the region anterior to the anal canal in males has been described, although the anatomical details remain unclear. The present study was undertaken to clarify the precise morphology of the anterior bundle of the longitudinal muscle and its relationship to the surrounding structures, and to visualize the anterior bundle of the longitudinal muscle via transanal ultrasonography. Histological examination was carried out using seven male cadavers; an additional three male cadavers were used for transanal ultrasonography, and the ultrasonography images were compared with the actual sagittal sections. In addition, transanal ultrasonography images of 50 male patients at Tokatsu-Tsujinaka Hospital were studied. The region anterior to the anal canal consisted of smooth muscles and skeletal muscles. The anterior bundle of the longitudinal muscle was situated between the bulbospongiosus and the external anal sphincter, and consisted of smooth muscle. The bundle was identified in the transanal ultrasonography of cadavers by comparison with the actual sections. Transanal ultrasonography images of living bodies showed the anterior bundle of the longitudinal muscle as a hypoechoic layer of approximately 17.7 mm in length. The detailed anatomical findings of the anterior bundle of the longitudinal muscle suggested “an alternate arrangement of smooth muscles and skeletal muscles” in the region anterior to the anal canal and facilitated the visualization of the anterior bundle of the longitudinal muscle in transanal ultrasonography.

OBJECTIVE The aim of this study was to compare the diagnostic precision of bone scintigraphy with BONENAVI version 1 and BONENAVI version 2 in bone metastasis of primary breast cancer. METHODS The subjects were 56 consecutive patients (all women, mean age 59 ± 12.7 years) who underwent bone scintigraphy with Tc-MDP and were diagnosed with bone metastasis of primary breast cancer from January 2012 to November 2014. Bone scintigraphy was performed with BONENAVI version 1 and BONENAVI version 2 to calculate artificial neural network (ANN), bone scan index (BSI), and hot-spot values, with ANN ≥ 0.5 considered to reflect bone metastasis for the calculation of sensitivity. Mean ANN, BSI, hot-spot values, and sensitivity were compared between BONENAVI version 1 and BONENAVI version 2, with P < 0.05 considered a significant difference. RESULTS With BONENAVI version 1, mean ANN was 0.73 ± 0.29, BSI was 1.47 ± 1.85, the hot-spot value was 12.4 ± 12.5, and sensitivity was 76.8% (43/56). With BONENAVI version 2, the mean ANN was 0.86 ± 0.19, BSI was 1.53 ± 2.09, hot-spot value was 12.9 ± 15.6, and sensitivity was 94.6% (53/56). BONENAVI version 2 yielded significantly better ANN and sensitivity than BONENAVI version 1 (both P < 0.01). CONCLUSION BONENAVI version 2 has improved sensitivity for detecting bone metastasis of primary breast cancer compared to BONENAVI version 1.

Aim This study investigated the prognostic factors of cardiac death or cardiac failure using cardiac scintigraphy, echocardiography (UCG), and magnetic resonance imaging (MRI) in asymptomatic systemic sclerosis (SSc) patients. Methods We retrospectively evaluated SSc patients who had undergone cardiac scintigraphy using 99m thallium (99m Tl) and 123 I-β-methyl-P-iodophenyl-pentadecanoic acid (123 I-BMIPP), UCG, and cardiac MRI. We calculated the mismatch score in scintigraphy by subtracting the uptake of 123 I-BMIPP from that of 99m Tl. Patients were divided into two groups according to whether they survived with no cardiac failure or subsequently proceeded to cardiac failure or death during the study period. We identified prognostic factors by analyzing 99m Tl and 123 I-BMIPP uptake, mismatch scores, UCG findings, and cardiac delayed enhancement on MRI. We also evaluated pathological evidence of myocardial fibrosis. Results Of 33 SSc cases, 11 proceeded to cardiac failure or death. There was no significant difference in UCG or MRI findings between the two groups. Low mismatch score in cardiac scintigraphy was the only predictive factor of cardiac failure or death by multivariate analysis (odds ratio, 6.48; 95% confidence interval, 1.22-423.2; P = 0.01). When patients were grouped according to high or low mismatch scores based on a cut-off using receiver operating characteristics curve analysis, the cumulative incidence of cardiac failure or death was higher in the low mismatch group than in the high mismatch group (P = 0.02). The percentage of fibrosis was significantly higher in deceased cases compared to surviving cases. Conclusions Low mismatch score in cardiac scintigraphy was associated with cardiac death or cardiac failure in SSc patients.

To improve diagnostic accuracy in cases of a suspected inguinal hernia, we perform a “CT hernia study,” with the patient lying prone to allow decompression of the structures in the inguinal region. We reviewed the records of 914 patients with a suspected inguinal hernia who underwent prone non-contrast lower abdominal CT with two rolled-up towels, 20 cm in diameter, placed transversely beneath them, at the umbilicus and hips, respectively. The CT hernia study yielded a diagnosis of inguinal hernia in 861 (94.2%) patients and a condition other than inguinal hernia in 43 (4.7%) patients. Hernia was not detected preoperatively but found intraoperatively in 10 patients (1.1%). Surgery was performed for a collective total of 1029 hernias in 873 patients, and the CT hernia study-based hernia detection rate was 98.3%. We compared the preoperative diagnoses of various types of hernia (Japanese Hernia Society Types I–V) against the intraoperative diagnoses and found that the CT hernia study yielded 95.8% accuracy. The CT hernia study appears to provide a high detection rate and makes differentiating the various types of inguinal hernia possible. We believe our CT hernia study adds a level of objectivity that is diagnostically beneficial.

Fluid collections in the retropharyngeal space (RPS) result from a wide spectrum of diseases, including retropharyngeal abscess, cervical osteomyelitis, and calcific tendinitis of the longus colli muscle. These conditions should be managed by different specialties; beginning with care in the emergency room, physicians from orthopedics, pediatrics, otolaryngology, and oncology are in charge of the treatment. Since these diseases demonstrate similar fluid collections in the RPS on computed tomography (CT) and magnetic resonance imaging (MRI), the radiologist's diagnosis based on the characteristic imaging findings is very important to identify the primary disease. Also, since some of the diseases require immediate surgical intervention to avoid life-threatening mediastinitis or airway obstruction, radiologists must distinguish these diseases correctly and provide recommendations for their management to physicians. Understanding clinical features and imaging findings of these fluid collections in the RPS is crucial for the best care.

The malignant phyllodes tumor is a relatively rare neoplasm and has not previously been a therapeutic target of interventional radiology. Herein, we report a successful case of preoperative chemoembolization of a giant malignant phyllodes tumor. The objective was to achieve sufficient tumor shrinkage before surgery to avoid the requirement for skin grafting after resection. Intra-arterial epirubicin infusion and subsequent embolization with Embosphere Microspheres (BioSphere Medical, Rockland, MA, USA) was undertaken three times over the course of 6 weeks and was well tolerated. The patient underwent surgery without skin grafting. Neither local recurrence nor distant metastasis was observed at 6 months after surgery.

Purpose: In patients with obstructive lung diseases, alteration of intrathoracic pressure is closely related to hyperinflation and leads to hemodynamic impairments. Both intrathoracic pressure and hemodynamics are affected by the respiratory phase. In fact, a previous study showed that respiratory phasic variations in the superior vena cava (SVC) area significantly correlated with the extent of emphysema. Chronic obstructive pulmonary disease (COPD) and bronchial asthma manifest different pathophysiological changes in hyperinflation and hemodynamics. The current study was conducted to evaluate differences in respiratory variations in the cross-sectional area of the SVC between patients with COPD and with asthma. Materials and Methods: We measured the SVC area and calculated the ratio of the SVC area on inspiratory and expiratory scans (i/e-SVC ratio) in 66 patients with COPD and 16 patients with asthma. The cor-relations of the i/e-SVC ratios with airflow limitation, pulmonary small vessels less than 5 mm2 (%cross-sectional area [%CSA] < 5), and respiratory changes in lung volume (i/e-LV) obtained by inspiratory and expiratory computed tomography (CT) images were evaluated. Results: There was no significant difference in i/e-SVC ratio between COPD and asthma groups. In COPD patients, the i/e-SVC ratio significantly correlated with the %CSA < 5 (ρ = ﹣0.433, P = 0.003), i/e-LV ratio (ρ = ﹣0.371, P = 0.011), and percent of predicted forced expiratory volume in 1 second (FEV1% predicted) (ρ = ﹣0.474, P = 0.001), whereas in asthma patients, there were no significant correlations between the i/e-SVC ratio and those functional parameters. Conclusion: There would be differences in the relationship between intrathoracic pressure and cardiopulmonary hemodynamics between COPD and asthma patients.

Objective We sought to detect the presence of left ventricular regional dysfunction and myocardial abnormalities in systemic sclerosis (SSc) patients without cardiac symptoms using a complementary cardiac magnetic resonance (CMR) imaging approach. Methods Consecutive patients with SSc without cardiac symptoms and healthy controls underwent CMR on a 1.5 T scanner. The peak systolic regional function in the circumferential and radial strain (Ecc, % and Err, %) were calculated using a feature tracking analysis on the mid-left ventricular slices obtained with cine MRI. In addition, we investigated the myocardial characteristics by contrast MRI. Pharmacological stress and rest perfusion scans were performed to assess perfusion defect (PD) due to micro- or macrovascular impairment, and late gadolinium enhancement (LGE) images were obtained for the assessment of myocarditis and/or fibrosis. Results We compared 15 SSc patients with 10 healthy controls. No statistically significant differences were observed in the baseline characteristics between the patients and healthy controls. The mean peak Err and Ecc of all segments was significantly lower in the patients than the controls (p=0.011 and p=0.003, respectively). Four patients with LGE (28.6%) and seven patients with PD (50.0%) were observed. PD was significantly associated with digital ulcers (p=0.005). Utilizing a linear regression model, the presence of myocardial LGE was significantly associated with the peak Ecc (p=0.024). After adjusting for age, the association between myocardial LGE and the peak Ecc was strengthened. Conclusion A subclinical myocardial involvement, as detected by CMR, was prevalent in the SSc patients without cardiac symptoms. Regional dysfunction might predict the myocardial abnormalities observed in SSc patients without cardiac symptoms.

A urethral caruncle is the most common disease of the urethra in postmenopausal women. A definitive diagnosis can usually be reached based on physical examination. Cross-sectional imaging is performed when malignant urethral tumor is suspected, such as a urethral carcinoma. No articles have discussed the detailed imaging of urethral caruncles. We present 3 patients with symptomatic urethral caruncles who underwent magnetic resonance imaging preoperatively.

This study investigated the prognostic factors of cardiac death or cardiac failure using cardiac scintigraphy, echocardiography (UCG), and magnetic resonance imaging (MRI) in asymptomatic systemic sclerosis (SSc) patients.We retrospectively evaluated SSc patients who had undergone cardiac scintigraphy usingOf 33 SSc cases, 11 proceeded to cardiac failure or death. There was no significant difference in UCG or MRI findings between the two groups. Low mismatch score in cardiac scintigraphy was the only predictive factor of cardiac failure or death by multivariate analysis (odds ratio, 6.48; 95% confidence interval, 1.22-423.2; P = 0.01). When patients were grouped according to high or low mismatch scores based on a cut-off using receiver operating characteristics curve analysis, the cumulative incidence of cardiac failure or death was higher in the low mismatch group than in the high mismatch group (P = 0.02). The percentage of fibrosis was significantly higher in deceased cases compared to surviving cases.Low mismatch score in cardiac scintigraphy was associated with cardiac death or cardiac failure in SSc patients.

The purpose of this study was to evaluate the correlation between generation-based bronchial wall attenuation on thin-section computed tomography (CT) scans and airflow limitation in patients with bronchial asthma.This study included 28 bronchial asthma patients (13 men, 15 women; age range, 23-89 years) who underwent both chest CT and spirometry. On CT, the mean values of peak wall attenuation, wall area percentage, and luminal area were measured in the segmental, subsegmental, and sub-subsegmental bronchi of the right B1 and B10 bronchi. Correlations of the CT measurements with forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), percent predicted forced expiratory flow at 25%-75% of the FVC (%pred forced expiratory flow25-75), and percent predicted peak flow rate were evaluated with Spearman's rank correlation test.The peak wall attenuation of each generation of segmental bronchi significantly correlated with the forced expiratory volume in 1 second/FVC (B1 segmental, ρ = -0.683, p0.0001; B1 subsegmental, ρ = -0.875, p0.0001; B1 sub-subsegmental, ρ = -0.926, p0.0001; B10 segmental, ρ = -0.811, p0.0001; B10 subsegmental, ρ = -0.903, p0.0001; B10 sub-subsegmental ρ = -0.950, p0.0001). Similar correlations were found between the peak wall attenuation and %pred forced expiratory flow 25-75 or percent predicted peak flow rate. Overall, the correlation coefficients were relatively high in the more peripheral bronchial generations. In all measurements, the coefficients of the peak wall attenuations were higher than those of the wall area percentage and luminal area.Peak attenuation of the bronchial wall, particularly in the peripheral bronchi, measured on CT is a good biomarker for the severity of bronchial asthma.

Background Selective venous sampling (SVS) is an invasive localization study for persistent or recurrent hyperparathyroidism. Purpose To assess the role of SVS in addition to non-invasive imaging for primary hyperparathyroidism (pHPT). Material and Methods This study was approved by the institutional review board and included 14 patients who underwent SVS and subsequent parathyroidectomy between January 2014 and April 2017 following a clinical diagnosis of pHPT. All patients underwent pre-SVS non-invasive imaging, including ultrasound, computed tomography (CT), and 99mTc-MIBI scintigraphy, and sensitivity was assessed using the operative and pathological findings. Results In all but one case, a single parathyroid adenoma was responsible for the pHPT; the remaining case exhibited a chemical response following surgical removal of parathyroid tissue. The sensitivity (%) for ultrasound, CT, 99mTc-MIBI scintigraphy, and SVS was 76.9, 84.6, 69.2, and 76.9, respectively. SVS yielded positive results in four patients with discordant results and one patient with non-detectable results on imaging. In seven patients, a significant increase in the intact parathyroid hormone level was recognized only in the thyroid veins. The procedure time was in the range of 52–183 min (median = 89.5 min). Conclusion The addition of SVS to a non-invasive imaging study would be helpful to locate the responsible lesion of pHPT with discordant or non-detectable results on imaging for initial surgical treatment as well.

To compare the detectability of unenhanced abbreviated magnetic resonance imaging (MRI) based on diffusion-weighted imaging (DWI) and abbreviated postcontrast MRI for breast cancer. The study population consisted of 87 patients undergoing breast MRI between December 2016 and March 2017 in a clinical setting. All breast MRIs were performed using a 1.5-T MRI scanner with a 16-channel breast radiofrequency coil. The abbreviated protocols based on DWI (AP1) and postcontrast MRI (AP2) were assessed independently by two radiologists. Sensitivity and specificity were calculated. Receiver operating characteristic analysis was performed and the areas under the curves (AUCs) were compared between AP1 and AP2. The study included 87 patients with 89 breast cancer lesions ≤ 2 cm in diameter. The sensitivity/specificity for AP1 and AP2 for reader 1 was 89.9/97.6% and 95.5/90.6%, respectively, and those for reader 2 was 95.5/94.1% and 98.9/94.1%, respectively. The AUCs for AP1 and AP2 for reader 1 were 0.9629 and 0.9640 (p = 0.95), respectively, and those for reader 2 were 0.9755 and 0.9843 (p = 0.46), respectively. The detectability of the unenhanced abbreviated protocol based on DWI would be comparable to that of abbreviated postcontrast MRI for breast cancer.

Objective The goal of this study was to determine whether the powerful anti-inflammatory effect of anti-interleukin-6 with tocilizumab (TCZ) might lead to a reduction in left ventricular (LV) dysfunction in patients with rheumatoid arthritis (RA). Methods Consecutive RA patients with active disease and healthy control subjects without a clinical diagnosis of cardiovascular disease were enrolled. The RA patients each had inadequate clinical response to non-biologic disease-modifying anti-rheumatic drugs and were prescribed TCZ therapy. All subjects underwent baseline evaluation of LV function, as measured by cardiac magnetic resonance imaging (CMRI). Peak systolic regional radial strain (Err, %) was calculated by feature tracking of cine CMRI. After baseline (BL) CMRI measurements, treatment with TCZ was initiated, and patients were followed for 52 weeks. We compared peak Err of RA patients at BL and at 52 weeks. Results Thirteen RA patients (mean age 52.6 ± 5.4 years) were assessed at BL and at 52 weeks, and these patients were compared with 10 non-RA controls (mean age 55.7 ± 4.6 years). Disease Activity Score of 28 joints – erythrocyte sedimentation rate and Simple Disease Activity Index were significantly lower in RA patients at 52 weeks than at BL. Mean peak Err at BL in RA patients was significantly lower than in normal subjects (P = 0.03). Mean peak Err was significantly higher at 52 weeks than at BL (P = 0.028) in RA patients. Conclusion We showed that TCZ was associated with left ventricular dysfunction in RA patients which correlated with a reduction in RA disease activity.

Background Diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) are widely used for detecting uterine endometrial cancer. The relationships between ADC values and pathological features of endometrial cancer have not yet been established. Purpose To investigate whether ADC values of endometrial cancer vary according to histologic tumor cellularity and tumor grade. Material and Methods We retrospectively reviewed 30 pathologically confirmed endometrial cancers. All patients underwent conventional non-enhanced magnetic resonance imaging (MRI) and DWI procedures, and ADC values were calculated. Tumor cellularity was evaluated by counting cancer cells in three high-power ( × 400) fields. The correlation between ADC values and tumor cellularity was assessed using Pearson’s correlation coefficient test for statistical analysis. Results The mean ± standard deviation (SD) ADC value ( ×10−3 mm2/s) of endometrial cancer was 0.85 ± 0.22 (range, 0.55–1.71). The mean ± SD tumor cellularity was 528.36 ± 16.89 (range, 298.0–763.6). ADC values were significantly inversely correlated with tumor cellularity. No significant relationship was observed between ADC values and tumor grade (mean ADC values: G1, 0.88 ± 0.265 × 10−3 mm2/s; G2, 0.80 ± 0.178 × 10−3 mm2/s; G3, 0.81 ± 0.117 × 10−3 mm2/s). Conclusion There is a significant inverse relationship between ADC values and tumor cellularity in endometrial cancer. No significant differences in average ADC value were observed between G1, G2, and G3 tumors. However, the lower the tumor grade, the wider the SD.

To clarify appropriate timing for magnetic resonance examination to predict pathological complete response to neoadjuvant chemotherapy for patients with human epidermal growth factor receptor 2 (HER2)-positive and triple-negative breast cancers in terms of tumor volume change. Between September 2009 and December 2014, 113 women with HER2-positive (n = 51) and triple-negative (n = 62) invasive breast cancers undergoing neoadjuvant chemotherapy were enrolled. Patients with HER2-positive tumors underwent neoadjuvant chemotherapy with an anthracycline-based regimen followed by docetaxel with trastuzumab. Patients with triple-negative tumors underwent neoadjuvant chemotherapy with anthracycline-based (first in most cases) and taxane-based regimens. Magnetic resonance imaging was performed before neoadjuvant chemotherapy, between the regimens (midpoint examination), and after neoadjuvant chemotherapy (final examination). Response ratio of tumor volume was calculated and receiver-operating characteristic analyses for them for both subtypes were performed at the midpoint and final examinations. Twenty-eight women with HER2-positive tumors (54.9 %) and 29 women with triple-negative tumors (46.8 %) had pathological complete response. The response ratios were better in cases with pathological complete response than in those without (p = 0.0341, p

Background: Magnetic resonance (MR) imaging is known to be useful to demonstrate Lisfranc ligament injury. There are few studies that report differences in MR imaging findings of acute or chronic Lisfranc ligament injuries. We applied oblique MR imaging planes parallel to the Lisfranc ligament for better visualization of the entire course of the ligament and assessed the detailed MR imaging appearances of the Lisfranc ligament in cadavers and patients with presumed Lisfranc injuries. Methods: Twelve preserved cadaveric feet were examined using a small-diameter surface coil. Long axis, oblique sagittal, and oblique short axis cross sections parallel to the Lisfranc ligament, dorsal ligament, and plantar ligament were obtained. Twenty-six MR examinations from 23 patients with suspected Lisfranc joint injuries were evaluated. Results: In the cadaveric study, the Lisfranc ligament was satisfactorily visible along its entire course in a single slice on long axis and oblique sagittal MR images. The dorsal ligament and the plantar ligament were visible separately from the Lisfranc ligament in oblique sagittal and oblique short axis planes. In the patient study, 11 MR examinations led to diagnoses of complete tears of the Lisfranc ligament that were acute injuries (3-21 days after trauma) mostly associated with disruption of the dorsal and plantar ligaments. Nine studies led to diagnoses of incomplete tears of the Lisfranc ligament that were chronic injuries (2-14 months after trauma). Recovery of the continuity of the disrupted ligament was observed in 3 patients. Conclusion: MR imaging demonstrated the integrity of the ligaments and was useful for diagnosing an acute Lisfranc injury. Fibrous healing of the torn ligament was observed in a chronic injury. Level of Evidence: Level IV, case series.

Objective The objective of this study was to clarify the anatomical variation of thyroid veins into the systemic vein using contrast-enhanced multi-detector row computed tomography (MDCT). Design and methods : The subjects were 80 patients (34 males and 46 females; mean age, 50.1 years; age range, 15–92 years) with neck diseases who underwent MDCT. The number and location of inflow points of the thyroid veins into the systemic vein, and the length from the junction of bilateral brachiocephalic veins to the orifice of inferior thyroid vein were investigated by reviewing the axial and coronal images. Results All superior thyroid veins were detected. Right and left middle thyroid veins were identified in 39 and 29 patients, respectively. Right inferior thyroid veins, left inferior thyroid veins, and common trunks were detected in 43, 46, and 39 patients, respectively; in five patients, two left thyroid veins were identified. All left inferior thyroid veins and 34 common trunks flowed into the innominate vein, while right ones had some variations in inflow sites. Mean lengths were 3.01 ± 1.30 cm (range, 0.5–6.19) and 2.04 ± 0.91 cm (0.5–4.4) in the left inferior thyroid vein and common trunk, and 1.96 ± 1.05 cm (0.81–4.8) and 1.65 ± 0.69 cm (0.63–2.94) in the right one flowing into the right internal jugular vein and the innominate vein, respectively. Conclusions The numbers and orifices of thyroid veins were identified at high rates on contrast-enhanced MDCT. This strategy can provide anatomical information before selective venous sampling for measurements of parathyroid hormone.

Rationale and Objectives The purpose of this study was to evaluate the correlations between objective quantitative computed tomography (CT) measurements of the extent of emphysematous and fibrotic lesions and the results of pulmonary function tests (PFTs) in patients with combined pulmonary fibrosis and emphysema (CPFE). Materials and Methods This study involved 43 CPFE patients who underwent CT and PFTs. The extent of emphysematous lesions was obtained by calculating the percentage of low attenuation area (%LAA) values lower than −950 Hounsfield units (HU). Fibrotic lesions were defined as high attenuation area (HAA) using thresholds with pixels between 0 and −700 HU, and the extent of fibrosis was obtained by calculating the percentage of HAA (%HAA). The correlations of %LAA and %HAA with PFTs were evaluated by the Spearman rank correlation coefficients and multiple linear regression analysis. Results A significant negative correlation was found between %HAA and diffusing capacity of the lung for carbon monoxide (DLco) %predicted (ρ = −0.747; P Conclusions In CPFE, the extent of fibrosis has a more significant impact on DLco than emphysema.